Abstract:
OBJECT:This prospective study is based on a consecutive series of 20 patients with pineal region tumors who underwent minimally invasive preferential management. The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors. METHODS:If the tumor markers alpha-fetoprotein and human chorionic gonadotropin were not detected in serum and there was significant ventricular dilation visualized on neuroimages, neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventriculostomy. Subsequent procedures were determined on the basis of verified individual tumors. For treatment of germinomas and pineoblastomas, if no tumor dissemination was confirmed by pre-, intra-, or postoperative findings, stereotactic radiotherapy or radiosurgery was performed after one course of chemotherapy with the ICE regimen (isofomid, cisplatin, and etoposide) and followed by two additional courses of chemotherapy. For treatment of malignant germ cell tumors, after extensive surgery, adjuvant chemotherapy with the ICE regimen was performed in three courses in all cases. Then radiotherapy was started using various methods, depending on the evidence of tumor dissemination. For treatment of teratomatous and neuroectodermal tumors other than pineoblastomas, extensive surgical removal was performed. As for adjuvant therapy, if the tumor was a low-grade glioma or if the patient was younger than 5 years of age, postoperative treatment did not include radiotherapy. If the tumor was a malignant teratoma or high-grade glioma, conventional focal radiotherapy was performed, followed by chemotherapy with ICE for 1 year. All but two treated patients had ventriculomegaly. Neuroendoscopic procedures were performed in six of 15 treated patients. Neuroendoscopic biopsy with tumor debulking offered enough material for tissue diagnosis, including immunohistochemical analysis and, in one case, revealed evidence of tumor dissemination undetectable on neuroimaging. With one exception, no shunt was required in any patient undergoing endoscopic third ventriculostomy. Stereotactic radiotherapy was performed in indicated cases. Favorable therapeutic outcomes were obtained in all cases of germinoma and pineoblastoma, with follow-up periods ranging from 24 months to 6.5 years. CONCLUSIONS:Our minimally invasive preferential regimen clarified the precise indication for neuroendoscopic procedures, and the majority of our patients with dilated ventricles and no evidence of tumor markers were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure, avoiding unnecessary craniotomy and radiotherapy and promising excellent therapeutic outcomes. The treatment for malignant pineal region tumors remains a subject for further study.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Oi S,Shibata M,Tominaga J,Honda Y,Shinoda M,Takei F,Tsugane R,Matsuzawa K,Sato Odoi
10.3171/jns.2000.93.2.0245subject
Has Abstractpub_date
2000-08-01 00:00:00pages
245-53issue
2eissn
0022-3085issn
1933-0693journal_volume
93pub_type
杂志文章abstract::Focal cortical dysplasia type II (FCD II) is a common histopathological substrate of epilepsy surgery. Here, the authors propose a sulcus-centered resection strategy for this malformation, provide technical details, and assess the efficacy and safety of this technique. The main purpose of the sulcus-centered resection...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2020.5.JNS20751
更新日期:2020-08-07 00:00:00
abstract::Lysosomal proteases, although tightly regulated under physiological conditions, are known to contribute to cell injury after various forms of tissue ischemia have occurred. Because cathepsin B is a prominent lysosomal protease found in brain parenchyma, the authors hypothesized that it may contribute to neuronal cell ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1997.87.5.0716
更新日期:1997-11-01 00:00:00
abstract:OBJECT:The 201Tl uptake index was evaluated for its usefulness in formulating a diagnosis of hemangioblastoma. Thallium-201-single-photon emission computerized tomography (SPECT) studies were performed in nine patients harboring hemangioblastomas in the posterior fossa and in five patients (six lesions) with gliomas in...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2001.95.2.0292
更新日期:2001-08-01 00:00:00
abstract::Between April, 1989, and January, 1991, a total of 19 cases of giant aneurysm were treated by the endovascular approach. The patients included seven males and 12 females aged 15 to 72 years. Detachable balloons, occlusion coils, and ethylene vinyl alcohol copolymer liquid were used as embolic materials. In seven cases...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1992.77.1.0037
