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Buwaider A, Backlund EO, Almqvist P, Lippitz B, Fletcher-Sandersjöö A, Bartek J. 55-Year Follow-Up of the First Adult Patient With Craniopharyngioma Treated With Gamma Knife Radiosurgery. Neurosurgery 2024:00006123-990000000-01154. [PMID: 38690888 DOI: 10.1227/neu.0000000000002973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/03/2024] Open
Abstract
In May 1968, Lars Leksell and Erik-Olof Backlund achieved a pioneering breakthrough by performing the first Gamma Knife radiosurgery (GKRS) on a craniopharyngioma (CP). Today, more than 50 years later, this patient remains under continuous monitoring, providing the longest documented follow-up of a GKRS-treated CP. This case report provides a complete record of the patient's preoperative presentation, surgical assessment, GKRS, and an extensive long-term follow-up with multiple interventions. The investigation involved analysis of archived and digitalized patient records and radiological images. The patient was a 21-year-old female who presented with amenorrhea and low levels of gonadotropins. Pneumoencephalography showed a calcified 2 × 2.5 cm mass located in the suprasellar region, indicative of a CP. Subsequent stereotactic puncture confirmed a predominantly solid nature of the CP. Given the size and composition of the tumor, the surgical team opted for GKRS. Dose planning was performed manually, with coordinates determined using Leksell's stereotactic frame. The tumor was targeted with a total dose of 50 Gy using 179 beams of 60Co. Over the subsequent 55 years, the patient underwent radiological and clinical follow-ups. Throughout this period, 4 cystic tumor recurrences occurred and were managed by stereotactic puncture and Yttrium-90 instillation radiotherapy. The solid component remained stable without repeated GKRS. The patient suffered lateral quadrant anopsia and endocrinological deficits, necessitating pharmaceutical intervention. Despite these challenges, the patient is still living an active life at age 76 years. This case stands as historic evidence of long-term safety and efficacy of GKRS for CPs.
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Affiliation(s)
- Ali Buwaider
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik-Olof Backlund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Almqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Bodo Lippitz
- Interdisciplinary Centre for Radiosurgery (ICERA), Radiological Alliance, Hamburg, Germany
| | - Alexander Fletcher-Sandersjöö
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Bartek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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Niedermeyer S, Terpolilli NA, Nerlinger P, Weller J, Schmutzer-Sondergeld M, Quach S, Thon N. Efficacy and safety of cysto-ventricular catheter implantation for space-occupying cysts arising from glioma and brain metastasis: a retrospective study. Acta Neurochir (Wien) 2024; 166:36. [PMID: 38277007 PMCID: PMC10817835 DOI: 10.1007/s00701-024-05931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Cysto-ventricular catheters (CVC) have emerged as promising treatment option for cystic craniopharyngioma and arachnoid cysts, but their effectiveness in treating cysts originating from glioma or brain metastasis (BM) remains limited. This study aimed to analyze the efficacy of CVC in patients with glioma and BM as well as procedure-associated morbidity. METHODS This single-center retrospective study included all patients treated with CVC placement for acquired space-occupying cysts deriving from previously treated glioma or BMs between 1/2010 and 12/2021. RESULTS A total of 57 patients with a median age of 47 years (IQR 38-63) were identified. Focal neurological deficits were the predominant symptoms in 60% of patients (n = 34), followed by cephalgia in 14% (n = 8), and epileptic seizures in 21.1% (n = 12). Accurate CVC placement was achieved in all but one case requiring revision surgery due to malposition. Three months after CVC implantation, 70% of patients showed symptomatic improvement. Multivariate logistic regression analysis identified the development of space-occupying cysts later in the course of the disease (OR 1.014; p = 0.04) and a higher reduction of cyst-volume postoperatively (OR 1.055; p = 0.05) were significant predictors of postoperative symptomatic improvement following CVC placement. Local cyst recurrence was observed in three cases during follow-up MRI after an average time of 5 months (range 3-9 months). Further complications included secondary malresorptive hydrocephalus in three cases and meningeosis neoplastica in one patient. CONCLUSIONS Stereotactic implantation of CVC is an efficient treatment option for patients suffering from symptomatic space-occupying cysts from BMs or glioma, independently from their CNS WHO grade. However, a vigilant approach is crucial regarding potential complications and treatment failures.
