1
|
Trofin AM, Buzea CG, Buga R, Agop M, Ochiuz L, Iancu DT, Eva L. Predicting Tumor Dynamics Post-Staged GKRS: Machine Learning Models in Brain Metastases Prognosis. Diagnostics (Basel) 2024; 14:1268. [PMID: 38928683 PMCID: PMC11203132 DOI: 10.3390/diagnostics14121268] [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: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
This study assesses the predictive performance of six machine learning models and a 1D Convolutional Neural Network (CNN) in forecasting tumor dynamics within three months following Gamma Knife radiosurgery (GKRS) in 77 brain metastasis (BM) patients. The analysis meticulously evaluates each model before and after hyperparameter tuning, utilizing accuracy, AUC, and other metrics derived from confusion matrices. The CNN model showcased notable performance with an accuracy of 98% and an AUC of 0.97, effectively complementing the broader model analysis. Initial findings highlighted that XGBoost significantly outperformed other models with an accuracy of 0.95 and an AUC of 0.95 before tuning. Post-tuning, the Support Vector Machine (SVM) demonstrated the most substantial improvement, achieving an accuracy of 0.98 and an AUC of 0.98. Conversely, XGBoost showed a decline in performance after tuning, indicating potential overfitting. The study also explores feature importance across models, noting that features like "control at one year", "age of the patient", and "beam-on time for volume V1 treated" were consistently influential across various models, albeit their impacts were interpreted differently depending on the model's underlying mechanics. This comprehensive evaluation not only underscores the importance of model selection and hyperparameter tuning but also highlights the practical implications in medical diagnostic scenarios, where the accuracy of positive predictions can be crucial. Our research explores the effects of staged Gamma Knife radiosurgery (GKRS) on larger tumors, revealing no significant outcome differences across protocols. It uniquely considers the impact of beam-on time and fraction intervals on treatment efficacy. However, the investigation is limited by a small patient cohort and data from a single institution, suggesting the need for future multicenter research.
Collapse
Affiliation(s)
- Ana-Maria Trofin
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
| | - Călin Gh. Buzea
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu” Iași, 700309 Iasi, Romania; (C.G.B.); (L.E.)
- National Institute of Research and Development for Technical Physics, IFT Iași, 700050 Iasi, Romania
| | - Răzvan Buga
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu” Iași, 700309 Iasi, Romania; (C.G.B.); (L.E.)
| | - Maricel Agop
- Physics Department, Technical University “Gheorghe Asachi” Iasi, 700050 Iasi, Romania;
| | - Lăcrămioara Ochiuz
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
| | - Dragos Teodor Iancu
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Lucian Eva
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu” Iași, 700309 Iasi, Romania; (C.G.B.); (L.E.)
- University Apollonia, 700511 Iasi, Romania
| |
Collapse
|
2
|
Tipton PW, Atik M, Soto-Beasley AI, Day GS, Grewal SS, Chaichana K, Fermo OP, Ball CT, Heckman MG, White LJ, Quicksall ZS, Reddy JS, Ramanan VK, Vemuri P, Elder BD, Ertekin-Taner N, Ross O, Graff-Radford N. CWH43 Variants Are Associated With Disease Risk and Clinical Phenotypic Measures in Patients With Normal Pressure Hydrocephalus. Neurol Genet 2023; 9:e200086. [PMID: 37476022 PMCID: PMC10356132 DOI: 10.1212/nxg.0000000000200086] [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: 01/31/2023] [Accepted: 05/25/2023] [Indexed: 07/22/2023]
Abstract
Background and Objectives Variants in the CWH43 gene have been associated with normal pressure hydrocephalus (NPH). We aimed to replicate these findings, identify additional CWH43 variants, and further define the clinical phenotype associated with CWH43 variants. Methods We determined the prevalence of CWH43 variants by whole-genome sequencing (WGS) in 94 patients with NPH. The odds of having CWH43 variant carriers develop NPH were determined through comparison with 532 Mayo Clinic Biobank volunteers without a history of NPH. For patients with NPH, we documented the head circumference, prevalence of disproportionate enlargement of subarachnoid hydrocephalus (DESH), microvascular changes on MRI quantified by the Fazekas scale, and ambulatory response to ventriculoperitoneal shunting. Results We identified rare (MAF <0.05) coding CWH43 variants in 15 patients with NPH. Ten patients (Leu533Terfs, n = 8; Lys696Asnfs, n = 2) harbored previously reported predicted loss-of-function variants, and combined burden analysis confirmed risk association with NPH (OR 2.60, 95% CI 1.12-6.03, p = 0.027). Additional missense variations observed included Ile292Thr (n = 2), Ala469Ser (n = 2), and Ala626Val (n = 1). Though not quite statistically significant, in single variable analysis, the odds of having a head circumference above the 75th percentile of normal controls was more than 5 times higher for CWH43 variant carriers compared with that for noncarriers (unadjusted OR 5.67, 95% CI 0.96-108.55, p = 0.057), and this was consistent after adjusting for sex and height (OR 5.42, 95% CI 0.87-106.37, p = 0.073). DESH was present in 56.7% of noncarriers and only 21.4% of carriers (p = 0.016), while sulcal trapping was also more prevalent among noncarriers (67.2% vs 35.7%, p = 0.030). All 8 of the 15 variant carriers who underwent ventriculoperitoneal shunting at our institution experienced ambulatory improvements. Discussion CWH43 variants are frequent in patients with NPH. Predicted loss-of-function mutations were the most common; we identified missense mutations that require further study. Our findings suggest that congenital factors, rather than malabsorption or vascular dysfunction, are primary contributors to the CWH43-related NPH clinical syndrome.
