Asunto(s)
COVID-19 , Equipo de Protección Personal , COVID-19/prevención & control , Diseño de Equipo , Humanos , Pandemias , Papel , PlásticosRESUMEN
Tumor suppressor protein p19(ARF) (Arf; p14(ARF) in humans) functions in both p53-dependent and -independent modes to counteract hyper-proliferative signals caused by proto-oncogene activation, but its p53-independent activities remain poorly understood. Using the tandem affinity purification-tag technique, we purified Arf-containing protein complexes and identified p68 DEAD-box protein (DDX5) as a novel interacting protein of Arf. In this study, we found that DDX5 interacts with c-Myc, and harbors essential roles for c-Myc-mediated transcription and its transforming activity. Furthermore, when c-Myc was forcibly expressed, the expression level of DDX5 protein was drastically increased through the acceleration of protein synthesis of DDX5, suggesting the presence of an oncogenic positive feedback loop including c-Myc and DDX5. Strikingly, Arf blocked the physical interaction between DDX5 and c-Myc, and drove away DDX5 from the promoter of c-Myc target genes. These observations most likely indicate the mechanism by which Arf causes p53-independent tumor-suppressive activity.
Asunto(s)
Inhibidor p16 de la Quinasa Dependiente de Ciclina/metabolismo , ARN Helicasas DEAD-box/metabolismo , Retroalimentación Fisiológica , Proteínas Proto-Oncogénicas c-myc/metabolismo , Animales , Línea Celular , Línea Celular Tumoral , Células Cultivadas , Inhibidor p16 de la Quinasa Dependiente de Ciclina/genética , ARN Helicasas DEAD-box/genética , Embrión de Mamíferos/citología , Fibroblastos/metabolismo , Células HEK293 , Células HeLa , Humanos , Immunoblotting , Células MCF-7 , Ratones , Ratones de la Cepa 129 , Ratones Endogámicos C57BL , Ratones Noqueados , Ratones Desnudos , Células 3T3 NIH , Unión Proteica , Proto-Oncogenes Mas , Proteínas Proto-Oncogénicas c-myc/genética , Interferencia de ARNRESUMEN
BACKGROUND: Coregistration of any neuroimaging studies into treatment planning for stereotactic radiosurgery became easily applicable using the Leksell Gamma Knife 4C, a new model of gamma knife. The authors investigated the advantage of this image processing. METHOD: Since installation of the Leksell Gamma Knife 4C at the authors' institute, 180 sessions of radiosurgery were performed. Before completion of planning, coregistration of frameless images of other modalities or previous images was considered to refine planning. Treatment parameters were compared for planning before and after refinement by use of coregistered images. FINDINGS: Coregistered computed tomography clarified the anatomical structures indistinct on magnetic resonance imaging. Positron emission tomography visualized lesions disclosing metabolically high activity. Coregistration of prior imaging distinguished progressing lesions from stable ones. Diffusion-tensor tractography was integrated for lesions adjacent to the corticospinal tract or the optic radiation. After refinement of planning in 36 sessions, excess treated volume decreased (p = 0.0062) and Paddick conformity index improved (p < 0.001). Maximal dose to the white matter tracts was decreased (p < 0.001). CONCLUSION: Image coregistration provided direct information on anatomy, metabolic activity, chronological changes, and adjacent critical structures. This gathered information was sufficiently informative during treatment planning to supplement ambiguous information on stereotactic images, and was useful especially in reducing irradiation to surrounding normal structures.
Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/cirugía , Procesamiento de Imagen Asistido por Computador/métodos , Radiocirugia/métodos , Encefalopatías/metabolismo , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/cirugía , Glioblastoma/diagnóstico , Glioblastoma/metabolismo , Glioblastoma/cirugía , Humanos , Imagenología Tridimensional , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico , Meningioma/metabolismo , Meningioma/cirugía , Estudios RetrospectivosRESUMEN
To evaluate the treatment outcome of radiotherapy combined with cis-diammine-glycolatoplatinum (nedaplatin) plus 5-fluorouracil (5-FU) for esophageal cancer. From January 2000 to December 2004, a total of 12 esophageal cancer patients with locally advanced and metastatic esophageal cancer (stages II-IVB) were treated with radiation therapy (50.4 Gy) combined with nedaplatin (80 mg/m(2), bolus infusion) and 5-FU (800 mg/m(2)/24 h, continuous infusion for 4 days) (NDP group). We compared the data with those of patients during the same period receiving a different chemotherapy regimen consisting of cisplatin (75 mg/m(2), bolus infusion) and 5-FU (1000 mg/m(2)/24 h, continuous infusion for 4 days) (n = 29, CDDP group) combined with the same radiation therapy. The median survival period was 11.5 months in the NDP group and 13.1 months in the CDDP group. The overall survival rates at 1-, 2-, and 3-years were 40%, 13%, and 13% in the NDP group and 56%, 42%, and 8% in the CDDP group (P = 0.2472), respectively. Grade III and IV leukocytopenia was observed in six (50%) and none of the patients in the NDP group and 14 (48%) and seven (24%) in the CDDP group, respectively. Grade III thrombocytopenia was observed in three (25%) in the NDP group and four (14%) in the CDDP group. Radiation combined with nedaplatin and 5-FU is a safe and effective method for treating esophageal cancer. We recommend that NDP should be used rather than dose-reduction of CDDP combined with 5-FU in patients with impaired renal function as indicated by low creatinine clearance value (40-60 mL/min).
Asunto(s)
Adenocarcinoma/terapia , Antineoplásicos/uso terapéutico , Cisplatino/uso terapéutico , Neoplasias Esofágicas/terapia , Fluorouracilo/uso terapéutico , Compuestos Organoplatinos/uso terapéutico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/radioterapia , Adulto , Anciano , Antineoplásicos/administración & dosificación , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/radioterapia , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Radioterapia Adyuvante , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The aim of this paper is to evaluate the treatment outcome of radiation therapy (RT) for 16 loco-regionally recurrent esophageal cancer patients. Between 1995 and 2004, patients with loco-regional recurrence of esophageal cancer after curative surgery received RT with or without chemotherapy (CTx) at an average total dose of 56.6 Gy (n = 16, REC group). The site of recurrence was the supraclavicular region in three patients, the mediastinal region in nine patients, and both the supraclavicular and mediastinal regions in four patients. We compared the data with those of patients receiving palliative RT with or without CTx for mediastinal relapse, distant metastasis or malignant pleural effusion (n = 39, META group) and with those of patients receiving postoperative RT with or without CTx in a planned fashion 4-6 weeks after esophagectomy (n = 27, PORT group). The median survival period was 13.8 months in the REC group, 3.5 months in the META group, and 19.1 months in the PORT group. The survival rates at 1 and 2 years were 56% and 19% in the REC group, 6% and 3% in the META group (P = 0.0003), and 70% and 43% in the PORT group (P = 0.1917), respectively. According to univariate analysis, the factor of worse prognosis was not found in the REC group. Complete or partial responses were observed in four (25%) and nine (56%) of the REC group patients, respectively. In the REC group, changes in clinical symptoms, such as dysphagia and recurrent nerve paralysis, could be evaluated in eight patients, and improvement in symptoms was obtained in five (63%) patients. The prognosis of patients who received RT for postoperative loco-regional recurrence of esophageal cancer was significantly better than that of the META group patients and compatible with that of the PORT group patients. Additionally, there is symptomatic relief in a substantial proportion of such patients, and long-term survival is possible in some patients.
