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El Damaty A, Issa M, Paggetti F, Seitz A, Unterberg A. Intracranial arachnoid cysts: What is the appropriate surgical technique? A retrospective comparative study with 61 pediatric patients. World Neurosurg X 2023; 19:100195. [PMID: 37151993 PMCID: PMC10160597 DOI: 10.1016/j.wnsx.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Objective Symptomatic intracranial arachnoid cysts (ACs) should be treated either through microsurgical (MS) or endoscopic surgical (ES) fenestration. Implantation of cysto-peritoneal shunt (CPS) system is another treatment option with decreasing indication. In our study, we compared the complication and revision rates between the three operative techniques in pediatric patients. Methods We included patients below 18 years with symptomatic intracranial ACs operated between 2004 and 2021. Initial symptoms, location, complication rate, clinical and radiological improvement, postoperative events and revision rate were compared retrospectively. Results Sixty-one patients; 33 (54.1%) MS operated (mean age 7.6 years), 18 (29.5%) ES operated (mean age 6.2 years) and 10 (16.4%) with CPS (mean age 3.0 years) were collected. The most common initial symptom was headache in 45.9%. 20 (32.8%) postoperative events were documented. The highest revision rate (60%) was seen in the CPS group compared to 33.3% in MS group and 16.7% in ES group. 31 patients harbored perisylvian ACs, 89% remained event-free after ES, 71% after MS and 20% after CPS. Clinical improvement immediately after surgery was observed in 58 patients (96.9% in MS, 88.9% in ES and 100% in CPS). A radiological volume reduction could be proven postoperative in 51 patients (78.8% MS, 88.9% ES and 90% CPS). Conclusion Endoscopic fenestration of AC is a safe and efficient technique which is being widely used nowadays with the highest event free survival compared to microsurgical fenestration especially in perisylvian arachnoid cysts. CPS shows on long terms the highest revision rate but carries the least surgical risks.
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Affiliation(s)
- Ahmed El Damaty
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Corresponding author. Head of Pediatric Neurosurgery Division Heidelberg University Hospital Im Neuenheimer Feld, 400 69120, Heidelberg, Germany.
| | - Mohammed Issa
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Filippo Paggetti
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Angelika Seitz
- Dept. of Pediatric Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Unterberg
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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2
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Ewald VAM, Purnell JR, Bruss JE, Barsotti EJ, Aldine AS, Mahachi KG, Wemmie JA, Magnotta VA, Boes AD, Parker KL, Fiedorowicz JG. Posterior Fossa Sub-Arachnoid Cysts Observed in Patients with Bipolar Disorder: a Retrospective Cohort Study. CEREBELLUM (LONDON, ENGLAND) 2023; 22:370-378. [PMID: 35568792 PMCID: PMC9659668 DOI: 10.1007/s12311-022-01408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Posterior fossa arachnoid cysts (PFACs) are rare congenital abnormalities observed in 0.3 to 1.7% of the population and are traditionally thought to be benign. While conducting a neuroimaging study investigating cerebellar structure in bipolar disorder, we observed a higher incidence of PFACs in bipolar patients (5 of 75; 6.6%) compared to the neuronormative control group (1 of 54; 1.8%). In this report, we detail the cases of the five patients with bipolar disorder who presented with PFACs. Additionally, we compare neuropsychiatric measures and cerebellar volumes of these patients to neuronormative controls and bipolar controls (those with bipolar disorder without neuroanatomical abnormalities). Our findings suggest that patients with bipolar disorder who also present with PFACs may have a milder symptom constellation relative to patients with bipolar disorder and no neuroanatomical abnormalities. Furthermore, our observations align with prior literature suggesting an association between PFACs and psychiatric symptoms that warrants further study. While acknowledging sample size limitations, our primary aim in the present work is to highlight a connection between PFACs and BD-associated symptoms and encourage further study of cerebellar abnormalities in psychiatry.
