Abstract:
OBJECT:Insular gliomas remain surgically challenging cases due to complex anatomy, including surrounding vasculature and the relationship to functional structures. To define the morbidity profile associated with aggressive insular glioma removal as well as its impact on long-term outcome, the authors retrospectively evaluated the extent of resection (EOR) in the context of this complex anatomy and function and assessed its role in determining disease progression, malignant transformation, and, ultimately, patient survival. METHODS:The study population included adults who had undergone initial or repeat resection of insular gliomas of all grades. Tumor location was identified according to a proposed quadrant-style classification (Zones I-IV) of the insula. Low- and high-grade gliomas were volumetrically analyzed using FLAIR and contrast-enhanced T1-weighted MR imaging, respectively. RESULTS:One hundred fifteen procedures involving 104 patients with insular gliomas were identified. Patients presented with low-grade gliomas (LGGs) in 70 cases (60%) and high-grade gliomas (HGGs) in 45 (40%). Zone I (anterior-superior) was the most common site within the insula (40 patients [39%]), followed by Zone I+IV (anterior-superior + anterior-inferior; 26 patients [25%]). The median EOR was 82% (range 31-100%) for low-grade lesions and 81% (range 47-100%) for high-grade lesions. Zone I was associated with the highest median EOR (86%), and among all lesion grades, the insular quadrant anatomy was predictive of the EOR (p = 0.0313). Overall, there were 16 deaths (15%) during a median follow-up of 4.2 years. There were no surgery-related deaths, and new, permanent postoperative deficits were noted in 6 patients (6%). Among LGGs, tumor progression and malignant transformation were identified in 20 (29%) and 14 cases (20%), respectively. Among HGGs, progression was identified in 16 cases (36%). Patients with LGGs resected >or= 90% had a 5-year overall survival (OS) rate of 100%, whereas those with lesions resected < 90% had a 5-year OS rate of 84%. Patients with HGGs resected >or= 90% had a 2-year OS rate of 91%; when the EOR was < 90%, the 2-year OS rate was 75%. The EOR was predictive of OS both in cases of LGGs (hazard ratio [HR] 0.955, 95% CI 0.921-0.992, p = 0.017) and HGGs (HR 0.955, 95% CI 0.918-0.994, p = 0.024). Progression-free survival (PFS) was also predicted by the EOR in both LGGs (HR 0.973, 95% CI 0.948-0.998, p = 0.0414) and HGGs (HR 0.958, 95% CI 0.919-0.999, p = 0.0475). Interestingly, among patients with LGGs, malignant progression was also significantly associated with a lower EOR (HR 0.968, 95% CI 0.393-0.998, p = 0.0369). CONCLUSIONS:Aggressive resection of insular gliomas of all grades can be accomplished with an acceptable morbidity profile and is predictive of improved OS and PFS. Among insular LGGs, a greater EOR is also associated with longer malignant PFS. Data in this study also suggest that insular gliomas generally follow a more indolent course than similar lesions in other brain regions.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Sanai N,Polley MY,Berger MSdoi
10.3171/2009.6.JNS0952subject
Has Abstractpub_date
2010-01-01 00:00:00pages
1-9issue
1eissn
0022-3085issn
1933-0693journal_volume
112pub_type
杂志文章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::The clinical and angiographic findings of 55 patients with a spinal dural arteriovenous malformation (AVM) are reviewed, and the results of surgery assessed. The symptoms of dural AVM are usually gradual in onset, and hemorrhage from this type of AVM is less common than in true spinal cord angiomas. Other clinical fea...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.60.2.0238
更新日期:1984-02-01 00:00:00
abstract::The authors report on a young woman with Ehlers-Danlos syndrome (EDS) Type IV in whom a spontaneous direct carotid-cavernous fistula (CCF) was treated by transvenous occlusion with regular and fiber-coated Guglielmi detachable coils. To the authors' knowledge, this is the first time this approach has been used in a pa...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.2000.93.4.0689
更新日期:2000-10-01 00:00:00
abstract:OBJECT:A typical finding in supraclavicular exploration of infants with severe obstetric brachial plexus lesions (OBPLs) is a neuroma-in-continuity with the superior trunk and/or a root avulsion at C-5, C-6, or C-7. The operative strategy in these cases is determined by the intraoperative assessment of the severity of ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/109/11/0946
更新日期:2008-11-01 00:00:00
abstract:OBJECT:The authors conducted a retrospective review to examine and document the frequency, degree, and timing of the radiologically confirmed response to radiotherapy of low-grade gliomas in children. METHODS:Between 1963 and 1995, 80 patients 17 years of age or younger were referred to the London Regional Cancer Cent...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1998.88.6.0969
更新日期:1998-06-01 00:00:00
abstract:OBJECT:There is a growing body of evidence to support the safe and effective use of spine radiosurgery. However, there is much less experience regarding the use of radiosurgery for the treatment of benign as opposed to malignant spine tumors. This study represents an evaluation of, and reporting on, the technical aspec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.8.GKS12981
更新日期:2012-12-01 00:00:00
abstract::The authors have developed an extended transsphenoidal approach with submucosal posterior ethmoidectomy for resection of tumors located in the cavernous sinus or the suprasellar region that are difficult to remove via the conventional transsphenoidal approach. Surgery was performed using this approach in 14 patients w...
