Terms Docs Use Can Influence Patients' Cancer Choices
Cancer: MedlinePlus
Clearer definitions might avoid unnecessary treatments, study says 
Source: HealthDay
Original Article: http://www.nlm.nih.gov/medlineplus/news/fullstory_140081.html
Wednesday, August 28, 2013
Terms Docs Use Can Influence Patients' Cancer Choices
Cancer After Spinal Fusion: The Role of Bone Morphogenetic Protein
Cancer After Spinal Fusion: The Role of Bone Morphogenetic Protein
Neurosurgery - Most Popular Articles
BACKGROUND:Bone morphogenetic protein (BMP) is used in tens of thousands of spinal fusions each year. A trial evaluating a high-dose BMP formulation demonstrated that its use may be associated with an increased risk of cancer. OBJECTIVE:To evaluate whether BMP, as commonly used today, is associated with an increased risk of cancer or benign tumors. METHODS:We performed a retrospective study using the Thomson Reuter MarketScan database. We retained all patients who had no previous diagnosis of cancer or benign tumor and had at least 2 years of uninterrupted enrollment in the database before and after their operations. A propensity score--matched cohort was created to ensure greater covariate balance between treatment groups. RESULTS:Within the propensity score--matched cohort (n = 4698), BMP-exposed patients had a nonsignificant increase in the rate of cancer diagnosis (9.37% vs 7.92%; P = .08). After adjustment for covariates, BMP exposure was associated with a 31% increased risk of benign tumor diagnosis (odds ratio, 1.31; 95% confidence interval, 1.02-1.68; P < .05). When the benign tumor diagnoses were stratified by organ type, BMP patients had significantly more diagnoses of benign nervous system tumors (0.81% vs 0.34%; P = .03), and within this group, benign tumors of the spinal meninges were much more common in the BMP-treated group (0.13% vs 0.02%; P = .002). CONCLUSION:The results of this large, independent, propensity-matched study suggest that the use of BMP in lumbar fusions is associated with a significantly higher rate of benign neoplasms but not malignancies. ABBREVIATIONS:aOR, adjusted odds ratioBMP, bone morphogenetic proteinCI, confidence intervalCPT-4,Current Procedural Terminology, Fourth EditionICD-9-CM,International Classification of Disease, Ninth Revision, Clinical ModificationOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2013/09000/Cancer_After_Spinal_Fusion___The_Role_of_Bone.8.aspx
[Review] Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group
[Review] Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group
The Lancet Oncology
Neurocognitive function, neurological symptoms, functional independence, and health-related quality of life are major concerns for patients with brain metastases. The inclusion of these endpoints in trials of brain metastases and the methods by which these measures are assessed vary substantially. If functional independence or health-related quality of life are planned as key study outcomes, then the reliability and validity of these endpoints can be crucial because methodological issues might affect the interpretation and acceptance of findings.
Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70308-5/abstract?rss=yes
Robotic radiosurgery versus micro-multileaf collimator: a dosimetric comparison for large or critically located arteriovenous malformations
Robotic radiosurgery versus micro-multileaf collimator: a dosimetric comparison for large or critically located arteriovenous malformations
Radiation Oncology - Latest Articles
Background: Stereotactic irradiation of large or critically located arteriovenous malformations (AVMs) is a special challenge for clinicians and radiation physicists. To date, no comprehensive comparison of two linac-based radiosurgery systems used for hypofractionated radiotherapy of large AVMs was published. The aim of the study was to compare dose distributions between CyberKnife (CK) system and linac with a micro-multileaf collimator (L-mMLC) in high-grade or critically located cerebral AVMs. Methods: Two sets of plans made for 15 different patients with at least 95% target coverage were selected for comparisons. Conformity (CI), homogeneity (HI) and gradient score (GSI) indices, conformity index proposed by Lomax (CIL), conformation number (CN), quality of coverage (Q), volumes of brain receiving 12,10,8,6,4, and 2 Gy, minimum and maximum doses and volumes of structures in both treatment planning systems (TPS) were compared. Finally, the number of monitor units needed to deliver the prescribed dose was compared. Results: The mean minimum doses in the target volume were 93.3% (CK) and 90.7% (L-mMLC),p=n.s, maximum: 119.7 and 110%, respectively (p=0.004). The mean CI was 1.46 and 1.86, HI: 1.2, and 1.11, CIL 0.7, and 0.6, CN: 0.68 and 0.58 for CK and mMLC, respectively (p<0.05). The values of GSI and Q were not significantly different. The volumes of the brain receiving low doses (4 Gy and 2 Gy) were significantly lower in the CK system. The number of monitor units necessary to deliver the prescribed dose was significantly greater in case of the CK system. Conclusions: Better conformity can favor the CK system for treatment of large AVMs at the cost of higher maximum doses and worse homogeneity. L-mMLC is superior when shorter treatment time is required. Neither system can assure satisfying dose gradients outside large targets surrounded by numerous critical structures.
