| 1: AJNR
Am J Neuroradiol. 2004 Nov-Dec;25(10):1851-5. |
|
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Retroclival ecchordosis physaliphora: MR imaging and
review of the literature.
Mehnert F, Beschorner R, Kuker W, Hahn U, Nagele T.
Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Str 3,
D-72076 Tuebingen, Germany.
BACKGROUND AND PURPOSE: Ecchordosis physaliphora (EP), found in about 2% of
autopsies, is a clinically inconspicuous notochordal remnant appearing at
the dorsal wall of the clivus. To our knowledge, a systematic review of its
MR features does not exist. The aim of this study was to describe the MR
imaging findings of incidentally found retroclival EP with special respect
to its differentiation from intradural chordomas. METHODS: We reviewed 300
consecutive 1.5-T MR imaging studies that included thin-section transverse
T2-weighted images of the skull base for the presence of a retroclival EP.
In cases in which an EP was identified, two neuroradiologists observed MR
signal intensity characteristics, contrast enhancement, size, form, stalk of
EP, and signal intensity changes of the adjacent clivus. RESULTS: Five cases
with retroclival EP were found (incidence, 1.7%). In all cases, the
ecchordoses was hyperintense on T2-weighted images and hypointense on
T1-weighted images. Contrary to the reported findings in chordomas, none of
the lesions showed contrast enhancement. In four cases, there were signal
intensity changes in the adjacent clivus. A stalklike connection between
clivus and EP was seen in three patients. CONCLUSION: Because of the benign
character of EP and the difficulties in its histopathologic differentiation
from chordomas, precise knowledge of the radiologic characteristics of EP is
important. On the basis of these five cases and a review of literature,
contrast enhancement and the presence of clinical symptoms seem to be highly
reliable parameters in the differential diagnosis of intradural chordoma and
EP.
Publication Types:
- Review
- Review of Reported Cases
PMID: 15569763 [PubMed - indexed for MEDLINE]
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| 2: Br
J Neurosurg. 2004 Aug;18(4):391-5. |
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Detecting glioma invasion of the corpus callosum using
diffusion tensor imaging.
Price SJ, Pena A, Burnet NG, Pickard JD, Gillard JH.
Academic Neurosurgical Unit, Addenbrooke's Hospital, Cambridge, UK.
sip58@cam.ac.uk
We present a patient with a recurrent glioblastoma and abnormalities of the
corpus callosum seen on diffusion tensor MRI that were not seen on
conventional imaging. These abnormalities preceded the development of the
tumour. We describe the technique of diffusion tissue signatures to assess
tissue infiltration by tumours compared with values from normal volunteers.
PMID: 15702843 [PubMed - in process]
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| 3: Br
J Neurosurg. 2004 Aug;18(4):357-61. |
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MIB1 proliferation index in meningiomas: does it predict
recurrence? A clinicopathological study.
Tyagi A, Chakrabarty A, Franks A.
Department of Neurosurgery, General Infirmary at Leeds, UK.
atul.tyagi@leedsth.nhs.uk
The usefulness of proliferation marker MIB1 in predicting recurrences in
cranial meningiomas when other clinical and pathological factors are
considered was assessed. Data from 65 patients with meningiomas were
analysed and their clinical notes reviewed to define the Simpson grade of
surgical excision, the location of tumour, amongst other clinical factors.
The diagnosis was reviewed; immunohistochemical staining for a proliferation
marker MIB1 was carried out on archival formalin-fixed, paraffin-embedded
tumour and a labelling index for MIB1 (MIB1 L1) calculated. Analysis was
undertaken of the impact of histology, grade of excision, tumour location
and proliferation index on the risk of recurrence. The grade of surgical
resection and histology type were the most important factors likely to
predict recurrence. MIB1 LI was not considered useful in predicting tumour
recurrence.
PMID: 15702834 [PubMed - in process]
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| 4: Br
J Neurosurg. 2004 Aug;18(4):343-6. |
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In vivo growth suppression of rat C6 glioma transplanted
in rat brain using antisense oligonucleotide for microtubule-associated
protein 1A messenger ribonucleic acid.
Matsuno A, Katayama H, Murakami M, Nagashima T.
Department of Neurosurgery, Teikyo University Ichihara Hospital, Ichihara
City, Chiba, Japan. akirakun@med.teikyo-u.ac.jp
Microtubule-associated proteins (MAPs) are essential for various cellular
processes such as mitosis. The aim of this study was to verify that the
suppression of MAP 1A using antisense oligonucleotide can suppress the in
vivo proliferation of C6 glioma cells transplanted in rat brain. After 7
days from transplantation, antisense, sense or scramble phosphorothioate
oligodeoxynucleotide for MAP 1A mRNA was gradually delivered into the
established tumours through amini-osmotic pump. The mean diameters of the
tumours from rats treated with antisense, sense and scramble
phosphorothioate oligodeoxynucleotide for MAP 1A mRNA were 2.33, 4.625 and
5.25 mm. There was statistically significant difference in diameters of
tumours between rats treated with antisense oligodeoxynucleotide, and those
treated with sense or scramble oligodeoxynucleotide. This study strongly
suggests the important role of MAP 1A in cell proliferation and its
suppressionmay serve as a novel antitumour therapy for gliomas.
PMID: 15702832 [PubMed - in process]
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| 5: Cancer
Res. 2005 Feb 1;65(3):999-1006. |
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Ras Inhibition in Glioblastoma Down-regulates
Hypoxia-Inducible Factor-1{alpha}, Causing Glycolysis Shutdown and Cell
Death.
