Abstract:
OBJECT:In the course of their lives most patients with von Hippel-Lindau (VHL) disease require treatment for several symptom-producing hemangioblastomas of the cerebellum, brainstem, or spinal cord. However, many tumors never produce symptoms and do not require treatment. Detection at an early stage of lesions that will later produce symptoms and ultimately require treatment would allow for earlier excision of hemangioblastomas of the spinal cord, brainstem, or cerebellum, and may identify cerebellar hemangioblastomas that can be treated with radiosurgery at a stage before treatment is contraindicated because of tumor size or the presence of an associated cyst. METHODS:To identify features predictive of symptom development that might allow for earlier treatment of smaller, presymptomatic hemangioblastomas in patients with VHL disease, the authors reviewed and analyzed the serial clinical and imaging findings in all patients with VHL disease who were followed up at the National Institutes of Health for more than 10 years. Features predictive of symptom formation were determined by recursive partition and regression analyses. Nineteen patients (10 men and nine women; mean age 32.6 +/- 11.6 years) harboring a total of 143 hemangioblastomas were identified (mean follow-up duration 12.4 +/- 1.4 years). Hemangioblastomas were located in the cerebellum (68 hemangioblastomas, 48% of patients), brainstem (17 hemangioblastomas, 12% of patients), and spinal cord (58 hemangioblastomas, 40% of patients). Despite measurable growth in almost all hemangioblastomas (138 lesions, 97% of patients), only 58 (41% of patients) became symptomatic. Hemangioblastomas grew in a stuttering pattern. (mean growth period 13 +/- 15 months, mean quiescent period 25 +/- 19 months). Twenty-six (45%) of the hemangioblastomas that eventually produced symptoms were not among the tumors that were apparent on the initial MR imaging study. Depending on location, the hemangioblastoma size and/or tumor and cyst growth rates predicted symptom development and the need for treatment (p < 0.05). Cerebellar hemangioblastomas growing faster than 112 mm3/ month or larger than 69 mm3 with associated tumor and cyst growth rates greater than 14 mm3/month became symptomatic (100% sensitivity, 72% specificity). Brainstem hemangioblastomas larger than 245 mm3 with growth rates greater than 0.1 mm3/month became symptomatic (75% sensitivity, 89% specificity). Spinal hemangioblastomas larger than 22 mm3 became symptomatic (79% sensitivity, 94% specificity). CONCLUSIONS:Because hemangioblastomas exhibit a stuttering growth pattern, frequently remain asymptomatic, and do not require treatment for long intervals, unqualified radiographic progression is not an indication for treatment. Basing the decision to intervene in individual tumors solely on radiographic progression would have resulted in approximately four additional procedures per patient during the 10-year study period. Threshold values are presented for tumor size and/or tumor and cyst growth rates that can be used to predict symptom formation and future need for treatment.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Ammerman JM,Lonser RR,Dambrosia J,Butman JA,Oldfield EHdoi
10.3171/jns.2006.105.2.248subject
Has Abstractpub_date
2006-08-01 00:00:00pages
248-55issue
2eissn
0022-3085issn
1933-0693journal_volume
105pub_type
杂志文章abstract:OBJECTIVE:Intraoperative nerve action potential (NAP) recording is a useful tool for surgeons to guide decisions on surgical approaches during nerve repair surgeries. However, current methods remain technically challenging. In particular, stimulus artifacts that contaminate or mask the NAP and therefore impair the inte...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.5.JNS19146
更新日期:2019-08-16 00:00:00
abstract:OBJECT:Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patient...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.92.5.0771
更新日期:2000-05-01 00:00:00
abstract:OBJECT:Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predict...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.7.JNS132433
更新日期:2014-11-01 00:00:00
abstract::OBJECTIVE The authors undertook this study to validate the feasibility and safety of stereotactic radiofrequency thermocoagulation (SRT) for the surgical treatment of giant hypothalamic hamartoma (HH). METHODS Of the 109 patients who underwent SRT for hypothalamic hamartoma (HH) at the authors' institution between 199...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.6.JNS15200
更新日期:2016-10-01 00:00:00
abstract::In clinical follow-up studies after radiosurgery, imaging modalities such as computerized tomography (CT) and magnetic resonance (MR) imaging are used. Accurate determination of the residual lesion volume is necessary for realistic assessment of the effects of treatment. Usually, the diameters rather than the volume o...
