By H. Penzholz (auth.), Prof. Dr. Wolfgang Piotrowski, Prof. Dr. Mario Brock, Priv.-Doz. Dr. Margareta Klinger (eds.)

Distribution rights for Japan: Nankodo Co., Ltd., Tokyo

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CNS Metastases Neurosurgery in the Aged

Distribution rights for Japan: Nankodo Co. , Ltd. , Tokyo

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Metastatic tumors of the brain, a follow-up study of 195 patients with neurosurgical considerations. J. Neurosurg. , 361-373 (f960) 27. Veronesi, I. : A randomized trial of adjuvant chemotherapy and immunotherapy in cutaneous melanoma. N. Engl. J. Med. 307, 913-916 (1982) 28. : Intracranial metastases and their neurosurgical treatment. J. Neurosurg. 23, 375-383 (1965) 29. : Bronchial malignant melanoma. J. Surg. Oncal. 15, 243-248 (1980) -30. : Melanoma of the central nervous system: Clinical course, diagnosis and results of surgical treatment.

The most frequent presenting symptom was backache, usually occurring close to the involved area of the vertebral column and of a different character. The patients described the pain partly a pricking or penetrating, but also due to simultaneous root irritation partly as an intercostal neuralgia or as a lumbar or cervical root irritation syndrome. These, at first glance, rather uncharacteristic symptoms carry the danger of incorrect or of very late diagnosis. The average duration of case history with reference to the individual symptoms can be seen in Table 1.

This prognosis is very unfavorable being hardly better than the prognosis of carcinoma metastases. Of the eight patients who survived six months, three were improved and five were unchanged or worse. Twelve months after operations only four patients were alive and of these only one showed improvement. Patients with malignant lymphomas already showed a different clinical picture before the operation. Only half of the patients had a marked hemiparesis, although all suffered from urinary incontinence.

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