Neurochirurgische Onkologie

J.C. Tonn

doi:10.1055/s-0038-1630032

Nervenheilkunde, Table of Contents

Nervenheilkunde 2005; 24(10): 903-907
DOI: 10.1055/s-0038-1630032

Original Article

Schattauer GmbH

Neurochirurgische Onkologie

Radikalität versus FunktionserhaltSurgical neurooncologyRadicalism versus functional integrity

J.C. Tonn

¹Neurochirurgische Klinik und Poliklinik am Klinikum Großhadern, München

› Author Affiliations

Abstract

Zusammenfassung

In der neurochirurgischen Onkologie gilt heute mehr denn je das Primat des Funktionserhaltes bei gleichzeitigem Streben nach größtmöglicher Radikalität. Eine Vielzahl von Techniken ermöglicht uns heute, Tumore vollständiger zu entfernen als früher. „Radikalität“ um jeden Preis ist jedoch nicht mehr zeitgemäß und wird von Patienten und ihren behandelnden Ärzten auch nicht mehr akzeptiert. Die Kombination operativer Möglichkeiten in der Neurochirurgie mit dem Wissen um die Biologie der jeweiligen Geschwülste und ihrem natürlichen Krankheitsverlauf ermöglicht es uns heute, für jeden Patienten differenzierte Behandlungskonzepte zu entwickeln, die im Vorfeld mit dem Patienten und den zuweisenden Kollegen besprochen werden müssen. Am Beispiel der Gliome, der Hirnmetastasen und von häufigen Schädelbasistumoren (Meningeome und Neurinome) werden Strategien zur Verbesserung der Radikalität bei gleichzeitiger Schonung der neurologischen Funktion vorgestellt.

Summary

In neurosurgical oncology, today more then ever, the principle of function preservation while striving for the highest possible surgical radicalism is evident. A number of techniques make it possible to remove tumours more completely than was previously the case. “Radicalism” at any cost, however, is no longer appropriate or accepted by patients or by treating physicians. The combination of neurosurgical possibilities and knowledge about the biology of the different tumours as well as the natural disease progression, allows us today to develop differentiated treatment concepts for individual patients, which are discussed beforehand with the patient and the referring colleague. Based on the example of gliomas, brain metastases, and frequent skull-base tumours (meningiomas and neurinomas), strategies to improve the radicalism of tumour resection and to simultaneously preserve the neurological function are described.

Schlüsselwörter

Gliome - Meningeome - Neurinome - Metastasen - Radiochirurgie

Keywords

Glioma - meningioma - neurinoma - metastases - radiosurgery

Full Text

References

Literatur
1 Ganslandt O, Stadlbauer A, Fahlbusch R, Kamasa K, Buslei R, Blumcke I, Moser E, Nimsky C. Proton magnetic resonance spectroscopic imaging integrated into image guided surgery: correlation to standard magnetic resonance imaging and tumor cell density. Neurosurgery 2005; 56: 291-8.
2 Henson JW, Gaviani P, Gonzales RG. MRI in treatment of adult gliomas. Lancet Oncol. 2005; 6: 167-75.
3 Kaal EC, Niel CG, Vecht CJ. Therapeutic management of brain metastasis. Lancet Neurol. 2005; 4: 289-98.
4 Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS. Intraoperative subcorti cal stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg. 2004; 100: 369-75.
5 Kirsch DG, Loeffler JS. Treating brain metastases: current approaches and future directions. Expert Rev Neurother 2004; 4: 1015-22.
6 Kreth FW, Muacevic A, Medele R, Bise K, Meyer T, Reulen HJ. The risk of haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours-- a prospective study. Acta Neurochir (Wien) 2001; 143: 539-45.
7 Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R. A Multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001; 95: 190-8.
8 Oertel J, Von Buttlar E, Schroeder HW, Gaab MR. Prognosis of gliomas in the 1970s and today. Neurosurg Focus 2005; 15 (18) e12.
9 Oh DS, Black PM. A low-field intraoperative MRI system for glioma surgery: is it worthwhile?. Neurosurg Clin N Am. 2005; 16: 135-41.
10 Paulus W, Pfeiffer J, Schroeder JM. (Hrsg) Neuropathologie – Morphologische Diagnostik der Krankheiten des Nervensystems und der Skelettmuskulatur. Berlin: Springer Verlag; 2002
11 Peraud A, Meschede M, Eisner W, Ilmberger J, Reulen HJ. Surgical resection of grade II astrocytomas in the superior frontal gyrus. Neurosurgery 2002; 50: 966-75.
12 Reulen HJ, Schmid DU, Ilmberger J, Eisner W, Bise K. Tumor surgery of the speech cortex in local anesthesia. Neuropsychological and neurophysiological monitoring during operations in the dominant hemisphere Nervenarzt 1997; 68: 813-24.
13 Schlake HP, Goldbrunner R, Milewski C, Siebert M, Behr R, Riemann R, Helms J, Roosen K. Technical developments in intra-operative monitoring for the preservation of cranial motor nerves and hearing in skull base surgery. Neurol Res. 1999; 21: 11-24.
14 Schlake HP, Goldbrunner R, Siebert M, Behr R, Roosen K. Intra-Operative electromyographic monitoring of extra-ocular motor nerves (Nn. III, VI) in skull base surgery. Acta Neurochir (Wien) 2001; 143: 251-61.
15 Stummer W, Reulen HJ, Novotny A, Stepp H, Tonn JC. Fluoresecence-guided resections of malignant gliomas – an overview. Acta Neurochir Suppl. 2003; 88: 9-12.
16 Tonn JC. Microneurosurgery and radiosurgery-- an attractive combination. Acta Neurochir Suppl. 2004; 91: 103-8.
17 Trantakis C, Tittgemeyer M, Schneider JP, Lindner D, Winkler D, Strauss G, Meixensberger J. Investigation of time-dependency of intracranial brain shift and its relation to the extent of tumor removal using intra-operative MRI. Neurol Res. 2003; 25: 9-12.
18 Westphal M, Schlegel U, Weller M. (Hrsg) Neuroonkologie. Stuttgart: Georg Thieme Verlag; 2003
19 Wowra B, Muacevic A, Jess-Hempen A, Hempel JM, Muller-Schunk S, Tonn JC. Outpatient gamma knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience. J Neurosurg 2005; 102: 114-8.
20 Woydt M, Krone A, Becker G, Schmidt K, Roggendorf W, Roosen K. Correlation of intra-operative ultrasound with histopathologic findings after tumour resection in supratentorial gliomas. A method to improve gross total tumour resection. Acta Neurochir (Wien) 1996; 138: 1391-8.
21 Woydt M, Vince GH, Krauss J, Krone A, Soerensen N, Roosen K. New ultrasound techniques and their application in neurosurgical intra-operative sonography. Neurol Res. 2001; 23: 697-705.