scholarly journals Pulsed reduced dose-rate radiotherapy for previously irradiated tumors in the brain and spine

2021 ◽  
Vol 12 ◽  
pp. 280
Author(s):  
Arpan V. Prabhu ◽  
Madison Lee ◽  
Edvaldo Galhardo ◽  
Madison Newkirk ◽  
Analiz Rodriguez ◽  
...  
Keyword(s):  
Dose Rate ◽  
Cranial Irradiation ◽  
Recurrent Glioblastoma ◽  
Precentral Gyrus ◽  
Management Options ◽  
Thoracic Spinal Cord ◽  
Reduced Dose ◽  
Thoracic Spinal ◽  
The Brain

Background: Patients with unresectable locoregional cancer recurrences have limited management options. Reirradiation increases the risk of toxicity, particularly when perilesional dose-volume constraints are exceeded. We present and discuss two cases of previously irradiated tumors in the central nervous system (CNS) that was reirradiated using the pulsed reduced dose-rate radiotherapy (PRDR) technique. Case Description: A 58-year-old female with a history of metastatic small cell lung cancer to the brain status post multiple rounds of radiation and chemotherapy presented with increasing weakness in her right arm and leg. Magnetic resonance imaging (MRI) revealed a growly peripherally enhancing 1.2 cm mass in the left precentral gyrus that had previously received prophylactic cranial irradiation and stereotactic radiosurgery. The patient was re-irradiated with 35 Gy in 100 fractions over 3 weeks, using PRDR with improved motor function at 3-month follow-up. A 41-year-old male with recurrent glioblastoma of the thoracic spinal cord presented with worsening neurological symptoms, including inability to ambulate due to bilateral leg weakness, causing wheelchair use. MRI thoracic spine revealed a recurrent thoracic lesion 2.2 × 1 × 0.8 cm. In addition to chronic chemotherapy, the patient was retreated palliatively in the same area at 50 Gy in 250 fractions, over 6 weeks, using PRDR. The treated lesion was stable on follow-up imaging, and the patient was able to walk with the assistance of a walker. Conclusion: In our two cases, PRDR proved effective in the treatment of recurrent malignant CNS tumors that were previously irradiated. Prospective studies are needed to delineate the efficacy and toxicity of PRDR.

scholarly journals Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury

Neurology ◽  
2019 ◽  
Vol 93 (16) ◽  
pp. e1550-e1560 ◽  
Author(s):  
Dario Pfyffer ◽  
Eveline Huber ◽  
Reto Sutter ◽  
Armin Curt ◽  
Patrick Freund
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Status ◽  
Lesion Length ◽  
Lesion Area ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Cord Injury ◽  
Cystic Cavity

ObjectiveTo investigate the spatiotemporal evolution and predictive properties of intramedullary damage and midsagittal tissue bridges at the epicenter of a thoracic spinal cord injury (SCI) using MRI.MethodsWe retrospectively assessed midsagittal T2-weighted scans from 25 patients with thoracic SCI (14 traumatic, 11 ischemic) at 1 month post-SCI. In 12 patients with SCI, linear mixed-effects models on serial MRI explored temporal trajectories of quantifiable lesion markers (area, length, and width) and tissue bridges. Using partial correlation analysis, we assessed associations between structural lesion characteristics at 1 month post-SCI and recovery at 1 year postinjury, adjusting for baseline clinical status, age, and sex.ResultsLesion area decreased by 5.68 mm2 (p = 0.005), lesion length by 2.14 mm (p = 0.004), and lesion width by 0.13 mm (p = 0.004) per month. Width of tissue bridges increased by 0.06 mm (p = 0.019) per month, being similar in traumatic and ischemic SCI (p = 0.576). Smaller lesion area, length, width, and wider tissue bridges at 1 month post-SCI predicted better recovery at 1-year follow-up.ConclusionsOver time, the immediate area of cord damage shrunk while the cystic cavity became demarcated. Adjacent to the cyst, midsagittal tissue bridges became visible. The width of tissue bridges at 1 month post-SCI predicted recovery at 1 year follow-up. Measures of lesion area and tissue bridges early after traumatic and ischemic thoracic SCI therefore allow characterizing the evolution of focal cord damage and are predictive of recovery in thoracic SCI. Thus, lesion extent and tissue bridges hold potential to improve diagnosis and patient stratification in interventional trials.

