Results of excision of cerebral radionecrosis: experience in patients treated with radiation therapy for nasopharyngeal carcinoma

2010 ◽  
Vol 113 (2) ◽  
pp. 293-300 ◽  
Author(s):  
Sui-To Wong ◽  
Ka-Tai Loo ◽  
Kwong-Yui Yam ◽  
Wai-Man Hung ◽  
Kam-Fuk Fok ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Brain Edema ◽  
Temporal Lobe ◽  
Mass Effect ◽  
Karnofsky Performance Scale ◽  
Low Incidence ◽  
Indications For Operation ◽  
Age Range ◽  
Reoperation Rates

Object In theory, the purpose of the treatment of cerebral radionecrosis (CRN), a nonneoplastic condition, is to minimize loss of brain function by preventing the progression and reversing some of the processes of CRN. In a practical sense, factors for achieving this purpose may include the following: removal of a CRN lesion that is causing mass effect, control of brain edema, prevention of recurrence of CRN lesions, minimization of adverse effects from treatments, and achievement of reasonably long and good-quality survivals. Based on these practical issues, the authors performed a retrospective study to evaluate the results of excision for the treatment of CRN. Methods The authors retrospectively reviewed the results of excision of CRN lesions in a group of patients with temporal lobe CRN due to radiotherapy for nasopharyngeal carcinoma. Patients who had undergone surgery at the authors' institution between January 1998 and November 2008 were analyzed. Surgical results were evaluated by assessing postoperative resolution of brain edema, recurrence of temporal lobe CRN, surgery-related complications, and postoperative functional status and survival. Results Twenty-four patients were included (age range 39–69 years; in 23 patients nasopharyngeal carcinoma was in remission). All patients underwent craniotomy for excision of the contrast-enhancing region. The indications for operation were temporal lobe CRN lesions with a mass-occupying effect beyond the temporal lobe. There were 32 craniotomies in all (mean postoperative follow-up 40 months). It was found that brain edema resolved rapidly postoperatively. The recurrence and reoperation rates were 6.3 and 3.1%, respectively. There were no surgery-related deaths. The median survival was 72 months, and 67% of the patients had a Karnofsky Performance Scale score of ≥ 70% at the time of their last follow-up. Conclusions In a specific group of patients with CRN of the temporal lobe in whom the CRN lesions were causing a mass-occupying effect beyond the temporal lobe, excision of the contrast-enhancing region was safe and could achieve prompt resolution of brain edema and a low incidence of recurrence of CRN.

scholarly journals Dynamic MRI follow-up of radiation encephalopathy in the temporal lobe following nasopharyngeal carcinoma radiotherapy

2017 ◽  
Vol 14 (1) ◽  
pp. 715-724 ◽  
Author(s):  
Xiaofeng Zhou ◽  
Xiaofang Liao ◽  
Xiaoqiu Ren ◽  
Kewei Xiang ◽  
Qiongge Hu ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Temporal Lobe ◽  
Dynamic Mri ◽  
Radiation Encephalopathy

scholarly journals Treatment of Intracranial Aneurysms Using Flow-Diverting Silk Stents (BALT): A Single Centre Experience

2011 ◽  
Vol 17 (3) ◽  
pp. 306-315 ◽  
Author(s):  
M. Leonardi ◽  
L. Cirillo ◽  
F. Toni ◽  
M. Dall'Olio ◽  
C. Princiotta ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Major Complication ◽  
Mass Effect ◽  
Time Frame ◽  
Post Treatment ◽  
Parent Artery ◽  
Silk Stent ◽  
Single Centre Experience ◽  
Age Range

The Silk stent (Balt, Montmorency, France) is a retractable device designed to achieve curative reconstruction of the parent artery associated with an intracranial aneurysm. We present our initial experience with the Silk flow-diverting stent in the management and follow-up of 25 patients presenting with intracranial aneurysms. Twenty-five patients (age range, 34–81 years; 24 female) were treated with the Silk flow-diverting device. Aneurysms ranged in size from small (5), large (10) and giant (10) and included wide-necked aneurysms, multiple, nonsaccular, and recurrent intracranial aneurysms. Nine aneurysms were treated for headache, 14 for mass effect. None presented with haemorrhage. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least three months after treatment. A total of 25 Silk stents were used. Control MR angiography and/or CT angiography was typically performed prior to discharge and at one, three, six and 12 months post treatment. A follow-up digital subtraction angiogram was performed between six and 19 months post treatment. Complete angiographic occlusion or subtotal occlusion was achieved in 15 patients in a time frame from three days to 12 months. Three deaths and one major complication were encountered during the study period. Two patients, all with cavernous giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the Silk treatment. Both were treated with corticosteroids, and symptoms resolved completely within a month. In our experience the Silk stent has proven to be a valuable tool in the endovascular treatment of intracranial giant partially thrombosed aneurysms and aneurysms of the internal carotid artery cavernous segment presenting with mass effect. The time of complete occlusion of the aneurysms and the risk of the bleeding is currently not predictable.

