Clinical evaluation of cellulose porous beads for the
therapeutic embolization of meningiomas.
Kai
Y, Hamada
JI, Morioka
M, Yano
S, Nakamura
H, Makino
K, Mizuno
T, Takeshima
H, Kuratsu
JI.
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto
University, Kumamoto, Japan.
BACKGROUND AND PURPOSE: Cellulose porous beads (CPBs) are a new,
exceptionally uniformly sized, nonabsorbable embolic agent. We evaluated
their efficacy in the preoperative embolization of meningiomas. METHODS: In
141 consecutive patients, we used CPBs (200-mum diameter) for the
preoperative embolization of meningiomas. We selected patients whose tumors
were >/=4 cm with 50% of blood to the tumor supplied by the external
carotid artery (ECA). All patients underwent a provocation test before
embolization. The percentage of blood supplied to the tumor by the internal
carotid artery and ECA was determined angiographically. Nonenhanced areas on
postembolization MR imaging were calculated. Intraoperative blood loss,
units of blood transfusion, and hemostasis at the time of surgery were
recorded for each patient. The interval between embolization and surgery was
intentionally longer than 7 days. RESULTS: Of the 141 patients, 128
underwent CBP embolization. Eleven patients had positive provocation test
results, and 2 had vasospasm; they were not CBP embolized. In 72% of the
patients CBP embolization achieved reduction in the flow of the feeding
artery by more than 50%. The nonenhanced area on MR imaging was not
significantly correlated with the degree of ECA supply or devascularization.
The interval between embolization and surgery was 8-26 days (mean, 9.9
days). The longer this interval, the greater was the tumor-softening effect
and the rate of tumor removal. CONCLUSIONS: CPBs may be useful for the
preoperative embolization of meningiomas. To increase the efficacy of CPB
embolization, the interval to surgery should be at least 7 days.
PMID: 16687561 [PubMed - in process]
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Rapamycin causes regression of astrocytomas in tuberous
sclerosis complex.
Franz
DN, Leonard
J, Tudor
C, Chuck
G, Care
M, Sethuraman
G, Dinopoulos
A, Thomas
G, Crone
KR.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center,
University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039,
USA. david.franz@cchmc.org
OBJECTIVE: Tuberous sclerosis complex (TSC) is a genetic disorder
characterized by the formation of hamartomas in multiple organs. Five to 15%
of affected individuals display subependymal giant cell astrocytomas, which
can lead to substantial neurological and postoperative morbidity due to the
production of hydrocephalus, mass effect, and their typical location
adjacent to the foramen of Monro. We sought to see whether therapy with oral
rapamycin could affect growth or induce regression in astrocytomas
associated with TSC. METHODS: Five subjects with clinically definite TSC and
either subependymal giant cell astrocytomas (n = 4) or a pilocytic
astrocytoma (n = 1) were treated with oral rapamycin at standard
immunosuppressive doses (serum levels 5-15 ng/ml) from 2.5 to 20 months. All
lesions demonstrated growth on serial neuroimaging studies. Magnetic
resonance imaging scans were performed before and at regular intervals
following initiation of therapy. RESULTS: All lesions exhibited regression
and, in one case, necrosis. Interruption of therapy resulted in regrowth of
subependymal giant cell astrocytomas in one patient. Resumption of therapy
resulted in further regression. Treatment was well tolerated.
INTERPRETATION: Oral rapamycin therapy can induce regression of astrocytomas
associated with TSC and may offer an alternative to operative therapy of
these lesions.
Publication Types:
PMID: 16453317 [PubMed - indexed for MEDLINE]
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Gamma-Knife radiosurgery in the management of melanoma
patients with brain metastases: A series of 106 patients without whole-brain
radiotherapy.
Gaudy-Marqueste
C, Regis
JM, Muracciole
X, Laurans
R, Richard
MA, Bonerandi
JJ, Grob
JJ.
Dermatology Department, Hopital Sainte Marguerite, Marseille, France.