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Affiliation(s)
- Sebastian Niedermeyer
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Nicole A Terpolilli
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Pia Nerlinger
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Schmutzer-Sondergeld
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Meißner AK, Dreher L, Jünger ST, Visser-Vandewalle V, Ruge MI, Rueß D. Frame-based stereotactic implantation of cystoventricular shunts for treating acquired intracerebral cysts. J Neurosurg 2022; 137:227-234. [PMID: 34767526 DOI: 10.3171/2021.7.jns211180] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The treatment of symptomatic, progressive or recurrent acquired intracerebral cysts is challenging, especially when they are localized in eloquent structures. In addition to resection, endoscopic fenestration, or stereotactic puncture, the implantation of a cystoventricular shunt by stereotactic guidance (SCVS) has been reported as a minimally invasive procedure; however, only scarce data are available regarding its feasibility and efficacy. Here, the authors evaluated the feasibility and efficacy of frame-based SCVS in patients with acquired intracranial cysts. METHODS In this single-center retrospective analysis, the authors included all patients with acquired intracerebral cysts treated by SCVS following a standardized prospective protocol between 2012 and 2020. They analyzed clinical symptoms, complications, and radiological outcome with regard to cyst volume reduction by 3D volumetry. RESULTS Thirty-four patients (17 females and 17 males; median age 44 years, range 5-77 years) were identified. The median initial cyst volume was 11.5 cm3 (range 1.6-71.6 cm3), and the mean follow-up was 20 months (range 1-82 months). At the last follow-up, 27 of 34 patients (79%) showed a cyst volume reduction of more than 50%. Initial symptoms improved or resolved in 74% (n = 25) and remained stable in 24% (n = 8). No permanent clinical deterioration after treatment was observed. The total complication rate was 5.9%, comprising transient neurological deterioration (n = 1) and ventriculitis (n = 1). There were no deaths. The overall recurrence rate was 11.8%. CONCLUSIONS In this study, SCVS proved to be a safe, minimally invasive, and effective treatment with reliable long-term volume reduction, resulting in clinical improvement and a minor complication rate.
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Affiliation(s)
- Anna-Katharina Meißner
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Lena Dreher
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Stephanie Theresa Jünger
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Veerle Visser-Vandewalle
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
| | - Maximilian I Ruge
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
- 3Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany
| | - Daniel Rueß
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
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Matsuda R, Morimoto T, Tamamoto T, Inooka N, Ochi T, Miyasaka T, Hontsu S, Yamaki K, Miura S, Takeshima Y, Tamura K, Yamada S, Nishimura F, Nakagawa I, Motoyama Y, Park YS, Hasegawa M, Nakase H. Salvage Surgical Resection after Linac-Based Stereotactic Radiosurgery for Newly Diagnosed Brain Metastasis. Curr Oncol 2021; 28:5255-5265. [PMID: 34940078 PMCID: PMC8699906 DOI: 10.3390/curroncol28060439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to assess the clinical outcomes of salvage surgical resection (SSR) after stereotactic radiosurgery and fractionated stereotactic radiotherapy (SRS/fSRT) for newly diagnosed brain metastasis. Methods: Between November 2009 and May 2020, 318 consecutive patients with 1114 brain metastases were treated with SRS/fSRT for newly diagnosed brain metastasis at our hospital. During this study period, 21 of 318 patients (6.6%) and 21 of 1114 brain metastases (1.9%) went on to receive SSR after SRS/fSRT. Three patients underwent multiple surgical resections. Twenty-one consecutive patients underwent twenty-four SSRs. Results: The median time from initial SRS/fSRT to SSR was 14 months (range: 2–96 months). The median follow-up after SSR was 17 months (range: 2–78 months). The range of tumor volume at initial SRS/fSRT was 0.12–21.46 cm3 (median: 1.02 cm3). Histopathological diagnosis after SSR was recurrence in 15 cases, and radiation necrosis (RN) or cyst formation in 6 cases. The time from SRS/fSRT to SSR was shorter in the recurrence than in the RNs and cyst formation, but these differences did not reach statistical significance (p = 0.067). The median survival time from SSR and from initial SRS/fSRT was 17 and 74 months, respectively. The cases with recurrence had a shorter survival time from initial SRS/fSRT than those without recurrence (p = 0.061). Conclusions: The patients treated with SRS/fSRT for brain metastasis need long-term follow-up. SSR is a safe and effective treatment for the recurrence, RN, and cyst formation after SRS/fSRT for brain metastasis.