Subependymomas

1999 ◽  
Vol 123 (4) ◽  
pp. 306-309 ◽  
Author(s):  
Richard A. Prayson ◽  
John H. Suh
Keyword(s):  
Cell Proliferation ◽  
Tertiary Care ◽  
Cystic Degeneration ◽  
Subtotal Resection ◽  
Positive Staining ◽  
Low Grade ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Mib 1

Abstract Background.—Subependymomas are uncommonly encountered ependymal tumors, which are important to distinguish from ordinary ependymomas because of their generally better prognosis. Objective.—To review the clinicopathologic features and MIB-1 labeling indices (marker of cell proliferation) of 14 subependymomas. Design.—Retrospective review of 14 subependymomas encountered in a tertiary care setting. Results.—Fourteen ependymomas presenting in 8 men and 6 women between the ages of 18 and 78 years (mean, 53.6 years) comprise the study group. The most common clinical presentations included ataxia (n = 4), dizziness/vertigo (n = 3), nausea/vomiting (n = 3), headaches (n = 3), and incidental finding at autopsy (n = 2). Tumor locations included fourth ventricle (n = 7), lateral ventricle (n = 4), third ventricle (n = 2), and thoracic spinal cord (n = 1). Eight patients underwent gross total resection, and 4 had subtotal resection. Tumors were characterized by clustering of cell nuclei arranged against a fibrillary background. Focal cystic degeneration was seen in 10 tumors, hemosiderin deposition in 8 tumors, sclerotic vessels in 8 tumors, calcifications in 5 tumors, and focal nuclear pleomorphism in 2 tumors. Mitotic figures, vascular endothelial proliferation, and necrosis were not seen in any of these tumors. Cell proliferation marker MIB-1 labeling indices (percentage of positive staining tumor cells) ranged from 0 to 1.4 (mean, 0.3). In comparison, 13 myxopapillary ependymomas had labeling indices ranging from 0 to 5.5 (mean, 1.1). Thirty-nine low-grade ependymomas had MIB-1 labeling indices of 0.1 to 5.4 (mean, 1.1). Fourteen anaplastic/malignant ependymomas had MIB-1 labeling indices ranging from 0.4 to 34.0 (mean, 12.8). One subependymoma was treated with radiation therapy. Six patients were alive with no evidence of tumor at a mean follow-up of 94.4 months. Two patients were alive with residual tumor (follow-up of 4 and 53 months). Two patients died with tumor at 0.67 and 43.4 months. One patient was lost to follow-up, 1 is a recent case, and 2 were incidental findings at autopsy. None of the patients developed tumor recurrence. Conclusions.—Subependymomas are generally low-grade lesions, as evidenced by their benign clinical course and low MIB-1 labeling indices. Compared with other ependymal tumors, subependymomas have the lowest rate of cell proliferation as evidenced by MIB-1 immunostaining.

Preganglionic discharge to the cardiovascular system in the comatose cat

1963 ◽  
Vol 205 (4) ◽  
pp. 754-760 ◽  
Author(s):  
Richard S. Tuttle
Keyword(s):  
Cardiovascular System ◽  
Systemic Blood Pressure ◽  
Direct Stimulation ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Organ Response ◽  
Frequency Of Stimulation ◽  
The Brain ◽  
Sympathetic Discharge ◽  
Postganglionic Nerve

A technique for isolating and recording from single fibers in the thoracic spinal canal permits access to the entire preganglionic outflow of the thoracic spinal cord of the cat. In the cat rendered comatose by the selective destruction of the brain stem, there are two interchangeable patterns of impulse activity which reflect the level of systemic blood pressure. Periodic bursts of high-frequency discharge, synchronous with the respiratory cycle, are replaced by continuous activity when increased sympathetic discharge to the cardiovascular system is evoked by hypothalamic stimulation or by reflex mechanisms. The data suggest that impulse pattern as well as frequency of stimulation may be a factor of importance in the sympathetic organ response to direct stimulation of the innervating postganglionic nerve.

