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At least 19 recordsLinked to original sources
PubMed1999

Management of intracranial meningiomas secondarily involving the infratemporal fossa: radiographic characteristics, pattern of tumor invasion, and surgical implications.

OBJECTIVE: Intracranial meningiomas extending into the infratemporal fossa (ITF) are uncommon. This series describes the radiographic characteristics, histological pattern of invasion, and implications for surgical treatment of intracranial meningiomas. METHODS: Nine patients (median age, 52 yr) underwent resection of a transcranial meningioma extending into the ITF. Five patients (56%) had undergone a previous resection; however, none had involvement of the ITF. Four patients (44%) had received prior radiation therapy to the area. RESULTS: Preoperative neuroradiography uniformly showed erosion of the middle fossa floor and extension of the tumor through cranial base foramina. Histological results indicated tumor invasion of the middle fossa floor and skeletal muscle in all patients. Perineural invasion was present in four patients. Mucosal invasion was observed in six patients. A middle fossa/zygomatic approach provided access to the intra- and extracranial components of the tumor, as well as the cavernous sinus, ITF structures, paranasal sinuses, and nasopharynx. Reconstruction was performed using the temporalis muscle, which provides a vascularized flap between exposed mucosa and the carotid artery and intradural structures. A gross total resection was performed in seven patients (78%). Postoperative complications included soft tissue ischemia (one patient), worsening of preoperative cranial neuropathy (two patients), and lower extremity deep vein thrombosis (two patients). One patient died 2 months postoperatively from a pulmonary embolus. Two patients had recurrence of intracranial meningiomas extending into the ITF at 2 and 3 years postoperatively, necessitating further resection. CONCLUSION: Understanding the pertinent clinical and morphological aspects of meningioma transcranially involving the ITF is essential to surgical treatment of patients with this condition.

Adult↗
PubMed2000

Neoplastic meningitis: a guide to diagnosis and treatment.

Neoplastic meningitis is a disease of the entire neuraxis and is pleomorphic in its clinical presentation. Diagnosis is achieved by recognition of the clinical manifestations of neoplastic meningitis followed by neuroradiography of the brain and spinal cord and examination of the cerebrospinal fluid. Treatment, if clinically warranted, includes irradiation of symptomatic or bulky disease and intracerebrospinal fluid chemotherapy following an assessment of the extent of metastatic disease treatment is based on the results of four randomized intracerebrospinal fluid chemotherapy trials.

Animals↗
PubMed2006

Lymphomatous meningitis in primary central nervous system lymphoma.

Lymphomatous meningitis (LM) due to primary central nervous system (CNS) lymphoma is an uncommon problem in neurooncology and can occur at time of diagnosis or recurrence. Notwithstanding frequent focal signs and symptoms, LM is a disease affecting the entire neuraxis, and therefore staging and treatment need to encompass all cerebrospinal fluid (CSF) compartments. Central nervous system staging of LM includes contrast agent-enhanced cranial computed tomography (CT) or Gd-enhanced magnetic resonance (MR) imaging, Gd-enhanced spinal MR imaging, CT myelography, and radionuclide CSF flow study. Treatment of LM includes involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy can benefit patients with LM and can obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (methotrexate, cytosine arabinoside, and thiotepa) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Although treatment of LM is palliative and the expected median survival of patients is 4 to 6 months, it often provides stabilization and protection from further neurological deterioration. In patients with primary CNS lymphoma, CNS prophylaxis has been recommended (using a combination of high-dose systemic chemotherapy and intra-CSF chemotherapy), but the strategy remains controversial because high-dose systemic methotrexate is commonly used as an adjuvant therapy. Patients with primary CNS lymphoma at high risk as defined by positive CSF cytology or neuroradiography consistent with LM may benefit from the inclusion of intra-CSF chemotherapy.

Brain Neoplasms↗
PubMed2005

Leptomeningeal metastases: current concepts and management guidelines.

