1
|
Lin TC, Uchino H, Ito M, Yamaguchi S, Ishi Y, Fujimura M. Moyamoya syndrome after proton beam therapy in a pediatric patient with a pineal germ cell tumor and a germline polymorphism in RNF213. Childs Nerv Syst 2024:10.1007/s00381-024-06576-5. [PMID: 39167199 DOI: 10.1007/s00381-024-06576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
The effects of RNF213, which leads to moyamoya disease susceptibility, on radiation-induced moyamoya syndrome (MMS) remain unknown. We report a case of MMS after proton beam therapy (PBT) was deployed to treat a brain tumor in a patient with an RNF213 polymorphism. An 8-year-old boy underwent whole ventricular and local PBT for a pineal germ cell tumor and was diagnosed with radiation-induced MMS 9 months later. He underwent right and left revascularization surgeries for cerebral hemodynamic compromise at 17- and 18-years of age, respectively. Genetic analysis revealed a heterozygous germline polymorphism RNF213 p.R4810K. This is the first report to suggest an association between RNF213 polymorphism and radiation-induced MMS.
Collapse
Affiliation(s)
- Ting-Chun Lin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Yukitomo Ishi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| |
Collapse
|
2
|
Oermann EK, Ding D, Yen CP, Starke RM, Bederson JB, Kondziolka D, Sheehan JP. Effect of Prior Embolization on Cerebral Arteriovenous Malformation Radiosurgery Outcomes: A Case-Control Study. Neurosurgery 2016; 77:406-17; discussion 417. [PMID: 25875580 DOI: 10.1227/neu.0000000000000772] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Embolization before stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations (AVM) has been shown to negatively affect obliteration rates, but its impact on the risks of radiosurgery-induced complications and latency period hemorrhage is poorly defined. OBJECTIVE To determine, in a case-control study, the effect of prior embolization on AVM SRS outcomes. METHODS We evaluated a database of AVM patients who underwent SRS. Propensity score analysis was used to match the case (embolized nidi) and control (nonembolized nidi) cohorts. AVM angioarchitectural complexity was defined as the sum of the number of major feeding arteries and draining veins to the nidus. Multivariate Cox proportional hazards regression analyses were performed on the overall study population to determine independent predictors of obliteration and radiation-induced changes. RESULTS The matching process yielded 242 patients in each cohort. The actuarial obliteration rates were significantly lower in the embolized (31%, 49% at 5, 10 years, respectively) compared with the nonembolized (48%, 64% at 5, 10 years, respectively) cohort (P = .003). In the multivariate analysis for obliteration, lower angioarchitectural complexity (P < .001) and radiologically evident radiation-induced changes (P = .016) were independent predictors, but embolization was not significant (P = .744). In the multivariate analysis for radiologic radiation-induced changes, lack of prior embolization (P = .009) and fewer draining veins (P = .011) were independent predictors. CONCLUSION The effect of prior embolization on AVM obliteration after SRS may be significantly confounded by nidus angioarchitectural complexity. Additionally, embolization could reduce the risk of radiation-induced changes. Thus, combined embolization and SRS may be warranted for appropriately selected nidi.
