Abstract:
OBJECT:Whole-brain radiation therapy (WBRT) has been the traditional approach to minimize the risk of intracranial recurrence following resection of brain metastases, despite its potential for late neurotoxicity. In 2007, the authors demonstrated an equivalent local recurrence rate to WBRT by using stereotactic radiosurgery (SRS) to the operative bed, sparing 72% of their patients WBRT. They now update their initial experience with additional patients and more mature follow-up. METHODS:The authors performed a retrospective review of all cases involving patients with limited intracranial metastatic disease (< or = 4 lesions) treated at their institution with SRS to the operative bed following resection. No patient had prior cranial radiation and WBRT was used only for salvage. RESULTS:From November 2000 to June 2009, 52 patients with a median age of 61 years met inclusion criteria. A single metastasis was resected in each patient. Thirty-four of the patients each had 1 lesion, 13 had 2 lesions, 3 had 3 lesions, and 2 had 4 lesions. A median dose of 1500 cGy (range 800-1800 cGy) was delivered to the resection bed targeting a median volume of 3.85 cm(3) (range 0.08-22 cm(3)). With a median follow-up of 13 months, the median survival was 15.0 months. Four patients (7.7%) had a local recurrence within the surgical site. Twenty-three patients (44%) ultimately developed distant brain recurrences at a median of 16 months postresection, and 16 (30.7%) received salvage WBRT (8 for diffuse disease [> 3 lesions], 4 for local recurrence, and 4 for diffuse progression following salvage SRS). The median time to WBRT administration postresection was 8.7 months (range 2-43 months). On univariate analysis, patient factors of a solitary tumor (19.0 vs 12 months, p = 0.02), a recursive partitioning analysis (RPA) Class I (21 vs 13 months, p = 0.03), and no extracranial disease on presentation (22 vs 13 months, p = 0.01) were significantly associated with longer survival. Cox multivariate analysis showed a significant association with longer survival for the patient factors of no extracranial disease on presentation (p = 0.01) and solitary intracranial metastasis (p = 0.02). Among patients with no extracranial disease, a solitary intracranial metastasis conferred significant additional survival advantage (43 vs 10.5 months, p = 0.05, log-rank test). No factor (age, RPA class, tumor size or histological type, disease burden, extent of resection, or SRS dose or volume) was related to the need for salvage WBRT. CONCLUSIONS:Adjuvant SRS to the metastatic intracranial operative bed results in a local recurrence rate equivalent to adjuvant WBRT. In combination with SRS for unresected lesions and routine imaging surveillance, this approach achieves robust overall survival (median 15 months) while sparing 70% of the patients WBRT and its potential acute and chronic toxicity.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Karlovits BJ,Quigley MR,Karlovits SM,Miller L,Johnson M,Gayou O,Fuhrer Rdoi
10.3171/2009.9.FOCUS09191subject
Has Abstractpub_date
2009-12-01 00:00:00pages
E7issue
6issn
1092-0684journal_volume
27pub_type
杂志文章abstract:OBJECT:The management of pediatric intraventricular tumors is highly dependent on identification of the tumor type. Choroid plexus papillomas, a common intraventricular tumor in children, can be difficult to distinguish radiographically from choroid plexus carcinomas and other common pediatric central nervous system (C...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:
更新日期:2005-06-15 00:00:00
abstract::Intraoperative optical imaging (IOI) is a marker-free, contactless, and noninvasive imaging technique that is able to visualize metabolic changes of the brain surface following neuronal activation. Although it has been used in the past mainly for the identification of functional brain areas under general anesthesia, t...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.11.FOCUS19759
更新日期:2020-02-01 00:00:00
abstract::PIn 1994 the National Football League (NFL) initiated a comprehensive clinical and biomechanical research study of mild traumatic brain injury (TBI), a study that is ongoing. Data on mild TBIs sustained between 1996 and 2001 were collected and submitted by NFL team physicians and athletic trainers, and these data were...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2006.21.4.13
更新日期:2006-10-15 00:00:00
abstract:OBJECT:Using strict biochemical remission criteria, the authors assessed surgical outcomes after endoscopic transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas and identified preoperative factors that significantly influence the rate of remission. METHODS:A retrospective review of a prospecti...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.7.FOCUS10153
更新日期:2010-10-01 00:00:00
abstract::Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options acc...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2011.9.FOCUS11222
更新日期:2011-12-01 00:00:00
