Elective Tumor Resection Research Articles

A Retrospective Study of Pediatric Posterior Fossa Tumors: Was the Outcome Different in Patients Undergoing Elective versus Emergency Surgery?

Abstract Background: Pediatric posterior fossa tumors (pPFTs) may present acutely with features of increased intracranial pressure that need urgent intervention or with stable symptoms requiring elective management. In this article, we have analyzed the outcomes of pPFTs managed under three arms: (1) emergency tumor resection (A), (2) elective tumor resection (B), and (3) pre-resection cerebrospinal spinal fluid (CSF) diversion followed by elective tumor resection (C). Materials and Methods: We retrospectively reviewed our database from July 2012 to March 2020 for pediatric patients (age ≤16 years) with PFTs. The patients were classified into three groups based on the timing and type of intervention. Their result was assessed as the primary (postoperative complications) and secondary outcomes (post-resection CSF diversion, CSF diversion failure, residual tumor, and survival). A P value < 0.05 was considered significant (SPSS version 22.0, IBM, New York). Results: A total of 154 patients (M:F = 2.42:1) were included with a mean age of 8.1 (SD ± 4.2)-years (range 1–16). Group B (n = 72/46.8%) had a significantly higher number of patients as compared to the group A (n = 40/26%) and group C (n = 42/27.3%) (χ2 test, P value = 0.02). The primary outcomes were comparable between group A and group B. A higher incidence of preoperative external ventricular drain insertion and post-resection CSF diversion failure was noted in group A as compared to group B (P value < 0.01). Group C had a significantly higher proportion of patients with residual tumor (n = 19/48.7%) as compared to group A (n = 11/29.7%, P value = 0.09) and group B (n = 20/ 29.4%,P value < 0.05). The post-resection CSF diversion failure rate was significantly higher in group C than in the other two groups (P value < 0.05). Conclusion: The pre-resection CSF diversion subgroup had a poorer outcome as compared to elective and emergency tumor resection. The outcomes of elective and emergency resection of pPFTs were comparable, except for the higher risk of shunt failure in the emergency cohort.

Synopsis Neuroanesthesia: Brain, Anesthetics and Skills

Central aspects of anesthesia management of intracranial interventions are the maintenance of cerebral homeostasis and the prevention of secondary brain damage. The focus is on cerebral metabolism and perfusion pressure, cerebral blood flow and intracranial pressure. Ensuring the balance of these parameters is the essential task of the anesthetist. This article provides insight into current anesthesia procedures. These include clinical cases of elective tumor resection to wake craniotomy. Furthermore this review covers emergencies with acute intracranial pressure increase and intracranial hemorrhage.

Elevated levels of circulating osteopontin are associated with a poor survival after resection of cholangiocarcinoma

Cholangiocarcinoma (CCA) represents a primary hepatic malignancy with incidence and mortality rising globally. Surgical treatment has remained the only potentially curative treatment option, but it is still unclear which patients benefit most from extended liver surgery, highlighting the need for new pre-operative stratification strategies. Osteopontin is a secreted extracellular glyco-phosphoprotein that has been associated with inflammation, metabolic disorders and cancer. Here, we examined the potential of circulating osteopontin serum levels as a diagnostic or prognostic biomarker in patients with CCA undergoing extended liver surgery. Osteopontin expression levels were analysed in human and murine CCA tumour samples, using semi-quantitative reverse transcriptase PCR and immunohistochemistry. Osteopontin serum concentrations were measured by enzyme-linked immunosorbent assay in 107 patients with CCA undergoing elective tumour resection as well as 55 healthy controls. Results were correlated with clinical data. Correlating with an upregulation in CCA tumour cells and the tumour stroma, serum levels of osteopontin were elevated in patients with cholangiocarcinoma compared to healthy controls and patients with primary sclerosing cholangitis. Importantly, pre- and postoperative elevations of osteopontin showed a striking association with poor postoperative survival. Serum osteopontin concentrations represent a promising prognostic biomarker in patients resectable CCA which could help to guide preoperative treatment decisions and to identify patients that will particularly benefit from extended liver surgery. Lay summary: Extended liver surgery is the only potentially curative treatment for patients with cholangiocarcinoma (CCA/biliary cancer), but it is currently unclear which patients benefit most from surgery. Detecting serum levels of osteopontin - a specific secreted glycoprotein involved in multiple human diseases - in CCA patients might help to identify those patients that particularly benefit from tumour resection.

Acil Serviste Nadir Görülen Bir Kişilik Değişikliği Nedeni: Glioblastoma Multiforme

ABSTRACT A 24-year-old male was admitted to emergency department with personality changes and long-lasting headache. Neurologic examination did not show any abnormalities. In cranial computed tomography scan brain mass was detected in frontal cortex bilaterally. Patient was hospitalized in Neurosurgery clinic with a diagnosis of intracranial tumor. Elective tumor resection was performed and his topathologic examination was reported as glioblastoma multiforme. In follow-up, no personality changes were observed. Patients with personality changes should be examined carefully, besides possible frequent underlying pathologies, intracranial tumors must be considered in differential diagnosis. Long lasting headaches may be a clue for emergency physicians.

