Management of intracranial plasmacytoma

1995 ◽  
Vol 83 (2) ◽  
pp. 218-221 ◽  
Author(s):  
Ajay K. Bindal ◽  
Rajesh K. Bindal ◽  
Harry van Loveren ◽  
Raymond Sawaya
Keyword(s):  
Multiple Myeloma ◽  
Radiation Therapy ◽  
Skull Base ◽  
Surgical Resection ◽  
Postoperative Period ◽  
Definitive Treatment ◽  
Content Type ◽  
Complete Surgical Resection ◽  
Fine Print

✓ The authors report on a study of eight cases of intracranial plasmacytoma to identify the risk of progression to multiple myeloma and suggest the treatment required for cure of solitary lesions. The diagnosis of multiple myeloma or myelomatous changes was made in the immediate postoperative period in four patients (50%), two of whom had skull base lesions. Of the four remaining patients, three were treated with complete surgical resection and radiation therapy and had no recurrence of plasmacytoma or progression to multiple myeloma during mean follow up of 12 years (range 2–25 years); one patient underwent subtotal surgical resection and had recurrence of the tumor despite radiation therapy. It is concluded that multiple myeloma is unlikely to develop during the long term in patients with intracranial plasmacytoma who do not develop multiple myeloma or myelomatous changes in the early postoperative period. However, lesions that infiltrate the skull base are not likely to be solitary, and patients who harbor these neoplasms should undergo complete evaluation and close follow-up review to exclude multiple myeloma. A recurrence of solitary intracranial plasmacytoma is possible with subtotal surgical resection despite radiation therapy. Definitive treatment should consist of complete surgical resection with adjuvant radiation therapy.

Successful management of an intracranial arteriovenous malformation by conventional irradiation

1985 ◽  
Vol 63 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Francesco Tognetti ◽  
Alvaro Andreoli ◽  
Anna Cuscini ◽  
Claudio Testa
Keyword(s):  
Radiation Therapy ◽  
Arteriovenous Malformation ◽  
Successful Management ◽  
Intracranial Arteriovenous Malformation ◽  
Content Type ◽  
Conventional Radiation ◽  
Complete Obliteration ◽  
Conventional Radiation Therapy ◽  
Fine Print

✓ The reduction of an intracranial arteriovenous malformation (AVM) by conventional radiation therapy is described in a patient who refused surgery. The 2-year follow-up angiogram documented nearly complete obliteration of the nidus of the AVM, accompanied by progressive narrowing of the arteries supplying the lesion. The scanty literature dealing with this form of treatment is summarized.

Seizure outcome after lesionectomy for cavernous malformations

1995 ◽  
Vol 83 (2) ◽  
pp. 237-242 ◽  
Author(s):  
Douglas S. Cohen ◽  
Geoffrey P. Zubay ◽  
Robert R. Goodman
Keyword(s):  
Retrospective Analysis ◽  
Surgical Resection ◽  
Seizure Outcome ◽  
Cavernous Malformations ◽  
Content Type ◽  
Female Sex ◽  
Antiepileptic Medications ◽  
Fine Print

✓ Cavernous malformations that are associated with seizures are often treated by surgical resection consisting of lesion removal, “lesionectomy,” alone. Through retrospective analysis the authors have examined some factors that may predict failure to eradicate seizures by such a procedure. A group of 51 patients were examined who had been treated for supratentorial cavernous malformations with preoperative seizures and received postoperative follow up lasting at least 1 year. There was one mortality in the group. Of the remaining 50 patients, 15 (30%) had continued postoperative seizures despite therapeutic levels of antiepileptic medications. Variables that were significantly associated with continued seizures postoperatively included increasing duration of preoperative seizure history (p = 0.03), increasing number of preoperative seizures (p < 0.003), and female sex (p < 0.04). One hundred percent of patients with only one preoperative seizure or a seizure history lasting less than 2 months were seizure free following lesionectomy: approximately 75% to 80% of all patients with two to five seizures, or a seizure history lasting 2 to 12 months, were seizure free; and only 50% to 55% of those with more than five seizures or with preoperative seizure histories lasting more than 1 year were seizure free postoperatively. This investigation indicates that patients with shorter seizure histories and fewer preoperative seizures can be effectively treated by lesionectomy alone, whereas those with longer histories and more seizures are not effectively treated by this procedure and may require more extensive resections.

Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents

2001 ◽  
Vol 95 (3) ◽  
pp. 412-419 ◽  
Author(s):  
Gary Redekop ◽  
Thomas Marotta ◽  
Alain Weill
Keyword(s):  
Skull Base ◽  
Stent Placement ◽  
Vascular Lesions ◽  
Definitive Treatment ◽  
Parent Artery ◽  
Base Region ◽  
Endovascular Stents ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

Object. The authors describe their preliminary clinical experience with the use of endovascular stents in the treatment of traumatic vascular lesions of the skull base region. Because adequate distal exposure and direct surgical repair of these lesions are not often possible, conventional treatment has been deliberate arterial occlusion. The purpose of this report is to demonstrate the safety and efficacy as well as limitations of endovascular stent placement in the management of craniocervical arterial injuries. Methods. Six patients with vascular injuries were treated using endovascular stents. There were two arteriovenous fistulas and two pseudoaneurysms of the distal extracranial internal carotid or vertebral arteries resulting from penetrating trauma, and two petrous carotid pseudoaneurysms associated with basal skull fractures. In one patient a porous stent placement procedure was undertaken as well as coil occlusion of an aneurysm, whereas in the remaining five patients covered stent grafts were used as definitive treatment. There were no procedural complications. One patient in whom there was extensive traumatic arterial dissection was found to have asymptomatic stent thrombosis when angiography was repeated 1 week postoperatively. This was the only patient whose associated injuries precluded routine antithrombotic or antiplatelet therapy. Follow-up examinations in the remaining five patients included standard angiography (four patients) or computerized tomography angiography (one patient), which were performed 3 to 6 months postoperatively, and clinical assessments ranging from 3 months to 1 year in duration (mean 9 months). In all five cases the vascular injury was successfully treated and the parent artery remained widely patent. No patient experienced aneurysm recurrence or hemorrhage, and there were no thromboembolic complications. Conclusions. The authors' experience demonstrates that endovascular treatment of traumatic vascular lesions of the skull base region is both feasible and safe. The advantages of minimally invasive stent placement and parent artery preservation make this procedure for repair of neurovascular injuries a potentially important addition to existing methods.

The long-term side effects of radiation therapy for benign brain tumors in adults

1990 ◽  
Vol 73 (4) ◽  
pp. 502-512 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Jane E. Kersh ◽  
Anupam Routh ◽  
Robert R. Smith
Keyword(s):  
Radiation Therapy ◽  
Side Effects ◽  
Brain Tumors ◽  
Adult Patients ◽  
Intracranial Tumors ◽  
Content Type ◽  
Pituitary Dysfunction ◽  
Fine Print

✓ Radiation therapy plays an integral part in managing intracranial tumors. While the risk:benefit ratio is considered acceptable for treating malignant tumors, risks of long-term complications of radiotherapy need thorough assessment in adults treated for benign tumors. Many previously reported delayed complications of radiotherapy can be attributed to inappropriate treatment or to the sensitivity of a developing child's brain to radiation. Medical records, radiological studies, autopsy findings, and follow-up information were reviewed for 58 adult patients (31 men and 27 women) treated between 1958 and 1987 with radiotherapy for benign intracranial tumors. Patient ages at the time of irradiation ranged from 21 to 87 years (mean 47.7 years). The pathology included 46 pituitary adenomas, five meningiomas, four glomus jugulare tumors, two pineal area tumors, and one craniopharyngioma. Average radiation dosage was 4984 cGy (range 3100 to 7012 cGy), given in an average of 27.2 fractions (range 15 to 45 fractions), over a period averaging 46.6 days. The follow-up period ranged from 3 to 31 years (mean 8.1 years). Findings related to tumor recurrence or surgery were excluded. Twenty-two patients had complications considered to be delayed side effects of radiotherapy. Two patients had visual deterioration developing 3 and 6 years after treatment; six had pituitary dysfunction; and 17 had varying degrees of parenchymal changes of the brain, occurring mostly in the temporal lobes and relating to the frequent presentation of pituitary tumors (two of these also had pituitary dysfunction). One clival tumor, with the radiographic appearance of a meningioma, developed 30 years post-irradiation for acromegaly. This study unveils considerable delayed sequelae of radiotherapy in a series of adult patients receiving what is considered “safe” treatment for benign brain tumors.

Evaluation of a new concept for the management of skull base chordomas and chondrosarcomas

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 165-170 ◽  
Author(s):  
Guenther Christian Feigl ◽  
Otto Bundschuh ◽  
Alireza Gharabaghi ◽  
Sam Safavi-Abassi ◽  
Amr El Shawarby ◽  
...  
Keyword(s):  
Skull Base ◽  
Tumor Volume ◽  
Tumor Resection ◽  
Volume Reduction ◽  
Recurrence Rates ◽  
Content Type ◽  
The Mean ◽  
Tumor Volume Reduction ◽  
Fine Print

