scholarly journals Outcome of Intracerebral Cavernoma Treated by Gamma Knife Radiosurgery Based on a Double-blind Assessment of Treatment Indication

2021 ◽  
Author(s):  
Chiung-Chyi Shen ◽  
Ming-Hsi Sun ◽  
Men-Yin Yang ◽  
Weir Chiang You ◽  
Meei-Ling Sheu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Seizure Control ◽  
Gamma Knife Radiosurgery ◽  
Neurological Deficits ◽  
Seizure Freedom ◽  
Double Blind ◽  
Highly Correlated

Abstract Background: The benefit and the risk profile of Gamma Knife radiosurgery for intracerebral cavernoma remains incompletely defined in part due to the natural history of low incidence of bleeding and spontaneous regression of this vascular malformation. In this study, we retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with Gamma Knife using a double blinded review process for treatment.Methods: From 2003 to 2018, there were 94 cases of cavernoma treated by Gamma Knife radiosurgery doubly blinded assessed by two experienced neurological and approved for Gamma Knife treatment. All the patients received Gamma Knife radiosurgery with margin dose of 11-12 Gy and afterwards were assessed for neurological outcome, radiologic response, and quality of life.Results: The median age of the patients was 48(15-85) years with median follow up of 77(26-180) months post SRS. The mean treated volume was 1.93±3.45cc. In those who has pre-SRS epilepsy, 7 of 16(43.7%) achieved seizure freedom (Engel I/II) and 9 of 16 (56.3%) achieved decreased seizures (Engel III) after SRS. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post SRS. The radiologic assessment demonstrated 20 (21.3%) cases of decreased cavernoma volume, 69(73.4%) were stable, and 5 (7.3%) increased size. Eight-seven of 94 (92.5%) cases at the last follow up achieve improvement in their quality of life, but 7 cases (7.4%) showed a deterioration. In statistical analysis, the effective seizure control class (Engel I/II) was highly correlated with patient harboring a single lesion (p<0.05) and deep seated location of the cavernoma (p<0.01). New neurological deficits were highly correlated with decreased mental (p<0.001) and physical (p<0.05) components of quality of life testing, KPS (p<0.001), deep seated location (p<0.01), and increased nidus volume (p<0.05). Quality of life deterioration either in physical component (p<0.01), mental component (p<0.01), and KPS (p<0.05) was highly correlated with increased cavernoma volume.Conclusion: Low margin dose Gamma Knife radiosurgery for intracerebral cavernoma offers reasonable seizure control and improved quality of life while conferring a low risk of treatment complications including adverse radiation effect.

scholarly journals Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chiung-Chyi Shen ◽  
Ming Hsi Sun ◽  
Meng-Yin Yang ◽  
Weir-Chiang You ◽  
Meei-Ling Sheu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Seizure Control ◽  
Gamma Knife Radiosurgery ◽  
Neurological Deficits ◽  
Seizure Freedom ◽  
Double Blind ◽  
Highly Correlated

Abstract Background The benefit and the risk profile of Gamma Knife radiosurgery (GKRS) for intracerebral cavernoma remains incompletely defined in part due to the natural history of low incidence of bleeding and spontaneous regression of this vascular malformation. In this study, we retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with GKRS using a double blinded review process for treatment. Methods From 2003 to 2018, there were 94 cases of cavernoma treated by GKRS in the doubly blinded assessments by two experienced neurological and approved for GKRS treatment. All the patients received GKRS with margin dose of 11–12 (Gray) Gy and afterwards were assessed for neurological outcome, radiologic response, and quality of life. Results The median age of the patients was 48 (15–85) years with median follow up of 77 (26–180) months post SRS. The mean target volume was 1.93 ± 3.45 cc. In those who has pre-SRS epilepsy, 7 of 16 (43.7%) achieved seizure freedom (Engel I/II) and 9 of 16 (56.3%) achieved decreased seizures (Engel III) after SRS. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post SRS. The radiologic assessment demonstrated 20 (21.3%) cases of decreased cavernoma volume, 69 (73.4%) were stable, and 5 (7.3%) increased size. Eighty-seven of 94 (92.5%) cases at the last follow up achieve improvement in their quality of life, but 7 cases (7.4%) showed a deterioration. In statistical analysis, the effective seizure control class (Engel I/II) was highly correlated with patient harboring a single lesion (p < 0.05) and deep seated location of the cavernoma (p < 0.01). New neurological deficits were highly correlated with decreased mental (p < 0.001) and physical (p < 0.05) components of quality of life testing, KPS (p < 0.001), deep seated location (p < 0.01), and increased nidus volume (p < 0.05). Quality of life deterioration either in physical component (p < 0.01), mental component (p < 0.01), and KPS (p < 0.05) was highly correlated with increased cavernoma volume. Conclusion Low margin dose GKRS for intracerebral cavernoma offers reasonable seizure control and improved quality of life while conferring a low risk of treatment complications including adverse radiation effect.

