Pub Date : 2018-11-01DOI: 10.1097/01.CNE.0000549709.01850.03
Thomas J. Buell, A. Buchholz, J. Quinn, R. Haid, S. Bess, V. Lafage, F. Schwab, C. Shaffrey, Justin S. Smith
{"title":"Adjacent Segment Disease and Proximal Junctional Kyphosis—Part 1: Etiology and Classification","authors":"Thomas J. Buell, A. Buchholz, J. Quinn, R. Haid, S. Bess, V. Lafage, F. Schwab, C. Shaffrey, Justin S. Smith","doi":"10.1097/01.CNE.0000549709.01850.03","DOIUrl":"https://doi.org/10.1097/01.CNE.0000549709.01850.03","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000549709.01850.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45531297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1097/01.CNE.0000547434.42996.47
Bárbara Nettel, Alma Rosa García, D. Gallardo, G. Guinto, B. Sandoval, I. Feria-Romero
patients to a wide variety of treatment results, as every patient will have a different path through this illness. Patients must be evaluated individually, and therapeutic decisions must be made according to the specifi c patient and tumor characteristics. Glioblastoma, anaplastic astrocytoma, and anaplastic oligodendroglioma provide clear examples of the importance of teamwork by all specialists involved in the treatment of high-grade gliomas. A multidisciplinary approach is the key to success. But, what is considered a “successful treatment” in highgrade gliomas? In the past 2 decades, advances in surgical techniques and intraoperative technology have allowed the neurosurgeon to offer considerable improvement in survival and quality of life. When it comes to a disease without a cure, this could be considered success. Achieving a better prognosis for patients depends not only on development of effective treatments; it is also necessary to create systems for an effective organization within all the specialists involved to ensure the patient will receive those treatments at the best time and in the best possible way. Patients with the diagnosis of high-grade glioma provide one of the best examples of how the communication among the various specialists is essential to obtain the best results. It has been demonstrated that patients’ prognosis is much better at centers where subspecialized surgeons in the various disciplines of neurosurgery take care of patients as compared with centers that do not have the appropriate organization. The main objectives in the creation of an oncologic neurosurgery clinic are: 1) to discuss the best treatment option for each patient with a brain tumor; and 2) to perform close follow-up of every case by having an open channel for communication among the various specialists. A system for multidisciplinary communication is the basis to create an oncologic neurosurgery clinic (Figure 1). Today, the standard treatment for a patient with a highgrade glioma consists of gross total resection followed by radiation therapy concomitant with chemotherapy and at least 6 cycles of adjuvant chemotherapy. Until now, it could be considered that the multidisciplinary team comprises the neurosurgeon, the radiation oncologist, and the neurooncologist. However, successful treatment of these patients depends on more than 3 specialists. Treatment is complex, and it is necessary to ensure after every phase that treatment will not generate a new neurologic defi cit or
{"title":"High-Grade Gliomas: A Multidisciplinary Approach","authors":"Bárbara Nettel, Alma Rosa García, D. Gallardo, G. Guinto, B. Sandoval, I. Feria-Romero","doi":"10.1097/01.CNE.0000547434.42996.47","DOIUrl":"https://doi.org/10.1097/01.CNE.0000547434.42996.47","url":null,"abstract":"patients to a wide variety of treatment results, as every patient will have a different path through this illness. Patients must be evaluated individually, and therapeutic decisions must be made according to the specifi c patient and tumor characteristics. Glioblastoma, anaplastic astrocytoma, and anaplastic oligodendroglioma provide clear examples of the importance of teamwork by all specialists involved in the treatment of high-grade gliomas. A multidisciplinary approach is the key to success. But, what is considered a “successful treatment” in highgrade gliomas? In the past 2 decades, advances in surgical techniques and intraoperative technology have allowed the neurosurgeon to offer considerable improvement in survival and quality of life. When it comes to a disease without a cure, this could be considered success. Achieving a better prognosis for patients depends not only on development of effective treatments; it is also necessary to create systems for an effective organization within all the specialists involved to ensure the patient will receive those treatments at the best time and in the best possible way. Patients with the diagnosis of high-grade glioma provide one of the best examples of how the communication among the various specialists is essential to obtain the best results. It has been demonstrated that patients’ prognosis is much better at centers where subspecialized surgeons in the various disciplines of neurosurgery take care of patients as compared with centers that do not have the appropriate organization. The main objectives in the creation of