Asunto(s)
Neoplasias Esofágicas/radioterapia , Recurrencia Local de Neoplasia/radioterapia , Terapia Recuperativa , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/cirugía , Quimioterapia Adyuvante , Neoplasias Esofágicas/cirugía , Esofagectomía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neoplasias del Mediastino/radioterapia , Neoplasias del Mediastino/secundario , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Cuidados Paliativos , Derrame Pleural Maligno/radioterapia , Dosificación Radioterapéutica , Inducción de Remisión , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
This study investigated treatment results and prognostic factors in radical radiotherapy for stage IIB-IVA cervical cancer. This is a retrospective analysis of 71 patients with cancer of the uterine cervix treated radically with external beam radiotherapy and high-dose-rate intracavitary brachytherapy between June 1991 and May 2004. In 47/71 (66%) of patients' chemotherapy was combined with radiotherapy. All 71 patients were retrospectively analysed. The median follow-up time was 34.8 months. The median age was 57 years (range 26-78 years) There were 21 patients (30%) in stage IIB, 3 (4%) stage IIIA, 40 (56%) stage IIIB, and 7 (10%) stage IVA. The 5-year overall survival rate was 83.5%, 77.0%, and 42.9% for stage IIB, III, and IVA, respectively. Federation Internationale de Gynocologie et d'Obstetrique (FIGO) classification stage and pelvic and para-aortic nodal status significantly affected survival in univariate analysis, but no treatment-related factor was found to be significant in multivariate analysis. In this study para-aortic nodal status was the most important prognostic factor in the radical radiotherapy of cervical cancer.
Asunto(s)
Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias del Cuello Uterino/radioterapia , Adenocarcinoma/secundario , Adulto , Anciano , Braquiterapia/métodos , Carcinoma de Células Escamosas/secundario , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática/radioterapia , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
A 66-year-old man underwent successfully on one-staged operation for aneurysms of the descending thoracic aorta and abdominal aorta. For the operation of descending thoracic aortic aneurysm, a temporary bypass was used from the proximal side of aneurysm to the distal one. The sacculer aneurismal wall of the descending thoracic aorta was repaired by patch formation using a knitted graft. Abdominal aortic aneurysm was replaced using a Gelsoft graft. The operation time was 7 hours and 35 minutes. Blood transfusion was not needed. The postoperative course was uneventful. It is suggested that one-staged operation for descending thoracic aortic aneurysm under the assist of temporary bypass and abdominal aortic aneurysm is possible.
Asunto(s)
Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Anciano , Humanos , Masculino , Resultado del TratamientoRESUMEN
Assessment of intracranial arteriovenous malformations (AVMs) by conventional catheter angiography carries risks; moreover, this invasive procedure is often repeated for follow-up. We investigated the clinical applicability of two-dimensional thick-slice, contrast-enhanced magnetic resonance digital subtraction angiography (2D MRDSA) with high temporal resolution in the assessment of AVMs. We performed 78 2D MRDSA studies of treated or untreated small to medium-size AVMs on a 1.5 tesla imager. Two observers independently evaluated demonstration of nidus flow void on T2-weighted images and each component of the AVM on 2D MRDSA employing a three-point grading scale. In 55 patients with AVMs, the mean ratings of nidus flow voids, feeding vessels, nidi, draining vessels and early venous filling on MRI were 2.8, 2.4, 2.6, 2.8 and 2.8, respectively. sensitivity, specificity, positive and negative predictive values for an AVM using 2D MRDSA were 87, 100, 100 and 78%, respectively and for nidus flow voids on T2-weighted images 80, 91, 96 and 66%, respectively. 2D MRDSA can thus demonstrate haemodynamic features of AVMs. It can be employed as a less invasive, dynamic angiographic tool for follow-up of AVMs previously delineated by catheter angiography.