Collapse
Affiliation(s)
- Eric K Oermann
- *Mount Sinai Health System, Department of Neurosurgery, New York City, New York; ‡University of Virginia, Department of Neurosurgery, Charlottesville, Virginia; §New York University Langone Medical Center, Department of Neurosurgery, New York City, New York
| | | | | | | | | | | | | |
Collapse
|
3
|
Kashba SR, Patel NJ, Grace M, Lee VS, Raoufi-Rad N, Raj JVA, Duong TTH, Stoodley M. Angiographic, hemodynamic, and histological changes in an animal model of brain arteriovenous malformations treated with Gamma Knife radiosurgery. J Neurosurg 2015; 123:954-60. [PMID: 25884263 DOI: 10.3171/2014.10.jns1435] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Brain arteriovenous malformations (AVMs) are a major cause of stroke. Many AVMs are effectively obliterated by stereotactic radiosurgery, but such treatment for lesions larger than 3 cm is not as effective. Understanding the responses to radiosurgery may lead to new biological enhancements to this treatment modality. The aim of the present study was to investigate the hemodynamic, morphological, and histological effects of Gamma Knife surgery (GKS) in an animal model of brain AVM. METHODS An arteriovenous fistula was created by anastomosing the left external jugular vein to the side of the common carotid artery in 64 male Sprague-Dawley rats (weight 345 ± 8.8 g). Six weeks after AVM creation, 32 rats were treated with a single dose of GKS (20 Gy); 32 animals received sham radiation. Eight irradiated and 8 control animals were studied at each specified time point (1, 3, 6, and 12 weeks) for hemodynamic, morphological, and histological characterization. RESULTS Two AVMs showed partial angiographic obliteration at 6 weeks. Angiography revealed complete obliteration in 3 irradiated rats at 12 weeks. Blood flow in the ipsilateral proximal carotid artery (p < 0.001) and arterialized jugular vein (p < 0.05) was significantly lower in the irradiated group than in the control group. The arterialized vein's external diameter was significantly smaller in GKS-treated animals at 6 (p < 0.05) and 12 (p < 0.001) weeks. Histological changes included subendothelial cellular proliferation and luminal narrowing in GKS-treated animals. Neither luminal obliteration nor thrombus formation was identified at any of the time points in either irradiated or nonirradiated animals. CONCLUSIONS GKS produced morphological, angiographic, and histological changes in the model of AVM as early as 6 weeks after treatment. These results support the use of this model for studying methods to enhance radiation response in AVMs.
Collapse
Affiliation(s)
- Saleh R Kashba
- Australian School of Advanced Medicine, Macquarie University; and
| | - Nirav J Patel
- Australian School of Advanced Medicine, Macquarie University; and
| | - Michael Grace
- Genesis Cancer Care, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Vivienne S Lee
- Australian School of Advanced Medicine, Macquarie University; and
| | | | - Jude V Amal Raj
- Australian School of Advanced Medicine, Macquarie University; and
| | | | - Marcus Stoodley
- Australian School of Advanced Medicine, Macquarie University; and
| |
Collapse
|
4
|
Watanabe T, Nagamine H, Ishiuchi S. Progression of cerebellar chronic encapsulated expanding hematoma during late pregnancy after gamma knife radiosurgery for arteriovenous malformation. Surg Neurol Int 2015; 5:S575-9. [PMID: 25593781 PMCID: PMC4287896 DOI: 10.4103/2152-7806.148054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/04/2014] [Indexed: 12/02/2022] Open
Abstract
Background: The etiology and appropriate management strategy of chronic encapsulated expanding hematoma during pregnancy after gamma knife radiosurgery for arteriovenous malformation (AVM) remain unclear. Case Description: A 34-year-old female developed chronic encapsulated expanding hematoma during late pregnancy, after angiographic disappearance of cerebellar AVM following two courses of gamma knife radiosurgery. The present case implicates pregnancy as a potential promoter of growth and enlargement of chronic encapsulated expanding hematoma, which may become life-threatening and require surgical intervention. Conclusion: Immediate surgical management after delivery may be associated with a favorable outcome, so close follow-up management and patient education are very important in women planning pregnancy.