Collapse
Affiliation(s)
- Philip W Tipton
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Merve Atik
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Alexandra I Soto-Beasley
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Gregory S Day
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Sanjeet S Grewal
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Kaisorn Chaichana
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Olga P Fermo
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Colleen T Ball
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Michael G Heckman
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Launia J White
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Zachary S Quicksall
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Joseph S Reddy
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Vijay K Ramanan
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Benjamin D Elder
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Nilufer Ertekin-Taner
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Owen Ross
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Neill Graff-Radford
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| |
Collapse
|
3
|
Carswell C. Idiopathic normal pressure hydrocephalus: historical context and a contemporary guide. Pract Neurol 2023; 23:15-22. [PMID: 36162853 DOI: 10.1136/pn-2021-003291] [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] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
Idiopathic normal pressure hydrocephalus (NPH) was described in 1965 as a syndrome in which hydrocephalus develops but with a normal cerebrospinal fluid (CSF) pressure, causing shunt-responsive gait apraxia, cognitive impairment and urinary incontinence. Not all patients respond to shunting despite having the clinical syndrome with appropriate radiological features. This has led to considerable debate over subsequent decades regarding idiopathic NPH. It is now understood that asymptomatic communicating hydrocephalus can develop in many healthy older people, and that over time this can develop into a symptomatic state that sometimes responds to CSF shunting, but to a variable extent. This review looks at the historical background of NPH, the use of predictive tests, the current state of clinical evidence for the diagnosis and treatment of idiopathic NPH and the possible underlying causes, to provide a contemporary practical guide for assessing patients with the radiological features of idiopathic NPH.
Collapse
Affiliation(s)
- Christopher Carswell
- Imperial College Healthcare NHS Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| |
Collapse
|
4
|
Vetkas A, Germann J, Boutet A, Samuel N, Sarica C, Yamamoto K, Santyr B, Cheyuo C, Conner CR, Lang SM, Lozano AM, Ibrahim GM, Valiante T, Kongkham PN, Kalia SK. Laser interstitial thermal therapy for the treatment of insular lesions: A systematic review. Front Neurol 2023; 13:1024075. [PMID: 36686528 PMCID: PMC9845884 DOI: 10.3389/fneur.2022.1024075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/02/2022] [Indexed: 01/06/2023] Open
Abstract
Background The surgical treatment of insular lesions has been historically associated with high morbidity. Laser interstitial thermal therapy (LITT) has been increasingly used in the treatment of insular lesions, commonly neoplastic or epileptogenic. Stereotaxis is used to guide laser probes to the insula where real-time magnetic resonance thermometry defines lesion creation. There is an absence of previously published reviews on insular LITT, despite a rapid uptake in use, making further study imperative. Methods Here we present a systematic review of the PubMed and Scopus databases, examining the reported clinical indications, outcomes, and adverse effects of insular LITT. Results A review of the literature revealed 10 retrospective studies reporting on 53 patients (43 pediatric and 10 adults) that were treated with insular LITT. 87% of cases were for the treatment of epilepsy, with 89% of patients achieving seizure outcomes of Engle I-III following treatment. The other 13% of cases reported on insular tumors and radiological improvement was seen in all cases following treatment. All but one study reported adverse events following LITT with a rate of 37%. The most common adverse events were transient hemiparesis (29%) and transient aphasia (6%). One patient experienced an intracerebral hemorrhage, which required a decompressive hemicraniectomy, with subsequent full recovery. Conclusion This systematic review highlights the suitability of LITT for the treatment of both insular seizure foci and insular tumors. Despite the growing use of this technique, prospective studies remain absent in the literature. Future work should directly evaluate the efficacy of LITT with randomized and controlled trials.
Collapse
Affiliation(s)
- Artur Vetkas
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Neurology Clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia,*Correspondence: Artur Vetkas ✉
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Christopher R. Conner
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Stefan M. Lang
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Krembil Research Institute, Toronto, ON, Canada
| | - George M. Ibrahim
- Division of Pediatric Neurosurgery, Sick Kids Toronto, University of Toronto, Toronto, ON, Canada
| | - Taufik Valiante
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada,The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Paul N. Kongkham
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada,The KITE Research Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
5
|
Carlsen JF, Backlund ADL, Mardal CA, Taudorf S, Holst AV, Munch TN, Hansen AE, Hasselbalch SG. Can Shunt Response in Patients with Idiopathic Normal Pressure Hydrocephalus Be Predicted from Preoperative Brain Imaging? A Retrospective Study of the Diagnostic Use of the Normal Pressure Hydrocephalus Radscale in 119 Patients. AJNR Am J Neuroradiol 2022; 43:223-229. [PMID: 34969666 PMCID: PMC8985670 DOI: 10.3174/ajnr.a7378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE The Normal Pressure Hydrocephalus Radscale is a combined scoring of 7 different structural imaging markers on preoperative brain CT or MR imaging in patients with idiopathic normal pressure hydrocephalus: callosal angle, Evans Index, Sylvian fissure dilation, apical sulcal narrowing, mean temporal horn diameter, periventricular WM lesions, and focal sulcal dilation. The purpose of this retrospective study was to assess the performance of the Normal Pressure Hydrocephalus Radscale in distinguishing idiopathic normal pressure hydrocephalus shunt responders from nonresponders. MATERIALS AND METHODS The preoperative MR imaging and CT scans of 119 patients with idiopathic normal pressure hydrocephalus were scored using the Normal Pressure Hydrocephalus Radscale. A summary shunt-response score assessed within 6 months from ventriculoperitoneal shunt surgery, combining the effect on cognition, gait, and urinary incontinence, was used as a reference. The difference between the mean Normal Pressure Hydrocephalus Radscale for responders and nonresponders was tested using the Student t test. The area under the curve was calculated for the Normal Pressure Hydrocephalus Radscale to assess shunt response. To ascertain reproducibility, we assessed the interobserver agreement between the 2 independent observers as intraclass correlation coefficients for the Normal Pressure Hydrocephalus Radscale for 74 MR imaging scans and 19 CT scans. RESULTS Ninety-four (79%) of 119 patients were shunt responders. The mean Normal Pressure Hydrocephalus Radscale score for shunt responders was 8.35 (SD, 1.53), and for nonresponders, 7.48 (SD, 1.53) (P = .02). The area under the curve for the Normal Pressure Hydrocephalus Radscale was 0.66 (range, 0.54-0.78). The intraclass correlation coefficient for the Normal Pressure Hydrocephalus Radscale was 0.86 for MR imaging and 0.82 for CT. CONCLUSIONS The Normal Pressure Hydrocephalus Radscale showed moderate discrimination for shunt response but cannot, on its own, be used for selecting patients with idiopathic normal pressure hydrocephalus for shunt surgery.
