1
|
Hirata T, Umekawa M, Shinya Y, Hasegawa H, Katano A, Shinozaki-Ushiku A, Saito N. Radiation-induced malignancies after stereotactic radiosurgery for brain arteriovenous malformations: a large single-center retrospective study and systematic review. Neurosurg Rev 2024; 47:870. [PMID: 39586842 PMCID: PMC11588909 DOI: 10.1007/s10143-024-03093-6] [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: 08/30/2024] [Revised: 10/09/2024] [Accepted: 11/10/2024] [Indexed: 11/27/2024]
Abstract
Stereotactic radiosurgery (SRS) is widely utilized to treat small- and medium-sized brain arteriovenous malformations (BAVMs); however, radiation-induced malignancies (RIMs) have been reported as extremely rare yet potentially life-threatening complications of SRS. This study aimed to investigate the risk of RIMs after SRS for BAVMs. The outcomes of patients who underwent single-session SRS for BAVMs at our institution and were followed for ≥ 5 years were analyzed to calculate the incidence of RIMs. In addition, a systematic review was conducted using the existing literature reporting RIMs after SRS for BAVMs in compliance with the PRISMA guideline. Regarding the in-hospital analysis, only one (0.18%) RIM (gliosarcoma) was observed among 569 patients, with a median follow-up period of 151 months (interquartile range, 103-255 months). The 15, 20, and 25-year cumulative incidences of RIMs were 0%, 0%, and 1.01%, respectively, whereas the overall incidence rate was 0.12 per 1,000 patient-years. In the systematic review, 14 studies were included, with the incidence of RIMs ranging from 0.00 to 0.24%. Eight patients with RIMs were identified, and the most common pathology was glioblastoma. The median time until the diagnosis of RIM was 7.1 years (range, 4-19 years) after SRS, and their clinical courses were largely dismal, with the post-diagnosis survival periods being 1-10 months. RIM constitutes an extremely rare but potentially fatal complication following SRS for BAVMs, with its incidence rate being at most 0.24%.
Collapse
Affiliation(s)
- Takeru Hirata
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Aya Shinozaki-Ushiku
- Department of Pathology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| |
Collapse
|
2
|
Pikis S, Mantziaris G, Ramanathan P, Xu Z, Sheehan JP. Repeat stereotactic radiosurgery for cerebral arteriovenous malformations. Neurosurg Focus 2022; 53:E11. [DOI: 10.3171/2022.4.focus2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The purpose of this retrospective, single-institution study was to evaluate radiological and clinical outcomes of patients managed with repeat stereotactic radiosurgery (SRS) for residual cerebral arteriovenous malformation (AVM) after prior SRS.
METHODS
The authors evaluated the clinical and radiological outcomes of consecutive patients treated with repeat single-session SRS for a residual brain AVM from 1989 to 2021.
RESULTS
In total, 170 patients underwent repeat SRS for AVM (90 [52.9%] females; median [interquartile range] age at the first SRS procedure 28 [21.5] years; median [interquartile range] age at the second SRS procedure 32 [22.5] years). After repeat SRS, the actuarial 3-, 5-, and 10-year AVM obliteration rates were 37.6%, 57.3%, and 80.9%, respectively. Higher obliteration rates were associated with margin dose ≥ 19 Gy (p = 0.001). After the second SRS procedure, hemorrhage occurred in 8.2% of patients and was lethal in 1 patient. The risk factors of intracranial hemorrhage were age < 18 years (p = 0.03) and residual AVM diameter > 20 mm (p = 0.004). Lower obliteration rates were noted in patients with residual AVM diameter > 20 mm (p = 0.04) and those < 18 years of age (p = 0.04). Asymptomatic, symptomatic, and permanent radiation-induced changes (RICs) after the second SRS procedure occurred in 25.9%, 8.8%, and 5.3% of patients, respectively, and were associated with RIC after the first SRS procedure (p = 0.006). There was 1 case of a radiation-induced meningioma 12 years after SRS.
CONCLUSIONS
Repeat SRS is a reasonable therapeutic option, in particular for patients with residual AVM. Repeat SRS was associated with more favorable outcomes in adult patients and those with residual AVM smaller than 20 mm in maximum diameter. To increase the rate of residual AVM obliteration, a prescription dose ≥ 19 Gy should ideally be used for repeat SRS.
Collapse
Affiliation(s)
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Purushotham Ramanathan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| |
Collapse
|
3
|
Richter KR, Richter RA, Griessenauer C, Monaco EA. Glioblastoma Adjacent to Radiosurgically Treated Arteriovenous Malformation: A Case Report and Review of the Literature. Cureus 2022; 14:e22097. [PMID: 35295367 PMCID: PMC8917819 DOI: 10.7759/cureus.22097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic radiosurgery (SRS) is a noninvasive therapy for patients suffering from both benign and malignant intracranial pathologies. While SRS allows for increased precision and efficacy, significant risks have been reported, such as radiation necrosis. Although traditional radiation therapies are associated with a well-understood risk of causing tumors or inducing malignancy, the risks associated with SRS are not well understood. Here, we present the case of a patient who underwent SRS post-Onyx embolization of a Spetzler-Martin grade 4 left parasagittal arteriovenous malformation. Four years later, the patient presented with a high-grade glioma adjacent to where the SRS was targeted. SRS has fundamentally altered the way we treat intracranial pathologies. While the risks for SRS-induced glioma appear to be extremely low, this case illustrates that they ought to be considered. Here, we discuss the details of our case and explore the currently available literature. Knowing these potential risks will further aid physicians and patients balance the associated benefits and risks.
Collapse
|
4
|
Giammattei L, di Russo P, Starnoni D, Passeri T, Bruneau M, Meling TR, Berhouma M, Cossu G, Cornelius JF, Paraskevopoulos D, Zazpe I, Jouanneau E, Cavallo LM, Benes V, Seifert V, Tatagiba M, Schroeder HWS, Goto T, Ohata K, Al-Mefty O, Fukushima T, Messerer M, Daniel RT, Froelich S. Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section. Acta Neurochir (Wien) 2021; 163:1639-1663. [PMID: 33740134 DOI: 10.1007/s00701-021-04798-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. RESULTS The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the management of PCMs.
Collapse
Affiliation(s)
- Lorenzo Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France.
| | - P di Russo
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - D Starnoni
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - T Passeri
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - T R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - M Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - G Cossu
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - J F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - D Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - I Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - L M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, NA, Italy
| | - V Benes
- Department of Neurosurgery, First Medical Faculty, Military University Hospital and Charles University, Prague, Czech Republic
| | - V Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - H W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - T Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - O Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Fukushima
- Department of Neurosurgery, Carolina Neuroscience Institute, Raleigh, NC, USA
| | - M Messerer
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| |
Collapse
|
5
|
Bunevicius A, Pikis S, Schlesinger D, Sheehan J. Editorial: Radiosurgical induced malignancy associated with stereotactic radiosurgery. Acta Neurochir (Wien) 2021; 163:969-970. [PMID: 33404875 DOI: 10.1007/s00701-020-04667-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Adomas Bunevicius
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Styllianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - David Schlesinger
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
- Health Sciences Center, Box 800212, Charlottesville, VA, 22908, USA.
| |
Collapse
|
6
|
Labuschagne JJ, Chetty D. Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report. Neurosurg Focus 2020; 46:E11. [PMID: 31153146 DOI: 10.3171/2019.3.focus1948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/18/2019] [Indexed: 11/06/2022]
Abstract
The documentation and exact incidence of stereotactic radiosurgery (SRS)-induced neoplasia is not well understood, with most literature restricted to single case reports and single-center retrospective reviews. The authors present a rare case of radiosurgery-induced glioblastoma multiforme (GBM) following radiosurgical treatment of a meningioma. A 74-year-old patient with a sporadic meningioma underwent radiosurgery following surgical removal of a WHO grade II meningioma. Eighteen months later she presented with seizures, and MRI revealed an intraaxial tumor, which was resected and proven to be a glioblastoma. As far as the authors are aware, this case represents the third case of GBM following SRS for a meningioma. This report serves to increase the awareness of this possible complication following SRS. The possibility of this rare complication should be explained to patients when obtaining their consent for radiosurgery.