Collapse
Affiliation(s)
- Takashi Watanabe
- Department of Neurosurgery, Faculty of Clinical Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideki Nagamine
- Department of Neurosurgery, Faculty of Clinical Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shogo Ishiuchi
- Department of Neurosurgery, Faculty of Clinical Medicine, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
5
|
Wang C, Roberts KB, Bindra RS, Chiang VL, Yu JB. Delayed cerebral vasculopathy following cranial radiation therapy for pediatric tumors. Pediatr Neurol 2014; 50:549-56. [PMID: 24739378 DOI: 10.1016/j.pediatrneurol.2013.09.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/17/2013] [Accepted: 09/27/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radiation-induced cerebrovascular injury is a well-known phenomenon. We analyze reported cases of delayed radiation-induced cerebrovasculopathy that present as moyamoya syndrome and/or intracerebral hemorrhage and to statistically analyze the relationship between radiation dose and the interval period between radiation and the presentation of cerebrovasculopathy. METHODS Patients ages <21 years at the time of radiation were included in analysis. A review of previous publications yielded 77 cases of delayed radiation-induced cerebrovasculopathy consisting of 45 cases of moyamoya syndrome, 30 cases of intracerebral hemorrhage, and two cases of both. RESULTS The median age at radiation was 4.8 years, with a range of 0.5-20 years. Approximately, 75% of these patients received radiation at the age of <9 years. The median interval period for moyamoya cases was 3.3 years (range: 0.3-20; P < 0.001), whereas the median interval period from radiation to presentation for intracerebral hemorrhage cases was 7.5 years (range: 0.8-27). There was significant association between radiation dose and interval from radiation to moyamoya syndrome (P < 0.001), whereas for patients with intracerebral hemorrhage, the association was insignificant (P = 0.31). CONCLUSIONS Pediatric patients who presented with moyamoya generally presented earlier than those who presented with intracerebral hemorrhage, suggesting that moyamoya may be a factor that predisposes the patient to intracerebral hemorrhage. In patients who presented with moyamoya, there was a statistically significant correlation between increasing doses of radiation and shorter time from radiation to disease presentation.
Collapse
Affiliation(s)
| | - Kenneth B Roberts
- Yale School of Medicine, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Ranjit S Bindra
- Yale School of Medicine, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Veronica L Chiang
- Yale School of Medicine, New Haven, Connecticut; Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - James B Yu
- Yale School of Medicine, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
| |
Collapse
|
6
|
Lorenzoni J, David P, Levivier M. MR-based follow-up of the superior cerebellar artery after radiosurgery for trigeminal neuralgia. Clin Neurol Neurosurg 2011; 113:758-61. [DOI: 10.1016/j.clineuro.2011.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 07/04/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
|
7
|
van der Sanden B, Bräuer-Krisch E, Siegbahn EA, Ricard C, Vial JC, Laissue J. Tolerance of Arteries to Microplanar X-Ray Beams. Int J Radiat Oncol Biol Phys 2010; 77:1545-52. [DOI: 10.1016/j.ijrobp.2010.02.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 02/15/2010] [Accepted: 02/17/2010] [Indexed: 11/30/2022]
|
8
|
Achrol AS, Guzman R, Varga M, Adler JR, Steinberg GK, Chang SD. Pathogenesis and radiobiology of brain arteriovenous malformations: implications for risk stratification in natural history and posttreatment course. Neurosurg Focus 2009; 26:E9. [PMID: 19409010 DOI: 10.3171/2009.2.focus0926] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Brain arteriovenous malformations (BAVMs) are an important cause of intracerebral hemorrhage (ICH) in young adults. Biological predictors of future ICH risk are lacking, and controversy exists over previous studies of natural history risk among predominantly ruptured BAVM cohorts. Recent studies have suggested that the majority of BAVMs are now diagnosed as unruptured lesions, and that the risk according to natural history among these lesions may be less than previously assumed. In the first part of this review, the authors discuss available data on the natural history of BAVMs and highlight the need for future studies that aim to develop surrogate biomarkers of disease progression that accurately predict future risk of ICH in BAVMs. The etiology of BAVM remains unknown. Recent studies have suggested a role for genetic factors in the pathogenesis of sporadic BAVM, which is further supported by reports of familial occurrence of BAVM and association with known systemic genetic disorders (such as Osler-Weber-Rendu disease, Sturge-Weber disease, and Wyburn-Mason syndrome). Molecular characterization of BAVM tissue demonstrates a highly angiogenic milieu with evidence of increased endothelial cell turnover. Taken together with a number of reports of de novo BAVM formation, radiographic growth after initial BAVM diagnosis, and regrowth after successful treatment of BAVM, these findings challenge the long-held assumption that BAVMs are static lesions of congenital origin. In the second part of this review, the authors discuss available data on the origins of BAVM and offer insights into future investigations into genetics and endothelial progenitor cell involvement in the pathogenesis of BAVM. Current treatment options for BAVM focus on removal or obliteration of the lesion in an attempt to protect against future ICH risk, including microsurgical resection, endovascular embolization, and stereotactic radiosurgery (SRS). In the third part of this review, the authors discuss available data on SRS in BAVMs and highlight the need for future studies on the radiobiology of BAVMs, especially in regard to biomarker detection for tracking SRS response during the latency period. Insights from future investigations in BAVM may not only prove important for the development of novel therapies and relevant biomarkers for BAVM, but could also potentially benefit a variety of other disorders involving new vessel formation in the CNS, including stroke, tumors, moyamoya disease, and other cerebrovascular malformations.