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Affiliation(s)
- Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
- Correspondence: ; Tel.: +81-744-22-3051
| | - Takayuki Morimoto
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Tetsuro Tamamoto
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
- Department of Medical Informatics, Nara Medical University Hospital, Kashihara 634-8522, Japan
| | - Nobuyoshi Inooka
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Tomoko Ochi
- Department of Radiology, Nara Medical University Hospital, Kashihara 634-8522, Japan; (T.O.); (T.M.)
| | - Toshiteru Miyasaka
- Department of Radiology, Nara Medical University Hospital, Kashihara 634-8522, Japan; (T.O.); (T.M.)
| | - Shigeto Hontsu
- Department of Respiratory Medicine, Nara Medical University Hospital, Kashihara 634-8522, Japan;
| | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Sachiko Miura
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Masatoshi Hasegawa
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
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Tan AP, Yeo TT, Yong HRC, Karlsson B. Dynamic radiation-induced imaging changes more than 20 years following gamma knife surgery. Acta Neurochir (Wien) 2021; 163:1935-1939. [PMID: 33999264 DOI: 10.1007/s00701-021-04865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Gamma knife radiosurgery (GKS), a technique which involves delivery of a high dose of radiation to a precisely defined target, has become the predominant treatment option for brain metastases (BM) because of its high effectiveness and relatively minimal toxicity. Herein, we report a case of late-onset radiation-induced edema around an asymptomatic cyst, more than 20 years after salvage GKS, with 27 years of imaging follow-up, allowing the description of the evolutionary trajectory of these relatively rare complications. Our reported case also demonstrated the benign nature of delayed cyst formation (DCF), emphasizing that observation alone is reasonable for asymptomatic patients.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Imaging, National University Hospital, 1E Kent Ridge Rd, Singapore, 119228, Singapore.
- Singapore Institute for Clinical Sciences (SICS), A*STAR Research Entities (ARES), 30 Medical Dr, Singapore, 117609, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), 21 Lower Kent Ridge Road, Singapore, 119077, Singapore.
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, 1E Kent Ridge Rd, Singapore, 119228, Singapore
| | - Hsiang Rong Clement Yong
- Department of Diagnostic Imaging, National University Hospital, 1E Kent Ridge Rd, Singapore, 119228, Singapore
| | - Bengt Karlsson
- Division of Neurosurgery, Department of Surgery, National University Hospital, 1E Kent Ridge Rd, Singapore, 119228, Singapore
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Kahrom A, Grimley R, Jeffree RL. A case of delayed cyst formation post brain AVM stereotactic radiosurgery for arteriovenous malformation: Case report. J Clin Neurosci 2021; 87:17-19. [PMID: 33863526 DOI: 10.1016/j.jocn.2021.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/22/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
Arteriovenous malformations (AVMs) are a rare cause of cerebrovascular abnormality with incidence of about 1 in 100,000 people per year and point prevalence of about 0.2%. AVMs are associated with serious complications such as intracranial haemorrhage (2-4% a year, 16% and 29% at 10 and 20 years after diagnosis), seizures (10-30%), focal neurologic deficits, and headaches. The management options are surveillance, endovascular embolization, microsurgical excision and stereotactic radiosurgery (SRS). In SRS Stereotactically focused high energy beams of photons induce progressive thrombosis by fibro-intimal hyperplasia and subsequent luminal obliteration. These changes usually take one to three years known as "latency period". Complications are reported in 8% of patients undergoing SRS, including radiographic parenchymal lesions, cranial nerve deficits, seizures, headaches, and cyst formation. Cyst formation is reported in about 1.2 % of patients undergoing SRS. While the exact mechanism of post SRS cyst formation is unclear, it is hypothesized that it might be due to damage to the blood brain barrier and increased vessel wall permeability. Delayed cyst formation is reported with latency period between 3 and 10 years after radiotherapy for treatment of cerebrovascular AVMs. However, cystic formation with longer latency periods (in one case upto 17 years) after radiotherapy for other causes such as nasopharyngeal cancers have been reported. Here we report a case of delayed cyst formation after SRS for cerebrovascular AVM with latency period of 20 years.
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Affiliation(s)
- Arash Kahrom
- Princess Alexandra Hospital, Queensland, Australia.
| | - Rohan Grimley
- Sunshine Coast University Hospital, Queensland, Australia.
