Dejerine-Roussy syndrome from thalamic metastasis treated with stereotactic radiosurgery

Dejerine-Roussy syndrome (central thalamic pain) is associated with damage to the ventral posterior sensory nuclei of the thalamus. We report a patient with breast cancer who developed contralateral hemibody paresthesias and dysesthesias. MR imaging revealed limited volume intracranial metastatic disease including a right posterior thalamic lesion. Stereotactic radiosurgery was utilized to selectively treat the lesion while preserving the remaining thalamus. Two months following treatment, the patient reported vastly improved to complete resolution of her sensory symptoms. This is the first reported case of thalamic tumor directed radiosurgical treatment leading to resolution of central neuropathic pain.     

Pediatric arteriovenous malformation: University of Toronto experience using stereotactic radiosurgery

Introduction and background Arteriovenous malformations (AVMs) are congenital vascular lesions of the brain, which behave differently in pediatric population compared to adults. Treatment of pediatric AVMs includes a combination of microsurgery, embolization and radiation therapies. However, the role of radiosurgery in the treatment of pediatric AVMs is not fully accepted because of concerns regarding the long-term effects of radiation on the pediatric brain. Discussion In this study, we review our experience at the University of Toronto with treating pediatric AVMs using linear accelerator-based (LINAC) radiosurgery over the past 15 years. We report our results, obliteration rates, and complications on a total of 40 patients. In addition, we provide a review of series published to date combined with our own results to determine whether radiosurgery is a safe and reasonable treatment modality for pediatric AVMs.     

A comparative outcomes analysis of patients treated for arteriovenous malformation with LINAC-based stereotactic radiosurgery by a standard frame-based technique or a frameless technique utilizing 3-dimensional rotational angiography

Previous work at our institution treating arteriovenous malformation (AVM) with radiosurgery (RS) demonstrated superior nidus visualization and geometric accuracy with use of 3-dimensional rotational angiography (3DRA) compared to biplanar digital subtraction angiography. We have since adopted a unique radiosurgical protocol that utilizes 3DRA in the planning of linear accelerator (LINAC)-based RS delivered in a frameless manner. This study seeks to compare clinical outcomes between patients treated by this novel approach and those treated by our historic frame-based protocol. Clinical data were queried for all patients treated for AVM by single-fraction RS from 2003 to 2017. RICs were identified and classified as radiologic, symptomatic, or permanent. Excellent outcome was defined as nidus obliteration without intracranial hemorrhage (ICH) or symptomatic RIC. Clinical predictors of study outcomes were identified through univariate and multivariate logistic regression using backwards elimination to optimize a predictive model. 131 AVMs in 124 patients were included with a median follow-up of 88 months. 59 AVMs received frame-based RS and 72 AVMs received frameless RS. Rate of obliteration was 64% for frame-based RS and 61% for frameless RS (p = 0.70). Radiologic, symptomatic, and permanent RICs rates were 68%, 17%, and 8%, respectively, for frame-based cases, versus 40% (p < 0.01), 8% (p = 0.13), and 3% (p = 0.15), respectively, for frameless cases. Excellent outcome was achieved in 49% of frame-based cases and 53% of frameless cases (p = 0.68). These results illustrate the safety and effectiveness of frameless LINAC-based AVM RS utilizing 3DRA.     

立体定向穿刺引流并X-刀治疗颅内囊性转移瘤 (附18例临床分析)

目的探讨立体定向穿刺引流加X刀对囊性脑转移瘤的治疗价值。方法对18例(21个脑囊性转移灶)采用立体定向穿刺引流囊液后再行X刀治疗,随访观察其影像学变化及临床疗效。结果所有病例术后均获得6个月以上随访,肿瘤完全消失10个病灶,明显缩小7个病灶,肿瘤实质增大1个病灶,另3个病灶术后3个月内囊腔再度增大,经抽吸1~3次后稳定,而肿瘤实质部分明显缩小。总体局部肿瘤控制率为95.2%,中位生存期12.3个月。结论立体定向穿刺引流加X刀是囊性脑转移瘤理想的微侵袭治疗组合。     

