Surgical Treatment of the Septuagenarian Patients Suffering From Brain Metastases: A Large Retrospective Observational Analytic Cohort-Comparison Study.

BACKGROUND: The benefits associated to the surgical treatment of brain metastases (BMs) in elderly patients has been extensively debated due to their higher biological fragility, but we still miss a "threshold." The aim of this study is to evaluate their outcomes by a systematic comparison with a cohort of the youngest patients of our series of BMs. METHODS: The surgical, radiologic, and oncologic outcomes of patients suffering from BM have been retrospectively reviewed for the present study. The patients have been subsequently assigned, according to their age in 2 groups: group A (<45 years old) and group B (>70 years old). Patient, surgery, and lesion-related data were recorded to identify the relationships with the following outcome variables: postoperative Karnofsky performance status, complications, and accessibility to adjuvant treatment. RESULTS: The final cohort consisted of 309 patients, 201 men (65.2%) and 108 women (34.8%); average age was 39.1 ± 3.4 years for group A and 74.8 ± 2.9 years for group B. Expected survival was 6.15 ± 2.18 months for group A and 5.01 ± 2.43 months for group B. The statistical analysis disclosed no significant difference between the 2 groups, in term of postoperative Karnofsky performance status and the incidence of complications. Important, the accessibility to adjuvant treatment was not different between the 2 groups. CONCLUSIONS: The surgical treatment of BM in the septuagenarian patients is safe and effective. It increases the chances of long-term survival by preserving the functional and neurological status and leaving intact the accessibility to adjuvant treatments, similarly to what happens in the younger patients.

Massive Lumbar Disk Herniation Following "Therapeutic" Water Boiling of the Lower Extremities: Case Report and Literature Review.

BACKGROUND: Legs burning for treating lumbar radicular pain are still in use nowadays in low socioeconomical environments. They are dangerous as the case we report shows clearly. CLINICAL CASE: A 49-year-old man came to our attention with severe flaccid paraparesis occurred 10 days before, almost immediately after he had immersed his legs in boiling water to treat his severe left lumbocrural pain. This was known to be due to a right L3/4 herniated disk diagnosed by magnetic resonance imaging. At the examination he showed severe motor paresis and absent reflexes of his lower limbs, while crural pain was mild and sensation and urinary function were unaffected. The results of his neurologic examination led us to suspect an acute motor axon degeneration related to thermal shock. Lumbar magnetic resonance imaging, performed before the planned electromyogram as an exception to the established routine, showed instead a giant 5- × 5.5-cm, herniated disk compressing the dural sac at L3. CONCLUSIONS: Prompt surgical decompression led to rapid improvement. We discuss here the pathophysiology of this unusual case and point out how medieval practices for treating sciatica-like pain are not only unjustified from a medical viewpoint but also potentially dangerous.