Abstract:
OBJECT:The authors sought to determine the incidence, time course, and risk factors for overall adverse radiation effect (ARE) and symptomatic ARE after stereotactic radiosurgery (SRS) for brain metastases. METHODS:All cases of brain metastases treated from 1998 through 2009 with Gamma Knife SRS at UCSF were considered. Cases with less than 3 months of follow-up imaging, a gap of more than 8 months in imaging during the 1st year, or inadequate imaging availability were excluded. Brain scans and pathology reports were reviewed to ensure consistent scoring of dates of ARE, treatment failure, or both; in case of uncertainty, the cause of lesion worsening was scored as indeterminate. Cumulative incidence of ARE and failure were estimated with the Kaplan-Meier method with censoring at last imaging. Univariate and multivariate Cox proportional hazards analyses were performed. RESULTS:Among 435 patients and 2200 brain metastases evaluable, the median patient survival time was 17.4 months and the median lesion imaging follow-up was 9.9 months. Calculated on the basis of 2200 evaluable lesions, the rates of treatment failure, ARE, concurrent failure and ARE, and lesion worsening with indeterminate cause were 9.2%, 5.4%, 1.4%, and 4.1%, respectively. Among 118 cases of ARE, approximately 60% were symptomatic and 85% occurred 3-18 months after SRS (median 7.2 months). For 99 ARE cases managed without surgery or bevacizumab, the probabilities of improvement observed on imaging were 40%, 57%, and 76% at 6, 12, and 18 months after onset of ARE. The most important risk factors for ARE included prior SRS to the same lesion (with 20% 1-year risk of symptomatic ARE vs 3%, 4%, and 8% for no prior treatment, prior whole brain radiotherapy [WBRT], or concurrent WBRT) and any of these volume parameters: target, prescription isodose, 12-Gy, or 10-Gy volume. Excluding lesions treated with repeat SRS, the 1-year probabilities of ARE were < 1%, 1%, 3%, 10%, and 14% for maximum diameter 0.3-0.6 cm, 0.7-1.0 cm, 1.1-1.5 cm, 1.6-2.0 cm, and 2.1-5.1 cm, respectively. The 1-year probabilities of symptomatic ARE leveled off at 13%-14% for brain metastases maximum diameter > 2.1 cm, target volume > 1.2 cm(3), prescription isodose volume > 1.8 cm(3), 12-Gy volume > 3.3 cm(3), and 10-Gy volume > 4.3 cm(3), excluding lesions treated with repeat SRS. On both univariate and multivariate analysis, capecitabine, but not other systemic therapy within 1 month of SRS, appeared to increase ARE risk. For the multivariate analysis considering only metastases with target volume > 1.0 cm(3), risk factors for ARE included prior SRS, kidney primary tumor, connective tissue disorder, and capecitabine. CONCLUSIONS:Although incidence of ARE after SRS was low overall, risk increased rapidly with size and volume, leveling off at a 1-year cumulative incidence of 13%-14%. This study describes the time course of ARE and provides risk estimates by various lesion characteristics and treatment parameters to aid in decision-making and patient counseling.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Sneed PK,Mendez J,Vemer-van den Hoek JG,Seymour ZA,Ma L,Molinaro AM,Fogh SE,Nakamura JL,McDermott MWdoi
10.3171/2014.10.JNS141610subject
Has Abstractpub_date
2015-08-01 00:00:00pages
373-86issue
2eissn
0022-3085issn
1933-0693journal_volume
123pub_type
杂志文章abstract:OBJECT:A naming task has been used to spare cortical areas involved in language. In the present study, a calculation task was combined with electrostimulation mapping (awake surgery) to spare cortical areas involved in calculation in patients undergoing surgery for brain lesions. The organization of language and calcul...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2008.8.JNS17649
更新日期:2009-06-01 00:00:00
abstract::To clarify the contribution of vasoconstrictor prostaglandins to the hypoperfusion state typically following total global cerebral ischemia, 14 mongrel dogs were subjected to 11 minutes of global cerebral ischemia. They were then randomly assigned to receive either no treatment or an intravenous bolus of the calcium c...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.69.3.0416
更新日期:1988-09-01 00:00:00
abstract::The authors report seven cases of thoracic spinal stenosis caused by thickening of the laminar arch and facet joints. Claudication was a prominent clinical feature of this disorder. Motor and sensory abnormalities were found in all cases with either segmental or peripheral distribution. Diagnosis was best made from th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.68.1.0037
更新日期:1988-01-01 00:00:00
abstract:OBJECT:The authors report the 3-year results of the Barrow Ruptured Aneurysm Trial (BRAT). The objective of this ongoing randomized trial is to compare the safety and efficacy of microsurgical clip occlusion and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to compare funct...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,随机对照试验
doi:10.3171/2013.3.JNS12683
更新日期:2013-07-01 00:00:00