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Affiliation(s)
- Victόria A Müller Ewald
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
| | - Jessica R Purnell
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
| | - Joel E Bruss
- Department of Neurology, The University of Iowa, Iowa City, IA, USA
| | - Ercole J Barsotti
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - Amro S Aldine
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kurayi G Mahachi
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - John A Wemmie
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
| | - Vincent A Magnotta
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - Aaron D Boes
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA
- Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
| | - Krystal L Parker
- Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA.
| | - Jess G Fiedorowicz
- Brain and Mind Institute, University of Ottawa, The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Qureshi HM, Mekbib KY, Allington G, Elsamadicy AA, Duy PQ, Kundishora AJ, Jin SC, Kahle KT. Familial and syndromic forms of arachnoid cyst implicate genetic factors in disease pathogenesis. Cereb Cortex 2023; 33:3012-3025. [PMID: 35851401 PMCID: PMC10388392 DOI: 10.1093/cercor/bhac257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/13/2022] Open
Abstract
Arachnoid cysts (ACs) are the most common space-occupying lesions in the human brain and present significant challenges for clinical management. While most cases of ACs are sporadic, nearly 40 familial forms have been reported. Moreover, ACs are seen with increased frequency in multiple Mendelian syndromes, including Chudley-McCullough syndrome, acrocallosal syndrome, and autosomal recessive primary ciliary dyskinesia. These findings suggest that genetic factors contribute to AC pathogenesis. However, traditional linkage and segregation approaches have been limited in their ability to identify causative genes for ACs because the disease is genetically heterogeneous and often presents asymptomatically and sporadically. Here, we comprehensively review theories of AC pathogenesis, the genetic evidence for AC formation, and discuss a different approach to AC genomics that could help elucidate this perplexing lesion and shed light on the associated neurodevelopmental phenotypes seen in a significant subset of these patients.
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Affiliation(s)
- Hanya M Qureshi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Kedous Y Mekbib
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Garrett Allington
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Phan Q Duy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
- Department of Neurology, Harvard Medical School, Boston, MA 02115, United States
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, United States
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4
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Starowicz-Filip A, Bętkowska-Korpała B, Yablonska T, Kwiatkowski S, Milczarek O, Klasa Ł, Chrobak AA. Involvement of the cerebellum in the regulation of executive functions in children—Preliminary analysis based on a neuropsychological study of children after cerebellar tumour surgery. Front Psychol 2022; 13:961577. [PMID: 36275206 PMCID: PMC9583864 DOI: 10.3389/fpsyg.2022.961577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
Aim Preliminary assessment of executive functions in children with cerebellar lesions, description of their emotional-social functioning and selection of sensitive neuropsychological tools to detect the cerebellar cognitive affective syndrome (CCAS). Materials and methods The study group consisted of 10 children after cerebellar tumour surgery. The control group consisted of 10 healthy children, matched for age and sex: The IDS-2 executive functions battery, the Conners 3 ADHD questionnaire, the Autism Spectrum Rating Scales (ASRS) and the International Cooperative Ataxia Rating Scale (ICARS) were used. Results Statistical analysis showed statistically significant differences between the experimental and control groups in terms of two dimensions of executive functioning. Children from experimental group was characterised by worse planning and divided attention than healthy controls. Moreover children with cerebellar lesions were characterised by significantly higher levels of some behaviours similar to that observed in autism spectrum disorders, namely difficulties in social relationships, self-regulation of emotions, attention, and greater behavioural rigidity. Test power analysis and estimation of the effect size by the Cohen’s d coefficient indicated that with a slight increase in the size of the experimental group, the probability of detecting statistically significant difference in the executive functions total measure score as well as in several ASRS subscales increased, but not in Conners 3 subscales. Conclusions Cerebellar damage may pose a risk for dysexecutive syndrome and social-emotional problems in children. The IDS-2 executive functions battery and the ASRS test are sufficiently sensitive tools to assess elements of the CCAS in children.