Collapse
Affiliation(s)
- J F Carlsen
- From the Department of Radiology (J.F.C., C.A.M., A.E.H.)
| | - A D L Backlund
- Department of Radiology (A.D.L.B.), Hospital of North Zealand, Hillerød, Denmark
| | - C A Mardal
- From the Department of Radiology (J.F.C., C.A.M., A.E.H.)
| | - S Taudorf
- Department of Neurology (S.T., S.G.H.)
| | - A V Holst
- Danish Dementia Research Centre, and Department of Neurosurgery (A.V.H., T.N.M.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - T N Munch
- Danish Dementia Research Centre, and Department of Neurosurgery (A.V.H., T.N.M.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine (T.N.M., A.E.H.), University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research (T.N.M.), Statens Serum Institut, Copenhagen, Denmark
| | - A E Hansen
- From the Department of Radiology (J.F.C., C.A.M., A.E.H.)
- Department of Clinical Medicine (T.N.M., A.E.H.), University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
6
|
Ryska P, Slezak O, Eklund A, Salzer J, Malm J, Zizka J. Variability of Normal Pressure Hydrocephalus Imaging Biomarkers with Respect to Section Plane Angulation: How Wrong a Radiologist Can Be? AJNR Am J Neuroradiol 2021; 42:1201-1207. [PMID: 33888457 DOI: 10.3174/ajnr.a7095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/13/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Systematic analysis of angulation-related variability of idiopathic normal pressure hydrocephalus imaging biomarkers has not been published yet. Our aim was to evaluate the variability of these radiologic biomarkers with respect to imaging plane angulation. MATERIALS AND METHODS Eighty subjects (35 with clinically confirmed idiopathic normal pressure hydrocephalus and 45 age- and sex-matched healthy controls) were prospectively enrolled in a 3T brain MR imaging study. Two independent readers assessed 12 radiologic idiopathic normal pressure hydrocephalus biomarkers on sections aligned parallel or perpendicular to the bicallosal, bicommissural, hypophysis-fastigium, and brain stem vertical lines, respectively. RESULTS Disproportionately enlarged subarachnoid space hydrocephalus, simplified callosal angle, frontal horn diameter, z-Evans Index, and cella media vertical width did not show significant systematic differences in any of 6 section plane combinations studied. The remaining 7 biomarkers (including the Evans Index and callosal angle) showed significant differences in up to 4 of 6 mutually compared section plane combinations. The values obtained from sections aligned with the brain stem vertical line (parallel to the posterior brain stem margin) showed the most deviating results from other section angulations. CONCLUSIONS Seven of 12 idiopathic normal pressure hydrocephalus biomarkers including the frequently used Evans Index and callosal angle showed statistically significant deviations when measured on sections whose angulations differed or did not comply with the proper section definition published in the original literature. Strict adherence to the methodology of idiopathic normal pressure hydrocephalus biomarker assessment is, therefore, essential to avoid an incorrect diagnosis. Increased radiologic and clinical attention should be paid to the biomarkers showing low angulation-related variability yet high specificity for idiopathic normal pressure hydrocephalus-related morphologic changes such as the z-Evans Index, frontal horn diameter, or disproportionately enlarged subarachnoid space hydrocephalus.
Collapse
Affiliation(s)
- P Ryska
- From the Department of Diagnostic Radiology (P.R., O.S.), University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - O Slezak
- From the Department of Diagnostic Radiology (P.R., O.S.), University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Diagnostic Radiology (O.S.), Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - A Eklund
- Departments of Radiation Sciences (A.E.)
