Abstract:
OBJECT:Convection-enhanced delivery (CED) is an increasingly used novel local/regional delivery method targeted directly to tissue. It relies on a continuous pressure gradient for distribution of therapeutic agents into the interstitial space, with administration of the infusate over a few days. Cintredekin besudotox (also known as IL13- PE38QQR) is a recombinant chimeric cytotoxin consisting of interleukin-13 and a truncated exotoxin produced by the Pseudomonas aeruginosa bacterium, which targets malignant glioma cells. METHODS:Cintredekin besudotox was administered via intraparenchymal CED after resection of supratentorial recurrent malignant glioma. The safety and toxicity profile was reviewed for 53 patients in whom infusion catheters had been placed; 51 of them received CED of the study drug. Adverse events were categorized based on time of onset in relation to CED, and the causal relationship with catheter placement or delivery of cintredekin besudotox. Catheters were placed in 53 patients, although only 51 of them received cintredekin besudotox. Most adverse events related to catheter placement or the study drug originated from the central nervous system. Three symptomatic windows were defined: the first one was between surgical procedure and CED; the second was during CED and up to 1 week after its completion; and the third window was 2 to 10 weeks after treatment. Those windows generally reflected adverse events related to surgical procedures, mass effect from infusate, and drug effect on tumor-infiltrated and normal brain parenchyma, respectively. CONCLUSIONS:The symptomatic windows identified in this study apply to any CED clinical trials, particularly those in which chimeric cytotoxins are used, and will help to determine the most likely underlying pathophysiological process causing symptoms. This information, in turn, will help to prevent adverse events or minimize their severity. Those events also have implications for dose escalation and outcome measures.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Kunwar S,Chang SM,Prados MD,Berger MS,Sampson JH,Croteau D,Sherman JW,Grahn AY,Shu VS,Dul JL,Husain SR,Joshi BH,Pedain C,Puri RKsubject
Has Abstractpub_date
2006-04-15 00:00:00pages
E15issue
4issn
1092-0684pii
200415journal_volume
20pub_type
临床试验,杂志文章abstract:OBJECT:Coil embolization of aneurysms has been shown to be as safe and effective as surgical clip ligation, but has a higher recurrence rate. Advances in coil technology aim to reduce aneurysm recurrence by coating the devices with biological substances. An example of this is MicroVention's HydroCoil, which is a platin...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2005.18.2.6
更新日期:2005-02-15 00:00:00
abstract::Although the expectation of monetary compensation has been associated with failures in lumbar discectomy, the issue has not been investigated in patients undergoing cervical disc surgery. The authors analyzed the relationship between economic forms of secondary gain and surgical outcome in a group of patients with a c...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1998.5.2.9
更新日期:1998-08-15 00:00:00
abstract::Aquaporin-4 (AQP4) channels play an important role in brain water homeostasis. Water transport across plasma membranes has a critical role in brain water exchange of the normal and the diseased brain. AQP4 channels are implicated in the pathophysiology of hydrocephalus, a disease of water imbalance that leads to CSF a...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2016.7.FOCUS16191
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:Unruptured intracranial aneurysms are common incidental findings on brain imaging. Short-term follow-up for conservatively treated aneurysms is routinely performed in most cerebrovascular centers, although its clinical relevance remains unclear. In this study, the authors assessed the extent of growth as well...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.4.FOCUS1995
更新日期:2019-07-01 00:00:00
abstract::The retrosigmoid approach is a work-horse approach to the cerebellopontine angle (CPA), providing access from the foremen magnum to the tentorium. Indications for this approach are variable such as resection of meningiomas, acoustic neuromas and epidermoid tumors, treatment of vascular lesions of vertebrobasilar syste...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V1.FOCUS13445
更新日期:2014-01-01 00:00:00
abstract:OBJECT:Tethering of the spinal cord has been a recognized cause of neurological symptoms in pediatric patients and is increasingly being recognized as a cause of symptoms in adults as well. The pathophysiology surrounding spinal cord tethering has begun to be understood in the pediatric population but is still unclear ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2010.3.FOCUS1080
更新日期:2010-07-01 00:00:00
