Brain-stem tumors in childhood: a prospective randomized trial of irradiation with and without adjuvant CCNU, VCR, and prednisone

1987 ◽  
Vol 66 (2) ◽  
pp. 227-233 ◽  
Author(s):  
R. Derek T. Jenkin ◽  
Carl Boesel ◽  
Inta Ertel ◽  
Audrey Evans ◽  
Robert Hittle ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Brain Stem ◽  
Radiation Treatment ◽  
Risk Of Infection ◽  
Content Type ◽  
Standard Methods ◽  
Increased Risk ◽  
Brain Stem Tumors ◽  
A Prospective Study ◽  
Fine Print

✓ Seventy-four children with a brain-stem tumor diagnosed between 1977 and 1980 were entered into a prospective study in which exploration and assessment for resection were optional, radiation treatment using standard methods was required, and randomization occurred with regard to the use of adjuvant chemotherapy (l-(2-chloroethyl)-l-nitrosourea, vincristine, and prednisone) or no further treatment. The overall 5-year survival rate was 20% and was not improved by the adjuvant chemotherapy program. An increased risk of infection was associated with the adjuvant therapy.

Cystic schwannoma of the trochlear nerve mimicking a brain-stem tumor

1987 ◽  
Vol 67 (6) ◽  
pp. 928-930 ◽  
Author(s):  
Paul Douglas Garen ◽  
Clive Gordon Harper ◽  
Charles Teo ◽  
Ian Hugh Johnston
Keyword(s):  
Brain Stem ◽  
Cranial Nerve ◽  
Clinical Approach ◽  
Trochlear Nerve ◽  
Surgical Biopsy ◽  
Content Type ◽  
Brain Stem Tumors ◽  
Fourth Cranial Nerve ◽  
Cystic Schwannoma ◽  
Fine Print

✓ A case is reported of a rare cystic schwannoma of the fourth cranial nerve which was interpreted as a probable intrinsic brain-stem lesion. The clinical approach to brain-stem tumors in terms of empirical treatment or surgical biopsy is discussed.

CCNU chemotherapy in adult patients with tumors of the basal ganglia and brain stem

1980 ◽  
Vol 53 (3) ◽  
pp. 361-363 ◽  
Author(s):  
Alfredo Pompili ◽  
Antonio Riccio ◽  
Bruno Jandolo ◽  
Maurizio Fontana
Keyword(s):  
Radiation Therapy ◽  
Basal Ganglia ◽  
Brain Stem ◽  
Computerized Tomography ◽  
Surgical Decompression ◽  
Control Group ◽  
Content Type ◽  
Brain Stem Tumors ◽  
Fine Print

✓ The present investigation evaluates those few patients of our series with basal ganglia and brain-stem tumor who refused either surgical decompression and biopsy or radiation therapy. Four patients were suffering from tumors of the basal ganglia and three from brain-stem tumors; all the tumors were diagnosed by classical neuroradiological investigations and computerized tomography. The patients were given CCNU by mouth, 13 mg/sq m every 6 weeks. No toxicity was recorded. Mean survival was 19 weeks for patients with basal ganglia tumors and 48 weeks for those with brain-stem tumors. All patients were evaluated with respect to the quality of survival. Results were compared with those obtained in a control group of patients who received methylprednisolone therapy only.

Surgical management of brain-stem tumors in children: results and statistical analysis of 75 cases

1993 ◽  
Vol 79 (6) ◽  
pp. 845-852 ◽  
Author(s):  
Alain Pierre-Kahn ◽  
Jean-François Hirsch ◽  
Mathieu Vinchon ◽  
Christine Payan ◽  
Christian Sainte-Rose ◽  
...  
Keyword(s):  
Brain Stem ◽  
Malignant Tumors ◽  
Benign Tumors ◽  
Patient Age ◽  
Content Type ◽  
Patient Âgé ◽  
Significant Difference ◽  
Brain Stem Tumors ◽  
Subtotal Removal ◽  
Fine Print