Blum R, Jacob-Hirsch J, Amariglio N, Rechavi G, Kloog Y.
Department of Neurobiochemistry, George S. Wise Faculty of Life Sciences and
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and
Department of Pediatric Hematology-Oncology, Safra Children's Hospital,
Sheba Medical Center, Tel Hashomer, Israel.
Active Ras and phosphatidylinositol-3-kinase-dependent pathways contribute
to the malignant phenotype of glioblastoma multiformes (GBM). Here we show
that the Ras inhibitor trans-farnesylthiosalicylic acid (FTS) exhibits
profound antioncogenic effects in U87 GBM cells. FTS inhibited active Ras
and attenuated Ras signaling to extracellular signal-regulated kinase,
phosphatidylinositol-3-kinase, and Akt. Concomitantly, hypoxia-inducible
factor 1alpha (HIF-1alpha) disappeared, expression of key glycolysis pathway
enzymes and of other HIF-1alpha-regulated genes (including vascular
endothelial growth factor and the Glut-1 glucose transporter) was
down-regulated, and glycolysis was halted. This led to a dramatic reduction
in ATP, resulting in a severe energy crisis. In addition, the expression of
E2F-regulated genes was down-regulated in the FTS-treated cells.
Consequently, U87 cell growth was arrested and the cells died. These results
show that FTS is a potent down-regulator of HIF-1alpha and might therefore
block invasiveness, survival, and angiogenesis in GBM.
PMID: 15705901 [PubMed - as supplied by publisher]
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| 6: Cancer
Res. 2005 Feb 1;65(3):919-24. |
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Identification of OTX2 as a Medulloblastoma Oncogene
Whose Product can be Targeted by All-Trans Retinoic Acid.
Di C, Liao S, Adamson DC, Parrett TJ, Broderick DK, Shi Q, Lengauer C,
Cummins JM, Velculescu VE, Fults DW, McLendon RE, Bigner DD, Yan H.
Brain Tumor Center, Department of Pathology, Duke University Medical Center,
Durham, North Carolina.
Through digital karyotyping of permanent medulloblastoma cell lines, we
found that the homeobox gene OTX2 was amplified more than 10-fold in three
cell lines. Gene expression analyses showed that OTX2 transcripts were
present at high levels in 14 of 15 (93%) medulloblastomas with anaplastic
histopathologic features. Knockdown of OTX2 expression by siRNAs inhibited
medulloblastoma cell growth in vitro, whereas pharmacologic doses of
all-trans retinoic acid repressed OTX2 expression and induced apoptosis only
in medulloblastoma cell lines that expressed OTX2. These observations
suggest that OTX2 is essential for the pathogenesis of anaplastic
medulloblastomas and that these tumors may be amenable to therapy with
all-trans-retinoic acid.
PMID: 15705891 [PubMed - in process]
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| 7: Cancer
Res. 2005 Feb 1;65(3):703-7. |
|
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Genomic amplification of orthodenticle homologue 2 in
medulloblastomas.
Boon K, Eberhart CG, Riggins GJ.
Departments of Neurosurgery and Pathology, Johns Hopkins University School
of Medicine, Baltimore, Maryland.
To better understand the genetic basis of medulloblastoma development, we
sought genomic amplifications and deletions in these tumors using digital
karyotyping in combination with expression analysis. Five medulloblastoma
genomes were karyotyped by sequencing an average of 195,745 genomic DNA tags
for each analysis. Tags were tallied at unique positions and mapped to the
human genome to determine DNA copy numbers in high resolution along each
chromosome. Genomic alterations normally associated with medulloblastomas,
including MYC amplification and isochromosome 17q, were easily detected.
Surprisingly, analysis of only five genomes revealed novel amplicons on
chromosome 14q, one of which contained the orthodenticle homologue 2 (OTX2)
homeobox gene. DNA copy number analysis showed that OTX2 had undergone
genomic amplification in 2 of 11 medulloblastoma cell lines and 8 of 42
primary tumors. The three genes and a predicted open reading frame flanking
OTX2 in the 14q amplicon were not amplified in at least one of the other
nine amplicons, implicating OTX2 as the gene target conferring a selective
advantage. The degree of OTX2 amplification ranged from 8 copies to over 50
copies of the gene. OTX2 transcript was highly and specifically expressed in
medulloblastoma or developing cells. Serial analysis of gene expression of
240 different human tumors or normal tissues revealed that 96% of all 783
OTX2 transcripts sequenced were in medulloblastomas or embryonic stem cells.
OTX2 functions to specify the fate of neuroectoderm in various regions of
the developing brain. This developmental role is consistent with the
evidence suggesting that OTX2 is a medulloblastoma oncogene.
PMID: 15705863 [PubMed - in process]
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| 8: Cancer
Res. 2005 Feb 1;65(3):686-91. |
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Hyaluronic Acid Induces Osteopontin via the
Phosphatidylinositol 3-Kinase/Akt Pathway to Enhance the Motility of Human
Glioma Cells.
Kim MS, Park MJ, Moon EJ, Kim SJ, Lee CH, Yoo H, Shin SH, Song ES, Lee
SH.
Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi,
Korea.
Hyaluronic acid (HA) binds to cell-surface receptors such as CD44, and seems
to be involved in cell adhesion, motility, and tumor progression in brain.