Collapse
Affiliation(s)
- Jason J Labuschagne
- 1Department of Neurosurgery, University of the Witwatersrand.,2Department of Paediatric Neurosurgery, Nelson Mandela Children's Hospital; and.,3Gamma Knife Centre, Milpark, Johannesburg, South Africa
| | | |
Collapse
|
7
|
Chen CJ, Lee CC, Kano H, Kearns KN, Ding D, Tzeng SW, Atik A, Joshi K, Barnett GH, Huang PP, Kondziolka D, Mathieu D, Iorio-Morin C, Grills IS, Quinn TJ, Siddiqui ZA, Marvin K, Feliciano C, Faramand A, Lunsford LD, Sheehan JP. Stereotactic radiosurgery for pediatric brain arteriovenous malformations: long-term outcomes. J Neurosurg Pediatr 2020; 25:497-505. [PMID: 32032957 DOI: 10.3171/2019.12.peds19595] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Contrary to the better described obliteration- and hemorrhage-related data after stereotactic radiosurgery (SRS) of brain arteriovenous malformations (AVMs) in pediatric patients, estimates of the rarer complications, including cyst and tumor formation, are limited in the literature. The aim of the present study was to assess the long-term outcomes and risks of SRS for AVMs in pediatric patients (age < 18 years). METHODS The authors retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database for the years 1987 to 2018. AVM obliteration, post-SRS hemorrhage, cyst formation, and tumor formation were assessed. Cumulative probabilities, adjusted for the competing risk of death, were calculated. RESULTS The study cohort comprised 539 pediatric AVM patients (mean follow-up 85.8 months). AVM obliteration was observed in 64.3% of patients, with cumulative probabilities of 63.6% (95% CI 58.8%-68.0%), 77.1% (95% CI 72.1%-81.3%), and 88.1% (95% CI 82.5%-92.0%) over 5, 10, and 15 years, respectively. Post-SRS hemorrhage was observed in 8.4% of patients, with cumulative probabilities of 4.9% (95% CI 3.1%-7.2%), 9.7% (95% CI 6.4%-13.7%), and 14.5% (95% CI 9.5%-20.5%) over 5, 10, and 15 years, respectively. Cyst formation was observed in 2.1% of patients, with cumulative probabilities of 5.5% (95% CI 2.3%-10.7%) and 6.9% (95% CI 3.1%-12.9%) over 10 and 15 years, respectively. Meningiomas were observed in 2 patients (0.4%) at 10 and 12 years after SRS, with a cumulative probability of 3.1% (95% CI 0.6%-9.7%) over 15 years. CONCLUSIONS AVM obliteration can be expected after SRS in the majority of the pediatric population, with a relatively low risk of hemorrhage during the latency period. Cyst and benign tumor formation after SRS can be observed in 7% and 3% of patients over 15 years, respectively. Longitudinal surveillance for delayed neoplasia is prudent despite its low incidence.
Collapse
Affiliation(s)
- Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Cheng-Chia Lee
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hideyuki Kano
- 4Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathryn N Kearns
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- 5Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Shih-Wei Tzeng
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
| | - Ahmet Atik
- 6Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Krishna Joshi
- 6Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gene H Barnett
- 6Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Paul P Huang
- 7Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Douglas Kondziolka
- 7Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - David Mathieu
- 8Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Iorio-Morin
- 8Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Inga S Grills
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Thomas J Quinn
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Zaid A Siddiqui
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Kim Marvin
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Caleb Feliciano
- 10Section of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | - Andrew Faramand
- 4Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 4Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| |
Collapse
|
8
|
Byun MR, Lee SW, Paulson B, Lee S, Lee W, Lee KK, Kim YR, Kim JK, Choi JW. Micro-endoscopic In Vivo Monitoring in the Blood and Lymphatic Vessels of the Oral Cavity after Radiation Therapy. Int J Med Sci 2019; 16:1525-1533. [PMID: 31673245 PMCID: PMC6818205 DOI: 10.7150/ijms.36470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022] Open
Abstract
Radiotherapy, although used worldwide for the treatment of head, neck, and oral cancers, causes acute complications, including effects on vasculature and immune response due to cellular stress. Thus, the ability to diagnose side-effects and monitor vascular response in real-time during radiotherapy would be highly beneficial for clinical and research applications. In this study, recently-developed fluorescence micro-endoscopic technology provides non-invasive, high-resolution, real-time imaging at the cellular level. Moreover, with the application of high-resolution imaging technologies and micro-endoscopy, which enable improved monitoring of adverse effects in GFP-expressing mouse models, changes in the oral vasculature and lymphatic vessels are quantified in real time for 10 days following a mild localized single fractionation, 10 Gy radiotherapy treatments. Fluorescence micro-endoscopy enables quantification of the cardiovascular recovery and immune response, which shows short-term reduction in mean blood flow velocity, in lymph flow, and in transient immune infiltration even after this mild radiation dose, in addition to long-term reduction in blood vessel capacity. The data provided may serve as a reference for the expected cellular-level physiological, cardiovascular, and immune changes in animal disease models after radiotherapy.
Collapse
Affiliation(s)
- Mi Ran Byun
- Department of Pharmacology, College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Seok Won Lee
- Department of Pharmacology, College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea.,Department of Life and Nanopharmaceutical Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Bjorn Paulson
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Sanghwa Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Wan Lee
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Wonkwang University, Iksan, 54538, Republic of Korea
| | - Kang Kyoo Lee
- Department of Radiation Oncology, School of Medicine, Wonkwang University, Iksan, 54538, Republic of Korea
| | - Yi Rang Kim
- Department of Hemato-Oncology, Yuseong Sun Hospital, Daejeon, 34084, Republic of Korea
| | - Jun Ki Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.,Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Jin Woo Choi
- Department of Pharmacology, College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea.,Department of Life and Nanopharmaceutical Science, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
| |
Collapse
|
9
|
Hafez RFA, Morgan MS, Fahmy OM, Hassan HT. Long-term effectiveness and safety of stereotactic gamma knife surgery as a primary sole treatment in the management of glomus jagulare tumor. Clin Neurol Neurosurg 2018. [PMID: 29514114 DOI: 10.1016/j.clineuro.2018.02.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study aims to report and confirm long-term effectiveness and safety of stereotactic Gamma Knife Surgery as a primary sole treatment in the management of 40 glomus jagulare tumors patients. PATIENTS AND METHODS Retrospective analysis of clinical and radiological outcomes of 40 GJTs consecutive patients treated with GKS as primary sole treatment at International Medical Center (IMC), Cairo-Egypt from the beginning of 2005 till the end of 2014,with mean follow-up period of 84 months (range 36-156 months), mean tumor volume was 6.5 cc, and mean peripheral radiation dose of 15 Gy, to mean isodose curve of 38%. RESULTS The most common neurological deficit at initial evaluation was bulbar symptoms in 24 patients, followed by pulsatile tinnitus in 22, deterioration of hearing in 20 patients. The overall clinical control achieved in 92.5% of patients, while actuarial tumor size control rate post- GKS was 97.5% at 3 years, 97% at 5 years and 92% at 10 years of follow-up period. CONCLUSIONS Gamma knife surgery could be used effectively and safely as a primary sole treatment tool in the management of glomus jugulare tumors.