垂体腺瘤的X刀治疗

目的：观察分析X刀对垂体瘤的治疗效果。方法：对1997年1月至2000年6月应用Radionic公司头部X刀系统,治疗的垂体腺瘤患者随访54例,单次治疗32例,分次治疗22例。其中54例获得影像学复查,36例获得血激素水平复查。随访期3个月到32个月,平均13．2个月。结果：肿瘤缩小达55．6％,无一例肿瘤增大;临床症状改善率72．2％,随访期3个月到32个月,平均13．2个月。结果：肿瘤缩小达55．6％,无一例肿瘤增大;临床症状改善率72．2％,无临床症状加重着。血激素水平恢复正常达30．6％。结论：X刀治疗垂体腺瘤安全、有效、无明显副作用,SRT治疗后血激素水平恢复正常率高于SRS治疗,但血激素水平恢复时间长于SRS治疗。     

Successful use of frameless stereotactic radiosurgery for treatment of recurrent brain metastases in an 18-month-old child

Abstract

There are very few reported cases of stereotactic radiosurgery (SRS) delivered in children under 3 years of age. We report an 18-month-old boy with metastatic recurrence of undifferentiated round cell sarcoma to the brain which was treated with chemotherapy, resection and robotic frameless SRS. Frameless SRS was delivered without technical difficulties, acute adverse events, or clinical sequelae 1.5 months post-radiation. Longer term follow-up will be needed to evaluate local tumor control and effects on neurocognitive development, endocrine function and growth. This report adds to the literature of the few reported cases of successfully attempted SRS in very young children.     

Leksell gamma knife radiosurgery for cerebral arteriovenous malformations in pediatric patients

Objects The authors report their experience of gamma knife radiosurgery (GKR) in a large series of pediatric cerebral arteriovenous malformations (cAVMs). The advantages, risks and failures of this approach are presented and discussed.Methods Gamma knife radiosurgery was performed on 63 children aged 16 years. Haemorrhage was the clinical onset in 50 out of 63 cases. The mean pre-GK cAVM volume was 3.8 cm³. Fifty-eight out of 63 cAVMs were Spetzler-Martin grades I–III. Most lesions (47 out of 63) were in eloquent or deep-seated brain regions.Conclusion Gamma knife radiosurgery-related complications occurred in 2 out of 47 cases with an available follow-up (1 had transient and 1 permanent morbidity). No bleeding occurred during the latency period. In 39 children with >36-month follow-up, complete cAVM occlusion was angiographically documented in 31, with a 3- and 4-year actuarial obliteration rate of 72 and 77% respectively. High rates of complete obliteration and very low frequency of permanent morbidity with no bleeding during the latency period encourage widespread application of GKR in the treatment of pediatric cAVMs.A commentary on this paper is available at     

放射外科治疗面肌抽搐的初步研究

目的探讨放射治疗对原发性面肌抽搐的效果及并发症分析。方法其中1例听觉减弱的患者单次给予一次性剂量8 Gy治疗,其余3位听觉正常患者给予5天5次连续不同部位每次3 Gy剂量,共计15 Gy。所有患者靶点选择在面听神经束出脑干处至进入内听道前部分。结果 2例患者症状消失,1例症状明显减轻。另1例口服药物治疗下症状未见发作。未见明显并发症,特别是听、面神经功能无损伤。4例患者均放疗后2~4周短期随访及18个月到42个月的中期随访,放疗结果满意。结论放疗治疗原发性面肌抽搐仍为不适于手术患者的一种治疗选择方法,疗效确切。     

Survival of brain metastatic patients treated with gamma knife radiosurgery alone

Purpose

To evaluate the impact of gamma knife radiosurgery (GKRS) alone on the survival of brain metastasis patients.

