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Isabella Zhang, Silvia C Formenti, Jonathan P S Knisely
The brain has long been considered an immunologically privileged site, and the role of immunotherapy in treating intracranial disease has only recently been revived-with preclinical evidence showing that the systemic immune system responds to immunotherapy for intracranial disease, and with clinical evidence demonstrating improved locoregional control and survival compared with historical outcomes when immune-directed therapies are combined with radiation. Pharmaceutical industry-supported multi-institutional drug efficacy studies routinely exclude patients with brain metastases, so current evidence for treatment of brain metastases using stereotactic radiosurgery combined with immunotherapy comes from single-institution studies...
March 15, 2018: Oncology (Williston Park, NY)
Anna S Berghoff, Priscilla K Brastianos
Brain metastases (BMs) reflect an area of high clinical need, as up to 40% of patients with metastatic cancer will develop this morbid and highly fatal complication. Historically, treatment strategies have relied on local approaches including radiosurgery, whole-brain radiotherapy, and neurosurgical resection. Recently, targeted and immune-modulating therapies have shown promising responses and have been introduced in the clinical management of patients with BMs. Recent improvements in genomic technologies have enriched our understanding of BMs and have demonstrated that BMs present with significant genetic divergence from the originating primary tumor, such that potentially targetable genetic alterations are detected only in the BMs...
February 2018: Seminars in Neurology
Daniel A Tonetti, Bradley A Gross, Brian T Jankowitz, Hideyuki Kano, Edward A Monaco, Ajay Niranjan, John C Flickinger, L Dade Lunsford
OBJECTIVE Aggressive dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) are known for their relatively high risk of recurrent neurological events or hemorrhage. However, recent natural history literature has indicated that nonaggressive dAVFs with CVD have a significantly lower prospective risk of hemorrhage. These nonaggressive dAVFs are typically diagnosed because of symptomatic headache, pulsatile tinnitus, or ocular symptoms, as in low-risk dAVFs. Therefore, the viability of stereotactic radiosurgery (SRS) as a treatment for this lesion subclass should be investigated...
March 16, 2018: Journal of Neurosurgery
Alejandra M Petrilli, Cristina Fernández-Valle
Schwannomas are benign nerve tumors that occur sporadically in the general population and in those with neurofibromatosis type 2 (NF2), a tumor predisposition genetic disorder. NF2-associated schwannomas and most sporadic schwannomas are caused by inactivating mutations in Schwann cells in the neurofibromatosis type 2 gene (NF2) that encodes the merlin tumor suppressor. Despite their benign nature, schwannomas and especially vestibular schwannomas cause considerable morbidity. The primary available therapies are surgery or radiosurgery which usually lead to loss of function of the compromised nerve...
2018: Methods in Molecular Biology
Aldo Berti, Michelle Granville, Robert E Jacobson
A case of an extremely healthy, active, 96-year-old patient, nonsmoker, is reviewed. He was initially treated for left V1, V2, and V3 trigeminal neuralgia in 2001, at age 80, with stereotactic radiosurgery (SRS) with a dose of 80 Gy to the left retrogasserian trigeminal nerve. He remained asymptomatic for nine years until his trigeminal pain recurred in 2010. He was first treated medically but was intolerant to increasing doses of carbamazepine and gabapentin. He underwent a second SRS in 2012 with a dose of 65...
January 12, 2018: Curēus
Georges Al-Helou, Nardos Temesgen, Jonathan Gwizdala, Jalil Ahari
Our patient is a 69-year-old man who presented to the emergency department with left-sided hemiparesis that started 4 hours prior to presentation. Brain CT showed right basal ganglia and internal capsule haemorrhagic strokes. MRI revealed multiple brain lesions suspicious for metastases. Further workup revealed a 5 cm lung mass and a 1 cm pancreatic nodule. Biopsy of both pulmonary and pancreatic lesions was consistent with melanoma and was similar histologically. The patient underwent cyberknife stereotactic radiosurgery to the brain metastases followed by immunotherapy with pembrolizumab, and then by nivolumab and ipilimumab...
March 15, 2018: BMJ Case Reports
Krzysztof Slosarek, Barbara Bekman, Jacek Wendykier, Aleksandra Grządziel, Antonella Fogliata, Luca Cozzi
BACKGROUND: To appraise the dosimetric features and the quality of the treatment plan for radiosurgery of multiple brain metastases optimized with a novel automated engine and to compare with plans optimized for robotic-based delivery. METHODS: A set of 15 patients with multiple brain metastases was selected for this in silico study. The technique under investigation is the recently introduced HyperArc. For all patients, three treatment plans were computed and compared: i: a HyperArc; ii: a standard VMAT; iii) a CyberKnife...