an oncologic neurosurgery clinic are: 1) to discuss the best treatment option for each patient with a brain tumor; and 2) to perform close follow-up of every case by having an open channel for communication among the various specialists. A system for multidisciplinary communication is the basis to create an oncologic neurosurgery clinic (Figure 1). Today, the standard treatment for a patient with a highgrade glioma consists of gross total resection followed by radiation therapy concomitant with chemotherapy and at least 6 cycles of adjuvant chemotherapy. Until now, it could be considered that the multidisciplinary team comprises the neurosurgeon, the radiation oncologist, and the neurooncologist. However, successful treatment of these patients depends on more than 3 specialists. Treatment is complex, and it is necessary to ensure after every phase that treatment will not generate a new neurologic defi cit or","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1–5"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000547434.42996.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48694840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1097/01.CNE.0000546556.80258.22
Wendell B. Lake
cant medical problems that effect various patient populations. Systemic medical treatments include baclofen and other medications such as tizanadine and benzodiazepines. Many of these medications cross the blood-brain barrier poorly, only producing a low concentration of drug in the central nervous system. Due to systemic side effects, and the diffi culty achieving blood levels suffi cient to satisfactorily treat spasticity and generalized dystonia, it is often necessary to employ subcutaneous pumps and spinal catheters that allow intrathecal dosing of baclofen. Intrathecal baclofen therapy can be very efficacious for properly selected patients, but there are signifi cant risks that the practitioner and the patient must bear in mind; these include infection, wound breakdown, catheter malfunction, and adverse medication events. As with any surgical treatment, patient selection and appropriate surgical technique are crucial if one is to maximize the benefi ts of therapy and minimize complications. With appropriate patient selection and surgical technique, intrathecal baclofen therapy is a rewarding endeavor that signifi cantly improves patient and caregiver quality of life.
{"title":"Intrathecal Baclofen Infusion: A Treatment for Spasticity and Secondary Generalized Dystonia","authors":"Wendell B. Lake","doi":"10.1097/01.CNE.0000546556.80258.22","DOIUrl":"https://doi.org/10.1097/01.CNE.0000546556.80258.22","url":null,"abstract":"cant medical problems that effect various patient populations. Systemic medical treatments include baclofen and other medications such as tizanadine and benzodiazepines. Many of these medications cross the blood-brain barrier poorly, only producing a low concentration of drug in the central nervous system. Due to systemic side effects, and the diffi culty achieving blood levels suffi cient to satisfactorily treat spasticity and generalized dystonia, it is often necessary to employ subcutaneous pumps and spinal catheters that allow intrathecal dosing of baclofen. Intrathecal baclofen therapy can be very efficacious for properly selected patients, but there are signifi cant risks that the practitioner and the patient must bear in mind; these include infection, wound breakdown, catheter malfunction, and adverse medication events. As with any surgical treatment, patient selection and appropriate surgical technique are crucial if one is to maximize the benefi ts of therapy and minimize complications. With appropriate patient selection and surgical technique, intrathecal baclofen therapy is a rewarding endeavor that signifi cantly improves patient and caregiver quality of life.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"40 1","pages":"1–6"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000546556.80258.22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43442230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-01DOI: 10.1097/01.CNE.0000544523.15949.a8
M. Karsy, D. Gillespie, K. Horn, J. Guan, Andrea Brock, R. Jensen
Hypoxia plays a key role in tumor resistance to treatment and prediction of patient prognosis in a variety of central nervous system (CNS) tumors, including glioblastoma (GBM) and meningioma. The current noninvasive imaging modalities allow for assessment of hypoxia with implications for understanding tumor biology, predicting recurrence, and aiding in treatment strategies. In part I of this review, we discuss the underlying mechanism of hypoxia in GBM and describe the use of advanced MRI to understand tumor hypoxia. In part II, we will discuss the role of positron emission tomography (PET) in assessing GBM. Importance of Hypoxia in Tumors Hypoxia is defi ned as decreased oxygen tissue perfusion below normal physiological levels, and its infl uence is at the heart of tumor biology (Figure 1). As tumors increase in size beyond 1 mm, vasculature is required to meet oxygenation requirements. Tumors that grow rapidly in size or resistance to hypoxic environments often have