scholarly journals Gamma Knife Radiosurgery for Berry Aneurysms: Quo Vadis

2020 ◽  
Author(s):  
Manjul Tripathi ◽  
Aman Batish ◽  
Sandeep Mohindra
Keyword(s):  
Gamma Knife ◽  
Intracranial Aneurysms ◽  
Vascular Malformations ◽  
Gamma Knife Radiosurgery ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Invasive Treatment ◽  
Mortality And Morbidity ◽  
Primary Treatment Modality ◽  
Quo Vadis

Abstract Background Intracranial aneurysms are vascular malformations with significant mortality and morbidity profile. Various treatment modalities have been developed to positively impact the outcome profile with gradual shift to the minimally invasive treatment modalities. Gamma knife radiosurgery (GKRS) is an established primary treatment modality for various intracranial arteriovenous malformations (AVMs); however, its efficacy for berry aneurysmal obliteration has been historically dismal. Objective The aim of this study is to evaluate the factors responsible for poor radio surgical outcome for intracranial aneurysms. Methods The literature is reviewed for the differential efficacy of GKRS for aneurysm and AVM. Results Though both are vascular malformations, aneurysm and AVM have inherent differences in angioarchitecture, intracranial location, surrounding neighborhood, radio-sensitivity, and latency for obliteration. The major difference arises because of surrounding neighborhood of connective tissue stroma which stabilizes the irradiated pathology. Conclusion Though considered radioresistant, aneurysms show promising results with animal models of radiosurgery. The future lies in two hypothetical improvements: with a supporting neighborhood or sensitization of the vessel wall that may change the natural history of an aneurysm, especially an unruptured one.

Treatment of temporal artery pseudoaneurysms

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 274-279 ◽  
Author(s):  
Irene Thomassen ◽  
Elisabeth G Klompenhouwer ◽  
Edith M Willigendael ◽  
Joep AW Teijink
Keyword(s):  
Superficial Temporal Artery ◽  
Surgical Excision ◽  
Temporal Artery ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Diagnostic Process ◽  
Thrombin Injection ◽  
Invasive Treatment ◽  
Artery Pseudoaneurysm ◽  
Primary Treatment Modality

Purpose To give an overview of the etiology and diagnostic process of superficial temporal artery pseudoaneurysms and to evaluate different treatment modalities. Basic methods PubMed was used for searching multiple databases for relevant clinical studies. Principal findings A total of 62 studies were included, harboring 82 patients. Surgical excision is the most frequently described treatment, but less invasive treatment modalities as coiling and thrombin injections are gaining popularity. Surgical treatment was successful in all cases (67/67). Endovascular treatment was successful in 69% (9/13); the five cases treated with thrombin injection were all successful. Complementary, a description of our experience with thrombin injection is given. Conclusions Limited evidence of minimal invasive treatment for superficial temporal artery pseudoaneurysm is available. Based on this review combined with our limited experience, we suggest thrombin injections to be considered as the future primary treatment modality. In the case of unsuccessful exclusion of the aneurysm, surgical excision can be performed.

scholarly journals P03.07 Radiosurgical managementof trigeminal schwannomas: A single center experience

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii26-iii26
Author(s):  
R M Emad Eldin ◽  
A M El-Shehaby ◽  
K Abdel Karim ◽  
W A Reda ◽  
A Nabeel ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
Target Volume ◽  
Primary Treatment ◽  
Tumor Control ◽  
Single Center Experience ◽  
Primary Treatment Modality ◽  
The Mean

Abstract BACKGROUND Trigeminal schwannomas are a rare form of intracranial schwannomas. They can occur anywhere along the track of the trigeminal nerve, including the middle, posterior fossa or both. It can even extend extracranially. The variability of its location and extent, in addition to its close proximity to critical neurovascular structures makes surgical intervention challenging. Taking from the success of treating vestibular schwannomas with stereotactic radiosurgery, it has been used as an alternative to surgery for the treatment of trigeminal schwannomas. Because these tumors are rare more clinical evidence is required to assess the response of these tumors to stereotactic radiosurgery.The aim of this study was to evaluate the efficacy and complications associated with treatment of the trigeminal schwannomas by gamma knife radiosurgery. MATERIAL AND METHODS The study included 51 patients with trigeminal schwannomas not associated with NF2, treated by Leksell gamma knife. There were 25 males and 26 females. The mean age at presentation was 43 years. The patients underwent a total of 58 gamma knife sessions (44 single and 7 volume-staged sessions). Eight patients had previous surgery. The tumor nature was solid in 46, cystic in 3 and mixed in 2 patients. The mean target volume was 8.5 cc (0.6–30.7 cc) with the mean overall tumor volume being 9.6 cc (0.6–31.1 cc). The mean prescription dose was 12 Gy. RESULTS The mean follow up was 57 months (12–152 months). The tumor shrank in 23 (45%) patients and remained stable in 25 (49%). Tumor progressions occurred in 3 (6%) patients. The tumor control rate was 92%. The progression-free survival at 5,7 and 10 years was 95%, 88% and 79%, respectively. Clinical improvement occurred in 27 (53%) patients and was significantly associated with tumor shrinkage (p 0.03). Twenty patients (39%) remained clinically unchanged. Adverse radiation events occurred in 7 patients and were significantly associated with target and overall tumor volume (p 0.028 and 0.004). CONCLUSION Gamma knife radiosurgery appears to be an effective and safe adjuvant and primary treatment modality for trigeminal schwannomas. Large tumors should be debulked first before radiosurgery, when feasible.