更新日期:1992-07-01 00:00:00
abstract::In an observational study in head-injured patients, cerebrovascular pressure transmission was investigated using a systems analysis approach whereby the blood pressure (BP) waveform was used as a measure of an input stimulus to the cerebrovascular bed (CVB) and the intracranial pressure (ICP) waveform as the response ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1990.73.6.0871
更新日期:1990-12-01 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:OBJECT:There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,meta分析,评审
doi:10.3171/2014.5.JNS131766
更新日期:2014-08-01 00:00:00
abstract:OBJECT:In many new clinical trials of patients with malignant gliomas surgical intervention is incorporated as an integral part of tumor-directed interstitial therapies such as gene therapy, biodegradable wafer placement, and immunotherapy. Assessment of toxicity is a major component of evaluating these novel therapeut...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.98.6.1175
更新日期:2003-06-01 00:00:00
abstract::The authors report on a 57-year-old woman in whom progression to brain death occurred on day 9 after aneurysmal subarachnoid hemorrhage without evidence of significant brain edema or vasospasm. Neuromonitoring demonstrated that brain death was preceded by a series of cortical spreading depolarizations that occurred in...
journal_title:Journal of neurosurgery
pub_type:
doi:10.3171/2018.7.JNS181478
更新日期:2018-12-07 00:00:00
abstract:OBJECT:Obsessive-compulsive disorder (OCD) is a common and disabling psychiatric illness, and in a significant proportion of patients with OCD the disease is refractory to conventional pharmacotherapy and psychotherapy. For more than half a century, patients with severe, treatment-resistant OCD have been treated with s...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.11.JNS12389
更新日期:2013-03-01 00:00:00
abstract::Two unusual cases of neurocutaneous melanosis are presented. Both patients had congenital giant hairy nevi and both developed hydrocephalus, seizures, and myelopathy. The first patient displayed multicentric cerebral and spinal cord melanosis, as opposed to the more commonly described basilar leptomeningeal involvemen...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.61.4.0782
更新日期:1984-10-01 00:00:00
abstract::In this study, 24 aneurysms occurring in 23 patients under the age of 18 years (mean 12 years) are analyzed. The male:female ratio was 2.8:1, and the youngest patient was 3 months old. Mycotic lesions and those associated with other vascular malformations were excluded. Forty-two percent of the aneurysms were located ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1989.70.3.0420
更新日期:1989-03-01 00:00:00
abstract::Retrospective analysis of 13 patients who had bifrontal decompressive craniectomy for the management of posttraumatic cerebral edema shows a significant decrease in expected mortality, but severe morbidity in the survivors. Only one patient returned to the pretrauma level of neurological function. No correlation could...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1975.42.4.0429
更新日期:1975-04-01 00:00:00
abstract:OBJECT:Dissections were performed in 100 fresh cadaver palms to determine the frequency with which superficial palmar communication between the median and ulnar nerves occurs and to what extent it might incur iatrogenic injury during endoscopic carpal tunnel release. METHODS:Superficial palmar communication between th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.91.6.1027
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to demonstrate the feasibility and safety of CorPath GRX robotic-assisted (RA) transradial (TR) carotid artery stenting (CAS) compared with manual TR CAS. METHODS:The authors conducted a retrospective analysis of a prospectively maintained database and identified 13 consecutiv...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2020.5.JNS201421
更新日期:2020-08-28 00:00:00
abstract::A patient is reported whose hydrocephalus was controlled by diverting the ventricular cerebrospinal fluid directly into the urinary bladder. This drainage route may have a useful place in the management of the adult pressure-sensitive patient whose more conventional shunt requires frequent revision for repeated obstru...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.6.0858
更新日期:1980-12-01 00:00:00
abstract:OBJECT:Surgical or endovascular occlusion of the parent artery proximal to an aneurysm has been recommended for treatment of dissecting aneurysms of the intracranial posterior circulation. However, dissecting aneurysms may rupture even after proximal occlusion because distal progression of thrombus is necessary to occl...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.90.5.0853