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Affiliation(s)
- Anna Starowicz-Filip
- Department of Medical Psychology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- *Correspondence: Anna Starowicz-Filip,
| | - Barbara Bętkowska-Korpała
- Department of Medical Psychology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tetiana Yablonska
- Department of Developmental Psychology, Faculty of Psychology, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Stanisław Kwiatkowski
- Department of Pediatric Neurosurgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Olga Milczarek
- Department of Pediatric Neurosurgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Klasa
- Department of Pediatric Neurosurgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Adrian Andrzej Chrobak
- Department of Adult Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Cuny ML, Piolino P, Paternoster G, Piana H, Blauwblomme T, Beccaria K, Bourgeois M, Stricker S, Prodhomme J, Trousson C, Navarro B, Esnault E, Cozzo M, Abram M, James S, Boddaert N, Sainte-Rose C, Vaivre-Douret L, Puget S. Temporosylvian arachnoid cysts in children. Part 2: Postoperative neuropsychological and clinical improvement. J Neurosurg Pediatr 2022; 30:150-159. [PMID: 35594879 DOI: 10.3171/2021.11.peds21207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to study clinical, imaging, and neuropsychological changes in children who underwent surgery for a temporal arachnoid cyst (TAC). METHODS Thirty-four children were prospectively assessed similarly at diagnosis and postoperatively (mean 14 months) with clinic visits, images, cognitive tests, and parental questionnaires on mood/behavior and executive functions. The scores were compared pre- and postoperatively for the entire cohort and individually. The scores of 25 children were also compared with a control group of 23 healthy age-matched children. Parents were administered an outcome questionnaire on average 4 years postoperatively. RESULTS The 34 children selected for surgery had signs of raised intracranial pressure (74%) and/or selective neuropsychological disorders presumably linked to cyst location (learning difficulties in 65%, cognitive difficulties in 56%, and mood/behavior difficulties in 47%). The majority of patients had a convex cyst (85%) and underwent microsurgical fenestration (85%). The TAC volume decreased ≥ 50% for 59% of children. On the Wechsler Intelligence Scale, the entire cohort significantly improved on Full Scale IQ and verbal and perceptual nonverbal indexes. Individually, nearly half of the children (47%) highly increased their scores (≥ 15 points) on at least one IQ index and 26% on at least two indexes. Language, working memory, episodic memory, and executive functions were also significantly improved. Improvements were more pronounced in patients with a preoperative heterogeneous profile with isolated lower scores and a left-sided cyst. Parental questionnaires showed reduction in anxiety, aggressiveness, social problems, and daily life executive disorders. Preschool-aged children improved significantly in language and verbal IQ, as did middle/high school-aged children in many domains. Individual analyses revealed improvement in 76% of cases. Cognitive scores were lower for patients preoperatively than for controls and were no longer significantly different postoperatively in verbal fluency, visual memory, and working memory. Four years later, 97% of parents described an improvement in their child, correlated with cognitive improvements. CONCLUSIONS Among children with a TAC, some have no clinical signs or neuropsychological difficulties, and others may show signs of raised intracranial pressure and/or specific neuropsychological disorders that impact daily life and require significant and long-lasting rehabilitation. In these cases, consideration may be given to surgical decompression. It is interesting to note that 76% of this surgically treated cohort improved regardless of the child's age, particularly in patients with selective disorders and an impact on daily life. However, a larger number of children will need to be investigated before the true benefit of such treatment can be known.
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Affiliation(s)
- Marie-Laure Cuny
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 2INSERM UMR 1018-CESP, Universités Paris-Saclay, UVSQ, Villejuif, France
- 5Laboratoire Mémoire, Cerveau et Cognition, Institut de Psychologie, Université de Paris; INSERM UMR S894, Paris, France; and
| | - Pascale Piolino
- 4Institut universitaire de France, Paris, France
- 5Laboratoire Mémoire, Cerveau et Cognition, Institut de Psychologie, Université de Paris; INSERM UMR S894, Paris, France; and
| | | | - Hélène Piana
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Thomas Blauwblomme
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
| | - Kévin Beccaria
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
| | - Marie Bourgeois
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Sarah Stricker
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Julie Prodhomme
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Clémence Trousson
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Béatrice Navarro
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Eglantine Esnault
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Mathilde Cozzo
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Maria Abram
- 5Laboratoire Mémoire, Cerveau et Cognition, Institut de Psychologie, Université de Paris; INSERM UMR S894, Paris, France; and
| | - Syril James
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
| | - Nathalie Boddaert
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
| | - Christian Sainte-Rose
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
- 6Service de Neurochirurgie, Centre Hospitalier Universitaire de Fort de France, Université des Antilles, Fort-de-France, Martinique
| | - Laurence Vaivre-Douret
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 2INSERM UMR 1018-CESP, Universités Paris-Saclay, UVSQ, Villejuif, France
- 3Faculté de Médecine, Université de Paris, France
- 4Institut universitaire de France, Paris, France
| | - Stephanie Puget
- 1Service de Neurochirurgie, Hôpital universitaire Necker, AP-HP, Paris, France
- 3Faculté de Médecine, Université de Paris, France
- 6Service de Neurochirurgie, Centre Hospitalier Universitaire de Fort de France, Université des Antilles, Fort-de-France, Martinique
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TURGUT M, YAY MÖ. Baş ağrısı ve anksiyete bozukluğu ile seyreden konveksite araknoid kisti tedavisinde burr hole trefinasyonu: olgu sunumu. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1086267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Škarić M, Aukst Margetić B, Bogović Dijaković A, Karlović D. COGNITIVE AND PSYCHOTIC SYMPTOMS IN A PATIENT WITH INFRATENTORIAL ARACHNOID CYST: CASE REPORT. Acta Clin Croat 2021; 60:304-308. [PMID: 34744282 PMCID: PMC8564833 DOI: 10.20471/acc.2021.60.02.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 08/20/2020] [Indexed: 11/24/2022] Open
Abstract
We present a case of a patient with treatment resistant hallucinatory experiences with incidental finding of an arachnoid cyst localized in the posterior infratentorial cranial fossa dorsally to the cerebellum. Psychological testing revealed significant deficit of cognitive functions to the level of mild intellectual disability in a person that had previously finished high school with good grades. A combination of clozapine and lamotrigine led to significant improvement in mood and reduction of hallucinations, but without improvement in cognitive functions. We also performed a literature review of previously published case reports or case series of co-occurring posterior fossa arachnoid cyst and schizophrenia or psychosis or psychiatric symptoms using PubMed search and discuss some controversies considering their treatment outcome.