Methods

Fifty patients, 17 men and 33 women, with 169 metastatic tumors were retrospectively reviewed. Before therapy, their mean Karnofsky Performance Score was 78. The majority of their primary cancers stemmed from the lung (56%). Thirty-five patients harbored multiple tumors. The mean tumor volume was 3.7 ml. The mean margin dose was 16 Gy. The mean/median clinical follow-up period was 37/25 weeks.

Results

The overall image-proven tumor control rate was 76%, and the median tumor progression-free period was 26 weeks after radiosurgery. The survival rate of the patients was 58% and 30% at 6 and 12 months, respectively, and the overall median post-radiosurgery survival time was 38 weeks. Both uni- and multi-variate Cox analyses demonstrated that patients with KPS ≧ 80 or who were in Recursive Partitioning Analysis Class I survived significantly longer (p < 0.05).

Conclusions

Patients treated with GKRS alone can prolong their median lifespan by a range of 6–10 months if they are in a good pre-GKRS functional state.     

Management of intracranial cavernous malformation in pediatric patients

Objective Cavernous malformations (CMs) are vascular malformations affecting any part of the central nervous system. CMs in the pediatric age group are known to be different from those of adults both in origin and clinical characteristics. In this paper, we report our experience in managing CMs in pediatric patients. Materials and methods Between January 1994 and December 2006, 33 patients younger than 20 years of age with intracranial CMs were treated with microsurgery or radiosurgery. We retrospectively reviewed the presentation and treatment of these 33 patients (18 boys and 15 girls; average age 11.6 years). Results The most common symptom at presentation was seizure (19 children, 57.6%). The most common type of CM, classified on the basis of magnetic resonance imaging, was type II (18, 54.5%). The supratentorial compartment was the most frequent location (27, 71.8%), and only six CMs (18.2%) were observed in the infratentorial compartment. Microsurgery was performed on 25 patients (75.8%), and radiosurgery was performed on eight patients (24.2%). The overall post-treatment results were positive. Only two children (6.1%) had persistent presurgical neurological signs, although the treatment ameliorated them. No progression of the preoperative neurological signs or onset of new neurological deficits was seen in any of the patients. In our patient group, the microsurgical removal of CMs resulted in the prevention of recurrent hemorrhage and the control of seizure disorders in all cases. Conclusions Our results suggest that pediatric patients with symptomatic CMs should be treated surgically because of the risk of recurrent hemorrhaging and the general benefits of CM removal.     

Variations in red blood cell polyamines in brain tumour patients treated with stereotactic radiosurgery

Abstract

Red blood cell polyamine levels were followed in 13 patients treated with stereotactic radiosurgery for various types of brain tumours. In the most malignant tumours radiosurgery resulted in a decrease in spermine and an increase in spermidine levels. This discrepancy between variations in polyamine levels was not found after conventional radiotherapy. The results may indicate a change in tumour polyamine activity induced by high energy radiotherapy.     

Observed magnetic resonance imaging changes in pediatric patients treated with stereotactic radiosurgery for intracranial tumors

Purpose  

This study seeks to characterize magnetic resonance imaging (MRI) changes following stereotactic radiosurgery (SRS) of pediatric brain malignancies.     