March 15, 2018: Radiation Oncology
Zijian Zhang, Jinzhong Yang, Angela Ho, Wen Jiang, Jennifer Logan, Xin Wang, Paul D Brown, Susan L McGovern, Nandita Guha-Thakurta, Sherise D Ferguson, Xenia Fave, Lifei Zhang, Dennis Mackin, Laurence E Court, Jing Li
The original version of this article, published on 24 November 2017, unfortunately contained a mistake.
March 14, 2018: European Radiology
Richa Thakur, Ali S Haider, Ashley Thomas, Steven Vayalumkal, Umair Khan, Tijani Osumah, Kyle Doughty, Sam Finn, Kennith F Layton
A number of treatment options are available for cerebral arteriovenous malformations (AVMs) including surgical resection, stereotactic radiosurgery, and endovascular embolization. Endovascular embolization may be used pre-operatively to reduce the size of large AVMs and thus reduce surgical complications. Here we present two patients who successfully underwent preoperative embolization of their AVMs and subsequent surgery. Preoperative embolization is a viable option for AVMs to reduce complications and improve patient outcomes...
January 8, 2018: Curēus
Yee Pei Song, Rovel J Colaco
Stereotactic radiosurgery (SRS) provides excellent control in the treatment of brain metastases (BM). The use of newer, targeted and immunotherapy treatments have resulted in improved overall survival in patients even with an extensive metastatic disease. Hence, it is increasingly important to consider the potential for late toxicities like radiation-induced necrosis (RN) of the brain. We present a case of a patient with stage IV anaplastic lymphoma kinase (ALK) positive adenocarcinoma of the lung who underwent stereotactic radiosurgery to her brain metastases and received targeted treatment...
January 8, 2018: Curēus
Furkan Diren, Serra Sencer, Tayfun Hakan
Objective: Arteriovenous malformation (AVM) is the most common form of intracranial vascular malformations in adults. Intracranial pediatric AVMs are rare. AVM located in the vicinity of the brain stem in children are even more rare. Case report: This study reports a rare case of acute obstructive hydrocephalus following aqueductal stenosis caused by an unruptured grade IV perimesencephalic arteriovenous malformation. An 11-year-old boy admitted to the hospital with progressive headache, nausea and vomiting throughout a month...
2018: Open Neuroimaging Journal
Youngbeom Seo, Dong Gyu Kim, Yun-Sik Dho, Jin Wook Kim, Yong Hwy Kim, Chul-Kee Park, Hyun-Tai Chung, Sun-Ha Paek
BACKGROUND: Gamma knife radiosurgery (GKRS) has recently been used as a treatment modality for dural arteriovenous fistula (DAVF). OBJECTIVE: To retrospectively analyze the outcomes of GKRS for DAVF at a single institute. METHODS: Between 1998 and 2016, a total of 20 patients underwent GKRS for DAVF. After excluding 4 patients with > 12 months of follow-up, 16 patients were enrolled in this study. Twelve patients had undergone embolization prior to GKRS...
March 14, 2018: Stereotactic and Functional Neurosurgery
Youngbeom Seo, Dong Gyu Kim, Jin Wook Kim, Jung Ho Han, Hyun-Tai Chung, Sun-Ha Paek
BACKGROUND: Gamma knife radiosurgery (GKRS) is recognized as an important treatment modality for meningioma. OBJECTIVE: To analyze the long-term outcomes in meningioma patients treated with GKRS to determine the risk factors related to treatment failure and peritumoral edema (PTE) development. METHODS: Between 1998 and 2010, 770 consecutive patients were treated with GKRS for intracranial meningioma. After the exclusion of patients with follow-up periods of less than 5 yr and those with neurofibromatosis, multiple meningiomas, nonbenign meningioma, or radiotherapy, a total of 424 patients were enrolled in this study...
March 12, 2018: Neurosurgery
Michael T Milano, Jimm Grimm, Scott G Soltys, Ellen Yorke, Vitali Moiseenko, Wolfgang A Tomé, Arjun Sahgal, Jinyu Xue, Lijun Ma, Timothy D Solberg, John P Kirkpatrick, Louis S Constine, John C Flickinger, Lawrence B Marks, Issam El Naqa
PURPOSE: Dosimetric and clinical predictors of radiation-induced optic nerve/chiasm neuropathy (RION) after single-fraction stereotactic radiosurgery (SRS) or hypofractionated (2-5 fractions) radiosurgery (fSRS) were analyzed from pooled data that were extracted from published reports (PubMed indexed from 1990 to June 2015). This study was undertaken as part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, investigating normal tissue complication probability (NTCP) after hypofractionated radiation...