Results of external pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing's disease

1991 ◽  
Vol 125 (4) ◽  
pp. 470-474 ◽  
Author(s):  
A. Vicente ◽  
J. Estrada ◽  
C. de la Cuerda ◽  
B. Astigarraga ◽  
M. Marazuela ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
High Efficiency ◽  
Cushing's Disease ◽  
Anterior Pituitary Function ◽  
Low Incidence ◽  
Pituitary Irradiation ◽  
Age Range ◽  
Pituitary Adrenal Axis ◽  
Tsh Deficiency

Abstract. Fourteen adult patients (10 females and 4 males; age range 20-60 years) with persistent Cushing's disease after transsphenoidal microsurgery were treated with pituitary irradiation. Supervoltage multiportal administration was employed at a total dose of 50 Gy (±0.65 sd). The interval between microsurgery and pituitary irradiation was less than 6 months in 6 patients and more than 6 months in 8. The pituitary-adrenal axis was evaluated postsurgically, before irradiation and every 6 months thereafter. The remaining anterior pituitary function was simultaneously tested. Remission rates at 12 months and 24 months after radiotherapy were 61 and 70%, respectively. Two patients developed TSH deficiency and another gonadotropin deficiency during the follow-up after radiation. We conclude that pituitary irradiation is the treatment of choice for persistent Cushing's disease after unsuccessful surgery because of its high efficiency and low incidence of adverse reactions when compared with other forms of treatment.

scholarly journals Peritumoral brain edema in intracranial meningiomas: the emergence of vascular endothelial growth factor–directed therapy

2013 ◽  
Vol 35 (6) ◽  
pp. E2 ◽  
Author(s):  
Jack Hou ◽  
Varun R. Kshettry ◽  
Warren R. Selman ◽  
Nicholas C. Bambakidis
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Brain Edema ◽  
Antiangiogenic Therapy ◽  
Mass Effect ◽  
Vascular Endothelial ◽  
Close Relationship ◽  
Peritumoral Brain Edema ◽  
Endothelial Growth Factor

Meningioma is the second most common type of adult intracranial neoplasm. A substantial subset of patients present with peritumoral brain edema (PTBE), which can cause significant morbidity via mass effect, complicate surgical management, and impact the safety of stereotactic radiosurgery. Recent studies suggest a close relationship between vascular endothelial growth factor-A (VEGF-A) expression and PTBE development in meningiomas. The authors performed a systematic review of the literature on the pathogenesis of PTBE in meningiomas, the effectiveness of steroid therapy, the role played by VEGF-A, and the current clinical evidence for antiangiogenic therapy to treat peritumoral brain edema. Mounting evidence suggests VEGF-A is secreted directly by meningioma cells to induce angiogenesis and edemagenesis of tumoral as well as peritumoral brain tissue. The VEGF-A cascade results in recruitment of cerebral-pial vessels and disruption of the tumor-brain barrier, which appear to be requisite for VEGF-A to have an edemagenic effect. Results of preliminary clinical studies suggest VEGF-directed therapy has modest activity against recurrent and progressive meningioma growth but can alleviate PTBE in some patients. A comprehensive understanding of the VEGF-A pathway and its modulators may hold the key to an effective therapeutic approach to treating PTBE associated with meningiomas. Further clinical trials with larger patient cohorts and longer follow-up periods are warranted to confirm the efficacy of VEGF-directed therapy.