Neoplastic infiltration of the meninges occurs when malignant cells gain entry into the cerebrospinal fluid (CSF). This is clinically recognized in 4% to 7% of all cancer patients. Leptomeningeal metastases may involve any part of the neural axis via tumor seeding; thus, a multitude of clinical presentations involving one or more domains exist, including the cerebral hemisphere, cranial nerves, and spinal cord and roots. The diagnosis of CSF metastases is often delayed and not appreciated until fixed neurologic deficits become evident. Adequate cytologic analysis of CSF fluid, neuroradiography of brain and spine, and an appropriate clinical context are the key element in diagnosing leptomeningeal metastases. A major challenge of treating neoplastic meningitis is the importance of treating the entire neural axis and stratifying patients in poor risk or good risk categories. Treatment is palliative and involves stabilizing neurologic status and prolonging survival. Median survival for untreated patients is 4 to 6 weeks. Treatment in a broad perspective entails radiotherapy and chemotherapy (systemic and intra-CSF). Commonly used intra-CSF chemotherapy regimens use drugs such as methotrexate, cytarabine, thiotepa, and a sustained-release liposome-encapsulated form of cytarabine (Depocyt, SkyePharma, London, UK). Patients with neoplastic meningitis usually experience a limited survival, even when treated using close adherence to evaluation algorithms and treatment protocols. In randomized controlled clinical trials using currently available intra-CSF chemotherapeutic agents, median survival in carefully selected, study-eligible groups of patients was 2 to 6 months.

Algorithms↗
PubMed1978

A nationwide system for computer recording of neuroradiologic examinations.

For 2 years the system of recording radiologic examinations connected with the computer called SYBAR has been in operation. The examination methods are coded using the Index of Roentgen Examinations of the Swedish National Medical Board (1970), while the diagnoses are coded according to [4]. The positive experience accumulated so far prompted the authors to project and put in operation the system NEURO-SYBAR in order to organize a bank of data of neuroradiologic examinations. This system required the widening of two anatomic fields, 'skull and contents' and 'spine and contents,' according to the 'Index for Roentgen Diagnoses' of the American College of Radiology [1]. The NEURO-SYBAR system was adopted by ten radiologic departments in the country. The complete neuroradiologic data from these departments were collected in one computer center in Lodz.

Computers↗
PubMed2001

Quality factors in interventional neuroradiology.

The interest we take in medical economics and strategy is like the one we take in politics: we may scorn politics, but it cannot be denied that it commands our entire life. For this reason, we must try to determine the conditions required to evaluate the quality of interventional neuroradiology, its operators, its practice, its advances, its teaching, and to maintain this quality. It is probably vital to the freedom of our future therapeutic decisions that we contribute effectively to this discussion before the standard is forced upon us by an exclusively economical or administrative logic. On the other hand, any advance can only be turned into progress if it is diffused and applied. There is no doubt that several levels of quality are acceptable, thus the best approach will be to look for and identify the minimum standard for quality or the limits of non-quality. We shall refrain from suggesting that the level of excellence at a given moment should be imposed upon all operators and constitute the standard level of practice. Practice is based on knowledge and competence. The most skilled surgical act cannot guarantee safe medical treatment if it is not supported by sufficient knowledge about the diseases and their symptoms. Mastership of the decision process requires a thorough vision of the therapeutic decision tree involved. Quality is a composition of global view and detailed analysis to allow a fuzzy gestion of the performance. Regardless of the plan chosen, openmindedness should be kept to allow adaptation, correction or interruption of a given therapeutic process in view of unpredicted pieces of information. Such input is a predictable possibility that should be explained to the patient prior to starting the procedure. Dealing with human beings, the attitude along with the technical management will be of paramount importance in the overall quality assessment.

Cost-Benefit Analysis↗
PubMed1984

Update and trends in venous (VDSA) and arterial (ADSA) digital subtraction angiography in neuroradiology.

After presentation of the principles and technology of digital subtraction angiography the results of 649 investigations with the peripheral venous method are presented and first experiences are discussed critically. In conclusion the method of venous digital subtraction angiography can be stated to be useful for adequate diagnosis of the extracranial brain vessels. Diagnostic statements about the intracranial vessels by venous injection are limited, and therefore a combined investigation including normal angiography remains necessary. In the near future neuroradiological investigations cannot abandon selective arterial techniques. One may expect however that normal angiographic investigations will subsequently be replaced by digital subtraction angiography with arterial injection of contrast medium.

Angiography↗