| | - J Salzer
- Pharmacology and Clinical Neuroscience (J.S., J.M.), Section of Neurology
| | - J Malm
- Pharmacology and Clinical Neuroscience (J.S., J.M.), Section of Neurology
| | - J Zizka
- Imaging and Functional Medicine (J.Z.), University Hospital of Umeå, Umeå, Sweden
| |
Collapse
|
7
|
Park HY, Park CR, Suh CH, Kim MJ, Shim WH, Kim SJ. Prognostic Utility of Disproportionately Enlarged Subarachnoid Space Hydrocephalus in Idiopathic Normal Pressure Hydrocephalus Treated with Ventriculoperitoneal Shunt Surgery: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2021; 42:1429-1436. [PMID: 34045302 DOI: 10.3174/ajnr.a7168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/17/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Disproportionately enlarged subarachnoid space hydrocephalus is a specific radiologic marker for idiopathic normal pressure hydrocephalus. However, controversy exists regarding the prognostic utility of disproportionately enlarged subarachnoid space hydrocephalus. PURPOSE Our aim was to evaluate the prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and its predictive utility regarding prognosis in patients treated with ventriculoperitoneal shunt surgery. DATA SOURCES We used MEDLINE and EMBASE databases. STUDY SELECTION We searched for studies that reported the prevalence or the diagnostic performance of disproportionately enlarged subarachnoid space hydrocephalus in predicting treatment response. DATA ANALYSIS The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was obtained. Pooled sensitivity, specificity, and area under the curve of disproportionately enlarged subarachnoid space hydrocephalus to predict treatment response were obtained. Subgroup and sensitivity analyses were performed to explain heterogeneity among the studies. DATA SYNTHESIS Ten articles with 812 patients were included. The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus was 44% (95% CI, 34%-54%). The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was higher in the studies using the second edition of the Japanese Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus compared with the studies using the international guidelines without statistical significance (52% versus 43%, P = .38). The pooled sensitivity and specificity of disproportionately enlarged subarachnoid space hydrocephalus for prediction of treatment response were 59% (95% CI, 38%-77%) and 66% (95% CI, 57%-74%), respectively, with an area under the curve of 0.67 (95% CI, 0.63-0.71). LIMITATIONS The lack of an established method for assessing disproportionately enlarged subarachnoid space hydrocephalus using brain MR imaging served as an important cause of the heterogeneity. CONCLUSIONS Our meta-analysis demonstrated a relatively low prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and a poor diagnostic performance for treatment response.
Collapse
Affiliation(s)
- H Y Park
- From the Department of Radiology and Research Institute of Radiology (H.Y.P., C.H.S., M.J.K., W.H.S., S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - C R Park
- Department of Medical Science (C.R.P.) Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Korea
| | - C H Suh
- From the Department of Radiology and Research Institute of Radiology (H.Y.P., C.H.S., M.J.K., W.H.S., S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M J Kim
- From the Department of Radiology and Research Institute of Radiology (H.Y.P., C.H.S., M.J.K., W.H.S., S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - W H Shim
- From the Department of Radiology and Research Institute of Radiology (H.Y.P., C.H.S., M.J.K., W.H.S., S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S J Kim
- From the Department of Radiology and Research Institute of Radiology (H.Y.P., C.H.S., M.J.K., W.H.S., S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Todisco M, Zangaglia R, Minafra B, Pisano P, Trifirò G, Bossert I, Pozzi NG, Brumberg J, Ceravolo R, Isaias IU, Fasano A, Pacchetti C. Clinical Outcome and Striatal Dopaminergic Function After Shunt Surgery in Patients With Idiopathic Normal Pressure Hydrocephalus. Neurology 2021; 96:e2861-e2873. [PMID: 33893195 DOI: 10.1212/wnl.0000000000012064] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine changes in clinical features and striatal dopamine reuptake transporter (DAT) density after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS Participants with probable iNPH were assessed at baseline by means of clinical rating scales, brain MRI, and SPECT with [123I]-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane (FP-CIT). Levodopa responsiveness was also evaluated. Patients who did or did not undergo lumboperitoneal shunt were clinically followed up and repeated SPECT after 2 years. RESULTS We enrolled 115 patients with iNPH. Of 102 patients without significant levodopa response and no signs of atypical parkinsonism, 92 underwent FP-CIT SPECT (58 also at follow-up) and 59 underwent surgery. We identified a disequilibrium subtype (phenotype 1) and a locomotor subtype (phenotype 2) of higher-level gait disorder. Gait impairment correlated with caudate DAT density in both phenotypes, whereas parkinsonian signs correlated with putamen and caudate DAT binding in patients with phenotype 2, who showed more severe symptoms and lower striatal DAT density. Gait and caudate DAT binding improved in both phenotypes after surgery (p < 0.01). Parkinsonism and putamen DAT density improved in shunted patients with phenotype 2 (p < 0.001). Conversely, gait, parkinsonian signs, and striatal DAT binding worsened in patients who declined surgery (p < 0.01). CONCLUSIONS This prospective interventional study highlights the pathophysiologic relevance of striatal dopaminergic dysfunction in the motor phenotypic expression of iNPH. Absence of levodopa responsiveness, shunt-responsive parkinsonism, and postsurgery improvement of striatal DAT density are findings that corroborate the notion of a reversible striatal dysfunction in a subset of patients with iNPH.
Collapse
Affiliation(s)
- Massimiliano Todisco
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Roberta Zangaglia
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Brigida Minafra
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Patrizia Pisano
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Giuseppe Trifirò
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Irene Bossert
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Nicoló Gabriele Pozzi
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Joachim Brumberg
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Roberto Ceravolo
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Ioannis Ugo Isaias
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Alfonso Fasano
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Claudio Pacchetti
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada.