PURPOSE: To assess retrospectively a strategy that uses Gamma-Knife
radiosurgery (GKR) in the management of patients with brain metastases (BMs)
of malignant melanoma (MM). METHODS: GKR without whole-brain radiotherapy (WBRT)
was performed for patients with Karnofsky Performance Status (KPS) of 60 or
above who harbored 1 to 4 BMs of 30 mm or less and was repeated as often as
needed. Survival was assessed in the whole population, whereas local-control
rates were assessed for patients with follow-up longer than 3 months.
RESULTS: A total of 221 BMs were treated in 106 patients; 61.3% had a single
BM. Median survival from the time of GKR was 5.09 months. Control rate of
treated BMs was 83.7%, with 14% of complete response (14 BMs), 42% of
partial response (41 BMs), and 43% of stabilization (43 BMs). In
multivariate analysis, survival prognosis factors retained were KPS greater
than 80, cortical or subcortical location, and Score Index for Radiosurgery
(SIR) greater than 6. On the basis of KPS, BM location, and age, a score
called MM-GKR, predictive of survival in our population, was defined.
CONCLUSION: Gamma-Knife radiosurgery provides a surgery-like ability to
obtain control of a solitary BM and could be consider as an alternative
treatment to the combination of GKR+WBRT as a palliative strategy. MM-GKR
classification is more adapted to MM patients than are SIR, RPA and Brain
Score for Brain Metastasis.
PMID: 16682138 [PubMed - as supplied by publisher]
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Research foundations find strength in numbers.
Hede
K.
Publication Types:
PMID: 16670378 [PubMed - indexed for MEDLINE]
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Levetiracetam therapy in patients with brain tumour and
epilepsy.
Maschio
M, Albani
F, Baruzzi
A, Zarabla
A, Dinapoli
L, Pace
A, Pompili
A, Carapella
CM, Occhipinti
E, Jandolo
B.
Department of Neuroscience and Cervical-Facial Pathology, Epilepsy
Outpatienta9s Centre, "Regina Elena" National Institute for
Cancer, Via Elio Chianesi 53, 00144, Rome, Italy, maschio@ifo.it.
Epilepsy is a common clinical problem in patients with brain tumours,
strongly affecting patientsa9 quality of life. Tumour-related seizures are
often difficult to control, and the clinical picture is complicated by
frequent interactions between antiepileptic drugs (AEDs) and antineoplastic
agents. We studied the safety and efficacy of levetiracetam (LEV), a new AED
with a different pharmacological profile from traditional anticonvulsants,
in 19 patients (6 females; age range 28-70 years, mean 48 years) with
supratentorial gliomas and epilepsy. Seizure types were simple partial in
four patients, complex partial in 4, complex partial with secondary
generalization in 7, and generalized tonic-clonic in 4. LEV was added to the
existing AED treatment on account of persisting seizures, and titrated at
dosages of 1,000-3,000 mg/day. Patients were seen at the Outpatienta9s
Centre every 1-3 months, and followed-up for 7-50 months (mean 25 months,
median 20 months). At the end of the observation period, nine patients were
seizure free (seizure free period ranging from 7 to 33 months, mean 16,
median 12) and five patients reported an improvement in seizure-frequency
from daily to weekly (n = 1) or from weekly to monthly (n = 3). Seizure
frequency was unmodified in four patients and increased (from monthly to
weekly) in one. No LEV-related adverse effects were observed. LEV plasma
concentrations monitored in 12 subjects ranged from 11.9 to 82.1 microg/ml.
Our preliminary open data indicate that add-on treatment with LEV in
patients with brain tumours is safe and appears to be effective in reducing
seizure frequency. Controlled studies on larger populations are warranted to
confirm these open observations.
PMID: 16685465 [PubMed - as supplied by publisher]
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Comment on:
Re: Cerebellar mutism in adults after posterior fossa
surgery: a report of 2 cases (Sherman JH et al. Surg Neurol 2005;63:476-9).
Akil
H.
Publication Types:
PMID: 16531220 [PubMed - indexed for MEDLINE]
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An unusual case of tumor-to-cavernoma metastasis. A case
report and literature review.
