Midterm Prognosis and Surgical Implication of Clival Chordoma after an Extended Transsphenoidal Tumor Removal and Gamma Knife Radiosurgery

2020 ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Hidefumi Jokura ◽  
Teiji Tominaga
Keyword(s):  
Survival Rate ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Total Removal ◽  
Tumor Removal ◽  
Clinical Investigations ◽  
Extended Transsphenoidal Approach ◽  
Prophylactic Irradiation

Abstract Background: Treatment for chordoma by surgery alone is often ineffective, so surgery and irradiation is often performed with a reported 5-year survival rate of 60-75%. The clinical course varies; however, disease rarity has prevented large number clinical investigations. Methods: Nineteen patients suffering from clival chordomas were retrospectively investigated. They were initially treated with maximal tumor removals by extended transsphenoidal approach. When total removal was achieved prophylactic irradiation was not performed. If tumor remnants or recurrence was confirmed, gamma knife (GK) was performed. Follow-up periods ranged from 9 to 224 months (mean 85.4 months). Results: Total removal was achieved in 10 patients; however, 4 patients suffered recurrence and required GK. Overall progression free intervals were 9 to 151 months (mean 59.9 mzonths). GK was applied for 11 patients with a 50 % isodose of 13 to 18 Gy (mean 15.4 Gy). Eight patients remained progression free, but 3 patients suffered repeated local recurrence and died from tumor related complications. Overall survival was 9 to 224 months (mean 90.9 months). Eighteen patients survived more than 5 years with the exception of one male patient, who died of lung cancer 36 months after the initial treatment (5-year survival rate 94.7 %). The results indicated that sex (males), those given more than 15 Gy of a 50% isodose by GK, and prophylactic brain scanning were significant favorable prognostic factors. Conclusions: The favorable outcomes in this investigation may indicate value for early detection and early treatment. The role of surgery may be adequate conditioning for enough dose of GK.

scholarly journals Midterm prognosis and surgical implication for clival chordomas after extended transsphenoidal tumor removal and gamma knife radiosurgery

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Hidefumi Jokura ◽  
Teiji Tominaga
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
Gamma Knife ◽  
Clinical Course ◽  
Gamma Knife Radiosurgery ◽  
Tumor Removal ◽  
Extended Transsphenoidal Approach ◽  
The Mean ◽  
Total Tumor Removal ◽  
Prophylactic Irradiation

Abstract Background Treating chordoma through surgery alone is often ineffective. Thus, surgery often performed with irradiation, with a reported 5-year survival rate of 60–75%. The clinical course varies, and disease rarity prevents larger number of clinical investigations. Methods In total, 19 patients with clival chordomas were retrospectively extracted from our institutional database. They were initially treated with maximal tumor removal using the extended transsphenoidal approach between March 2006 and January 2021. When total tumor removal was achieved, prophylactic irradiation was not performed. If tumor remnants or recurrence were confirmed, Gamma Knife (GK) radiosurgery was performed. The mean follow-up period was 106.7 months (ranged 27–224 months). The clinical course and prognostic factors were investigated. Results Total removal was achieved in 10 patients, whereas 4 patients suffered recurrence and required GK. GK was applied to 11 patients with a 50% isodose of 13–18 Gy (mean: 15.4 Gy), and eight patients remained progression free, whereas three patients suffered repeated local recurrence and died of tumor-related complications. The mean overall progression-free interval was 57.2 months (range: 6–169 months). One male patient died of tumor un-related lung cancer 36 months after the initial treatment, and other patients survived throughout the observational periods. The mean overall survival was 106.7 months (range: 27–224 months). Thus, the 5-year survival rate was 94.7%. Statistical analysis indicated that sex (men), > 15 Gy of 50% isodose by GK, and screening brain examinations as prophylactic medicine were significant favorable prognostic factors. Conclusions The favorable outcomes in this investigation suggest the importance of early detection and treatment. Surgery may enable better conditions for sufficient GK doses.

PETROCLIVAL MENINGIOMAS

Neurosurgery ◽  
2007 ◽  
Vol 60 (6) ◽  
pp. 965-981 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Laligam N. Sekhar ◽  
David Schessel ◽  
Akio Morita
Keyword(s):  
Survival Rate ◽  
Gamma Knife ◽  
Cranial Nerve ◽  
Tumor Resection ◽  
Gamma Knife Radiosurgery ◽  
Free Survival ◽  
Petroclival Meningiomas ◽  
Long Term Follow Up

Abstract OBJECTIVE To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclivaTl meningiomas. METHODS During a 13-year period (1991–2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of the patients. Thirty patients (20%) previously underwent operation or irradiation. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and seven patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation or radiosurgery was administered to 47 of the 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, telephone calls, and review of their recent radiological images. RESULTS At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow-up period was 102 months (range, 15–180 mo). Seven patients (5%; five of the subtotal and partially resected patients and two of the total resection patients) had recurrence; of these patients, two underwent repeat resection and four were treated with gamma knife radiosurgery. One of the patients died of tumor progression with no response to gamma knife radiosurgery. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years; the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky Performance Scale score was 78 ± 11 preoperatively, 76 ± 11 at 1 year postoperatively, and 84 ± 9 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included diplopia, loss of hearing, balance problems, and loss of sensation in the V1 and V2 cranial nerve distribution. Most patients developed coping mechanisms. CONCLUSION This series has the largest number of patients with the longest follow-up period, to our knowledge, reported in the literature to date. The excellent quality of life at the time of the long-term follow-up examination for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.