deranged hypoxia signaling pathways. Multiple mechanisms contribute to the development of hypoxia in CNS tumors, including high cell proliferation rates, ineffi cient neovascularization, limited oxygen diffusion, alterations of normal blood–brain barrier function, poor nitric oxide permeability, and formation of a necrotic microenvironment. Hypoxia has been implicated in the development of tumor resistance via numerous mechanisms, including reduced effi cacy of oxidative radicals critical to the function of radiotherapy and chemotherapy, impaired delivery of chemotherapy agents, dysregulation of cancer stem cells in CNS tumors, increased hematopoietic cell infi ltration and neovascularization, increased endothelial cell survival via secreted vascular endothelial growth factor (VEGF), and
{"title":"MRI of Hypoxia in Primary Central Nervous System Tumors: Part I","authors":"M. Karsy, D. Gillespie, K. Horn, J. Guan, Andrea Brock, R. Jensen","doi":"10.1097/01.CNE.0000544523.15949.a8","DOIUrl":"https://doi.org/10.1097/01.CNE.0000544523.15949.a8","url":null,"abstract":"Hypoxia plays a key role in tumor resistance to treatment and prediction of patient prognosis in a variety of central nervous system (CNS) tumors, including glioblastoma (GBM) and meningioma. The current noninvasive imaging modalities allow for assessment of hypoxia with implications for understanding tumor biology, predicting recurrence, and aiding in treatment strategies. In part I of this review, we discuss the underlying mechanism of hypoxia in GBM and describe the use of advanced MRI to understand tumor hypoxia. In part II, we will discuss the role of positron emission tomography (PET) in assessing GBM. Importance of Hypoxia in Tumors Hypoxia is defi ned as decreased oxygen tissue perfusion below normal physiological levels, and its infl uence is at the heart of tumor biology (Figure 1). As tumors increase in size beyond 1 mm, vasculature is required to meet oxygenation requirements. Tumors that grow rapidly in size or resistance to hypoxic environments often have deranged hypoxia signaling pathways. Multiple mechanisms contribute to the development of hypoxia in CNS tumors, including high cell proliferation rates, ineffi cient neovascularization, limited oxygen diffusion, alterations of normal blood–brain barrier function, poor nitric oxide permeability, and formation of a necrotic microenvironment. Hypoxia has been implicated in the development of tumor resistance via numerous mechanisms, including reduced effi cacy of oxidative radicals critical to the function of radiotherapy and chemotherapy, impaired delivery of chemotherapy agents, dysregulation of cancer stem cells in CNS tumors, increased hematopoietic cell infi ltration and neovascularization, increased endothelial cell survival via secreted vascular endothelial growth factor (VEGF), and","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1–8"},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000544523.15949.a8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48608469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.1097/01.CNE.0000544188.79232.dd
T. Sorenson, Gabriel Kaufmann, John J. Chen, J. Cutsforth-Gregory, P. Morris, G. Lanzino
of increased intracranial pressure (ICP) without a recognizable cause, typically associated with headache and papilledema. The historic term “benign intracranial hypertension” has been abandoned in modern clinical practice. IIH is used to indicate the clinical features of increased ICP secondary to nonobstructive causes, as elevated ICP is associated with a significant risk of vision loss. IIH is most prevalent in women of gestational age, although it can, rarely, affect men and children, and in those groups often has atypical features. Although the specifi c cause of IIH is unknown, it has been closely associated with obesity and has increased in prevalence parallel to rising obesity rates. In this review, we discuss emerging aspects in the clinical features, diagnosis, and treatment of IIH to update a review published in this series in 2013. Epidemiology and Pathophysiology Past reviews have demonstrated the incidence of IIH in the general population to be 0.5 to 2.0 per 100,000 people, increasing to 19.3 per 100,000 in overweight women of gestational age. The incidence of IIH has doubled over the past 2 decades in parallel to the obesity epidemic in the United States and elsewhere. The frequent co-occurrence of IIH and obesity suggests that truncal obesity may cause high intra-abdominal pressure that is transmitted to the superior vena cava and inhibits venous drainage from the brain. However, incidence rates and symptoms differ between obese men and women, suggesting that factors other than obesity are at play, and the infl uence of hormonal factors has been speculated. More than 90% of patients with IIH are female. Therefore, any male patient with presumed IIH should be evaluated closely for secondary causes of raised ICP such as venous sinus thrombosis. Men with IIH also have a higher risk of vision loss than women. Although obesity and sex are the largest risk factors in adults, there is no association with obesity in children.