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:OBJECTIVE:Magnetic resonance-guided focused ultrasound surgery (MRgFUS) was recently introduced as treatment for movement disorders such as essential tremor and advanced Parkinson's disease (PD). Although deep brain target lesions are successfully generated in most patients, the target area temperature fails to increas...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.3.JNS142592
更新日期:2016-02-01 00:00:00
abstract::A 13-year-old girl was referred for evaluation of the deceleration in her rate of linear growth, an arrest in the progression of her pubertal maturation, and bifrontal headaches. Detailed endocrinological and radiological studies revealed the following abnormalities: partial growth hormone deficiency, prepubertal lute...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.58.6.0932
更新日期:1983-06-01 00:00:00
abstract:OBJECT:In this prospective multicenter study the authors hypothesized that investigational epidural cortical stimulation (CS) delivered concurrently with rehabilitation therapy may enhance motor recovery following stroke. METHODS:Patients who had suffered their index stroke >or= 4 months previously were randomized int...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.3171/JNS/2008/108/4/0707
更新日期:2008-04-01 00:00:00
abstract:OBJECT:The central role of endothelin (ET)-1 in the development of cerebral vasospasm after subarachnoid hemorrhage is indicated by the successful treatment of this vasospasm in several animal models by using selective ET(A) receptor antagonists. Clazosentan is a selective ET(A) receptor antagonist that provides for th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.102.6.1101
更新日期:2005-06-01 00:00:00
abstract::Mongrel dogs with experimental spinal cord injury were treated with the carotenoid compound crocetin. It has been shown that crocetin increases the diffusion speed of oxygen through plasma, and should provide a net increase in oxygen at the level of the capillary endothelial cell. The treated animals showed a signific...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.46.3.0358
更新日期:1977-03-01 00:00:00
abstract:OBJECT:The aim of this study was to acquire intraoperative images during neurosurgical procedures for later reconstruction into a stereoscopic image system (QuickTime Virtual Reality [QTVR]) that would improve visualization of complex neurosurgical procedures. METHODS:A robotic microscope and digital cameras were used...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.2004.100.4.0591
更新日期:2004-04-01 00:00:00
abstract:OBJECT:The goal in this study was to compare flat-panel detector (FD) CT with multislice (MS) CT in the visualization of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), intraventricular hemorrhage, and external ventricular drains (EVDs) to evaluate the diagnostic quality and limitations of the new FD CT ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.2.JNS091054
更新日期:2010-10-01 00:00:00
abstract:OBJECT:The difference in the hemodynamics of wall shear stress (WSS) and oscillatory shear index (OSI) between ruptured and unruptured aneurysms is not well understood. The authors investigated the hemodynamic similarities and dissimilarities in ruptured and thin-walled unruptured aneurysm blebs. METHODS:Magnetic reso...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.7.JNS111991
更新日期:2012-10-01 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::A 54-year-old female presented with multiple episodes of emesis, intractable headaches, worsening balance, and slowly progressive right facial weakness. Imaging demonstrated a 3-cm mass in the left internal capsule and corona radiata region with associated edema, mass effect, and midline shift concerning for high-grad...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.7.JNS1690
更新日期:2017-08-01 00:00:00
abstract:OBJECT:Galectin-1 is highly expressed in motile cell lines. The authors investigated whether galectin-1 actually modulates the migration and invasion of human glioblastoma multiforme (GBM) cell lines, and whether its expression with respect to invasion and prognosis is attributable to certain glioma subgroups. METHODS...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/109/8/0273
更新日期:2008-08-01 00:00:00
abstract::Magnetic resonance (MR) angiography offers a safe, noninvasive alternative to conventional angiography in patients with suspected carotid stenosis; however, it tends to overestimate the severity of stenosis. Loss of the MR signal with a resulting flow gap is a frequent finding in cases of high-grade stenosis. The auth...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.85.3.0384
更新日期:1996-09-01 00:00:00
abstract:OBJECT:The aims of this study were to construct an animal model of deafferentation of the spinal cord by brachial plexus avulsion and to analyze the effects of subsequent dorsal root entry zone (DREZ) lesions in this model. To this end, the authors measured the clinical and electrophysiological effects of total deaffer...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.97.6.1402