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Kosyrkova AV, Goryainov SA, Kravchuk AD, Golanov AV, Maryashev SA, Vetlova ER, Antipina NA, Pronin IN, Batalov AI, Zakharova NE, Potapov AA. [Multicystic transformation of the post-radiation necrosis zone of the brain. A case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2020; 84:72-82. [PMID: 32412196 DOI: 10.17116/neiro20208402172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Post-radiation cyst of the brain is a rare complication that often arises many years after irradiation for head and neck neoplasms. The majority of the articles devoted to this problem are small samples or case reports. Nevertheless, the overall number of these patients is steadily increasing. The feature of post-radiation cysts is gradual enlargement followed by general cerebral and focal symptoms and ineffectiveness of therapy. Some patients with clinically significant post-radiation cysts can require surgical treatment. Insertion of Ommaya reservoir may be preferred in these patients. In some cases, this method is ineffective and more complex surgeries may be required. The objectives of this report were to analyze literature data and describe the patient with multiple recurrent brain cysts after previous irradiation for frontotemporal skin melanoma. Twenty-seven publications were analyzed for the period from 1997 to 2018. According to the literature, the incidence of post-radiation cysts varies from 0.4% to 28%, timing of occurrence - from 2 months to 27 years. These values significantly depend on the underlying disease. We report a 27-year-old patient who admitted to the Burdenko Neurosurgery Center with focal and general cerebral symptoms after irradiation for skin melanoma of the right frontotemporal region. These symptoms were caused by cystic lesion of the right temporal and frontal lobes. Surgical treatment consisted in insertion of 2 Ommaya reservoirs. This approach ensured complete regression of the cyst in the right temporal lobe and mild decrease of the cyst in the right frontal lobe.
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Affiliation(s)
| | | | | | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - E R Vetlova
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A A Potapov
- Burdenko Neurosurgical Center, Moscow, Russia
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8
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Aiyama H, Yamamoto M, Kawabe T, Watanabe S, Koiso T, Sato Y, Higuchi Y, Ishikawa E, Yamamoto T, Matsumura A, Kasuya H. Clinical significance of conformity index and gradient index in patients undergoing stereotactic radiosurgery for a single metastatic tumor. J Neurosurg 2019; 129:103-110. [PMID: 30544326 DOI: 10.3171/2018.6.gks181314] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAlthough the conformity index (CI) and the gradient index (GI), which were proposed by Paddick and colleagues, are both logically considered to correlate with good posttreatment results after stereotactic radiosurgery (SRS), this hypothesis has not been confirmed clinically. The authors' aim was to reappraise whether high CI values correlate with reduced tumor progression rates, and whether low GI values correlate with reduced complication incidences.METHODSThis was an institutional review board-approved, retrospective cohort study conducted using a prospectively accumulated database including 3271 patients who underwent Gamma Knife SRS for brain metastases (BMs) during the 1998-2016 period. Among the 3271 patients, 925 with a single BM at the time of SRS (335 women and 590 men, mean age 66 [range 24-93] years) were studied. The mean/median CIs were 0.62/0.66 (interquartile range [IQR] 0.53-0.74, range 0.08-0.88) and the mean/median GIs were 3.20/3.09 (IQR 2.83-3.39, range 2.27-11.4).RESULTSSRS-related complications occurred in 38 patients (4.1%), with a median post-SRS interval of 11.5 (IQR 6.0-25.8, maximum 118.0) months. Cumulative incidences of post-SRS complications determined by a competing risk analysis were 2.2%, 3.2%, 3.6%, 3.8%, and 3.9% at the 12th, 24th, 36th, 48th, and 60th post-SRS month, respectively. Multivariable analyses showed that only two clinical factors (i.e., peripheral doses and brain volume receiving ≥ 12 Gy) correlated with complication rates. However, neither CIs nor GIs impacted the incidences of complications. Among the 925 patients, post-SRS MRI was performed at least once in 716 of them, who were thus eligible for local progression evaluation. Among these 716 patients, local progression was confirmed in 96 (13.4%), with a median post-SRS interval of 10.8 (IQR 6.7-19.5, maximum 59.8) months. Cumulative incidences of local progression determined by a competing risk analysis were 7.7%, 12.6%, 14.2%, 14.8%, and 15.3% at the 12th, 24th, 36th, 48th, and 60th post-SRS month, respectively. Multivariable analyses showed neurological symptoms, extracerebral metastases, repeat SRS, and CIs to correlate with incidences of local progression, whereas GIs had no impact on local tumor progression. Particularly, cumulative incidences of local progression were significantly lower in patients with CIs < 0.65 than in those with CIs ≥ 0.65 (adjusted hazard ratio 1.870, 95% confidence interval 1.299-2.843; p = 0.0034).CONCLUSIONSTo the authors' knowledge, this is the first analysis to focus on the clinical significance of CI and GI based on a large series of patients with BM. Contrary to the majority opinion that dose planning with higher CI and lower GI results in good post-SRS outcomes (i.e., low local progression rates and minimal complications), this study clearly showed that the lower the CIs were, the lower the local progression rates were, and that the GI did not impact complication rates.