A Reappraisal of Angioplasty and Stenting for the Treatment of Vertebral Origin Stenosis

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 607-616 ◽  
Author(s):  
Felipe C. Albuquerque ◽  
David Fiorella ◽  
Patrick Han ◽  
Robert F. Spetzler ◽  
Cameron G. McDougall
Keyword(s):  
High Rate ◽  
Transient Ischemic Attacks ◽  
Technical Success ◽  
Technical Success Rate ◽  
Basilar Thrombosis ◽  
Permanent Morbidity ◽  
Low Incidence ◽  
Angioplasty And Stenting ◽  
Age Range

Abstract OBJECTIVE To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS We reviewed the records of 33 patients (24 men, 9 women; age range, 49–81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0–24%), mild (25–49%), moderate (50–74%), or severe (75–100%). RESULTS Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.

EXTENSIVE PERITUMORAL BRAIN EDEMA IN A SMALL CLINOIDAL MENINGIOMA: CLINICAL CASE

2021 ◽  
Vol 74 (10) ◽  
pp. 2678-2681
Author(s):  
Abdalrahman Nassar ◽  
Volodymyr I. Smolanka ◽  
Andriy V. Smolanka
Keyword(s):  
Brain Edema ◽  
Neurological Deficit ◽  
Mass Effect ◽  
Tumour Resection ◽  
Karnofsky Performance Scale ◽  
Focal Neurological Deficit ◽  
Regional Center ◽  
Peritumoral Brain Edema ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri

Peritumoral brain edema (PTBE) is seen in 40-78% of all cases of intracranial meningiomas. It may vary in shape and size, occasionally being two to three times larger than the tumor. We present a case of a 62-year-old female patient, suffering from seizure and progressive headache. She was diagnosed with left medial sphenoid wing meningioma and referred for treatment to Uzhhorod Regional Center of Neurosurgery and Neurology. The patient had no major focal neurological deficit and Karnofsky Performance Scale (KPS) of 70 on admission. The preoperative magnetic resonance imaging (MRI) with and without contrast showed a 2.1×2.2×2.5 cm solid mass at the inner third of the left sphenoid wing, with homogenous enhancement and encasement of middle cerebral artery (MCA). In addition, there was a disproportionately extensive PTBE in the left cerebral hemisphere that caused midline shift and mass effect. The patient underwent left pterional craniotomy and gross total resection of the mass. The postoperative course was without complications or new neurological deficit, MRI within 48 hours revealed gross total tumour resection with residual brain edema and the patient was discharged with a KPS of 80 on day 7. Based on several studies, significant correlation between PTBE and tumor volume was observed: larger tumors cause larger PTBE. This particular case had a very large hemispheric PTBE, which was disproportionate to the small size of the meningioma. Most likely, the PTBE in this patient was caused by venous congestion, but this had no influence on surgical outcome. Therefore, the presence of a large PTBE does not necessarily indicate a poor prognosis and isn’t always the reason of surgical complications.

Gamma Knife surgery–induced meningioma

2006 ◽  
Vol 105 (2) ◽  
pp. 325-329 ◽  
Author(s):  
Jason Sheehan ◽  
Chun PO Yen ◽  
Ladislau Steiner
Keyword(s):  
Gamma Knife ◽  
Mass Effect ◽  
Senior Author ◽  
Gamma Knife Surgery ◽  
Imaging Characteristics ◽  
Radiation Induced ◽  
Neurosurgical Technique ◽  
Low Incidence

✓Gamma Knife surgery (GKS) is a minimally invasive neurosurgical technique. During the past 30 years, radiosurgery has been performed for a number of intracranial disorders with a generally low incidence of side effects. Although radiation-induced neoplasia following radiotherapy is well documented, there are few reports of this complication following radiosurgery. The authors are engaged in an ongoing project in which they are studying the delayed adverse effects of radiosurgical changes in 2500 patients with arteriovenous malformations (AVMs) treated within a 30-year period. The cases of 1333 patients treated by the senior author (L.S.) have been reviewed thus far. A subset of 288 patients in this group underwent neuroimaging and participated in clinical follow up for at least 10 years. The authors report two cases of radiosurgically induced neoplasia. In both cases the patient was treated with GKS for an AVM. Longer than 10 years after GKS, each of the patients was found to have an incidental, uniformly enhancing, dura-based mass lesion near the site of the AVM. These lesions displayed the imaging characteristics of a meningioma. Because in both cases the lesion has displayed no evidence of a mass effect, they continue to be followed using serial neuroimaging. These are the fifth and sixth cases meeting the criteria for radiation-induced neoplasms defined by Cahan, et al., in 1998. Although radiosurgery is generally considered quite safe, the incidence of radiation-induced neoplasms is not known. These cases and the few others detailed in the literature emphasize the need for long-term neurosurgical follow-up review in patients after radiosurgery.