| |
Collapse
|
9
|
Zhang J, Zhang Y, Xu M, Miao Z, Tian Y. Inhibition of the CDK5/caspase-3 Pathway by p5-TAT Protects Hippocampal Neurogenesis and Alleviates Radiation-induced Cognitive Dysfunction. Neuroscience 2021; 463:204-215. [PMID: 33838288 DOI: 10.1016/j.neuroscience.2021.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
Radiation-induced cognitive dysfunction is a common complication associated with cranial radiation therapy. Inhibition of hippocampal neurogenesis and proliferation plays a critical role in this complication. Relieving hippocampal apoptosis may significantly protect hippocampal neurogenesis and proliferation. Previous studies have demonstrated that hyperactivity of cyclin-dependent kinase 5 (Cdk5) is closely related to apoptosis. The exact molecular changes and function of Cdk5 in radiation-induced cognitive dysfunction are still not clear. Whether inhibition of Cdk5 and the relevant caspase-3 could improve hippocampal neurogenesis and ameliorate radiation-induced cognitive dysfunction needs further exploration. We hypothesized that inhibition of the Cdk5/caspase-3 pathway by p5-TAT could protect hippocampal neurogenesis and alleviate radiation-induced cognitive dysfunction. In our study, we reported that radiation induced hyperactivity of Cdk5 accompanied by elevation of the levels of cleaved caspase-3, a marker of neuronal apoptosis. Inhibition of hippocampal neurogenesis and proliferation as well as cognitive dysfunction was also observed. p5-TAT, a specific inhibitor of Cdk5, decreased the overactivation of Cdk5 without affecting the levels of Cdk5 activators. Additionally, this treatment suppressed the expression of cleaved caspase-3. We further demonstrated that p5-TAT treatment reduced hippocampal dysfunction and improved behavioral performance. Therefore, Cdk5 inhibition by the small peptide p5-TAT is a promising therapeutic strategy for radiation-induced cognitive dysfunction.
Collapse
Affiliation(s)
- Junjun Zhang
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou City, China; Institute of Radiotherapy and Oncology, Soochow University, China; Suzhou Key Laboratory for Radiation Oncology, China
| | - Yujuan Zhang
- Experiment Center, Medicine College of Soochow University, Suzhou City, China
| | - Meiling Xu
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou City, China; Institute of Radiotherapy and Oncology, Soochow University, China; Suzhou Key Laboratory for Radiation Oncology, China
| | - Zhigang Miao
- Institute of Neuroscience, Soochow University, Suzhou City, China.
| | - Ye Tian
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou City, China; Institute of Radiotherapy and Oncology, Soochow University, China; Suzhou Key Laboratory for Radiation Oncology, China.
| |
Collapse
|
10
|
Rasmussen J, Ajler P, Massa D, Plou P, Baccanelli M, Yampolsky C. Surgical Indication Optimization of Brain Metastases Based on the Evolutionary Analysis of Karnofsky Performance Status. J Neurol Surg A Cent Eur Neurosurg 2021; 82:211-217. [PMID: 33486750 DOI: 10.1055/s-0040-1714410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgical resection of brain metastases (BM) offers the highest rates of local control and survival; however, it is reserved for patients with good functional status. In particular, the presence of BM tends to oversize the detriment of the overall functional status, causing neurologic deterioration, potentially reversible following symptomatic pharmacological treatment. Thus, a timely indication of surgical resection may be dismissed. We propose to identify and quantify these variations in the functional status of patients with symptomatic BM to optimize the indication of surgical resection. PATIENTS AND METHODS Historic, retrospective cohort analysis of adult patients undergoing BM microsurgical resection, consecutively from January 2012 to May 2016, was conducted. The Karnofsky performance status (KPS) variation was recorded according to the symptomatic evolution of each patient at specific moments of the diagnostic-therapeutic algorithm. Finally, survival curves were delineated for the main identified factors. RESULTS One hundred and nineteen resection surgeries were performed. The median overall survival was 243 days, while on average it was 305.7 (95% confidence interval [CI]: 250.6-360.9) days. The indication of surgical resection of 10% of the symptomatic patients in our series (7.5% of overall) could have been initially rejected due to pharmacologically reversible neurologic impairment. Survival curves showed statistically significant differences when KPS was stratified following pharmacological symptomatic treatment (p < 0.0001), unlike when they were estimated at the time of BM diagnosis (p = 0.1128). CONCLUSION The preoperative determination of the functional status by KPS as an evolutive parameter after the nononcologic symptomatic pharmacological treatment allowed us to optimize the surgical indication of patients with symptomatic BM.
Collapse
Affiliation(s)
- Jorge Rasmussen
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniela Massa
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pedro Plou
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Matteo Baccanelli
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Claudio Yampolsky
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
11
|
Abstract
Background:
Drug delivery to cancerous brain is a challenging task as it is
surrounded by an efficient protective barrier. The main hurdles for delivery of bioactive
molecules to cancerous brain are blood brain barrier (BBB), the invasive nature of gliomas,
drug resistance, and difficult brain interstitium transportation. Therefore, treatment
of brain cancer with the available drug regimen is difficult and has shown little improvement
in recent years.
Methods:
We searched about recent advancements in the use of nanomedicine for effective
treatment of the brain cancer. We focused on the use of liposomes, nanoparticles,
polymeric micelles, and dendrimers to improve brain cancer therapy.
Results:
Nanomedicines are well suited for the treatment of brain cancer owing to their
highly acceptable biological, chemical, and physical properties. Smaller size of nanomedicines
also enhances their anticancer potential and penetration into blood brain barrier
(BBB).
Conclusion:
Recently, nanomedicine based approaches have been developed and investigated
for effective treatment of brain cancer. Some of these have been translated into
clinical practice, in order to attain therapeutic needs of gliomas. Future advancements in
nanomedicines will likely produce significant changes in methods and practice of brain
cancer therapy.