journal_title:Journal of neurosurgery
pub_type: 评论,信件
doi:10.3171/jns.2001.95.5.0917
更新日期:2001-11-01 00:00:00
abstract:OBJECT:In this study the authors investigated the relationship between variations in the circle of Willis observed on magnetic resonance (MR) angiograms and locations of cerebral aneurysms, and evaluated the risk of aneurysm formation. METHODS:One hundred thirty-one patients with cerebral aneurysms were retrospectivel...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.96.4.0697
更新日期:2002-04-01 00:00:00
abstract::Proximal shunt obstruction or obstruction of the ventricular catheter may present with signs and symptoms of shunt failure with either no cerebrospinal fluid flow or a falsely low intracranial pressure (ICP) upon shunt tap. The author reports a technique for lowering the ICP and for measuring the pressure in patients ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.68.5.0817
更新日期:1988-05-01 00:00:00
abstract:OBJECT:Insular gliomas can be resected with acceptable rates of neurological morbidity, but little is known with regard to impairment of higher-order neurocognitive functions. The frequency and functional impact of neurocognitive deficits in patients with gliomas has until recently been underappreciated. The authors th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.8.JNS11488
更新日期:2011-12-01 00:00:00
abstract::In patients with pineal tumors, clinical symptoms are due to direct compression of adjacent structures. The most common signs include increased intracranial pressure (80%) caused by obstruction of the sylvian aqueduct, and Parinaud syndrome (50%) caused by direct compression of the superior colliculi. Hearing loss is ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.99.3.0587
更新日期:2003-09-01 00:00:00
abstract::The authors report the neuroimaging features, treatment planning, and outcome in a case of radiosurgical thalamotomy targeting the centromedian nucleus (CMN) for stroke-induced thalamic pain. A 79-year-old man, with embolic occlusion of the left middle cerebral artery and large hemispheric infarction involving the tha...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/sup.2006.105.7.222
更新日期:2006-12-01 00:00:00
abstract::To test the hypothesis that concussive brain injury interferes with the normal vasodilator response of the cerebral circulation to hypoxemia, 30 cats were subjected to mild (PaO2 50 mm Hg) and severe (PaO2 30 mm Hg) hypoxemia while measurements were made of arterial and intracranial pressure, regional cerebral blood f...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1982.56.3.0332
更新日期:1982-03-01 00:00:00
abstract::OBJECTIVE Electrical motor cortex stimulation can relieve neuropathic pain (NP), but its use requires patients to undergo an invasive procedure. Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) using a figure-8 coil can relieve NP noninvasively, but its ability to relieve lower limb...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,随机对照试验
doi:10.3171/2016.9.JNS16815
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:Gamma Knife surgery (GKS) obliterates 65%-87% of cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, the hemodynamic effect on GKS outcomes is relatively unknown. The authors thus used the classification scheme developed by Suh et al. to explore this effect. METHODS:The authors retrospectively (...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.9.JNS182040
更新日期:2019-01-25 00:00:00
abstract:OBJECT:The authors reviewed their experience with endoscopic approaches to determine their safety and efficacy in the treatment of pediatric patients who harbor skull base lesions. Although they were interested in ascertaining outcomes after surgery as well as validating and defining indications and limitations of thes...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.2.75
更新日期:2007-02-01 00:00:00
abstract::The effect of hypercholesterolemia on vascular responsiveness was studied in isolated rabbit arteries. The arteries of animals maintained on a cholesterol-rich (1%) diet for 6 months had more pronounced intimal lesion than those receiving the diet for 3 months. The aortas were more severely damaged than the carotid or...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.5.0793
更新日期:1989-05-01 00:00:00
abstract:OBJECT:Atorvastatin, a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor, has pleiotropic effects, such as promoting angiogenesis, increasing fibrinolysis, and reducing inflammatory responses, and has shown promise in enhancing recovery in animals with traumatic brain injury (TBI) and stroke. The authors ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.101.5.0813
