Tag: prognosis

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Postoperative Magnetic Resonance Imaging Can Predict Neurological Recovery After Surgery for Cervical Spondylotic Myelopathy: A Prospective Study With Blinded Assessments

Neurosurgery 69:362–368, 2011 DOI: 10.1227/NEU.0b013e31821a418

Factors that can predict the recovery of cervical spondylotic myelopathy (CSM) patients postoperatively are of significant interest to physicians and patients and their families. Magnetic resonance imaging (MRI) scans are a common method of examination after surgery, and thus of interest as a predictor of outcome.

OBJECTIVE: To investigate whether findings on MRI at 6 months postoperatively could predict recovery at 1 year in CSM patients.

METHODS: In 52 consecutive prospective patients, MRI was performed preoperatively and 6 months postoperatively. T1 and T2 signal change (area, height, and segmentation) and spinal cord re-expansion were measured. Outcome measures evaluated at 1 year postoperatively were compared with preoperative values. Univariate and stepwise multiple regressions were undertaken.

RESULTS: Using univariate analysis, patients whose cord failed to re-expand had poorer outcome according to the modified Japanese Orthopedic Association score and Nurick score (P = .014) and grip test (P = .006) postoperatively. Stepwise multivariate regression showed lack of cord re-expansion to be predictive of prognosis postoperatively in the modified Japanese Orthopedic Association score (P = .013) and Berg Balance Scale (P = .014), and walking test (P = .011). Postoperative hyperintense T2 signal change was predictive of worse outcome on the Berg Balance Scale (P = .014) and walking test (P = .020), Nurick score (P = .001), and Short Form-36 scores (P = .020). In cases in which the T2 signal intensified, there was a poorer outcome on Nurick scores (P = .013), grip test (P = .017), and Short Form-36 scores (P = .030).

CONCLUSION: Findings on postoperative MRI at 6 months is of predictive value in determining outcomes in CSM patients. The persistence and type of T2 signal change and lack of re-expansion of the cord correlate with poorer recovery and likely reflect irreversible structural changes in the spinal cord.

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Meningiomas in the elderly, the surgical benefit and a new scoring system

Acta Neurochir (2010) 152:87–97 DOI 10.1007/s00701-009-0552-6

Objective The purpose of the study was to define and identify prognostic indicators within an elderly population of patients suffering from intracranial meningiomas. The clinical presentation of the patient with meningioma is diverse, manifesting as a different clinical entity in the elderly patient compared to a similar type of tumor in a young patient.

Methods Two hundred fifty patients aged over 65 years admitted to RAMBAM Medical Center with meningiomas from 1995–2005 were characterized. We report the present- ing symptoms, chronic illnesses, perioperative and long- term follow-up results for a 5-year period.

Results Based on univariate and multivariate analysis, significant prognostic indicators were identified and were implemented into a new geriatric scoring system (GSS) including tumor size and location, peritumoral edema, neurological deficits, Karnofsky score (Clancey J Neurosci Nurs 27:220, 1995; Crooks et al. J Gerontol 46:M139– M144, 1991), and associated diabetes, hypertension or lung disease. Seven outcome parameters were retrospectively tested using the scoring system, namely mortality, Barthel Index score (Mahoney and Barthel Md State Med J 14:61–65, 1965), Karnofsky score and consciousness expressed by the Glasgow Coma Scale score (Jennett and Bond Lancet 1:480–484, 1975) 5 years after surgery, as well as recurrence within and beyond 12 months. Age proved to inversely correlate with outcome. Morbidity and mortality were significantly lower in women. The extent of surgical resection (Simpson J Neurol Neurosurg Psychiatry 20:22–39, 1957) had no influence on function- al outcome, although radical resection was associated with significantly lower mortality. Generally, a GSS score higher than 14 was associated with a significantly more favorable outcome.

Conclusion The present results suggest that common experience-based considerations may be optimized and implemented into a simple scoring system that in turn may allow for outcome prediction and evidence-based decision making.


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Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

Neurosurg Focus 27 (5):E3, 2009. DOI: 10.3171/2009.8.FOCUS09167

Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity. The incidence of CVST in chil- dren and neonates has been reported to be as high as 7 cases per million people, whereas in adults the incidence is 3–4 cases per million. The predisposing factors to this condition are mainly genetic and acquired prothrombotic states and infection. The clinical picture of CVST is nonspecific, highly variable, and can mimic several other clinical conditions. Diagnosis of CVST is established with the implementation of neuroimaging studies, especially MR imaging and venography. Identification and elimination of the underlying cause, anticoagulation, proper management of intracranial hypertension, and anticonvulsant prophylaxis constitute cornerstones of CVST treatment. Newer treatment strategies such as endovascular thrombolysis and decompressive craniectomy have been recently used in the treatment of patients with CVST with variable success rates. Further clinical research must be performed to delineate the exact role of these newer treatments in the management of severe cases of CVST. The recent advances in the diagnosis and treatment of patients with CVST have significantly lowered the associated mortality and morbidity and have improved the outcome of these patients.

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