Follow-up of intra-arterial delivery of bevacizumab for treatment of butterfly glioblastoma in patient with first-in-human, real-time MRI-guided intra-arterial neurointervention

2021 ◽  
pp. neurintsurg-2021-017900
Author(s):  
Michal Zawadzki ◽  
Jerzy Walecki ◽  
Boguslaw Kostkiewicz ◽  
Kacper Kostyra ◽  
Piotr Walczak ◽  
...  
Keyword(s):  
Real Time ◽  
Tumor Recurrence ◽  
Tumor Volume ◽  
Neurological Status ◽  
Arterial Infusion ◽  
Second Procedure ◽  
Discharge From Hospital ◽  
The Brain ◽  
Positive Effect

This case report shows that real-time MRI may aid in the precision of intra-arterial delivery of bevacizumab to butterfly glioblastoma. Fast clinical improvement, decrease of contrast enhancing status, and no serious adverse effects were observed at discharge from hospital. The patient regained pre-recurrent neurological status for 2 months with a subsequent fast clinical decline and an increase in tumor volume. The patient underwent a second procedure of intra-arterial delivery of bevacizumab to the brain, with substantial clinical and radiological improvement, but not the level of improvement observed after the first procedure. Another clinical decline occurred with an increase in tumor size and the patient was treated 2 months later with a third intra-arterial infusion of bevacizumab. While another positive effect was achieved, it was less pronounced than before, and the patient died 1.5 months later. There were no technical, ischemic or other complications during the procedures. The patient survived 218 days from the first symptoms of tumor recurrence, 190 days from the first MRI, and 175 days from the first intra-arterial treatment of bevacizumab.

MULTISESSION CYBERKNIFE STEREOTACTIC RADIOSURGERY OF LARGE, BENIGN CRANIAL BASE TUMORS

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 898-907 ◽  
Author(s):  
Francesco Tuniz ◽  
Scott G. Soltys ◽  
Clara Y. Choi ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Stereotactic Radiosurgery ◽  
Radiation Injury ◽  
Tumor Volume ◽  
Neurological Status ◽  
Cranial Base ◽  
Single Session ◽  
Effective Option ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE Although radiosurgery plays an important role in managing benign cranial base lesions, the potential for increased toxicity with single-session treatment of large tumors is a concern. In this retrospective study, we report the intermediate-term rate of local control, morbidity, and clinical outcomes of patients with large cranial base tumors treated with multisession stereotactic radiosurgery with the CyberKnife (Accuray, Inc., Sunnyvale, CA). METHODS Between 1999 and 2008, 34 consecutive patients with large (>15 cm3), benign cranial base tumors (21 meningiomas, 9 schwannomas, 4 glomus jugulare tumors) underwent primary or postoperative radiosurgical treatment using a multisession approach at Stanford University and were considered in this retrospective study. Forty-four percent of these patients had undergone previous subtotal surgical resection or radiotherapy. CyberKnife radiosurgery was delivered in 2 to 5 sessions (median, 3 sessions) to a median tumor volume of 19.3 cm3 (range, 15.8–69.3 cm3). The median marginal dose was 24 Gy (range, 18–25 Gy) prescribed to a median 78% isodose line. RESULTS After a median clinical follow-up of 31 months (range, 12–77 months), 21% of patients experienced clinical improvement of neurological symptoms, whereas neurological status remained unchanged among the rest. Four patients experienced prolonged use of glucocorticoids owing to transient neurological worsening and radiographic signs of radiation injury. No permanent neurotoxicity was seen. To date, all tumors remain locally controlled. CONCLUSION Over our modest length of follow-up, multisession radiosurgery appears to be a safe and effective option for selected large, benign brain and cranial base lesions.

Microsurgery for Small Arteriovenous Malformations of the Brain: Results in 110 Consecutive Patients

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 571-577 ◽  
Author(s):  
Justin H. T. Pik ◽  
Michael K. Morgan
Keyword(s):  
Arteriovenous Malformations ◽  
Postoperative Outcome ◽  
Neurological Status ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
History Of ◽  
The Brain ◽  
Results Of Surgery

ABSTRACT OBJECTIVE To examine the results of surgery in 110 consecutive patients with arteriovenous malformations (AVMs) smaller than 3 cm in diameter. These results are compared with the published results of other microsurgical series as well as with results for patients treated with focused irradiation. METHODS From January 1989 to November 1998, 121 patients with AVMs smaller than 3 cm were treated at our institution. One hundred ten patients underwent microsurgical removal of their AVMs. The presentation, preoperative neurological status, and postoperative outcome were recorded. Follow-up was complete for all surgical cases. RESULTS Of the 110 patients, 109 (99%) had angiographically confirmed obliteration of their AVMs. Two patients (1.8%) required reoperation for residual AVM. Two (4.3%) of 46 patients with AVMs in eloquent brain areas experienced worsening of their neurological status after surgery. One (1.6%) of 64 patients was worse neurologically after removal of an AVM in a noneloquent area. CONCLUSION Microsurgical removal is a safe and effective treatment for the majority of AVMs smaller than 3 cm in diameter. Although the treatment is accompanied by a risk of acute onset of neurological deficits, this tends to be transient in the majority of cases. Furthermore, microsurgical excision of small AVMs offers patients immediate protection from the natural history of their vascular lesions.

