Abstract:
:OBJECTIVE Stereotactic radiosurgery (SRS) with or without whole-brain radiotherapy can be used to achieve local control (> 90%) for small brain metastases after resection. However, many brain metastases are unsuitable for SRS because of their size or previous treatment, and whole-brain radiotherapy is associated with significant neurocognitive morbidity. The purpose of this study was to investigate the efficacy and toxicity of surgery and iodine-125 (125I) brachytherapy for brain metastases. METHODS A total of 95 consecutive patients treated for 105 brain metastases at a single institution between September 1997 and July 2013 were identified for this analysis retrospectively. Each patient underwent MRI followed by craniotomy with resection of metastasis and placement of 125I sources as permanent implants. The patients were followed with serial surveillance MRIs. The relationships among local control, overall survival, and necrosis were estimated by using the Kaplan-Meier method and compared with results of log-rank tests and multivariate regression models. RESULTS The median age at surgery was 59 years (range 29.9-81.6 years), 53% of the lesions had been treated previously, and the median preoperative metastasis volume was 13.5 cm3 (range 0.21-76.2 cm3). Gross-total resection was achieved in 81% of the cases. The median number of 125I sources implanted per cavity was 28 (range 4-93), and the median activity was 0.73 mCi (range 0.34-1.3 mCi) per source. A total of 476 brain MRIs were analyzed (median MRIs per patient 3; range 0-22). Metastasis size was the strongest predictor of cavity volume and shrinkage (p < 0.0001). Multivariable regression modeling failed to predict the likelihood of local progression or necrosis according to metastasis volume, cavity volume, or the rate of cavity remodeling regardless of source activity or previous SRS. The median clinical follow-up time in living patients was 14.4 months (range 0.02-13.6 years), and crude local control was 90%. Median overall survival extended from 2.1 months in the shortest quartile to 62.3 months in the longest quartile (p < 0.0001). The overall risk of necrosis was 15% and increased significantly for lesions with a history of previous SRS (p < 0.05). CONCLUSIONS Therapeutic options for patients with large or recurrent brain metastases are limited. Data from this study suggest that resection with permanent 125I brachytherapy is an effective strategy for achieving local control of brain metastasis. Although metastasis volume significantly influences resection cavity size and remodeling, volumetric parameters do not seem to influence local control or necrosis. With careful patient selection, this treatment regimen is associated with minimal toxicity and can result in long-term survival for some patients. ▪ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: retrospective case series; evidence: Class IV.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Raleigh DR,Seymour ZA,Tomlin B,Theodosopoulos PV,Berger MS,Aghi MK,Geneser SE,Krishnamurthy D,Fogh SE,Sneed PK,McDermott MWdoi
10.3171/2016.4.JNS152530subject
Has Abstractpub_date
2017-06-01 00:00:00pages
1749-1755issue
6eissn
0022-3085issn
1933-0693journal_volume
126pub_type
杂志文章abstract:OBJECT:Spinal cord injury without radiological abnormality (SCIWORA) was defined in the era when magnetic resonance (MR) images were not popularly used as diagnostic tools. Although it is generally accepted that MR imaging can effectively illustrate the level and severity of spinal cord injury in the acute phase of tra...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2005.103.1.0017
更新日期:2005-07-01 00:00:00
abstract:OBJECT:The authors retrospectively reviewed 121 patients with traumatic cervical spine injuries to determine the risk of neurological deterioration following early closed reduction. METHODS:After excluding minor fractures and injuries without subluxation, the medical records and imaging studies (computerized tomograph...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.1999.90.1.0013
更新日期:1999-01-01 00:00:00
abstract::In this experiment, the effects of ischemia on neural conduction in the monkey spinal cord were studied. In six monkeys generalized ischemia of the spinal cord was created by bleeding the animals to a hypotensive level below the lower limits of autoregulation in the spinal cord. The progressive development of spinal c...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.50.5.0639
更新日期:1979-05-01 00:00:00
abstract:OBJECT:Intracerebral hemorrhage (ICH) is an uncommon complication of carotid endarterectomy (CEA), and carries a high rate of mortality and morbidity. Traditionally, attention has been focused on the cerebral hyperperfusion syndrome (HPS) as the leading cause of ICH after CEA. Other mechanisms, such as a perioperative ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.95.6.0964
更新日期:2001-12-01 00:00:00
abstract:OBJECT:Hemispheric low-grade gliomas (LGGs) have an unpredictable progression and overall survival (OS) profile. As a result, the objective in the present study was to design a preoperative scoring system to prognosticate long-term outcomes in patients with LGGs. METHODS:The authors conducted a retrospective review wi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/109/11/0817