Object. Chordomas and chondrosarcomas of the skull base are rare locally invasive tumors associated with high recurrence rates. The aim of this study was to evaluate the concept of microsurgical tumor volume reduction followed by early gamma knife surgery (GKS). Methods. Thirteen patients with 15 tumors were treated between October 2000 and June 2003. There were three patients (23.1%) with chordomas and 10 (76.9%) with chondrosarcomas. There were nine men and four women who ranged in age between 19 and 69 years. All patients first underwent maximal tumor resection. Within 2 to 10 months after surgery they were treated with GKS. The mean postoperative tumor volume treated with GKS was 9.7 cm3 (range 1.4–20.3 cm3). Follow-up computerized tomography and magnetic resonance imaging examinations with volumetric tumor analysis were performed every 6 months after GKS. The mean treatment dose was 17 Gy and the mean isodose was 52%. The mean follow-up duration was 17 months during which there was only one tumor recurrence at the margin of the radiation field. The mean volume reduction was 35.4%. Conclusions. Results of this treatment strategy are encouraging but the efficacy of this multimodal treatment combining surgery and early GKS requires a longer follow up.

Radiosurgical treatment of recurrent hemangiopericytomas of the meninges: preliminary results

1993 ◽  
Vol 78 (6) ◽  
pp. 903-908 ◽  
Author(s):  
Robert J. Coffey ◽  
Terrence L. Cascino ◽  
Edward G. Shaw
Keyword(s):  
Radiation Therapy ◽  
Surgical Resection ◽  
Treatment Session ◽  
Tumor Shrinkage ◽  
Previous Surgery ◽  
Content Type ◽  
Intracranial Lesion ◽  
Visceral Metastases ◽  
Field Defect ◽  
Fine Print

✓ Hemangiopericytomas of the meninges, classified previously as angioblastic meningiomas, have a propensity to recur either locally or at distant sites within the nervous system after surgical resection. Visceral metastases also develop much more commonly in these lesions than in other types of histologically benign meningiomas. The radiosurgical gamma knife was used to treat five patients with 11 meningeal hemangiopericytomas (seven new, two recurrent, and two residual tumors) after surgical resection of an initially solitary intracranial lesion. Three patients had undergone multiple craniotomies and radiation therapy before referral, and two patients underwent a second radiosurgical procedure for lesions that appeared between 5 and 13 months after the first treatment session. Dramatic tumor shrinkage occurred in most patients within 6 to 10 months after treatment. The only treatment-related morbidity in this series was a partial visual-field defect in one patient with a large falx-tentorial junction hemangiopericytoma who had previously undergone radiation therapy. Radiosurgery appears to cause dramatic early shrinkage of small and medium-sized intracranial hemangiopericytomas that have recurred or developed after previous surgery and/or radiation therapy.

Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme

1993 ◽  
Vol 78 (5) ◽  
pp. 762-766 ◽  
Author(s):  
Friedrich W. Kreth ◽  
Peter C. Warnke ◽  
Rudolf Scheremet ◽  
Christoph B. Ostertag
Keyword(s):  
Radiation Therapy ◽  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Cytoreductive Surgery ◽  
Neurological Deficits ◽  
Karnofsky Performance Scale ◽  
Treatment Variable ◽  
Content Type ◽  
Resection Group ◽  
Fine Print

✓ There has been considerable controversy over the concept of treating glioblastoma multiforme with cytoreductive surgery. Therefore, a retrospective study of cases treated between 1986 and 1991 was conducted to analyze and compare the results of stereotactic biopsy followed by radiation therapy performed in 58 patients with those of surgical resection plus radiation therapy in 57 patients. In both groups, conventionally fractionated radiation (1.7 to 2.0 Gy/day) was delivered, with a total dose of 50 to 60 Gy. Biopsy was performed only in patients with tumors judged to be inoperable. These patients carried a higher surgical risk and were in worse neurological condition than the patients in the resection group. The median survival time for the resection group was 39.5 weeks, as compared with 32 weeks for the biopsy group. This difference was not significant. The most important prognostic factor was the patient's age. The treatment variable biopsy versus resection did not reach prognostic relevance. In patients with midline shift who underwent biopsy, the Karnofsky Performance Scale score decreased in more patients during radiation therapy. The clinical status 6 weeks after surgery, however, showed no significant differences between the two groups. The comparable survival times for the two groups place doubt on the concept of treating glioblastoma multiforme with cytoreductive surgery. Presently, radiation therapy is the most effective treatment for patients with glioblastoma. There is no question that decompressive surgery followed by radiation therapy should be performed whenever necessary for severe space-occupying lesions and when it will not cause new neurological deficits.

