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PubMed Journal Database | Progress in neurological surgery RSS

01:59 EDT 20th June 2019 | BioPortfolio

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Showing PubMed Articles 1–25 of 77 from Progress in neurological surgery

Leksell Radiosurgery for Vestibular Schwannomas.

Vestibular schwannomas (VS) are benign tumors predominantly originating from the balance portion of cranial nerve VIII. These tumors have an incidence of 1-2 per 100,000 people. The growth of these tumors is approximately 1-2 mm per year. A VS can result in significant neurologic dysfunction from continued growth or the management paradigms designed to control this predominantly benign tumor. The impacts on the critical space within the auditory canal and cerebellopontine angle can lead to hearing deficits,...

Targeted Therapies for Brain Metastases.

The most common primary cancers that metastasize to the brain are lung cancer, breast cancer, and melanoma. The established management approaches for brain metastasis include stereotactic radiosurgery, fractionated radiation therapy, and surgical resection. In the past the role of medical therapies in brain metastases was limited. In the last decade, our understanding of molecular drivers of brain metastases and CNS penetration of drugs across the blood-brain barrier has improved. The molecular targeted tyr...

Frame versus Frameless Leksell Stereotactic Radiosurgery.

For more than 65 years localization of brain targets suitable for stereotactic radiosurgery has been performed after application of an intracranial guiding device to the cranial vault. After imaging and dose planning the same frame is used to secure the target at the focus of the intersection of the ionizing radiation beams that create the radiobiological effect. Non-invasive immobilization systems first proposed for linear accelerator or proton radiation technologies have now been developed for the Leksell...

The Role of Leksell Radiosurgery in the Management of Craniopharyngiomas.

Management of craniopharyngiomas remains challenging due to the tumor's often intimate relationship with the optic apparatus, the hypothalamus, and the pituitary gland. Often multimodal management is needed to achieve the best treatment outcome: tumor control coupled with endocrine, visual, and neurocognitive preservation. Many surgeons favor initial subtotal resection followed by adjunctive therapy to improve quality of life in a tumor with potentially long-term survival even if coupled with a need for per...

Radiosurgery for Behavioral Disorders.

Psychiatric illnesses create great suffering for patients and the medical solution is sometimes limited. The experience observed after treating patients with obsessive-compulsive disorder (OCD), depression, and anorexia nervosa by Gamma Knife radiosurgery (GKRS) is presented. Ten patients with medically refractory OCD, 3 patients with depression resistant to medical treatment and electroconvulsive therapy, and 5 patients with refractory anorexia nervosa have been treated. Bilateral anterior capsulotomy has ...

Leksell Radiosurgery for Ependymomas and Oligodendrogliomas.

Stereotactic radiosurgery (SRS) has become a standard management option for less common glial tumors. When imaging defines a recurrent or progressive ependymoma after initial resection in a child who has completed adjuvant fractionated radiation therapy, SRS may be used as a boost or salvage strategy. For patients with oligodendrogliomas diagnosed by biopsy or after cytoreductive surgery, SRS may be used as a primary option in smaller volume tumors, or as an adjuvant option for tumors that have progressed a...

Leksell Radiosurgery for Orbital, Uveal, and Choroidal Tumors.

Stereotactic radiosurgery using the Leksell Gamma Knife has proven to be a valuable alternative to orbital enucleation or fractionated radiation therapy for primary tumors of the orbit, metastatic tumors to the choroid, and primary uveal melanomas. With this approach in a single outpatient setting, the eye is immobilized by a local block after which high-definition MRI or CT is performed to define the target. After rapid dose planning, radiation delivery is completed before the local block dissipates. The t...

Pituitary Tumor Radiosurgery.

Pituitary adenomas represent a common intracranial pathology, usually resulting in the systemic secretion of hormones and compression of local endocrine and optic structures, causing a wide variety of clinical sequelae. While they are typically treated with upfront endocrine and/or surgical decompressive therapy, in patients with residual, recurrent, or refractory disease, decades of data support management with stereotactic radiosurgery. This modality offers favorable local tumor control, endocrine remissi...

The First North American Clinical Gamma Knife Center.