scholarly journals Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication

2021 ◽  
Author(s):  
Chiung-Chyi Shen ◽  
Ming-Hsi Sun ◽  
Men-Yin Yang ◽  
Weir Chiang You ◽  
Meei-Ling Sheu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Seizure Control ◽  
Gamma Knife Radiosurgery ◽  
Neurological Deficits ◽  
Seizure Freedom ◽  
Double Blind ◽  
Treatment Indications ◽  
Double Blinded

Abstract Purpose The benefit and risk profile of Gamma Knife radiosurgery (GKRS) for intracerebral cavernoma remains undefined due to the low incidence of bleeding and spontaneous regression of cavernoma. We retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with GKRS using a double blinded review process for treatment. Methods From 2003 to 2018, 94 cases of cavernoma were treated by GKRS with margin dose of 11–12 Gy. The treatment indications were doubly blinded assessed by two experienced neurosurgeon and afterward assessed for neurological outcome, radiologic response, and quality of life. Results Seven of 16(43.7%) achieved seizure freedom and 9 of 16 (56.3%) achieved decreased seizures. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post GKRS. The nidus volume demonstrated the decrease in 20 (21.3%) cases, 69(73.4%) stable and 5 (7.3%) increase. Eight-seven of 94 (92.5%) cases achieve improvement in their quality of life. The effective seizure control was correlated with patients harboring a single lesion (p < 0.05) and deep seated location of the cavernoma (p < 0.01). New neurological deficits were correlated with decreased mental (p < 0.001) and physical (p < 0.05) components of quality of life testing, KPS (p < 0.001), deep seated location (p < 0.01), and increased nidus volume (p < 0.05). Quality of life deterioration either in physical component (p < 0.01), mental component (p < 0.01), and KPS (p < 0.05) was correlated with increased cavernoma volume. Conclusion Low margin dose GKRS for intracerebral cavernoma offers reasonable seizure control and improved quality of life with a low risk of treatment complications.

Long-Term Follow-Up of Quality of Life after Gamma Knife Radiosurgery Treatment for Arteriovenous Malformations

Radiosurgery ◽  
2006 ◽  
pp. 211-220
Author(s):  
Michael J. Jr. Musacchio ◽  
Brian Kuchay ◽  
Nimesh H. Patel ◽  
Sepehr B. Sani ◽  
Demetrius K. Lopes
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Long Term Follow Up

Gamma Knife Radiosurgery for Low-Grade Gliomas: Clinical Results at Long-Term Follow-Up of Tumor Control and Patients' Quality of Life

2017 ◽  
Vol 101 ◽  
pp. 540-553 ◽  
Author(s):  
Filippo Gagliardi ◽  
Michele Bailo ◽  
Alfio Spina ◽  
Carmine A. Donofrio ◽  
Nicola Boari ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Clinical Results ◽  
Tumor Control ◽  
Low Grade ◽  
Long Term Follow Up

LONG-TERM PAIN RESPONSE AND QUALITY OF LIFE IN PATIENTS WITH TYPICAL TRIGEMINAL NEURALGIA TREATED WITH GAMMA KNIFE STEREOTACTIC RADIOSURGERY

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 915-924 ◽  
Author(s):  
Andrew S. Little ◽  
Andrew G. Shetter ◽  
Mary E. Shetter ◽  
Curt Bay ◽  
C. Leland Rogers
Keyword(s):  
Quality Of Life ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Pain Intensity Score ◽  
Long Term Outcome ◽  
Long Term Treatment

Abstract OBJECTIVE The long-term outcome of patients treated with gamma knife radiosurgery (GKRS) for typical trigeminal neuralgia has not been fully studied. We evaluated 185 patients who underwent their first GKRS treatment between 1997 and 2003 at the Barrow Neurological Institute. METHODS Follow-up was obtained by surveys and review of medical records. Outcomes were assessed by the Barrow Neurological Institute Pain Intensity Score and Brief Pain Inventory. The most common maximum dose was 80 Gy targeted at the root entry zone. Outcomes are presented for the 136 (74%) patients for whom more than 4 years of clinical follow-up data were obtained. RESULTS Treatment failed in 33% of the cohort within 2 years, but only an additional 1% relapsed after 4 years. Actuarial analysis demonstrated that 32% of patients were pain-free off medication and 63% had at least a good outcome at 7 years. When GKRS was used as the primary treatment, 45% of the patients were pain-free at 7 years. In contrast, 10% of patients in whom previous treatment had failed were pain-free. When needed, salvage therapy with repeat GKRS, microvascular decompression, or percutaneous lesioning was successful in 70%. Posttreatment facial numbness was reported as very bothersome in 5%, most commonly in patients who underwent another invasive treatment. After GKRS, 73% reported that trigeminal neuralgia had no impact on their quality of life. CONCLUSION GKRS is a reasonable long-term treatment option for patients with typical trigeminal neuralgia. It yields durable pain control in a majority of patients, as well as improved quality of life with limited complications and it does not significantly affect the efficacy of other surgical treatments, should they be needed.