Collapse
Affiliation(s)
- Raef F A Hafez
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
| | - Magad S Morgan
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
| | - Osama M Fahmy
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
| | - Hamdy T Hassan
- Department of Neurosurgery and Gamma Knife Center, International Medical Center (IMC), 42 km. Ismailia Desert Road, Cairo, Egypt.
| |
Collapse
|
10
|
Yamanaka R, Hayano A, Kanayama T. Radiation-induced gliomas: a comprehensive review and meta-analysis. Neurosurg Rev 2016; 41:719-731. [DOI: 10.1007/s10143-016-0786-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/25/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
|
11
|
Stone JB, DeAngelis LM. Cancer-treatment-induced neurotoxicity--focus on newer treatments. Nat Rev Clin Oncol 2015; 13:92-105. [PMID: 26391778 DOI: 10.1038/nrclinonc.2015.152] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neurotoxicity caused by traditional chemotherapy and radiotherapy is widely recognized in patients with cancer. The adverse effects of newer therapeutics, such as biological and immunotherapeutic agents, are less well established, and are associated with considerable neurotoxicity in the central and peripheral nervous systems. This Review addresses the main neurotoxicities of cancer treatment with a focus on the newer therapeutics. Recognition of these patterns of toxicity is important because drug discontinuation or dose adjustment might prevent further neurological injury. Knowledge of these toxicities also helps to differentiate treatment-related symptoms from progression of cancer or its involvement of the nervous system. Familiarity with the neurological syndromes associated with cancer treatments enables clinicians to use the appropriate treatment for the underlying malignancy while minimizing the risk of neurological damage, which might preserve patients' quality of life.
Collapse
Affiliation(s)
- Jacqueline B Stone
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| |
Collapse
|
12
|
Hirono S, Iwadate Y, Kambe M, Hiwasa T, Takiguchi M, Nakatani Y, Saeki N. Role of Evaluating MGMT Status and 1p36 Deletion in Radiosurgery-Induced Anaplastic Ependymoma That Rapidly and Completely Resolved by Temozolomide Alone: Case Report and Review of the Literature. J Neurol Surg Rep 2015; 76:e43-7. [PMID: 26251808 PMCID: PMC4521005 DOI: 10.1055/s-0034-1396657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/20/2014] [Indexed: 10/27/2022] Open
Abstract
Stereotactic gamma knife surgery (GKS)-induced brain tumors are extremely rare, and no ependymal tumors induced by GKS have been reported. Therefore, little is known about their clinical, pathologic, and genetic features. In addition, a regimen of adjuvant chemotherapy for anaplastic ependymoma (AE) has not been established. A 77-year-old man presented with a gait disturbance and left-side cerebellar ataxia more than 19 years after GKS performed for a cerebellar arteriovenous malformation. Imaging studies demonstrated an enhancing mass in the irradiated field with signs of intraventricular dissemination. Surgical resection confirmed the diagnosis of AE. Temozolomide (TMZ) was administrated postoperatively because the methylated promoter region of O(6)-methylguanine-DNA methyltransferase (MGMT) and 1p36 deletion were observed. Surprisingly, images 16 days after TMZ initiation demonstrated a complete resolution of the residual tumor that was maintained after three cycles of TMZ. This first case report of GKS-induced AE emphasizes the importance of genetic evaluation of MGMT and chromosomal deletion of 1p36 that are not commonly performed in primary ependymal tumors. In addition, it is speculated that a GKS-induced tumor may have a different genetic background compared with the primary tumor because the pathogenesis of the tumors differed.
Collapse
Affiliation(s)
- Seiichiro Hirono
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chuoku, Chiba, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chuoku, Chiba, Japan
| | - Michiyo Kambe
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chuoku, Chiba, Japan
| | - Takaki Hiwasa
- Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chuoku, Chiba, Japan
| | - Masaki Takiguchi
- Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chuoku, Chiba, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chuoku, Chiba, Japan
| | - Naokatsu Saeki
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chuoku, Chiba, Japan
| |
Collapse
|
13
|
Yu J, Yang H, Qu L, Li Y. Prolactinoma associated with an ependymoma in the fourth ventricle: A case report and review of the literature. Oncol Lett 2015; 10:228-232. [PMID: 26171004 DOI: 10.3892/ol.2015.3199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 04/21/2015] [Indexed: 11/05/2022] Open
Abstract
Pituitary adenoma associated with ependymoma in the fourth ventricle is a rare condition. In the present study, a 46-year-old man diagnosed with prolactinoma, who previously underwent two surgical procedures (one for the removal of a primary tumor and a second following its recurrence) developed a complication of ependymoma in the fourth ventricle. The presence of the ependymoma was confirmed by pathological analysis and the patient recovered well following two-phase surgical resection of the two tumors. The present study compared the probable cause of concurrent pituitary adenoma and ependymoma within the fourth ventricle with previous relevant studies. These comparisons were used to propose possible genomic and endocrine contributions for the development of the ependymoma from the pituitary adenoma.
Collapse
Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hongfa Yang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Limei Qu
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| |
Collapse
|
14
|
Radiosurgery for unruptured cerebral arteriovenous malformations in pediatric patients. Acta Neurochir (Wien) 2015; 157:281-91. [PMID: 25514868 DOI: 10.1007/s00701-014-2305-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Unruptured cerebral arteriovenous malformations (AVMs) in pediatric patients (age <18 years) were excluded from A Randomized Trial of Unruptured AVMs (ARUBA). Therefore, the efficacy of radiosurgery for unruptured pediatric AVMs is poorly understood. The goal of this study is to determine the outcomes and define the predictors of obliteration following radiosurgery for unruptured AVMs in pediatric patients. METHODS We evaluated a prospective database, from 1989 to 2013, of AVM patients treated with radiosurgery at our institution. Patients with age less than 18 years at the time of radiosurgery, unruptured nidi, and at least 2 years of radiologic follow-up or AVM obliteration were selected for analysis. Statistical analyses were performed to determine actuarial obliteration rates and identify factors associated with obliteration. RESULTS In the 51 unruptured pediatric AVM patients included for analysis, the median age was 13 years, and the most common presentation was seizure in 53 %. The median nidus volume and radiosurgical margin dose were 3.2 cm(3) and 21.5 Gy, respectively. The median radiologic follow-up was 45 months. The actuarial AVM obliteration rates at 3, 5, and 10 years were 29 %, 54 %, and 72 %, respectively. In the multivariate Cox proportional hazards regression analysis, higher margin dose (P = 0.002), fewer draining veins (P = 0.038), and lower Virginia Radiosurgery AVM Scale (P = 0.003) were independent predictors of obliteration. Obliteration rates were significantly higher with a margin dose of at least 22 Gy (P = 0.003) and for nidi with 2 or fewer draining veins (P = 0.001). The incidences of radiologically evident, symptomatic, and permanent radiation-induced changes were 55 %, 16 %, and 2 %, respectively. The annual post-radiosurgery hemorrhage rate was 1.3 %, and the incidence of post-radiosurgery cyst formation was 2 %. CONCLUSION Radiosurgery affords a favorable risk to benefit profile for unruptured pediatric AVMs. Pediatric patients with unruptured AVMs merit further study to define an optimal management approach.
Collapse
|
15
|
Marta GN, Murphy E, Chao S, Yu JS, Suh JH. The incidence of second brain tumors related to cranial irradiation. Expert Rev Anticancer Ther 2014; 15:295-304. [PMID: 25482749 DOI: 10.1586/14737140.2015.989839] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Secondary brain tumor (SBT) is a devastating complication of cranial irradiation (CI). We reviewed the literature to determine the incidence of SBT as related to specific radiation therapy (RT) treatment modalities. The relative risk of radiation-associated SBT after conventional and conformal RT is well established and ranges from 5.65 to 10.9; latent time to develop second tumor ranges from 5.8 to 22.4 years, depending on radiation dose and primary disease. Theories and dosimetric models suggest that intensity-modulated radiation therapy may result in an increased risk of SBT, but clinical evidence is limited. The incidence of stereotactic radiosurgery-related SBT is low. Initial data suggest that no increased risk from proton therapy and dosimetric models predict a lower incidence of SBT compared with photons. In conclusion, the incidence of SBT related to CI is low. Longer follow-up is needed to clarify the impact of intensity-modulated radiation therapy, proton therapy and other developing technologies.
