Large and XXXX : therapeutic strategy and the choice of microsurgical approaches - report of the experience with 41 cases.

@entity1 @entity1688 @entity129 @entity1183 @entity66 @entity5 @entity260 @entity5173 @entity1653 @entity281 @entity1282 @entity892
OBJECTIVE: To evaluate @entity1 ' clinical outcome, survival and performance status at the mild-term follow-up evaluation after optimal microsurgical resection of large and @entity1653 ( @entity1653 ). METHODS: During a 4-year period (2004-2008), 41 @entity1 underwent operative procedures for resection of @entity1653 . The @entity5 size was large or giant in 100% of the @entity1 , with a mean @entity5 diameter of 4.4   cm. @entity5 extended into adjoining regions in 26 of the @entity1 . Six previously underwent operation or irradiation. @entity5 resection (GTR) was accomplished in 25 (61.0%) @entity1 , subtotal resection (STR) in 15 (36.6%) @entity1 and partial resection in 1 (2.4%) @entity1 . There were no operative deaths. @entity260 ( @entity5173 , @entity1688 , @entity281 , @entity129 , etc.) were observed in 27 (65.9%) @entity1 . Postoperative radiation or radiosurgery was administered to 6 of the 41 @entity1 who had residual @entity5 . RESULTS: At the conclusion of the study, 27 (65.9%) @entity1 were alive with radiological evidence of the @entity66 , and 14 (34.1%) @entity1 were alive without radiological evidence of the @entity66 . The mean follow-up period was 35 months (range, 15-45 months). Six (14.6%; five of the STR and partially resected @entity1 and one of the total resection @entity1 ) had recurrence; of these @entity1 , four underwent repeat resection and two were treated with gamma knife radiosurgery. The Karnofsky Performance Scale score was 78  14 preoperatively, 80  10 at 1 year postoperatively and 81  10 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included @entity892 , @entity1183 and @entity1282 . Most @entity1 developed coping mechanisms. CONCLUSIONS: The surgical strategy of large and @entity1653 should be focused on the survival and postoperative quality of life. The good surgical approach should be based on the @entity5 location, the growth direction, the invasion of adjacent structure, the age of the @entity1 and the experience of neurosurgeons. Selectively pursuing an STR without radiotherapy rather than a GTR is a reasonable strategy. Moreover, microneurosurgical technique plays a key role in the level of @entity5 resection and preservation of nerve function. Intraoperative electrophysiological monitoring also contributes dramatically to the preservation of the nerve function.