Collapse
Affiliation(s)
- Shivani Verma
- I. K. Gujral Punjab Technical University, Jalandhar-Punjab 144601, India
| | - Puneet Utreja
- I. K. Gujral Punjab Technical University, Jalandhar-Punjab 144601, India
| | - Lalit Kumar
- I. K. Gujral Punjab Technical University, Jalandhar-Punjab 144601, India
| |
Collapse
|
12
|
Neikter J, Agerskov S, Hellström P, Tullberg M, Starck G, Ziegelitz D, Farahmand D. Ventricular Volume Is More Strongly Associated with Clinical Improvement Than the Evans Index after Shunting in Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2020; 41:1187-1192. [PMID: 32527841 DOI: 10.3174/ajnr.a6620] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/27/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ventricular enlargement in idiopathic normal pressure hydrocephalus is often estimated using the Evans index. However, the sensitivity of the Evans index to estimate changes in ventricular size postoperatively has been questioned. Here, we evaluated the postoperative change in ventricle size in relation to shunt response in patients with idiopathic normal pressure hydrocephalus, by comparing ventricular volume and the Evans index. MATERIALS AND METHODS Fifty-seven patients with idiopathic normal pressure hydrocephalus underwent high-resolution MR imaging preoperatively and 6 months after shunt insertion. Clinical symptoms of gait, balance, cognition, and continence were assessed according to the idiopathic normal pressure hydrocephalus scale. The ventricular volume of the lateral and third ventricles and the Evans index were measured using ITK-SNAP software. Semiautomatic volumetric analysis was performed, and postoperative changes in ventricular volume and the Evans index and their relationships to postoperative clinical improvement were compared. RESULTS The median postoperative ventricular volume decrease was 25 mL (P < .001). The proportional decrease in ventricular volume was greater than that in the Evans index (P < .001). The postoperative decrease in ventricular volume was associated with a postoperative increase in the idiopathic normal pressure hydrocephalus scale score (P = .004). Shunt responders (75%) demonstrated a greater ventricular volume decrease than nonresponders (P = .002). CONCLUSIONS Clinical improvement after shunt surgery in idiopathic normal pressure hydrocephalus is associated with a reduction of ventricular size. Ventricular volume is a more sensitive estimate than the Evans index and, therefore, constitutes a more precise method to evaluate change in ventricle size after shunt treatment in idiopathic normal pressure hydrocephalus.
Collapse
Affiliation(s)
- J Neikter
- From the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
| | - S Agerskov
- From the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
| | - P Hellström
- From the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
| | - M Tullberg
- From the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
| | - G Starck
- Institute of Neuroscience and Physiology, Hydrocephalus Research Unit, and Departments of Radiation Physics (G.S.)
| | - D Ziegelitz
- Neuroradiology (D.Z.), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - D Farahmand
- From the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
| |
Collapse
|
13
|
Hussain NS, Ahmed SH. Metastatic Intracerebral Chondrosarcoma: Case Report and Literature Review of Endocrine Effects and Management Paradigms. Cureus 2020; 12:e8417. [PMID: 32642333 PMCID: PMC7336601 DOI: 10.7759/cureus.8417] [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] [Indexed: 11/09/2022] Open
Abstract
The most common underlying diagnosis of intracranial tumor pathology is metastatic disease, followed by primary brain tumors. Chondrosarcomatous metastatic disease of the brain is a rare subtype of this disease process. The patient presented with right-sided weakness. Her history was significant for femur chondrosarcoma which was resected and treated. Laboratory analysis revealed persistent hypercalcemia and hyperglycemia. MRI of the brain was completed, which revealed a left parietal-occipital lesion with smaller lesions in the left frontal and right parietal lobe. Multidisciplinary tumor board recommended surgery for lesion resection and pathology. Surgical pathologic diagnosis after lesion resection was metastatic chondrosarcoma. The patient’s preoperative arm and leg weakness improved after surgery. Our paper delineates this unique case of intracranial spread of femur chondrosarcoma.
Collapse
Affiliation(s)
- Namath S Hussain
- Neurological Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Sara H Ahmed
- Endocrinology, Anaheim Regional Medical Center, Anaheim, USA
| |
Collapse
|
14
|
Cranial irradiation acutely and persistently impairs injury-induced microglial proliferation. Brain Behav Immun Health 2020; 4:100057. [PMID: 34589843 PMCID: PMC8474291 DOI: 10.1016/j.bbih.2020.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 12/12/2022] Open
Abstract
Microglia, the resident immune cells of the central nervous system (CNS), play multiple roles in maintaining CNS homeostasis and mediating tissue repair, including proliferating in response to brain injury and disease. Cranial irradiation (CI), used for the treatment of brain tumors, has a long-lasting anti-proliferative effect on a number of cell types in the brain, including oligodendrocyte progenitor and neural progenitor cells; however, the effect of CI on CNS-resident microglial proliferation is not well characterized. Using a sterile cortical needle stab injury model in mice, we found that the ability of CNS-resident microglia to proliferate in response to injury was impaired by prior CI, in a dose-dependent manner, and was nearly abolished by a 20 Gy dose. Similarly, in a metastatic tumor model, prior CI (20 Gy) reduced microglial proliferation in response to tumor growth. The effect of irradiation was long-lasting; 20 Gy CI 6 months prior to stab injury significantly impaired microglial proliferation. We also investigated how stab and/or irradiation impacted levels of P2Y12R, CD68, CSF1, IL-34 and CSF1R, factors involved in the brain’s normal response to injury. P2Y12R, CD68, CSF1, and IL-34 expression were altered by stab similarly in irradiated mice and controls; however, CSF1R was differentially affected. qRT-PCR and flow cytometry analyses demonstrated that CI reduced overall Csf1r mRNA levels and microglial specific CSF1R protein expression, respectively. Interestingly, Csf1r mRNA levels increased after injury in unirradiated controls; however, Csf1r levels were persistently decreased in irradiated mice, and did not increase in response to stab. Together, our data demonstrate that CI leads to a significant and lasting impairment of microglial proliferation, possibly through a CSF1R-mediated mechanism. Irradiation leads to a long-term deficit in injury-induced microglial proliferation. Irradiation reduces microglial proliferation associated with tumor growth. Irradiation decreases microglial CSF1R and prevents its upregulation after injury.