Original Article: http://www.ro-journal.com/content/8/1/205
Medical Treatments Other Than Chemotherapy, Help Fight Metastases - Science World Report
Medical Treatments Other Than Chemotherapy, Help Fight Metastases - Science World Report
neurosurgery - Google News
Science World Report | Medical Treatments Other Than Chemotherapy, Help Fight Metastases Science World Report "Currently nothing exists that can filter cerebrospinal fluid -- which, in some patients, contains malignant active cancer cells," said Akshal S. Patel, neurosurgery resident at the Penn State Milton S. Hershey Medical Center, via the release. "This ... |
Original Article: http://news.google.com/news/url?sa=t&fd=R&usg=AFQjCNGdZJr_79ui4lAszSsPFzeYYZyrWw&url=http://www.scienceworldreport.com/articles/9036/20130825/medical-treatments-chemotherapy-help-fight-metastases.htm
Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers
Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers
Cancer
BACKGROUND
Neurosurgical resection and whole-brain radiation therapy (WBRT) are accepted treatments for single and oligometastatic cancer to the brain. To avoid the decline in neurocognitive function (NCF) linked to WBRT, the authors conducted a prospective, multicenter, phase 2 study to determine whether surgery and carmustine wafers (CW), while deferring WBRT, could preserve NCF and achieve local control (LC).
METHODS
NCF and LC were measured in 59 patients who underwent resection and received CW for a single (83%) or dominant (oligometastatic, 2 to 3 lesions) metastasis and received stereotactic radiosurgery (SRS) for tiny nodules not treated with resection plus CW. Preservation of NCF was defined as an improvement or a decline ≤1 standard deviation from baseline in 3 domains: memory, executive function, and fine motor skills, evaluated at 2-month intervals.
RESULTS
Significant improvements in executive function and memory occurred throughout the 1-year follow-up. Preservation or improvement of NCF occurred in all 3 domains for the majority of patients at each of the 2-month intervals. NCF declined in only 1 patient. The chemowafers were well tolerated, and serious adverse events were reversible. There was local recurrence in 28% of the patients at 1-year follow-up.
CONCLUSIONS
Patients with brain metastases had improvements in their cognitive trajectory, especially memory and executive function, after treatment with resection plus CW. The rate of LC (78%) was comparable to historic rates of surgery with WBRT and superior to reports of WBRT alone. For patients who undergo resection for symptomatic or large-volume metastasis or for tissue diagnosis, the addition of CW can be considered as an option. Cancer 2013. © 2013 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28307
Wednesday, August 7, 2013
Impact of internet-based cancer survivorship care plans on health care and lifestyle behaviors
Impact of internet-based cancer survivorship care plans on health care and lifestyle behaviors
Cancer
BACKGROUND Survivorship care plans (SCP) are currently recommended by the Institute of Medicine, and will soon be required for accreditation by the American College of Surgeons Commission on Cancer. To the best of the authors' knowledge, the impact of SCPs on cancer survivors has not been previously reported. METHODS In 2007, the authors created an Internet tool for the creation of SCPs that provides customized guidelines for survivorship care. Users are sent a voluntary follow-up survey 1 month after initial use. RESULTS From May 2010 through January 2013, 8690 cancer survivors used the SCP tool. The most common diagnoses were breast (45%), hematologic (12%), and gastrointestinal (11%) cancers; the median age of the survivors was 51 years. Of these, 875 (10%) respondents provided information for future electronic contact and 298 responded to a 1-month follow-up survey. They reported that the information provided was "good" to "excellent" in 93% of cases, and new in 65% of cases. With regard to the emotional impact of the SCP, 62% of responding survivors believed that it provided "just enough" information, 72% felt "more informed," and 94% believed they would recommend it to others. The majority of respondents (63%) thought that the SCP changed their health care participation, and 80% shared/planned to share it with their health care team. Of those survivors who had done so, 80% reported that it improved communication with their health care providers. Greater than one-half of survey users (54%) reported that they had made or planned to make a lifestyle change in response to the SCP, most commonly dietary modification and increased exercise. CONCLUSIONS Survivorship care plans are useful vehicles with which to promote lifestyle and behavioral changes, and to assist survivors with communication with health care providers. These findings support recommendations from the Institute of Medicine and the American College of Surgeons Commission on Cancer. Cancer 2013. © 2013 American Cancer Society.
Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28286
Some glioblastoma patients would benefit from personalized treatment with drugs currently used in other cancers
Some glioblastoma patients would benefit from personalized treatment with drugs currently used in other cancers
Neurology News & Neuroscience News from Medical News Today
A team of researchers at the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center has identified 18 new genes responsible for driving glioblastoma multiforme, the most common - and most aggressive - form of brain cancer in adults. The study was published in Nature Genetics...