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Affiliation(s)
| | - Branka Aukst Margetić
- 1Department of Psychiatry, Dr. Ivan Barbot Neuropsychiatric Hospital, Popovača, Croatia; 2Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Anamarija Bogović Dijaković
- 1Department of Psychiatry, Dr. Ivan Barbot Neuropsychiatric Hospital, Popovača, Croatia; 2Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Dalibor Karlović
- 1Department of Psychiatry, Dr. Ivan Barbot Neuropsychiatric Hospital, Popovača, Croatia; 2Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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8
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Kwiatkowska K, Milczarek O, Dębicka M, Baliga Z, Maryniak A, Kwiatkowski S. Epilepsy and cognitive deterioration as postoperative complications of the arachnoid cyst fenestration. Case report. Clin Neuropsychol 2020; 36:1599-1609. [PMID: 33103580 DOI: 10.1080/13854046.2020.1837959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE With the aim of contributing to the discussion on treatment of patients with arachnoid cysts (AC) and their neuropsychological functioning, we present the case of a patient who has undergone surgery of AC located in the left Sylvian fissure. Case description: The patient had no cognitive deficits and no seizures before the cyst's fenestration. After the procedure, however, occurrences of seizures have been observed. Along with the concomitant epileptic seizures, aphasia and serious memory problems also developed. The initial pharmacological treatment of the seizures brought about unsatisfactory results. The treatment was therefore modified a number of times and ultimately, seizures were brought under control to some extent. Despite the varied efforts at neuropsychological rehabilitation, cognitive impairment was still persistent up to a year after the surgery. Conclusions: 1) While referring patients with AC for surgery, one should always consider both the positive outcomes and the unintended and deleterious consequences. A cyst fenestration could in some cases lead to epilepsy and cause neuropsychological symptoms such as anomic aphasia and cognitive deterioration with memory function impairment. 2) Neurological patients, especially the ones qualified for surgery, should always undergo neuropsychological examination. The lack of data from presurgical neuropsychological examination may impact further treatment of neurosurgical patients.