更新日期:2008-11-01 00:00:00
abstract:OBJECT:The aim of this study was to assess the incidence and outcome of procedure-related rupture of intracranial aneurysms in patients treated with Guglielmi detachable coils (GDCs) and to identify risk factors for this complication. METHODS:Procedure-related rupture occurred in seven of 264 treated aneurysms in 239 ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.94.2.0238
更新日期:2001-02-01 00:00:00
abstract::Rarely are both sides of the hippocampus available for pathological study in a patient with intractable temporal lobe epilepsy (TLE). The authors report a patient with TLE investigated with bilateral depth electrodes who had an episode of postictal psychosis. The patient died 4 weeks after temporal lobectomy of unknow...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.2.0228
更新日期:1995-02-01 00:00:00
abstract::During craniotomy for supratentorial intraparenchymal space-occupying lesions, with the patient either under general anesthesia or awake, a smaller durotomy designed to expose only the region of resection may be desirable because of brain swelling. Similarly, during repeat craniotomy or craniotomy following cerebral i...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.80.4.0756
更新日期:1994-04-01 00:00:00
abstract:OBJECT:The authors performed a study to review outcomes following Gamma Knife radiosurgery for cerebral arteriovenous malformations (AVMs) and to create a practical scale to predict long-term outcome. METHODS:Outcomes were reviewed in 1012 patients who were followed up for more than 2 years. Favorable outcome was defi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.5.JNS1311
更新日期:2013-10-01 00:00:00
abstract::In the late 19th century, Dr. William B. Coley introduced the theory that infections may aid in the treatment of malignancy. With the creation of Coley's toxin, reports of remission during viral illnesses for systemic malignancies soon emerged. A few decades after this initial discovery, Austrian physicians performed ...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章,评审
doi:10.3171/2016.12.JNS162123
更新日期:2018-04-01 00:00:00
abstract:OBJECT:Sedation regimens for head-injured patients are quite variable. The short-acting sedative-anesthetic agent propofol is being increasingly used in such patients, yet little is known regarding its safety and efficacy. In this multicenter double-blind trial, a titratable infusion of 2% propofol accompanied by low-d...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.3171/jns.1999.90.6.1042
更新日期:1999-06-01 00:00:00
abstract::Some intracranial aneurysms that might be considered inoperable by open craniotomy are readily treatable by stereotaxic thrombosis. This is possible because the stereotaxic technique requires only that some point on the fundus of the aneurysm can be punctured with a needle. Illustrative cases are given describing the ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.6.0833
更新日期:1977-12-01 00:00:00
abstract::OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grad...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.3.JNS162383
更新日期:2018-07-01 00:00:00
abstract::OBJECT The frontal and insular fiber network in humans remains largely unknown. This study investigated the connectivity of the frontal and anterior insular network in humans using cortico-cortical evoked potential (CCEP). METHODS This retrospective analysis included 18 patients with medically intractable focal epilep...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.6.JNS15622
更新日期:2016-07-01 00:00:00
abstract:OBJECT:The aim of this study was to compare the effects of two different treatment protocols on physiological characteristics and outcome in patients with brain trauma. One protocol was primarily oriented toward reducing intracranial pressure (ICP), and the other primarily on maintaining cerebral perfusion pressure (CP...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.3171/jns.2005.102.2.0311
更新日期:2005-02-01 00:00:00
abstract::The sphenopalatine ganglion (SPG) has been assumed to be involved in the genesis of several types of facial pain, including Sluder's neuralgia, trigeminal neuralgia, persistent idiopathic facial pain, cluster headache, and atypical facial pain. The gold standard treatments for SPG-related pain are percutaneous procedu...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.1.JNS152272
更新日期:2017-02-01 00:00:00
abstract::The problem of implanted metals causing tissue damage by movement in patients exposed to MRI fields has produced a confusing welter of erroneous, pseudoscientific publications about magnetics, metals, medical equipment, and tissue compatibility. Quite simply, among the devices made for implantation, only those fabrica...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章,评审
doi:10.3171/2012.1.JNS111786
更新日期:2012-07-01 00:00:00
abstract::OBJECTIVE Different surgical routes have been used over the years to achieve adequate decompression of the optic nerve in its canal including, more recently, endoscopic approaches performed either through the endonasal corridor or the transorbital one. The present study aimed to detail and quantify the amount of bone ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.8.JNS16566