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Affiliation(s)
- Hitoshi Aiyama
- 1Katsuta Hospital Mito GammaHouse, Hitachi-naka.,2Department of Neurosurgery, Faculty of Medicine, and
| | - Masaaki Yamamoto
- 1Katsuta Hospital Mito GammaHouse, Hitachi-naka.,4Department of Neurosurgery, Tokyo Women's Medical University, Medical Center East, Tokyo
| | - Takuya Kawabe
- 5Department of Neurosurgery, Rakusai Shimizu Hospital, Kyoto
| | - Shinya Watanabe
- 3Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba
| | - Takao Koiso
- 2Department of Neurosurgery, Faculty of Medicine, and
| | - Yasunori Sato
- 6Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo
| | - Yoshinori Higuchi
- 7Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba; and
| | | | - Tetsuya Yamamoto
- 8Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | | | - Hidetoshi Kasuya
- 4Department of Neurosurgery, Tokyo Women's Medical University, Medical Center East, Tokyo
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Carminucci A, Parr M, Bitar M, Danish SF. Delayed Onset Cyst Formation After Laser Interstitial Thermal Therapy: An Unreported Long-term Complication. World Neurosurg 2019; 124:219-223. [PMID: 30639484 DOI: 10.1016/j.wneu.2018.12.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022]
Abstract
The majority of complications following LITT therapy occur in the early post-operative period, with few long-term complications being reported. Here we present 2 cases of delayed onset cyst formation occurring more than 1 year following ablation, a previously unreported complication. In the first case, a 59 year-old female who previously underwent LITT for a radiation induced cavernoma developed a 2 cm cystic lesion 18 months following ablation, resulting in recurrent seizure. In the second case, 53 year-old female with a recurrent left frontal cerebral metastasis developed a large cystic lesion 30 months post ablation. Both patients required craniotomies and resection of their cystic lesions. In both cases pathology demonstrated reactive gliosis and blood vessel sclerosis. We hypothesize chronic gliosis following LITT therapy results in blood vessel sclerosis leading to blood-brain-barrier breakdown and resulting delayed cyst formation. These findings support need for long-term surveillance of patients treated with LITT.
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Affiliation(s)
- Arthur Carminucci
- Department of Neurological Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Matthew Parr
- Department of Neurological Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Mireille Bitar
- Department of Pathology, Rutgers-RWJMS, New Brunswick, NJ, USA
| | - Shabbar F Danish
- Department of Neurological Surgery, Rutgers University, New Brunswick, NJ, USA.
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Aizawa R, Uto M, Takehana K, Arakawa Y, Miyamoto S, Mizowaki T. Radiation-induced cystic brain necrosis developing 10 years after linac-based stereotactic radiosurgery for brain metastasis. Oxf Med Case Reports 2018; 2018:omy090. [PMID: 30364384 PMCID: PMC6194183 DOI: 10.1093/omcr/omy090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/09/2018] [Accepted: 08/20/2018] [Indexed: 12/30/2022] Open
Abstract
Cystic brain necrosis (CBN) is a rare form of BN. It typically occurs as a very late complication, and no standard treatment has been established. We report a case of a 59-year-old man who developed CBN 10 years after radiation therapy for metastatic brain tumors. The therapy consisted of whole brain radiotherapy followed by linac-based stereotactic radiosurgery as a boost. Initially, the CBN continued to expand despite treatment with corticosteroids and bevacizumab. Therefore, we resected the tumor and implanted an Ommaya reservoir, which successfully stabilized the lesion. Although the prognosis of patients with brain metastases is generally poor, some patients, like the one reported here, achieve long survival. Therefore, we should follow such cases carefully, considering the possibility of developing CBN as a late complication.
