Abstract:
OBJECTIVE:Stereotactic radiosurgery is being used with more frequency in the management of patients with trigeminal neuralgia. To improve facial pain outcomes, many centers have increased the prescribed radiation dose to the trigeminal nerve. METHODS:Between April 1997 and December 1999, 68 patients underwent radiosurgery for trigeminal neuralgia with use of the Leksell gamma knife (Elekta Instruments, Norcross, GA) and a single 4-mm isocenter of radiation. Twenty-seven patients (40%) received 70 Gy (low dose) of irradiation and 41 patients (60%) received 90 Gy (high dose). The groups were similar with regard to age, sex, duration of pain, number of prior surgeries, and preexisting trigeminal deficits. The primary facial pain outcomes for analysis were excellent (pain-free, no medications) and good (pain-free, reduced medications). The mean length of follow-up after radiosurgery was 14.4 months (range, 2-36 mo). RESULTS:At last follow-up examination, 11 (41%) of the 27 patients with low-dose radiosurgery remained pain-free compared with 25 (61%) of the 41 patients with high-dose radiosurgery (P = 0.17). Additional surgery was performed in 12 low-dose patients (44%) and 8 high-dose patients (20%) (P = 0.05). High-dose radiosurgery was associated with an increased rate of permanent trigeminal nerve dysfunction (54% versus 15%, P = 0.003). Bothersome dysesthesias occurred in 13 high-dose patients (32%), whereas only 1 low-dose patient had this complication (P = 0.01). Three high-dose patients (8%) developed corneal numbness after radiosurgery. Pain recurred with more frequency in patients not developing trigeminal nerve dysfunction after radiosurgery (9 of 22 patients, 41 %) compared with those who sustained facial numbness, paresthesias, or dysesthesias (4 of 27 patients, 15%); however, the difference was not statistically significant (P = 0.08). CONCLUSION:Higher doses of radiation may correlate with better facial pain outcomes after radiosurgery for trigeminal neuralgia. However, the incidence of significant trigeminal nerve dysfunction is markedly increased after radiosurgery for patients receiving high-dose radiosurgery. Because of the nonselective nature of this ablative technique, dose prescription should be limited to less than 90 Gy.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Pollock BE,Phuong LK,Foote RL,Stafford SL,Gorman DAdoi
10.1097/00006123-200107000-00008keywords:
subject
Has Abstractpub_date
2001-07-01 00:00:00pages
58-62; discussion 62-4issue
1eissn
0148-396Xissn
1524-4040journal_volume
49pub_type
杂志文章相关文献
NEUROSURGERY文献大全abstract:BACKGROUND:Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure. OBJECTIVE:The objective of this systematic review was to answer the question: What is the evidence for the effectiveness of prenatal vs postnatal closure of MM regarding short and long-...
journal_title:Neurosurgery
pub_type: 杂志文章,实务指引
doi:10.1093/neuros/nyz263
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:Although arachnoid cysts and intracranial aneurysms are very common lesions, their association in the same patient is rare. We present a case of a middle cerebral artery aneurysm ruptured into an arachnoid cyst. We found only six cases with intracystic hemorrhage reported in the literature. The presence of an...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000290917.70717.39
更新日期:2007-09-01 00:00:00
abstract::A patient with air gun bullets in the 3rd ventricle associated with delayed ventricular hemorrhage is presented. Through an anterior transcallosal approach, the surgeon successfully removed the bullets without any significant permanent sequelae. ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198702000-00022
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:In selected patients, extracranial-intracranial bypass remains an important treatment for the prevention of stroke. Traditionally, superficial temporal artery-middle cerebral artery (STA-MCA) bypass uses 1 STA branch. We have adopted a "double-barrel" technique in which both branches are joined with MCA reci...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0b013e318285b587
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:Noninvasive observation of degenerating and regenerating peripheral nerves could improve the diagnosis and treatment of nerve injuries. We constructed a novel phased-array radiofrequency coil to permit magnetic resonance imaging (MRI) observation of the sciatic nerve and its target muscles in rats after injur...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000069534.43067.28
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Middle cerebral artery (MCA) aneurysms are often considered unsuitable for endovascular coiling because of unfavorable morphological features. With improvements in endovascular techniques, several series have detailed the results and complications of endovascular treatment of MCA aneurysms. OBJECTIVE:We per...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/NEU.0b013e318201d7f4