Original Article: http://www.medicalnewstoday.com/releases/264426.php
Saturday, August 3, 2013
Making Cancer Survivorship Last: How Docs Can Help
Making Cancer Survivorship Last: How Docs Can Help
Medscape Today- Medscape
New guidelines list 8 ways that cancer survivors can stay healthy. The key is for physicians to tailor these recommendations to individual patients. Here's what you need to know to get started.
Medscape Oncology
Original Article: http://www.medscape.com/viewarticle/808526?src=rss
Comparison of Survival Between Cerebellar and Supratentorial Glioblastoma Patients: Surveillance, Epidemiology, and End Results (SEER) Analysis
Comparison of Survival Between Cerebellar and Supratentorial Glioblastoma Patients: Surveillance, Epidemiology, and End Results (SEER) Analysis
Neurosurgery - Current Issue
BACKGROUND:Cerebellar glioblastoma multiforme (cGBM) is rare, and although there is a general belief that these tumors have a worse prognosis than supratentorial GBM (sGBM), few studies have been published to support this belief. OBJECTIVE:To investigate the effect of cerebellar location on survival through a case-control design comparing overall survival time of cGBM and sGBM patients. METHODS:The Surveillance, Epidemiology, and End Results (SEER) registry was used to identify 132 patients with cGBM (1973-2008). Each cGBM patient was matched with an sGBM patient from among 20 848 sGBM patients on the basis of age, extent of resection, decade of diagnosis, and radiation therapy using propensity score matching. RESULTS:Within the cGBM, 37% were older than 65 years of age, 62% were men, and 87% were white. Most patients underwent surgery and radiation (74%), whereas only 26% underwent surgical resection only. The median survival time for the cGBM and sGBM matched cohort was 8 months; however, the survival distributions differed (log-rank P = .04). Survival time for cGBM vs sGBM at 2 years was 21.5% vs 8.0%, and 12.7% vs 5.3% at 3 years. Multivariate analysis of survival among cGBM patients showed that younger age (P < .0001) and having radiation therapy (P < .0001) were significantly associated with reduced hazard of mortality. Among all patients, multivariate analysis showed that tumor location (P = .03), age (P < .0001), tumor size (P = .009), radiation (P < .0001), and resection (P < .0001) were associated with survival time in the unmatched cohort. CONCLUSION:Median survival time for cGBM and sGBM patients was 8 months, but cGBM patients had a survival time advantage as the study progressed. These findings suggest that cGBM patients should be treated as aggressively as sGBM patients with surgical resection and radiation therapy. ABBREVIATIONS:GBM, glioblastoma multiformecGBM, cerebellar glioblastoma multiformeIQR, interquartile rangeSEER, Surveillance, Epidemiology, and End ResultssGBM, supratentorial glioblastoma multiformeOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2013/08000/Comparison_of_Survival_Between_Cerebellar_and.16.aspx
Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life
Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 318-323, August 2013.
Object A main concern with regard to surgery for low-grade glioma (LGG, WHO Grade II) is maintenance of the patient's functional integrity. This concern is particularly relevant for gliomas in the central region, where damage can have grave repercussions. The authors evaluated postsurgical outcomes with regard to neurological deficits, seizures, and quality of life. Methods Outcomes were compared for 33 patients with central LGG (central cohort) and a control cohort of 31 patients with frontal LGG (frontal cohort), all of whom had had medically intractable seizures before undergoing surgery with mapping while awake. All surgeries were performed in the period from February 2007 through April 2010 at the same institution. Results For the central cohort, the median extent of resection was 92% (range 80%–97%), and for the frontal cohort, the median extent of resection was 93% (range 83%–98%; p = 1.0). Although the rate of mild neurological deficits was similar for both groups, seizure freedom (Engel Class I) was achieved for only 4 (12.1%) of 33 patients in the central cohort compared with 26 (83.9%) of 31 patients in the frontal cohort (p < 0.0001). The rate of return to work was lower for patients in the central cohort (4 [12.1%] of 33) than for the patients in the frontal cohort (28 [90.3%] of 31; p < 0.0001). Conclusions Resection of central LGG is feasible and safe when appropriate intraoperative mapping is used. However, seizure control for these patients remains poor, a finding that contrasts markedly with seizure control for patients in the frontal cohort and with that reported in the literature. For patients with central LGG, poor seizure control ultimately determines quality of life because most will not be able to return to work.
Original Article: http://thejns.org/doi/abs/10.3171/2013.5.JNS122235?ai=ru&mi=0&af=R
Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology
Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 434-441, August 2013.