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Affiliation(s)
- Rihito Aizawa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiichi Takehana
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Aiyama H, Yamamoto M, Kawabe T, Watanabe S, Koiso T, Sato Y, Higuchi Y, Ishikawa E, Yamamoto T, Matsumura A, Kasuya H, Barfod BE. Complications after stereotactic radiosurgery for brain metastases: Incidences, correlating factors, treatments and outcomes. Radiother Oncol 2018; 129:364-369. [PMID: 30293644 DOI: 10.1016/j.radonc.2018.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. MATERIALS AND METHODS This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998-2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. RESULTS The overall median survival time after SRS was 7.8 (95% CI; 7.4-8.1) months. Post-SRS complications occurred in 86 patients (2.9%) 1.9-211.4 (median; 24.0, IQR; 12.0-64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4%, 2.2%, 2.4%, 2.6% and 2.9% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95% CI; 0.381-0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95% CI; 1.646-4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95% CI; 1.028-2.514, p = 0.0374), KPS ≥80% (Adjusted HR; 2.715, 95% CI; 1.245-5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95% CI; 0.318-0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. CONCLUSION The post-SRS complication incidence is acceptably low (2.9%). Meticulous long-term follow-up after SRS is crucial for all patients.
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Affiliation(s)
- Hitoshi Aiyama
- Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaaki Yamamoto
- Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan; Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
| | - Takuya Kawabe
- Department of Neurosurgery, Rakusai Shimizu Hospital, Kyoto, Japan
| | - Shinya Watanabe
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | - Takao Koiso
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Higuchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokoyama, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Alattar AA, Carroll K, Hirshman BR, Joshi RS, Sanghvi P, Chen CC. Cystic Formation After Stereotactic Radiosurgery of Brain Metastasis. World Neurosurg 2018; 114:e719-e728. [PMID: 29551723 DOI: 10.1016/j.wneu.2018.03.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limited information is available on the natural history and etiology of cystic formation after stereotactic radiosurgery (SRS) for brain metastases (BM). We aimed to characterize the natural history of cyst formation after SRS of BM and analyze potential risk factors. METHODS We retrospectively reviewed 214 consecutive patients who underwent a total of 1106 SRSs for BM. Demographic, clinical, dosimetric, and magnetic resonance imaging MRI data were reviewed. Statistical analysis was accomplished using Student's t test, and univariate and multivariate logistic regression. RESULTS The median patient age was 61 years (range, 19-91 years), and the median duration of follow-up was 424 days (range, 91-2934 days). Eleven cases of cyst formation (0.9% of 1106 treated lesions) were identified at SRS-treated BM sites among 9 patients (2 patients developed cysts at independent sites). The median interval between first SRS and first evidence of cyst was 218 days. Seven of the 9 patients (78%) sustained progressive cyst expansion and neurologic decline requiring steroid treatment. Four of these 7 patients (57%) experienced continued neurologic decline and needed surgical fenestration. On univariate analysis, receipt of >4 rounds of SRS was the sole variable associated with an increased risk of cyst formation (odds ratio, 16.58; P = 0.001). This association remained robust after adjusting for duration of follow-up (odds ratio, 13.59; P = 0.003). CONCLUSIONS In our experience with 1106 SRS-treated cases of BM, cyst formation was a rare phenomenon. However, 1 in 3 patients who underwent >4 rounds of SRS sustained cyst formation. A high proportion (78%) of SRS-associated cysts progressively expanded and required medical or surgical treatment.