Collapse
Affiliation(s)
- Gustavo Nader Marta
- Radiation Oncology Department, Hospital Sírio-Libanês, Rua Dona Adma Jafet 91., Sao Paulo, Sao Paulo 01308-050, Brazil
| | | | | | | | | |
Collapse
|
16
|
Maurer AJ, Safavi-Abbasi S, Cheema AA, Glenn CA, Sughrue ME. Management of petroclival meningiomas: a review of the development of current therapy. J Neurol Surg B Skull Base 2014; 75:358-67. [PMID: 25276602 PMCID: PMC4176539 DOI: 10.1055/s-0034-1373657] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/23/2014] [Indexed: 10/25/2022] Open
Abstract
The surgical management of petroclival meningioma remains challenging, due to the difficulty of accessing the region and the vital structures adjacent to the origin of these tumors. Petroclival meningiomas were originally considered largely unresectable. Until the 1970s, resection carried a 50% mortality rate, with very high rates of operative morbidity if attempted. However, in the past 40 years, advances in neuroimaging and approaches to the region were refined, and results from resection of petroclival meningiomas have become more acceptable. Today, the developments of a multitude of surgical approaches as well as innovations in neuroimaging and stereotactic radiotherapy have proved powerful options for multimodality management of these challenging tumors.
Collapse
Affiliation(s)
- Adrian J. Maurer
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States
| | - Sam Safavi-Abbasi
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States
| | - Ahmed A. Cheema
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States
| | - Chad A. Glenn
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States
| | - Michael E. Sughrue
- Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States
| |
Collapse
|
17
|
Gandía-González ML, Kusak ME, Moreno NM, Sárraga JG, Rey G, Álvarez RM. Jugulotympanic paragangliomas treated with Gamma Knife radiosurgery: a single-center review of 58 cases. J Neurosurg 2014; 121:1158-65. [PMID: 24926654 DOI: 10.3171/2014.5.jns131880] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Jugulotympanic paragangliomas (JTPs) are rare benign tumors whose surgical treatment is usually associated with partial resection of the lesion, high morbidity, and even death. Gamma Knife radiosurgery (GKRS) has been reported as a useful treatment option. The goal of this retrospective study is to analyze the role of GKRS in tumor volume control and clinical outcomes of these patients. METHODS A total of 75 patients with JTPs were treated with GKRS at the authors' center from 1995 to 2012. The authors analyzed those treated during this period to allow for a minimal observation time of 2 years. The MR images and clinical reports of these patients were reviewed to assess clinical and volumetric outcomes of the tumors. The radiological and clinical assessments, along with a group of prognostic factors measured, were analyzed using descriptive methods. The time to volumetric and clinical progression was analyzed using the Kaplan-Meier method. Prognostic factors were identified using log-rank statistics and multivariate Cox regression models. RESULTS The mean follow-up was 86.4 months. The authors observed volumetric tumor control in 94.8% of cases. In 67.2% of cases, tumor volume decreased by a mean of 40.1% from the original size. Of patients with previous tinnitus, 54% reported complete recovery. Improvement of other symptoms was observed in 34.5% of cases. Overall, clinical control was achieved in 91.4% of cases. Previous embolization and familial history of paraganglioma were selected as significant prognostic factors for volumetric response to GKRS treatment in the univariate analysis. In multivariate analysis, no factors were significantly correlated with progression-free survival. No patient died of side effects related to GKRS treatment or tumor progression. CONCLUSIONS Gamma Knife radiosurgery is an effective, safe, and efficient therapeutic option for the treatment of these tumors as a first-line treatment or in conjunction with traditional surgery, endovascular treatment, or conventional fractionated radiotherapy.
Collapse
|
18
|
Rahman M, Neal D, Baruch W, Bova FJ, Frentzen BH, Friedman WA. The Risk of Malignancy Anywhere in the Body after Linear Accelerator (LINAC) Stereotactic Radiosurgery. Stereotact Funct Neurosurg 2014; 92:323-33. [DOI: 10.1159/000365225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/06/2014] [Indexed: 11/19/2022]
|
19
|
Ecemis GC, Atmaca A, Meydan D. Radiation-associated secondary brain tumors after conventional radiotherapy and radiosurgery. Expert Rev Neurother 2013; 13:557-65. [PMID: 23621312 DOI: 10.1586/ern.13.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although there is not enough strong molecular evidence for radiation to be a causal factor for the development of secondary brain tumors, a relationship has still been found. There is a slight but significant 2-2.7% increased risk of secondary brain tumors after conventional radiotherapy. However, this risk is small and should not preclude the use of radiotherapy as an effective treatment for uncontrolled pituitary tumors. The risk of radiosurgery-associated secondary brain tumors has not been precisely determined. Taking into account the considerable number of patients who received radiosurgery worldwide and the small number of secondary brain tumors, radiosurgery seems to be a safe treatment modality. This review summarizes the pathogenesis, prevalence and characteristics of secondary brain tumors after conventional radiotherapy and stereotactic radiosurgery for pituitary adenomas.
Collapse
Affiliation(s)
- Gulcin Cengiz Ecemis
- Dr. I Sevki Atasagun Government Hospital, Clinic of Endocrinology, Nevsehir, Turkey.
| | | | | |
Collapse
|
20
|
Starke RM, Yen CP, Ding D, Sheehan JP. A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients. J Neurosurg 2013; 119:981-7. [DOI: 10.3171/2013.5.jns1311] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors performed a study to review outcomes following Gamma Knife radiosurgery for cerebral arteriovenous malformations (AVMs) and to create a practical scale to predict long-term outcome.
Methods
Outcomes were reviewed in 1012 patients who were followed up for more than 2 years. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent, symptomatic, radiation-induced complication. Preradiosurgery patient and AVM characteristics predictive of outcome in multivariate analysis were weighted according to their odds ratios to create the Virginia Radiosurgery AVM Scale.
Results
The mean follow-up time was 8 years (range 2–20 years). Arteriovenous malformation obliteration occurred in 69% of patients. Postradiosurgery hemorrhage occurred in 88 patients, for a yearly incidence of 1.14%. Radiation-induced changes occurred in 387 patients (38.2%), symptoms in 100 (9.9%), and permanent deficits in 21 (2.1%). Favorable outcome was achieved in 649 patients (64.1%). The Virginia Radiosurgery AVM Scale was created such that patients were assigned 1 point each for having an AVM volume of 2–4 cm3, eloquent AVM location, or a history of hemorrhage, and 2 points for having an AVM volume greater than 4 cm3. Eighty percent of patients who had a score of 0–1 points had a favorable outcome, as did 70% who had a score of 2 points and 45% who had a score of 3–4 points. The Virginia Radiosurgery AVM Scale was still predictive of outcome after controlling for predictive Gamma Knife radiosurgery treatment parameters, including peripheral dose and number of isocenters, in a multivariate analysis. The Spetzler-Martin grading scale and the Radiosurgery-Based Grading Scale predicted favorable outcome, but the Virginia Radiosurgery AVM Scale provided the best assessment.
Conclusions
Gamma Knife radiosurgery can be used to achieve long-term AVM obliteration and neurological preservation in a predictable fashion based on patient and AVM characteristics.