abstract:OBJECT:Lamotrigine is an antiepileptic drug that inhibits presynaptic voltage-gated sodium channels and reduces the presynaptic release of glutamate in pathological states. Neuroprotective effects of this drug have already been demonstrated in cerebral ischemia models. The aim of the present study was to determine the ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/FOC.2008.25.11.E6
更新日期:2008-01-01 00:00:00
abstract::Over the last decade, the analysis of genetic defects in primary tumors has been central to the identification of molecular events and biological pathways involved in the pathogenesis of medulloblastoma, the most common malignant brain tumor of childhood. Despite this, understanding of the molecular basis of the major...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2005.19.5.11
更新日期:2005-11-15 00:00:00
abstract::OBJECT Spinal tumor resection has historically been performed via open approaches, although minimally invasive approaches have recently been found to be effective in small cohort series. The authors compare surgical characteristics and clinical outcomes of surgery in patients undergoing mini-open and open approaches f...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.5.FOCUS15187
更新日期:2015-08-01 00:00:00
abstract::The transthoracic approach to herniated thoracic discs is an important procedure in the management of these uncommonly encountered lesions. Whereas posterior and posterolateral microsurgical approaches and thoracoscopic procedures have been widely advocated in the recent neurosurgical literature, the transthoracic ope...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2000.9.4.8
更新日期:2000-10-15 00:00:00
abstract::The histological appearance of a meningioma is an important predictor of tumor behavior and is frequently a factor in decisions concerning therapy. The relationship between histological features and prognosis is formalized in grading schemes such as those published by the World Health Organization (WHO), most recently...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC-07/10/E3
更新日期:2007-01-01 00:00:00
abstract::The diagnosis and treatment of a patient with a pituitary adenoma or another type of pituitary lesion requires a team approach involving the neurosurgeon, endocrinologist, primary care physician, and, in some patients, an ophthalmologist and radiation therapist. The diagnosis of excessive pituitary hormone secretion a...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2004.16.4.2
更新日期:2004-04-15 00:00:00
abstract:Objective:The aim of this study was to investigate the diagnostic potential of the inflammatory markers interleukin-6 (IL-6), total leukocyte count (TLC), and protein in the CSF and IL-6, C-reactive protein, and white blood cell count in the serum for the early diagnosis of ventriculitis in patients with traumatic brai...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.8.FOCUS19407
更新日期:2019-11-01 00:00:00
abstract:OBJECT:Clinical and radiographic results were assessed to determine the clinical outcomes and fusion rate in eight consecutive patients selected for minimally invasive transforaminal lumbar interbody fusion (TLIF) in which a percutaneous pedicle screw system was used unilaterally. METHODS:Eight patients underwent one-...
journal_title:Neurosurgical focus
pub_type: 临床试验,杂志文章
doi:
更新日期:2006-03-15 00:00:00
abstract::Surgery for cranial deformity was associated with significant surgical morbidity during the early part of the 20th century. For this reason, Harvey Cushing was initially not in favor of surgical treatment of craniosynostosis. Later in his career, Cushing began to operate on these children, although it never became a m...
journal_title:Neurosurgical focus
pub_type: 传,历史文章,杂志文章
doi:10.3171/2010.9.FOCUS10191
更新日期:2010-12-01 00:00:00
abstract::The potential advantages of a mini-open transforaminal interbody fusion (TLIF) operation are reduced blood loss, shorter length of stay, and less soft-tissue trauma compared to the standard open technique. Prior reports from our group and others have demonstrated successful outcomes using MIS techniques in lumbar fusi...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2013.V2.FOCUS13187
更新日期:2013-07-01 00:00:00
abstract::OBJECTIVE The microscopic transoral, endoscopic transnasal, and endoscopic transoral approaches are used alone and in combination for a variety of craniovertebral junction (CVJ) pathologies. The endoscopic transoral approach provides a more direct exposure that is not restricted by the nasal cavity, pterygoid plates, ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.11.FOCUS15498
更新日期:2016-02-01 00:00:00
abstract:OBJECT:Resorbable polymer implants have become a compelling option in the treatment of acquired and congenital craniofacial deformities. In particular, the resorbable polylactide and polyglycolide polymers have demonstrated excellent safety profiles in multiple in vitro, animal, and clinical studies and are currently b...