To identify gene expression changes that are initiated by HA, we explored
human cytokine arrays in U87MG glioma cells and identified osteopontin, a
secreted matrix protein, as a transcriptional target of HA. Interestingly,
expression of osteopontin was induced by HA in glioma cells lacking
functional PTEN, a tumor suppressor gene (U87MG, U251MG, and U373MG), but
not in wild-type (wt)-PTEN-harboring cells (LN18 and LN428). To confirm the
role of PTEN, adenoviral (Ad)-wt-PTEN was used to induce ectopic expression
of wt-PTEN in U87MG cells, leading to reduced HA-mediated osteopontin
induction. Reciprocally, transfection with dominant-negative Akt repressed
HA-induced osteopontin expression. Furthermore, HA promoted the motility of
glioma cells, and down-regulation of induced osteopontin activity via a
neutralizing anti-osteopontin antibody repressed HA-induced motility in
vitro. Together, these results strongly suggest that induction of
osteopontin expression by HA is dependent on activation of the
phosphatidylinositol 3-kinase/Akt pathway. Furthermore, our data indicate
that PTEN can effectively modulate the expression of osteopontin, and
HA-induced osteopontin plays an important role in the motility response
induced by HA in human glioma cells.
PMID: 15705860 [PubMed - in process]
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| 9: Clin
Cancer Res. 2005 Jan 15;11(2 Pt 1):835-42. |
|
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Effect of the Tumor Vascular-Damaging Agent, ZD6126, on
the Radioresponse of U87 Glioblastoma.
Wachsberger PR, Burd R, Marero N, Daskalakis C, Ryan A, McCue P, Dicker
AP.
Departments of Radiation Oncology, Division of Clinical Pharmacology, and
Pathology, Anatomy, and Cell Ocology, Thomas Jefferson University,
Philadelphia, Pennsylvania; and AstraZeneca, Alderley Park, Macclesfield,
United Kingdom.
PURPOSE: The effect of ZD6126 on tumor oxygen tension and tumor growth delay
in combination with ionizing radiation was examined in the human U87
glioblastoma tumor model. Resistance to ZD6126 treatment was investigated
with the nitric oxide synthase inhibitor, l-N(G)-nitroarginine methyl ester
(hydrochloride; l-NAME/active form, l-NNA).Methods: U87 human xenografts
were grown in athymic nude mice. ZD6126 was given with or without l-NNA.
Tumor oxygen tension was measured using the Oxford Oxylite (Oxford, England)
fiberoptic probe system. Tumor volume was determined by direct measurement
with calipers and calculated by the formula [(smallest diameter(2) x widest
diameter)/2].RESULTS: Multiple doses of ZD6126 treatment (three doses) had a
significant effect on tumor growth delay, reducing the average daily tumor
growth rate from 29% to 16%. When given 1 hour before radiation, ZD6126
caused an acute increase in hypoxia in U87 tumors, and reduced tumor growth
delay compared with that of radiation alone. The combination of ZD6126 given
after radiation, either as a single dose or in multiple doses, had greater
or similar antitumor activity compared with radiation alone. Twenty-four
hours after administration, a single dose of ZD6126 induced little (10 +/-
8%) necrosis in U87 xenografts. l-NNA, when given in combination with
ZD6126, significantly enhanced the effectiveness of ZD6126 in inducing tumor
necrosis.CONCLUSIONS: Our observation that ZD6126-induced tumor hypoxia can
decrease radiation response when ZD6126 is given prior to radiation
indicates the importance of scheduling. Our findings suggest that the
optimal therapeutic benefit of ZD6126 plus radiation in human glioblastoma
may require multiple dosing in combination with a nitric oxide synthase
inhibitor, to be scheduled following radiotherapy.
PMID: 15701874 [PubMed - in process]
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| 10: Clin
Cancer Res. 2005 Jan 15;11(2 Pt 1):768-76. |
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Continuous delivery of endogenous inhibitors from
poly(lactic-co-glycolic Acid) polymeric microspheres inhibits glioma tumor
growth.
Benny O, Duvshani-Eshet M, Cargioli T, Bello L, Bikfalvi A, Carroll RS,
Machluf M.
Laboratory of Cancer Drug Therapeutics and Mammalian Cell Technology,
Faculty of Biotechnology and Food Engineering, Technion-Israel Institute of
Technology, Haifa, Israel.
PURPOSE: There is an urgent need for modalities that can localize and
prolong the administration of the antitumor agents, particularly
antiangiogenic, to achieve long-term tumor inhibition. However, one of the
major obstacles is designing a device in which the biological activity of
sensitive endogenous inhibitors is retained. We have designed a
biodegradable polymeric device, which provides a unique and practical means
of localizing and continuously delivering hemopexin (PEX) or platelet factor
4 fragment (PF-4/CTF) at the tumor site while maintaining their biological
activity. The potential and efficacy of this system is shown in vitro and in
vivo in a human glioma mouse model.EXPERIMENTAL DESIGN: Polymeric
microspheres made of poly(lactic-co-glycolic acid) (PLGA) were loaded with
very low amounts of PEX and PF-4/CTF. The release profiles of these factors
from PLGA and their biological activity were confirmed in vitro using
proliferation assays done on endothelial and tumor cells. Tumor inhibition
using this system was studied in nude mice bearing a human s.c.
glioma.RESULTS: PEX and PF-4/CTF released in vitro from PLGA microspheres
were biologically active and significantly inhibited the proliferation of
human umbilical vein endothelial cells, bovine capillary endothelial cells,
and U87-MG cells. A single local s.c. injection of PLGA microspheres loaded
with low amounts of PEX or PF-4/CTF resulted in an 88% and 95% reduction in
glioma tumor volume 30 days post-treatment. Immunohistochemical analysis of
the treated tumors showed a marked decrease in tumor vessel density compared
with untreated tumors.CONCLUSION: Our findings show that polymeric
microspheres are a very promising approach to locally and efficiently
deliver endogenous inhibitors to the tumor site leading to a significant
inhibition of the tumor.