Collapse
|
15
|
Takase H, Chou SHY, Hamanaka G, Ohtomo R, Islam MR, Lee JW, Hsu L, Mathew J, Reyes-Bricio E, Hayakawa K, Xing C, Ning MM, Wang X, Arai K, Lo EH, Lok J. Soluble vascular endothelial-cadherin in CSF after subarachnoid hemorrhage. Neurology 2020; 94:e1281-e1293. [PMID: 32107323 DOI: 10.1212/wnl.0000000000008868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine if CSF and plasma levels of soluble vascular endothelial (sVE)-cadherin are associated with functional outcome after subarachnoid hemorrhage (SAH) and to investigate sVE-cadherin effects on microglia. METHODS Serial CSF and plasma were collected from prospectively enrolled patients with nontraumatic SAH from a ruptured aneurysm in the anterior circulation and who required an external ventricular drain for clinical indications. Patients with normal-pressure hydrocephalus without SAH served as controls. For prospective assessment of long-term outcomes at 3 and 6 months after SAH, modified Rankin Scale scores (mRS) were obtained and dichotomized into good (mRS ≤ 2) vs poor (mRS > 2) outcome groups. For SAH severity, Hunt and Hess grade was assessed. Association of CSF sVE-cadherin levels with long-term outcomes, HH grade, and CSF tumor necrosis factor (TNF)-α levels were evaluated. sVE-cadherin effects on microglia were also studied. RESULTS sVE-cadherin levels in CSF, but not in plasma, were higher in patients with SAH and were associated with higher clinical severity and higher CSF TNF-α levels. Patients with SAH with higher CSF sVE-cadherin levels over time were more likely to develop worse functional outcome at 3 months after SAH. Incubation of cultured microglia with sVE-cadherin resulted in increased inducible nitric oxide synthase, interleukin-1β, reactive oxygen species, cell soma size, and metabolic activity, consistent with microglia activation. Microinjection of sVE-cadherin fragments into mouse brain results in an increased number of microglia surrounding the injection site, compared to injection of denatured vascular endothelial-cadherin fragments. CONCLUSIONS These results support the existence of a novel pathway by which sVE-cadherin, released from injured endothelium after SAH, can shift microglia into a more proinflammatory phenotype and contribute to neuroinflammation and poor outcome in SAH.
Collapse
Affiliation(s)
- Hajime Takase
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Sherry Hsiang-Yi Chou
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Gen Hamanaka
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Ryo Ohtomo
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Mohammad R Islam
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Jong Woo Lee
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Liangge Hsu
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Justin Mathew
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Estefania Reyes-Bricio
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Kazuhide Hayakawa
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Changhong Xing
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Ming Ming Ning
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Xiaoying Wang
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Ken Arai
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Eng H Lo
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA
| | - Josephine Lok
- From Neuroprotection Research Laboratories (H.T., S.H.-Y.C., G.H., R.O., M.R.I., J.M., E.R.-B., K.H., C.X., M.M.N., X.W., K.A., E.H.L., J.L.), Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown; Departments of Neurology (S.H.-Y.C., J.W.L.) and Radiology (L.H.), Brigham and Women's Hospital, Boston; Department of Pediatrics, Pediatric Critical Care Medicine (J.L.), Department of Radiology (E.H.L.), and Department of Neurology (M.M.N., E.H.L.), Massachusetts General Hospital, Boston; Department of Neurosurgery (H.T.), Yokohama City University, Yokohama, Japan; and Departments of Critical Care Medicine, Neurology, and Neurosurgery (S.H.-Y.C.), University of Pittsburgh, PA.
| |
Collapse
|
16
|
Ito D, Aoyagi K, Nagano O, Serizawa T, Iwadate Y, Higuchi Y. Comparison of two-stage Gamma Knife radiosurgery outcomes for large brain metastases among primary cancers. J Neurooncol 2020; 147:237-246. [PMID: 32026433 DOI: 10.1007/s11060-020-03421-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/31/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Stereotactic radiosurgery (SRS) is typically considered for patients who cannot undergo surgical resection for large (> 10 cm3) brain metastases (BMs). Staged SRS requires adaptive planning during each stage of the irradiation period for improved tumor control and reduced radiation damage. However, there has been no study on the tumor reduction rates of this method. We evaluated the outcomes of two-stage SRS across multiple primary cancer types. METHODS We analyzed 178 patients with 182 large BMs initially treated with two-stage SRS. The primary cancers included breast (BC), non-small cell lung (NSCLC), and gastrointestinal tract cancers (GIC). We analyzed the overall survival (OS), neurological death, systemic death (SD), tumor progression (TP), tumor recurrence (TR), radiation necrosis (RN), and the tumor reduction rate during both stages. RESULTS The median survival time after the first Gamma Knife surgery (GKS) procedure was 6.6 months. Compared with patients with BC and NSCLC, patients with GIC had shorter OS and a higher incidence of SD. Compared with patients with NSCLC and GIC, patients with BC had significantly higher tumor reduction rates in both sessions. TP rates were similar among primary cancer types. There was no association of the tumor reduction rate with tumor control. The overall cumulative incidence of RN was 4.2%; further, the RN rates were similar among primary cancer types. CONCLUSIONS Two-stage SRS should be considered for BC and NSCLC if surgical resection is not indicated. For BMs from GIC, staged SRS should be carefully considered and adapted to each unique case given its lower tumor reduction rate and shorter OS.
