Chapters authored
Minimally Invasive Surgery for Treatment of Patients with Advanced Cancer and Thoraco-lumbar Spine Metastases
Spinal metastases are common in patients with cancer. Spinal cord compression is the initial symptom of 5–10% of patients with diffuse cancer, and about 70% of lesions are found in the thoracic vertebrae. Patients with advanced cancer are generally excluded from major spine surgery, to reduce postoperative morbidity and mortality. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, especially in advanced cancer patients, seeking to decrease the morbidity of more traditional open spine surgery; furthermore, reducing the recovery time, MISS permits the post-operative chemotherapy and radiotherapy to begin sooner.
Part of the book: Neurooncology
Surgical Treatment of Spinal Meningiomas
Spinal meningiomas are common spinal tumors; in most cases they are benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring to a less favorable prognosis. We reviewed a series of 173 consecutive patients with spinal meningiomas treated from 1976 to 2011 in our institution, and data were stratified according to sex, age, symptoms, axial location, Simpson resection grade, and functional pre-/postoperative status. Particular attention was paid to description of those factors leading to a poor outcome. Functional improvement at follow-up was observed in 86.7% of cases, 6.4% of patients resulted stable, and 6.9% worsened; a low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grade I and II) was conducted in 98.8% and a macroscopically complete removal without dural resection or coagulation (Simpson grade III) was performed in 1.2%. According to data from our series, negative prognostic factors seem to be: anterior or anterolateral axial implant, long-lasting symptoms before diagnosis, WHO grade > I, Simpson grade II and III resection, sphincter involvement, and worse functional grade at onset.
Part of the book: Trauma, Tumors, Spine, Functional Neurosurgery