Quality of life is maintained using Gamma Knife radiosurgery: a prospective study of a brain metastases patient cohort

2017 ◽  
Vol 126 (3) ◽  
pp. 708-725 ◽  
Author(s):  
Bente Sandvei Skeie ◽  
Geir Egil Eide ◽  
Marianne Flatebø ◽  
Jan Ingeman Heggdal ◽  
Elisabeth Larsen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Radiation Therapy Oncology Group ◽  
Gamma Knife Radiosurgery ◽  
Karnofsky Performance Scale ◽  
Patient Cohort

OBJECTIVE Gamma Knife radiosurgery (GKRS) is increasingly used in the management of brain metastases (BMs), but few studies have evaluated how GKRS impacts quality of life (QOL). The aim of this study was to monitor QOL as the primary end point following GKRS in a patient cohort with BM. METHODS The study included 97 consecutive patients with 1–6 BMs treated with GKRS between May 2010 and September 2011. QOL was assessed at baseline and at 1, 3, 6, 9, and 12 months postoperatively using the Functional Assessment of Cancer Therapy–Brain (FACT-BR) questionnaire with the brain cancer subscale (BRCS) questionnaire. Factors predicting QOL were identified by mixed linear regression analyses. Local control and toxicity were evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) and the European Organisation for Research and Treatment/Radiation Therapy Oncology Group (EORTC/RTOG) criteria of late effects, respectively. RESULTS Compliance was high from baseline (97%) to 12-month follow-up (78%). Mean BRCS scores remained high during follow-up: they improved in 66% of patients and remained unchanged in 6% at 9 months. Local control (p = 0.018), improved symptoms (p = 0.005), and stable extracerebral disease (p = 0.001) correlated with high QOL-BRCS score. High baseline recursive partitioning analysis class predicted improved QOL (p = 0.031), whereas high Karnofsky Performance Scale score (p = 0.017), asymptomatic BMs (p = 0.001), and no cognitive deficits (p = 0.033) or seizures (p = 0.040) predicted high, stable QOL-BRCS during the 12-month follow-up. CONCLUSIONS QOL remained stable for up to 12 months following GKRS for the total cohort. High QOL was reported if local control occurred, cerebral symptoms improved/stabilized, or the need for steroids declined, which all reflected successful GKRS. Conversely, low QOL accompanied progression of intra- and extracerebral disease. Based on the study findings, GKRS appears to be a safe and effective treatment option for patients with BMs.

scholarly journals Epilepsziasebészeti beavatkozások eredményei a Pécsi Epilepszia Centrumban 2005 és 2016 között

2019 ◽  
Vol 160 (7) ◽  
pp. 270-278 ◽  
Author(s):  
Katalin Nóra Lőrincz ◽  
Beáta Bóné ◽  
Márton Tóth ◽  
Réka Horváth ◽  
Norbert Kovács ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Epilepsy Surgery ◽  
Employment Status ◽  
Postoperative Outcome ◽  
Seizure Freedom ◽  
Neurologic Disease ◽  
Exact Test ◽  
Epileptic Patients

Abstract: Introduction: Epilepsy as a chronic, severe neurologic disease significantly influences the quality of life of the epileptic patients. In candidates well selected for surgery, the seizure freedom is realistically achievable, and the quality of life can be further improved with complex individual rehabilitation. Aim: We aimed to evaluate the postoperative outcome of patients who underwent epilepsy surgery between 2005 and 2016 at the Epilepsy Center at Pécs. Method: We evaluated seizure status at regular follow-up visits after surgery and the quality of life using questionnaires focusing on employment and social status. Results: 76% of the 72 patients who underwent surgical resection for epilepsy were free from disabling seizures , and 10% had rare disabling seizures (almost seizure-free), 7% experienced worthwhile improvement and 7% had no worthwhile improvement. Comparing the employment status of patients free from disabling seizures to patients not free from disabling seizures, we found that the employment status is significantly influenced by seizure freedom (p<0.01, Fisher’s exact test). While 67% of seizure-free patients were employed, only 19% of patients not free from disabling seizures were hired. Conclusion: Our results resemble the international tendencies and success rate, proving epilepsy surgery as an available, valid and effective treatment in well selected patients. Orv Hetil. 2019; 160(7): 270–278.

