ICAR: endoscopic skull‐base surgery

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Foramen magnum meningiomas: surgical treatment in a single public institution in a developing country

Objective: To analyze the clinical outcome of patients with foramen magnum (FM) meningiomas. Method: Thirteen patients (11 Feminine / 2 Masculine with FM meningiomas operated on through lateral suboccipital approach were studied. Clinical outcome were analyzed using survival (SC) and recurrence-free survival curves (RFSC). Results: All tumors were World Health Organization grade I. Total, subtotal and partial resections were acchieved in 69.2%, 23.1% and 7.7%, respectively, and SC was better for males and RFSC for females. Tumor location, extent of resection and involvement of vertebral artery/lower cranial nerves did not influence SC and RFSC. Recurrence rate was 7.7%. Operative mortality was 0. Main complications were transient (38.5%) and permanent (7.7%) lower cranial nerve deficits, cerebrospinal fluid fistula (30.8%), and transient and permanent respiratory difficulties in 7.7% each. Conclusions: FM meningiomas can be adequately treated in public hospitals in developing countries if a multidisciplinary team is available for managing postoperative lower cranial nerve deficits

Limited additional lateral biopsies improve the diagnostic accuracy of transrectal ultrasound guided sextant prostate biopsy

We prospectively evaluated the need for routine use of additional lateral biopsies at the time of standard sextant prostatic biopsy to reduce the false negative rates. A total of 23 consecutive patients underwent 24 TRUS guided prostatic biopsies resulting in 246 biopsy cores. Prostate cancer was diagnosed in 8/24 (33.3%) biopsies. Although the age and prostate volume did not significantly differ between patients with or without cancer (p>O. 05), the pre-biopsy PSA and PSAD were significantly higher in pa-tients diagnosed with prostate cancer (p< 0.05). Of the 8 patients diagnosed with prostate cancer 2/8 (25%) had cancer in the biopsies lateral to but not in the standard sextant biopsy sites. The additional lateral biopsies im-proved the sensitivity and negative predictive value of TRUS guided biopsy by 33.3% and 13% respectively. In conclusion, in spite of the small sample size in this study, prostate cancer detection is increased by 25% because of additional lateral biopsies at time of standard sextant prostatic biopsy

Compound osteosynthesis in the thoracic spine for treatment of vertebral metastases: technical report

Metastases to vertebrae often cause bone destruction leading to instability and neural compression. Anterior surgical approaches allow tumor resection and direct neural decompression. For patients with a short life expectancy, vertebral body replacement with methyl-methacrylate polymerized in situ can be used for load sharing in the axial plane. Screws hung from the rod into the corpectomy site are incorporated into the acrylic cement. The technique described in this article allows for immediate spinal stabilization and provides a protective environment for the neural elements. All the patients tolerated the procedure well and were able to ambulation without an orthoses