Collapse
Affiliation(s)
- Achal S Achrol
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305-5487, USA
| | | | | | | | | | | |
Collapse
|
9
|
Karunanyaka A, Tu J, Watling A, Storer KP, Windsor A, Stoodley MA. Endothelial molecular changes in a rodent model of arteriovenous malformation. J Neurosurg 2008; 109:1165-72. [PMID: 19035737 DOI: 10.3171/jns.2008.109.12.1165] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The cellular and molecular processes underlying arteriovenous malformation (AVM) development and response to radiosurgery are largely unknown. An animal model mimicking the molecular properties of AVMs is required to examine these processses. This study was performed to determine whether the endothelial molecular changes in an animal model of arteriovenous fistula (AVF) are similar to those in human AVMs.
Methods
Arteriovenous fistulas were created in 18 Sprague–Dawley rats by end-to-side anastomosis of the left jugular vein to the common carotid artery creating a model “nidus” of arterialized branching veins that coalesce into a “draining vein” (sigmoid sinus). Six control animals underwent sham operations.
Results
After 1 or 3 days, or 1, 3, 6, or 12 weeks, fresh-frozen sections of the fistula, nidus vessels, and contralateral vessels were studied immunohistochemically for thrombomodulin, von Willebrand factor, E-selectin, P-selectin, and vascular endothelial growth factor.
Conclusions
The AVF model has a “nidus” with endothelial molecular changes similar to those observed in human AVMs, supporting its use as a model for studying the effects of radiosurgery on AVMs.
Collapse
Affiliation(s)
- Athula Karunanyaka
- 1Prince of Wales Medical Research Institute, University of New South Wales, Sydney; and
| | - Jian Tu
- 1Prince of Wales Medical Research Institute, University of New South Wales, Sydney; and
| | - Amy Watling
- 1Prince of Wales Medical Research Institute, University of New South Wales, Sydney; and
| | - Kingsley P. Storer
- 1Prince of Wales Medical Research Institute, University of New South Wales, Sydney; and
| | - Apsara Windsor
- 1Prince of Wales Medical Research Institute, University of New South Wales, Sydney; and
| | - Marcus A. Stoodley
- 1Prince of Wales Medical Research Institute, University of New South Wales, Sydney; and
- 2Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Lawton MT, Arnold CM, Kim YJ, Bogarin EA, Stewart CL, Wulfstat AA, Derugin N, Deen D, Young WL. RADIATION ARTERIOPATHY IN THE TRANSGENIC ARTERIOVENOUS FISTULA MODEL. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000313579.15666.8d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
11
|
Lawton MT, Arnold CM, Kim YJ, Bogarin EA, Stewart CL, Wulfstat AA, Derugin N, Deen D, Young WL. RADIATION ARTERIOPATHY IN THE TRANSGENIC ARTERIOVENOUS FISTULA MODEL. Neurosurgery 2008; 62:1129-38; discussion 138-9. [PMID: 18580811 DOI: 10.1227/01.neu.0000325875.82999.3c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michael T Lawton
- Department of Neurological Surgery, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, California 94143-0112, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Barami K, Grow A, Brem S, Dagnew E, Sloan AE. Vascular complications after radiosurgery for meningiomas. Neurosurg Focus 2007; 22:E9. [PMID: 17608362 DOI: 10.3171/foc.2007.22.3.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓During the past 25 years, radiosurgery has evolved as a primary treatment modality for certain meningiomas when resection would be associated with high patient morbidity. In addition, radiosurgery is now routinely used as an adjunctive therapy for residual or recurrent meningiomas after surgical removal. In this review the authors summarize the vascular complications that occur after radiosurgery for meningiomas as well as experimental study data that give insight into the pathogenesis of this complication. These data may be useful when discussing with patients the risk/benefit ratio of choosing among conservative management, radiosurgery, and surgery.