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVE:Fifty percent of implanted cerebrospinal fluid (CSF) shunts fail within 2 years, primarily because of obstruction of the proximal catheter. Percutaneous techniques to reduce the morbidity of shunt revision are being developed. The authors describe the development of a device that uses ultrasonic cavitation to...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000233968.80352.25
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVE:Surgical resection of mass lesions in Broca's area is controversial. To demonstrate that pathology may influence the localization of functional areas and language performance, we reviewed our experience of awake craniotomies in Broca's area. METHODS:Sixteen consecutive patients who underwent awake craniotomy...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000368442.92290.04
更新日期:2010-05-01 00:00:00
abstract:UNLABELLED:OBJECTIVE AND CLINICAL IMPORTANCE: We present two cases of post-traumatic indirect carotid-cavernous fistulas. Trauma produces the direct type of carotid-cavernous fistula in almost all cases, and recognition that trauma may induce the indirect type has been rarely reported. CLINICAL PRESENTATION:Both patie...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199612000-00033
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:The treatment of space-occupying cystic lesions includes percutaneous cyst aspiration, marsupialization, percutaneous ventriculocystotomy, or Rickham catheter implantation. In some patients, the cysts tend to recur and repeated evacuations are necessary. The authors present a new treatment method with interna...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000233694.52492.74
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:Neurophysiological monitoring is routinely used during neurosurgical procedures. Use of neurophysiological monitoring has extended to neuroendovascular procedures, but evidence of its impact on clinical outcome in this arena is limited. OBJECTIVE:To report the incidence of significant intraoperative somatos...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0000000000000510
更新日期:2014-11-01 00:00:00
abstract:OBJECTIVE AND IMPORTANCE:Among patients with spontaneous internal carotid artery (ICA) or vertebral artery dissections, there is a small but significant risk of development of dissection in an uninvolved ICA or vertebral artery at some time in the future. Recurrence of dissection in a previously dissected and healed IC...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:2002-09-01 00:00:00
abstract::Neuroendovascular embolization represents a critical component of the multidisciplinary management of cerebral arteriovenous malformations. Safe and effective embolization may be performed only in the context of a well-designed, rational treatment plan that is fundamentally based on a clear understanding of the natura...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/01.NEU.0000237544.20452.47
更新日期:2006-11-01 00:00:00
abstract::The phosphorylation of an M(r) 20,000 myosin light chain (MLC20) promotes the generation of contractile force through actin-myosin adenosine triphosphatase in most agonist-mediated vascular smooth muscle cell contraction. However, the role of calcium-mediated contractile processes in sustained arterial narrowing after...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199506000-00018
更新日期:1995-06-01 00:00:00
abstract::To review the literature on endovascular therapies available to clinicians to aid in the management of head, neck, and intracranial tumors. Hypervascular tumors of the head and neck region, as well as the intracranial region, are associated with large amounts of blood loss intraoperatively. Preoperative embolization o...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000239249.65742.1C
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE AND IMPORTANCE:Anterior cervical discectomy is one of the most frequently performed surgical procedures of the cervical spine. CLINICAL PRESENTATION:We describe a patient with a postoperative hemothorax as a complication after an anterior cervical discectomy. INTERVENTION:The patient was intubated, and reop...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000156489.12893.92
更新日期:2005-04-01 00:00:00
abstract::Localization of the placental form of glutathione S-transferase (GST-pi) messenger ribonucleic acid (mRNA) in three human glioma cell lines (A172, T98G, and Tc77) was studied by in situ hybridization with digoxigenin-labeled GST-pi complementary DNA followed by immunocytochemistry with antidigoxigenin antibody. A172 g...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199307000-00016