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Affiliation(s)
- Karolina Kwiatkowska
- Jagiellonian University Medical College, Clinic of Children's Neurosurgery, Kraków, Poland
| | - Olga Milczarek
- Jagiellonian University Medical College, Clinic of Children's Neurosurgery, Kraków, Poland
| | - Magdalena Dębicka
- Clinic of Neurosurgery and Neurotraumatology, The University Hospital, Kraków, Poland
| | - Zuzanna Baliga
- Jagiellonian University Medical College, Clinic of Children's Neurosurgery, Kraków, Poland
| | | | - Stanisław Kwiatkowski
- Jagiellonian University Medical College, Clinic of Children's Neurosurgery, Kraków, Poland
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9
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Guell X, Anteraper SA, Ghosh SS, Gabrieli JDE, Schmahmann JD. Neurodevelopmental and Psychiatric Symptoms in Patients with a Cyst Compressing the Cerebellum: an Ongoing Enigma. THE CEREBELLUM 2020; 19:16-29. [PMID: 31321675 DOI: 10.1007/s12311-019-01050-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient diagnosed with developmental delay, intellectual disability, and autistic and obsessive-compulsive symptoms was found to have a posterior fossa arachnoid cyst (PFAC) compressing the cerebellum. The patient was referred to our Ataxia Unit for consideration of surgical drainage of the cyst to improve his clinical constellation. This scenario led to an in-depth analysis including a literature review, functional resting-state MRI analysis of our patient compared to a group of controls, and genetic testing. While it is reasonable to consider that there may be a causal relationship between PFAC and neurodevelopmental or psychiatric symptoms in some patients, there is also a nontrivial prevalence of PFAC in the asymptomatic population and a significant possibility that many PFAC are incidental findings in the context of primary cognitive or psychiatric symptoms. Our functional MRI analysis is the first to examine brain function, and to report cerebellar dysfunction, in a patient presenting with cognitive/psychiatric symptoms found to have a structural abnormality compressing the cerebellum. These neuroimaging findings are inherently limited due to their correlational nature but provide unprecedented evidence suggesting that cerebellar compression may be associated with cerebellar dysfunction. Exome gene sequencing revealed additional etiological possibilities, highlighting the complexity of this field of cerebellar clinical and scientific practice. Our findings and discussion may guide future investigations addressing an important knowledge gap-namely, is there a link between cerebellar compression (including arachnoid cysts and possibly other forms of cerebellar compression such as Chiari malformation), cerebellar dysfunction (including fMRI abnormalities reported here), and neuropsychiatric symptoms?
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Affiliation(s)
- Xavier Guell
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Cambridge, MA, USA. .,Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sheeba A Anteraper
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, Boston, MA, USA.,PEN Laboratory, Northeastern University, Boston, MA, USA
| | - Satrajit S Ghosh
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - John D E Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeremy D Schmahmann
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Ataxia Unit, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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10
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Dellatolas G, Câmara-Costa H. The role of cerebellum in the child neuropsychological functioning. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:265-304. [PMID: 32958180 DOI: 10.1016/b978-0-444-64150-2.00023-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This chapter proposes a review of neuropsychologic and behavior findings in pediatric pathologies of the cerebellum, including cerebellar malformations, pediatric ataxias, cerebellar tumors, and other acquired cerebellar injuries during childhood. The chapter also contains reviews of the cerebellar mutism/posterior fossa syndrome, reported cognitive associations with the development of the cerebellum in typically developing children and subjects born preterm, and the role of the cerebellum in neurodevelopmental disorders such as autism spectrum disorders and developmental dyslexia. Cognitive findings in pediatric cerebellar disorders are considered in the context of known cerebellocerebral connections, internal cellular organization of the cerebellum, the idea of a universal cerebellar transform and computational internal models, and the role of the cerebellum in specific cognitive and motor functions, such as working memory, language, timing, or control of eye movements. The chapter closes with a discussion of the strengths and weaknesses of the cognitive affective syndrome as it has been described in children and some conclusions and perspectives.
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Affiliation(s)
- Georges Dellatolas
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France.
| | - Hugo Câmara-Costa
- GRC 24, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France; Centre d'Etudes en Santé des Populations, INSERM U1018, Paris, France
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11
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Rechtman E, Puget S, Saitovitch A, Lemaitre H, Fillion L, Tacchella JM, Boisgontier J, Cuny ML, Boddaert N, Zilbovicius M. Posterior Fossa Arachnoid Cyst in a Pediatric Population is Associated with Social Perception and Rest Cerebral Blood Flow Abnormalities. THE CEREBELLUM 2019; 19:58-67. [PMID: 31732920 DOI: 10.1007/s12311-019-01082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posterior fossa arachnoid cysts (PFAC) may produce not only neurological symptoms but also other symptoms still poorly understood such as behavioral and learning deficits, awkwardness, and difficulties in social interaction. These subtle social impairments have not been formally described and their underlying brain mechanisms remain unknown. In the present case-control study, we aimed to empirically characterize social impairments in a pediatric population with PFAC using eye tracking. In addition, we investigated putative functional cortical abnormalities in these children using arterial spin labeling magnetic resonance imaging. Overall, 15 patients with PFAC (3f, age = 9.4 ± 4 years) and 43 typically developing volunteer children (16f, age = 9.3 ± 3.6 years) were enrolled in this study. Eye tracking was used to record gaze patterns during visualization of social interaction scenes. Viewing times to faces of characters and non-social background were analyzed. A voxel-wise whole-brain analysis was performed to investigate rest cerebral blood flow (CBF) abnormalities. Significantly reduced viewing time to faces was observed in patients compared with controls (p < 0.01). A ROC curve analysis revealed that 30% of PFAC patients presented viewing time to the face lower than the cutoff, while none of the controls did. The whole-brain analysis revealed a significant decrease in rest CBF in PFAC patients compared with controls bilaterally in the superior temporal gyrus and the temporoparietal junction (TPJ) (p < 0.05 FWE). These results suggest that early life PFAC may have an impact on functional activity of the temporal lobe, which could be associated with social perception deficits.