Object Low-grade astrocytomas are slow-growing, infiltrative gliomas that over time may progress into more malignant tumors. Various factors have been shown to affect the time to progression and overall survival including age, performance status, tumor size, and the extent of resection. However, more recently it has been suggested that histological subtypes (fibrillary, protoplasmic, and gemistocytic) may impact patient outcome. In this study the authors have performed a large comparative population-based analysis to examine the characteristics and survival of patients with the various subtypes of WHO Grade II astrocytomas. Methods Patients diagnosed with fibrillary, protoplasmic, and gemistocytic astrocytomas were identified through the Surveillance, Epidemiology, and End Results (SEER) database. The chi-square test and Student t-test were used to evaluate differences in patient and treatment characteristics between astrocytoma subtypes. Kaplan-Meier analysis was used to assess overall survival, and the log-rank test was used to evaluate the differences between survival curves. Univariate and multivariate analyses were also performed to determine the effect of various patient, tumor, and treatment variables on overall survival. Results A total of 500 cases were included in the analysis, consisting of 326 fibrillary (65.2%), 29 protoplasmic (5.8%), and 145 gemistocytic (29%) variants. Gemistocytic astrocytomas presented at a significantly older age than the fibrillary variant (46.8 vs 37.7 years, p < 0.0001), with protoplasmic and fibrillary subtypes having a similar age. Although protoplasmic and fibrillary variants underwent radiotherapy at similar rates, gemistocytic tumors more frequently received radiotherapy (p = 0.0001). Univariate analysis revealed older age, larger tumor size, and the use of radiotherapy to be poor prognostic factors, with resection being associated with improved survival. The gemistocytic subtype (hazard ratio [HR] 1.62 [95% CI 1.27–2.07], p = 0.0001) also resulted in significantly worse survival than fibrillary tumors. Bivariate analyses demonstrated that older age, the use of radiotherapy, and resection significantly influenced median survival. Tumor subtype also affected median survival; patients who harbored gemistocytic tumors experienced less than half the median survival of fibrillary and protoplasmic tumors (38 vs 82 months, p = 0.0003). Multivariate analysis revealed increasing age (HR 1.05 [95% CI 1.04–1.05], p < 0.0001), larger tumor size (HR 1.02 [95% CI 1.01–1.03], p = 0.0002), and the use of resection (HR 0.70 [95% CI 0.52–0.94], p = 0.018) to be independent predictors of survival. Examination of tumor subtype revealed that the gemistocytic variant (HR 1.30 [95% CI 0.98–1.74], p = 0.074) was associated with worse patient survival than fibrillary tumors, although this only approached significance. The protoplasmic subtype did not affect overall survival (p = 0.33). Conclusions Gemistocytic tumor histology was associated with worse survival than fibrillary and protoplasmic astrocytomas. As protoplasmic astrocytomas have a survival similar to fibrillary tumors, there may be limited utility to the identification of this rare variant. However, increased attention should be paid to the presence of gemistocytes in low-grade gliomas as this is associated with shorter time to progression, increased malignant transformation, and reduced overall survival.
Original Article: http://thejns.org/doi/abs/10.3171/2013.4.JNS122329?ai=ru&mi=0&af=R
Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study
Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 446-456, August 2013.
Object Pituitary adenomas are fairly common intracranial neoplasms, and nonfunctioning ones constitute a large subgroup of these adenomas. Complete resection is often difficult and may pose undue risk to neurological and endocrine function. Stereotactic radiosurgery has come to play an important role in the management of patients with nonfunctioning pituitary adenomas. This study examines the outcomes after radiosurgery in a large, multicenter patient population. Methods Under the auspices of the North American Gamma Knife Consortium, 9 Gamma Knife surgery (GKS) centers retrospectively combined their outcome data obtained in 512 patients with nonfunctional pituitary adenomas. Prior resection was performed in 479 patients (93.6%) and prior fractionated external-beam radiotherapy was performed in 34 patients (6.6%). The median age at the time of radiosurgery was 53 years. Fifty-eight percent of patients had some degree of hypopituitarism prior to radiosurgery. Patients received a median dose of 16 Gy to the tumor margin. The median follow-up was 36 months (range 1–223 months). Results Overall tumor control was achieved in 93.4% of patients at last follow-up; actuarial tumor control was 98%, 95%, 91%, and 85% at 3, 5, 8, and 10 years postradiosurgery, respectively. Smaller adenoma volume (OR 1.08 [95% CI 1.02–1.13], p = 0.006) and absence of suprasellar extension (OR 2.10 [95% CI 0.96–4.61], p = 0.064) were associated with progression-free tumor survival. New or worsened hypopituitarism after radiosurgery was noted in 21% of patients, with thyroid and cortisol deficiencies reported as the most common postradiosurgery endocrinopathies. History of prior radiation therapy and greater tumor margin doses were predictive of new or worsening endocrinopathy after GKS. New or progressive cranial nerve deficits were noted in 9% of patients; 6.6% had worsening or new onset optic nerve dysfunction. In multivariate analysis, decreasing age, increasing volume, history of prior radiation therapy, and history of prior pituitary axis deficiency were predictive of new or worsening cranial nerve dysfunction. No patient died as a result of tumor progression. Favorable outcomes of tumor control and neurological preservation were reflected in a 4-point radiosurgical pituitary score. Conclusions Gamma Knife surgery is an effective and well-tolerated management strategy for the vast majority of patients with recurrent or residual nonfunctional pituitary adenomas. Delayed hypopituitarism is the most common complication after radiosurgery. Neurological and cranial nerve function were preserved in more than 90% of patients after radiosurgery. The radiosurgical pituitary score may predict outcomes for future patients who undergo GKS for a nonfunctioning adenoma.
