Tag: treatment

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Treatment policy for petroclival meningioma based on tumor size: aiming radical removal in small tumors for obtaining cure without morbidity

Neurosurg Rev (2011) 34:327–335. DOI 10.1007/s10143-011-0308-7

Aggressive tumor removal is not always the best treatment for petroclival meningioma (PCM). However, radical removal actually provides the cure with minimal morbidity.

We evaluated the relation of surgical results and tumor size in the PCM removal to clarify the treatment policy for PCM. This study comprised 32 consecutive patients with newly-diagnosed PCM who underwent tumor removal; tumor size was small (< 3 cm) in 12 patients and large (≥3 cm) in 20. Tumor removal was classified into radical (Simpson’s grade I/II) and non-radical (Simpson’s grade III/IV). Removal of small PCM was 11 radical and one non-radical; no surgical morbidity/mortality occurred and postoperative regular follow-up using magnetic resonance imaging showed no recurrence in the period of 66± 45 months. Removal of large PCM was eight radical and 12 non-radical; despite no mortality, the incidence of permanent cranial nerve deficits and major neurological deficits newly developed postoperatively was 35% and 25%, respectively. Radical removal was significantly more frequent in small PCMs than in large PCMs. Permanent cranial nerve deficits newly developed postoperatively and poor outcome (Karnofsky score ≤80) were significantly more frequent in large PCMs than in small PCMs. Radical removal of small PCM is achieved with minimal morbidity and results in the cure. Notwithstanding high morbidity, aggressive removal of large PCM does not achieve a high rate of radical removal.

To find and remove PCM radically while it is small is the only way to cure the disease with minimal morbidity.

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Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Stroke. 2010;41:2108-2129. DOI: 10.1161/STR.0b013e3181ec611b

Purpose—The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage.

Methods—A formal literature search of MEDLINE was performed. Data were synthesized with the use of evidence tables. Writing committee members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council’s Levels of Evidence grading algorithm was used to grade each recommendation. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statements Oversight Committee and Stroke Council Leadership Committee. It is intended that this guideline be fully updated in 3 years’ time.

Results—Evidence-based guidelines are presented for the care of patients presenting with intracerebral hemorrhage. The focus was subdivided into diagnosis, hemostasis, blood pressure management, inpatient and nursing management, preventing medical comorbidities, surgical treatment, outcome prediction, rehabilitation, prevention of recurrence, and future considerations.

Conclusions—Intracerebral hemorrhage is a serious medical condition for which outcome can be impacted by early, aggressive care. The guidelines offer a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

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