scholarly journals Long-term outcomes of rotating gamma knife for vestibular schwannoma: A 4-year prospective longitudinal study of 89 consecutive patients in Vietnam

2021 ◽  
Vol 12 ◽  
pp. 585
Author(s):  
Hung Dinh Kieu ◽  
Duong Ngoc Vuong ◽  
Khoa Trong Mai ◽  
Phuong Cam Pham ◽  
Tam Duc Le
Keyword(s):  
Longitudinal Study ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Vestibular Schwannoma ◽  
Tumor Control ◽  
Prospective Longitudinal Study ◽  
Nerve Preservation ◽  
Prospective Longitudinal

Background: Microsurgical total removal of vestibular schwannoma (VS) is the definitive treatment but has a high incidence of postoperative neurological deficits. Rotating Gamma Knife (RGK) is a preferred option for a small tumor. This study aims to evaluate long-term neurological outcomes of RGK for VS. Methods: This prospective longitudinal study was conducted at the Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam. Eighty-nine consecutive patients were enrolled from October 2011 to October 2015 and followed up to June 2017. RGK was indicated for VS measuring <2.2 cm, while RGK for tumors measuring 2.2–3 cm was considered in patients with severe comorbidities, high-risk surgery, and who denied surgery. Concurrently, VS consisted of newly diagnosed, postoperative residual, and recurrent tumors. Patients with neurofibromatosis type 2 were excluded from the study. Primary outcomes were radiological tumor control rate, vestibulocochlear functions, facial and trigeminal nerve preservation. Stereotactic radiosurgery was performed by the Rotating Gamma System Gamma ART 6000. Results: The tumors were measured 20.7 ± 5.6 mm at pre treatment and 17.6 ± 4.1 mm at 3-year post treatment. The mean radiation dose was 13.5 ± 0.9 Gy. Mean follow-up was 40.6 ± 13.3 months. The radiological tumor control rate was achieved 95.5% at 5-year post treatment. The hearing and vestibular functions were preserved in 70.3% and 68.9%, respectively. The facial and trigeminal nerve preservation rates were 94.4% and 73.3%, respectively. Conclusion: RGK is an effective and safe treatment for VS measuring ≤3 cm with no significant complications during long-term follow-up.

scholarly journals The fall in antibody response to SARS-CoV-2: a longitudinal study of asymptomatic to critically ill patients up to 10 months after recovery

2021 ◽  
Author(s):  
Maddalena Peghin ◽  
Maria De Martino ◽  
Martina Fabris ◽  
Alvisa Palese ◽  
Erica Visintini ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Antibody Response ◽  
Seroconversion Rate ◽  
Disease Onset ◽  
Acute Onset ◽  
Serological Response ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

Background. The aim was to assess long-term dynamics and factors associated with the serological response against the Severe Acute Respiratory Syndrome Coronavirus 2 after primary infection. Methods. A prospective longitudinal study with monthly serological follow-up during the first 4 months, and then at 6, 8 and 10 months after the disease onset of all recovered adult in- and out-patients with Coronavirus Disease 2019 (COVID-19) attending Udine Hospital (Italy) during the first wave (from March to May 2020). Results. 542 individuals were included (289 female, mean age 53.1 years), mostly with mild COVID-19 (370, 68.3%). Patients were followed for a median of 302 days (Interquartile Range, 186-311). Overall seroconversion rate within two months was 32% for IgM and 90% for IgG. Seroreversion was observed in 90% of patients for IgM at 4 months and in 47% for IgG at 10 months. older age, number of symptoms at acute onset, severity of acute COVID-19, were all independent predictors of long-term immunity both for IgM (β, linear regression coefficient, 1.10, p=0.001; β 5.15 p=0.014; β 43.84 p=0.021, respectively) and for IgG (β 1.43 p<0.001; β 10.46 p<0.001; β 46.79 p<0.001, respectively), whereas the initial IgG peak was associated only with IgG duration (β 1.12, p <0.001). Conclusions. IgM antibodies disappeared at four months and IgG antibodies declined in about half of patients 10 months after acute COVID-19. These effects varied depending on the intensity of the initial antibody response, age and burden of acute COVID-19.