{"title":"Idiopathic Intracranial Hypertension: Emerging Concepts","authors":"T. Sorenson, Gabriel Kaufmann, John J. Chen, J. Cutsforth-Gregory, P. Morris, G. Lanzino","doi":"10.1097/01.CNE.0000544188.79232.dd","DOIUrl":"https://doi.org/10.1097/01.CNE.0000544188.79232.dd","url":null,"abstract":"of increased intracranial pressure (ICP) without a recognizable cause, typically associated with headache and papilledema. The historic term “benign intracranial hypertension” has been abandoned in modern clinical practice. IIH is used to indicate the clinical features of increased ICP secondary to nonobstructive causes, as elevated ICP is associated with a significant risk of vision loss. IIH is most prevalent in women of gestational age, although it can, rarely, affect men and children, and in those groups often has atypical features. Although the specifi c cause of IIH is unknown, it has been closely associated with obesity and has increased in prevalence parallel to rising obesity rates. In this review, we discuss emerging aspects in the clinical features, diagnosis, and treatment of IIH to update a review published in this series in 2013. Epidemiology and Pathophysiology Past reviews have demonstrated the incidence of IIH in the general population to be 0.5 to 2.0 per 100,000 people, increasing to 19.3 per 100,000 in overweight women of gestational age. The incidence of IIH has doubled over the past 2 decades in parallel to the obesity epidemic in the United States and elsewhere. The frequent co-occurrence of IIH and obesity suggests that truncal obesity may cause high intra-abdominal pressure that is transmitted to the superior vena cava and inhibits venous drainage from the brain. However, incidence rates and symptoms differ between obese men and women, suggesting that factors other than obesity are at play, and the infl uence of hormonal factors has been speculated. More than 90% of patients with IIH are female. Therefore, any male patient with presumed IIH should be evaluated closely for secondary causes of raised ICP such as venous sinus thrombosis. Men with IIH also have a higher risk of vision loss than women. Although obesity and sex are the largest risk factors in adults, there is no association with obesity in children.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"40 1","pages":"1–5"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000544188.79232.dd","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42357763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.1097/01.CNE.0000541304.89980.89
Á. Campero, Julio Diloné, P. Ajler
the pterional approach (PA), is one of the most widely used approaches in cranial surgery. This is because, through the sylvian fi ssure (SF), it allows access to the subarachnoid cisterns, the insula, and the mesial temporal lobe. Even nowadays, the PA it is still a published topic, although it was fi rst described more than 40 years ago by Yaş argil. Over time, multiple variants were added to the PA, including minipterional, transzygomatic, and orbitozygomatic approaches. The PA takes the pterion as the midpoint, thus exposing a small section of the lateral part of the frontal, parietal, temporal (squamous), and sphenoid (greater wing) bones. In this way, the PA makes it possible to expose, through the SF and the lateral subfrontal via, the insula, the basal ganglia, the mesial temporal region, the supra and parasellar area, a large part of the anterior and middle fossa, and the basal cisterns. The PA is based on exposure and opening of the SF. Therefore, accurate anatomic knowledge of the SF is necessary, as well as the techniques to open it; when separating both opercula, upper or frontal and lower or temporal, the neurosurgeon is able to approach multiple anatomic structures that were previously described.