Asunto(s)
Malformaciones Arteriovenosas Intracraneales/diagnóstico , Angiografía por Resonancia Magnética/métodos , Adulto , Angiografía de Substracción Digital , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/cirugía , Masculino , Valor Predictivo de las Pruebas , Radiocirugia , Sensibilidad y EspecificidadRESUMEN
We report a case of DeBakey IIIb type dissecting aneurysm with adrenal myelo-lipoma in a 50-year-old woman. The patient was referred to our hospital for severe back pain with severe hypertension. The chest computed tomography (CT) scans and aortography showed the DeBakey IIIb type dissecting aneurysm. And the round-shaped masses on her both side adrenal glands were detected by abdominal CT scans. First, the thoracic aneurysm was replaced with a 26 mm woven dacron graft under cardiopulmonary bypass. Six months later a right adrenal tumor was removed under a postero lateral approach. Her postoperative course was uneventful. And her blood pressure control was good with no antihypertensive drug. Pathological findings for the resected tumor was diagnosed as myelolipoma. To our knowledge, a dissecting aneurysm with adrenal myelolipoma has not been previously reported.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Aneurisma de la Aorta Torácica/complicaciones , Disección Aórtica/complicaciones , Mielolipoma/complicaciones , Femenino , Humanos , Hipertensión/complicaciones , Persona de Mediana EdadRESUMEN
A 51-year-old man with dyspnea was admitted to our hospital. Chest computed tomography (CT) scan and aortogram indicated a diagnosis of aneurysm of diverticulum of the ductus arteriosus. Aneurysm of the diverticulum of the ductus arteriosus in the adult is rare. To our knowledge, 34 cases have been reported in the Japanese literature. Operation was performed through standard left postero-lateral thoracotomy. Initially left pneumonectomy was performed because of severe left lung collapse. And subsequently graft replacement of distal aortic arch was performed with hypothermic retrograde cerebral perfusion. The aneurysmal wall directly penetrated into the trachea with occluded orifice by thrombus. The penetrating wall of the trachea was closed by mattress suture with pericardial pledget. And an omental graft was placed. Five weeks after surgery, high fever and pus discharge from the wound of the thoracotomy developed. The debridement of the thoracic cavity was performed, and the cavity was intermittently irrigated with an electrolyzed strong acid solution. The infection successfully subsided gradually and the patient has been well for 9 months after the initial surgery.
Asunto(s)
Aneurisma/cirugía , Divertículo/cirugía , Conducto Arterial/cirugía , Implantación de Prótesis Vascular , Humanos , Masculino , Persona de Mediana Edad , Epiplón/trasplante , Perfusión , Neumonectomía , Resultado del TratamientoRESUMEN
OBJECT: The long-term outcome of stereotactic radiosurgery for cavernous sinus (CS) meningiomas is not fully understood. The authors retrospectively reviewed their experience with 40 CS meningiomas treated with gamma knife radiosurgery. METHODS: Follow-up periods for the 40 patients ranged from 12 to 123 months (median 42 months), and the overall tumor control rates were 86.4% at 3 years and 82.3% at 10 years. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). When the tumor was completely covered with a dose to the margin that was higher than 14 Gy (Group A, 22 patients), no patient showed recurrence within the median follow-up period of 37 months. On the other hand, when a part of the tumor was treated with 10 to 12 Gy (Group B, 15 patients) or did not receive radiation therapy (Group C, three patients), the recurrence rates were 20% and 100%, respectively. Neurological deterioration was seen in nine patients, but all symptoms were transient or very mild. CONCLUSIONS: The data indicate that stereotactic radiosurgery can control tumor growth if the whole mass can be irradiated by dosages of more than 14 Gy. When optimal radiosurgical planning is not feasible because of a tumor's large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications.
Asunto(s)
Seno Cavernoso/cirugía , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Radiocirugia , Adulto , Anciano , Seno Cavernoso/patología , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Estudios RetrospectivosRESUMEN
We report a case of successful radiosurgical treatment of lesional epilepsy of mesial temporal origin. A patient presented with a 2-year history of medically intractable complex partial seizures associated with a mesial temporal angioma. Interictal scalp EEG and MEG showed focal epileptiform activity around the lesion. 99mTc-HMPAO-SPECT and 18F-FDG-PET demonstrated depressed blood flow and glucose metabolism in the corresponding temporal lobe. The patient underwent gamma knife radiosurgery for the causative lesion with a low marginal dose of 18 Gy. After treatment, the partial attack ceased without shrinkage of the lesion or peri-lesional parenchymal radiation injury.