A decision to develop a stereotactic radiosurgery center and install the first 201 cobalt-60 Gamma Knife in Pittsburgh was made in 1981 after gathering regional and leadership support. This was part of a 7-year quest that required overcoming barriers to a new technology unfamiliar to US regulatory authorities and insurance companies. The first patient was treated in August 1987. Since that time our center has installed each succeeding Gamma Knife device developed. During an initial 30-year experience we per...

Leksell Radiosurgery for Movement Disorders.

Tremor is the most prevalent movement disorder in adults. Patients who are refractory to medical management can explore surgical intervention. Deep-brain stimulation (DBS) and radiofrequency thalamotomy (RFT) are surgical procedures for intractable tremor that target the ventralis intermedius (VIM) nucleus to relieve contralateral tremor. For patients who are not candidates for surgical procedures, stereotactic radiosurgery (SRS) is a minimally invasive management option for tremor relief. SRS has been used...

Re-Evaluating Clinical Outcomes for AVM Stereotactic Radiosurgery.

Traditional outcome measures after stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations (AVMs) have focused predominantly on angiographic obliteration and general neurologic complications. Several grading scales attempting to predict the outcome for specific patients have previously been proposed and validated, and are outlined here. These have largely been based on both AVM and patient characteristics and attempt to predict obliteration. However, the most practical and clinically orient...

Radiosurgery for Chordoma and Chondrosarcoma.

Chordomas and chondrosarcomas are rare locally aggressive skull base tumors with high progression or recurrence rates. Ultimately, they have high mortality rates unless they respond to multimodality management options that include one or more surgical resections, fractionated radiation therapy, and stereotactic radiosurgery (SRS). SRS has become a standard management option for recurrent or residual chordomas and chondrosarcomas after failed surgical resection and fractionated radiation therapy. This report...

Adverse Radiation Effects.

Here we discuss the low risk of radiation-related complications after Leksell radiosurgery, as well as its diagnosis and management. Using multimodality imaging in the context of clinical suspicion of radiation injury clinicians can now start management with agents designed to reduce the progression of radiation vasculopathy. In more severe cases both medical and surgical management options can be offered.

Non-Vestibular Schwannoma Radiosurgery.

There is a growing body of studies regarding the effects of Gamma Knife radiosurgery on vestibular schwannomas. However, due to their rare presence and variability, our experience with the management of non-vestibular schwannomas is relatively limited. Management strategies include radiological monitoring, microsurgical resection, microsurgery combined with radiosurgery, or upfront radiosurgery. The lack of large series and heterogeneous data makes it difficult to suggest a definitive treatment strategy and...

Guidelines for Multiple Brain Metastases Radiosurgery.

Stereotactic radiosurgery (SRS) is an effective treatment for patients with multiple brain metastases. Three decades of increasingly powerful scientific studies have shown that SRS improves outcomes and reduces toxicity when it replaces whole-brain radiation therapy (WBRT). Expert opinion surveys of clinicians have reported that the total intracranial tumor volume rather than the number of brain metastases is related to outcomes. As a result, an increasing number of treating and referring physicians have re...

Stereotactic Radiosurgery for Patients with 10 or More Brain Metastases.

The JLGK0901 study showed the non-inferiority of stereotactic radiosurgery (SRS) alone as the initial treatment for 5-10 as compared to 2-4 brain metastases (BM) in terms of overall survival and most secondary endpoints [Lancet Oncol 2014;15:387-395]. A trend for patients with 5-10 tumors to undergo SRS alone has since become apparent. The next step is to reappraise whether results of SRS treatment alone for tumor numbers ≥10 differ from those for 2-9 tumors. During the past 2 decades, several retrospecti...

Trigeminal Neuralgia and Other Facial Neuralgias.

Radiosurgery is an effective treatment approach for the management of type 1 trigeminal neuralgia (TN), comparable to other ablative techniques. Also, radiosurgery can effectively treat TN secondary to other causes, including multiple sclerosis, tumor-related TN, as well as other craniofacial neuralgias in select cases with minimal complications. An increasing number of patients favor radiosurgery over other more invasive approaches in order to avoid a general anesthetic, a prolonged hospital stay, and a hi...