Collapse
Affiliation(s)
- Kaveh Barami
- Memorial Neuroscience Center, Memorial Hospital Jacksonville, Florida, USA.
| | | | | | | | | |
Collapse
|
13
|
Herynek V, Burian M, Jirák D, Liscák R, Námestková K, Hájek M, Syková E. Metabolite and diffusion changes in the rat brain after Leksell Gamma Knife irradiation. Magn Reson Med 2004; 52:397-402. [PMID: 15282823 DOI: 10.1002/mrm.20150] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our study describes the time course of necrotic damage to the rat brain resulting from Leksell Gamma Knife (LGK) irradiation at a dose that was previously considered to be subnecrotic. A lesion induced in the rat hippocampus by 35 Gy irradiation was monitored by MRI, MRS, and DW-MRI for 16 months. T2-weighted images revealed a large hyperintense area with an increased apparent diffusion coefficient of water (ADCw), which occurred 8 months after irradiation, accompanied by metabolic changes (increase of lactate (Lac) and choline (Cho), and decrease of creatine (Cr) and N-acetyl aspartate (NAA), as determined by MRS) that indicated an edema. In two animals, the hyperintensity persisted and a postnecrotic cavity connected to enlarged lateral ventricles developed. In the rest of the animals, the hyperintensity started to decrease 9 months post-irradiation (PI), revealing hypointense areas with a decreased ADCw. Histology confirmed the MRI data, showing either scar formation or the development of a postnecrotic cavity.
Collapse
Affiliation(s)
- Vít Herynek
- MR Unit, Radiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
14
|
DesRosiers C, Mendonca MS, Tyree C, Moskvin V, Bank M, Massaro L, Bigsby RM, Caperall-Grant A, Valluri S, Dynlacht JR, Timmerman R. Use of the Leksell Gamma Knife for localized small field lens irradiation in rodents. Technol Cancer Res Treat 2004; 2:449-54. [PMID: 14529310 DOI: 10.1177/153303460300200510] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For most basic radiobiological research applications involving irradiation of small animals, it is difficult to achieve the same high precision dose distribution realized with human radiotherapy. The precision for irradiations performed with standard radiotherapy equipment is +/-2 mm in each dimension, and is adequate for most human treatment applications. For small animals such as rodents, whose organs and tissue structures may be an order of magnitude smaller than those of humans, the corresponding precision required is closer to +/-0.2 mm, if comparisons or extrapolations are to be made to human data. The Leksell Gamma Knife is a high precision radiosurgery irradiator, with precision in each dimension not exceeding 0.5 mm, and overall precision of 0.7 mm. It has recently been utilized to treat ocular melanoma and induce targeted lesions in the brains of small animals. This paper describes the dosimetry and a technique for performing irradiation of a single rat eye and lens with the Gamma Knife while allowing the contralateral eye and lens of the same rat to serve as the "control". The dosimetry was performed with a phantom in vitro utilizing a pinpoint ion chamber and thermoluminescent dosimeters, and verified by Monte Carlo simulations. We found that the contralateral eye received less than 5% of the administered dose for a 15 Gy exposure to the targeted eye. In addition, after 15 Gy irradiation 15 out of 16 animals developed cataracts in the irradiated target eyes, while 0 out of 16 contralateral eyes developed cataracts over a 6-month period of observation. Experiments at 5 and 10 Gy also confirmed the lack of cataractogenesis in the contralateral eye. Our results validate the use of the Gamma Knife for cataract studies in rodents, and confirmed the precision and utility of the instrument as a small animal irradiator for translational radiobiology experiments.
