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Niedermeyer S, Terpolilli NA, Nerlinger P, Weller J, Schmutzer-Sondergeld M, Quach S, Thon N. Efficacy and safety of cysto-ventricular catheter implantation for space-occupying cysts arising from glioma and brain metastasis: a retrospective study. Acta Neurochir (Wien) 2024; 166:36. [PMID: 38277007 PMCID: PMC10817835 DOI: 10.1007/s00701-024-05931-4] [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: 10/03/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Cysto-ventricular catheters (CVC) have emerged as promising treatment option for cystic craniopharyngioma and arachnoid cysts, but their effectiveness in treating cysts originating from glioma or brain metastasis (BM) remains limited. This study aimed to analyze the efficacy of CVC in patients with glioma and BM as well as procedure-associated morbidity. METHODS This single-center retrospective study included all patients treated with CVC placement for acquired space-occupying cysts deriving from previously treated glioma or BMs between 1/2010 and 12/2021. RESULTS A total of 57 patients with a median age of 47 years (IQR 38-63) were identified. Focal neurological deficits were the predominant symptoms in 60% of patients (n = 34), followed by cephalgia in 14% (n = 8), and epileptic seizures in 21.1% (n = 12). Accurate CVC placement was achieved in all but one case requiring revision surgery due to malposition. Three months after CVC implantation, 70% of patients showed symptomatic improvement. Multivariate logistic regression analysis identified the development of space-occupying cysts later in the course of the disease (OR 1.014; p = 0.04) and a higher reduction of cyst-volume postoperatively (OR 1.055; p = 0.05) were significant predictors of postoperative symptomatic improvement following CVC placement. Local cyst recurrence was observed in three cases during follow-up MRI after an average time of 5 months (range 3-9 months). Further complications included secondary malresorptive hydrocephalus in three cases and meningeosis neoplastica in one patient. CONCLUSIONS Stereotactic implantation of CVC is an efficient treatment option for patients suffering from symptomatic space-occupying cysts from BMs or glioma, independently from their CNS WHO grade. However, a vigilant approach is crucial regarding potential complications and treatment failures.
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Affiliation(s)
- Sebastian Niedermeyer
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Nicole A Terpolilli
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Pia Nerlinger
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Schmutzer-Sondergeld
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Long-Term Survival after Linac-Based Stereotactic Radiosurgery and Radiotherapy with a Micro-Multileaf Collimator for Brain Metastasis. Curr Oncol 2022; 29:6068-6076. [PMID: 36135046 PMCID: PMC9497847 DOI: 10.3390/curroncol29090477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background: this study aimed to evaluate the prognostic factors associated with long-term survival after linear accelerator (linac)-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for brain metastasis (BM). Methods: This single-center retrospective study included 226 consecutive patients with BM who were treated with linac-based SRS or fSRT with a micro-multileaf collimator between January 2011 and December 2018. Long-term survival (LTS) was defined as survival for more than 2 years after SRS/fSRT. Results: The tumors originated from the lung (n = 189, 83.6%), breast (n = 11, 4.9%), colon (n = 9, 4.0%), stomach (n = 4, 1.8%), kidney (n = 3, 1.3%), esophagus (n = 3, 1.3%), and other regions (n = 7, 3.1%). The median pretreatment Karnofsky performance scale (KPS) score was 90 (range: 40–100). The median follow-up time was 13 (range: 0–120) months. Out of the 226 patients, 72 (31.8%) were categorized in the LTS group. The median survival time was 43 months and 13 months in the LTS group and in the entire cohort, respectively. The 3-year, 4-year, and 5-year survival rate in the LTS group was 59.1%, 49.6%, and 40.7%, respectively. Multivariate regression logistic analysis showed that female sex, a pre-treatment KPS score ≥ 80, and the absence of extracranial metastasis were associated with long-term survival. Conclusions: female sex, a favorable pre-treatment KPS score, and the absence of extracranial metastasis were associated with long-term survival in the current cohort of patients with BM.