Gamma Knife Radiosurgery of Arteriovenous Malformations: Long-Term Outcomes and Late Effects.

Gamma Knife radiosurgery (GKRS) of cerebral arteriovenous malformations (AVM) is an accepted treatment option that has been performed for more than 40 years. The goal of AVM GKRS is nidus obliteration to eliminate the risk of intracranial hemorrhage while minimizing the risk of short- and long-term adverse radiation effects (ARE). Nidus obliteration typically occurs between 1 and 5 years after GKRS. The most important factor associated with nidus obliteration is the prescribed radiation dose. The chance of ...

Gamma Knife Radiosurgery for Meningioma.

Since its first reported use in 1976 in Sweden, Gamma Knife (GK) radiosurgery has become an accepted treatment option for intracranial meningioma, either upfront, in combination with planned subtotal resection, or as adjuvant/salvage treatment. Initially, GK was used in patients unfit for a major surgical procedure or for high-risk meningiomas adjacent to critical neurovascular structures. However, with the availability of larger and increasingly long-term follow-up studies, the proven durability of GK in t...

Leksell Radiosurgery for the 3 H Tumors: Hemangiomas, Hemangioblastomas, and Hemangiopericytomas.

Leksell stereotactic radiosurgery has proven to be effective for less common tumors encountered in the brain, including hemangiomas of the orbit or cavernous sinus, recurrent hemangiopericytomas, and both sporadic hemangioblastomas as well as those encountered in the context of von Hippel-Lindau (VHL) disease. While all three tumors are responsive to single-session radiosurgery, hemangiomas and hemangiopericytomas are the most likely to demonstrate tumor regression. Hemangiopericytomas that recur after init...

Radiosurgery for Glomus Tumors.

Glomus tumors of the head and neck typically compress adjacent blood vessels and cranial nerves and result in varied clinical presentations. Moreover, they are seldom encountered, even at large medical centers, and specialists in neurosurgery, otolaryngology, and radiation oncology have yet to reach a generalized consensus regarding the optimal management approach. In an effort to summarize the available data and better elucidate optimal treatment and management strategies for glomus tumors, we conducted a ...

Stereotactic Radiosurgery for Low-Grade Gliomas.

Low-grade gliomas represent a heterogeneous group of tumors. The goals of treatment include prolonged survival and reduced morbidity. Treatment strategies vary depending upon tumor histology, anatomic location, age, and the general medical condition of the patient. Safe surgical resection remains the first choice for the treatment of resectable tumors. In cases of unresectable lesions, adjuvant radiotherapy and chemotherapy are considered. Several reports in recent years have documented the safety and effec...

Leksell Stereotactic Radiosurgery for Cavernous Malformations.

Cavernous malformations (CM) represent a distinct subgroup of brain vascular malformations that are characterized by small sinusoidal vascular channels with hyaline degeneration and old blood pigments. Because of the increasing availability of magnetic resonance imaging (MRI) they are detected much more frequently in the present era. CM may be solitary or found in the context of a familial variant that results in an increasing number of CM developing as the patient ages. Because of the variable risk of suba...

Salvage Leksell Stereotactic Radiosurgery for Malignant Gliomas.

The outcome of patients with malignant gliomas has not substantially improved, even with advances in imaging, neurosurgery, molecular subtyping, and radiation, and newer oncologic options. Maximal safe resection when feasible remains the initial treatment of choice for most malignant gliomas. These tumors often recur and require additional therapy to control the tumor growth. Leksell stereotactic radiosurgery (SRS) is offered as salvage therapy in patients with recurrent or residual malignant gliomas. SRS i...

Radiosurgery for Central Neurocytoma.

The classification of central neurocytoma (CN) by the WHO was upgraded to grade 2 in 1993 as it was recognized that at least some of these tumors can exhibit more aggressive behavior. Currently, as of 2016, CN is classified as WHO grade 2. Indeed, some atypical variants have been reported and residual postsurgical tumor is believed to have the potential for malignant transformation. Although gross total resection is usually curative for CN (5-year survival rate 99%), it is achieved in nearly 30-50% of cases...


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