Management of extensive and difficult cranial defects

1988 ◽  
Vol 69 (2) ◽  
pp. 210-212 ◽  
Author(s):  
Bahman Guyuron ◽  
Melvin Shafron ◽  
Benedict Columbi
Keyword(s):  
Radiation Therapy ◽  
Bone Resorption ◽  
Bone Graft ◽  
Donor Site ◽  
Turn Of The Century ◽  
Content Type ◽  
Reconstruction Surgery ◽  
Fine Print

✓ The procedure of split-skull cranioplasty was first investigated at the turn of the century. The present authors first reported their technique of split-skull cranioplasty in 1983, and describe here their experience with this procedure in the management of extensive and difficult cranial defects. Twenty-nine patients (11 females and 18 males) are reviewed. Ten patients had histories of infection before reconstruction surgery. Eleven patients received radiation therapy at the grafted areas. The postoperative follow-up period ranged from 6 months to 4½ years. There was no evidence of bone resorption during that time, and minor complications occurred in only two of the patients. This procedure offered several advantages: 1) the bone graft, an autogenous material, can be used in previously infected areas; 2) the reconstruction contour is smooth and natural; 3) there was no morbidity or scarring at the donor site; 4) surgery time is much shorter than with split-rib cranioplasty. The primary disadvantage of split-skull cranioplasty is the decreased thickness of the skull at the donor site.

Skull base approaches and gamma knife radiosurgery for multimodality treatment of skull base tumors

2002 ◽  
Vol 97 ◽  
pp. 674-676 ◽  
Author(s):  
Paul C. Francel ◽  
Sumon Bhattacharjee ◽  
Paul Tompkins
Keyword(s):  
Radiation Dose ◽  
Skull Base ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Multimodality Treatment ◽  
Skull Base Tumor ◽  
Skull Base Tumors ◽  
Content Type ◽  
Fine Print

Object. The purpose of this study was to evaluate descriptive data obtained in patients who had received multimodality treatment with resection and gamma knife radiosurgery (GKS) for skull base tumors. Retrospective data were collected from 71 patients with skull base tumors who were treated from November 1996 to December 2000, all of whom underwent follow-up evaluation at 1 year or more. Methods. Data were collected from hospital charts and office records, including patient age, tumor type and location, number of tumors, maximum radiation dose, estimated radiation dose to the periphery, tumor volume, and percentage of patients with tumors smaller or the same size at follow-up evaluation. Conclusions. Of the 71 patients with 1 year or more of follow up, 93% had tumor either the same size or smaller and 34% of these patients had a smaller tumor size. It is concluded that: 1) GKS with multimodality treatment is effective for control of skull base tumors; 2) the radiosurgical team should consider the benefits of GKS for treatment of any skull base tumor to afford optimum patient management; and 3) neurosurgeons involved with the management of skull base tumors should either be trained and proficient in GKS or work closely with a colleague trained in the technique. This will ensure proper consideration of both options, resulting in overall improved patient treatment.

Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma

1998 ◽  
Vol 88 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroki Shirato ◽  
Jun Ikeda ◽  
Mitsuhiro Tada ◽  
Nobuaki Ishii ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Risk Groups ◽  
Complete Response ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Local Radiation ◽  
Fine Print

Object. Although curative, radiation, which is conventionally administered for germinomas, causes significant neurological sequelae. This study aimed at reducing the volume and dose of radiation to a localized level of 24 Gy by pretreating the patient with chemotherapy. Methods. Seventeen patients were divided into two risk groups based on serological findings and the extent of tumor. They were treated with chemotherapy prior to receiving localized radiation therapy. Six patients with solitary pure germinomas were treated with three or four cycles of cisplatin and etoposide (EP regimen) followed by 24-Gy local radiation therapy. Eleven patients with human chorionic gonadotropin (HCG)—secreting, multifocal, or disseminated germinomas received four to five cycles of ifosfamide, cisplatin, and etoposide (ICE regimen) followed by 24-Gy local radiation therapy. Craniospinal ports were used only in three cases of germinomas with dissemination. Gross-total resection was performed in three patients. Fourteen patients were able to be evaluated for their responses to chemotherapy. All patients achieved a complete response within three cycles. At a median follow-up duration of 24 months, 16 patients (94%) were alive without recurrence. One patient with an HCG-secreting germinoma experienced recurrence 38 months after surgery. That patient underwent successful salvage therapy using the same protocol. Thus, all 17 patients became free of disease with a 70 to 100% Karnofsky Performance Scale status. Toxicities associated with this study's chemotherapy regimen were mostly transient. No patient showed neurological or endocrinological deterioration during the follow-up period. Conclusions. The EP and ICE regimens were highly effective in treating the central nervous system germinomas and permitted dose and volume reduction of the radiotherapy. Localized 24-Gy irradiation was sufficient for disease control.

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