Cerebellar Lesions and The Neurosurgeon

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Cerebellar Lesions and The Neurosurgeon Modern Surgical Approaches The incorporation of computed topography into stereo tactic techniques coincided with a general interest in stereo tactic approaches to intracranial tumors. Several authors including Moser and Backlund in 1982 and Apuzzo in 1984 reported safe CT based stereo tactic tumor biopsies ofpineal region tumors. Most series of stereo tactic tumor biopsies contain a number of pineal region lesions. The reported mortality and morbidity of imaging based stereo tactic biopsy is very low. It is now clear that stereo tactic biopsy is one option in a management of a pineal region tumor. However, the question of sampling is frequency raised. In addition, many pineal region tumors are not cured with radiation and chemotherapy and need to be resected. Open Approaches The evolution of modern microsurgical techniques have resulted in a precipitous reduction in the morbidity andmortality in the open approaches for the excision of pineal tumors. Packer (1984) reported nomortality in the partial resection of 24 pineal region tumors most of which were operated using a transcallosal approach, although an infratentorial approach was use d in some of these. Larger subsequentseries were reported by Lapras and Patet (1987) with 100 patients and no mortality and Sano (1987) with 125 patients. Edwards (1988) and Hoffman (1991) each reported pediatric series of 30 and 33 patients respectively.No mortality was experienced in any of these surgical series. Most employed infratentorial or transtentorial approaches. The open approach has two major advantages over stereo tactic biopsy: it provides more tissue and adequate histological sampling and it allows excision of tumors, which can potentially cure by resection. Stereotactic Biopsy The surgical methods are reported elsewhere and described briefly here.Stereo tactic biopsies were performed utilizing the COMPASS stereo tactic system (COMPASS international, Inc. Rochester, Minnesota). The procedures comprise three steps: data base acquisition, surgical planning and thesurgical procedure. Data base acquisition: Under sedation and local anesthesia a CT/MRI compatible stereo tactic head frame is placed.

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