A study was made of 75 children treated between 1970 and 1990, with partial, subtotal, or total removal of three intrinsic and 72 exophytic or surface brain-stem tumors. In all cases, the goal of surgery was to remove as much tumor as possible. Extent of removal was defined according to data obtained from postoperative computerized tomography or magnetic resonance imaging, and was considered partial when only a small amount of tumor was removed, subtotal when a few cubic millimeters of tumor was left, and total when no residual tumor was seen on postoperative radiological investigations. An ultrasonic aspirator was used for the 43 most recent operations. Among tumor removals without the aspirator, 24 (75%) were partial, eight (25%) subtotal, and none total; with the use of the aspirator, the number of partial removals decreased to 44.5% while that of subtotal and total removals increased to 32% and 23.5%, respectively. There were 69 gliomas (92%) and 47 benign tumors (62.6%). Forty-nine patients were irradiated postoperatively, and 14 of the 23 patients whose benign tumors were removed totally or subtotally did not undergo irradiation. This study showed that: 1) the overall prognosis of patients with malignant tumors was poor and was not improved by surgery; 2) the survival rate of those with benign tumors was significantly (p < 0.01) lower after partial removal than after total or subtotal removal (52% and 94%, respectively, at 5 years); 3) comparison of means and proportions (Student's and chi-squared tests) between benign and malignant tumors showed a significant difference relating to patient age (p < 0.03), peritumoral hypodensity (p < 0.001), and preoperative duration of symptoms (p < 0.001); 4) stepwise logistic regression analysis confirmed that two of these three variables were related to malignancy: namely, patient age at surgery (p < 0.03) and presence of peritumoral hypodensity (p < 0.001); and 5) routine postoperative irradiation was contraindicated after total or subtotal removal of benign tumors.

Schwannoma of the brain stem

1980 ◽  
Vol 53 (1) ◽  
pp. 121-123 ◽  
Author(s):  
Brahm Prakash ◽  
Subimal Roy ◽  
Prakash N. Tandon
Keyword(s):  
Brain Stem ◽  
Content Type ◽  
Brain Stem Tumors ◽  
Intramedullary Schwannoma ◽  
The Brain ◽  
Fine Print

✓ A case of intramedullary schwannoma of the brain stem is reported, and its possible origin discussed. The importance of a biopsy in brain-stem tumors is emphasized.

Magnetic resonance images of brain-stem encephalitis

1987 ◽  
Vol 66 (2) ◽  
pp. 283-285 ◽  
Author(s):  
Kohkichi Hosoda ◽  
Norihiko Tamaki ◽  
Michio Masumura ◽  
Satoshi Matsumoto
Keyword(s):  
Magnetic Resonance ◽  
Brain Stem ◽  
Pathological Condition ◽  
Magnetic Resonance Images ◽  
Resonance Imaging ◽  
Radiological Findings ◽  
Content Type ◽  
Brain Stem Tumors ◽  
Fine Print ◽  
Brain Stem Encephalitis

✓ The clinical and radiological findings in a case of brain-stem encephalitis are described with special emphasis on the serial magnetic resonance imaging. This pathological condition should be differentiated from brain-stem tumors, which may present with similar symptoms.

Use of intraoperative auditory evoked potentials to preserve hearing in unilateral acoustic neuroma removal

1984 ◽  
Vol 61 (5) ◽  
pp. 938-948 ◽  
Author(s):  
Robert G. Ojemann ◽  
Robert A. Levine ◽  
William M. Montgomery ◽  
Patricia McGaffigan
Keyword(s):  
Evoked Potentials ◽  
Brain Stem ◽  
Auditory Evoked Potentials ◽  
Compound Action Potential ◽  
Speech Discrimination ◽  
Sound Perception ◽  
Content Type ◽  
Increased Risk ◽  
The Status ◽  
Fine Print

✓ Twenty-two patients with unilateral acoustic neuromas and preoperative speech discrimination scores of 35% or more had intraoperative monitoring of the electrocochleogram (ECoG) using a transtympanic electrode, and of the brain-stem auditory evoked potentials (BAEP's) using scalp electrodes. Rapid feedback was provided about the status of the cochlear microphonics from the hair cells of the inner ear (CM of the ECoG), the compound action potential of the auditory nerve (N-1 of the ECoG or Wave I of the BAEP's) and the potentials from the lower brain stem (Wave V of the BAEP's). All patients had total removal of the tumor. In 21, the cochlear nerve was anatomically preserved, and 20 had good postoperative facial nerve function. Correlation of tumor size with postoperative hearing was as follows: discrimination scores of more than 35% in three of four patients with 1-cm tumors, two of eight with 1.5-cm tumors, two of six with 2- to 2.5-cm tumors, and one of four with tumors of 3 cm or more. Two other patients with 1.5-cm tumors had discrimination scores of less than 35%, and one patient with a 2-cm tumor had only sound perception. In two patients, the discrimination scores improved. At the end of the operation, all patients with hearing had a detectable N-1, and, when recorded, CM. All but one patient with no hearing had lost N-1, and CM was absent or reduced. Unless Wave V was unchanged, it was a poor predictor of postoperative hearing, and its absence did not preclude preservation of good hearing. The electrophysiological changes during each stage of the operation were analyzed and correlated with events during surgery. Areas in which there was an increased risk of loss of the potentials were determined. In some patients monitoring was unnecessary, because either there were no significant changes or the changes were abrupt and no recovery occurred. However, in other patients, monitoring alerted the surgeon to a possible problem and the method of dissection was altered. Possible mechanisms of hearing loss were suggested from the changes in the recordings.