Asunto(s)
Epilepsia del Lóbulo Temporal/etiología , Epilepsia del Lóbulo Temporal/cirugía , Radiocirugia/métodos , Lóbulo Temporal/cirugía , Adulto , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Electroencefalografía , Epilepsia del Lóbulo Temporal/diagnóstico , Femenino , Fluorodesoxiglucosa F18 , Hemangioma/complicaciones , Hemangioma/cirugía , Humanos , Imagen por Resonancia Magnética , Magnetoencefalografía , Radiofármacos , Exametazima de Tecnecio Tc 99m , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Tomografía Computarizada de Emisión , Tomografía Computarizada de Emisión de Fotón Único , Resultado del TratamientoRESUMEN
Treatment of giant cell tumors (GCT) especially in the vertebrae remains controversial. With multidisciplinary treatments, their results are still insufficient. Moreover, GCT shows the potential for malignant transformation and metastasis, additional options such as adjuvant medication must be considered. We report favorable results in three consecutive cases diagnosed with GCT of the spine which were treated with radiotherapy and bisphosphonate (BP) as a new treatment option, and present a review of the literature and a comparison with these case reports.
Asunto(s)
Difosfonatos/uso terapéutico , Tumores de Células Gigantes/terapia , Neoplasias de la Columna Vertebral/terapia , Adulto , Anciano , Tumores de Células Gigantes/diagnóstico por imagen , Tumores de Células Gigantes/patología , Humanos , Masculino , Radioterapia Adyuvante , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Tomografía Computarizada por Rayos XRESUMEN
We report a rare case of 65-year-old man who developed thoracoabdominal aortic aneurysm of Crawford type III complicated with Buerger's disease. He was admitted to our hospital with chief complaints of upper abdominal and back pain. CT showed that the aneurysm extended from the descending thoracic aorta to the aortic bifurcation and its had a maximum width of 95 mm. Angiogram (IA-DSA) revealed that both popliteal arteries were occluded slightly above the level of the knee joint, although collateral vessels were visualized. He underwent preliminary graft replacement of the abdominal aorta with the end-to-side supplemental branch for cannulation. Subsequently we performed graft replacement of the thoracoabdominal aorta with reconstruction of the celiac and superior mesenteric arteries and intercostal arteries on under partial cardiopulmonary bypass. This supplemental branch of abdominal aortic graft was useful in preventing ipsilateral leg ischemia. During the reconstruction of the major visceral branches, the branches were perfused selectively via partial extracorporeal circulation. Post operative courses were uneventful without paraplegia and leg ischemia. Angiographic examination revealed excellent hemodynamic results.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Tromboangitis Obliterante/complicaciones , Anciano , Aorta Abdominal/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Abdominal/etiología , Aneurisma de la Aorta Torácica/etiología , Implantación de Prótesis Vascular/métodos , Arteria Celíaca/cirugía , Circulación Extracorporea/métodos , Humanos , Hipertensión/complicaciones , Masculino , Arteria Mesentérica Superior/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: The aim of the study was to evaluate the efficacy of stereotactic radiosurgery (SRS) for thoracic tumors with megavoltage computed tomography (MVCT) from the point of view of symptom palliation as well as local control. METHODS AND MATERIALS: MVCT-assisted positioning verification and real-time monitoring for a multileaf collimator (MLC) were used to enhance the accuracy of the thoracic SRS. Twenty-two thoracic tumors in 15 patients underwent the present treatment. All but 1 tumor were metastases from various primary malignancies. Eleven patients were symptomatic. The treatment site was the chest wall/pleura in 10 tumors, and the lung in 12 tumors. The median volume of the clinical target was 4.5 cc and the median peripheral dose was 20 Gy, for the lung tumors. For the chest wall/pleura tumors, the median volume of the clinical target was 40 cc and the median peripheral dose was 20 Gy. Conventional fractionated conformal radiation therapy (CRT) followed SRS in 10 tumors. RESULTS: Of 21 tumors eligible for evaluation, there were 13 with complete responses, 6 with partial responses, and 2 without response. Duration of local control ranged from 0.6 to 82 months with a median of 8 months, with only one local recurrence seen. Immediate palliation was obtained in most symptomatic patients. Interstitial changes in the lung were limited. Autopsy performed for a patient revealed remarkable histologic effects with minimal injuries to the lung. CONCLUSION: The geometric accuracy of MVCT-assisted SRS appeared to enhance the clinical efficacy and safety of treatment to thoracic malignancies.