更新日期:2017-07-01 00:00:00
abstract::The treatment of patients with low-grade gliomas remains a subject of controversy, especially with respect to new treatment modalities such as interstitial radiosurgery (brachytherapy), radiosurgery, and stereotactic radiotherapy. In a retrospective analysis conducted between 1979 and 1991, the authors studied the res...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.3.0418
更新日期:1995-03-01 00:00:00
abstract::A 48-year-old laborer presented with a 1-year history of low-back pain radiating into the posterior aspects of both thighs. Two weeks before admission, acute exacerbation resulted in signs and symptoms of compressive radiculopathy at L-5. Myelography revealed concentric constriction of the lower thecal sac due to abun...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1982.57.4.0559
更新日期:1982-10-01 00:00:00
abstract::A patient with acute subdural hematoma was successfully treated with hemicraniectomy. He developed contralateral weakness 4 months after surgery which was reversed by cranioplasty. The presumptive mechanism is a gradient between atmospheric and intracranial pressure. Early cranioplasty is suggested to prevent this phe...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1976.44.4.0506
更新日期:1976-04-01 00:00:00
abstract:OBJECT:Ascites and abdominal pseudocysts are two complications that can occur following placement of a ventriculoperitoneal (VP) shunt. Although various factors have been implicated, the exact pathogenesis of the two conditions remains elusive. To the authors' knowledge, there are no studies in which these two obviousl...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.5.350
更新日期:2007-05-01 00:00:00
abstract:OBJECT:A pullout strength biomechanical study was performed in 20 fresh swine vertebral bodies in which titanium expander (Group 1) and conventional screws (Group 2) were placed. METHODS:The screws were inserted into the anterosuperior portion of the anterior spine, and assessment was performed after application of lo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2002.97.3.0346
更新日期:2002-10-01 00:00:00
abstract::A case of hemangioblastoma of the spinal cord is described in which the tumor presented in an intradural extramedullary location. The patient did not have von Hippel-Lindau's disease or metastatic seeding. It is assumed that the tumor arose in the pia, and its direction of growth was purely extramedullary. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.48.3.0461
更新日期:1978-03-01 00:00:00
abstract::OBJECTIVE The purpose of this study was to describe in detail the cortical and subcortical anatomy of the central core of the brain, defining its limits, with particular attention to the topography and relationships of the thalamus, basal ganglia, and related white matter pathways and vessels. METHODS The authors stud...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.5.JNS162897
更新日期:2018-09-01 00:00:00
abstract::Tenascin is an extracellular matrix glycoprotein expressed during both normal development and neoplastic growth in both neural and nonneural tissues. During development of the central nervous system (CNS), tenascin is synthesized by glial cells, in particular by immature astrocytes, and is concentrated in transient bo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.1.0106
更新日期:1995-01-01 00:00:00
abstract::This article reviews the English language medical literature published from January, 1960, through June, 1978, on selected morbidity measures and economic costs of injury to the head or spinal cord. Most of the reports discussed here come from outside the United States. Regardless of the source of the report, however,...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:
更新日期:1980-11-01 00:00:00
abstract::In patients with vein of Galen malformations, high-flow shunting decreases cerebral perfusion. By reducing or eliminating these shunts, transarterial embolization can improve cerebral perfusion and clinical outcomes. Quantifying pre- and postembolization shunt blood flow may help determine the optimal timing and effic...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.104.1.41
更新日期:2006-01-01 00:00:00
abstract::This series of 228 patients with infantile non-neoplastic hydrocephalus who received either a ventriculoatrial (VA) or a ventriculoperitoneal (VP) shunt before 2 years of age was followed for an average of 7 years, and the results with the two types of shunt were compared. Mortality and infection rates were similar fo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.50.2.0179
更新日期:1979-02-01 00:00:00
abstract::In this study, the authors performed deep brain stimulation (DBS) of the subgenual anterior cingulate cortex (SACC) in a patient with a history of bipolar disorder. After a right thalamic stroke, intractable depression without mood elevation or a mixed state developed in this patient. He underwent bilateral SACC DBS a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.2.JNS081299
更新日期:2009-10-01 00:00:00