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Meißner AK, Dreher L, Jünger ST, Visser-Vandewalle V, Ruge MI, Rueß D. Frame-based stereotactic implantation of cystoventricular shunts for treating acquired intracerebral cysts. J Neurosurg 2022; 137:227-234. [PMID: 34767526 DOI: 10.3171/2021.7.jns211180] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The treatment of symptomatic, progressive or recurrent acquired intracerebral cysts is challenging, especially when they are localized in eloquent structures. In addition to resection, endoscopic fenestration, or stereotactic puncture, the implantation of a cystoventricular shunt by stereotactic guidance (SCVS) has been reported as a minimally invasive procedure; however, only scarce data are available regarding its feasibility and efficacy. Here, the authors evaluated the feasibility and efficacy of frame-based SCVS in patients with acquired intracranial cysts. METHODS In this single-center retrospective analysis, the authors included all patients with acquired intracerebral cysts treated by SCVS following a standardized prospective protocol between 2012 and 2020. They analyzed clinical symptoms, complications, and radiological outcome with regard to cyst volume reduction by 3D volumetry. RESULTS Thirty-four patients (17 females and 17 males; median age 44 years, range 5-77 years) were identified. The median initial cyst volume was 11.5 cm3 (range 1.6-71.6 cm3), and the mean follow-up was 20 months (range 1-82 months). At the last follow-up, 27 of 34 patients (79%) showed a cyst volume reduction of more than 50%. Initial symptoms improved or resolved in 74% (n = 25) and remained stable in 24% (n = 8). No permanent clinical deterioration after treatment was observed. The total complication rate was 5.9%, comprising transient neurological deterioration (n = 1) and ventriculitis (n = 1). There were no deaths. The overall recurrence rate was 11.8%. CONCLUSIONS In this study, SCVS proved to be a safe, minimally invasive, and effective treatment with reliable long-term volume reduction, resulting in clinical improvement and a minor complication rate.
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Affiliation(s)
- Anna-Katharina Meißner
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Lena Dreher
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Stephanie Theresa Jünger
- 1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - Veerle Visser-Vandewalle
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
| | - Maximilian I Ruge
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
- 3Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany
| | - Daniel Rueß
- 2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and
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LINAC stereotactic radiosurgery for brain arteriovenous malformations: An updated single centre analysis of outcomes. J Clin Neurosci 2022; 102:54-59. [PMID: 35728395 DOI: 10.1016/j.jocn.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
Arteriovenous malformations (AVM) of the brain are congenital, high pressure vascular malformations, which are at risk of haemorrhage. Stereotactic radiosurgery (SRS) can obliterate the nidus by delivering a precise high dose of ionising radiation in a single fraction. This paper updates long term AVM obliteration rates, time to obliteration and retreatment outcomes in LINAC delivered SRS treatment at the Royal Adelaide Hospital. A retrospective review of a prospectively maintained AVM SRS database supplemented by clinical case notes, patient correspondence and electronic medical records was performed. 89 AVMs received primary SRS treatment for which the crude obliteration rate was 61% (68% for 79 patients with adequate follow up). Higher marginal dose, smaller nidus size and lower Pollock-Flickinger (PF) score were significantly associated with AVM obliteration. The crude obliteration rates for patients with adequate follow-up and AVM diameter < 3 cm vs ≥ 3 cm were 76% vs 48%, respectively, and 93% with PF score < 1.0. Median time to obliteration was 36 months. Higher dose and lower PF score were associated with earlier obliteration. The crude obliteration rate after second SRS was 56% (9/16 patients) and no significant associations were found. These obliteration rates after primary and retreatment LINAC SRS are comparable to other studies. Marginal dose and PF score were the main predictors of obliteration overall as well as early (<36 months) obliteration.