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:Glioma imaging, used for diagnostics, treatment planning, and follow-up, is currently based on standard magnetic resonance imaging (MRI) modalities (T1 contrast-enhancement for gadolinium-enhancing gliomas and T2 fluid-attenuated inversion recovery hyperintensity for nonenhancing gliomas). The diagnostic acc...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0000000000001355
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To study the biomechanical behavior of lumbar interbody instrumentation techniques using titanium cages as either transforaminal lumbar interbody fusion (TLIF) or anterior lumbar interbody fusion (ALIF), with and without posterior pedicle fixation. METHODS:Six fresh-frozen lumbar spines (L1-L5) were loaded w...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000245609.01732.E4
更新日期:2006-12-01 00:00:00
abstract::Endovascular neurosurgical procedures are complex, requiring significant planning, foresight, and coordination. The neuroanesthetist is an integral part of these procedures, organizing efforts of the technicians and nurses and responding to the needs of the neurointerventionalist. The purpose of this article is to rev...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/01.NEU.0000237337.38375.90
更新日期:2006-11-01 00:00:00
abstract::Intraoperative monitoring with electroencephalography and the use of brain protection with steroids, phenytoin, mannitol, and pentobarbital or etomidate were evaluated in 15 patients undergoing operation for an aneurysm of the upper basilar artery. One patient harbored a basilar trunk aneurysm, 1 an aneurysm of the pr...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-198912000-00008
更新日期:1989-12-01 00:00:00
abstract:BACKGROUND:Extent of resection (EOR) is well established as correlating with overall survival in patients with glioblastoma (GBM). The impact of EOR on reported quality metrics such as patient safety indicators (PSIs) and hospital-acquired conditions (HACs) is unknown. OBJECTIVE:To perform a retrospective study to eva...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1093/neuros/nyz313
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:Spine deformities, notably scoliosis, are known to occur in conjunction with syringomyelia. This study aims to analyze the effect of laminectomies performed in the course of treatment of syringomyelia. It examines the incidence, severity, and type of spine deformity as it relates to the extent and location of...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000279971.87437.1F
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure freedom rates are limited by small sample size and patient heter...
journal_title:Neurosurgery
pub_type: 杂志文章,meta分析
doi:10.1093/neuros/nyx158
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Stereotactic radiosurgery (SRS) is an effective option in the management of brain metastases, offering improved overall survival to whole-brain radiation therapy (WBRT). However, given the need for active surveillance and the possibility of repeated interventions for local/distant brain recurrences, the bala...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1093/neuros/nyaa075
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:To define and discuss elements of the escalation in scientific data availability and their importance to neurosurgery. METHODS:This multifactorial essay describes the evolution of communication methodologies, the information revolution, and the advent and effect of Internet communication with its potential e...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::Two cases of subdural hematoma, one acute and the other chronic, associated with cancer metastatic to the dura are reported. Various mechanisms of the association of hematomas with cancer are reviewed. ...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1097/00006123-199010000-00019
更新日期:1990-10-01 00:00:00
abstract::Twenty-one patients with recurrent malignant central nervous system gliomas were treated with a combination of 5-fluorouracil, CCNU, hydroxyurea, and 6-mercaptopurine. Thirteen patients had brain stem gliomas, 3 patients had spinal cord gliomas, 3 patients had thalamic gliomas, and 2 patients had cerebellar astrocytom...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198804000-00012
更新日期:1988-04-01 00:00:00
abstract::Experimental gliomas were induced in rats by prenatal exposure to ethyl nitrosourea. Changes in the blood-brain barrier were determined by the uptake of a water-soluble compound, 99mTc-glucoheptonate. Increased uptake of 99mTc-glucoheptonate was measured in intact tumors and in various sectors of dissected tumors. The...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:Interventional magnetic resonance imaging (MRI) allows neurosurgeons to interactively perform surgery using MRI guidance. High-field strength (1.5-T) imaging permits exceptional observation of intracranial and spinal pathological features. The development of this technology and its application to a variety of...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200003000-00022
更新日期:2000-03-01 00:00:00