Asunto(s)
Radiocirugia/métodos , Radioterapia Conformacional/métodos , Neoplasias Torácicas/cirugía , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Mieloma Múltiple/diagnóstico por imagen , Mieloma Múltiple/cirugía , Cuidados Paliativos , Neoplasias Pleurales/diagnóstico por imagen , Neoplasias Pleurales/cirugía , Investigación , Neoplasias Torácicas/diagnóstico por imagen , Neoplasias Torácicas/secundario , Timoma/diagnóstico por imagen , Timoma/cirugía , Neoplasias del Timo/diagnóstico por imagen , Neoplasias del Timo/cirugíaRESUMEN
OBJECT: The goal of this study was to determine the prevalence, characteristics, and radiosurgical outcomes of headaches associated with occipital arteriovenous malformations (AVMs). METHODS: The authors reviewed the medical records of 37 consecutive patients with occipital AVMs who had been treated by radiosurgery to identify the radiological features of the AVMs before and after treatment and the clinical features and outcomes of headaches described in accordance with the criteria of the International Headache Society (IHS). Thirty-six patients (97.3%) were followed for a mean period of 46.6 months. The median volume of the AVMs was 1.9 cm3, to which a mean radiation dose of 21.6 Gy was delivered. In the entire study group, periodic headaches were found in 17 patients (45.9%), of whom seven (18.9%) suffered from migraines with the characteristic visual aura. Migraine was predominantly found in patients with right-sided (p = 0.038) or laterally located (p = 0.025) AVMs. Factors associated with a higher incidence of any type of headache included larger nidus volume (p = 0.02), tortuous change of feeding artery (p = 0.036), and cortical drainage with reflux in the superior sagittal sinus (p = 0.032). The actuarial rate of angiographic obliteration was 71.6% at 3 years. Headaches resolved or improved in 12 (70.6%) of 17 patients, including six (85.7%) of seven with migraine. The outcome of headache closely correlated with the obliteration results of the AVM (p = 0.002). CONCLUSIONS: A portion of occipital AVMs do cause headaches that satisfy the current IHS criteria for migraine, and the prevalence varies by the topography of the lesion. Radiosurgery can resolve headaches in the majority of treated patients.
Asunto(s)
Malformaciones Arteriovenosas Intracraneales/cirugía , Trastornos Migrañosos/etiología , Lóbulo Occipital/irrigación sanguínea , Radiocirugia , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Incidencia , Malformaciones Arteriovenosas Intracraneales/complicaciones , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/cirugía , Lóbulo Occipital/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The authors present a case of meningeal melanocytoma arising from Meckel's cave. A coal-black, vascular tumor was partially removed by surgery. Histopathologically, the tumor lacked anaplastic features. Immunohistochemical studies confirmed that the tumor was of neuroectodermal origin and had low proliferating activity. The patient underwent gamma knife radiosurgery for the residual tumor, in which 25 Gy of radiation was delivered to the tumor margin. Three years after irradiation, the tumor showed marked shrinkage without complication.
Asunto(s)
Duramadre/patología , Melanocitos/patología , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Radiocirugia , Adulto , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To assess the treatment results of radiosurgery for brain stem arteriovenous malformations (AVMs) and to seek optimal dose and treatment volume prescription for these lesions. METHODS: The clinical and radiological data of 30 consecutive patients with brain stem AVM treated with gamma knife radiosurgery were retrospectively reviewed with a mean follow up period of 52.2 months. There were 26 patients with previous haemorrhages and 21 with neurological deficit. Seventeen AVMs were located in the midbrain, 11 in the pons, and two in the medulla oblongata. All of the lesions were small with the intra-axial component occupying less than one third of the area of brain stem parenchyma on axial section of multiplanar MRI or CT. The mean diameter of the nidus was 1.26 cm, and the nidus volume within the brain stem parenchyma ranged from 0.1 to 2.0 cm(3). The mean radiation dose to the AVM margin was 18.4 Gy. RESULTS: The actuarial 3 year obliteration rate was 52.2%; 69.4% in cases treated with standard doses (minimum target dose, 18-20Gy), and 14.3% in cases treated with low doses (<18 Gy) (p<0.05). Two patients sustained symptomatic radiation injury, but there was no permanent neurological deficit caused by radiosurgery. Five patients had haemorrhage from the AVM after irradiation, including four fatal cases, resulting in a 4.0% annual rate of post-treatment bleeding. CONCLUSIONS: Radiosurgery is a viable treatment modality for patients with small deep parenchymal brain stem AVMs. A standard radiosurgical dose is safe and effective when directed to a small treatment volume. However, latent interval haemorrhage remains a significant problem until the nidus is obliterated completely.