Stereotactic Radiotherapy for Vestibular Schwannomas: Favorable Outcome with Minimal Toxicity

Neurosurgery ◽  
2005 ◽  
Vol 57 (1) ◽  
pp. 60-70 ◽  
Author(s):  
Annie W. Chan ◽  
Peter McL. Black ◽  
Robert G. Ojemann ◽  
Fred G. Barker ◽  
Hanne M. Kooy ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Stereotactic Radiotherapy ◽  
Tumor Recurrence ◽  
Tumor Volume ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Trigeminal Neuropathy ◽  
Neurosurgical Intervention ◽  
Conventionally Fractionated

Abstract OBJECTIVE: To determine the outcome and toxicity in patients with vestibular schwannomas treated with conventionally fractionated stereotactic radiotherapy (SRT) and to identify prognostic factors that are predictive of outcome. METHODS: Between 1992 and 2001, 70 patients with vestibular schwannomas were treated with linear accelerator-based SRT in our institutions. Eleven patients had neurofibromatosis Type II (NF2). The median age was 53 years (range, 17–82 yrs). The median tumor volume was 2.4 cm3 (range, 0.05–21.1 cm3). The indications for SRT were distributed as follows: 47% newly diagnosed, 31% progressive tumors after watchful waiting, 3% adjuvant postoperative radiation, and 19% recurrent tumors after surgical resection. The median dose was 54 Gy in 1.8 Gy per fraction, prescribed to 95% of the isodose line. Relocatable stereotactic frames were used for daily treatments. The median follow-up was 45.3 months. RESULTS: Tumor recurrence was defined as progressive enlargement of tumor on follow-up magnetic resonance imaging studies. One patient had a tumor recurrence at 38 months after SRT. The actuarial tumor control rates were 100 and 98% at 3 and 5 years, respectively. Three patients with a median tumor volume of 16.2 cm3 required surgical resection for persistent or increasing symptoms at a median of 37 months. The actuarial freedom from resection rates were 98 and 92% at 3 and 5 years, respectively. In multivariate analysis, tumor volume at time of treatment was predictive for neurosurgical intervention (surgical resection or shunt placement) after SRT (P = 0.001). The 3- and 5-year actuarial rates of freedom from any neurosurgical intervention were 100 and 97% for patients with tumor volume less than 8 cm3 and 74 and 47% respectively for patients with tumor of at least 8 cm3 (P < 0.0001). The 3-year actuarial rates of facial and trigeminal nerve preservation were 99 and 96%, respectively. Surgery before SRT was predictive of posttreatment trigeminal neuropathy. The 3-year actuarial rates of freedom from trigeminal neuropathy were 86 and 98% for patients with and without previous resection, respectively (P = 0.04). There was no difference in tumor control and cranial nerve function preservation rates seen in NF2 patients compared with non-NF2 patients. No second primary cancer or malignant transformation was observed. CONCLUSION: SRT in the conventionally fractionated approach results in a very favorable outcome with minimal toxicity, with results comparable to those of the best of the radiosurgery series. Patients with large tumors are more likely to undergo neurosurgical interventions after SRT. Patients who have undergone previous surgery are at increased risk of developing trigeminal neuropathy.

scholarly journals Clinical and laboratorial characterization and post-surgical follow-up of 87 patients with non-functioning pituitary macroadenomas

2013 ◽  
Vol 71 (5) ◽  
pp. 307-312 ◽  
Author(s):  
Paulo Andrade de Mello ◽  
Luciana Ansaneli Naves ◽  
Aldo Pereira Neto ◽  
Eduardo Henrique Oliveira ◽  
Ivan Coelho Ferreira ◽  
...  
Keyword(s):  
Visual Field ◽  
Postoperative Complications ◽  
Hair Loss ◽  
Tumor Recurrence ◽  
Tumor Volume ◽  
Surgical Approaches ◽  
Tumor Diameter ◽  
Acid Base ◽  
Pituitary Macroadenomas

Objective:It was to assess the main characteristics of patients undergoing pituitary tumor surgery.Method:Eighty-seven patients (44 men; 44.8±13 years old) were included.Results:The main symptoms were visual alterations (87.3%), headache (70.1%), diminished libido (34.4%), galactorrhea (22.9%) and hair loss (19.5%). The axes affected were gonadotropic (72.6%), thyrotropic (48.4%) and corticotropic (38.7%), without significant changes after surgery. The average largest tumor diameter was 3.1 cm before surgery and 1.56 cm after surgery. The most frequent postoperative complications were hydro-electrolyte and acid-base disorders (12%), diabetes insipidus (9%), visual field alterations (9%), liquoric fistula (8%) and nasal obstruction (7%). The patients were affected by more than one complication.Conclusion:Although a decrease in tumor volume was achieved through surgery, hormonal deficiencies persisted in most of the patients and new surgical approaches were necessary for dealing with tumor recurrence or persistence.

