Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Apr 2020
ReviewEvolving Role of Stereotactic Body Radiation Therapy in the Management of Spine Metastases: Defining Dose and Dose Constraints.
When treating solid tumor spine metastases, stereotactic high-dose-per-fraction radiation, given in a single fraction or in a hypofractionated approach, has proved to be a highly effective and safe therapeutic option for any tumor histology, in the setting of de novo therapy, as salvage treatment of local progression after previous radiation, and in the postoperative setting. There are variations in practice based on the clinical presentation, goals of therapy, as well as institutional preferences. As a biologically potent therapy, a thoughtful and careful attention to detail with patient selection, treatment planning, and delivery is crucial for treatment success.
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The combination of separation surgery and stereotactic body radiotherapy optimizes the treatment of metastatic spine tumors. The integration of SBRT into treatment paradigms produces superb local control rates and consequently has diminished the role of surgery from principle treatment to one of adjuvant therapy. Under this paradigm, hybrid therapy for the treatment of metastatic spine tumors employs separation surgery to decompress the spinal cord and stabilize the spine while creating a safe target for ablative SBRT. Hybrid therapy is well tolerated, allows an early return to systemic therapy, and provides durable, local tumor control compared with more aggressive traditional approaches.
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Neurosurg. Clin. N. Am. · Jan 2020
ReviewRobotic Tissue Manipulation and Resection in Spine Surgery.
Spine surgery has evolved from the advent of imaging and navigation guidance, particularly with the rise of robotic surgical assistance. Navigation guidance has demonstrated potential for increased accuracy of transpedicular screw placement and resecting primary and metastatic spinal tumors. ⋯ Robotic assistance with spinal tumors has enjoyed rising interest owing to the potential for safe and minimally traumatic resection. We discuss available robots used for navigation-guided transpedicular screw placement and state-of-the-art robotic techniques for spinal or paraspinal tumor resection.
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Neurosurg. Clin. N. Am. · Oct 2019
ReviewIntraoperative Fluorescent Visualization of Pituitary Adenomas.
Tumor recurrence in pituitary adenomas is as high as 20% after surgery. Conventional neuronavigation and white light visualization are not sufficiently accurate in detecting residual neoplastic tissue. ⋯ The authors' group has explored the use of near-infrared imaging, which is superior to visible-light fluorescence in both signal contrast and tissue penetration, in transsphenoidal endoscopic surgeries for pituitary adenomas using 2 techniques: second window indocyanine green, in which indocyanine green passively accumulates in the tumor, and OTL38, which actively targets folate receptors on adenoma cells. This work establishes the foundation of intraoperative near-infrared imaging for fluorescence-guided neurosurgery.
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Neurosurg. Clin. N. Am. · Apr 2019
ReviewEvolving Techniques and Indications in Peripheral Nerve Stimulation for Pain.
Peripheral nerve stimulation is the direct electrical stimulation of named nerves outside the central neuraxis to alleviate pain in the distribution of the targeted peripheral nerve. These treatments have shown efficacy in treating a variety of neuropathic, musculoskeletal, and visceral refractory pain pathologies; although not first line, these therapies are an important part of the treatment repertoire for chronic pain. With careful patient selection and judicious choice of stimulation technique, excellent results can be achieved for a variety of pain etiologies and distributions. This article reviews current and past practices of peripheral nerve stimulation and upcoming advancements in the field.