更新日期:1999-05-01 00:00:00
abstract::The authors of this prospective, single-case study evaluated the potential for functional recovery from chronic spinal cord injury (SCI). The patient was motor complete with minimal and transient sensory perception in the left hemibody. His condition was classified as C-2 American Spinal Injury Association (ASIA) Grad...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2002.97.2.0252
更新日期:2002-09-01 00:00:00
abstract:OBJECT:The goal of this study was fourfold: 1) to determine the incidence of traumatic subarachnoid hemorrhage (tSAH) in patients with traumatic brain injury (TBI); 2) to verify agreement in the diagnosis of tSAH in a multicenter study; 3) to assess the incidence of tSAH on the outcome of the patient; and 4) to establi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.3171/jns.2003.98.1.0037
更新日期:2003-01-01 00:00:00
abstract::Sixteen patients referred for atlantoaxial fixation failures were treated surgically with revision procedures during the past decade. Of these 16 patients, atlantoaxial instability occurred because of rheumatoid arthritis in five, as odontoideum in seven, transverse ligament disruption in two, and odontoid fracture no...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.83.2.0248
更新日期:1995-08-01 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
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 spinal cord of anesthetized cats was subjected to impact trauma of different intensities to determine how changes in trauma magnitude affect the formation and distribution of edema. All animals underwent a laminectomy to expose the cord segments corresponding to the T5--7 vertebrae. Fourteen cats were injected wit...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1981.54.6.0802
更新日期:1981-06-01 00:00:00
abstract::The authors present a rare entity, an intrasellar cavernous hemangioma that on neuroimages mimicked a nonfunctioning pituitary macroadenoma in a patient with a known orbital hemangioma. Such lesions can grow extraaxially within the dural sinuses, particularly the cavernous sinus, and present like tumors. A better unde...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.94.3.0520
更新日期:2001-03-01 00:00:00
abstract::Experience indicates that stand-alone cages may lack the necessary stability to secure highly unstable motion segments at the lumbosacral junction. The authors have designed a special carbon fiber composite interbody cage that allows additional screw placement in anterior lumbar interbody fusion procedures performed a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2003.98.2.0222
更新日期:2003-03-01 00:00:00
abstract::The authors present an unusual case of sciatic nerve entrapment due to a World War II shrapnel injury to the left thigh suffered during the battle of Anzio in 1943. The patient presented for evaluation of left lower-extremity pain in the sciatic nerve distribution. Magnetic resonance imaging of the lumbosacral spine r...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2004.100.3.0295
更新日期:2004-03-01 00:00:00
abstract::The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally invasive procedure allowing cannulat...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.8.JNS16342.test
更新日期:2017-03-17 00:00:00
abstract:OBJECT:Traditional treatment of transected peripheral nerves has been by suturing the nerve ends to each other. Because this approach is not widely available and is technically demanding, the authors evaluated an easier method for end-to-end anastomosis using cyanoacrylate-based glue. METHODS:The authors used a rat sc...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.7.JNS091266
更新日期:2011-01-01 00:00:00
abstract::Nine patients with malignant glioma were treated with the lymphokine interleukin-2 (IL-2) or with lymphokine-activated killer (LAK) cells, and one patient received combination therapy with both LAK cells and IL-2. The LAK cells were generated by culturing recombinant IL-2 with peripheral blood lymphocytes obtained fro...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.1986.64.5.0743
更新日期:1986-05-01 00:00:00
abstract:OBJECTIVE:To investigate the risk of bleeding from unruptured cerebral aneurysms (UCAs), previous studies have used Kaplan-Meier analyses without treating the definitive treatment as a competing risk event, which may underestimate the rupture rate. The authors analyzed the survival of patients with UCAs alongside the o...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.11.JNS181781
更新日期:2019-03-08 00:00:00