PMID: 15701867 [PubMed - in process]
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| 11: Clin
Neuropathol. 2005 Jan-Feb;24(1):8-12. |
|
Invasive meningioma is associated with a low expression
of E-cadherin and beta-catenin.
Utsuki S, Oka H, Sato Y, Kawano N, Tsuchiya B, Kobayashi I, Fujii K.
Department of Neurosurgery, Kitasato University School of Medicine,
Sagamihara, Kanagawa, Japan. utsuki@med.kitasato-u.ac.jp
Invasive meningioma shows benign histological features (WHO grade 1) and the
brain expansion at the tumor-brain interface, and recurs more frequently
than common meningiomas. To determine the mechanism of brain expansion, we
studied the relationship between invasive meningioma and cell adhesion
molecules. Immunostaining for E-cadherin (E-CH), N-cadherin (N-CH),
beta-catenin, and Ki-67 was performed in 103 meningiomas that consisted of
61 meningothelial meningiomas, 25 fibrous meningiomas, 12 invasive
meningiomas and 5 anaplastic meningiomas. All tumors were negative for N-CH.
All the 61 meningothelial meningiomas, 10 of 12 invasive meningiomas, and 3
of 5 anaplastic meningiomas were positive for both E-CH and beta-catenin,
while these were both negative in all of the fibrous meningiomas. In
invasive meningiomas, the expansive part of the tumor showed a lower rate
(4/12 tumors) of E-CH and beta-catenin positivity, while the central part
showed a higher rate (10/12 tumors). The Ki-67 labeling index was higher in
invasive and anaplastic meningiomas than in meningothelial meningiomas.
These results suggest that a reduction in cell adhesion molecules and
increased proliferative activity may be related, which may lead to a better
understanding of the mechanism of meningioma expansion in the future.
PMID: 15696778 [PubMed - in process]
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| 12: Clin
Neuropathol. 2005 Jan-Feb;24(1):1-7. |
|
Intracerebral rhabdoid and papillary meningioma with
leptomeningeal spread and rapid clinical progression.
Al-Habib A, Lach B, Al Khani A.
Department of Pathology and Laboratory Medicine, King Faisal Specialist
Hospital and Research Centre, Riyadh, KSA.
OBJECTIVE AND IMPORTANCE: Rhabdoid meningioma (RM) is a relatively new,
Grade III tumor entity according to the latest WHO classification. We report
rhabdoid and partly papillary, highly anaplastic, intracerebral meningioma
with diffuse leptomeningeal spread and distant SCF metastasis to the
cervical cord. CLINICAL PRESENTATION: This 27-year-old female was admitted
to the hospital with radiological findings suggestive of a primary brain
tumor or a metastasis. After subtotal resection and during radiotherapy,
follow-up MRI revealed recurrence, metastasis to meninges at the high
cervical level, and diffuse basal leptomeningeal enhancement indicating
infiltrating tumor. She died approximately 3 months after onset of symptoms.
RESULTS: Histological examination revealed rhabdoid and papillary meningioma
with high proliferation rate (80% of MIB1-positive cells), necrosis and
extensive brain invasion. It was positive for vimentin and S-100 protein,
showed focal epithelial membrane antigen expression and accumulation of
intermediate filaments on ultrastructural examination. The recurrent tumor
diffusely infiltrated leptomeninges and subarachnoid space. CONCLUSION: This
is a rare example of mixed, rhabdoid and papillary variant of meningioma,
located entirely within the brain parenchyma and accompanied by a fulminant
clinical course. The combination of the histological anaplasia with the
highest reported proliferation rate, and loss of the cohesion of neoplastic
cells led to diffused infiltration of the leptomeninges and metastasis to
the spinal cord.
PMID: 15696777 [PubMed - in process]
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| 13: J
Neurosurg. 2005 Jan;102 Suppl:247-54. |
|
Radiosurgery for patients with recurrent small cell lung
carcinoma metastatic to the brain: outcomes and prognostic factors.
Sheehan J, Kondziolka D, Flickinger J, Lunsford LD.
Department of Neurological Surgery, University of Virginia, Charlottesville,
Virginia 22908, USA. jps2f@virginia.edu
OBJECT: Lung carcinoma is the leading cause of death from cancer. More than
50% of those with small cell lung cancer develop a brain metastasis.
Corticosteroid agents, radiotherapy, and resection have been the mainstays
of treatment. Nonetheless, median survival for patients with small cell lung
carcinoma metastasis is approximately 4 to 5 months after cranial
irradiation. In this study the authors examine the efficacy of gamma knife
surgery for treating recurrent small cell lung carcinoma metastases to the
brain following tumor growth in patients who have previously undergone
radiation therapy, and they evaluate factors affecting survival. METHODS: A
retrospective review of 27 patients (47 recurrent small cell lung cancer
brain metastases) undergoing radiosurgery was performed. Clinical and
radiographic data obtained during a 14-year treatment period were collected.