abstract::The authors reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia. Syringoperitoneal (SP) shunting was used in 15 patients and other procedures were used in 24 patients. Follow-up periods ranged from 1 1/2 to 12 years. During the period of this study, metrizam...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.61.3.0531
更新日期:1984-09-01 00:00:00
abstract::This case report of 74-year-old man with trigeminal neuralgia is presented to underscore the importance of evaluating the entire treatment plan, especially when delivering large doses where even a low percentage of the prescription dose can contribute a substantial dose to an unintended target. The patient was treated...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.6.JNS102129
更新日期:2011-11-01 00:00:00
abstract:OBJECT:The concept of selective amygdalohippocampectomy is based on pathophysiological insights into the epileptogenicity of the hippocampal region and the definition of the clinical syndrome of mesial temporal lobe epilepsy (TLE). High-resolution magnetic resonance (MR) imaging allows correlation of the site of histol...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.96.3.0464
更新日期:2002-03-01 00:00:00
abstract:OBJECT:Frameless stereotactic biopsy has been shown in multiple studies to be a safe and effective tool for the diagnosis of brain lesions. However, no study has directly evaluated its safety in lesions located in eloquent regions in comparison with noneloquent locations. In this study, the authors determine whether an...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.3.JNS081695
更新日期:2009-10-01 00:00:00
abstract::The authors report the first DNA-based diagnosis of Bartonella henselae cultured from a brain lesion in a patient with acquired immune deficiency syndrome. This human immunodeficiency virus-infected patient presented with altered mental status, fever, and diabetes insipidus. Magnetic resonance imaging revealed multifo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1998.89.4.0640
更新日期:1998-10-01 00:00:00
abstract::The authors have designed an experiment to detect a hitherto unrecognized interaction between high doses of the glucocorticoid, dexamethasone, and brain irradiation. Eighteen juvenile male rhesus monkeys received 1800 rads to the whole brain in 8.5 minutes. For 1 1/2 days before and 10 1/2 days after the irradiation, ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.51.5.0587
更新日期:1979-11-01 00:00:00
abstract::The end of the first 100 years of any endeavor is an appropriate time to look back and peer forward. As neurosurgery celebrates its 1st century as a specialty, the increasing role of women neurosurgeons is a major theme. This article documents the early women pioneers in neurosurgery. The contributions of these trailb...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.12.JNS192878
更新日期:2020-02-14 00:00:00
abstract:OBJECT:Glutamate is important in the pathogenesis of brain damage after cerebral ischemia and traumatic brain injury. Notably, brain extracellular and cerebrospinal fluid as well as blood glutamate concentrations increase after experimental and clinical trauma. While neurons are one potential source of glutamate, plate...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.3.JNS132130
更新日期:2014-12-01 00:00:00
abstract::Cranial and spinal trauma resulted in disseminated intravascular coagulation (DIC) in a 78-year-old man, causing widespread bleeding and incoagulable blood. Traumatized brain tissue was found in the lumina of dural venous sinuses. The mechanisms of DIC are reviewed. It is suggested that intravascular release of potent...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.52.2.0266
更新日期:1980-02-01 00:00:00
abstract::Of the various anterior surgical approaches to the spine, exposure of the upper two thoracic vertebrae remains the most challenging. An operative approach to this region is described. The major features include resection of a portion of the clavicle and the manubrium sterni. Following resection of the tumor and involv...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.61.4.0686
更新日期:1984-10-01 00:00:00
abstract::Suprascapular nerve entrapment (SNE) in the suprascapular notch is a rare entity that must be considered in the differential diagnosis of radicular pain, as well as that of shoulder discomfort. Over a period of 10 years (1985-1995), the authors treated 28 cases of SNE in 27 patients by surgical decompression of the ne...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.85.6.1020
更新日期:1996-12-01 00:00:00
abstract::The authors report the successful staged stenting and coil embolization of a large vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm fro...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS-07/12/1214
更新日期:2007-12-01 00:00:00
abstract:OBJECT:The goal of this study was to evaluate the safety and efficacy of recombinant human bone morphogenetic protein 2 (rhBMP-2) in cranial applications. METHODS:Critical-sized calvarial defects were created bilaterally in four rhesus monkeys, and bilateral rectangular bone flaps were created in six others. Control a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.98.1.0125
更新日期:2003-01-01 00:00:00