Assessing the Long-term Safety and Efficacy of Gamma Knife and Linear Accelerator Radiosurgery for Vestibular Schwannoma: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Sergio W Guadix ◽  
Alice J Tao ◽  
Anjile An ◽  
Michelle Demetres ◽  
Umberto Tosi ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Vestibular Schwannoma ◽  
Linear Accelerator ◽  
Meta Analysis ◽  
Hearing Preservation ◽  
Tumor Control ◽  
Nerve Function ◽  
Safety And Efficacy

Abstract Background Differences in long-term outcomes of single-fraction stereotactic radiosurgery (SRS) between Gamma Knife (GK) and Linear Accelerator (LINAC) systems for vestibular schwannoma (VS) management remain unclear. To investigate differences in safety and efficacy between modalities, we conducted a meta-analysis of studies over the past decade. Methods MEDLINE, EMBASE, and Cochrane databases were queried for studies with the following inclusion criteria: English-language, published between January 2010—April 2020, cohort size ≥ 30, and mean/median follow-up ≥ 5 years. Odds ratios (OR) compared rates of tumor control, hearing preservation, and cranial nerve toxicities before and after SRS. Results Thirty-nine studies were included (29 GK, 10 LINAC) with 6,516 total patients. Tumor control rates were 93% (95% CI 91-94%) and 94% (95% CI 91-97%) for GK and LINAC, respectively. Both GK (OR 0.06, 95% CI 0.02-0.13) and LINAC (OR 0.47, 95% CI 0.29-0.76) reduced odds of serviceable hearing. Neither GK (OR 0.71, 95% CI 0.41-1.22) nor LINAC (OR 1.13, 95% CI 0.64-2.00) impacted facial nerve function. GK decreased odds of trigeminal nerve impairment (OR 0.55, 95% CI 0.32-0.94) while LINAC did not impact trigeminal nerve function (OR 1.45, 95% CI 0.81-2.61). Lastly, LINAC offered decreased odds of tinnitus (OR 0.15, 95% CI 0.03-0.87) not observed with GK (OR 0.70, 95% CI 0.48-1.01). Conclusions VS tumor control and hearing preservation rates are comparable between GK and LINAC SRS. GK may better preserve trigeminal nerve function, while LINAC decreases tinnitus rates. Future studies are warranted to investigate the efficacy of GK and LINAC SRS more directly.

scholarly journals Long-term follow-up studies of Gamma Knife surgery with a low margin dose for vestibular schwannoma

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 57-62 ◽  
Author(s):  
Shibin Sun ◽  
Ali Liu
Keyword(s):  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Facial Palsy ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Trigeminal Neuropathy ◽  
Brainstem Compression ◽  
Long Term Follow Up

Object The aim of this study was to assess long-term clinical outcomes in patients who underwent Gamma Knife surgery (GKS) with a low margin dose—14 Gy or less—to treat vestibular schwannoma (VS) unrelated to neurofibromatosis Type II. Methods Between December 1994 and December 2001, 200 patients with VSs underwent GKS, which was performed using the Leksell Gamma Knife model B. More than 10 years of follow-up is available in these patients. One hundred ninety patients (88 male and 102 female patients) were followed up using MRI (follow-up rate 95%). The mean age of these patients was 50.6 years (range 10–77 years). Gamma Knife surgery was the primary treatment for VS in 134 cases (70.5%) and was an adjunctive management approach in 56 cases (29.5%). The median tumor margin dose was 13.0 Gy (range 6.0–14.4 Gy), and the median maximum tumor dose was 28.0 Gy (range 15.0–60.0 Gy). The median tumor volume was 3.6 cm3 (range 0.3–27.3 cm3). The median duration of follow-up in these patients was 109 months (range 8–195 months). Results In the 190 patients, the latest follow-up MRI studies demonstrated tumor regression in 122 patients (64.2%), stable tumor in 48 patients (25.3%), and tumor enlargement in 20 patients (10.5%). The total rate of tumor control was 89.5%. Using the Kaplan-Meier method, the authors found the estimated 3-, 5-, 10-, and 15-year tumor control rates to be 95%, 93%, 86%, and 79%, respectively; and the estimated 3-, 5-, and 10-year hearing preservation rates to be 96%, 92%, and 70%, respectively. Twenty-six patients (13.7%) exhibited transient mild facial palsy or facial spasm, and 2 patients (1.1%) suffered persistent mild facial palsy. Thirty-nine patients (20.5%) had transient trigeminal neuropathy, and 5 patients (2.6%) suffered from persistent mild facial numbness. The incidence of persistent severe facial and trigeminal neuropathy was 0.0%. Conclusions With a low prescribed margin dose of 14 Gy or less, GKS was confirmed to provide long-term tumor control for small to medium-sized VSs and largely to prevent cranial nerves from iatrogenic injury. Based on the findings of this study, GKS is also a reasonable option for the treatment of large, heterogeneously enhancing tumors without symptomatic brainstem compression. Gamma Knife surgery can preserve a high quality of life for most patients with VS who do not have symptomatic brainstem compression. Long-term follow-up is required because of the risk of delayed recurrence of VS.