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

2014 ◽  
Vol 20 (1) ◽  
pp. 30-40 ◽  
Author(s):  
Christoph J. Griessenauer ◽  
David F. Bauer ◽  
Thomas A. Moore ◽  
Patrick R. Pritchard ◽  
Mark N. Hadley
Keyword(s):  
Thoracic Myelopathy ◽  
Short Segment ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Signal Change ◽  
Long Term Follow Up ◽  
Outcome Comparison ◽  
Thoracic Cord

Object Various pathologies involving the thoracic arachnoid mater uniformly manifest as thoracic myelopathy and may present a significant management dilemma. The authors undertook this study to assess outcome in cases of thoracic myelopathy due to thoracic arachnoid pathology. Methods The authors have cared for and followed 28 patients with thoracic myelopathy from thoracic arachnoid pathology over the last 17 years. A chart review and contemporary follow-up of these patients was performed and outcomes were reported. Results Patients with thoracic myelopathy from thoracic arachnoid pathology often have improvement in their condition after surgical decompression/detethering procedures. While not universal, patients in this series had improvement in mJOA scores at 1 year after surgery (p = 0.0001) and at last follow-up (p = 0.04). Results indicated that across a wide variety of pathologies the extent of thoracic spinal cord involvement is a predictor of the disease course and outcome. Comparison of the group of patients with cord involvement limited to 2 vertebral segments (short-segment pathology) versus the group with cord tethering of more than 2 segments (long-segment pathology) showed that patients in the short-segment group more frequently had ventral or dorsal arachnoid bands (p = 0.003), more frequently had signal change in the cord on MRI (p = 0.02), and less frequently presented with a syrinx (p = 0.02), and a smaller percentage of patients in this group underwent reoperation (p = 0.02). While patients with short-segment pathology typically improved after a single operative intervention, patients with long-segment pathology typically improved after multiple operations, frequently for CSF diversion. Conclusions Thoracic arachnoid pathology causing thoracic cord dysfunction and myelopathy is varied, has multiple etiologies, and can be difficult to treat over the long term. Surgical management, when indicated, is case specific. Serial long-term follow-up is essential to document enduring clinical and radiographic success.

scholarly journals Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management

1999 ◽  
Vol 6 (1) ◽  
pp. E6 ◽  
Author(s):  
Fernando L. Vale ◽  
Jennifer Burns ◽  
Amie B. Jackson ◽  
Mark N. Hadley
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Bladder Function ◽  
Thoracic Spinal Cord ◽  
Arterial Blood ◽  
Thoracic Spinal ◽  
Cord Injury

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

Multifocal meningeal melanocytoma: a new pathological entity or the result of leptomeningeal seeding?

2009 ◽  
Vol 111 (3) ◽  
pp. 488-491 ◽  
Author(s):  
Youssef Ali ◽  
Ralph Rahme ◽  
Ronald Moussa ◽  
Gerard Abadjian ◽  
Lina Menassa-Moussa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Malignant Transformation ◽  
Treatment Options ◽  
Pathological Features ◽  
Unique Case ◽  
Thoracic Spinal Cord ◽  
Meningeal Melanocytoma ◽  
Leptomeningeal Seeding ◽  
Thoracic Spinal ◽  
The Brain

Meningeal melanocytoma is a rare benign CNS tumor derived from the leptomeningeal melanocytes. Although unusual, malignant transformation with leptomeningeal seeding into the brain or spinal cord may occur years after the initial diagnosis. The authors report a unique case of multifocal benign meningeal melanocytoma involving both cerebellopontine angles and the thoracic spinal cord, with associated diffuse leptomeningeal hyperpigmentation. They review the literature relevant to this topic and discuss the radiological and pathological features of this disease as well as its treatment options.

scholarly journals Outcomes with multi-disciplinary management of central lung tumors with CT-guided percutaneous high dose rate brachyablation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Stephanie M. Yoon ◽  
Robert Suh ◽  
Fereidoun Abtin ◽  
Drew Moghanaki ◽  
Scott Genshaft ◽  
...  
Keyword(s):  
Adverse Events ◽  
Dose Rate ◽  
Pulmonary Hemorrhage ◽  
Lung Tumors ◽  
High Dose Rate ◽  
High Dose ◽  
Median Dose ◽  
Management Options ◽  
Ct Guided