更新日期:2002-12-01 00:00:00
abstract::Arteriovenous malformations (AVM's) of lateral and sigmoid sinuses are acquired lesions evolving from a previously thrombosed dural sinus. Their natural history is usually that of gradual progression and hence surgery is frequently necessary. The preferred surgical treatment is complete excision coupled with packing o...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.59.1.0032
更新日期:1983-07-01 00:00:00
abstract::This report describes a large, asymptomatic, subdural skeletal-type condrosarcoma originating from the meninges. Distinction between the mesenchymal and skeletal types of intracranial chondrosarcoma is important since they have different prognoses. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.48.5.0825
更新日期:1978-05-01 00:00:00
abstract::Nucleolar organizer regions (NOR's) are loops of deoxyribonucleic acid (DNA) which transcribe to ribosomal ribonucleic acid (RNA) by RNA polymerase I. They possess vital significance in the ultimate synthesis of cellular proteins. A silver colloid staining technique for demonstration of NOR-associated proteins (Ag-NOR...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1991.74.6.0979
更新日期:1991-06-01 00:00:00
abstract::Previously presented data showed that Vicryl mesh was a potentially effective dural grafting material. It is easily handled, relatively inexpensive, absorbed over time, and elicits a minimal inflammatory response. The present experimental project was conducted to investigate the effectiveness of a tightly woven versio...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.71.1.0124
更新日期:1989-07-01 00:00:00
abstract:OBJECT:Outcome following brain tumor operations is often assessed by health professionals using various gross function scales. However, surprisingly little is known about how modern glioma surgery affects quality of life (QOL) as reported by the patients themselves. In the present study the authors aimed to assess chan...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.1.JNS101657
更新日期:2011-06-01 00:00:00
abstract::Spontaneous intracranial hypotension due to a cerebrospinal fluid (CSF) leak in the spine is an important cause of new, daily persistent headaches. Most patients respond well to conservative treatments including epidural blood patching. Limited options for effective treatment are available for patients in whom these t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.100.6.1098
更新日期:2004-06-01 00:00:00
abstract:Objective:The authors previously described a graded approach to skull base repair following endonasal microscopic or endoscope-assisted tumor surgery. In this paper they review their experience with skull base reconstruction in the endoscopic era. Methods:A retrospective review of a single-institution endonasal endosc...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.11.JNS172141
更新日期:2018-05-11 00:00:00
abstract:OBJECT:Primary and metastatic neoplasms of the lumbosacral junction frequently pose a complex problem for the surgical management and stabilization of the spine because of the anatomical and biomechanical factors of this transition zone between spine and pelvis. The authors have used a modification of the Galveston tec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2000.92.1.0061
更新日期:2000-01-01 00:00:00
abstract::This study was undertaken to evaluate the role of two sets of growth factors, platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF-beta), in the induction and maintenance of glial tumors and their phenotypic expression. Explants from eight malignant tumors, five benign tumors, and two nontumo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1991.75.3.0447
更新日期:1991-09-01 00:00:00
abstract::The authors present an unusual case in which increased intracranial pressure developed because of multiple-suture craniosynostosis and megaloencephaly in a child with a previously undiagnosed lysosomal storage disease, alpha-D-mannosidase deficiency. This 3-year-old boy presented with a history of frequent naps, heada...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.4.0647
更新日期:1995-04-01 00:00:00
abstract::A Remington humane stunner was used to deliver blows to the skulls of anesthetized cats. Alternate animals were post-treated with either dexamethasone (4 mg/kg/day) or a comparable volume of saline. Each animal was tested for cerebral edema 48 hours after impact by measurement of the change in density of white matter ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.48.2.0220
更新日期:1978-02-01 00:00:00
abstract::This follow-up study analyzes the results of dorsal column stimulation instituted between 1972 and 1974 for the relief of pain in 84 patients, including 64 amputees. Good results decreased from 52.4% after 2 years of stimulation to 39% after 5 years. Special therapeutic problems in amputees are discussed. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.52.3.0346
更新日期:1980-03-01 00:00:00