Methods: A clinical prospective study was conducted on 94 cases with skull base lesion that were treated in Neuroscience Hospital in Baghdad, Iraq between October 2011 and December 2016. We followed each patient for an average of 2 years after surgery to determine most common lesion involving the skull base, age and gender distribution, surgical outcome, complications and hospital accommodation. Freeze system of Storz all the cases in the study. Result:The majority of our patients were between the ages of 20-29 years. Among the 94 patients, 67% had macro adenomas, followed by craniopharyngioma 11%. The mortality rate was 2.1%, Gross total removal was 57.4%. All patients show improvement of the headache after surgery, visual improvement was noticed in 73.4% and hospital accommodation was 2-5 days. Three patients developed cerebrospinal fluid leak, Infection meningitis developed in 3 patients 3.1%, and 2 patients )2.1%( suffered from hormonal disorders and were referred to endocrinologist for therapy. Diabetes insipidus developed as a temporary complication in 4 cases )4.2%(. Conclusion:Trassphenoidal surgery is relatively safe surgery for properly selected patients.
Patients presented with spinal metastases from unknown primary tumours are rare. In this research we evaluated all patients with metastatic spinal tumour of unknown primary tumour, all patients were evaluated pre-operatively and comparison was done to those patients who had known primary tumour the study aimed to compare the group with known primary and the group with the unknown primary regarding the: mean age, gender, duration of symptoms, complication rate, region of the spine affected by metastasis, presence or absence of other skeletal or visceral metastasis, histological cell type and neurological outcome. Method: A retrospective study was performed on 40 patients presented to Neuroscience hospital in Baghdad from January 2010 till January 2014; all patients with metastatic spinal tumour were included in our study. We reviewed all patients' records including age, sex, primary tumour, duration of their symptoms, neurological out come and complications. Results: Out of the 40 patient who presented with spinal tumours that underwent surgery duo to metastatic spinal tumour, five patients presented with spinal compression duo to metastatic tumour of unknown primary tumour (12.5%). The mean age was 64 years, 4 male and one female. For those with a known primary tumour mean age was 61 year, 22 male 13 female. Duration of symptoms prior to surgery was the same 180 days for those with unknown primary and 190 day for those with known primary tumours. They also had similar neurological outcome (80%) remain the same or improved post operatively for those with unknown primary and (85.7%) for those with a known primary tumour, and a similar complication rate for unknown primary was 25% versus 28% for known. The primary site of metastatic spinal tumour of unknown primary was confirmed after histopathology all shown adenocarcinoma four from the lung (80%) and one from colorectal. While the most common known carcinoma site were the lung 18 patient (51.4%), colorectal 8 (22.8%), breast 7 (20%), and renal 2 (5.71%). All patient who complain from secondary spinal metastasis with unknown primary tumour didn't show any other * Corresponding author. W. J. Sagban et al. 19 skeletal or visceral metastasis, while those with a known primary tumour 6 patient out of 35 (17.1%) shown involvement of other site, the indication of surgery was to remove cord compression and restore neurological deficit. The most common site for metastasis was the dorsal spine for those of an unknown primary tumour 4 out of 5 patients (80%), and for those of a known primary tumour it was the lumbar area 28 out of 35 patient (80%). In conclusion metastatic spinal tumour of unknown primary was a common condition; it has similar demographic features, complications, and neurologic sequel with the spinal metastasis of known primary. Adenocarcinoma of the lung is the most common primary tumour proved after histopathology for spinal metastasis of unknown primary.
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