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Alternative Tumor-Targeting Strategies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
GliadelTM was approved by the FDA in 1996 for use as an adjunct to surgery to prolong survival in patients with recurrent glioblastoma multiforme for whom surgical resection is indicated. The approval was based on the results of a 222-patient clinical trial which showed that patients with glioma who were treated with GliadelTM had an increase in survival of more than 50% at a six-month time point (i.e., from 44% to 64%). Importantly, side effects were consistent with those normally encountered after surgery of this type. In particular, the incidence of seizures was the same in both groups, although the GliadelTM group tended to experience them earlier on. After many years of experience of use in the clinic, it is now known that carmustine can leak into the systemic circulation, and that some patients experience mild ADRs such as nausea, vomiting, and hair loss. Another problem is that the known side effects of brain surgery itself (e.g., weakness or paralysis on one side of the body and seizures) appear to be more frequent after GliadelTM wafers have been inserted, and a brain surgery wound may also take longer to heal, although the reason for these effects is unclear.
Consent to treatment
Published in Gary Chan Kok Yew, Health Law and Medical Ethics in Singapore, 2020
For the purpose of the tort of battery, the patient is only required to be informed in “broad terms” as to the nature of the medical procedures intended to be performed.12 For instance, the patient must be aware of the main and general purpose of the brain surgery proposed by the surgeon (eg, to remove a tumour diagnosed by the brain scan). The fact that the doctor failed to warn him of a possible side effect from the removal of tumour (eg, that the patient may experience intermittent headaches shortly after the surgery) does not negate the consent to the surgery itself.
Understanding my Wonderland-ing
Published in Esther Dreifuss-Kattan, Cancer and Creativity, 2018
Ashley Myers-Turner, Esther Dreifuss-Kattan, Ashley Myers-Turner
Brain surgery recovery touches each person differently. My recovery felt like an adolescent experimenting with drugs. The room would spin. I felt like I was flying. My furniture would spontaneously move and morph into different shapes.
Influence of cerebrospinal fluid drainage and other variables on the plasma vancomycin trough levels in postoperative neurosurgical patients
Published in British Journal of Neurosurgery, 2021
Chunyan Chen, Ping Xu, Tao Xu, Keting Zhou, Suyan Zhu
Intracranial infection is a potential complication in neurosurgical treatment. Its high incidence impacts patient outcome considerably.1 Studies have shown that in complications caused by brain surgery, the prevalence of intracranial infection is 1.8 to 8.9%, and that of mortality is 3.8 to 30%.2 Gram-positive cocci are the most common causative pathogenic bacteria of intracranial infection after craniotomy.3 Vancomycin, a glycopeptide bactericidal antibiotic naturally produced by Streptomyces orientalis, remains the primary antibiotic for the treatment of multiresistant gram-positive infections, such as methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium.4–6 Therapeutic drug monitoring of VCM is recommended from the first stage of administration for the reason that plasma vancomycin trough levels are correlated with its efficacy and safety.5,7–10
Laser thermal ablation in epilepsy
Published in Expert Review of Neurotherapeutics, 2019
Sanjeet S. Grewal, William O. Tatum
The current state of epilepsy surgery and usage of LITT continues to increase as a strong option for the treatment of patients with drug-resistant focal epilepsy due to the minimally invasive nature. Most patients have surgery and leave the hospital in 1 day making outpatient brain surgery a reality in 2019 for selected patients. The overall benefit and risks associated with the procedure will vary dependent upon the site-specific nature of the targeted brain tissue. Because most patients with drug-resistant epilepsy will have uncontrolled seizures of temporal lobe origin, the initial approach to treatment will likely emerge as a staged approach (similar to corpus callosotomy) due to the ability to perform more widespread resections such as temporal lobectomy when success is not achieved. Emerging evidence in the next year will demonstrate prospective assessment of LITT and its effectiveness to enhance what has initially been learned predominately from retrospective case series. One thing is certain, LITT has solidified its position as a therapy in patients with epilepsy. Furthermore, it can be expected to continue to grow in popularity in parallel to patient and physician acceptance of the procedure due to the minimally invasive nature of the procedure and accessibility to deeper structures of the brain [45].
More than meets the MRI: case report of a carcinoid tumour metastasis mimicking a meningioma
Published in British Journal of Neurosurgery, 2019
Conrad J. Harrison, Sean C. Martin, Monika Hofer, Rufus Corkill, D. Sanjeeva Jeyaretna, Stewart J. Griffiths
The treatment options of metastatic cerebral carcinoid include surgery, whole-brain radiotherapy (WBRT), gamma-knife surgery, and chemotherapy, alone or in combination. The two largest series addressing the efficacy of different therapies favour surgery with subsequent WBRT. In a series of 24 patients Hlatky et al found a median survival time of 4.8 months (95% CI, 0.1–22.8 months) in patients treated with brain surgery alone and 6.0 months (95% CI, 0.1–20.4 months) in patients treated with WBRT alone. Patients treated with surgery followed by WBRT had a median survival time of 3.2 years (95% CI, 0.8–5.5 years), which was significantly longer than all other treatments (p < .01).2 In their series of 15 patient Mallory et al also found a survival advantage in patients undergoing surgery followed by WBRT.1 On actuarial analysis there was a trend towards an improved progression free survival interval in patients undergoing surgery as their primary treatment modality (p = .095) which became significant when perioperative mortality was controlled for. Only WBRT (which was largely adjuvant) was predictive of time to progression (HR 0.15, CI 0.0074–0.95, p = .044).