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Affiliation(s)
- Ali A Alattar
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Kate Carroll
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Brian R Hirshman
- Division of Neurological Surgery, University of California San Diego, San Diego, California, USA; Computation, Organization, and Society Program, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Rushikesh S Joshi
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Shuto T, Matsunaga S. Two cases of cystic enlargement of vestibular schwannoma as a late complication following gamma knife surgery. J Clin Neurosci 2016; 33:239-241. [DOI: 10.1016/j.jocn.2016.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/08/2016] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE The goal of this study was to investigate the treatment results of Gamma Knife radiosurgery (GKRS) for cystic brain metastases and relevant factors associated with local tumor control. MATERIALS AND METHODS We retrospectively reviewed the clinical, radiological, and dosimetry data of 37 cystic brain metastases of 28 patients who were treated with GKRS. Cyst drainage was performed in 8 large lesions before GKRS to decrease the target volume. The mean target volume was 4.8 (range, 0.3-15.8) cc at the time of GKRS, and the mean prescription dose was 16.6 (range, 13-22) Gy. RESULTS The actuarial median survival time was 17.7 ± 10.2 months, and the primary tumor status was a significant prognostic factor for survival. The actuarial local tumor control rate at 6 and 12 months was 93.1 and 82.3%, respectively. Among the various factors, only prescription dose (>15 Gy) was a significant factor related to local tumor control after multivariate analysis (p = 0.049). Cyst volume or cyst/total tumor volume ratio did not influence local control after GKRS, when the target volume was reduced to about 15 cc after cyst drainage. CONCLUSION According to our results, we suggest that stereotactic radiosurgery should be considered as one of the treatment options for cystic brain metastases, when large tumor volume can be reduced by surgical drainage before radiosurgery, especially for patients with a controlled primary tumor.
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Affiliation(s)
- Sang Ryul Lee
- a Gamma Knife Center, Department of Neurosurgery , Ajou University School of Medicine , Suwon , Korea
| | - Ji Young Oh
- a Gamma Knife Center, Department of Neurosurgery , Ajou University School of Medicine , Suwon , Korea
| | - Se-Hyuk Kim
- a Gamma Knife Center, Department of Neurosurgery , Ajou University School of Medicine , Suwon , Korea
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Ohtakara K, Hoshi H. Cerebral cyst formation following stereotactic ablative irradiation for non-nasopharyngeal head and neck malignancies: imaging findings and relevant dosimetric parameters. Br J Radiol 2014; 87:20140071. [PMID: 24766501 DOI: 10.1259/bjr.20140071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe the clinical characteristics, imaging findings and relevant dosimetric parameters of cases presenting with cerebral cyst formation (CCF) after single or oligo-fractionated stereotactic radiotherapy (SRT) for non-nasopharyngeal head and neck malignancies (HNMs). METHODS We identified four cases with the follow-up duration of 5.7-9.1 years from SRT. The irradiated sites included the middle ear in one case and the ethmoid sinus in three cases, two of the latter possessed brain invasion. The chronological changes in MR images and the dose-volume histogram of the adjacent brain tissue were evaluated. RESULTS CCF with or without multiple septi presented with a latency of 29-86 months (median, 45.5 months), which was preceded by either non-specific parenchymal enhancement or typical radiation necrosis. In three cases, CCF adjacent to the frontal base resultantly caused mass effect, and two of these three cases required surgical intervention at 38 and 54 months, respectively, after SRT for alleviation of symptoms. The relation of the irradiated brain volumes to the biological equivalent dose based on the linear-quadratic (LQ) and LQ-cubic models was represented as a threshold. CONCLUSION When contemplating SRT for HNM cases, caution should be exercised to the dose-volume relation-ship of the adjacent brain tissue, especially the frontal base, as well as other critical structures, and long-term vigilant follow-up is also mandatory. ADVANCES IN KNOWLEDGE CCF can occur as an unusual consequence of late brain injury with variable but mostly long latency following SRT for non-nasopharyngeal HNMs adjacent to the brain, even superficial parts that were previously irradiated via conventional radiotherapy.
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Affiliation(s)
- K Ohtakara
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
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Ujifuku K, Matsuo T, Toyoda K, Baba S, Okunaga T, Hayashi Y, Kamada K, Morikawa M, Suyama K, Nagata I, Hayashi N. Repeated delayed onset cerebellar radiation injuries after linear accelerator-based stereotactic radiosurgery for vestibular schwannoma: case report. Neurol Med Chir (Tokyo) 2013; 52:933-6. [PMID: 23269054 DOI: 10.2176/nmc.52.933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 63-year-old woman presented with right hearing disturbance and vertigo. Magnetic resonance (MR) imaging revealed the presence of right vestibular schwannoma (VS). Stereotactic radiosurgery (SRS) was performed with a tumor marginal dose of 14 Gy using two isocenters. She was followed up clinically and neuroradiologically using three-dimensional spoiled gradient-echo MR imaging. She experienced temporal neurological deterioration due to peritumoral edema in her right cerebellar peduncle and pons for a few months beginning 1.5 years after SRS, when she experienced transient right facial dysesthesia and hearing deterioration. Ten years after SRS, the patient presented with sudden onset of vertigo, gait disturbance, diplopia, dysarthria, and nausea. MR imaging demonstrated a new lesion in the right cerebellar peduncle, which was diagnosed as radiation-induced stroke. The patient was followed up conservatively and her symptoms disappeared within a few months. Multiple delayed onset radiation injuries are possible sequelae of SRS for VS.