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Affiliation(s)
- Elza Rechtman
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France. .,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY, 10029, USA.
| | - Stephanie Puget
- Department of Pediatric Neurosurgery, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Pres Sorbonne Paris Cité, Paris, France
| | - Ana Saitovitch
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France
| | - Hervé Lemaitre
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France.,Faculté De Médecine, Université Paris-Sud, Orsay, France
| | - Ludovic Fillion
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France
| | - Jean-Marc Tacchella
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France
| | - Jennifer Boisgontier
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France
| | - Marie-Laure Cuny
- Department of Pediatric Neurosurgery, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Pres Sorbonne Paris Cité, Paris, France.,Laboratory of Memory and Cognition, Institute of Psychology, University Paris Descartes, Sorbonne Paris Cité, Paris, France.,CESP, University Paris-Sud, UVSQ, INSERM 1018, University Paris-Saclay, Paris, France
| | - Nathalie Boddaert
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France
| | - Monica Zilbovicius
- INSERM U1000, Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, University René Descartes, Institut Imagine and UMR 1163, Paris, France
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12
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Amelot A, Beccaria K, Blauwblomme T, Bourgeois M, Paternoster G, Cuny ML, Zerah M, Sainte-Rose C, Puget S. Microsurgical, endoscopic, and shunt management of pediatric temporosylvian arachnoid cysts: a comparative study. J Neurosurg Pediatr 2019; 23:749-757. [PMID: 30901748 DOI: 10.3171/2018.12.peds18484] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/18/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Arachnoid cysts (ACs) are most frequently located in the middle cranial fossa. Some patients are asymptomatic whereas others exhibit signs of increased intracranial pressure, seizures, or cognitive and behavioral symptoms. When ACs do require treatment, the optimal surgical technique remains controversial. This study was conducted to assess the most effective surgical treatment for these cysts. METHODS The authors retrospectively reviewed 240 temporal intracranial ACs managed over a 25-year period in their pediatric neurosurgical unit. Pre- and posttreatment results were clinically and radiologically assessed. RESULTS A majority of male patients (74.6%) with an overall median age of 6.9 years were included. The mean cyst size was 107 cm3; the Galassi classification showed 99 (41.3%) type I, 77 (32.1%) type II, and 64 (26.7%) type III cysts. Forty-four ACs (18.3%) were diagnosed after rupture. Surgical management was performed by microsurgery (28.3%), endoscopic cyst fenestration (14.6%), cystoperitoneal shunting (CPS; 16.2%), or subdural shunting (10%). Furthermore, 74 children (30.8%) did not undergo operations. After a mean follow-up of 4.1 years, the mean percentage decrease in cyst volume and the overall rate of clinical improvement did not significantly differ. The endoscopy group had earlier complications and a shorter event-free survival (EFS) time (EFS at 3 years = 67.7%, vs 71.5% and 90.5% for CPS and microsurgery, respectively; p < 0.007) and presented with more subdural hematomas compared to the microsurgery group (p < 0.005). The microsurgery group also showed a tendency for longer cystocisternostomy permeability than the endoscopy group. CONCLUSIONS Concerning the management of unruptured symptomatic temporal ACs, microsurgery appears to be the most effective treatment, with longer EFS and fewer complications compared to shunting or endoscopy.