Original Article: http://thejns.org/doi/abs/10.3171/2013.3.JNS12766?ai=ru&mi=0&af=R
En bloc resection of a multilevel high-cervical chordoma involving C-2: new operative modalities
En bloc resection of a multilevel high-cervical chordoma involving C-2: new operative modalities
Journal of Neurosurgery: Journal of Neurosurgery: Spine: Table of Contents
Journal of Neurosurgery: Spine, Volume 19, Issue 2, Page 232-242, August 2013.
En bloc resection of cervical chordomas has led to longer survival rates but has resulted in significant morbidities from the procedure, especially when the tumor is multilevel and located in the high-cervical (C1–3) region. To date, there have been only 5 reported cases of multilevel en bloc resection of chordomas in the high-cervical spine. In this technical report the authors describe a sixth case. A complete spondylectomy was performed at C-2 and C-3 with spinal reconstruction and stabilization, using several new modalities that were not used in the previous cases. The use of 1) preoperative endovascular sacrificing of the vertebral artery, 2) CT image-guidance, 3) an ultrasonic aspirator for skeletonizing the vertebral artery, and 4) the custom design of an anterior cage all contributed to absence of intraoperative or long-term (20 months) hardware failure and pseudarthrosis.
Original Article: http://thejns.org/doi/abs/10.3171/2013.5.SPINE121039?ai=rt&mi=0&af=R
Gamma Knife surgery for large vestibular schwannomas: a single-center retrospective case-matched comparison assessing the effect of lesion size
Gamma Knife surgery for large vestibular schwannomas: a single-center retrospective case-matched comparison assessing the effect of lesion size
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 463-471, August 2013.
Object Gamma Knife surgery (GKS) is a safe and effective treatment for patients with small to moderately sized vestibular schwannomas (VSs). Reports of stereotactic radiosurgery for large VSs have demonstrated worse tumor control and preservation of neurological function. The authors endeavored to assess the effect of size of VSs treated using GKS. Methods This study was a retrospective comparison of 24 patients with large VSs (> 3 cm in maximum diameter) treated with GKS compared with 49 small VSs (≤ 3 cm) matched for age, sex, radiosurgical margin and maximal doses, length of follow-up, and indication. Results Actuarial tumor progression-free survival (PFS) for the large VS cohort was 95.2% and 81.8% at 3 and 5 years, respectively, compared with 97% and 90% for small VSs (p = 0.009). Overall clinical outcome was better in small VSs compared with large VSs (p < 0.001). Patients with small VSs presenting with House-Brackmann Grade I (good facial function) had better neurological outcomes compared with patients with large VSs (p = 0.003). Treatment failure occurred in 6 patients with large VSs; 3 each were treated with resection or repeat GKS. Treatment failure did not occur in the small VS group. Two patients in the large VS group required ventriculoperitoneal shunt placement. Univariate analysis did not identify any predictors of treatment failure among the large VS cohort. Conclusions Patients with large VSs treated using GKS had shorter PFS and worse clinical outcomes compared with age-, sex-, and indication-matched patients with small VSs. Nevertheless, GKS has efficacy for some patients with large VSs and represents a reasonable treatment option for selected patients.
Original Article: http://thejns.org/doi/abs/10.3171/2013.4.JNS122195?ai=ru&mi=0&af=R
A magnetic resonance imaging, histological, and dose modeling comparison of focused ultrasound, radiofrequency, and Gamma Knife radiosurgery lesions in swine thalamus
A magnetic resonance imaging, histological, and dose modeling comparison of focused ultrasound, radiofrequency, and Gamma Knife radiosurgery lesions in swine thalamus
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 307-317, August 2013.