Placement of the Decompression Tube as a Bridge to Surgery for Acute Malignant Left-Sided Colonic Obstruction

PurposeThe aim of this study is to investigate the feasibility, safety, and effectiveness of placing the decompression tube as a bridge to surgery for acute malignant left-sided colonic obstruction. MethodsFrom January 2009 to August 2014, consecutive patients with acute malignant left-side colonic obstruction underwent placement of the decompression tube as a bridge to surgery in our center. The technical and clinical success of placing the decompression tube was evaluated. Clinical success was defined as relief of obstructive symptoms within 48 h after placing the decompression tube. Elective tumor resection was performed 7–9 days after colonic decompression. The types of surgery, primary anastomosis rate, and follow-up findings were analyzed. ResultsTwenty patients with acute malignant left-side colonic obstruction underwent placement of the decompression tube as a bridge to surgery. Placement of decompression tube was technically successful in all patients. No procedure-related complication occurred. Clinical success was achieved in 19 patients. Elective tumor resection and primary anastomosis were successfully performed in all 19 patients. The postoperative complications included wound infection (n = 2) and anastomotic stenosis (n = 1). ConclusionDecompression tube can serve as an easy, safe, and effective bridge to subsequent surgery for patients with acute malignant left-sided colonic obstruction.

Cerebral Autoregulation and CO2 Reactivity Before and After Elective Supratentorial Tumor Resection

The effect of surgical decompression of tumor on autoregulation and CO2 reactivity is not known. We examined the effect of elective tumor resection on cerebral autoregulation and CO2 reactivity. Patients with supratentorial tumors undergoing elective craniotomy for tumor resection under standard anesthesia underwent cerebral autoregulation and CO2 reactivity testing immediately before and between 6 and 24 hours after surgery. Transient hyperemic response of the middle cerebral artery after the release of 10 second compression of the ipsilateral common carotid artery was used to calculate the transient hyperemic response ratio (THRR). THRR>1.1 defined the normal autoregulation. Voluntary hyperventilation was titrated to reduce the ETCO2 by 10 mm Hg below baseline and CO2 reactivity was calculated. Thirty-five patients (26 male and 9 female) were studied. Overall, cerebral autoregulation was intact before and after tumor resection for the cohort (THRR 1.27+/-0.10 and 1.30+/-0.12, P=0.11). However, cerebral autoregulation was impaired preoperatively in 7 (20%) patients and remained impaired in all 7 patients after tumor resection. Larger tumor size (P=0.002), and midline shift more than 5 mm (P<0.001) were associated with impaired cerebral autoregulation. Twenty-eight (80%) patients who had intact preoperative cerebral autoregulation maintained autoregulation postoperatively. CO2 reactivity was within normal limits before and after surgery in all patients and did not change between the 2 periods (3.41+/-0.46/mm Hg and 3.60+/-0.63%/mm Hg, P=0.07). Preoperative cerebral autoregulation was impaired in a significant number of patients with large supratentorial tumor size and midline shift more than 5 mm and was associated with postoperative impaired cerebral autoregulation during the first 24 hours after the surgery.

Acute Open Brain Herniation During Elective Tumour Resection

Acute Open Brain Herniation During Elective Tumour Resection

Beta-carbolines in chronic alcoholics undergoing elective tumor resection.

The prevalence of chronic alcoholism in patients with carcinomas of the upper digestive tract exceeds 60%. The patient's history and laboratory markers, preoperatively, are often not sensitive or specific enough to detect alcohol-dependent patients, preoperatively, who are at risk of developing alcohol withdrawal syndrome (AWS) during their postoperative intensive care unit (ICU) stay. Previously, it was found that plasma norharman was elevated in chronic alcoholics, suggesting marker characteristics for chronic ethanol misuse and possibly alcohol dependence. We investigated whether beta-carbolines (i.e., harman and norharman) were different between chronic alcoholics and nonalcoholics with carcinoma, and how the levels change in alcohol-dependent patients during their hospital stay. Ninety-seven patients with oral, pharyngeal, laryngeal, or esophageal carcinomas were evaluated regarding their drinking habits. Sixty patients were transferred to the ICU following tumor resection. Chronic alcoholics met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in chronic alcoholics was > or = 60 g. Blood samples were collected on admission to the hospital, preoperatively, on admission to the ICU and on days 2, 4, and 7 in the ICU. Harman and norharman were determined by HPLC. Elevated norharman was found in chronic alcoholics on admission to the hospital, whereas harman did not differ between groups. On admission, the area under the receiver operating characteristics curve was significantly larger for carbohydrate-deficient transferrin and preoperatively for norharman. The preoperative norharman levels were significantly correlated with the period of mechanical ventilation and the length of ICU stay. Postoperatively, norharman decreased in all patients, except a group of 11 alcohol-dependent patients who developed AWS during their ICU stay. The finding that elevated norharman levels were found in chronic alcoholics on admission to the hospital and preoperatively supports the view of a specific marker for alcoholism. Preoperative norharman was superior to carbohydrate-deficient transferrin and was associated with a prolonged ICU stay and a prolonged period of mechanical ventilation. Further studies are required to determine whether norharman aids in the preoperative diagnosis of chronic alcohol misuse with respect to the prevention of postoperative complications.

Use of magnesium sulphate in the anaesthetic management of phaeochromocytoma in pregnancy

The anaesthetic management of two patients with phaeochromocytoma complicating pregnancy is presented. In one patient, the operative delivery was followed by elective tumour resection at a later stage. Magnesium sulphate was used as an adjunct to all three anaesthetics, with notable success on two occasion. In one of the operative deliveries, it proved impossible to achieve adequate blood levels of magnesium, due to severe pre-existing magnesium deficiency. Hypomagnesaemia is likely to be present in such cases and must be corrected preoperatively. Magnesium sulphate is a useful adjunct to the anaesthetic management of the pregnant patient with a phaeochromocytoma provided that adequate serum levels of magnesium can be established.