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Malignant Melanoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Stereotactic radiosurgery refers to radiation that is focused, and there are a number of platforms that deliver this. Surgery is often preferentially used for large superficial brain lesions (>3 cm), for infratentorial lesions, and in combination with stereotactic radiosurgery. In contrast, stereotactic surgery has minimal perioperative morbidity; however it is more effective on smaller lesions (<3 cm) with minimal mass effect or edema. It can be used in patients who have co-morbidities, thus avoiding the need for surgery, and can be used for more than one lesion. In a study of 118 melanoma brain metastases treated with stereotactic radiosurgery, freedom from progression was achieved in 90–95% of lesions with a reduction in size occurring in 55%.49 Intracranial tumor volume and status of systemic disease are independent predictors of survival in melanoma patients undergoing radiosurgery to brain metastases. The results of RTOG 9508 demonstrated that adding stereotactic radiosurgery to WBRT for patients with 1–3 brain metastases improved survival in patients of RPA Class 1 (11.6 months vs. 9.6 months, p < 0.0001). A phase III trial of stereotactic radiosurgery vs. WBRT for patients with >3 brain metastases from melanoma is currently recruiting.
Computer-assisted surgery in medical and dental applications
Published in Expert Review of Medical Devices, 2021
Yen-Wei Chen, Brian W. Hanak, Tzu-Chian Yang, Taylor A. Wilson, Jenovie M. Hsia, Hollie E. Walsh, Huai-Che Shih, Kanako J. Nagatomo
Neuronavigation arose through a combination of stereotaxy, neuroimaging, and computer technology [6,7]. Stereotaxy is an approach to localizing and targeting a specific point within a defined space using a three-dimensional coordinate system. Thus, regarding the brain as a geometric volume, stereotactic surgery utilizes a coordinate system to precisely and accurately target any structure within the brain [8]. In the early 1900s, stereotactic neurosurgery began by using a three-dimensional Cartesian coordinate system defined by a rigid frame affixed to the patient’s head to target specific anatomical regions in the brain. These early frame-based stereotactic systems were used to localize deep brain structures based on external skull landmarks using relationships defined by normalized cadaveric dissection studies, giving rise to the field of ‘craniometry’ [9]. Not surprisingly, however, these early stereotactic systems, of which there were several, all suffered from inaccuracies generated by the variability of brain structures’ correlation with skull landmarks.
Early-start vs delayed-start donepezil against cognitive decline in Parkinson disease: a randomized clinical trial
Published in Expert Opinion on Pharmacotherapy, 2021
Hideyuki Sawada, Tomoko Oeda, Masayuki Kohsaka, Satoshi Tomita, Atsushi Umemura, Kwiyoung Park, Kenji Yamamoto, Kosuke Kiyohara
Patient eligibility criteria for phase 1 were the following: 20–80 years of age (inclusive) at the time of signing the consent, diagnosed as PD according to steps 1 and 2 of the United Kingdom Brain Bank Parkinson’s disease criteria, with modified Hoehn-Yahr (mH-Y) stage from 2.5 to 4 (‘ON’ period if patients suffered from motor fluctuations), and MMSE scores of 24 or more [19]. For 8 weeks before study enrollment, patients must have had no hallucinations or delusions according to the Parkinson Psychosis Questionnaire (PPQ), because the original purpose of EDAP was to investigate the prophylactic effect of donepezil against psychosis in PD. Exclusion criteria for phase 1 were the following: 1) taken donepezil, 2) taken central anticholinergic drugs within 4 weeks prior to week 0, 3) taken Yokukansan within 4 weeks, 4) taken antipsychotics within 12 weeks, 5) patients who fulfilled the criteria of probable dementia with Lewy bodies, 6) diagnosed with schizophrenia, 7) history of stereotactic surgery, 8) allergic to piperidine derivatives, 9) severe hepatic or renal dysfunction, 10) sick sinus syndrome or intra-atrial or AV nodal block, 11) patients with present or previous serious gastrointestinal ulcer, bronchial asthma or obstructive pulmonary diseases, 12) bradycardia (heart rate of 45 bpm or less), 13) QTc time longer than 460 ms, 14) pregnant or feeding a baby, 15) having participated in other clinical trials within 12 weeks, 16) diagnosed with malignancy, or 17) judged as not suitable by the investigators.
Role of deep brain stimulation therapy in the magnetic resonance-guided high-frequency focused ultrasound era: current situation and future prospects
Published in Expert Review of Neurotherapeutics, 2020
C. Fernandez-Garcia, F. Alonso-Frech, M.H.G. Monje, J. Matias-Guiu
The highest risk associated with DBS is during implantation, when bleeding can occur and disabling consequences obscure the final result. We have reviewed the incidence of intracranial hemorrhage over the past few decades. From 1989 to 2014, 77 articles that reported the incidence of bleeding in more than 13,000 patients were selected. All studies were included independently of the number of patients treated, the target, or the severity of bleeding. We determined the median of the range of years in which the study had taken place and assigned the result to one of two groups: 1) early treatments (1990–2001); 2) contemporary treatments (2002–2012 or later). As Table 1 shows, the mean risk of bleeding in a stereotactic surgery was 5.1% in the early treatment group. However, this percentage decreased to 1.87% with contemporary treatment (p = 0.0008).