Journal of neurosurgery
-
Journal of neurosurgery · Dec 2008
Gamma Knife surgery in the management of radioresistant brain metastases in high-risk patients with melanoma, renal cell carcinoma, and sarcoma.
The purpose of this study was to examine the results of using Gamma Knife surgery (GKS) for brain metastases from classically radioresistant malignancies. ⋯ Gamma Knife surgery is an effective treatment option for patients with radioresistant brain metastases. In this setting, KPS score appeared to be a more important factor in predicting survival than having > 3 metastases. Higher rates of local tumor control were achieved for RCC in comparison with melanoma, and this may have an effect on survival in some patients. Although outcomes generally remained poor in this study population, these results suggest that GKS can be considered as a treatment option for many patients with radioresistant brain metastases, even if these patients have multiple lesions.
-
Journal of neurosurgery · Dec 2008
Prognostic factors and grading systems for overall survival in patients treated with radiosurgery for brain metastases: variation by primary site.
The authors conducted a study to determine whether prognostic factors and the applicability of prognostic systems vary by primary tumor site in patients treated with radiosurgery for brain metastases. ⋯ Favorable prognostic factors for patients with newly diagnosed brain metastases treated with radiosurgery vary by primary site. The 4 prognostic grading systems analyzed were applicable to different primary sites depending on which prognostic factors each individual system incorporated. Therefore, the authors recommend further development and use of primary-specific prognostic systems.
-
Journal of neurosurgery · Dec 2008
Endovascular treatment of intracranial microarteriovenous malformations.
Microarteriovenous malformations (micro-AVMs) are an uncommon subgroup of brain AVMs defined by a nidus measuring < 1 cm in diameter. The clinical features, angiographic characteristics, and outcomes in patients with micro-AVMs who had been treated endovascularly after presenting with hemorrhage were reviewed to identify common features affecting prognosis. ⋯ Immediate complete obliteration of a micro-AVM with a high permanent cure and low morbidity rates was accomplished using endovascular treatment. Early embolization after bleeding should be considered as an alternative to resection.
-
Journal of neurosurgery · Dec 2008
Effect of electrical stimulation of the cervical spinal cord on blood flow following subarachnoid hemorrhage.
Cervical spinal cord stimulation (SCS) increases global cerebral blood flow (CBF) and ameliorates cerebral ischemia according to a number of experimental models as well as some anecdotal reports in humans. Nonetheless, such stimulation has not been systematically applied for use in cerebral vasospasm. In the present study the authors examined the effect of cervical SCS on cerebral vasoconstriction in a double-hemorrhage model in rats. ⋯ Data in this study showed that SCS can reverse BA constriction and improve global CBF in this SAH model. Spinal cord stimulation may represent a useful adjunct in the treatment of vasospasm.
-
Journal of neurosurgery · Dec 2008
Brain oxygen tension and outcome in patients with aneurysmal subarachnoid hemorrhage.
Poor outcome is common after aneurysmal subarachnoid hemorrhage (SAH). Clinical studies suggest that cerebral hypoxia after traumatic brain injury is associated with poor outcome. In this study we examined the relationship between brain oxygen tension (PbtO(2)) and death after aneurysmal SAH. ⋯ Patient deaths after SAH may be associated with a lower mean PbtO(2) and longer periods of compromised cerebral oxygenation than in survivors. This knowledge may be used to help direct therapy.