Background: Due to the limited number of clinical series and the lack of multi-institutional or national registries concerning retroperitoneal sarcoma (RPS) extending to major arterio-venous structures, the short and ...Background: Due to the limited number of clinical series and the lack of multi-institutional or national registries concerning retroperitoneal sarcoma (RPS) extending to major arterio-venous structures, the short and long-term benefits following concomitant resection of these major structures are still antagonistic. Objective: To present our institutional experience with RPS tumors, to assess their vascular involvement and to analyze the outcomes of onco-vascular approach. Patients and methods: A retrospective review of our institutional RPS patients’ clinical charts was performed. All consecutive adult patients surgically treated for RPS were included. Resection of RPS tumors was followed by histopathological examination for grading. Types of vascular involvement were assessed preoperatively. RPS tumors were resected en bloc together with blood vessels according to the type of vascular involvement and the surgical standards. Results: This study included 14 patients;8 males (57%) and 6 females (43%) with RPS. Vascular resection was performed in all patients. Adherent structures were resected in 43%. Resection was performed for 29% RPSs with arterial venous involvement, 14% with only arterial involvement, and 57% with only venous involvement. All RPSs were classified as high-grade lesions, and 64% showed secondarily major vessels involvement. 43% of patients were treated by arterial resection. 80% had venous involvement. Venous resections were followed by venous reconstruction in all patients with both arterial and venous involvement. The morbidity rate was 43% while the mortality rate was 7%. Conclusion: Complete resection with clear margins is important for long-term survival in patients with retroperitoneal soft tissue sarcomas.展开更多
A better comprehension of the superficial white matter organization is important in order to minimize potential and avoidable damage to long or intermediate association fibre bundles during every step of a surgical ap...A better comprehension of the superficial white matter organization is important in order to minimize potential and avoidable damage to long or intermediate association fibre bundles during every step of a surgical approach.We recently proposed a technique for cadaver specimen preparation,which seems able to identify a more systematic organization of the superficial white matter terminations.Moreover,the use of the physiological intracranial vascular network for the fixation process allowed us to constantly show main vascular landmarks associated with white matter structures.Hence three examples of standard approaches to eloquent areas are herein reanalyzed starting from the first superficial layer.New insights into the possible surgical trajectories and subsequent quantitative damages of both vessels and white matter fibres can help readapt even the most standard and widely accepted approach trough the brain cortex.A more detailed study of these fine anatomical details may become in the near future a fundamental part of the neurosurgical training and the preoperative planning.展开更多
Oral and maxillofacial hemangioma and vascular malformations account for 60% of all the lesions in the body and are still great challenges for clinicians because of their unknown etiology and difficulties in managemen...Oral and maxillofacial hemangioma and vascular malformations account for 60% of all the lesions in the body and are still great challenges for clinicians because of their unknown etiology and difficulties in management. Successful therapy of these lesions now requires cooperative or multidisciplinary approaches including surgical procedure, embolization through interventional radiology, sclerosing therapy, laser therapy,psychological support, and others. Different treatment modalities are mandatory for different primary sites, clinical types and stages. This paper summarized current comprehensive and sequential approaches to the management of oral and maxillofacial hemangioma and vascular anomalies based on the authors’ experiences and relevant literatures, emphasizing the importance of multidisciplinary approaches. Hopefully, with the unraveling of the causative factors of vascular anomalies, more effective and specific treatment will emerge for management of these lesions.展开更多
文摘Background: Due to the limited number of clinical series and the lack of multi-institutional or national registries concerning retroperitoneal sarcoma (RPS) extending to major arterio-venous structures, the short and long-term benefits following concomitant resection of these major structures are still antagonistic. Objective: To present our institutional experience with RPS tumors, to assess their vascular involvement and to analyze the outcomes of onco-vascular approach. Patients and methods: A retrospective review of our institutional RPS patients’ clinical charts was performed. All consecutive adult patients surgically treated for RPS were included. Resection of RPS tumors was followed by histopathological examination for grading. Types of vascular involvement were assessed preoperatively. RPS tumors were resected en bloc together with blood vessels according to the type of vascular involvement and the surgical standards. Results: This study included 14 patients;8 males (57%) and 6 females (43%) with RPS. Vascular resection was performed in all patients. Adherent structures were resected in 43%. Resection was performed for 29% RPSs with arterial venous involvement, 14% with only arterial involvement, and 57% with only venous involvement. All RPSs were classified as high-grade lesions, and 64% showed secondarily major vessels involvement. 43% of patients were treated by arterial resection. 80% had venous involvement. Venous resections were followed by venous reconstruction in all patients with both arterial and venous involvement. The morbidity rate was 43% while the mortality rate was 7%. Conclusion: Complete resection with clear margins is important for long-term survival in patients with retroperitoneal soft tissue sarcomas.
文摘A better comprehension of the superficial white matter organization is important in order to minimize potential and avoidable damage to long or intermediate association fibre bundles during every step of a surgical approach.We recently proposed a technique for cadaver specimen preparation,which seems able to identify a more systematic organization of the superficial white matter terminations.Moreover,the use of the physiological intracranial vascular network for the fixation process allowed us to constantly show main vascular landmarks associated with white matter structures.Hence three examples of standard approaches to eloquent areas are herein reanalyzed starting from the first superficial layer.New insights into the possible surgical trajectories and subsequent quantitative damages of both vessels and white matter fibres can help readapt even the most standard and widely accepted approach trough the brain cortex.A more detailed study of these fine anatomical details may become in the near future a fundamental part of the neurosurgical training and the preoperative planning.
文摘Oral and maxillofacial hemangioma and vascular malformations account for 60% of all the lesions in the body and are still great challenges for clinicians because of their unknown etiology and difficulties in management. Successful therapy of these lesions now requires cooperative or multidisciplinary approaches including surgical procedure, embolization through interventional radiology, sclerosing therapy, laser therapy,psychological support, and others. Different treatment modalities are mandatory for different primary sites, clinical types and stages. This paper summarized current comprehensive and sequential approaches to the management of oral and maxillofacial hemangioma and vascular anomalies based on the authors’ experiences and relevant literatures, emphasizing the importance of multidisciplinary approaches. Hopefully, with the unraveling of the causative factors of vascular anomalies, more effective and specific treatment will emerge for management of these lesions.