Collapse
|
21
|
Sasagawa Y, Tachibana O, Iizuka H. Undifferentiated sarcoma of the cavernous sinus after gamma knife radiosurgery for pituitary adenoma. J Clin Neurosci 2013; 20:1152-4. [DOI: 10.1016/j.jocn.2012.09.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/08/2012] [Indexed: 11/26/2022]
|
22
|
Yanamadala V, Williamson RW, Fusco DJ, Eschbacher J, Weisskopf P, Porter RW. Malignant Transformation of a Vestibular Schwannoma After Gamma Knife Radiosurgery. World Neurosurg 2013; 79:593.e1-8. [DOI: 10.1016/j.wneu.2012.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/02/2012] [Accepted: 03/28/2012] [Indexed: 11/30/2022]
|
23
|
Complications of gamma knife neurosurgery and their appropriate management. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 116:137-46. [PMID: 23417471 DOI: 10.1007/978-3-7091-1376-9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
There are four main risks with Gamma Knife neurosurgery. Firstly, there are direct complications that would not have arisen if the patient had not undergone the specific treatment under consideration. For radiosurgery, the direct complications are radiation-induced damage to the tissues, which may be temporary or permanent. They may be expressed clinically or be clinically silent. In addition, there are complications that are specific to certain diseases and their locations, such as pituitary failure following treatment of pituitary adenomas and deafness, facial palsy, or trigeminal deficit following the treatment of vestibular schwannomas. Second, there are indirect or management-related complications arising from delayed control of the disease process, such as a re-bleed after treatment of a vascular lesion before its occlusion. Third, there is the risk of induction of neoplasia from irradiation of normal tissue or tumor. These are separate processes. An example of the first would be induction of a glioma after treatment of a vascular malformation. An example of the second would be induction of malignant change in a benign vestibular schwannoma. Finally, there is treatment failure, where tumors continue to grow after treatment or vascular malformations fail to occlude.
Collapse
|
24
|
Radiation-induced glioma following CyberKnife® treatment of metastatic renal cell carcinoma: a case report. J Med Case Rep 2012; 6:271. [PMID: 22943305 PMCID: PMC3469351 DOI: 10.1186/1752-1947-6-271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Post-stereotactic radiation-induced neoplasms, although relatively rare, have raised the question of benefit regarding CyberKnife® treatments versus the risk of a secondary malignancy. The incidence of such neoplasms arising in the nervous system is thought to be low, given the paucity of case reports regarding such secondary lesions. CASE PRESENTATION Here we describe a case of a 43-year-old Middle Eastern woman with primary clear cell renal cell carcinoma and a metastatic focus to the left brain parenchyma who presented with focal neurologic deficits. Following post-surgical stereotactic radiation in the region of the brain metastasis, the patient developed a secondary high-grade astrocytoma nearly 5 years after the initial treatment. CONCLUSION Although the benefit of CyberKnife® radiotherapy treatments continues to outweigh the relatively low risk of a radiation-induced secondary malignancy, knowledge of such risks and a review of the literature are warranted.
Collapse
|
25
|
Sheehan JP, Tanaka S, Link MJ, Pollock BE, Kondziolka D, Mathieu D, Duma C, Young AB, Kaufmann AM, McBride H, Weisskopf PA, Xu Z, Kano H, Yang HC, Lunsford LD. Gamma Knife surgery for the management of glomus tumors: a multicenter study. J Neurosurg 2012; 117:246-54. [DOI: 10.3171/2012.4.jns11214] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Glomus tumors are rare skull base neoplasms that frequently involve critical cerebrovascular structures and lower cranial nerves. Complete resection is often difficult and may increase cranial nerve deficits. Stereotactic radiosurgery has gained an increasing role in the management of glomus tumors. The authors of this study examine the outcomes after radiosurgery in a large, multicenter patient population.
Methods
Under the auspices of the North American Gamma Knife Consortium, 8 Gamma Knife surgery centers that treat glomus tumors combined their outcome data retrospectively. One hundred thirty-four patient procedures were included in the study (134 procedures in 132 patients, with each procedure being analyzed separately). Prior resection was performed in 51 patients, and prior fractionated external beam radiotherapy was performed in 6 patients. The patients' median age at the time of radiosurgery was 59 years. Forty percent had pulsatile tinnitus at the time of radiosurgery. The median dose to the tumor margin was 15 Gy. The median duration of follow-up was 50.5 months (range 5–220 months).
Results
Overall tumor control was achieved in 93% of patients at last follow-up; actuarial tumor control was 88% at 5 years postradiosurgery. Absence of trigeminal nerve dysfunction at the time of radiosurgery (p = 0.001) and higher number of isocenters (p = 0.005) were statistically associated with tumor progression–free tumor survival. Patients demonstrating new or progressive cranial nerve deficits were also likely to demonstrate tumor progression (p = 0.002). Pulsatile tinnitus improved in 49% of patients who reported it at presentation. New or progressive cranial nerve deficits were noted in 15% of patients; improvement in preexisting cranial nerve deficits was observed in 11% of patients. No patient died as a result of tumor progression.
Conclusions
Gamma Knife surgery was a well-tolerated management strategy that provided a high rate of long-term glomus tumor control. Symptomatic tinnitus improved in almost one-half of the patients. Overall neurological status and cranial nerve function were preserved or improved in the vast majority of patients after radiosurgery.
Collapse
Affiliation(s)
- Jason P. Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Shota Tanaka
- 2Neuro-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael J. Link
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bruce E. Pollock
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Douglas Kondziolka
- 4Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - David Mathieu
- 5Division of Neurosurgery, University of Sherbrooke, Quebec, Canada
| | - Christopher Duma
- 6Hoag Neurosciences Institute, Hoag Memorial Hospital, Newport Beach, California
| | - A. Byron Young
- 7Department of Neurosurgery, University of Kentucky Medical Center, Lexington, Kentucky
| | - Anthony M. Kaufmann
- 8Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heyoung McBride
- 9Arizona Oncology Services Foundation; and
- 10Sections of Radiation Oncology and
| | | | - Zhiyuan Xu
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hideyuki Kano
- 4Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Huai-che Yang
- 4Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - L. Dade Lunsford
- 4Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| |
Collapse
|
26
|
Gamma knife surgery-induced ependymoma after the treatment of meningioma - a case report. Neurol Neurochir Pol 2012; 46:294-6. [PMID: 22773518 DOI: 10.5114/ninp.2012.29138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gamma knife surgery is widely used for a number of neurological disorders. However, little is known about its long-term complications such as carcinogenic risks. Here, we present a case of a radiosurgery-induced ependymoma by gamma knife surgery for the treatment of a spinal meningioma in a 7-year-old patient. In light of reviewing the previous reports, we advocate high caution in making young patients receive this treatment.
Collapse
|
27
|
Sheplan Olsen LJ, Robles Irizarry L, Chao ST, Weil RJ, Hamrahian AH, Hatipoglu B, Suh JH. Radiotherapy for prolactin-secreting pituitary tumors. Pituitary 2012; 15:135-45. [PMID: 21948464 DOI: 10.1007/s11102-011-0348-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Review the medical and surgical management of patients with prolactinomas and provide an in-depth appraisal of the role of radiotherapy in the treatment of prolactinomas. A thorough review of the pertinent literature was carried out and relevant topics were identified. Topics covered in this comprehensive review include: indications for the use of radiotherapy, choice between conventional radiotherapy and stereotactic radiosurgery, as well as the benefits and potential complications associated with each modality. Due to the excellent response rates with medical management, and rapid symptom relief afforded by resection or debulking surgery in patients who do not respond or tolerate medical therapy, radiotherapy is reserved for patients who do not respond to dopamine agonists and surgery. Both external beam radiotherapy and stereotactic radiosurgery retain important roles in the treatment of refractory or recurrent prolactinomas. Choosing the optimal approach is crucial in maximizing tumor control outcomes and minimizing the risks associated with treatment. The primary determinants of optimal radiation approach are proximity of the tumor to the optic apparatus and tumor size, with radiosurgery being our recommended treatment of choice unless the tumor is larger than 3-4 cm or within 3 mm of the optic nerves, chiasm or tracts. Optimal multidisciplinary management requires the identification of appropriate candidates for radiotherapy in order to take full advantage of treatment options available for each patient.