Chan
CH, Fabinyi
GC, Kalnins
RM.
Department of Neurosurgery, University of Melbourne, Austin Health,
Heidelberg 3084, Victoria, Australia.
BACKGROUND: Metastases of systemic neoplasia to preexisting intracranial
mass lesions are uncommon phenomena. Tumor-to-intracranial cavernoma
metastases are even more unusual and rarely reported. We describe here a
case of melanoma to intracranial cavernoma metastasis. CASE DESCRIPTION: A
39-year-old woman presented after an episode of generalized tonic-clonic
seizure on a background of infrequent epilepsy. She was found to have a left
parieto-occipital hemorrhagic lesion on imaging studies. The lesion was
surgically removed and histopathology showed a metastatic melanoma within a
cavernoma. CONCLUSION: This case report represents the third recorded case
of tumor-to-intracranial cavernoma metastasis and the first melanoma to
intracranial cavernoma metastasis. An extensive literature review of
tumor-to-intracranial tumor metastases was conducted and disclosed an
increase in reporting of the uncommon phenomenon of metastasis into
preexisting intracranial lesions. It should therefore be considered as a
differential diagnosis in patients with history of systemic cancer who
present with progression of preexistent intracranial lesions.
Publication Types:
PMID: 16531212 [PubMed - indexed for MEDLINE]
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Leptomeningeal carcinomatosis in a patient with
metastatic prostate cancer: case report and literature review.
Cone
LA, Koochek
K, Henager
HA, Fausel
R, Gade-Andavolu
R, Potts
BE, Jennings
LM.
Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA 92270,
USA. laconemedico@aol.com
BACKGROUND: Leptomeningeal metastasis is discovered at autopsy in
approximately 5% of patients with systemic cancer. Until recently with the
introduction of magnetic resonance imaging (MRI), premorbid diagnosis was
extremely difficult. In particular, initial spinal fluid cytology is
diagnostic in less than 50% of autopsy-verified patients, although repeated
spinal fluid examinations may increase the yield significantly.
Leptomeningeal metastasis in metastatic prostate cancer has been reported in
only 14 patients previously. CASE DESCRIPTION: We recently studied such a
patient and were able to establish a correct diagnosis based solely on the
MRI and the presence of an elevated cerebrospinal fluid (CSF)
prostate-specific antigen (PSA). Only 3 previous patients with
leptomeningeal prostate metastasis have undergone CSF PSA evaluations.
CONCLUSION: We believe that, in such patients, the combination of MRI and
CSF studies can overcome the lack of sensitivity of CSF cytology.
Publication Types:
PMID: 16531199 [PubMed - indexed for MEDLINE]
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Trigonal cavernous angiomas: report of three cases and
review of literature.
Kumar
GS, Poonnoose
SI, Chacko
AG, Rajshekhar
V.
Department of Neurological Sciences, Christian Medical College, Vellore,
Tamilnadu 632004, India.
BACKGROUND: Intraventricular cavernous angiomas are very rare. Only few
cases of trigonal angiomas have been reported. CASE DESCRIPTION: We report
three cases of trigonal cavernous angiomas who presented with raised
intracranial pressure or seizures and who underwent total excision with a
good recovery. We also review the literature and discuss surgical
approaches. CONCLUSION: On magnetic resonance imaging, intraventricular
cavernous angiomas lack the hemosiderin ring characteristically seen around
parenchymal cavernous angiomas. This explains why trigonal cavernous
angiomas can mimic malignant neoplasm on imaging, and they should be
considered in the differential diagnosis of intraventricular masses. Total
excision should be the goal of surgery.
Publication Types:
PMID: 16531197 [PubMed - indexed for MEDLINE]
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Gamma knife radiosurgery for intracranial mature teratoma--long-term
results and review of literature.
Chiu
CD, Chung
WY, Pan
DH, Wong
TT, Shih
YH, Lee
LS.
Department of Neurosurgery, Neurological Institute, Veterans General
Hospital-Taipei, and National Yang-Ming University, Taipei, Taiwan 11217,
Republic of China.