Multivariate analysis was utilized to determine significant prognostic
factors influencing survival. The overall median survival was 18 months
after the diagnosis of brain metastases. In multivariate analysis, factors
significantly affecting survival included: 1) tumor volume (p = 0.0042); 2)
preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time
between initial lung cancer diagnosis and development of brain metastasis (p
= 0.0127). Postradiosurgical imaging of the brain metastases revealed that
62% decreased, 19% remained stable, and 19% eventually increased in size.
One patient later underwent a craniotomy and tumor resection for a tumor
refractory to radiosurgery and radiation therapy. In three patients new
brain metastases were demonstrating on follow-up imaging. CONCLUSIONS:
Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases
provided effective local tumor control in the majority of patients. Early
detection of brain metastases, aggressive treatment of systemic disease, and
a therapeutic strategy including radiosurgery can extend survival.
PMID: 15662819 [PubMed - indexed for MEDLINE]
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| 14: J
Neurosurg. 2005 Jan;102 Suppl:230-3. |
|
Tolerance dose in gamma knife surgery of lesions
extending to the anterior visual pathway.
Kenai H, Yamashita M, Nakamura T, Asano T, Sainoh M, Nagatomi H.
Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, Japan.
ngkckenai@mb.neweb.ne.jp
OBJECT: The authors performed a retrospective analysis of the radiation dose
to the anterior visual pathway (AVP) to assess its tolerance to gamma knife
surgery. METHODS: They examined five cases followed for more than 3 years.
The AVP was treated with 10-Gy doses or higher. The mean maximum delivered
dose to the AVP was 14 Gy. Ten gray or more was delivered to 25.5% of the
ipsilateral AVP, 12 Gy or more to 12.5% of the ipsilateral AVP, and 14 Gy or
more to 5.7% of the ipsilateral AVP. Although the mean follow-up period was
40.8 months (36-51 months), no cases of visual function deterioration
developed. CONCLUSIONS: The tolerance dose of the AVP is considered to be
less than 8 to 10 Gy; however, although the delivered dose to the AVP
definitely exceeded the tolerance dose in all five cases, no visual
disturbance has been identified. Longer follow up is required before any
final conclusions may be drawn. Nonetheless, it is suggested that a visual
disturbance may be avoided by using careful accurate dose planning even if
the dose delivered to the AVP is higher than currently believed to be
acceptable.
PMID: 15662816 [PubMed - indexed for MEDLINE]
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| 15: J
Neurosurg. 2005 Jan;102 Suppl:225-9. |
|
The long-term results of gamma knife radiosurgery for
hemangioblastomas of the brain.
Wang EM, Pan L, Wang BJ, Zhang N, Zhou LF, Dong YF, Dai JZ, Cai PW, Chen
H.
Department of Neurosurgery and Radiology, Huashan Hospital and Shanghai
Gamma Knife Hospital Fudan University, Shanghai, China. enmwang@sh163.net
OBJECT: The authors assessed the long-term result of gamma knife surgery
(GKS) for hemangioblastomas of the brain (HABs) and show histopathological
findings after GKS. METHODS: Thirty-five patients, 28 men and seven women,
with a mean age of 36 years underwent GKS. Eighteen patients presented with
multiple tumors and 17 with a solitary tumor. Twenty-one patients had von
Hippel-Lindau (VHL) disease. The mean tumor diameter was 13 mm (range 5-55
mm). The mean follow up after GKS was 66 months (range 24-114 months). The
mean prescription dose was 17.2 Gy (range 12-24 Gy) at the tumor margin. For
tumors close to or within the brainstem a prescription dose of 12 to 13 Gy
was used. At the most recent follow up, 29 patients were alive, six were
dead, and satisfactory tumor control had been achieved in 29. A stable or
improved neurological status was obtained in 21 patients. Eight patients
underwent open surgery because of tumor-associated cyst enlargement or the
development of new tumors after GKS. Seven patients developed new tumors and
five of them required a second GKS. The 1-year tumor control rate was 94%; 2
years, 85%; 3 years, 82%; 4 years, 79%; and 5 years, 71%. Histopathology
showed that no tumor cells were found and there was degeneration and
necrosis in a tumor nodule 48 months after GKS with a prescription dose of
18 Gy. CONCLUSIONS: Gamma knife surgery was a useful choice for small- or
medium-sized, solid HAB in the long term, especially when the tumor margin
dose was 18 Gy. Although GKS can treat multiple tumors in a single session,
for HABs associated with VHL disease, GKS faces the dual problems of tumor
recurrence or development of a new tumor.
PMID: 15662815 [PubMed - indexed for MEDLINE]
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| 16: J
Neurosurg. 2005 Jan;102 Suppl:207-13. |
|
Gamma knife surgery of brain cavernous hemangiomas.
Liscak R, Vladyka V, Simonova G, Vymazal J, Novotny J Jr.
Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech
Republic. roman.liscak@homolka.cz
OBJECT: The authors conducted a study to record more detailed information
about the natural course and factors predictive of outcome following gamma
knife surgery (GKS) for cavernous hemangiomas. METHODS: One hundred twelve
patients with brain cavernous hemangiomas underwent GKS between 1993 and
2000. The median prescription dose was 16 Gy. One hundred seven patients
were followed for a median of 48 months (range 6-114 months). The rebleeding
rate was 1.6%, which is not significantly different with that prior to
radiosurgery (2%). An increase in volume was observed in 1.8% of cases and a
decrease in 45%. Perilesional edema was detected in 27% of patients, which,
together with the rebleeding, caused a transient morbidity rate of 20.5% and
permanent morbidity rate of 4.5%. Before radiosurgery 39% of patients
suffered from epilepsy and this improved in 45% of them. Two patients with
brainstem cavernous hemangiomas died due to rebleeding. Rebleeding was more
frequent in female middle-aged patients with a history of bleeding, a larger
lesion volume, and a prescription dose below 13 Gy. Edema after GKS occurred
more frequently in patients who had surgery, a larger lesion volume, and in
those in whom the prescription dose was more than 13 Gy. CONCLUSIONS: Gamma
knife surgery of cavernous hemangiomas can produce an acceptable rate of
morbidity, which can be reduced by using a lower margin dose. Lesion
regression was observed in many patients. Radiosurgery seems to remain a
suitable treatment modality in carefully selected patients.
PMID: 15662812 [PubMed - indexed for MEDLINE]
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| 17: J
Neurosurg. 2005 Jan;102 Suppl:175-9. |
|
Pineal tumors: analysis of treatment results in 20
patients.
Amendola BE, Wolf A, Coy SR, Amendola MA, Eber D.
Miami Neuroscience Center, Coral Gables, Florida 33143, USA.
bamendola@internationalradonc.com
OBJECT: The authors evaluate their results when using gamma knife surgery
(GKS) in the management of patients with tumors in the pineal region.
METHODS: This is a retrospective clinical evaluation of 20 patients with
primary tumors of the pineal region treated with GKS from November 1994
through August 2003. There were 13 germ cell tumors, two pineoblastomas, two
low-grade gliomas, one primitive neuroectodermal tumor, one teratoma, and
one pineocytoma. There were 10 male and 10 female patients. Their median age
was 15.5 years (range 5-71 years). The median margin dose was 11 Gy (range
8-20 Gy). The median target volume was 3.1 cm3 (range 0.1-49.9 cm3). Five
patients received sequential systemic chemotherapy and four underwent
adjuvant conventional radiation therapy. Seventeen (85%) of 20 patients are
alive with a median survival of 30.4 months (range 0-85.7 months). Two
patients required retreatment. Three patients died: one of unrelated causes,
one who presented with extensive local disease, and the other of meningeal
carcinomatosis with local control of the primary tumor. No complications
from GKS were noted. CONCLUSIONS: This initial experience suggests that GKS
is a valuable treatment modality for the management of pineal region tumors.
This technique offers excellent local tumor control and minimal patient
morbidity, allowing for immediate use of systemic chemotherapy and/or
conventional radiation if indicated.
PMID: 15662805 [PubMed - indexed for MEDLINE]
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| 18: J
Neurosurg. 2005 Jan;102 Suppl:171-4. |
|
Gamma knife surgery for hemangioblastomas.
Tago M, Terahara A, Shin M, Maruyama K, Kurita H, Nakagawa K, Ohtomo K.
Department of Radiology, University of Tokyo Hospital, Tokyo, Japan.
tago-rad@h.u-tokyo.ac.jp
OBJECT: The authors reviewed their 14-year experience using stereotactic
radiosurgery for the treatment of hemangioblastomas and define the role and
the proper strategy for radiosurgery of this condition. METHODS: This is a
retrospective study of 38 hemangioblastomas in 13 patients. Seven patients
had von Hippel-Lindau disease. All patients have undergone at least one
follow-up visit. The median and mean tumor volumes were 0.23 cm3 and 0.72
cm3 respectively (range 0.004::4.84 cm3). Twenty-eight tumors received 20 Gy
to the margin, and the remainder received 18 Gy. The median clinical
follow-up period was 36 months (range 3-159 months). No patient died. The
survival rate was 84.6% (11 of 13 patients). The actuarial 5- and 10-year
survival rates were both 80.8%. The median radiological follow-up period was
35 months (range 7-147 months). Only one tumor increased in volume 24 months
after treatment in association with an intratumoral hemorrhage. The tumor
control rate was 97.4% (37 of 38 tumors). Actuarial 5- and 10-year control
rates were both 96.2%. New lesions and/or those increasing in size outside
the irradiated area were discovered in five patients (38.5%). Nine tumors
revealed peritumoral contrast enhancement which was seen more frequently in
larger tumors with a volume greater than 0.5 cm3 (p = 0.0034). CONCLUSIONS:
Gamma knife surgery is a safe and effective method to control
hemangioblastomas for as many as 10 years. Higher doses and smaller tumors
probably contribute to good outcomes. Recurrence outside the original
irradiated area is common. Peritumoral contrast enhancement may be seen in
larger tumors. The authors recommend regular imaging follow up and early
repeated treatment in the face of new or growing tumors.
Publication Types:
- Review
- Review of Reported Cases
PMID: 15662804 [PubMed - indexed for MEDLINE]
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| 19: J
Neurosurg. 2005 Jan;102 Suppl:143-6. |
|
Visual changes after gamma knife surgery for optic nerve
tumors. Report of three cases.
Kwon Y, Bae JS, Kim JM, Lee do H, Kim SY, Ahn JS, Kim JH, Kim CJ, Kwun
BD, Lee JK.