Collapse
|
28
|
Monteith SJ, Yen CP, Sheehan JP. Gamma knife surgery for pediatric arteriovenous malformations: a review. Neurosurgery 2011; 58:126-32. [PMID: 21916137 DOI: 10.1227/neu.0b013e3182270d96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
29
|
Modern management of rare brain metastases in adults. J Neurooncol 2011; 105:9-25. [DOI: 10.1007/s11060-011-0613-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 05/22/2011] [Indexed: 12/13/2022]
|
30
|
Taylor ML, Kron T, Franich RD. A contemporary review of stereotactic radiotherapy: inherent dosimetric complexities and the potential for detriment. Acta Oncol 2011; 50:483-508. [PMID: 21288161 DOI: 10.3109/0284186x.2010.551665] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The advantages of highly localised, conformal treatments achievable with stereotactic radiotherapy (SRT) are increasingly being extended to extracranial sites as stereotactic body radiotherapy with advancements in imaging and beam collimation. One of the challenges in stereotactic treatment lies in the significant complexities associated with small field dosimetry and dose calculation. This review provides a comprehensive overview of the complexities associated with stereotactic radiotherapy and the potential for detriment. METHODS This study is based on a comprehensive review of literature accessible via PubMed and other sources, covering stereotactic radiotherapy, small-field dosimetry and dose calculation. FINDINGS Several key issues were identified in the literature. They pertain to dose prescription, dose measurement and dose calculation within and beyond the treatment field. Field-edge regions and penumbrae occupy a significant portion of the total field size. Spectral and dosimetric characteristics are difficult to determine and are compounded by effects of tissue inhomogeneity. Measurement of small-fields is made difficult by detector volume averaging and energy response. Available dosimeters are compared, and emphasis is given to gel dosimetry which offers the greatest potential for three-dimensional small-field dosimetry. The limitations of treatment planning system algorithms as applied to small-fields (particularly in the presence of heterogeneities) is explained, and a review of Monte Carlo dose calculation is provided, including simplified treatment planning implementations. Not incorporated into treatment planning, there is evidence that far from the primary field, doses to patients (and corresponding risks of radiocarcinogenesis) from leakage/scatter in SRT are similar to large fields. CONCLUSIONS Improved knowledge of dosimetric issues is essential to the accurate measurement and calculation of dose as well as the interpretation and assessment of planned and delivered treatments. This review highlights such issues and the potential benefit that may be gained from Monte Carlo dose calculation and verification via three-dimensional dosimetric methods (such as gel dosimetry) being introduced into routine clinical practice.
Collapse
Affiliation(s)
- Michael L Taylor
- School of Applied Sciences, RMIT University, Melbourne, Victoria, Australia.
| | | | | |
Collapse
|
31
|
Yen CP, Monteith SJ, Nguyen JH, Rainey J, Schlesinger DJ, Sheehan JP. Gamma Knife surgery for arteriovenous malformations in children. J Neurosurg Pediatr 2010; 6:426-34. [PMID: 21039165 DOI: 10.3171/2010.8.peds10138] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECT The aim of this study was to evaluate the long-term imaging and clinical outcomes of intracranial arteriovenous malformations (AVMs) in children treated with Gamma Knife surgery (GKS). METHODS Between 1989 and 2007, 200 patients with AVMs who were 18 years of age or younger were treated at the University of Virginia Health System. Excluding 14 patients who had not reached 2-year follow-up, 186 patients comprised this study. Hemorrhage was the most common presenting symptom leading to the diagnosis of AVMs (71.5%). The mean nidus volume was 3.2 cm(3) at the time of GKS, and a mean prescription dose of 21.9 Gy was used. RESULTS After initial GKS, 49.5% of patients achieved total angiographic obliteration. Forty-one patients whose AVM nidi remained patent underwent additional GKS. The obliteration rate increased to 58.6% after a second or multiple GKS. Subtotal obliteration was achieved in 9 patients (4.8%). Forty-nine patients (26.3%) still had a patent residual nidus. In 19 patients (10.2%), obliteration was confirmed on MR imaging only. Ten patients had 17 hemorrhages during the follow-up period. The hemorrhage rate was 5.4% within 2 years after GKS and 0.8% between 2 and 5 years. Six patients developed neurological deficits along with the radiation-induced changes. Two patients developed asymptomatic meningiomas 10 and 12 years after GKS. After a mean clinical follow-up of 98 months, less than 4% of patients had difficulty attending school or developing a career. CONCLUSIONS Gamma Knife surgery offers a reasonable chance of obliteration of an AVM in pediatric patients. The incidence of symptomatic radiation-induced changes is relatively low; however, long-term clinical and imaging follow-up is required to identify delayed cyst formation and secondary tumors.
Collapse
Affiliation(s)
- Chun Po Yen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA
| | | | | | | | | | | |
Collapse
|
32
|
Abdelaziz OS, Kandil A, El-Assaal S, Abdelaziz A, Rostom Y, Rashed Y. Linear accelerator-based stereotactic radiosurgery of intracranial meningiomas: results of the first 5 years of clinical practice. Neurosurg Rev 2010; 34:87-99. [DOI: 10.1007/s10143-010-0288-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 03/22/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
|
33
|
Rubin D, Santillan A, Greenfield JP, Souweidane M, Riina HA. Surgical management of pediatric cerebral arteriovenous malformations. Childs Nerv Syst 2010; 26:1337-44. [PMID: 20596869 DOI: 10.1007/s00381-010-1211-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/12/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arteriovenous malformations (AVMs) are the most common cause of intracerebral hemorrhage in children. Different options exist for their successful management consisting of surgery, endovascular embolization, stereotactic radiosurgery, or a combination of these treatments. DISCUSSION In this paper, we discuss the different treatment modalities in the treatment of pediatric cerebral AVMs emphasizing the role of surgery and endovascular embolization as a preoperative strategy.
Collapse
Affiliation(s)
- David Rubin
- Department of Neurological Surgery,Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA
| | | | | | | | | |
Collapse
|
34
|
Sheehan JP, Williams BJ, Yen CP. Stereotactic radiosurgery for WHO grade I meningiomas. J Neurooncol 2010; 99:407-16. [PMID: 20734218 DOI: 10.1007/s11060-010-0363-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 08/10/2010] [Indexed: 12/15/2022]
Abstract
Meningiomas represent a common intracranial tumor in the adult population. Although extirpation to achieve a gross total resection or at least decrease mass effect has been the mainstay of treatment, stereotactic radiosurgery has come to play an increasingly important role in the management of patients with meningiomas. Radiosurgery utilizes highly focused, beams of ionizing radiation to inactivate tumor cells. Image guidance and a steep dose fall off are critical features of this approach. The radiobiology of radiosurgery differs in certain advantageous ways from conventional radiotherapy. Radiosurgery initially was utilized to treat recurrent or residual skull base meningiomas. As success was observed in this setting, radiosurgery has gradually expanded its role so as to treat convexity meningiomas; it is also used as an upfront treatment for patients for whom clinical and neuro-imaging findings are consistent with a meningioma. Most large series demonstrate tumor control rates for patients with grade I meningiomas in excess of 85%. Neurological function is generally preserved or improved for patients with meningiomas. However, complications can occur. Longitudinal follow-up including neurologic and radiologic assessment is required. Single and multisession stereotactic radiosurgery will likely play an expanded role in the treatment of patients with meningiomas.
Collapse
Affiliation(s)
- Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
| | | | | |
Collapse
|
35
|
Yen CP, Jain S, Haq IU, Jagannathan J, Schlesinger D, Sheehan J, Steiner L. Repeat Gamma Knife Surgery for Incompletely Obliterated Cerebral Arteriovenous Malformations. Neurosurgery 2010; 67:55-64; discussion 64. [DOI: 10.1227/01.neu.0000370204.68711.ac] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The causes of failure after an initial Gamma procedure were studied, along with imaging and clinical outcomes, in a series of 140 patients with cerebral arteriovenous malformations (AVMs) treated with repeat Gamma Knife surgery (GKS).