scholarly journals Chikungunya Virus-associated Long-term Arthralgia: A 36-month Prospective Longitudinal Study

2013 ◽  
Vol 7 (3) ◽  
pp. e2137 ◽  
Author(s):  
Clémentine Schilte ◽  
Frédérik Staikovsky ◽  
Thérèse Couderc ◽  
Yoann Madec ◽  
Florence Carpentier ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Chikungunya Virus ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

scholarly journals MON-307 Prospective, Longitudinal Study of Glucose-Suppressed GH Levels in 87 Acromegaly Patients with IGF-1 Normalization After Surgical Therapy: Prognostic Value of Nadir GH Levels for Long-Term Remission or Recurrence

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Pamela Freda ◽  
Jeffrey N Bruce ◽  
Carlos Reyes-Vidal ◽  
Yessica De Leon ◽  
Zhezhen Jin ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Prognostic Value ◽  
Relevant Information ◽  
Oral Glucose ◽  
Surgical Removal ◽  
Prospective Longitudinal Study ◽  
Normal Ranges ◽  
Prospective Longitudinal

Abstract Surgical removal of the GH-secreting tumor is the initial treatment of choice for acromegaly. Outcome of surgery is assessed by measuring IGF-1 and glucose-suppressed GH levels. IGF-1 normalization is an essential biochemical criterion for remission. The cut-off for nadir GH after oral glucose that signifies remission, however, is debated. It also remains unclear whether GH levels provide additional prognostic or clinically relevant information when IGF-1 results are definitive. To address this question, we examined how initial postoperative glucose-suppressed GH levels change over time on serial testing in patients who achieve initial remission as defined by IGF-1 normalization. We studied 87 acromegaly patients (48M, 39F) who achieved a normal IGF-1 level after surgery alone longitudinally from 1996 to 2019. All had GH measured before and 60, 90 and 120 minutes after 75 or 100 mg oral glucose (OGTT) at ≥ 3 months after surgery and GH and IGF-1 repeated ≥ 1 year later. GH was by measured by sensitive, 22KDa GH specific assays, either a IRMA (DSL, International Reference Standard (IRS) 88/624) or a chemiluminescence immunoassay (IDS-iSYS, IRS 98/574). OGTT Nadir GH levels were also measured in healthy subjects; n=46 (26 M, 20 F, ages 19-71 yr.) by DSL and n=46 (29 M, 17 F; ages 20-66 yr.) by IDS-iSYS. Nadir GH levels in acromegaly patients were compared to the 95%CI of healthy subjects’ mean and categorized relative to healthy subjects’ 97.5 percentile, which was 0.14 µg/L for both assays. IGF-1 levels were compared to age and gender adjusted normal ranges. Subjects were grouped based on initial nadir GH ≤ or &gt; 0.14 µg/L and the patterns of change in nadir GH and IGF-1 at last follow up or until IGF-1 became elevated (i.e. recurrence). Follow up durations are given as median(range). In follow up, 73 patients remained in remission (normal IGF-1) and 14 had a recurrence (elevated IGF-1). Of the 73 in remission, 55 had initial nadir GH ≤ 0.14 µg/L that persisted to 10 yr.(1-22yr.) of follow up, 5 had initial GH ≤ 0.14 µg/L that rose to &gt; 0.14 µg/L by 9(3-21)yr., 10 had GH &gt; 0.14 µg/L that persisted at 5.5(2-22)yr., and 3 had GH &gt; 0.14 µg/L that fell to ≤ 0.14 µg/L at 5(4-7)yr. of follow up. Of the 14 that recurred, 11 had an initial and persistent GH &gt; 0.14 µg/L and developed an elevated IGF-1 level after 6(1-23) yr.. The 3 other patients that recurred had an initial GH ≤ 0.14 µg/L that rose to &gt; 0.14 µg/L by 1-6 years later and subsequently developed an elevated IGF-1 level by 14-16 years of follow up. In summary, we found that the pattern of normal IGF-1 along with nadir GH &gt; 0.14 µg/L on initial testing or developing with time, was associated with recurrence in 14/32 patients. We also found that initial nadir GH ≤ 0.14 µg/L was highly predictive of long-term persistent remission: 60/63 such patients remained in remission. In conclusion, glucose-suppressed GH levels are of prognostic value in acromegaly patients with normal IGF-1 after surgery.