abstract::OBJECTIVE Stereotactic needle biopsies are usually performed for histopathological confirmation of intracranial lymphomas to guide adequate treatment. During biopsy, intraoperative histopathology is an effective tool to avoid acquisition of nondiagnostic samples. In the last years, 5-aminolevulinic acid (5-ALA)-induce...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.3.FOCUS1859
更新日期:2018-06-01 00:00:00
abstract::In addition to standard management for the treatment of the acute phase of spinal cord injury (SCI), implementation of novel neuroprotective interventions offers the potential for significant reductions in morbidity and long-term health costs. A better understanding of the systemic changes after SCI could provide insi...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2018.12.FOCUS18206
更新日期:2019-03-01 00:00:00
abstract::The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality Outcomes Database (N2QOD), was established by the NeuroPoint Alliance (NPA) in collaboration with relevant national stakeholders and experts. The overarching goal of this project was to develop a centralized, nationally coordinate...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.2.FOCUS207
更新日期:2020-05-01 00:00:00
abstract:OBJECT:This paper describes a consecutive series of skull base meningiomas resected using an endoscopic endonasal approach through various corridors at a single institution over 7 years. The impact of case selection and experience, the presence of a cortical cuff between the tumor and surrounding vessels, and brain ede...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.7.FOCUS14321
更新日期:2014-01-01 00:00:00
abstract::OBJECTIVE Robot-guided pedicle screw placement is an established technique for the placement of pedicle screws. However, most studies have focused on degenerative disease. In this paper, the authors focus on metastatic spinal disease, which is associated with osteolysis. The associated lack of dense bone may potential...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.3.FOCUS1710
更新日期:2017-05-01 00:00:00
abstract::Foramen magnum meningiomas (FMMs) are slow growing, most often intradural and extramedullary tumors that pose significant challenges to the skull base neurosurgeon. The indolent clinical course of FMMs and their insidious onset of symptoms are important factors that contribute to delayed diagnosis and relative large s...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.10.FOCUS13332
更新日期:2013-12-01 00:00:00
abstract::There is growing evidence to suggest that pregnancy may increase the risk of hemorrhage from cavernous malformations (CMs). In the present case, a 21-year-old primigravida was admitted to the authors' neurosurgical service after a cesarean section. Three weeks before admission she had experienced rapidly progressive b...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2006.21.1.13
更新日期:2006-07-15 00:00:00
abstract::Cellular therapy has been evaluated in small animals, subhuman primates, and now humans for the potential repair of brain injury due to stroke. Experimental striate stroke models have proven useful for the purpose of evaluating different treatment paradigms. Early clinical trials involving neuronal transplantation in ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.5.2
更新日期:2002-11-15 00:00:00
abstract::Primary central nervous system lymphoma (PCNSL) is an aggressive neoplastic process that occurs in both immunocompetent and immunocompromised patients. Over the past 30 years there has been a steady increase in the number of cases in both patient populations. The imaging features for the disease and demographic charac...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2006.21.5.5
更新日期:2006-11-15 00:00:00
abstract::The clinical success of lumbar spinal fusion varies considerably, depending on techniques and indications. Although spinal fusion generally helps to eliminate certain types of pain, it may also decrease function by limiting patient mobility. Furthermore, spinal fusion may increase stresses on adjacent nonfused motion ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2007.22.1.1
更新日期:2007-01-15 00:00:00
abstract::Cerebral venous sinus thrombosis (CVST) is characterized by formation of widespread thrombus within the cerebral venous sinus system. CVST can cause venous hypertension, venous infarcts, hemorrhage and seizures. It is managed in most cases with systemic anticoagulation through the use of heparin to resolve the thrombu...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V2.FOCUS14186
更新日期:2014-07-01 00:00:00
abstract::Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentatio...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.8.FOCUS20600
更新日期:2020-11-01 00:00:00
