-
[show abstract]
[hide abstract]
ABSTRACT: IntroductionGlomus jugulare tumours represent a great therapeutic challenge. Previous papers have documented good results from Gamma Knife
surgery (GKS) with these tumours. However, the relationship between clinical improvement and tumour shrinkage has never been
assessed.
Materials and methodsThere were 14 patients, 9 women and 5 men. The mean follow-up period was 28months (range 6 to 60months). All the tumours
except one were Fisch type D and the mean volume was 14.2cm3 (range 3.7–28.4cm3). The mean prescription dose was 13.6Gy (range 12–16Gy).
ResultsNone of the tumours have continued to grow. Eight are smaller and 6 unchanged in volume. Two patients with bruit have had
no improvement in their symptoms. Among the other 12 patients, 5 have had symptomatic improvement of dysphagia, 4 in dysphonia,
3 in facial numbness, 3 in ataxia and 2 in tinnitus. Individual patients have experienced improvement in vomiting, vertigo,
tongue fasciculation, hearing, headache, facial palsy and accessory paresis. One patient developed a transient facial palsy.
Symptomatic improvement commonly began before any reduction in tumour volume could be detected. The mean time to clinical
improvement was 6.5months whereas the mean time to shrinkage was 13.5months.
ConclusionsGamma Knife treatment of glomus jugulare tumours is associated with a high incidence of clinical improvement with few complications,
using the dosimetry recorded here. Clinical improvement would seem to be a more sensitive early indicator of therapeutic success
than radiological volume reduction. Further follow-up will be needed.
Acta Neurochirurgica 04/2012; 151(5):423-426. · 1.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The anterior visual pathway (AVP) can be at risk during gamma knife surgery (GKS). There is no standardised published methodology for protecting the AVP. This paper suggests such an approach in relation to the treatment of meningiomas. There were 67 patients with a mean age of 48.8 years and a minimum follow-up of 25 months. A recent perimetry was available on the day of treatment. The visual pathway was outlined and the maximum radiation dose was recorded. In some cases a dose volume histogram (DVH) of the AVP was constructed to assess the volume receiving more than the desired maximum dose. The aim was a maximum dose between 8 and 10 Gy. A principle of sub-optimal dose planning was used to protect vision. Follow-up included new visual field examinations. Various anatomical locations place different parts of the AVP at risk. No patient suffered a deterioration of vision. In 21 (38.7%) patients there was an improvement in the visual field and in 7 (44%) associated diplopia improved. Vision could improve without corresponding tumour shrinkage. A standard measure of radiation toleration of the AVP could be the maximum dose within its volume, probably at least 10 Gy. Computerised perimetry should be available on the day of treatment and at follow-up. There is no need to have a distance between the tumour margin and the visual pathway. Sub-optimal dose-planning has been advantageous. Improvement in vision is not necessarily a consequence of tumour shrinkage.
British Journal of Neurosurgery 03/2010; 24(3):233-43. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Glomus jugulare tumours represent a great therapeutic challenge. Previous papers have documented good results from Gamma Knife surgery (GKS) with these tumours. However, the relationship between clinical improvement and tumour shrinkage has never been assessed.
There were 14 patients, 9 women and 5 men. The mean follow-up period was 28 months (range 6 to 60 months). All the tumours except one were Fisch type D and the mean volume was 14.2 cm(3) (range 3.7-28.4 cm(3)). The mean prescription dose was 13.6 Gy (range 12-16 Gy).
None of the tumours have continued to grow. Eight are smaller and 6 unchanged in volume. Two patients with bruit have had no improvement in their symptoms. Among the other 12 patients, 5 have had symptomatic improvement of dysphagia, 4 in dysphonia, 3 in facial numbness, 3 in ataxia and 2 in tinnitus. Individual patients have experienced improvement in vomiting, vertigo, tongue fasciculation, hearing, headache, facial palsy and accessory paresis. One patient developed a transient facial palsy. Symptomatic improvement commonly began before any reduction in tumour volume could be detected. The mean time to clinical improvement was 6.5 months whereas the mean time to shrinkage was 13.5 months.
Gamma Knife treatment of glomus jugulare tumours is associated with a high incidence of clinical improvement with few complications, using the dosimetry recorded here. Clinical improvement would seem to be a more sensitive early indicator of therapeutic success than radiological volume reduction. Further follow-up will be needed.
Acta Neurochirurgica 04/2009; 151(5):423-6. · 1.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The authors studied the relationship between dose planning parameters and complications in the treatment of cerebral arteriovenous malformations (AVMs).
There were 41 continuous unselected patients. The mean follow-up period was 19 months; the mean age was 28 years; the male/female ratio was 2.2:1.0; the median prescription dose was 25 Gy (range 14-25 Gy); the median prescription isodose was 50%. The median lesion volume was 4.4 cm3. The median lesion coverage was 93%; and the mean conformity index was 1.22. The authors found no relationship between lesion volume or integral dose and the development of the clinical effects based on the adverse radiation effects (AREs); however, there was a significant relationship between both target volume and integral dose with the development of AREs as well as the severity of the AREs.
The integral dose could be used as a guideline for the prescription dose. Arguments are made for maximizing the prescription dose for the long-term safety of the patient.
Journal of Neurosurgery 02/2005; 102 Suppl:4-7. · 2.96 Impact Factor