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Matsuda R, Morimoto T, Tamamoto T, Inooka N, Ochi T, Miyasaka T, Hontsu S, Yamaki K, Miura S, Takeshima Y, Tamura K, Yamada S, Nishimura F, Nakagawa I, Motoyama Y, Park YS, Hasegawa M, Nakase H. Salvage Surgical Resection after Linac-Based Stereotactic Radiosurgery for Newly Diagnosed Brain Metastasis. Curr Oncol 2021; 28:5255-5265. [PMID: 34940078 PMCID: PMC8699906 DOI: 10.3390/curroncol28060439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to assess the clinical outcomes of salvage surgical resection (SSR) after stereotactic radiosurgery and fractionated stereotactic radiotherapy (SRS/fSRT) for newly diagnosed brain metastasis. Methods: Between November 2009 and May 2020, 318 consecutive patients with 1114 brain metastases were treated with SRS/fSRT for newly diagnosed brain metastasis at our hospital. During this study period, 21 of 318 patients (6.6%) and 21 of 1114 brain metastases (1.9%) went on to receive SSR after SRS/fSRT. Three patients underwent multiple surgical resections. Twenty-one consecutive patients underwent twenty-four SSRs. Results: The median time from initial SRS/fSRT to SSR was 14 months (range: 2–96 months). The median follow-up after SSR was 17 months (range: 2–78 months). The range of tumor volume at initial SRS/fSRT was 0.12–21.46 cm3 (median: 1.02 cm3). Histopathological diagnosis after SSR was recurrence in 15 cases, and radiation necrosis (RN) or cyst formation in 6 cases. The time from SRS/fSRT to SSR was shorter in the recurrence than in the RNs and cyst formation, but these differences did not reach statistical significance (p = 0.067). The median survival time from SSR and from initial SRS/fSRT was 17 and 74 months, respectively. The cases with recurrence had a shorter survival time from initial SRS/fSRT than those without recurrence (p = 0.061). Conclusions: The patients treated with SRS/fSRT for brain metastasis need long-term follow-up. SSR is a safe and effective treatment for the recurrence, RN, and cyst formation after SRS/fSRT for brain metastasis.
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Affiliation(s)
- Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
- Correspondence: ; Tel.: +81-744-22-3051
| | - Takayuki Morimoto
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Tetsuro Tamamoto
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
- Department of Medical Informatics, Nara Medical University Hospital, Kashihara 634-8522, Japan
| | - Nobuyoshi Inooka
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Tomoko Ochi
- Department of Radiology, Nara Medical University Hospital, Kashihara 634-8522, Japan; (T.O.); (T.M.)
| | - Toshiteru Miyasaka
- Department of Radiology, Nara Medical University Hospital, Kashihara 634-8522, Japan; (T.O.); (T.M.)
| | - Shigeto Hontsu
- Department of Respiratory Medicine, Nara Medical University Hospital, Kashihara 634-8522, Japan;
| | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Sachiko Miura
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
| | - Masatoshi Hasegawa
- Department of Radiation Oncology, Nara Medical University, Kashihara 634-8521, Japan; (T.T.); (N.I.); (K.Y.); (S.M.); (M.H.)
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara 634-8521, Japan; (T.M.); (Y.T.); (K.T.); (S.Y.); (F.N.); (I.N.); (Y.M.); (Y.-S.P.); (H.N.)
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Meta-analysis of tumor control rates in patients undergoing stereotactic radiosurgery for cystic vestibular schwannomas. Clin Neurol Neurosurg 2020; 188:105571. [DOI: 10.1016/j.clineuro.2019.105571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 01/04/2023]
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Carminucci A, Parr M, Bitar M, Danish SF. Delayed Onset Cyst Formation After Laser Interstitial Thermal Therapy: An Unreported Long-term Complication. World Neurosurg 2019; 124:219-223. [PMID: 30639484 DOI: 10.1016/j.wneu.2018.12.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022]
Abstract
The majority of complications following LITT therapy occur in the early post-operative period, with few long-term complications being reported. Here we present 2 cases of delayed onset cyst formation occurring more than 1 year following ablation, a previously unreported complication. In the first case, a 59 year-old female who previously underwent LITT for a radiation induced cavernoma developed a 2 cm cystic lesion 18 months following ablation, resulting in recurrent seizure. In the second case, 53 year-old female with a recurrent left frontal cerebral metastasis developed a large cystic lesion 30 months post ablation. Both patients required craniotomies and resection of their cystic lesions. In both cases pathology demonstrated reactive gliosis and blood vessel sclerosis. We hypothesize chronic gliosis following LITT therapy results in blood vessel sclerosis leading to blood-brain-barrier breakdown and resulting delayed cyst formation. These findings support need for long-term surveillance of patients treated with LITT.
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Affiliation(s)
- Arthur Carminucci
- Department of Neurological Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Matthew Parr
- Department of Neurological Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Mireille Bitar
- Department of Pathology, Rutgers-RWJMS, New Brunswick, NJ, USA
| | - Shabbar F Danish
- Department of Neurological Surgery, Rutgers University, New Brunswick, NJ, USA.
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