Neurosurgery issues in oncology

Advances in the surgical management of central nervous system neoplasms have been reported in several areas including the skull base, the spine and the stereotaxic applications in neurosurgery. A national survey of patterns of care for brain tumor patients contributed data on 11,185 patients, 97% of whom underwent surgery. Stereotaxic-guided craniotomies are providing added accuracy and shortened operative time and length of hospitalization, while the stereotaxic implantation of I125 seeds for recurrent high grade glioma has resulted in prolongation of survival between 54 and 81 weeks. Radiosurgery is being applied with increasing frequency and remarkable success in the management of skull base tumors, acoustic neuroma, and brain metastasis. The two prototypes used are the Gamma-knife and the linear accelerator-based multiple converging arcs technique. In the area of the skull base, significant anatomical details have been provided. Historical facts and clinical series related to the management of meningiomas and acoustic neuromas are reviewed. Spinal cord ependymoma is a surgically curable tumor as reported in a series of twenty-three patients followed for a mean of 62 months, and a randomized study has established the superiority of surgical resection for single brain metastasis as compared to the results obtained with radiation therapy alone.