Department of Neurosurgery, Asan Medical Center, College of Medicine,
University of Ulsan, Seoul, Korea.
Tumors involving the optic nerve (optic glioma, optic nerve sheath
meningioma) are benign but difficult to treat. Gamma knife surgery (GKS) may
be a useful treatment. The authors present data obtained in three such cases
and record the effects of GKS.
Publication Types:
PMID: 15662798 [PubMed - indexed for MEDLINE]
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| 20: J
Neurosurg. 2005 Jan;102 Suppl:140-2. |
|
Stereotactic noninvasive volume measurement compared with
geometric measurement for indications and evaluation of gamma knife
treatment.
del Valle R, Perez M, Ortiz J, Ruiz S, de Anda S, Jaramillo J, Martinez
M, Corona R, Vivas I, Facha T, Olmos R, Arrieta A, Estrada J.
Gamma Radiosurgery Department and MRI Department, Hospital Medica Sur.
Mexico City, Mexico. rdvld@aol.com
OBJECT: Volume estimation is one of the most important criteria in the
evaluation and follow up of radiosurgical treatments and outcomes; however,
several limitations are involved in the calculation estimation of target
volumes. METHODS: Retrospective and prospective studies were conducted to
evaluate the efficacy of a new noninvasive stereotactic method when it is
compared with geometric volume calculation of intracranial tumors for
planning stereotactic radiosurgery treatment as well as for follow up and
outcome evaluation. Two equations were created that permit comparison of the
calculated and measured volumes. These equations took linear and quadratic
forms, respectively. Volume estimation using the stereotactic approach
compared with traditional volume calculation gave more accurate results
regardless of the shape and size of the lesion. CONCLUSIONS: The use of
stereotactic volume calculation is highly recommended in planning, follow
up, and determination of the outcome in patients participating in
radiosurgical treatment and should lead to more uniform reports of the
response to treatment.
PMID: 15662797 [PubMed - indexed for MEDLINE]
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| 21: J
Neurosurg. 2005 Jan;102 Suppl:119-23. |
|
Long-term results of gamma knife surgery for growth
hormone-producing pituitary adenoma: is the disease difficult to cure?
Kobayashi T, Mori Y, Uchiyama Y, Kida Y, Fujitani S.
Radiosurgery Center, Nagoya Kyoritsu Hospital and Gamma Knife Center, Komaki
City Hospital, Nagoya, Japan. ttkobayashi@kaikou.or.jp
OBJECT: The authors conducted a study to determine the long-term results of
gamma knife surgery for residual or recurrent growth hormine (GH)-producing
pituitary adenomas and to compare the results with those after treatment of
other pituitary adenomas. METHODS: The series consisted of 67 patients. The
mean tumor diameter was 19.2 mm and volume was 5.4 cm3. The mean maximum
dose was 35.3 Gy and the mean margin dose was 18.9 Gy. The mean follow-up
duration was 63.3 months (range 13-142 months). The tumor resolution rate
was 2%, the response rate 68.3%, and the control rate 100%. Growth hormone
normalization (GH < 1.0 ng/ml) was found in 4.8%, nearly normal (< 2.0
ng/ml) in 11.9%, significantly decreased (< 5.0 ng/ml) in 23.8%,
decreased in 21.4%, unchanged in 21.4%, and increased in 16.7%. Serum
insulin-like growth factor (IGF)-1 was significantly decreased (IGF-1 <
400 ng/ml) in 40.7%, decreased in 29.6%, unchanged in 18.5%, and increased
in 11.1%, which was almost parallel to the GH changes. CONCLUSIONS: Gamma
knife surgery was effective and safe for the control of tumors; however,
normalization of GH and IGF-1 secretion was difficult to achieve in cases
with large tumors and low-dose radiation. Gamma knife radiosurgery is thus
indicated for small tumors after surgery or medication therapy when a
relatively high-dose radiation is required.
Publication Types:
PMID: 15662793 [PubMed - indexed for MEDLINE]
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| 22: J
Neurosurg. 2005 Jan;102 Suppl:102-6. |
|
Gamma knife surgery for intracranial cavernous
hemangioma.
Kim MS, Pyo SY, Jeong YG, Lee SI, Jung YT, Sim JH.
Department of Neurosurgery, University Busan Paik Hospital, Busan, South
Korea. kinmmo@yahoo.co.kr
OBJECT: The purpose of this study was to assess the benefits of radiosurgery
for cavernous hemangioma. METHODS: Sixty-five cavernous hemangiomas were
treated with gamma knife surgery (GKS) between October 1994 and December
2002. Forty-two patients attended follow up. The mean patient age was 37.6
years (range 7-60 years). The lesions were located in the frontal lobe in 12
cases, deep in the parietal lobe in five, in the basal ganglia in five, in
the temporal in three, in the cerebellum in three, in the pons/midbrain in
six, and in multiple locations in eight cases. The presenting symptoms were
seizure in 12, hemorrhage in 11, and other in 19. The maximum dose was 26.78
Gy, and the mean margin dose was 14.55 Gy. The mean follow-up period after
radiosurgery was 29.6 months (range 5-93 months). The tumor decreased in
size in 29 cases, was unchanged in 12, and increased in size in one. In the
seizure group, seizures were controlled without anticonvulsant medication in
nine cases (81.8%) after 31.3 months (range 12-80 months). After 93 months,
one patient developed a cyst, which was resected. Rebleeding occurred in one
case (2.3%). On T2-weighted imaging changes were seen in 11 cases (26.2%),
in three (7.1 %) of which neurological deterioration was correlated with
imaging changes. In other cases these deficits were temporary. CONCLUSIONS:
The authors found that GKS was an effective treatment modality for cavernous
hemangiomas, especially for those located within the brainstem, basal
ganglia, or deep portions of the brain. It can reduce seizure frequency
significantly although this takes time. In the group receiving a marginal
dose below 15 Gy the patients fared better than when the dose exceeded 15
Gy.