Collapse
Affiliation(s)
- Colleen DesRosiers
- Departments of Radiation Oncology, Indiana University Schools of Medicine and Dentistry, Indianapolis, IN 46202, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Watanabe T, Saito N, Hirato J, Shimaguchi H, Fujimaki H, Sasaki T. Facial neuropathy due to axonal degeneration and microvasculitis following gamma knife surgery for vestibular schwannoma: a histological analysis. J Neurosurg 2003; 99:916-20. [PMID: 14609174 DOI: 10.3171/jns.2003.99.5.0916] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Complete facial palsy (House—Brackmann Grade VI) developed in a 63-year-old man with a vestibular schwannoma 25 months after he had undergone two gamma knife surgeries performed 33 months apart and involving a cumulative dose of 24 Gy directed to the tumor margin at the 50% isodose line. Magnetic resonance imaging demonstrated tumor enlargement with central nonenhancement, which initially had been recognized 21 months after the second radiosurgery. Microsurgery was performed to achieve total removal of the tumor. Histological and immunohistochemical examinations of the facial nerve specimen removed from the edge of the tumor revealed a loss of axons, proliferation of Schwann cells, and microvasculitis. In this case, microvasculitis and axonal degeneration were probably the major causes of the radiation-induced facial neuropathy.
Collapse
Affiliation(s)
- Takashi Watanabe
- Department of Neurosurgery, Gunma University School of Medicine, Maebashi, Gunma, Japan.
| | | | | | | | | | | |
Collapse
|
16
|
Lis˘c˘ák R, Vladyka V, Novotný J, Broz˘ek G, Námĕstková K, Mares˘ V, Herynek V, Jirák D, Hájek M, Syková E. Leksell gamma knife lesioning of the rat hippocampus: the relationship between radiation dose and functional and structural damage. J Neurosurg 2002. [DOI: 10.3171/jns.2002.97.supplement_5.0666] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The goals of the study were to determine at what dosage and after what interval impairment of hippocampal function occurs after Leksell gamma knife radiosurgery (GKS) of the rat hippocampus and to assess the associated structural changes.
Methods. Long—Evans rats were irradiated with maximum doses of 25, 50, 75, 100, and 150 Gy, and four 4-mm isocenters were used to cover the hippocampus bilaterally. The impairment of hippocampal function, which is associated with a loss of memory, was measured by testing the impairment of the rats' orientation in a Morris water maze. Changes in the irradiated tissue were measured using magnetic resonance imaging (Bruker 4.7/20 experimental spectrometer). The data were compared with histologically demonstrated changes.
Significantly higher incidences of edema, necrosis, and behavioral changes were observed following administration of doses higher than 50 Gy. No edema, necrosis, or behavioral changes were observed when doses were 25 Gy.
Conclusions. It would seem that rats can be used for experiments involving the induction of complex brain lesions by using four 4-mm isocenters. Testing retention memory for behavioral changes after bilateral GKS of the whole hippocampus proved insensitive; acquisition memory should be tested to assess functional changes of hippocampus. Significantly higher incidences of edema, necrosis, and behavioral changes were observed for doses higher than 50 Gy. There seems to be a therapeutic window during which doses may affect epilepsy without impairing the memory of the rat.
Collapse
|
17
|
Aoki S, Hayashi N, Abe O, Shirouzu I, Ishigame K, Okubo T, Nakagawa K, Ohtomo K, Araki T. Radiation-induced arteritis: thickened wall with prominent enhancement on cranial MR images report of five cases and comparison with 18 cases of Moyamoya disease. Radiology 2002; 223:683-8. [PMID: 12034935 DOI: 10.1148/radiol.2233010822] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate magnetic resonance (MR) imaging findings of radiation-induced cranial arteritis regarding arterial wall thickening and degree of enhancement, as well as to compare the findings with those of idiopathic moyamoya disease. MATERIALS AND METHODS We reviewed cerebral MR images in five patients with radiation-induced large cerebral arteritis. All patients had undergone irradiation 2-25 years prior to this study. Conventional nonenhanced MR, MR angiographic, and contrast material-enhanced MR images were evaluated. Special attention was paid to wall enhancement of the affected arteries (distal internal carotid artery). Wall enhancement was staged in three levels by two neuroradiologists. We also reviewed MR images in 18 patients with primary moyamoya disease for comparison and analyzed them statistically (Fisher exact test). RESULTS Wall thickening and prominent ring enhancement of the wall of the affected large cerebral arteries were observed in all (five of five) patients with radiation-induced arteritis. In contrast, wall thickening and prominent ring enhancement of the wall of the occluded arteries either were not seen (13 of 18 patients) or were faint (five of 18 patients) in patients with moyamoya disease. Contrast enhancement of the arterial walls in patients with radiation-induced arteritis was significantly more prominent than in patients with moyamoya disease (P =.003). CONCLUSION MR images of wall thickening and prominent ring enhancement of the wall of affected large cerebral arteries may be a diagnostic clue in differentiating radiation-induced arteritis from moyamoya disease.