Gamma Knife Radiosurgery for the Treatment of Cavernous Sinus Meningiomas

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 517-524 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Tomoya Ishiguro
Keyword(s):  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Tumor Regression ◽  
Gamma Knife Radiosurgery ◽  
Growth Control ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Tumor Diameter

Abstract OBJECTIVE We report on the efficacy of gamma knife radiosurgery for cavernous sinus meningiomas. METHODS Between January 1994 and December 1999, we used gamma knife radiosurgery for the treatment of 43 patients with cavernous sinus meningiomas. Forty-two patients were followed up for a mean of 49.4 months (range, 18–84 mo). The patients' average age was 55 years (range, 18–81 yr). Twenty-two patients (52%) underwent operations before radiosurgery, and 20 patients (48%) underwent radiosurgery after the diagnosis was made by magnetic resonance imaging. The tumor volumes ranged from 1.2 to 101.5 cm3 (mean, 14.7 cm3). The tumors either compressed or were attached to the optic apparatus in 17 patients (40.5%). The marginal radiation dose was 8 to 15 Gy (mean, 11 Gy), and the optic apparatus was irradiated with 2 to 12 Gy (mean, 6.2 Gy). Three patients with a mean tumor diameter greater than 4 cm were treated by two-stage radiosurgery. RESULTS Thirty-eight patients (90.5%) demonstrated tumor growth control during the follow-up period after radiosurgery. Tumor regression was observed in 25 patients (59.5%), and growth was unchanged in 13 patients (31%). Regrowth or recurrence occurred in four patients (9.5%). The actual tumor growth control rate at 5 years was 92%. Only one patient (2.4%) experienced regrowth within the treatment field; in other patients, regrowth occurred at sites peripheral to or outside the treatment field. Twelve patients (28.6%) had improved clinically by the time of the follow-up examination. None of the patients experienced optic neuropathy caused by radiation injury or any new neurological deficits after radiosurgery. CONCLUSION Gamma knife radiosurgery may be a useful option for the treatment of cavernous sinus meningiomas not only as an adjuvant to surgery but also as an alternative to surgical removal. We have shown it to be safe and effective even in tumors that adhere to or are in close proximity to the optic apparatus.

Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life

2013 ◽  
Vol 119 (2) ◽  
pp. 318-323 ◽  
Author(s):  
Philippe Schucht ◽  
Fadi Ghareeb ◽  
Hugues Duffau
Keyword(s):  
Quality Of Life ◽  
Return To Work ◽  
Seizure Control ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Neurological Deficits ◽  
Main Concern ◽  
Low Grade ◽  
Who Grade

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.

scholarly journals Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia

2005 ◽  
Vol 18 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Ajay Jawahar ◽  
Rishi Wadhwa ◽  
Caglar Berk ◽  
Gloria Caldito ◽  
Allyson Delaune ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Gamma Knife Surgery ◽  
Patient Satisfaction Score

Object There are various surgical treatment alternatives for trigeminal neuralgia (TN), but there is no single scale that can be used uniformly to assess and compare one type of intervention with the others. In this study the objectives were to determine factors associated with pain control, pain-free survival, residual pain, and recurrence after gamma knife surgery (GKS) treatment for TN, and to correlate the patients' self-reported quality of life (QOL) and satisfaction with the aforementioned factors. Methods Between the years 2000 and 2004, the authors treated 81 patients with medically refractory TN by using GKS. Fifty-two patients responded to a questionnaire regarding pain control, activities of daily living, QOL, and patient satisfaction. The median follow-up duration was 16.5 months. Twenty-two patients (42.3%) had complete pain relief, 14 (26.9%) had partial but satisfactory pain relief, and in 16 patients (30.8%) the treatment failed. Seven patients (13.5%) reported a recurrence during the follow-up period, and 25 (48.1%) reported a significant (> 50%) decrease in their pain within the 1st month posttreatment. The mean decrease in the total dose of pain medication was 75%. Patients' self-reported QOL scores improved 90% and the overall patient satisfaction score was 80%. Conclusions The authors found that GKS is a minimally invasive and effective procedure that yields a favorable outcome for patients with recurrent or refractory TN. It may also be offered as a first-line surgical modality for any patients with TN who are unsuited or unwilling to undergo microvascular decompression.

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