Object The purpose of this study was to use MRI and histology to compare stereotactic lesioning modalities in a large brain model of thalamotomy. Methods A unilateral thalamotomy was performed in piglets utilizing one of 3 stereotactic lesioning modalities: focused ultrasound (FUS), radiofrequency, and radiosurgery. Standard clinical lesioning parameters were used for each treatment; and clinical, MRI, and histological assessments were made at early (< 72 hours), subacute (1 week), and later (1–3 months) time intervals. Results Histological and MRI assessment showed similar development for FUS and radiofrequency lesions. T2-weighted MRI revealed 3 concentric lesional zones at 48 hours with resolution of perilesional edema by 1 week. Acute ischemic infarction with macrophage infiltration was most prominent at 72 hours, with subsequent resolution of the inflammatory reaction and coalescence of the necrotic zone. There was no apparent difference in ischemic penumbra or "sharpness" between FUS or radiofrequency lesions. The radiosurgery lesions presented differently, with latent effects, less circumscribed lesions at 3 months, and apparent histological changes seen in white matter beyond the thalamic target. Additionally, thermal and radiation lesioning gradients were compared with modeling by dose to examine the theoretical penumbra. Conclusions In swine thalamus, FUS and radiosurgery lesions evolve similarly as determined by MRI, histological examination, and theoretical modeling. Radiosurgery produces lesions with more delayed effects and seemed to result in changes in the white matter beyond the thalamic target.
Original Article: http://thejns.org/doi/abs/10.3171/2013.5.JNS122327?ai=ru&mi=0&af=R
Ophthalmological outcome after resection of tumors based on the pineal gland
Ophthalmological outcome after resection of tumors based on the pineal gland
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 420-426, August 2013.
Object Descriptions of visual dysfunction in pineal gland tumors tend to focus on upward gaze palsy alone. The authors aimed to characterize the nature, incidence, and functional significance of ophthalmological dysfunction after resection of tumors based on the pineal gland. Methods Review of a retrospective case series was performed and included consecutive patients who underwent surgery performed by a consultant neurosurgeon between 2002 and 2011. Only tumors specifically based on the pineal gland were included; tumors encroaching on the pineal gland from other regions were excluded. All patients with visual signs and/or symptoms were reviewed by a specialist consultant neuroophthalmologist to accurately characterize the nature of their deficits. Visual disturbance was defined as visual symptoms caused by a disturbance of ocular motility. Results A total of 20 patients underwent resection of pineal gland tumors. Complete resection was obtained in 85%, and there were no perioperative deaths. Visual disturbance was present in 35% at presentation; of those who had normal ocular motility preoperatively 82% had normal motility postoperatively. In total, 55% of patients had residual visual disturbance postoperatively. Although upward gaze tended to improve, significant functional deficits remained, particularly with regard to complex convergence and accommodation dysfunction. Prisms were used in 25% but were only ever partially effective. Visual outcome was only related to preoperative visual status and tumor volume (multivariate analysis). Conclusions Long-term visual morbidity after pineal gland tumor resection is common and leads to significant functional impairment. Improvement in deficits rarely occurs spontaneously, and prisms only have limited effectiveness, probably due to the dynamic nature of supranuclear ocular movement coordination.
Original Article: http://thejns.org/doi/abs/10.3171/2013.3.JNS122137?ai=ru&mi=0&af=R
The role of preoperative embolization for intracranial meningiomas
The role of preoperative embolization for intracranial meningiomas
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 364-372, August 2013.
Object As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date, however, no consensus has been reached on the use of this technique. To clarify the role of preoperative embolization in the management of meningiomas, the authors conducted a systematic review of case reports, case series, and prospective studies to increase the current understanding of the management options for these common lesions and complications associated with preoperative embolization. Methods A PubMed search was performed to include all relevant studies in which the management of intracranial meningiomas with preoperative embolization was reported. Immediate complications of embolization were reported as major (sustained) or minor (transient) deficits, death, or no neurological deficits. Results A total of 36 studies comprising 459 patients were included in the review. Among patients receiving preoperative embolization for meningiomas, 4.6% (n = 21) sustained complications as a direct result of embolization. Of the 21 patients with embolization-induced complications, the incidence of major complications was 4.8% (n = 1) and the mortality rate was 9.5% (n = 2). Conclusions Preoperative embolization is associated with an added risk for morbidity and mortality. Preoperative embolization may be associated with significant complications, but careful selection of ideal cases for embolization may help reduce any added morbidity with this procedure. Although not analyzed in the authors' study, embolization may still reduce rates of surgical morbidity and mortality and therefore may still have a potential benefit for selected patients. Future prospective studies involving the use of preoperative embolization in certain cases of meningiomas may further elucidate its potential benefit and risks.
Original Article: http://thejns.org/doi/abs/10.3171/2013.3.JNS121328?ai=ru&mi=0&af=R
Clinicopathological characteristics and treatment of rhabdoid glioblastoma
Clinicopathological characteristics and treatment of rhabdoid glioblastoma
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 412-419, August 2013.