METHODS
Causes of initial treatment failure included inaccurate nidus definition in 14 patients, failure to fill part of the nidus as a result of hemodynamic factors in 16, recanalization of embolized AVM compartments in 6, and suboptimal dose (< 20 Gy) in 23. Nineteen patients had repeat GKS for subtotal obliteration of AVMs. In 62 patients, the AVM failed to obliterate despite correct target definition and adequate dose. At the time of retreatment, the nidus volume ranged from 0.1 to 6.9 cm3 (mean, 1.4 cm3), and the mean prescription dose was 20.3 Gy.
RESULTS
Repeat GKS yielded a total angiographic obliteration in 77 patients (55%) and subtotal obliteration in 9 (6.4%). In 38 patients (27.1%), the AVMs remained patent, and in 16 patients (11.4%), no flow voids were observed on magnetic resonance imaging. Clinically, 126 patients improved or remained stable, and 14 experienced deterioration (8 resulting from a rebleed, 2 caused by persistent arteriovenous shunting, and 4 related to radiation-induced changes).
CONCLUSION
By using repeat GKS, we achieved a 55% angiographic cure rate. Although radiation-induced changes as visualized on magnetic resonance imaging occurred in 48 patients (39%), only 4 patients (3.6%) developed permanent neurological deficits. These findings may be useful in deciding the management of AVMs in whom total obliteration after initial GKS was not achieved.
Collapse
Affiliation(s)
- Chun-Po Yen
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Surbhi Jain
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Iftikhar-ul Haq
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Jay Jagannathan
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - David Schlesinger
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Jason Sheehan
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Ladislau Steiner
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health Sciences System, Charlottesville, Virginia
| |
Collapse
|
36
|
|
37
|
Radiosurgical Induced Neoplasia: A Seldom Seen Complication. World Neurosurg 2010; 73:644-5. [DOI: 10.1016/j.wneu.2010.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Indexed: 11/19/2022]
|
38
|
Niranjan A, Kondziolka D, Lunsford LD. Neoplastic Transformation After Radiosurgery or Radiotherapy: Risk and Realities. Otolaryngol Clin North Am 2009; 42:717-29. [DOI: 10.1016/j.otc.2009.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Epileptic seizures caused by encephalomalasic cysts following radiotherapy: a case report. CASES JOURNAL 2009; 2:7026. [PMID: 19829898 PMCID: PMC2740008 DOI: 10.4076/1757-1626-2-7026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 04/02/2009] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral radionecrosis is a delayed and rarely observed complication of radiotherapy. Cerebral radionecrosis may occur as cystic encephalomalasic formations which cover the intracranial region. These cysts may, in rare cases, become quite large. They may cause drug-resistant seizures, neurological deficits and consciousness disorders. CASE PRESENTATION A 55-year-old, Turkish female patient was admitted to hospital with seizure, consciousness disorder and weakness in the right side of her body. The patient had history of an operation in the left maxillary area due to basal cell carcinoma 7 years previously and then history of radiotherapy due to relapse 2 years later the operation. The patient had large cystic encephalomalasic lesions. Despite steroid and dual antiepileptic treatments, the patient's complaints had significantly worsened and seizures continued. Surgical treatment resulted in a significant improvement. CONCLUSION This report underlines the significance of surgery in cerebral radionecrosis treatment in well-selected cases using appropriate approaches.
Collapse
|
40
|
Sasagawa Y, Akai T, Itou S, Iizuka H. GAMMA KNIFE RADIOSURGERY–INDUCED CAVERNOUS HEMANGIOMA. Neurosurgery 2009; 64:E1006-7; discussion E1007. [DOI: 10.1227/01.neu.0000344005.23146.cc] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
We report a rare case of gamma knife radiation–induced cavernous hemangioma.
CLINICAL PRESENTATION
A 35-year-old man underwent resection of a left vestibular schwannoma and gamma knife radiosurgery (maximal dose, 24 Gy; marginal dose, 12 Gy) for the residual schwannoma. Follow-up magnetic resonance images showed no tumor progression. Ten years later, he developed right hemihyperesthesia and mild hemiparesis. Magnetic resonance imaging revealed a size reduction at the resected tumor site and a newly developed lesion in the adjacent pons. No connection was observed between the new mass and the previous tumor. The T2-weighted image showed the new mass as heterogeneous and “popcorn-like” with a mixed signal intensity core and a hypointense hemosiderin rim. Two years after its appearance, the new lesion appeared hypointense on the T2-weighted image, with a hyperintense core on the T1-weighted image. These findings were compatible with cavernous hemangioma.
INTERVENTION
We diagnosed the new lesion as a radiation-induced cavernous hemangioma. Ten days after admission, symptoms improved without surgical intervention.
CONCLUSION
Gamma knife radiosurgery induced this rare case of cavernous hemangioma in an area that received a low dose of irradiation and was distant from the primary tumor. Because patients undergoing radiosurgery face the possibility, although small, that such neoplasms may occur, they should be followed for many years.
Collapse
Affiliation(s)
- Yasuo Sasagawa
- Department of Neurosurgery, Tonami General Hospital, Toyama, Japan
| | - Takuya Akai
- Department of Neurosurgery, Kanazawa Medical University, Ishikawa, Japan
| | - Shoutarou Itou
- Department of Neurosurgery, Tonami General Hospital, Toyama, Japan
| | - Hideaki Iizuka
- Department of Neurosurgery, Kanazawa Medical University, Ishikawa, Japan
| |
Collapse
|
41
|
Olivier A, Tanriverdi T. Surgery of temporal lobe epilepsy: modalities, advantages, disadvantages and outcomes. FUTURE NEUROLOGY 2009. [DOI: 10.2217/fnl.09.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
From the standard anterior temporal to selective resections, several modalities have evolved in the surgical treatment of temporal lobe epilepsy. In this review, the various surgical approaches, their advantages and disadvantages are discussed from the standpoint of results on seizure tendency, cognitive function, quality of life and technical aspects. Numerous studies, including our own with intracranial recording and reoperations, have provided evidence that the vast majority of temporal lobe seizures arise within the mesial structures. As a result, more and more selective procedures are being carried out directed at the amygdala and hippocampal formation. However, there is still no clear evidence that one selective approach is superior to the more standard temporal resection, which entails removal of the anterior temporal cortex, amygdala and hippocampus, or to any other so-called selective approach in terms of seizure control, cognitive function and quality of life. Technically, in our hands, the transcortical transventricular approach combined with neuronavigation has proven to be safe and less invasive compared with anterior temporal resection. Our experience suggests that the type of resection should be chosen case by case, on an individual basis, determined mainly by symptomatology, imaging, intracranial recording, neuropsychological findings and, at times, by the surgeon‘s experience.
Collapse
Affiliation(s)
- Andre Olivier
- Department of Neurosurgery, Montreal Neurological Institute & Hospital, McGill University, Montreal, Quebec, Canada
| | - Taner Tanriverdi
- Department of Neurosurgery, Montreal Neurological Institute & Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
42
|
Abstract
The idea of surgical treatment for epilepsy is not new. However, widespread use and general acceptance of this treatment has only been achieved during the past three decades. A crucial step in this direction was the development of video electroencephalographic monitoring. Improvements in imaging resulted in an increased ability for preoperative identification of intracerebral and potentially epileptogenic lesions. High resolution magnetic resonance imaging plays a major role in structural and functional imaging; other functional imaging techniques (e.g., positron emission tomography and single-photon emission computed tomography) provide complementary data and, together with corresponding electroencephalographic findings, result in a hypothesis of the epileptogenic lesion, epileptogenic zone, and the functional deficit zone. The development of microneurosurgical techniques was a prerequisite for the general acceptance of elective intracranial surgery. New less invasive and safer resection techniques have been developed, and new palliative and augmentative techniques have been introduced. Today, epilepsy surgery is more effective and conveys a better seizure control rate. It has become safer and less invasive, with lower morbidity and mortality rates. This article summarizes the various developments of the past three decades and describes the present tools for presurgical evaluation and surgical strategy, as well as ideas and future perspectives for epilepsy surgery.