Collapse
Affiliation(s)
- Shigeki Aoki
- Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyoku, Tokyo 113-8655, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Yang T, Wu SL, Liang JC, Rao ZR, Ju G. Time-dependent astroglial changes after gamma knife radiosurgery in the rat forebrain. Neurosurgery 2000; 47:407-15; discussion 415-6. [PMID: 10942014 DOI: 10.1097/00006123-200008000-00026] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Using an experimental rat model and a clinically relevant treatment dose, we performed gamma knife radiosurgery to define the hyperacute radiation effects in normal rat forebrain, the time dependence of the astrocytic reaction, and the participation of astrocytes in the healing process after single-dose gamma radiation injuries. METHODS Seventy-one rats underwent radiosurgical treatment (4-mm collimator) of the caudate-putamen nucleus (single-fraction maximal dose of 100 Gy) and were killed at times ranging from 3 hours to 90 days. Serial cryostat brain sections were processed with the immunohistochemical avidin-biotin complex technique, using anti-glial fibrillary acidic protein as the primary antibody (to identify astrocytes). RESULTS Vascular changes, including endothelial hyperplasia and vessel wall thickening, were identified as the earliest postradiation manifestations and continued throughout the observation period. Astrocytes reacted to the radiation injury with hyperplasia and hypertrophy. At earlier time points (3-24 h), proliferation was the predominant reaction. The expression of glial fibrillary acidic protein in the proliferating and hypertrophic astrocytes formed an initial peak in the adjacent corpus callosum 3 days after radiosurgery and peaked within the target site between 14 and 30 days. Astrocytic proliferation and hypertrophy were also observed in distant cortices (frontal, parietal, insular, and piriform cortices) and in the hippocampus. No necrosis was observed less than 30 days after irradiation. By Day 90, necrotic lesions with a mean diameter of 4 mm were identified, with glial scar at their peripheries. Astrocytic morphological features varied according to the distance from the necrosis. The irradiated side contained more glial fibrillary acidic protein-containing cells than did the nonirradiated contralateral side. CONCLUSION During the early phase after radiation, vasculopathy was the first morphological change and may serve as the initiating factor for subsequent changes. Reactive astrocytes appeared not only at the target site but also in the surrounding regions; the severity of injury was determined by the distance from the target.
Collapse
Affiliation(s)
- T Yang
- Department of Neuromorphology, Institute of Neurosciences, Fourth Military Medical University, Xi'an, People's Republic of China
| | | | | | | | | |
Collapse
|
19
|
O'Connor MM, Mayberg MR. Effects of radiation on cerebral vasculature: a review. Neurosurgery 2000; 46:138-49; discussion 150-1. [PMID: 10626944 DOI: 10.1093/neurosurgery/46.1.138] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Radiation therapy plays a critical role in the treatment of central nervous system neoplasms and cerebral arteriovenous malformations. The deleterious effects of radiation on cerebral arteries may be the primary limitation to these treatment methods, as radiation may cause a variety of cerebrovascular injuries and hemodynamic changes. Radiation-induced changes in the cerebral arterial wall are determined by a number of cellular processes in endothelium and smooth muscle cells that modulate differences in radiosensitivity and phenotypic expression. The histopathological findings in arterial radiation injury include vessel wall thickening, thrombosis, luminal occlusion, and occasional telangiectases. Mechanisms for radiation injury to blood vessels include phenotypic changes in normal vessel wall cells (especially endothelium) manifested by the expression or suppression of specific gene and protein products that affect cell cycle progression or cellular proliferation or demise via cytotoxic injury or apoptosis. This review describes the molecular and cellular events involved in the systemic and cerebral vascular response to radiation and the potential means by which these responses may be influenced to augment the therapeutic effects of radiation while minimizing the untoward consequences.