三维立体定向放疗联合全脑放疗对脑转移瘤的作用

目的探讨三维立体定向放射治疗联合全脑放疗对脑转移瘤患者神经认知功能及生存质量的影响。方法选取河南科技大学附属三门峡市中心医院肿瘤医院2012-02—2016-01收治的54例脑转移瘤患者,依据治疗方案不同分为单一组与联合组各27例。单一组实施单纯全脑放疗,于此基础上,联合组实施三维立体定向放射治疗。统计2组临床效果、不良反应情况,并对比2组治疗前后生存质量及神经认知功能变化情况。结果 2组临床总有效率相比,联合组81.49%(22/27)显著高于单一组55.56%(15/27),差异有统计学意义(P0.05);2组治疗前神经认知功能评分比较差异均无统计学意义(P0.05);与单一组相比,治疗后联合组神经认知功能评分较高,差异有统计学意义(P0.05);2组治疗前各领域生存质量评分比较差异均无统计学意义(P0.05);与单一组相比,治疗后联合组各领域生存质量评分均较高,差异有统计学意义(P0.05);联合组不良反应发生率18.52%(5/27)与单一组11.10%(3/27)相比,差异无统计学意义(P0.05)。结论脑转移瘤患者予以全脑放疗联合三维立体定向放射治疗,肿瘤控制效果更为显著,且可改善患者神经认知功能,提高生活质量,安全性较高。     

Recurrence in pediatric craniopharyngiomas: analysis of clinical and histological features

Objective The purpose of this study was to investigate the recurrence pattern and significance of various clinical and histological features as predictors of recurrence in pediatric craniopharyngiomas.Methods A series of 116 pediatric craniopharyngiomas (68 boys and 48 girls; age range, 1.6–18 years) was reviewed. Mean follow-up period was 18.53 months. Tumors recurred in 15 patients within 96 months [mean recurrence-free survival (RFS), 12.67 months]. Of the recurrence cases, 2 had complete (mean RFS, 16 months) and 13 had subtotal tumor excision (mean RFS, 9.03 months). Histologically, an adamantinous pattern was seen in 95% of cases, whereas a papillary pattern was noted in 5%. Brain tissue was included in 41 cases. In 32 of 41 cases, brain invasion was noted, and all were of adamantinous histology. No correlation was noted of histopathological subtyping or brain invasion with recurrence.Conclusions The significant clinical factors associated with recurrence included extent of resection, tumor size >4 cm, and cystic tumors.     

恶性胶质瘤外照射加X刀推量治疗模式的探讨

目的恶性胶质瘤是预后极差的常见颅内恶性肿瘤，本研究报告恶性胶质瘤外照射加X刀推量的治疗模式的疗效。方法对15例确诊为恶性胶质瘤的患者进行了外照射加X刀推量的治疗。外照射50Gy／25F／5W后，紧接着用X刀推量7～10Gy。结果治疗后近期效果满意，无严重神经功能障碍并发症。3例患者分别死于X刀后4、5、11月，余均健在。全组仅1例在治疗后3月出现脑水肿，给予对症治疗后缓解。余患者无严重的放射反应。结论恶性胶质瘤外照射加X刀推量的治疗模式是可行的．疗效较好。     

Risk of symptomatic radiation necrosis in patients treated with stereotactic radiosurgery for brain metastases

IntroductioStereotactic radiosurgery (SRS) is a treatment option in the initial management of patients with brain metastases. While its efficacy has been demonstrated in several prior studies, treatment-related complications, particularly symptomatic radiation necrosis (RN), remains as an obstacle for wider implementation of this treatment modality. We thus examined risk factors associated with the development of symptomatic RN in patients treated with SRS for brain metastases.Patients and methodsWe performed a retrospective review of our institutional database to identify patients with brain metastases treated with SRS. Diagnosis of symptomatic RN was determined by appearance on serial MRIs, MR spectroscopy, requirement of therapy, and the development of new neurological complaints without evidence of disease progression.ResultsWe identified 323 brain metastases treated with SRS in 170 patients from 2009 to 2018. Thirteen patients (4%) experienced symptomatic RN after treatment of 23 (7%) lesions. After SRS, the median time to symptomatic RN was 8.3 months. Patients with symptomatic RN had a larger mean target volume (p < 0.0001), and thus larger V100% (p < 0.0001), V50% (p < 0.0001), V12 Gy (p < 0.0001), and V10 Gy (p = 0.0002), compared to the rest of the cohort. Single-fraction treatment (p = 0.0025) and diabetes (p = 0.019) were also significantly associated with symptomatic RN.ConclusionSRS is an effective treatment option for patients with brain metastases; however, a subset of patients may develop symptomatic RN. We found that patients with larger tumor size, larger plan V100%, V50%, V12 Gy, or V10 Gy, who received single-fraction SRS, or who had diabetes were all at higher risk of symptomatic RN.     