Intracerebral Hematoma, Perihemorrhagic Edema and Urinary Excreted Cysteinyl Leukotrienes Correlation Study

2014 ◽  
Vol 68 (2) ◽  
pp. 85-88
Author(s):  
Natalija Dolnenec-Baneva ◽  
Dijana Nikodijevic ◽  
Gordana Kiteva-Trenchevska ◽  
Igor Petrov ◽  
Dragana Petrovska-Cvetkovska ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Edema ◽  
Correlation Study ◽  
Intracerebral Hematoma ◽  
Moderate Correlation ◽  
Hematoma Volume ◽  
Cysteinyl Leukotrienes ◽  
Edema Volume ◽  
Perihemorrhagic Edema

AbstractIntroduction.Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage.Methods.An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2).Results.CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rdday (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5thday (R=0.3).Conclusion.In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rdday, a moderate correlation on admission and on the 5thday, which means that high cysLT and hematoma values were associated with high/moderate edema values.

Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 9-20 ◽  
Author(s):  
Hung-Chuan Pan ◽  
Ming-Hsi Sun ◽  
Jason Sheehan ◽  
Meei-Ling Sheu ◽  
Clayton Chi-Chang Chen ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Temporal Lobe ◽  
Treatment Modalities ◽  
Conformity Index ◽  
Index Number ◽  
The Mean ◽  
Instrument Accuracy ◽  
Group 1

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.

Topping-off technique for stabilization of lumbar degenerative instabilities in 322 patients

2020 ◽  
Vol 32 (3) ◽  
pp. 366-372
Author(s):  
Sandro M. Krieg ◽  
Nele Balser ◽  
Haiko Pape ◽  
Nico Sollmann ◽  
Lucia Albers ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Interbody Fusion ◽  
Smooth Transition ◽  
Lumbar Pain ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Rod System ◽  
Reoperation Rates ◽  
Topping Off

OBJECTIVESemi-rigid instrumentation (SRI) was introduced to take advantage of the concept of load sharing in surgery for spinal stabilization. The authors investigated a topping-off technique in which interbody fusion is not performed in the uppermost motion segment, thus creating a smooth transition from stabilized to free motion segments. SRI using the topping-off technique also reduces the motion of the adjacent segments, which may reduce the risk of adjacent segment disease (ASD), a frequently observed sequela of instrumentation and fusion, but this technique may also increase the possibility of screw loosening (SL). In the present study the authors aimed to systematically evaluate reoperation rates, clinical outcomes, and potential risk factors and incidences of ASD and SL for this novel approach.METHODSThe authors collected data for the first 322 patients enrolled at their institution from 2009 to 2015 who underwent surgery performed using the topping-off technique. Reoperation rates, patient satisfaction, and other outcome measures were evaluated. All patients underwent pedicle screw–based semi-rigid stabilization of the lumbar spine with a polyetheretherketone (PEEK) rod system.RESULTSImplantation of PEEK rods during revision surgery was performed in 59.9% of patients. A median of 3 motion segments (range 1–5 segments) were included and a median of 2 motion segments (range 0–4 segments) were fused. A total of 89.4% of patients underwent fusion, 73.3% by transforaminal lumbar interbody fusion (TLIF), 18.4% by anterior lumbar interbody fusion (ALIF), 3.1% by extreme lateral interbody fusion (XLIF), 0.3% by oblique lumbar interbody fusion (OLIF), and 4.9% by combined approaches in the same surgery. Combined radicular and lumbar pain according to a visual analog scale was reduced from 7.9 ± 1.0 to 4.0 ± 3.1, with 56.2% of patients indicating benefit from surgery. After maximum follow-up (4.3 ± 1.8 years), the reoperation rate was 16.4%.CONCLUSIONSThe PEEK rod concept including the topping-off principle seems safe, with at least average patient satisfaction in this patient group. Considering the low rate of first-tier surgeries, the presented results seem at least comparable to those of most other series. Follow-up studies are needed to determine long-term outcomes, particularly with respect to ASD, which might be reduced by the presented approach.

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