{"title":"Pterional Approach: Operative Technique and Surgical Applications","authors":"Á. Campero, Julio Diloné, P. Ajler","doi":"10.1097/01.CNE.0000541304.89980.89","DOIUrl":"https://doi.org/10.1097/01.CNE.0000541304.89980.89","url":null,"abstract":"the pterional approach (PA), is one of the most widely used approaches in cranial surgery. This is because, through the sylvian fi ssure (SF), it allows access to the subarachnoid cisterns, the insula, and the mesial temporal lobe. Even nowadays, the PA it is still a published topic, although it was fi rst described more than 40 years ago by Yaş argil. Over time, multiple variants were added to the PA, including minipterional, transzygomatic, and orbitozygomatic approaches. The PA takes the pterion as the midpoint, thus exposing a small section of the lateral part of the frontal, parietal, temporal (squamous), and sphenoid (greater wing) bones. In this way, the PA makes it possible to expose, through the SF and the lateral subfrontal via, the insula, the basal ganglia, the mesial temporal region, the supra and parasellar area, a large part of the anterior and middle fossa, and the basal cisterns. The PA is based on exposure and opening of the SF. Therefore, accurate anatomic knowledge of the SF is necessary, as well as the techniques to open it; when separating both opercula, upper or frontal and lower or temporal, the neurosurgeon is able to approach multiple anatomic structures that were previously described.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1–8"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000541304.89980.89","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47361605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-01DOI: 10.1097/01.cne.0000538910.75636.e9
{"title":"En Bloc Resection of Vertebral Tumors of Thoracic and Lumbar Spine","authors":"","doi":"10.1097/01.cne.0000538910.75636.e9","DOIUrl":"https://doi.org/10.1097/01.cne.0000538910.75636.e9","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.cne.0000538910.75636.e9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45231948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-01DOI: 10.1097/01.CNE.0000538909.68012.9c
C. Zamorano, Miguel Abdo, J. Kelly, G. Guinto, A. Del Real
sent 11% of all primary tumors of the musculoskeletal system, 4.2% of all spinal tumors, and approximately 0.4% of all cancers. The incidence of primary spinal tumors is calculated to range from 2.5 to 8.5 per 100,000 individuals per year. Plasmacytoma, which has a considerable tendency to appear in the vertebras, is often considered in the discussion of spinal tumors, even though it originates in the lymphoreticular system. Due to the rarity of these primary tumors in spine, and diffi culties reported in the past with partial resections and the high recurrence index of these tumors, en bloc resection techniques have been developed to follow oncologic criteria in the surgical resection of spinal tumors. This type of resection was conceived initially by Enneking and others for treatment of bone tumors and soft tissue tumors of the extremities. This new procedure dramatically reduced amputations and notably improved control of the disease in association with other adjuvant therapies. Whether this philosophy can be applied to spinal tumors has been debated, due to the anatomic characteristics and the proximity of unresectable structures. Steiner was the pioneer of this type spinal tumor resection, followed by Roy-Camille and Tomita in the 70s and 80s.
{"title":"En Bloc Resection of Vertebral Tumors of Thoracic and Lumbar Spine: Indications and Techniques","authors":"C. Zamorano, Miguel Abdo, J. Kelly, G. Guinto, A. Del Real","doi":"10.1097/01.CNE.0000538909.68012.9c","DOIUrl":"https://doi.org/10.1097/01.CNE.0000538909.68012.9c","url":null,"abstract":"sent 11% of all primary tumors of the musculoskeletal system, 4.2% of all spinal tumors, and approximately 0.4% of all cancers. The incidence of primary spinal tumors is calculated to range from 2.5 to 8.5 per 100,000 individuals per year. Plasmacytoma, which has a considerable tendency to appear in the vertebras, is often considered in the discussion of spinal tumors, even though it originates in the lymphoreticular system. Due to the rarity of these primary tumors in spine, and diffi culties reported in the past with partial resections and the high recurrence index of these tumors, en bloc resection techniques have been developed to follow oncologic criteria in the surgical resection of spinal tumors. This type of resection was conceived initially by Enneking and others for treatment of bone tumors and soft tissue tumors of the extremities. This new procedure dramatically reduced amputations and notably improved control of the disease in association with other adjuvant therapies. Whether this philosophy can be applied to spinal tumors has been debated, due to the anatomic characteristics and the proximity of unresectable structures. Steiner was the pioneer of this type spinal tumor resection, followed by Roy-Camille and Tomita in the 70s and 80s.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1–8"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000538909.68012.9c","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49365378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：