Collapse
Affiliation(s)
- Johannes Schramm
- Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany
| | | |
Collapse
|
43
|
Ramina R, Neto MC, Fernandes YB, Silva EB, Mattei TA, Aguiar PHP. Surgical removal of small petroclival meningiomas. Acta Neurochir (Wien) 2008; 150:431-8; discussion 438-9. [PMID: 18309454 DOI: 10.1007/s00701-007-1403-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 09/11/2007] [Indexed: 11/30/2022]
Abstract
UNLABELLED Treatment of large petroclival meningiomas causing brain stem compression is surgical removal followed by radiotherapy or radiosurgery if the lesion was partially resected. The management of small petroclival meningiomas is, however, controversial. Clinical observation, radiosurgery and surgical removal are the options of treatment. The natural history of these tumours is not well known. Published series of patients treated with radiosurgery are not comparable with surgical series because the latter also includes large size tumours. In this paper we present a series of 18 patients with small petroclival meningiomas (diameter <or= 2.8 cm) treated with radical surgical removal. Total resection (Simpson's Grade 1) [43] was possible with minimal morbidity and no mortality. BACKGROUND We present a series of small petroclival meningiomas (SPM) treated by radical surgical removal and compare the outcome with other management modalities proposed for these lesions. METHODS Eighteen patients with SPM were surgically treated at our department of neurological surgery. The tumours were classified as small when they had a diameter < 3.0 cm. Headaches (n = 12), diplopia (n = 8), facial hypoaesthesia (n = 3) and tinnitus (n = 6) were the most frequent symptoms at presentation. The approaches used were retrosigmoid (n = 14), fronto-orbito-zygomatic (n = 3) and presigmoid (n = 1). The post-operative follow-up ranged from 1 to 110 months (mean 41.8 months). FINDINGS Radical tumour resection (Simpson's Grades 1 and 2) was achieved in all patients. There was no major morbidity or mortality related to the surgical procedure. Transient abducent nerve palsy was the only post-operative complication. The pre-operative cranial nerves deficits improved after surgery. Only one patient had persistent diplopia postoperatively. CONCLUSION Radical surgical removal of SPM is possible with minimal morbidity and may cure the patient. The effectiveness and outcome of surgery for small petroclival meningiomas should be compared with series treated by radiosurgery.
Collapse
Affiliation(s)
- R Ramina
- Department of Neurosurgery, Neurological Institute of Curitiba, Curitiba, Brazil.
| | | | | | | | | | | |
Collapse
|
44
|
Crocker M, deSouza R, Epaliyanage P, Bodi I, Deasy N, Selway R. Masson's tumour in the right parietal lobe after stereotactic radiosurgery for cerebellar AVM: case report and review. Clin Neurol Neurosurg 2007; 109:811-5. [PMID: 17714859 DOI: 10.1016/j.clineuro.2007.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 06/14/2007] [Accepted: 07/09/2007] [Indexed: 12/20/2022]
Abstract
We present a 50-year-old patient who had undergone stereotactic radiosurgery for a cerebellar vermian arteriovenous malformation. On routine surveillance MR imaging a lesion suggestive of a meningioma was demonstrated and removed. Histologically it was found to be intravascular papillary endothelial hyperplasia (Masson's tumour). The characteristic radiological and histological findings are presented. Aspects of management of this rare tumour are discussed. Given that cases are often found in combination with a vascular abnormality, we discuss the possibility of a change in local haemodynamics after radiosurgery promoting development of this tumour.
Collapse
Affiliation(s)
- M Crocker
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
| | | | | | | | | | | |
Collapse
|
45
|
Crop F, Reynaert N, Pittomvils G, Paelinck L, De Gersem W, De Wagter C, Vakaet L, De Neve W, Thierens H. Monte Carlo modeling of the ModuLeaf miniature MLC for small field dosimetry and quality assurance of the clinical treatment planning system. Phys Med Biol 2007; 52:3275-90. [PMID: 17505102 DOI: 10.1088/0031-9155/52/11/022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this investigation was the verification of both the measured data and quality of the implementation of the add-on ModuLeaf miniature multileaf collimator (ML mMLC) into the clinical treatment planning system for conformal stereotactic radiosurgery treatment. To this end the treatment head with ML mMLC was modeled in the BEAMnrc Monte Carlo (MC) code. The 6 MV photon beams used in the setup were first benchmarked with a set of measurements. A total ML mMLC transmission of 1.13% of the 10 x 10 cm2 open field dose was measured and reproduced with the BEAMnrc/DOSXYZnrc code. Correspondence between calculated and measured output factors (OFs) was within 2%. Correspondence between MC and measured profiles was within 2% dose and 2 mm distance, only for the smallest 0.5 x 0.5 cm2 field the results were within 3% dose. In the next step, the MC model was compared with Gafchromic film measurements and Pinnacle(3) 7.4 f (convolution superposition algorithm) calculated dose distributions, using a gamma evaluation comparison, for a multi-beam patient setup delivered to a Lucytrade mark phantom. The gamma evaluation of the MC versus Gafchromic film resulted in 3.4% of points not fulfilling gamma <or= 1 for a 2%/2 mm criterion, the Pinnacle(3) 7.4 f versus Gafchromic results 3.8% and Pinnacle versus MC less than 1%. For specific patients with lesions of 8 cc and 0.2 cc, Monte Carlo and Pinnacle simulations of the plans were performed and compared using DVH evaluation. DVHs corresponded within 2% dose and 2% volume.
Collapse
Affiliation(s)
- F Crop
- Department of Medical Physics, Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Yen CP, Sheehan J, Steiner M, Patterson G, Steiner L. Gamma Knife surgery for focal brainstem gliomas. J Neurosurg 2007; 106:8-17. [PMID: 17236482 DOI: 10.3171/jns.2007.106.1.8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Object
Focal tumors, a distinct subgroup of which is composed of brainstem gliomas, may have an indolent clinical course. In the past, their management involved monitoring of open-ended imaging studies and shunt placement if cerebrospinal fluid diversion was required. Nonetheless, their treatment remains a significant challenge for neurosurgeons. Gamma Knife surgery (GKS) has recently been tried as an alternative to surgical extirpation. In the present study the authors assess clinical and imaging results in 20 patients who harbored focal brainstem gliomas treated with GKS between 1990 and 2001.
Methods
There were 10 male and 10 female patients with a mean age of 19.1 years. Sixteen tumors were located in the midbrain, three in the pons, and one in the medulla oblongata. The mean tumor volume at the time of GKS was 2.5 cm3. In 10 cases a tumor specimen was obtained either by open surgery or stereotactic biopsy, securing the diagnosis of pilocytic astrocytoma in five patients and nonpilocytic astrocytoma in five others. In the remaining 10 cases, the diagnosis was based on clinical and neuroimaging findings. The prescription Gamma Knife dose varied between 10 and 18 Gy, except in three patients who were receiving a boost to a site in which external-beam radiation was previously delivered. An average of four isocenters were utilized per GKS.
Patients were followed up for a mean of 78.0 months. The tumors disappeared in four patients and shrank in 12 patients. Of these patients, one experienced transitory extrapyramidal symptoms and fluctuating impairment of consciousness (from somnolence to coma) for 6 months. Another patient whose tumor disappeared 3 years following GKS died of stroke 8 years postoperatively. The rest of the patients either remained stable or improved clinically. Tumor progression occurred in four patients; of these four, one patient developed hydrocephalus requiring a ventriculoperitoneal shunt, two showed neurological deterioration, and one 4-year-old boy died of tumor progression.
Conclusions
Gamma Knife surgery may be an effective primary treatment or adjunct to open surgery for focal brainstem gliomas.
Collapse
Affiliation(s)
- Chun Po Yen
- Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA
| | | | | | | | | |
Collapse
|