Abstract Background Centrally located lung tumors present treatment challenges given their proximity to mediastinal structures including the central airway, esophagus, major vessels, and heart. Therapeutic options can be limited for medically inoperable patients, particularly if they have received previous thoracic radiotherapy. High dose rate (HDR) brachyablation was developed to improve the therapeutic ratio for patients with central lung tumors. The purpose of this study is to report initial safety and efficacy outcomes with this treatment for central lung malignancies. Methods From September 2015 to August 2019, a total of 25 patients with 37 pulmonary tumors were treated with percutaneous HDR brachyablation. Treatment was delivered by a multi-disciplinary team of interventional radiologists, pulmonologists, and radiation oncologists. Twenty-three patients received a median dose of 21.5 Gy (range 15–27.5) in a single fraction, whereas two patients received median dose of 24.75 Gy (range 24–25.5) over 2–3 fractions. Tumor local control (LC) was evaluated by Response Evaluation Criteria in Solid Tumors v1.1. Treatment-related toxicities were graded by Common Terminology Criteria for Adverse Events v5.0, with adverse events less than 90 days defined as acute, and those occurring later were defined as late. LC, progression-free survival (PFS), and overall survival (OS) rates were estimated by the Kaplan–Meier method. Results Of 37 treated tumors, 88% were metastatic. Tumor location was central and ultra-central in 24.3% and 54.1%, respectively. Average tumor volume was 11.6 cm3 (SD 12.4, range 0.57–62.8). Median follow-up was 19 months (range 3–48). Two–year LC, PFS, and OS were 96.2%, 29.7%, and 65.5%, respectively. Thirteen of 39 (33.3%) catheter implantation procedures were associated with trace minor pneumothorax requiring no intervention, 1 (2.5%) procedure with minor radiographic pulmonary hemorrhage, and 4 (10.3%) with major pneumothorax requiring chest tube insertions. All procedural complications resolved within 24 h from treatment. Acute grade 1–2 toxicity was identified in 4 patients, whereas none developed late toxicity beyond 90 days of follow-up. Conclusion Percutaneous HDR brachyablation is a safe and promising treatment option for centrally located primary and metastatic lung tumors. Future comparisons with stereotactic body radiotherapy and other ablative techniques are warranted to expand multi-disciplinary management options.

Regression of recurrent glioblastoma infiltrating the brainstem after convection-enhanced delivery of nimustine hydrochloride

2011 ◽  
Vol 7 (5) ◽  
pp. 522-526 ◽  
Author(s):  
Ryuta Saito ◽  
Yukihiko Sonoda ◽  
Toshihiro Kumabe ◽  
Ken-ichi Nagamatsu ◽  
Mika Watanabe ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Cranial Irradiation ◽  
Recurrent Glioblastoma ◽  
Lymphocytic Leukemia ◽  
Convection Enhanced Delivery ◽  
Brainstem Lesion ◽  
History Of ◽  
Nimustine Hydrochloride ◽  
The Right

This 13-year-old boy with a history of cranial irradiation for the CNS recurrence of acute lymphocytic leukemia developed a glioblastoma in the right cerebellum. Resection and chemo- and radiotherapy induced remission of the disease. However, recurrence was noted in the brainstem region 8 months later. Because no effective treatment was available for this recurrent lesion, the authors decided to use convection-enhanced delivery (CED) to infuse nimustine hydrochloride. On stereotactic insertion of the infusion cannula into the brainstem lesion, CED of nimustine hydrochloride was performed with real-time MR imaging to monitor the co-infused chelated gadolinium. The patient's preinfusion symptom of diplopia disappeared after treatment. Follow-up MR imaging revealed the response of the tumor. The authors report on a case of recurrent glioblastoma infiltrating the brainstem that regressed after CED of nimustine hydrochloride.

Transthoracic Approach to an Intramedullary Vascular Malformation of the Thoracic Spinal Cord

Neurosurgery ◽  
1982 ◽  
Vol 10 (5) ◽  
pp. 631-634 ◽  
Author(s):  
Richard B. Raynor ◽  
Richard Weiner
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Vascular Malformation ◽  
Anterior Spinal Artery ◽  
Intercostal Artery ◽  
Transthoracic Approach ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

Abstract A transthoracic approach with resection of a vertebral body was used to obtain access to an intramedullary vascular malformation of the thoracic spinal cord. The malformation consisted of three discrete intramedullary tufts of vessels fed by an abnormal branch of the anterior spinal artery arising from the T-9 intercostal artery. Although the abnormal branch of the anterior spinal artery did not appear to supply normal cord, the patient developed transient weakness postoperatively after occlusion of this artery. Follow-up angiography showed that one part of the malformation was still present and was fed by the T-6 intercostal artery.

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