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Affiliation(s)
- Kenta Ujifuku
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki
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Nakazaki K, Kano H. Evaluation of mini-mental status examination score after gamma knife radiosurgery as the first radiation treatment for brain metastases. J Neurooncol 2013; 112:421-5. [DOI: 10.1007/s11060-013-1071-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
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Yamamoto M, Kawabe T, Higuchi Y, Sato Y, Nariai T, Barfod BE, Kasuya H, Urakawa Y. Delayed Complications in Patients Surviving at Least 3 Years After Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2013; 85:53-60. [PMID: 22652110 DOI: 10.1016/j.ijrobp.2012.04.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 11/16/2022]
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Murakami K, Jokura H, Kawagishi J, Watanabe M, Tominaga T. Development of intratumoral cyst or extratumoral arachnoid cyst in intracranial schwannomas following gamma knife radiosurgery. Acta Neurochir (Wien) 2011; 153:1201-9. [PMID: 21369949 DOI: 10.1007/s00701-011-0972-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 02/09/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Intracranial schwannomas presenting with cyst formation following gamma knife radiosurgery (GKRS) were investigated to clarify their clinicopathological characteristics. METHODS Between 1994 and 2006, 492 patients presenting with intracranial schwannomas underwent GKRS. Among them, seven cases demonstrated either new formation of cysts or enlargement of preexisting cysts, which were treated with microsurgical intervention. These cases were retrospectively reviewed with regard to neuroradiological findings and histopathology. RESULTS These seven cases included five vestibular and two trigeminal schwannomas. Preexisting cysts were enlarged following GKRS in three cases, while they were newly formed in four cases. Salvage microsurgery was carried out at 7-167 months after the GKRS, and subtotal resection was achieved in three, partial resection with or without cyst fenestration in four. Neurological symptoms were improved in all six symptomatic cases. Preoperative MRI demonstrated two characteristic types of cyst. One was the intratumoral type, indicating hemorrhagic change on the MRI. Histopathological analysis demonstrated a cavernous angioma within the solid compartment of tumor. These two cases demonstrated enlargement of residual tumor with new cyst formation after resection of only the cyst. The other type was extratumoral cyst, which had a structure with a thin cyst wall without contrast enhancement, and the cyst was composed of arachnoid cells without tumor cells. Extratumoral cysts enlarged despite effective control of the tumor itself, which may be caused by osmotic gradient induced by tumor degeneration following GKRS. CONCLUSIONS There were two types of cysts, intratumoral cyst and extratumoral arachnoid cyst, which developed following GKRS in intracranial schwannomas. Resection of the solid compartment as well as the cyst is required in schwannomas with expanding intratumoral cyst. Conversely, fenestration of the cyst alone might be effective in extratumoral arachnoid cysts.
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Affiliation(s)
- Kensuke Murakami
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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Shen H, Huo Z, Liu L, Lin Z. Stereotatic implantation of Ommaya reservoir in the management of brain abscesses. Br J Neurosurg 2010; 25:636-40. [PMID: 21158509 DOI: 10.3109/02688697.2010.534201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We evaluated the effectiveness of computed tomography (CT)-guided stereotatic implantation of Ommaya reservoir in the management of brain abscess. Forty-five patients with brain abscesses were treated with CT-guided stereotatic implantation of Ommaya reservoir and followed up between September 1998 and February 2008. The Glasgow Outcome Scale (GOS) was use to evaluate the effectiveness of the Ommaya Reservoir treatment. The GOS score at 3-months post-operation was 5 for 41 patients (91.1%), 4 for 2 patients (4.4%) and 3 for 2 patients (4.4%), respectively. The results suggest that the CT-guided stereotatic implantation of Ommaya reservoir is a potential technique that can be safely used to treat the brain abscess.
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Affiliation(s)
- Hong Shen
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, Province, China
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