GAMMA KNIFE RADIOSURGERY FOR FACIAL SCHWANNOMAS

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. 1102-1105 ◽  
Author(s):  
Ricky Madhok ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Effective Management ◽  
Facial Weakness ◽  
Fractionated Radiotherapy ◽  
Muscle Twitching ◽  
Facial Function

Abstract OBJECTIVE Patients who have a schwannoma of the facial nerve (facial schwannoma, facial neuroma) can be managed with observation, surgical resection, stereotactic radiosurgery, or fractionated radiotherapy. Attempted complete resection is associated with facial weakness. The role of radiosurgery in these patients remains to be defined. METHODS We reviewed the clinical and imaging outcomes in patients who underwent gamma knife radiosurgery for a facial schwannoma. RESULTS Six patients had radiosurgery and were followed for a mean and median of 46.6 and 61.5 months, respectively (21–85 months). Three had a previous resection, and in 3 the diagnosis was made based on clinical and imaging criteria. All patients had facial nerve symptoms (5 had weakness and 1 had muscle twitching). House-Brackmann grades before radiosurgery were as follows: 1 (n = 1), 2 (n = 3), 3 (n = 1), and 6 (n = 1). The radiosurgery margin dose was 12 or 12.5 Gy. On later imaging, 3 tumors had regressed (with the longest follow-up duration) and 3 were unchanged. All patients had preservation of their preradiosurgery facial function. No other adverse effects were noted and all patients maintained their preradiosurgery level of hearing. CONCLUSION Over a mean of almost 4 years of follow-up, radiosurgery was shown to be a safe and effective management for residual and newly diagnosed facial schwannomas.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

Gamma knife radiosurgery as a lesioning technique in movement disorder surgery

1997 ◽  
Vol 2 (3) ◽  
pp. E13 ◽  
Author(s):  
Ronald F. Young ◽  
Anne Shumway-Cook ◽  
Sandra S. Vermeulen ◽  
Peter Grimm ◽  
John Blasko ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Movement Disorder ◽  
Gamma Knife ◽  
Movement Disorders ◽  
Rating Scale ◽  
Gamma Knife Radiosurgery ◽  
Magnetic Resonance Images ◽  
Maximum Deviation

Fifty-five patients underwent radiosurgical placement of lesions either in the thalamus (27 patients) or globus pallidus (28 patients) for treatment of movement disorders. Patients were evaluated pre- and postoperatively by a team of observers skilled in the assessment of gait and movement disorders who were blinded to the procedure performed. They were not associated with the surgical team and concomitantly and blindly also assessed a group of 11 control patients with Parkinson's disease who did not undergo any surgical procedures. All stereotactic lesions were made with the Leksell gamma unit using the 4-mm secondary collimator helmet and a single isocenter with dose maximums from 120 to 160 Gy. Clinical follow-up evaluation indicated that 88% of patients who underwent thalamotomy became tremor free or nearly tremor free. Statistically significant improvements in performance were noted in the independent assessments of Unified Parkinson's Disease Rating Scale (UPDRS) scores in the patients undergoing thalamotomy. Eighty-five and seven-tenths percent of patients undergoing pallidotomy who had exhibited levodopa-induced dyskinesias had total or near-total relief of that symptom. Clinical assessment indicated improvement of bradykinesia and rigidity in 64.3% of patients who underwent pallidotomy. Independent blinded assessments did not reveal statistically significant improvements in Hoehn and Yahr scores or UPDRS scores. On the other hand, 64.7% of patients showed improvements in subscores of the UPDRS, including activities of daily living (58%), total contralateral score (58%), and contralateral motor scores (47%). Ipsilateral total UPDRS and ipsilateral motor scores were both improved in 59% of patients. One (1.8%) of 55 patients experienced a homonymous hemianopsia 9 months after pallidotomy due to an unexpectedly large lesion. No other complications of any kind were seen. Follow-up neuroimaging confirmed correct lesion location in all patients, with a mean maximum deviation from the planned target of 1 mm in the vertical axis. Measurements of lesions at regular interals on postoperative magnetic resonance images demonstrated considerable variability in lesion volumes. The safety and efficacy of functional lesions made with the gamma knife appear to be similar to those made with the assistance of electrophysiological guidance with open functional stereotactic procedures. Functional lesions may be made safely and accurately using gamma knife radiosurgical techniques. The efficacy is equivalent to that reported for open techniques that use radiofrequency lesioning methods with electrophysiological guidance. Complications are very infrequent with the radiosurgical method. The use of functional radiosurgical lesioning to treat movement disorders is particularly attractive in older patients and those with major systemic diseases or coagulopathies; its use in the general movement disorder population seems reasonable as well.

The role of gamma knife radiosurgery in children

2001 ◽  
Vol 17 (6) ◽  
pp. 347-347
Author(s):  
Massimo Scerrati
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery
Sign in / Sign up

Export Citation Format

Share Document