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ABSTRACT: BACKGROUND: Infectious intracranial aneurysms (IIAs) are rare and potentially devastating. First-line management involves intravenous antibiotics, with surgical or endovascular management reserved for cases of failed medical treatment or aneurysmal rupture. Endovascular therapy has become the primary approach for treating these small, distally located aneurysms. Liquid embolic agents are well suited for use because of their ability to fill the aneurysm and parent vessel. We present our experience in treating these aneurysms via Onyx embolization and review the literature. METHODS: We retrospectively reviewed the endovascular treatment of IIAs at our institution from 2010 to 2012. Eight patients with 16 IIAs ranging in size from 1 to 16 mm underwent treatment. Seven of the patients initially presented after aneurysmal rupture. Onyx was pushed until the aneurysm and parent artery were filled. Confirmation of aneurysmal occlusion was made by repeat cerebral angiography. RESULTS: One symptomatic stroke occurred after embolization. Fourteen of the 16 aneurysms have been evaluated with follow-up angiography and remain occluded. CONCLUSIONS: Treatment of IIAs using an endovascular approach with Onyx is safe and effective.
Journal of neurointerventional surgery 05/2013; · 0.92 Impact Factor
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Journal of neuroimaging: official journal of the American Society of Neuroimaging 04/2013; · 1.72 Impact Factor
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ABSTRACT: To better establish the role of stereotactic radiosurgery (SRS) in treating patients with 10 or more intracranial metastases, the authors assessed clinical outcomes and identified prognostic factors associated with survival and tumor control in patients who underwent radiosurgery using the Leksell Gamma Knife Perfexion (LGK PFX) unit.
The authors retrospectively reviewed data in all patients who had undergone LGK PFX surgery to treat 10 or more brain metastases in a single session at the University of Pittsburgh. Posttreatment imaging studies were used to assess tumor response, and patient records were reviewed for clinical follow-up data. All data were collected by a neurosurgeon who had not participated in patient care.
Sixty-one patients with 10 or more brain metastases underwent SRS for the treatment of 806 tumors (mean 13.2 lesions). Seven patients (11.5%) had no previous therapy. Stereotactic radiosurgery was the sole prior treatment modality in 8 patients (13.1%), 22 (36.1%) underwent whole-brain radiation therapy (WBRT) only, and 16 (26.2%) had prior SRS and WBRT. The total treated tumor volume ranged from 0.14 to 40.21 cm(3), and the median radiation dose to the tumor margin was 16 Gy. The median survival following SRS for 10 or more brain metastases was 4 months, with improved survival in patients with fewer than 14 brain metastases, a nonmelanomatous primary tumor, controlled systemic disease, a better Karnofsky Performance Scale score, and a lower recursive partitioning analysis (RPA) class. Prior cerebral treatment did not influence survival. The median survival for a patient with fewer than 14 brain metastases, a nonmelanomatous primary tumor, and controlled systemic disease was 21.0 months. Sustained local tumor control was achieved in 81% of patients. Prior WBRT predicted the development of new adverse radiation effects.
Stereotactic radiosurgery safely and effectively treats intracranial disease with a high rate of local control in patients with 10 or more brain metastases. In patients with fewer metastases, a nonmelanomatous primary lesion, controlled systemic disease, and a low RPA class, SRS may be most valuable. In selected patients, it can be considered as first-line treatment.
Journal of Neurosurgery 05/2012; 117(2):237-45. · 2.96 Impact Factor
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ABSTRACT: Since Lars Leksell conceived of the Gamma Knife in the mid-20th century, it has become a fundamental strategy for managing intracranial tumors. The Gamma Knife harnesses around 200 focused beams of ionizing radiation that are directed stereotactically onto an intracranial target, destroying or inactivating it, all while sparing surrounding tissues. Today, a patient can have numerous intracranial tumors treated by radiosurgery in a minimally invasive fashion, during a single outpatient encounter, and return to usual activities the next day. Gamma Knife radiosurgery has found applications for nearly all intracranial tumors, either as a primary strategy or adjunctive therapy. In no area has Gamma Knife radiosurgery had a larger impact than in the treatment of brain metastases. In this article, we review the evolution of Gamma Knife radiosurgery, discuss current indications for the treatment of intracranial tumors and highlight how the future treatment of metastatic brain cancer may change.
Expert Review of Neurotherapeutics 04/2012; 12(4):437-45.
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ABSTRACT: Brain metastases are the most common intracranial tumors encountered by physicians. Historically, the mainstays of therapy were limited to surgery and whole brain radiation. Surgery is typically reserved for safely accessible and symptomatic tumors in patients well enough to tolerate a procedure. Whole-brain radiation therapy has proven to have limited efficacy and concerns have arisen regarding its toxicity. Advances in the treatment of systemic cancers have yielded improved long-term survival and quality of life for patients. To parallel these efforts in systemic treatment, continual improvement of the treatment of brain metastases is a must. The last two decades have seen a paradigm shift in the thinking about metastatic brain tumor treatment as a result of the advent of stereotactic radiosurgery. Radiosurgery has proven to be an efficacious, minimally invasive, and highly selective treatment for metastatic brain tumors. In this review, we discuss the evolution of metastatic brain tumor management, the appropriately diminished role for reflexive whole brain radiation, and the growing importance of stereotactic radiosurgery as an upfront treatment modality in conjunction with surgery and subsequent salvage radiosurgery.
Progress in neurological surgery 01/2012; 25:287-308.
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ABSTRACT: The authors performed a retrospective review of prospectively collected data to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) for the treatment of patients harboring symptomatic solitary cavernous malformations (CMs) of the brainstem that bleed repeatedly and are high risk for resection.
Between 1988 and 2005, 68 patients (34 males and 34 females) with solitary, symptomatic CMs of the brainstem underwent Gamma Knife surgery. The mean patient age was 41.2 years, and all patients had suffered at least 2 symptomatic hemorrhages (range 2-12 events) before radiosurgery. Prior to SRS, 15 patients (22.1%) had undergone attempted resection. The mean volume of the malformation treated was 1.19 ml, and the mean prescribed marginal radiation dose was 16 Gy.
The mean follow-up period was 5.2 years (range 0.6-12.4 years). The pre-SRS annual hemorrhage rate was 32.38%, or 125 hemorrhages, excluding the first hemorrhage, over a total of 386 patient-years. Following SRS, 11 hemorrhages were observed within the first 2 years of follow-up (8.22% annual hemorrhage rate) and 3 hemorrhages were observed in the period after the first 2 years of follow-up (1.37% annual hemorrhage rate). A significant reduction (p < 0.0001) in the risk of brainstem CM hemorrhages was observed following radiosurgical treatment, as well as in latency period of 2 years after SRS (p < 0.0447). Eight patients (11.8%) experienced new neurological deficits as a result of adverse radiation effects following SRS.
The results of this study support a role for the use of SRS for symptomatic CMs of the brainstem, as it is relatively safe and appears to reduce rebleeding rates in this high-surgical-risk location.
Neurosurgical FOCUS 09/2010; 29(3):E11. · 2.87 Impact Factor
