Progress in neurological surgery
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We evaluated the role of Gamma Knife stereotactic radiosurgery in the multidisciplinary management of brain metastases ovarian and endometrial, prostate, thyroid, sarcoma, or unknown primary cancers. From a series of over 3,000 patients who had Gamma Knife radiosurgery for brain metastases we reviewed indications and outcomes in patients with less common cancer types. ⋯ Patients with thyroid metastases appear to live much longer with a more indolent course. Radiosurgery is an effective and safe minimally invasive option for patients with brain metastases from these less common primary origins.
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Hematogeneous spread of primary neoplasm can result in central nervous system (CNS) disease burden in various anatomically distinct regions; calvarial, pachymeningeal, leptomeningeal, and intraparenchymal. The choice of imaging modality is dependent on the individual clinical situation, but, largely depends on the patients overall clinical status and the information needed to make treatment decisions. Contrast-enhanced magnetic resonance (MR) imaging is the preferred imaging modality of choice; however, computed tomography (CT) is often utilized as the first-pass screening modality for CNS disease. ⋯ Proton magnetic resonance spectroscopic and dynamic susceptibility contrast-enhanced perfusion-weighted imaging are two physiologic sequences which add additional diagnostic information allowing for improved tumor characterization. Common pitfalls in evaluating for metastatic disease burden include the misidentification of non-neoplastic hematomas, remote microvascular ischemia, and acute onset of ischemic stroke. In the pediatric population, CNS metastases are rare; however, the onset of acute neurological symptoms in a child with known primary tumor should prompt imaging of the neuroaxis.