scholarly journals Involvement of Microglia in the Pathophysiology of Intracranial Aneurysms and Vascular Malformations—A Short Overview

2021 ◽  
Vol 22 (11) ◽  
pp. 6141
Author(s):  
Teodora Larisa Timis ◽  
Ioan Alexandru Florian ◽  
Sergiu Susman ◽  
Ioan Stefan Florian
Keyword(s):  
Immune Cells ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Immune Cell ◽  
Vascular Malformations ◽  
Cerebral Injury ◽  
Future Research ◽  
Mortality And Morbidity ◽  
The Central Nervous System ◽  
The Brain

Aneurysms and vascular malformations of the brain represent an important source of intracranial hemorrhage and subsequent mortality and morbidity. We are only beginning to discern the involvement of microglia, the resident immune cell of the central nervous system, in these pathologies and their outcomes. Recent evidence suggests that activated proinflammatory microglia are implicated in the expansion of brain injury following subarachnoid hemorrhage (SAH) in both the acute and chronic phases, being also a main actor in vasospasm, considerably the most severe complication of SAH. On the other hand, anti-inflammatory microglia may be involved in the resolution of cerebral injury and hemorrhage. These immune cells have also been observed in high numbers in brain arteriovenous malformations (bAVM) and cerebral cavernomas (CCM), although their roles in these lesions are currently incompletely ascertained. The following review aims to shed a light on the most significant findings related to microglia and their roles in intracranial aneurysms and vascular malformations, as well as possibly establish the course for future research.

scholarly journals Postherpetic Nneuralgia: Review of Treatment Modalities

2000 ◽  
Vol 5 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Philip SL Chan ◽  
Alexander J Clark
Keyword(s):  
Postherpetic Neuralgia ◽  
Tricyclic Antidepressants ◽  
Opioid Analgesics ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Nerve Blocks ◽  
Varicella Zoster ◽  
Primary Treatment Modality ◽  
Topical Medications ◽  
Physical Modalities

BACKGROUND: Varicella zoster virus (VZV) is the etiological agent for both varicella (chickenpox) and herpes zoster (HZ) (shingles). HZ results from the reactivation of VZV acquired during childhood. Postherpetic neuralgia (PHN) is the most common complication of HZ infection in immunocompetent patients. There is no universally accepted definition of PHN. While the mechanisms producing pain associated with PHN are not fully understood, peripheral and central processes are thought to be important.METHODS: The literature on the pathophysiology and the treatment of postherpetic neuralgia was reviewed for the past 30 years by using Index Medicus.CONCLUSIONS: Many modalities to treat PHN are available; none of them are very effective. The most commonly used modalities are tricyclic antidepressants, anticonvulsants, opioid analgesics, topical medications, physical modalities such as acupuncture and transcutaneous nerve stimulation, and nerve blocks. The tricyclic antidepressants have the most evidence supporting their role in treating PHN, although only half of the patients with PHN benefit. Recent studies support the use of opioid analgesics in PHN. There is a growing body of evidence in support of the use of gabapentin for PHN. Physical modalities and topical medications are probably most useful as adjuncts to centrally acting agents, not as a primary treatment modality. Injections (nerve blocks) are effective in relieving PHN anecdotally, although there are no controlled clinical trials showing efficacy.

scholarly journals Cerebral arteriovenous malformation radiosurgery after intracranial hemorrhage: A case report and literature review

2017 ◽  
Vol 70 (7-8) ◽  
pp. 241-244
Author(s):  
Bojan Jelaca ◽  
Tomislav Cigic ◽  
Vladimir Papic ◽  
Mladen Karan ◽  
Jagos Golubovic ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Intracranial Hemorrhage ◽  
Good Condition ◽  
Gamma Knife Radiosurgery ◽  
Treatment Modalities ◽  
Temporal Region ◽  
Surgical Morbidity