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13
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Abstract
INTRODUCTION Arachnoid cysts are commonly considered congenital lesions, but this has not been proven. With the development of neuroimaging and DNA testing technology, more cases of familial arachnoid cysts have been reported. Herein, we review such cases. MATERIALS AND METHODS The PubMed, Embase, and Web of Science databases were searched for case reports of arachnoid cysts published through April 2018. Case reports were included only if two or more related patients were diagnosed with an arachnoid cyst by neuroimaging or intraoperatively. For each report, the following data were extracted: first author name, date of publication, number of families, number of patients, location of the arachnoid cysts, patient age, patient sex, and genetic mutations and associated disease. RESULTS Our searches identified 33 case reports involving 35 families and 115 patients. The locations of arachnoid cysts were similar in 25 of the 35 families. Spinal extradural arachnoid cysts were reported most often, followed by arachnoid cysts in the middle fossa and posterior fossa. A left-sided predominance was noticed for arachnoid cysts of the middle fossa. Mutation of the FOXC2 gene was reported most often, and arachnoid cysts may be associated with mutations on chromosome 16. CONCLUSIONS Although the origin of arachnoid cysts is believed to have a genetic component by some researchers, the genes associated with arachnoid cysts remain unknown. Unfortunately, the evidence remains insufficient.
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14
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Abstract
Intracranial arachnoidal cysts (AC) are relevant due to their space-demanding character. The pathophysiological sequelae are dependent on the size and location of the cyst and the patient's age. Direct pressure on surrounding tissue causes headaches (meninges) or rarely seizures (brain tissue). Cerebrospinal fluid (CSF) circulation disturbances resulting from brain mass displacement with occlusion of, for example, the foramen monroi or the aqueduct cause occlusive hydrocephalus, which can lead to an increase in intracranial pressure. Depending on age, the typical primary clinical symptoms or findings differ. In adults and older children, headaches are usually the first clinical symptom. Children, in whom skull growth is not yet complete, present with a head circumference above the 97th percentile. An abnormal one-sided deflection of the calotte in the region of the underlying AC may also be present. Cranial magnetic resonance imaging (cMRI), the first-line diagnostic tool of choice to demonstrate size and location of the cysts and the surrounding intracranial structures, is of utmost importance for therapy planning. In addition, further malformations can be detected. Moreover, cMRI may also be useful for a rough assessment of increased intracranial pressure (ICP). In most symptomatic AC, surgical treatment is unavoidable. The primarily goal is to establish communication between the CSF and the cysts' content in order to effect pressure equalization. If the CSF reabsorption capacity is insufficient, it may also be necessary to implant a CSF shunt. Asymptomatic arachnoidal cysts should be strictly followed clinically and by cMRI over time. The reasonable frequency for follow-up depends on the size and location of the cyst.
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Affiliation(s)
- R Eymann
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, Gebäude 90.5, 66421, Homburg/Saar, Deutschland.
| | - M Kiefer
- Universität des Saarlandes, Homburg/Saar, Deutschland
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15
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Eekers DBP, In 't Ven L, Deprez S, Jacobi L, Roelofs E, Hoeben A, Lambin P, de Ruysscher D, Troost EGC. The posterior cerebellum, a new organ at risk? Clin Transl Radiat Oncol 2017; 8:22-26. [PMID: 29594239 PMCID: PMC5862675 DOI: 10.1016/j.ctro.2017.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/03/2022] Open
Abstract
Eekers et al. have recently proposed a neuro-oncology atlas, which was co-authored by most centers associated in the European Proton Therapy Network (EPTN; Figure 1). With the introduction of new treatment techniques, such as integrated magnetic resonance imaging and linear accelerators (MR-linac) or particle therapy, the prediction of clinical efficacy of these more costly treatment modalities becomes more relevant. One of the side-effects of brain irradiation, being cognitive decline, is one of the toxicities most difficult to measure and predict. In order to validly compare different treatment modalities, 1) a uniform nomenclature of the organs at risk (OARs), 2) uniform atlas-based delineation [e.g., Eekers et al.], 3) long-term follow-up data with standardized cognitive tests, 4) a large patient population, and 5) (thus derived) validated normal tissue complication probability (NTCP) models are mandatory. Apart from the Gondi model, in which the role of the dose to 40% of both hippocampi (HC) proves to be significantly related to cognition in 18 patients, no similar models are available. So there is a strong need for more NTCP models, on HC, brain tissue and possible other relevant brain structures. In this review we summarize the available evidence on the role of the posterior cerebellum as a possible new organ at risk for cognition, which is deemed relevant for irradiation of brain and head and neck tumors.
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Affiliation(s)
- Daniëlle B P Eekers
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Proton Therapy Department South-East Netherlands (ZON-PTC), Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lieke In 't Ven
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Jacobi
- Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ann Hoeben
- Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philippe Lambin
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esther G C Troost
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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