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Pediatric Central Nervous System Tumors as Phenotypic Manifestation of Cancer Predisposition Syndromes
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Giorgio Perilongo, Irene Toldo, Stefano Sartori
The clinical history of hemangioblastoma is unpredictable. No clinical and/or biological markers are available to predict their behavior. They may remain dormant for long periods of time, but in some instances they may demonstrate growth capacity. A conservative neurosurgical approach should be the therapeutic concept guiding the treatment of hemangioblastomas, recognizing that surgery remains the cornerstone of treatment. Recently, radiosurgery has been used successfully for smaller lesions in critical locations. The National Institutes of Health (NIH) recommend that contrast-enhanced MRI of the brain and spinal cord should be performed for every patient with VHL every 2 years from the age of 11.72
Clinical Outcomes of Intracranial Surface-Guided Stereotactic Radiosurgery
Published in Jeremy D. P. Hoisak, Adam B. Paxton, Benjamin Waghorn, Todd Pawlicki, Surface Guided Radiation Therapy, 2020
Skull base tumors can be challenging to treat with radiosurgery given the proximity to critical structures such as the brainstem, cranial nerves, and cochleae. These lesions may also be geometrically more irregular than brain metastases (which are often spherical), which can make treatment planning more challenging. In order to justify treatment of these benign lesions, it is important for radiosurgery to maintain a very low risk of toxicity.
Postoperative Dressings
Published in Jeffrey A Sherman, Oral Radiosurgery, 2020
Proper care of the mouth after radiosurgery can reduce complications and speed healing of the surgical area. The following is recommended to insure healing: The patient should avoid smoking, eating hard or spicy foods, citrus juices, and alcohol following surgery.A toothbrush may be carefully used in areas not involved with the surgical procedure.Following radiosurgery, it is normal to experience some discomfort; therefore analgesics may be prescribed.If sutures have been placed, the patient should be instructed to return to the office for their removal.To control swelling in areas of extensive surgery, the patient should be instructed to apply ice packs to the area: alternately on for 15 minutes and off for 15 minutes.Patients should be instructed to call the surgery if any questions or problems arise.
Radionecrosis (RN) in patients with brain metastases treated with stereotactic radiosurgery (SRS) and immunotherapy
Published in International Journal of Neuroscience, 2023
Lauren Andring, Bryan Squires, Zachary Seymour, Daniel Fahim, Jeffrey Jacob, Hong Ye, Kimberly Marvin, Inga Grills
Our study is limited by its retrospective nature and the inherent biases of such analyses, although all cases were pulled from a prospectively maintained radiosurgery database. Another potential limitation of our study is that the overwhelming majority of RN cases were diagnosed by clinical information and imaging studies while only one case was confirmed by biopsy. As such, it is possible that RN was over-diagnosed in the patient population; however, such a limitation would indicate that the risk of RN may be even lower than what is reported in the current analysis, supporting the conclusion that the risk of RN is low in this population. While our results add to the current literature and may help to inform patient care and treatment decisions, prospective trials and further research are needed.
CyberKnife for the management of Cushing’s disease: our institutional experience and review of literature
Published in British Journal of Neurosurgery, 2021
Ashraf Abdali, Pavel L. Kalinin, Yuriy Y. Trunin, Ludmila E. Astaf’Eva, Alexey N. Shkarubo, Gennady E. Chmutin, Vishal Chavda, Andrey Golanov, Badshazar Abdali, Ilya V. Chernov, Atul Vats, Bipin Chaurasia
The median time in months between surgery and the start of Stereotactic radiosurgery was around 23.5 months. Thirty-four patients underwent single fraction radiation surgery, while 5 patients had 3 fractions and 2 patients had 5 fractions of radiations. In all cases, CT scan of the skull is performed in 1 and 5 mm cuts for planning of the planning target volume (PTV), to generate navigation plan for DRR (digitally reconstructed radiographs) and to specify the counters of target volume/critical structures. Target volume planning is performed by Multiplan system. Distance in preplanning from the optic tracts was kept about 2 mm and the radiation dose was kept bellow 8 Gy. The median target dose was 16 Gy. The median target volume was 3.8 cm3 with a maximum volume of 7.20 cm3 and a minimum volume of 0.8 cm3.
Cyberknife radiosurgery on the brainstem metastases of non-small cell lung cancer
Published in International Journal of Neuroscience, 2021
Guanghai Mei, Xiaoxia Liu, Kun Song, Yizheng Lv, Ming Xu, Hongzhi Xu, Enmin Wang
Radiosurgery is applied to prevent or reverse neurological dysfunction and to control the local progression of the metastatic lesions. Single-fraction doses are known to have a larger biological effect than equal doses delivered cumulatively over multiple fractions. This was the reason why patients treated with WBRT alone had a higher risk of subsequent local disease progression in the central nervous system than the patients who were treated with the Cyberknife [17]. Significant improvement in the general condition is usually more noticeable after the Cyberknife than after conventional WBRT. The likely reason for the higher incidence of radiation-induced complications in WBRT compared to the Cyberknife is that WBRT delivers a higher mean dose to the brain than that by the Cyberknife. In the Cyberknife system, the normal brain tissues and the brainstem can tolerate fairly high maximum doses to a very small tissue volume around the lesions. In this regard, a recently randomized and controlled trial showed that patients treated with SRS plus WBRT were at a greater risk of a significant decline in learning and memory function 4 months after the treatment than patients who received SRS alone [18,19], which indicated that the radiation toxicity might be caused by the high mean dose delivered to the hippocampus in WBRT [18,19].