更新日期:2004-11-01 00:00:00
abstract::Plateau waves, characterized by acute transient rises of the intracranial pressure (ICP), are accompanied by a marked decrease of the cerebral perfusion pressure. Patients with plateau waves, however, often show no clinical symptoms of ischemia of the brain stem, such as vasopressor response or impairment of conscious...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.63.4.0556
更新日期:1985-10-01 00:00:00
abstract:OBJECTIVE:The authors aimed to determine whether differences exist in presentation and natural history when comparing Asian patients with moyamoya disease (MMD) to those of other ethnicities in North America. METHODS:A database of 137 patients with MMD presenting to their institution between 1994 and 2015 was reviewed...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.7.JNS191507
更新日期:2019-10-04 00:00:00
abstract:OBJECT:The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors. METHODS:Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surge...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2001.94.2.0199
更新日期:2001-04-01 00:00:00
abstract:OBJECT:This study was conducted to evaluate the value of postoperative CT scans in determining the probability of return to the operating room (OR) and the optimal time to obtain such scans to determine the effects of surgery. METHODS:Between January and December 2006 (12 months), all postoperative head CT scans obtai...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.11.JNS081048
更新日期:2010-11-01 00:00:00
abstract::Ten cases of meningioma of the pineal region were histologically verified at a single institution during an 8-year period. These represented 0.3% of 3061 intracranial meningiomas, as well as 6.2% of 164 pineal tumors. Patients were predominantly women. Symptoms and signs of increased intracranial pressure were most co...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.85.4.0586
更新日期:1996-10-01 00:00:00
abstract:OBJECTIVE:Gliomas occur in 3-4 individuals per 100,000 individuals and are one of the most common primary brain tumors. Treatment options are limited for gliomas despite the progressive nature of the disease. The authors used the Value Driven Outcomes (VDO) database to identify cost drivers and subgroups that are invol...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.12.JNS183109
更新日期:2019-03-29 00:00:00
abstract::Changes in the brain parenchyma and cerebrospinal fluid spaces were demonstrated in three cases of dural arteriovenous malformations by computerized tomography (CT). In various combinations, there were 1) vermiform or patchy enhancement after intravenous contrast infusion, 2) abnormal decreased density mainly in the w...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.5.0698
更新日期:1980-11-01 00:00:00
abstract::Cerebral protection from an ischemic/hypoxic insult implies that tissue injury can be controlled or even prevented by certain therapeutic maneuvers. For example, physiological thresholds may be altered so that tissue vulnerability to the insult is reduced, or the intensity of an insult may be blunted by enhancing brai...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1986.65.5.0579
更新日期:1986-11-01 00:00:00
abstract:OBJECT:The effect of increased intracranial pressure (ICP) on cerebral venous blood flow has been the subject of very few clinical and experimental studies. The authors assessed the usefulness of venous transcranial Doppler (TCD) ultrasonography as a noninvasive monitoring tool for predicting raised ICP. METHODS:Seria...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.91.5.0744
更新日期:1999-11-01 00:00:00
abstract::The authors report on an unusual case of a primary intracranial myxoma in a 39-year-old woman. The patient presented with headache and generalized seizure. Magnetic resonance imaging revealed a large right frontal tumor resembling a parasagittal meningioma. A gross-total resection was performed, and histological revie...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2006.104.3.440
更新日期:2006-03-01 00:00:00
abstract::We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were dir...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.1.0050
更新日期:1977-07-01 00:00:00
abstract::The authors report a case in which the lateral C-1 arch fractured in a patient with rheumatoid arthritis and an intact fusion mass; this patient had previously undergone a C1-2 Brooks-type fusion. This unique complication occurred secondary to continued resorption of the C1-2 rheumatoid pannus. Two years after occipit...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2001.94.1.0137
更新日期:2001-01-01 00:00:00