Gamma-Knife Radiosurgery for Cranial Base Meningiomas: Experience of Tumor Control, Clinical Course, and Morbidity in a Follow-Up of More than 8 Years

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Iris Zachenhofer ◽  
Stefan Wolfsberger ◽  
Martin Aichholzer ◽  
Alexander Bertalanffy ◽  
Karl Roessler ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Open Surgery ◽  
Clinical Course ◽  
Gamma Knife Radiosurgery ◽  
Cranial Base ◽  
Long Term Results ◽  
Tumor Control ◽  
Long Term Follow Up

Abstract OBJECTIVE: Surgical resection of cranial base meningiomas is often limited owing to involvement of crucial neural structures. Within the last 2 decades Gamma Knife radiosurgery (GKRS) has gained increasing importance as an adjunct treatment after incomplete resection and as an alternative treatment to open surgery. However, reports of long-term results are still sparse. We therefore performed this study to analyze the long-term results of GKRS treatment of cranial base meningiomas, following our previously published early follow-up experience. METHODS: A retrospective analysis of the medical files for Gamma Knife and surgical treatments, clinicoradiological findings, and outcome was carried out focusing on tumor control, clinical course, and morbidity. RESULTS: Between 1992 and 1995, we treated 36 patients with cranial base meningiomas using GKRS (male:female ratio, 1:5; mean age, 59 yr; range, 44–89 yr). Twenty-five patients were treated with GKRS after open surgery, and 11 patients received GKRS alone. Tumor control, neurological outcomes, and adverse effects were analyzed after a long-term follow-up period (mean, 103 mo; range, 70–133 mo) and compared with our previous results after an early follow-up period (mean, 48 mo; range, 36–76 mo). Control of tumor growth was achieved in 94% of patients. Compared with the early follow-up period, the late neuroradiological effects of GKRS on cranial base meningiomas were continuing tumor shrinkage in 11 patients (33%), stable tumor size in 20 patients (64%) and tumor progression in two meningiomas (6%). The neurological status improved in 16 patients (44%), remained stable in 19 patients (52%), and deteriorated in one patient (4%). Adverse side effects of GKRS were found only during the early follow-up period. CONCLUSION: Our data confirm that GKRS is not only a safe and effective treatment modality for cranial base meningiomas in short-term observation, but also in a mean long-term follow-up period of more than 8 years. Tumor shrinkage and clinical improvement also continued during the longer follow-up period.

Long-term outcomes of Gamma Knife radiosurgery in patients with vestibular schwannomas

2011 ◽  
Vol 114 (2) ◽  
pp. 432-440 ◽  
Author(s):  
Erin S. Murphy ◽  
Gene H. Barnett ◽  
Michael A. Vogelbaum ◽  
Gennady Neyman ◽  
Glen H. J. Stevens ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Long Term Effects ◽  
Median Dose ◽  
The Mean

Object The authors sought to determine the long-term tumor control and side effects of Gamma Knife radiosurgery (GKRS) in patients with vestibular schwannomas (VS). Methods One hundred seventeen patients with VS underwent GKRS between January 1997 and February 2003. At the time of analysis, at least 5 years had passed since GKRS in all patients. The mean patient age was 60.9 years. The mean maximal tumor diameter was 1.77 ± 0.71 cm. The mean tumor volume was 1.95 ± 2.42 ml. Eighty-two percent of lesions received 1300 cGy and 14% received 1200 cGy. The median dose homogeneity ratio was 1.97 and the median dose conformality ratio was 1.78. Follow-up included MR imaging or CT scanning approximately every 6–12 months. Rates of progression to surgery were calculated using the Kaplan-Meier method. Results Of the 117 patients in whom data were analyzed, 103 had follow-up MR or CT images and 14 patients were lost to follow-up. Fifty-three percent of patients had stable tumors and 37.9% had a radiographically documented response. Imaging-documented tumor progression was present in 8 patients (7.8%), but in 3 of these the lesion eventually stabilized. Only 5 patients required a neurosurgical intervention. The estimated 1-, 3-, and 5-year rates of progression to surgery were 1, 4.6, and 8.9%, respectively. One patient (1%) developed trigeminal neuropathy, 4 patients (5%) developed permanent facial neuropathy, 3 patients (4%) reported vertigo, and 7 patients (18%) had new gait imbalance following GKRS. Conclusions Gamma Knife radiosurgery results in excellent local control rates with minimal toxicity for patients with VS. The authors recommend standardized follow-up to gain a better understanding of the long-term effects of GKRS.

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