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.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Stereotactic radiation treatment planning and follow-up studies involving fused multimodality imaging

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 326-333 ◽  
Author(s):  
Klaus D. Hamm ◽  
Gunnar Surber ◽  
Michael Schmücking ◽  
Reinhard E. Wurm ◽  
Rene Aschenbach ◽  
...  
Keyword(s):  
Image Fusion ◽  
Treatment Planning ◽  
Radiation Treatment ◽  
Data Sets ◽  
Slice Thickness ◽  
Radiation Treatment Planning ◽  
Content Type ◽  
Follow Up Studies ◽  
Fine Print

Object. Innovative new software solutions may enable image fusion to produce the desired data superposition for precise target definition and follow-up studies in radiosurgery/stereotactic radiotherapy in patients with intracranial lesions. The aim is to integrate the anatomical and functional information completely into the radiation treatment planning and to achieve an exact comparison for follow-up examinations. Special conditions and advantages of BrainLAB's fully automatic image fusion system are evaluated and described for this purpose. Methods. In 458 patients, the radiation treatment planning and some follow-up studies were performed using an automatic image fusion technique involving the use of different imaging modalities. Each fusion was visually checked and corrected as necessary. The computerized tomography (CT) scans for radiation treatment planning (slice thickness 1.25 mm), as well as stereotactic angiography for arteriovenous malformations, were acquired using head fixation with stereotactic arc or, in the case of stereotactic radiotherapy, with a relocatable stereotactic mask. Different magnetic resonance (MR) imaging sequences (T1, T2, and fluid-attenuated inversion-recovery images) and positron emission tomography (PET) scans were obtained without head fixation. Fusion results and the effects on radiation treatment planning and follow-up studies were analyzed. The precision level of the results of the automatic fusion depended primarily on the image quality, especially the slice thickness and the field homogeneity when using MR images, as well as on patient movement during data acquisition. Fully automated image fusion of different MR, CT, and PET studies was performed for each patient. Only in a few cases was it necessary to correct the fusion manually after visual evaluation. These corrections were minor and did not materially affect treatment planning. High-quality fusion of thin slices of a region of interest with a complete head data set could be performed easily. The target volume for radiation treatment planning could be accurately delineated using multimodal information provided by CT, MR, angiography, and PET studies. The fusion of follow-up image data sets yielded results that could be successfully compared and quantitatively evaluated. Conclusions. Depending on the quality of the originally acquired image, automated image fusion can be a very valuable tool, allowing for fast (∼ 1–2 minute) and precise fusion of all relevant data sets. Fused multimodality imaging improves the target volume definition for radiation treatment planning. High-quality follow-up image data sets should be acquired for image fusion to provide exactly comparable slices and volumetric results that will contribute to quality contol.

Factors affecting coagulation: fibrinolysis in chronic subdural fluid collections

1983 ◽  
Vol 58 (2) ◽  
pp. 242-245 ◽  
Author(s):  
Bryce Weir ◽  
Philip Gordon
Keyword(s):  
Degradation Products ◽  
Hemoglobin Content ◽  
Fibrin Degradation Product ◽  
Content Type ◽  
Factors Affecting ◽  
Fibrin Degradation Products ◽  
Subdural Hematomas ◽  
Increased Risk ◽  
Fluid Collections ◽  
Fine Print

✓ Plasminogen, alpha2-antiplasmin, fibrinogen, fibrin degradation products (FDP's), and hemoglobin were measured in the supernatant fluid of 25 chronic subdural hematomas and five chronic subdural hygromas. The 30 patients underwent pre- and postoperative computerized tomography. The hematomas were characterized by low fibrinogen and high fibrin degradation product concentrations. The hemoglobin content varied directly with the alpha2-antiplasmin, and inversely with the plasminogen. Four patients underwent reoperation for recurrences. The initial fluid from these cases was characterized by relatively high plasminogen and low alpha2-antiplasmin. The hygromas had no hemoglobin, and low fibrinogen, high FDP's, low alpha2-antiplasmin, and variable plasminogen levels. It is possible that those cases having the greatest capacity to produce plasmin (high plasminogen and low alpha2-antiplasmin) can produce more FDP's which in turn causes more rebleeding and an increased risk of reaccumulation of chronic subdural hematomas.

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