Object Rhabdoid glioblastoma (GB) is an exceedingly rare tumor in which some of the tumor cells possess rhabdoid features such as eccentric nuclei, abundant eosinophilic cytoplasm, and pseudopapillary formations. These tumors are exceptionally aggressive, and leptomeningeal dissemination is common. In the 9 previously reported cases, the longest survival was only 9 months, with a median survival of 17.8 weeks. The authors report the clinicopathological characteristics of 4 cases of rhabdoid GB and demonstrate the utility of intensive temozolomide and adjuvant therapy in these tumors. The authors also review the literature to provide the most comprehensive understanding of these rare tumors to date. Methods A retrospective review was performed of patients treated for GB at the Duke University Medical Center between 2004 and 2012. One of two experienced neuropathologists identified 4 cases as being rhabdoid GBs. Immunohistochemistry and fluorescence in situ hybridization analyses were performed in all cases. Kaplan-Meier analysis was used to assess overall survival, with the log-rank test being used to evaluate differences between survival curves. An extensive review of the literature was also performed. Results The median age of patients with rhabdoid GB was 30 years. Clinical presentation varied with location, with headache being a presenting symptom in 90% of patients. All lesions were supratentorial, and 45.5% of the cases involved the temporal lobe. Leptomeningeal dissemination occurred in 63.6% of patients, with 1 patient having extracranial metastasis to the scalp and lungs. Fluorescence in situ hybridization revealed epidermal growth factor receptor gain or amplification in all study cases. The median survival in the authors' cohort was significantly higher than that of all previously reported cases (27.5 vs 4.5 months, p = 0.003). Postoperative treatment in the authors' cohort included radiotherapy with concurrent temozolomide, bevacizumab, interleukin 13, CCNU, and/or etoposide. Conclusions Enhanced survival in the authors' 4 patients suggests that the current standard of care for the treatment of GB may be beneficial in rhabdoid GB cases, with postoperative radiotherapy and concomitant temozolomide treatment followed by adjuvant therapy. Due to the rapid tumor dissemination associated with these lesions, aggressive and timely therapy is warranted, with frequent surveillance and/or continued therapy despite stable disease. Additionally, patients should undergo full craniospinal imaging to monitor the development of distant metastatic disease.
Original Article: http://thejns.org/doi/abs/10.3171/2013.3.JNS121773?ai=ru&mi=0&af=R
Predictors of resource utilization in transsphenoidal surgery for Cushing disease
Predictors of resource utilization in transsphenoidal surgery for Cushing disease
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 504-511, August 2013.
Object The short-term cost associated with subspecialized surgical care is an increasingly important metric and economic concern. This study sought to determine factors associated with hospital charges in patients undergoing transsphenoidal surgery for Cushing disease in an effort to identify the drivers of resource utilization. Methods The authors analyzed the Nationwide Inpatient Sample (NIS) hospital discharge database from 2007 to 2009 to determine factors that influenced hospital charges in patients who had undergone transsphenoidal surgery for Cushing disease. The NIS discharge database approximates a 20% sample of all inpatient admissions to nonfederal US hospitals. A multistep regression model was developed that adjusted for patient demographics, acuity measures, comorbidities, hospital characteristics, and complications. Results In 116 hospitals, 454 transsphenoidal operations were performed. The mean hospital charge was $48,272 ± $32,060. A multivariate regression model suggested that the primary driver of resource utilization was length of stay (LOS), followed by surgeon volume, hospital characteristics, and postoperative complications. A 1% increase in LOS increased hospital charges by 0.60%. Patient charges were 13% lower when performed by high-volume surgeons compared with low-volume surgeons and 22% lower in large hospitals compared with small hospitals. Hospital charges were 12% lower in cases with no postoperative neurological complications. The proposed model accounted for 46% of hospital charge variance. Conclusions This analysis of hospital charges in transsphenoidal surgery for Cushing disease suggested that LOS, hospital characteristics, surgeon volume, and postoperative complications are important predictors of resource utilization. These findings may suggest opportunities for improvement.
Original Article: http://thejns.org/doi/abs/10.3171/2013.1.JNS121375?ai=ru&mi=0&af=R
Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas
Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 487-493, August 2013.
Object Increasingly, meningiomas are detected incidentally, prior to symptom development. While these lesions are traditionally managed conservatively until symptoms develop or lesion growth occurs, it is conceivable that patients at high risk for symptom development may benefit from earlier intervention prior to the appearance of symptoms. However, little research has been performed to determine whether Gamma Knife surgery (GKS) can alter the rate of symptom development in such patients. Methods A retrospective case study was performed by screening the University of Virginia GKS database for patients treated for asymptomatic meningiomas. From the patient's medical records, pertinent demographic and treatment information was obtained. Yearly follow-up MRI had been performed to assess tumor control and detect signs of radiation-induced injury. Clinical follow-up via neurological examination had been performed to assess symptom development. Results Forty-two patients, 33 females (78.6%) and 9 males (21.4%), with 42 asymptomatic meningiomas were included in the analysis. The median age at GKS was 53 years. The most common lesion location was the cerebral convexities (10 lesions [23.8%]), and the median lesion size was 4.0 ml. The median duration of imaging and clinical follow-ups was 59 and 76 months, respectively. During the follow-up period, 1 tumor (2.4%) increased in size, 2 patients (4.8%) demonstrated symptoms, and 1 patient (2.4%) exhibited possible signs of radiation-induced injury. Thus, actuarial tumor control rates were 100%, 95.7%, and 95.7% for 2, 5, and 10 years, respectively. Actuarial symptom control at 5 and 10 years was 97% and 93.1%, respectively. Overall progression-free survival was 91.1% and 77.8% at 5 and 10 years, respectively. Conclusions Compared with published rates of symptom development in patients with untreated meningiomas, results in this study indicated that patients with asymptomatic lesions may benefit from prophylactic radiosurgery prior to the appearance of symptoms. Additionally, GKS is a treatment option that offers low morbidity.