abstract::While the majority of cerebral revascularization advancements were made in the last century, it is worth noting the humble beginnings of vascular surgery throughout history to appreciate its progression and application to neurovascular pathology in the modern era. Nearly 5000 years of basic human inquiry into the vasc...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/2018.11.FOCUS18527
更新日期:2019-02-01 00:00:00
abstract:OBJECT:Positional plagiocephaly (PP) has been on the rise in recent years. In this review, the authors' aim was to assess the effectiveness of current recommendations to parents on this exceedingly common problem through a comprehensive literature search. Additionally, the current treatment options and the most recent ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,meta分析,评审
doi:10.3171/2013.8.FOCUS13261
更新日期:2013-10-01 00:00:00
abstract::Herniated thoracic discs, unlike their lumbar counterparts, are difficult to read and safely resect using traditional posterior approaches. Historically, the use of a laminectomy for thoracic disc resection has yielded poor clinical outcomes. Posterolateral and anterolateral approaches have become the standard surgica...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2001.10.1.9
更新日期:2001-01-15 00:00:00
abstract::High-flow microinfusion is a novel technique for delivery of compounds directly into the brain parenchyma, bypassing the blood-brain barrier. The feasibility of this technique has been demonstrated with low-molecular-weight compounds, macromolecular dyes, and proteins. Delivery of antisense oligonucleotides into the b...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1997.3.5.7
更新日期:1997-11-15 00:00:00
abstract::Germ line and somatic mutations in the neurofibromatosis Type 2 (NF2) tumor suppressor gene predispose individuals to tumors of the nervous system, including schwannomas and meningiomas. Since identification of the NF2 gene more than a decade ago, a large body of information has been collected on the nature and conseq...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2005.19.5.7
更新日期:2005-11-15 00:00:00
abstract::The authors detail the life and career of Dr. J. Lawrence Pool, as well as his significant contributions to the field of cerebrovascular neurosurgery. The discipline of cerebrovascular neurosurgery is a young and dynamic field, which underwent rapid and substantial growth during the middle of the twentieth century. As...
journal_title:Neurosurgical focus
pub_type: 传,历史文章,杂志文章
doi:
更新日期:2006-06-15 00:00:00
abstract:OBJECT:The authors present a series of 4 patients with rare facial nerve tumors. The relevant literature is reviewed and is discussed regarding diagnostic features, the role of operative management, and surgical approach. METHODS:A retrospective chart review was conducted for patients with tumors of the facial nerve t...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.1.FOCUS12380
更新日期:2013-03-01 00:00:00
abstract::The contemporary management of projectile head injuries owes much to the lessons neurosurgeons have distilled from their experiences in war. Through early investigation and an increasingly detailed account of wartime clinical experience, neurosurgeons--including the field's early giants--began to gain a greater unders...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/2010.2.FOCUS1038
更新日期:2010-05-01 00:00:00
abstract::Central skull base lesions in the upper retroclival and petroclival regions can be challenging to access because of their location anterior to the brainstem. Several transpetrosal approaches have been developed to access the petroclival junction, including anterior petrosal (anterior petrosectomy), posterior petrosal ...
journal_title:Neurosurgical focus
pub_type: 临床试验,杂志文章
doi:10.3171/FOC.2008.25.12.E5
更新日期:2008-01-01 00:00:00
abstract::Neuromodulation and deep brain stimulation (DBS) have been increasingly used in many neurological ailments, including essential tremor, Parkinson's disease, epilepsy, and more. Yet for many patients and practitioners the desire to utilize these therapies is met with caution, given the need for craniotomy, lead inserti...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2018.4.FOCUS18130
更新日期:2018-08-01 00:00:00
abstract::There has been increasing awareness that glioblastoma, which may seem histopathologically similar across many tumors, actually represents a group of molecularly distinct tumors. Emerging evidence suggests that cells even within the same tumor exhibit wide-ranging molecular diversity. Parallel to the discoveries of mol...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2014.9.FOCUS14521
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVE:In addition to the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low- and middle-income countries, especially in Uganda. In this study, the authors aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.7.FOCUS18270
更新日期:2018-10-01 00:00:00