abstract::Arachnoid cysts are commonly thought to arise from either congenital defects or trauma. In this article the authors report the spontaneous development of a suprasellar third ventricular arachnoid cyst whose origin was not clearly congenital or traumatic. At the age of 4 months, the patient presented with hypertonia, a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.104.6.426
更新日期:2006-06-01 00:00:00
abstract::Cerebrospinal fluid (CSF) was collected preoperatively (by lumbar puncture) or perioperatively (by lumbar or ventricular drain) from 32 patients with subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms. Samples were also obtained from six control patients without evidence of subarachnoid blood. Smooth-m...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.60.5.0927
更新日期:1984-05-01 00:00:00
abstract::Magnetic resonance imaging and spectroscopy may provide important clinical information in the acute stages of brain injury. For this to occur it must be ensured that intracranial pressure (ICP) monitoring devices are safe to bring into the MR imaging suite. The authors tested a Codman MicroSensor ICP Transducer (Codma...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/109/7/0159
更新日期:2008-07-01 00:00:00
abstract::We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.51.4.0507
更新日期:1979-10-01 00:00:00
abstract::The authors present the case of a 20-year-old man who, 3 months after his initial injury, underwent repair of a 1.7-cm defect of the ulnar nerve at the wrist; repair was performed with an acellular nerve allograft. Given the absence of clinical or electrophysiological recovery at 8 months postrepair, the patient under...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.4.JNS121938
更新日期:2013-09-01 00:00:00
abstract:OBJECT:In this paper the authors introduce a novel use of magnetoencephalography (MEG) for noninvasive mapping of language-specific cortex in individual patients and in healthy volunteers. METHODS:The authors describe a series of six experiments in which normative MEG data were collected and the reliability, validity,...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.90.1.0085
更新日期:1999-01-01 00:00:00
abstract::Twenty-nine patients consecutively admitted with a diagnosis of communicating hydrocephalus underwent continuous intracranial pressure (ICP) monitoring; pressure-volume studies; and measurement of resistance to outflow of cerebrospinal fluid (Rout). The two latter calculations were made by the bolus injection and pres...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1986.64.1.0045
更新日期:1986-01-01 00:00:00
abstract::A prospective study of 100 patients undergoing discectomy was carried out. The neurological findings were documented preoperatively and at 1 month and 1 year postoperatively. The clinical and radiological data were analyzed with respect to significant associations. There were no complications. At a minimum of 1 year p...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.50.3.0283
更新日期:1979-03-01 00:00:00
abstract::The magnetic resonance longitudinal relaxation time (T1) and transverse relaxation time (T2) of the water proton of the periventricular white and cortical gray matter were measured for 17 control patients and 21 patients with suspected normal-pressure hydrocephalus (NPH). Of the latter group, 14 showed good response t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.73.6.0864
更新日期:1990-12-01 00:00:00
abstract:OBJECT:Although traumatic brain injury (TBI) is the leading cause of death and morbidity in young adults, no effective pharmaceutical treatment is available. By inhibiting glycogen synthase kinase-3 (GSK-3) and histone deacetylases (HDACs), respectively, lithium and valproate (VPA) have beneficial effects in diverse ne...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.6.JNS13135
更新日期:2013-09-01 00:00:00
abstract:OBJECT:Age-related macular degeneration (AMD) is the leading cause of severe vision loss in people older than age 65 years in the western world. The visual acuity loss usually results from the ingrowth of new vessels from the choroid capillaries, so called choroidal neovascularization (CNV). The aim of this pilot study...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.93.supplement
更新日期:2000-12-01 00:00:00
abstract::A patient with a giant traumatic aneurysm of the right internal carotid artery presented with recurrent massive epistaxis 30 years after a head injury. During an episode of acute hemorrhage, this patient was effectively treated with occlusion of the internal carotid artery circulation by a detachable inflatable balloo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.68.1.0142
更新日期:1988-01-01 00:00:00
abstract::Procedures for relief of coronal synostosis and metopic synostosis have resulted in some undesirable sequelae. The authors present combined neurological and plastic surgical modifications to prevent additional synostoses, forehead ridging, and lateral orbital wall step-off. They recommend bifrontal craniotomy with lat...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.59.2.0245
更新日期:1983-08-01 00:00:00