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Re: An Institution Par Excellence: Prof. B. Ramamurthi 1922–2003. Surg Neurol 2004;61:511–14
Readers’ Comment
RE: An Institution Par Excellence: Prof. B. Ramamurthi 1922–2003. Surg Neurol 2004;61: 511–14. To the Editor: As soon as I opened the June issue of Surgical Neurology I was really stunned. I realized that my very good friend and companion-in-arms was no more. I knew Ram, as we used to call him intimately, while I was in training in Montreal. He was a great person and an excellent friend. He was one of the founders of the Middle East Neurosurgical Society and became its President in 1967. I feel that the caption on the cover did not give him all his due. I felt that it should have read, “A tribute to a great man who was also a great neurosurgeon.” Your editorial is so well written and conveys the feeling of everyone who knew him. He, Chandy, and Ram Ginde were the Founders of Neurosurgery in the subcontinent. I would like to pay my last tribute to Professor Ramamurthi, an exceptional person who gave so much to his country and to the world of Neurosurgery. My deepest heartfelt condolences go to his wife, Indira, his two sons, and to the family of Surgical Neurology. Fuad S. Haddad, M.D. Department of Neurosurgery American University of Beirut Beirut, Lebanon doi:10.1016/j.surneu.2004.06.009
RE: Surgical Management of Brachial Plexus Region Tumors. Surg Neurol 2004;61:372– 8. To the Editor: We read with great interest the article published in the April issue from 2004. Huang et al described their strategy in the management of brachial plexus tumors, discussed their results concerning the tumor pathology, and reviewed the results achieved by other authors. The most common tumor pathology found by the authors was benign nerve sheath tumors (20 from 44 cases). Among these patients, 55% had neurofibroma and 45% had schwannoma. Fifty-four percent of the patients with neurofibromas had von Recklinghausen’s disease. 0090-3019/04/$–see front matter
In this series of 20 surgically treated benign nerve sheath tumors, 27% of the patients with neurofibromas experienced a decrease in the motor function after the surgery, while among the patients with schwannomas, 78% had unchanged or improved motor function postoperatively. Unfortunately, the surgical strategy and the treatment results were not presented separately concerning the presence or abscence of neurofibromatosis. We agree in part with the authors regarding several operative strategy aspects, including that “complete surgical resection is the goal for treating most benign brachial plexus region tumors.” However, we do not think that this philosophy should also be applied to patients with neurofibromatosis. For several years, we have treated and followed a few hundred patients suffering from neurofibromatosis 1 or 2. We have learned that these patients will experience little or no benefit from radical surgery in the management of plexal and peripheral nerve benign tumors. Neurofibromatosis patients present multiple lesions, and subsequent radical resections of intracranial, spinal, plexal, and peripheral nerve lesions may lead to an unavoidable mutilation of the patient’s neurologic function. As cited by the authors, other series showed 60% of decrease of the motor function after the resection of brachial plexus neurofibromas in patients with von Recklinghausen’s disease [1]. Therefore, our philosophy is that the strategy of tumor resection is in some aspects different in the presence of such disease [2]. After an initial intratumoral debulking, the tumor is held with a tumor forceps, and its capsule is pushed out toward the nervous structures. Thus, a thin capsule is left adherent to the nerves and fascicles, and the neurologic function will be more likely preserved. Although this technique is easier to be performed in schwannomas than in neurofibromas, low morbidity can be achieved in both cases using this meticulous microsurgical technique. Patients’ quality of life rather than unconditional tumor resection has priority in neurofibromatosis therapy. In summary, we think that a fundamental point to minimize the neurologic deficits from brachial plexus tumor surgery is to adopt different strategies of tumor resection in treating patients with and without neurofibromatosis. © 2004 Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010 –1710
RE: An Institution Par Excellence: Prof. B. Ramamurthi 1922–2003. Surg Neurol 2004;61: 511–14. To the Editor: As soon as I opened the June issue of Surgical Neurology I was really stunned. I realized that my very good friend and companion-in-arms was no more. I knew Ram, as we used to call him intimately, while I was in training in Montreal. He was a great person and an excellent friend. He was one of the founders of the Middle East Neurosurgical Society and became its President in 1967. I feel that the caption on the cover did not give him all his due. I felt that it should have read, “A tribute to a great man who was also a great neurosurgeon.” Your editorial is so well written and conveys the feeling of everyone who knew him. He, Chandy, and Ram Ginde were the Founders of Neurosurgery in the subcontinent. I would like to pay my last tribute to Professor Ramamurthi, an exceptional person who gave so much to his country and to the world of Neurosurgery. My deepest heartfelt condolences go to his wife, Indira, his two sons, and to the family of Surgical Neurology. Fuad S. Haddad, M.D. Department of Neurosurgery American University of Beirut Beirut, Lebanon doi:10.1016/j.surneu.2004.06.009
RE: Surgical Management of Brachial Plexus Region Tumors. Surg Neurol 2004;61:372– 8. To the Editor: We read with great interest the article published in the April issue from 2004. Huang et al described their strategy in the management of brachial plexus tumors, discussed their results concerning the tumor pathology, and reviewed the results achieved by other authors. The most common tumor pathology found by the authors was benign nerve sheath tumors (20 from 44 cases). Among these patients, 55% had neurofibroma and 45% had schwannoma. Fifty-four percent of the patients with neurofibromas had von Recklinghausen’s disease. 0090-3019/04/$–see front matter
In this series of 20 surgically treated benign nerve sheath tumors, 27% of the patients with neurofibromas experienced a decrease in the motor function after the surgery, while among the patients with schwannomas, 78% had unchanged or improved motor function postoperatively. Unfortunately, the surgical strategy and the treatment results were not presented separately concerning the presence or abscence of neurofibromatosis. We agree in part with the authors regarding several operative strategy aspects, including that “complete surgical resection is the goal for treating most benign brachial plexus region tumors.” However, we do not think that this philosophy should also be applied to patients with neurofibromatosis. For several years, we have treated and followed a few hundred patients suffering from neurofibromatosis 1 or 2. We have learned that these patients will experience little or no benefit from radical surgery in the management of plexal and peripheral nerve benign tumors. Neurofibromatosis patients present multiple lesions, and subsequent radical resections of intracranial, spinal, plexal, and peripheral nerve lesions may lead to an unavoidable mutilation of the patient’s neurologic function. As cited by the authors, other series showed 60% of decrease of the motor function after the resection of brachial plexus neurofibromas in patients with von Recklinghausen’s disease [1]. Therefore, our philosophy is that the strategy of tumor resection is in some aspects different in the presence of such disease [2]. After an initial intratumoral debulking, the tumor is held with a tumor forceps, and its capsule is pushed out toward the nervous structures. Thus, a thin capsule is left adherent to the nerves and fascicles, and the neurologic function will be more likely preserved. Although this technique is easier to be performed in schwannomas than in neurofibromas, low morbidity can be achieved in both cases using this meticulous microsurgical technique. Patients’ quality of life rather than unconditional tumor resection has priority in neurofibromatosis therapy. In summary, we think that a fundamental point to minimize the neurologic deficits from brachial plexus tumor surgery is to adopt different strategies of tumor resection in treating patients with and without neurofibromatosis. © 2004 Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010 –1710