January 31, 2018: International Journal of Radiation Oncology, Biology, Physics
Ronald Sahyouni, Hossein Mahboubi, Omid Moshtaghi, Khodayar Goshtasbi, Sammy Sahyouni, Harrison W Lin, Hamid R Djalilian
OBJECTIVE: 1) Perform a meta-analysis of the available data on the outcomes of stereotactic radiosurgery (SRS) for the treatment of temporal bone glomus tumors (GT), and 2) evaluate the collective outcomes of SRS treatment with respect to tumor control. DATA SOURCES: A thorough literature search of the published English-language literature from 2011 to 2016 was performed in PubMed, Ovid, and Cochrane databases using the keywords ("Gamma Knife" or "CyberKnife" or "linear accelerator" or "radiosurgery") and ("glomus jugulare" or "jugular paraganglioma" or "glomus tympanicum")...
April 2018: Otology & Neurotology
Joshua T Prickett, Brendan J Klein, Christopher M Busch, Joshua A Cuoco, Lisa S Apfel, Eric A Marvin
Intraventricular meningiomas are uncommon intracranial tumors and infrequently present with hemorrhage. With only 10 reported cases in the literature, it is exceedingly rare for meningiomas of the ventricular system to present with hemorrhage. To our knowledge, this is the first report of a patient presenting with an acute intraventricular hemorrhage in relation to a ventricular meningioma suspected to be radiation induced. In addition, we review the current literature on hemorrhagic intraventricular meningiomas and review the natural history of radiation-induced meningiomas...
January 2018: Journal of Neurological Surgery Reports
Felix Ehret, Alexander Muacevic
Vestibular schwannomas are mostly sporadic, neuroectodermal, benign tumors of the myelin-forming cells of the vestibulocochlear nerve. Typical initial symptoms of vestibular schwannomas often include unilateral hearing loss, tinnitus, vertigo, and headaches. As schwannomas characteristically show a slow growth rate and various symptoms, different therapeutic approaches are possible, ranging from a watchful waiting strategy to radiation therapy and neurosurgical tumor removal. In addition, these treatment options should be evaluated carefully and assigned individually to the patients' needs and symptoms while respecting the feasibility and possible outcome of the chosen treatment...
January 5, 2018: Curēus
David Yuen Chung Chan, Danny Tat Ming Chan, Cannon Xian Lun Zhu, Patricia Kwok Yee Kan, Amelia Yikjin Ng, Yi-Pin Sonia Hsieh, Jill Abrigo, Wai Sang Poon, George Kwok Chu Wong
Treatment of arteriovenous malformations (AVM) located at the eloquent area has been a challenge. Awake brain mapping allows identification of a non-eloquent gyrus for intervention and can potentially facilitate resection with preservation of functions. An alternative treatment option is stereotactic radiosurgery (SRS). The objective of this study was to perform a qualitative comparison of the treatment outcome of awake AVM excision versus SRS. We conducted a 13-year retrospective review of AVM excision under awake craniotomy performed at Prince of Wales Hospital, Hong Kong, from 2003 to 2016...
March 9, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Nancy E Epstein
Background: Spinal meningiomas are found in patients typically between the ages of 75 and 84: some report the average age to be 50. They occur with an incidence of approximately 1000 patients per year in the US, are mostly single (90%) rather than multiple (10%), and arise from the spinal meninges (arachnoid/dura). Tumors are typically posterior/posterolateral (70%) in location, leaving the remaining 30% in the anterior/anterolateral spinal canal. They produce symptoms and signs of radiculopathy (nerve root) and/or myelopathy (cord compression) depending on their site of origin...
2018: Surgical Neurology International
Shigenari Nukaga, Katsuhiko Naoki, Hiroyuki Yasuda, Ichiro Kawada, Kentaro Ohara, Kenzo Soejima, Tomoko Betsuyaku
Stereotactic radiosurgery (SRS) using the Gamma Knife (GK) is now being increasingly utilized for the treatment of brain metastases. However, there are a few reported cases of SRS-induced brain neoplasms. We herein report the case of a Japanese woman with metastatic non-small cell lung cancer (NSCLC) harboring EGFR-mutations who was treated four times with a GK for brain metastases. She developed glioblastoma 5.7 years after the initial GK surgery. Radiation-induced secondary neoplasms generally appear after a latency period of several years...
March 9, 2018: Internal Medicine
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