Asunto(s)
Tronco Encefálico/irrigación sanguínea , Malformaciones Arteriovenosas Intracraneales/cirugía , Radiocirugia , Adolescente , Adulto , Anciano , Tronco Encefálico/patología , Hemorragia Cerebral/etiología , Niño , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE AND IMPORTANCE: Treatment of tentorial dural arteriovenous fistulae (DAVFs) primarily draining into the vein of Galen remains a therapeutic challenge. We present two cases of ruptured galenic DAVFs that were successfully treated with gamma knife radiosurgery. CLINICAL PRESENTATION: Patient 1, a 66-year-old woman, experienced a sudden onset of headache and loss of consciousness. Neuroimaging studies revealed intraventricular hemorrhage and a DAVF with aneurysmal dilation of the vein of Galen. The DAVF was supplied by tentorial branches of the right meningohypophyseal artery and bilateral supracerebellar arteries, which drained directly into the vein of Galen. Patient 2, a 64-year-old woman, experienced subarachnoid hemorrhage. Cerebral angiography revealed a galenic DAVF at the falcotentorial junction, which was supplied by bilateral supracerebellar arteries. This patient had an aneurysm at the origin of the left supracerebellar artery. INTERVENTION: Both patients were treated with gamma knife radiosurgery. In each case, the fistula was exclusively targeted and a dose of more than 20 Gy was delivered. Complete obliteration of the fistula was confirmed 27 and 29 months after radiosurgery for Patients 1 and 2, respectively, whereas the normal venous structures of the galenic system were preserved. CONCLUSION: Gamma knife radiosurgery is an effective treatment modality for DAVFs primarily draining into the vein of Galen. Irradiation doses of more than 20 Gy, strictly limited to the fistulae, seem to be sufficient for successful obliteration of these high-risk vascular lesions, with minimal invasiveness.
Asunto(s)
Fístula Arteriovenosa/fisiopatología , Fístula Arteriovenosa/cirugía , Enfermedades Cerebelosas/cirugía , Venas Cerebrales/fisiopatología , Duramadre/irrigación sanguínea , Radiocirugia , Técnicas Estereotáxicas , Anciano , Fístula Arteriovenosa/diagnóstico , Enfermedades Cerebelosas/diagnóstico , Angiografía Cerebral , Venas Cerebrales/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Arteria Vertebral/diagnóstico por imagenRESUMEN
Although Gamma Knife stereotactic radiosurgery (SRS) is widely used for metastatic brain tumors, optimal patient selection and treatment strategy continue to be investigated. The aim of this study was to provide treatment results with Gamma Knife SRS and to establish prognostic factors. Of the 54 patients treated from 1990 to 1997, 51 patients were evaluable. There were 28 males and 23 females, with a median age of 60 years. Median Karnofsky Index was 80. There were 19 non-small cell lung cancers, eight colon cancers, six renal cell cancers, five ovarian cancers, four gastric cancers, three breast cancers, and six others. Primary tumors were controlled in 33 patients, and extracranial tumors were absent in 25 patients. Sixty-eight metastatic brain tumors in 37 patients underwent SRS as an initial treatment for the brain metastasis. Brain metastasis was solitary in 32 patients. Conventional radiation was combined with SRS in 29 patients, 24 of whom received whole brain radiotherapy. Eight patients had some form of surgical resection. Median survival time was 7.4 months. Five-year actuarial survival and local control rates were 16 and 52%, respectively. Median duration time of keeping pretreatment quality of life was 6.9 months. On a multivariate analysis, uncontrolled primary tumor, combined conventional radiotherapy, and performance status were statistically significant prognostic factors. Four patients who underwent whole brain radiation developed low grade dementia.