journal_title:Neurosurgical focus
pub_type: 临床试验,杂志文章
doi:10.3171/foc.2004.16.3.13
更新日期:2004-03-15 00:00:00
abstract::In this paper the author summarizes currently available surgical approaches to spinal syringomyelia that is unrelated to Chiari I malformation or hindbrain descent. Primary spinal syringomyelia is most commonly associated with spinal trauma but is also encountered as a sequela to intradural inflammatory processes (inf...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2000.8.3.7
更新日期:2000-03-15 00:00:00
abstract:OBJECT:The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. METHODS:A PubMed search was conducted of English lan...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2012.7.FOCUS12199
更新日期:2012-09-01 00:00:00
abstract:OBJECT:Indocyanine green (ICG) videoangiography (VA) in cerebral aneurysm surgery allows confirmation of blood flow in parent, branching, and perforating vessels as well as assessment of remnant aneurysm parts after clip application. A retrospective analysis and review of the literature were conducted to determine the ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.11.FOCUS13475
更新日期:2014-02-01 00:00:00
abstract:OBJECT:Experience with minimal-access surgical approaches for revision lumbar surgery has not been previously reported. METHODS:During a 7-month period, 10 consecutive patients with recurrent disc herniations underwent revision operations in which microendoscopic discectomy (MED) was performed. Perioperative data and ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2003.15.3.12
更新日期:2003-09-15 00:00:00
abstract::Spinal laser interstitial thermal therapy has been developed as a minimally invasive modality to treat epidural spinal tumors percutaneously. The safe and effective use of this technology requires meticulous preoperative trajectory planning and an intraoperative workflow incorporating navigation and MR thermography. I...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.4.FocusVid.17732
更新日期:2018-04-01 00:00:00
abstract::Complex posterior circulation aneurysms are formidable lesions with an abysmal natural history. Their management continues to present a challenge to both endovascular and open microsurgical approaches. Affording an expansive, combined supra- and infratentorial exposure, the petrosal approaches are well suited for thes...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/2012.6.FOCUS12131
更新日期:2012-08-01 00:00:00
abstract::Surgical removal remains one of the key treatment modalities for vestibular schwannomas. A team approach between a neurotologist and a neurosurgeon offers the patient the expertise of both specialties and maximizes the chances for an optimal outcome. Vestibular schwannomas can typically be resected through 1 of 3 main...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2012.6.FOCUS12190
更新日期:2012-09-01 00:00:00
abstract::Chronic subarachnoid hemorrhage may cause deposition of hemosiderin on the leptomeninges and subpial layers of the neuraxis, leading to superficial siderosis (SS). The symptoms and signs of SS are progressive and fatal. Exploration of potential sites responsible for intrathecal bleeding and subsequent hemosiderin depo...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2004.16.5.11
更新日期:2004-05-15 00:00:00
abstract::The development of alternative approaches to spine disorders marked an evolutionary change in the methods by which surgeons address diseases that affect the ventral portion of the spine. From the advent of spinal surgery until quite recently, physicians used posterior approaches almost exclusively for the treatment of...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:
更新日期:2004-01-15 00:00:00
abstract::OBJECTIVEPatient-reported outcome measures (PROMs) following decompression surgery for lumbar spinal stenosis (LSS) demonstrate considerable heterogeneity. Individualized prediction tools can provide valuable insights for shared decision-making. The authors aim to evaluate the feasibility of predicting short- and long...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.2.FOCUS18723
更新日期:2019-05-01 00:00:00
abstract::Occipital plagiocephaly caused by lambdoid synostosis is rare. Positional flattening is more common and will most often respond to conservative measures. Surgical correction of a flat occiput is warranted if the deformity is profound. Skull molding devices may be effective for treating mild abnormalities but are ineff...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1997.2.2.9
更新日期:1997-02-15 00:00:00
abstract:OBJECT:Management of disease in patients undergoing neurosurgical treatment for tumors requires balancing the competing risks of hemorrhage and thrombosis. The authors compared the incidence of clinically apparent deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients admitted for treatment of intracrania...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2004.17.4.4
更新日期:2004-10-15 00:00:00
abstract:OBJECT:This study analyzes 84 cases of peroneal nerve injuries associated with sports-related knee injuries and their surgical outcome and management. METHODS:The authors retrospectively reviewed the cases of peroneal nerve injury associated with sports between the years 1970 and 2010. Each patient was evaluated for i...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2011.9.FOCUS11187
更新日期:2011-11-01 00:00:00