BACKGROUND: The purpose of this report is to present long-term outcomes of
gamma knife radiosurgery for intracranial mature teratoma after debulking
surgery. METHODS: Three patients with intracranial mature teratoma had
initial target volumes of 5.4, 18.7, and 5.1 cm(3), respectively, and were
treated by gamma knife radiosurgery between 1993 and 2004. Marginal doses of
17, 12.5, and 13.5 Gy, respectively, were delivered to the tumors at isodose
levels of 50%, 50%, and 62%, respectively. The first patient received
radiosurgery after surgical removal and conventional radiotherapy. The
second patient received similar management, including surgery and
radiotherapy, with tumor recurrence. Two additional operations and
subsequent radiosurgery were performed on this patient. Based on the
favorable results of the first 2 patients, we performed radiosurgery instead
of conventional radiotherapy after subtotal surgical removal in the last
patient. By reviewing literatures concerning the therapeutic modalities and
the long-term results of our 3 patients, we discuss the role of radiosurgery
in treating intracranial mature teratoma. RESULTS: A follow-up period of
121, 89, and 31 months, respectively, demonstrated tumor volume reduction
rates of 70%, 89%, and 48%, respectively. No evidence of further tumor
progression and no radiosurgery-related complication or morbidity was noted.
The school performances of the affected children are all above average.
CONCLUSIONS: Gamma knife radiosurgery provides a safe and effective
alternative as the adjuvant treatment of intracranial mature teratoma after
surgical debulking. Previous conventional radiotherapy does not alter final
tumor control. Radiosurgery should be considered when residual tumor growth
continues with no related symptoms or evaluations of tumor markers during
follow-up.
Publication Types:
PMID: 16531191 [PubMed - indexed for MEDLINE]
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Endonasal transsphenoidal surgery: the patient's
perspective-survey results from 259 patients.
Dusick
JR, Esposito
F, Mattozo
CA, Chaloner
C, McArthur
DL, Kelly
DF.
Division of Neurosurgery, University of California at Los Angeles School of
Medicine, 200 UCLA Medical Plaza, Los Angeles, CA 90095-7182, USA.
BACKGROUND: Patient impressions remain an important yet often overlooked
aspect of surgical success. Herein we present postoperative questionnaire
results in patients after a standard direct endonasal approach, an extended
suprasellar endonasal approach, and a reoperative transsphenoidal surgery
for tumor removal with the operating microscope. METHODS: From July 1998
through April 2005, of 452 patients undergoing endonasal surgery, 346 were
sent questionnaires, and of these, 259 (75%) completed them. Nasal packing
was placed for 24 hours in the first 95 patients but not in the last 357.
RESULT: Overall, 73% of patients reported a better experience than expected
and 8% worse than expected. A worse than expected overall experience was
noted in 15% of patients with nasal packing compared with 5% of patients
without packing (P = .001). Of patients with preoperative headache, 49%
resolved, 34% somewhat resolved, and 5% worsened. The frequency of
rhinological complaints declined from 2 weeks to 3 months postsurgery (P
< .001); by 3 months or more postsurgery, 67% to 87% of patients had no
rhinological complaints and 1% to 2% had severe complaints. Of 30 patients
with prior sublabial surgery, the endonasal procedure afforded easier
recovery (87%), less pain (80%), better nasal airflow (79%), and a shorter
hospital stay (median 3 vs 5 days) (P < .001). Of 28 patients with
complications, the severity of rhinological complaints was similar to those
without complications except this subgroup reported greater loss of sense of
smell 3 months after surgery (P < .001). CONCLUSIONS: Rhinological
recovery is typically rapid and relatively complete after direct endonasal
transsphenoidal surgery using both standard and extended suprasellar
approaches. Compared with the sublabial route, the endonasal approach is
associated with less pain, better nasal airflow, and a shorter hospital
stay.
PMID: 16531188 [PubMed - indexed for MEDLINE]
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Research news and notes.
Roitberg
B.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
60612, USA.
Publication Types:
PMID: 16531185 [PubMed - indexed for MEDLINE]
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Volume 5, Number 20 - 15 May 2006