伽玛刀联合立体定向手术治疗颅内囊性肿瘤

目的探讨立体定向穿刺抽吸手术与伽玛刀联合治疗颅内囊性肿瘤在立体定向放射外科治疗中的作用。方法分析颅内囊性肿瘤40例,单纯立体定向穿刺抽液19例,留置Ommaya囊抽液19例,内窥镜下手术切除肿瘤并排除囊液2例。肿瘤体积缩小后再行立体定向磁共振成像（MRI）定位、伽玛刀治疗,并计算抽液前后肿瘤体积的变化。依据Logistic综合方程计算抽液前后风险概率的变化,将抽液前后的肿瘤体积和风险概率进行配对t检验。结果抽液后瘤囊完全消失,病灶体积明显缩小。抽液前后肿瘤容积和风险概率均显著降低（容积变化：t＝8.108,P＜0．001;风险概率：t＝5．933,P＜0．001）。随访时间6个月～42个月,平均17.5个月。经伽玛刀治疗后,瘤结节消失10例,缩小12例,无变化17例,增大1例。结论颅内囊性肿瘤立体定向穿刺抽液后肿瘤体积缩小,使立体定向放射外科治疗并发症的风险概率显著降低,是联合伽玛刀治疗囊性肿瘤一种有效方法;针对肿瘤病理类型的不同采用伽玛刀放射外科联合单纯穿刺或置管抽取囊液、结合囊内治疗是囊性肿瘤治疗成功的关键。     

Delayed brain hemorrhage associated with prophylactic whole brain irradiation for pediatric malignant brain tumor: a case report

Intraparenchymal hemorrhage in the left frontal lobe suddenly occurred in a 7-year-old girl who had undergone partial removal of an undifferentiated brain stem glioma and received craniospinal (30 Gy) and posterior fossa booster (20 Gy) irradiation at the age of 20 months. The brain hemorrhage was thought to be delayed irradiation effect. Follow-up neuro-imaging at age 9 years showed two more small occult chronic and subacute hemorrhages in the brain. The possibility of repeated hemorrhage as a delayed reaction to brain irradiation is emphasized.     

Early detection of metachronous brain metastases by biannual brain MRI follow-up may provide patients with non-small cell lung cancer with more opportunities to have radiosurgery

Purpose

Those who have brain metastases smaller than 30 mm in diameter and less than 5 in number can be treated less invasively with radiosurgery. This retrospective study evaluated the optimal brain magnetic resonance image (MRI) follow-up interval for non-small cell lung cancer (NSCLC) patients to detect radiosurgically manageable metachronous brain metastases (MBM).

Patients and methods

The records of 551 patients with primary NSCLC, treated in our institute between 2002 and 2007, were reviewed. The initial brain MRI was performed within one month after diagnosis of NSCLC, and the follow-up brain MRI interval was at the discretion of physicians. The interval between the last MRI in which brain metastases were not found and the first MRI in which brain metastases were found was defined as the critical MRIs interval (CMI). The relationship between CMI and the maximum size or number of MBM was evaluated.

Results

Among reviewed patients, the initial MRI of 38 patients showed brain metastases and 29 patients were diagnosed as MBM. In these MBM patients, the median interval from diagnosis of NSCLC to diagnosis of brain metastases was 8.9 months. The median CMI was 4.7 (range: 1.6–18.9) months. All brain metastases smaller than 30 mm in maximum diameter were found when CMI was shorter than 6.0 months, although 5 or more brain metastases in number were detected even by shorter CMI than 3 months.

Conclusion

Early detection of MBM by biannual MRI follow-up may provide NSCLC patients with more opportunities to have less invasive treatment.