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patient did not develop a neurological deficit. The probe was allowed to warm to +25 C and then removed along with the thermocouples and frame, the wounds were closed. The patient was taken to the ICU and a plain CT scan was obtained 6 hours after the procedure to make sure that there was no hemorrhage. Since there was no additional edema the Decadron remained at 36 mg/day. The patient was transferred to the regular floor the following morning and discharged the second day after the procedure.
Repeat CT and MRI scans with and without contrast were performed as an outpatient at 1 week, 1 month and every 3 months for 1 year without signs of recurrence. No additional chemotherapy was given. The patient will continue to have follow up scans every 3 months. There was no additional neurologic deficit after 1 year.
Two additional patients have undergone the procedure, age 48 and 42, and are tumor free at 5 and 6 months post operative. Cryosurgery in young patients with good Karnovsky scores with recurrent GBM can increase survival time from the median non surgical rate of 31 weeks (2) without the 20% morbidity associated with reoperation (median survival 60 weeks (2)).
SUMMARY
As we journey into the future to look for new "cures" for terrible diseases we may turn to the past, to the ice age. This technology has been refined allowing more precision. The application of this old procedure carried many benefits that are only required at this moment in time i.e. reduced cost and reduced hospital length of stay in addition to increased patient safety and quality of life. Cryosurgery is not the answer to all of our questions but may help with our most feared ones.
BIBLIOGRAPHY
1 Ammirati M, Vick N, Liao Y, Mikhael M. Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastoma and anaplastic astrocytomas. Neurosurgery 1987;21:201-206.
2 Ammirati M, Galicich J, Arbit E, Liao Y. Reoperation in the treatment of recurrent intracranial malignant glioma. Neurosurgery 1987;21:607-614.
3 Carpeggiani C, Landisman C, Montaron M, Skinner J. Cryoblockade in limbic brain (amygdala) prevents or delays ventricular fibrillation after coronary artery occlusion in psychologically stressed pigs. Circulation Research 1992;70:600-606.
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