PMID: 15662789 [PubMed - indexed for MEDLINE]
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| 23: J
Neurosurg. 2005 Jan;102 Suppl:97-101. |
|
Gamma knife surgery for multiple hemangioblastomas.
Park YS, Chang JH, Chang JW, Chung SS, Park YG.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul,
Korea.
OBJECT: The authors describe their experience in treating patients with
hemangioblastoma, especially multiple lesions, with gamma knife surgery
(GKS). METHODS: Nine patients with 84 hemangioblastomas underwent GKS
between July 1992 and May 2003. Three patients harbored a single lesion and
six patients had multiple lesions. Of the six patients with multifocal
tumors, a diagnosis of von Hippel-Lindau disease had been established in
five. In the patients with multiple lesions, the mean radiation dose
delivered to the tumor margin was 16.6 Gy (range 12.8-29.75 Gy). The mean
margin isodose was 60% (range 40-95%). Three of the 84 lesions failed to be
controlled after a mean follow-up period of 4.3 years (range 8.6-141
months). One patient who had undergone two GKS treatments suffered delayed
radiation-induced complications, and posterior fossa decompression and
ventriculoperitoneal shunt insertion were required. CONCLUSIONS: To achieve
tumor control and avoid morbidity, the surgeon should keep in mind
minimizing field overlapping by using a small-diameter collimator or
applying a steep dose gradient, and by accurate dose prescription.
Publication Types:
PMID: 15662788 [PubMed - indexed for MEDLINE]
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| 24: J
Neurosurg. 2005 Jan;102 Suppl:71-4. |
|
Radiosurgery and the prevention of regrowth of
incompletely removed nonfunctioning pituitary adenomas.
Picozzi P, Losa M, Mortini P, Valle MA, Franzin A, Attuati L, Ferrari da
Passano C, Giovanelli M.
Pituitary Unit of the Department of Neurosurgery, Istituto Scientifico San
Raffaele, Universita Vita-Salute, Milano, Italy. picozzi.piero@hsr.it
OBJECT: The authors studied the efficacy of gamma knife radiosurgery (GKS)
in the prevention of regrowth of nonfunctioning pituitary adenomas (NPA).
METHODS: One hundred nineteen patients were included in this study and were
divided into two groups. All patients had undergone surgery in our
department and recurrent or residual adenoma was demonstrated on
postoperative MR imaging. Group A consisted of 68 patients who were followed
without additional treatment. Group B was composed of 51 patients who
received GKS within 1 year after microsurgery. There was no significant
demographic difference between the two groups. In Group B the mean margin
dose was 16.5 +/- 0.3 Gy (range 13-21 Gy). Fifty one and one tenth percent
of patients in Group A were recurrence free at 5 years and 89.8% in Group B
(p < 0.001). In Group B patients, tumor volume decreased from a baseline
value of 2.4 +/- 0.2 cm3 to 1.6 +/- 0.2 cm3 at last follow up (p <
0.001). CONCLUSIONS: The results of this study suggest that GKS is effective
in controlling growth of residual NPA for at least 5 years following initial
maximal surgical debulking compared with no radiation therapy. Thus, GKS is
recommended after microsurgery when visible tumor can be detected on imaging
studies.
PMID: 15662784 [PubMed - indexed for MEDLINE]
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| 25: J
Neurosurg. 2005 Jan;102 Suppl:25-8. |
|
A comparison of the gamma knife model C and the automatic
positioning system with Leksell model B.
Tlachacova D, Schmitt M, Novotny J Jr, Novotny J, Majali M, Liscak R.
Departments of Stereotactic and Radiation Neurosurgery, and Medical Physics,
Na Homolce Hospital, Prague, Czech Republic. daniela.tlachacova@homolka.cz
OBJECT: The authors sought to compare the quality of treatment planning,
radiation protection, and the time taken for treatment in the Leksell gamma
knife model B with that using the model C Automatic Positioning System
(APS). METHODS: Data were obtained in 463 patients treated with the B model
and 518 patients treated with the C model. Data were analyzed in patients in
whom the following diagnoses had been made: vestibular schwannoma, pituitary
adenoma, meningioma, solitary metastasis, and other benign and malignant
solitary tumors. Patients with arteriovenous malformations, ocular lesions,
and functional diagnoses were excluded from this study. CONCLUSIONS: With
the C model there was a better conformity for most treated targets, such as
vestibular schwannomas (p = 0.005) and meningiomas (p = 0.015). The level of
radiation exposures to personnel was significantly decreased when using the
model C (p < 0.001). There was no significant difference in radiation
exposure of extracranial structures for the same number of shots in patients
treated by both models. The mean time saved using the C model with the APS
was 41 minutes per treatment. It would seem that the gamma knife model C
permits better dose conformity, shorter treatment times, and less radiation
exposure to personnel.
PMID: 15662775 [PubMed - indexed for MEDLINE]
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Volume 4, Number 9 - 15 February 2005