Collapse
Affiliation(s)
- M M O'Connor
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, USA
| | | |
Collapse
|
20
|
Münter MW, Karger CP, Reith W, Schneider HM, Peschke P, Debus J. Delayed vascular injury after single high-dose irradiation in the rat brain: histologic immunohistochemical, and angiographic studies. Radiology 1999; 212:475-82. [PMID: 10429706 DOI: 10.1148/radiology.212.2.r99au42475] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate structural and functional changes in rats after focal brain irradiation by using histologic, immunohistochemical, and angiographic methods. MATERIALS AND METHODS Sixty rats were irradiated stereotactically with photons from a 15-MeV linear accelerator. Two collimators and single doses ranging from 20 to 100 Gy were used to treat stereotactically defined areas of 3.7- and 4.7-mm cross section (80% isodose) in the right frontal lobe. The dose-response relationship for the end-point necrosis at 19 months revealed a mean tolerance dose (D50) of 34.2 Gy (standard errors: +4.1, -3.7 Gy). Histologic, immunohistochemical, and angiographic examinations were performed to evaluate delayed radiation effects. RESULTS All animals irradiated with 100 Gy developed radiation necrosis after 9 months. Microangiography and immunohistochemical fluorescence staining of the endothelial cells revealed dose-dependent vascular dilatation and rarefaction. Animals irradiated with 20-50 Gy showed no morphologic changes after 9 months. With irradiation of 30-50 Gy, histologic vascular changes that increased with dose were found after 19 months. At that time, no changes were detected after irradiation with 20 Gy with both field sizes and after irradiation with 30 Gy and the 2-mm collimator. Radiation-induced functional disturbances of the brain vasculature could be demonstrated by extravasation of contrast medium by using a microangiographic technique. CONCLUSION The observed effect had a definite dependence on dose, volume, and time after treatment.
Collapse
Affiliation(s)
- M W Münter
- Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Abstract
Before 1937, members of the Department of Surgery and Gynecology practiced emergency neurosurgery at the University of Virginia in the same fashion as in other hospitals in the United States. In 1937, Claude C. Coleman, Chairman of the Department of Neurosurgery at the Medical College of Virginia in Richmond, organized a Division of Neurosurgery as part of the Department of Surgery and Gynecology at the University of Virginia. He designated one of his staff members, John M. Meredith, as Neurosurgeon-in-charge. Dr. Coleman served as Clinical Professor of Neurological Surgery at the University of Virginia from 1937 to 1941, while also working in Richmond. This arrangement attracted increasing numbers of patients, leading to the formation of a separate department, under the direction of William Gayle Crutchfield, in 1941. In conjunction with Juan de Dios Martinez-Galindo, who joined the faculty in 1943, Dr. Crutchfield built and directed the neurosurgical training program until his retirement. In 1969, John A. Jane, Sr., became Professor and Chairman of the Department of Neurosurgery. Pursuing the Jeffersonian intent of attracting "... those of due degree of science and of talents for instruction," the Department has been enhanced by the arrival of Neal F. Kassell in 1984, Ladislau Steiner in 1987, Edward R. Laws, Jr., in 1992, Dheerendra Prasad in 1995, Gregory Helm in 1996, and Mark Shaffrey in 1997. Resident training has been a priority of the Department of Neurosurgery; many academic neurosurgeons were trained and practiced their specialty in the Department early in their careers. Sixty years after its foundation, the Department of Neurosurgery continues its commitment to patient care, research, and the "... instruction of those who come after us."
Collapse
Affiliation(s)
- G Lanzino
- Department of Neurosurgery, University of Virginia and Virginia Neurological Institute, Charlottesville, USA
| | | |
Collapse
|