Longitudinal Changes in Individual BrainAGE in Healthy Aging, Mild Cognitive Impairment, and Alzheimer’s Disease

GeroPsych ◽  
2012 ◽  
Vol 25 (4) ◽  
pp. 235-245 ◽  
Author(s):  
Katja Franke ◽  
Christian Gaser
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Healthy Aging ◽  
Brain Aging ◽  
Elderly Subjects ◽  
Additional Increase ◽  
Longitudinal Changes ◽  
Novel Method ◽  
The Brain

We recently proposed a novel method that aggregates the multidimensional aging pattern across the brain to a single value. This method proved to provide stable and reliable estimates of brain aging – even across different scanners. While investigating longitudinal changes in BrainAGE in about 400 elderly subjects, we discovered that patients with Alzheimer’s disease and subjects who had converted to AD within 3 years showed accelerated brain atrophy by +6 years at baseline. An additional increase in BrainAGE accumulated to a score of about +9 years during follow-up. Accelerated brain aging was related to prospective cognitive decline and disease severity. In conclusion, the BrainAGE framework indicates discrepancies in brain aging and could thus serve as an indicator for cognitive functioning in the future.

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

2019 ◽  
Vol 58 (05) ◽  
pp. 371-378
Author(s):  
Alfred O. Ankrah ◽  
Ismaheel O. Lawal ◽  
Tebatso M.G. Boshomane ◽  
Hans C. Klein ◽  
Thomas Ebenhan ◽  
...  
Keyword(s):  
Tracer Uptake ◽  
Pet Ct ◽  
The Mean ◽  
18F Fdg ◽  
Definition Of ◽  
Gallium 68 ◽  
Attending Physician ◽  
Pet Scans ◽  
The Brain

Abstract 18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Head Injury ◽  
Brain Tumour ◽  
Severe Head Injury ◽  
Case Reports ◽  
Subsequent Development ◽  
Malignant Brain Tumour ◽  
Tumour Development ◽  
Short Period ◽  
The Brain

There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.

67-LB: Clinical Cost Offset Analysis Comparing Real-Time CGM (RTCGM) with SMBG Based on the COMISAIR 3-Year Follow-Up Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 67-LB
Author(s):  
JAN SOUPAL ◽  
JOHN J. ISITT ◽  
GEORGE GRUNBERGER ◽  
MARTIN PRAZNY ◽  
CHRISTOPHER PARKIN ◽  
...  
Keyword(s):  
Real Time ◽  
Follow Up Study ◽  
Cost Offset

EVALUASI KESESUAIAN PELAKSANAAN PROBITY AUDIT PADA BPKP PUSAT DENGAN PEDOMAN PROBITY AUDIT PENGADAAN BARANG/JASA PEMERINTAH

INFO ARTHA ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 17-34
Author(s):  
Fadlil Usman
Keyword(s):  
Public Sector ◽  
Real Time ◽  
Procurement Process ◽  
Assessment Activity

Probity audit is an independence assessment activity to ensure the goods/services procurement processes have been implemented consistently appropriate with the principle of upholding integrity, uprightness, honesty and fulfill certain occur legislation aimed for improving the accountability for the use of public sector fund. Probity audit is done in real time simultaneously with the goods/services procurement process. This study aims to evaluate the suitability of the implementation of probity audit conducted by BPKP Headquarter as agency that initiated the implementation of probity audit in Indonesia compared with the Probity audit Guidelines for Procurement of Goods/Services as criteria. The results of this study indicate that the implementation of probity audit conducted by BPKP Headquarter has been implemented adequately, but there are activities that do not fit the criteria, especially in the activities of the determination of the scope of the audit, the preparation of working papers and the follow-up monitoring of the audit results. Probity audit merupakan kegiatan penilaian (independen) untuk memastikan bahwa proses pengadaan barang/jasa telah dilaksanakan secara konsisten sesuai dengan prinsip penegakan integritas, kebenaran, kejujuran dan memenuhi ketentuan perundangan yang berlaku yang bertujuan meningkatkan akuntabilitas penggunaan dana sektor publik. Probity audit dilakukan secara real time yaitu bersamaan dengan pelaksanaan pengadaan barang/jasa. Penelitian ini bertujuan untuk melakukan evaluasi kesesuaian pelaksanaan probity audit yang dilakukan oleh BPKP Pusat selaku instansi yang menginisiasi pelaksanaan probity audit di Indonesia dibandingkan dengan kriteria berupa Pedoman Probity audit Pengadaan Barang/Jasa Pemerintah. Hasil dari penelitian ini menunjukkan bahwa pelaksanaan probity audit yang dilakukan oleh BPKP Pusat sudah dilaksanakan secara memadai, namun masih terdapat hal yang belum sesuai dengan kriteria terutama dalam kegiatan penentuan ruang lingkup audit, penyusunan kertas kerja dan pemantauan terhadap tindak lanjut hasil audit.

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