Introduction. Treatment of cerebral arteriovenous malformations is very challenging and controversial in spite of current recommendations. Surgery is recommended in patients with hemorrhagic stroke, but in patients with good neurological status, when symptoms improve rapidly, the risk of surgical morbidity may be much higher than the risk of rebleeding. Case report. We report a case of a patient with an intracranial hemorrhage due to a ruptured arteriovenous malformation located in the right temporal region of the brain. Because of angiographic and anatomical features of the arteriovenous malformation (deep location and deep venous drainage, but also small arteriovenous malformation nidus size), radiosurgery was the preferred treatment modality. The patient was treated conservatively in the acute stage, and the arteriovenous malformation was subsequently completely eradicated with gamma knife radiosurgery. During the 3-year imaging follow-up, no sings of rebleeding were found. Also, angiography demonstrated that the arteriovenous malformation was completely excluded from the cerebral circulation. The patient was in a good condition and presented without neurological deficits or seizures during the follow-up period. Conclusion. All treatment modalities carry a risk of neurological compromise, but gamma knife radiosurgery may be a good option, even in cases with hemorrhagic presentation. It needs to be mentioned that complete obliteration takes approximately 1 to 3 years after the treatment, and in some cases it cannot be obtained.

scholarly journals COVID-19 and end stage renal disease treatment modalities in the United States

2021 ◽  
pp. 003-009
Author(s):  
Sullivan John D
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Health Coverage ◽  
Home Hemodialysis ◽  
Primary Treatment Modality ◽  
Stage Renal Disease ◽  
End Stage

From the establishment of nearly universal health coverage for end stage renal disease in 1972 to 2021, the primary treatment modality has been in-center hemodialysis despite significant advances in home therapies such as peritoneal dialysis and home hemodialysis. There are many theories as to why peritoneal and home hemodialysis lack so far behind in prescriptions with profitability and or a patient’s compliance or support leading the logical explanations. But 2020 was a different year with the surge in COVID-19 cases.

Gamma knife radiosurgery for brain metastases: a primary therapeutic option

2002 ◽  
Vol 97 ◽  
pp. 515-524 ◽  
Author(s):  
Massimo Gerosa ◽  
Antonio Nicolato ◽  
Roberto Foroni ◽  
Bruno Zanotti ◽  
Laura Tomazzoli ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Functional Independence ◽  
Primary Treatment ◽  
Tumor Control ◽  
Content Type ◽  
Cystic Tumors ◽  
Fine Print

Object. The aim of this retrospective study was to assess the role of gamma knife radiosurgery (GKS) as a primary treatment for brain metastases by evaluating the results in particularly difficult cases such as oncotypes—which are unresponsive to radiation—cystic lesions, and highly critical locations such as the brainstem. Methods. Treatment of 804 patients with 1307 solitary (29%), single (26%), and multiple (45%) brain metastases was evaluated. Treatment planning parameters were as follows: mean tumor volume 4.8 cm3 (range 0.01–21.5 cm3), mean prescription dose 20.6 Gy (range 12–29 Gy), and mean number of isocenters 6.5 (one–19). In unresponsive oncotypes such as melanoma and renal cell carcinoma, the mean target dosages were higher. Cystic metastatic lesions were initially stereotactically evacuated and then GKS was performed. Patients with brainstem metastases were treated with lower doses. Conventional radiotherapy was used in only a minority (14%) of selected cases. The overall median patient survival time was 13.5 months, and the 1-year actuarial local progression-free survival rate was 94%, with a mean palliation index and functional independence index of 53.8 and 52.5 weeks, respectively. The local tumor control rate was 93%, with a mean follow-up period of 14 months. In the overall series, and especially in the unresponsive oncotypes, systemic disease progression was the main limiting factor with regard to patient life expectancy. Conclusions. Gamma knife radiosurgery seems to be the primary treatment option for patients harboring small-tomedium size (≤ 20-cm3) brain metastases with reasonable life expectancy and no impending intracranial hypertension. Results are better than with those obtained using whole-brain radiotherapy and comparable to the best selected surgery—radiation series, even in oncotypes unresponsive to therapeutic radiation, cystic tumors, and tumors located in the brain stem.

Lineac- and Gamma-Knife Radiosurgery for Angiographically Occult Vascular Malformations

1994 ◽  
pp. 195-208
Author(s):  
Kazumasa Ehara ◽  
Norihiko Tamaki ◽  
Katsuzo Fujita ◽  
Atsufumi Kawamura ◽  
Kazufumi Imanaka ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Vascular Malformations ◽  
Gamma Knife Radiosurgery
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