Original Article: http://thejns.org/doi/abs/10.3171/2013.4.JNS121746?ai=ru&mi=0&af=R
Characterization of the blood-brain barrier of metastatic and primary malignant neoplasms
Characterization of the blood-brain barrier of metastatic and primary malignant neoplasms
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents
Journal of Neurosurgery, Volume 119, Issue 2, Page 427-433, August 2013.
Object The astrocytic contribution to the blood-brain barrier (BBB) in metastatic and primary malignant brain tumors is not well understood. To better understand the vascular properties associated with metastatic and primary malignant brain tumors, the authors systematically analyzed the astrocytic component of the BBB in brain neoplasms. Methods Twelve patients who underwent resection of metastatic or primary brain neoplasms (4 metastatic lesions, 2 low-grade astrocytomas, 2 anaplastic astrocytomas, and 4 glioblastoma multiforme) were included. Clinical, MRI, operative, histopathological and immunohistochemical (glial fibrillary acidic protein [GFAP], CD31, and aquaporin 4 [AQ4]) findings were analyzed. Results Intratumoral regions of MRI enhancement corresponded with breakdown of the normal astrocyte–endothelial cell relationship in the BBB in metastatic deposits and malignant gliomas. Metastases demonstrated lack of perivascular GFAP and AQ4 on CD31-positive intratumoral vessels. At the metastasis-brain interface, normalization of GFAP and AQ4 staining associated with intraparenchymal vessels was observed. Intratumoral vasculature in enhancing regions of high-grade gliomas revealed gaps in GFAP and AQ4 staining consistent with disintegration of the normal astrocyte–endothelial cell association in the BBB. Intratumoral vasculature in low-grade and nonenhancing regions of high-grade gliomas maintained the normal astrocyte–endothelial cell relationship seen in an intact BBB, with GFAP- and AQ4-positive glial processes that were uniformly associated with the CD31-positive vasculature. Conclusions Regions of MRI enhancement in metastatic and primary malignancies correspond to areas of breakdown of the physiological astrocyte–endothelial cell relationship of the BBB, including loss of normal perivascular astrocytic architecture on GFAP and AQ4 immunohistochemistry. Nonenhancing areas are associated with preservation of the normal astrocyte–endothelial cell relationship of the intact BBB.
Original Article: http://thejns.org/doi/abs/10.3171/2013.3.JNS122226?ai=ru&mi=0&af=R
Surgical treatment of hypothalamic hamartoma causing central precocious puberty: long-term follow-up
Surgical treatment of hypothalamic hamartoma causing central precocious puberty: long-term follow-up
Journal of Neurosurgery: Journal of Neurosurgery: Pediatrics: Table of Contents
Journal of Neurosurgery: Pediatrics, Volume 12, Issue 2, Page 151-154, August 2013.
Hypothalamic hamartoma (HH) is a rare condition that often manifests as central precocious puberty (CPP). There is a lack of information available concerning the long-term effectiveness of surgery for the treatment of CPP due to HH. Here the authors describe 3 cases of CPP due to HH, with a follow-up ranging from 9 to 11 years after surgery. Three girls experienced breast growth and menses at 5–18 months of age and 5–36 months of age, respectively. Serum concentrations of luteinizing hormone, follicle-stimulating hormone, and estradiol concentrations ranged from 2.5 to 6.5 mIU/ml, 4.8–5.9 mIU/ml, and 47.9–133.0 pg/ml, respectively. Magnetic resonance imaging confirmed that CPP was caused by HH. Lesions were resected using a right pterional approach. After surgery, endocrine hormone concentrations were normalized, breasts shrunk, and menses ceased in each patient. Moreover, all of them subsequently developed normally and experienced age-appropriate onset of puberty. Each patient's height and weight were normal at the most recent follow-up (9–11 years after surgery), and none had experienced learning difficulties. Central precocious puberty due to HH can be successfully treated with resection. In the 3 cases presented, this approach was associated with both short- and long-term efficacy.
Original Article: http://thejns.org/doi/abs/10.3171/2013.4.PEDS12617?ai=3f6&mi=3ba5z2&af=R
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