Biomedical subjects

Fred J Epstein

Publications and source records attributed to Fred J Epstein.

3 recordsLinked to original sources

PubMed2005

Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis.

OBJECT: Intramedullary spinal cord tumors (IMSCTs) in the older-age adult population pose complex management issues regarding the extent of resection and functional outcome, especially in terms of quality of life. Historically, IMSCTs in the older adult population were treated with irradiation alone because it was assumed that functional recovery would be poor. The authors examined their IMSCT database and report the first large series of IMSCTs in patients older than 50 years of age. METHODS: In this retrospective clinical and chart review there were 30 cases meeting inclusion criteria drawn from databases at three different institutions. A modified McCormick Scale was used to assess functional levels in all 30 patients pre- and postoperatively. The mean age of patients in this cohort was 59.8 years (range 50-78 years), and the mean follow-up period was 10.6 years (range 2-16 years). Ependymoma was the most common tumor (83%), and 55% were located in the thoracic spine. The most common presenting symptom was sensory dysesthesia, with rare motor loss. The prodromal period to treatment was 19.4 months. Based on the McCormick Scale score at last follow-up examination 67% of patients were clinically functionally the same, 9% were worse, and 24% were improved after surgery. There were two deaths due tumor progression (both malignant tumors) and one recurrence (anaplastic astrocytoma). All three patients in whom malignant astrocytomas were diagnosed underwent postoperative radiation therapy. CONCLUSIONS: In the population of patients older than age 50 years, thoracic ependymomas are the most common IMSCTs that present characteristically with sensory symptoms. The longer prodromal period in the older adult population may reflect the fact that their diagnosis and workup is inadequate. There was no significant increase in the length of stay in the neurosurgical ward. The authors recommend motor evoked potential-guided aggressive microsurgical resection, because the long-term outcome of benign lesions is excellent (good functional recovery and no tumor recurrence).

Aged↗

PubMed2004

Spinal cord gangliogliomas: a review of 56 patients.

There have been only case reports concerning the management of intramedullary spinal cord gangliogliomas. We review our experience of 56 patients with respect to functional status, progression-free survival and long-term outcome. In this retrospective review, 56 patients, 35 males and 21 females ranging in age from 7 months to 25 years (mean, 7.0 y), underwent surgical treatment for intramedullary gangliogliomas located throughout the spinal cord. Forty-six patients had gross total resection as confirmed by postoperative imaging studies, and 10 had radical subtotal resection. Only five patients underwent postoperative irradiation or chemotherapy after surgery at our center and therefore outcome was attributed to surgery alone. There were no operative deaths, and the 5-year actuarial survival rate was 88%. The progression-free survival rate at 5 years was 67%. Neurological function in the surviving patients at recent follow-up evaluation was stable or improved in 72%. Patients have a long survival following radical surgery. These tumors have an indolent course, and radiotherapy appears to be unnecessary.

Adolescent↗

PubMed2002

Contact laser microsurgery.

INTRODUCTION: Lasers are commonly understood as instruments that produce a freestanding light beam that can cut or vaporize tissue. In contrast, a contact laser is an instrument where the laser beam resides entirely within a coated sapphire crystal probe tip. The authors describe the use of the contact laser for a variety of intraspinal procedures. METHOD: The probe is mounted on a curved handpiece and can be used in the same way as any microsurgical instrument. The laser energy is delivered only at the probe tip and only on contact of the tip with tissue. Different probe sizes and shapes allow for sharp cutting or tissue vaporization with minimal tissue penetration. FINDINGS: We have used this laser in 95 operations for dysraphic conditions, and intradural (both intra- and extramedullary) spinal tumors. It was easy to use for the microsurgically trained neurosurgeon. It is safer than a freestanding, noncontact, laser beam. To lyse scar tissue, evaporate lipomatous tissue, perform a precise myelotomy, and dissect, cut and debulk firm and fibrous intradural spinal lesions this instrument is superior to microscissors, suction, or the ultrasonic aspirator. INTERPRETATION: The contact laser is a useful microsurgical instrument for use in neurosurgery. It combines the advantages of lasers with those of microinstruments and avoids most shortcomings of both.

Humans↗