Collapse
Affiliation(s)
- Daisuke Ito
- Gamma Knife House, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 2900512, Japan.
| | - Kyoko Aoyagi
- Gamma Knife House, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 2900512, Japan
| | - Osamu Nagano
- Gamma Knife House, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 2900512, Japan
| | - Toru Serizawa
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshinori Higuchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| |
Collapse
|
17
|
Crook JE, Gunter JL, Ball CT, Jones DT, Graff-Radford J, Knopman DS, Boeve BF, Petersen RC, Jack CR, Graff-Radford NR. Linear vs volume measures of ventricle size: Relation to present and future gait and cognition. Neurology 2019; 94:e549-e556. [PMID: 31748251 DOI: 10.1212/wnl.0000000000008673] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 07/31/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To compare the clinical utility of volume-based ratios with the standard linear ratio of Evans index (EI) by examining their associations with gait, cognition, and other patient and imaging variables. METHODS From MRI scans of 1,774 participants in the Mayo Clinic Study of Aging, we calculated 3 ventricle size measures: Evan index (frontal horn width divided by widest width of skull inner table), total ventricular volume, and frontal horn volume as ratios of total intracranial volume. Gait was measured by a timed 25-foot walk and cognition by a composite of psychometric tests. We also evaluated variables associated with the measures of ventricular size. Further, we evaluated gait and cognition associations with MRI of extraventricular findings seen in normal-pressure hydrocephalus: disproportionate enlargement of subarachnoid space (DESH) and focal sulcal dilations (FSD). RESULTS Ventricular volume measures had stronger association with gait and cognition measures than EI. In decreasing order of strength of association with ventricle size were DESH, FSD, white matter hyperintensity volume ratio, age, male sex, cortical thickness, and education. Modest evidence was observed that FSD was associated with future decline in gait and cognition. CONCLUSION Ventricular volume measures are clinically more useful than EI in indicating current and future gait and cognition. Multiple factors are associated with ventricle volume size, including FSD and DESH, suggesting that changes in CSF dynamics may go beyond simple ventriculomegaly.
Collapse
Affiliation(s)
- Julia E Crook
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Jeffrey L Gunter
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Colleen T Ball
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - David T Jones
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Neill R Graff-Radford
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN.
| |
Collapse
|
18
|
Morimoto Y, Yoshida S, Kinoshita A, Satoh C, Mishima H, Yamaguchi N, Matsuda K, Sakaguchi M, Tanaka T, Komohara Y, Imamura A, Ozawa H, Nakashima M, Kurotaki N, Kishino T, Yoshiura KI, Ono S. Nonsense mutation in CFAP43 causes normal-pressure hydrocephalus with ciliary abnormalities. Neurology 2019; 92:e2364-e2374. [PMID: 31004071 PMCID: PMC6598815 DOI: 10.1212/wnl.0000000000007505] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/22/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To identify genes related to normal-pressure hydrocephalus (NPH) in one Japanese family with several members with NPH. Methods We performed whole-exome sequencing (WES) on a Japanese family with multiple individuals with NPH and identified a candidate gene. Then we generated knockout mouse using CRISPR/Cas9 to confirm the effect of the candidate gene on the pathogenesis of hydrocephalus. Results In WES, we identified a loss-of-function variant in CFAP43 that segregated with the disease. CFAP43 encoding cilia- and flagella-associated protein is preferentially expressed in the testis. Recent studies have revealed that mutations in this gene cause male infertility owing to morphologic abnormalities of sperm flagella. We knocked out mouse ortholog Cfap43 using CRISPR/Cas9 technology, resulting in Cfap43-deficient mice that exhibited a hydrocephalus phenotype with morphologic abnormality of motile cilia. Conclusion Our results strongly suggest that CFAP43 is responsible for morphologic or movement abnormalities of cilia in the brain that result in NPH.
Collapse
Affiliation(s)
- Yoshiro Morimoto
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Shintaro Yoshida
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Akira Kinoshita
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Chisei Satoh
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Hiroyuki Mishima
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Naohiro Yamaguchi
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Katsuya Matsuda
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Miako Sakaguchi
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Takeshi Tanaka
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Yoshihiro Komohara
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Akira Imamura
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Hiroki Ozawa
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Masahiro Nakashima
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Naohiro Kurotaki
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Tatsuya Kishino
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Koh-Ichiro Yoshiura
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan
| | - Shinji Ono
- From the Departments of Neuropsychiatry (Y.M., N.Y., H.O.) and Otolaryngology-Head and Neck Surgery (C.S.), Unit of Translation Medicine, and Department of Human Genetics (S.Y., A.K., H.M., K.-i.Y., S.O.), Nagasaki University Graduate School of Biomedical Sciences; Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute (K.M., M.N.), Central Laboratory, Institute of Tropical Medicine (NEKKEN) (M.S.), and Gene Research Center, Center for Frontier Life Sciences (T.K.), Nagasaki University; Department of Infectious Diseases (T.T.) and Child and Adolescent Psychiatry Community Partnership Unit (A.I.), Nagasaki University Hospital; Department of Cell Pathology (Y.K.), Graduate School of Medical Sciences, Kumamoto University; and Department of Clinical Psychology, Faculty of Medicine (N.K.), Kagawa University, Takamatsu, Japan.
| |
Collapse
|
19
|
Shanks J, Markenroth Bloch K, Laurell K, Cesarini KG, Fahlström M, Larsson EM, Virhammar J. Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery. AJNR Am J Neuroradiol 2019; 40:453-459. [PMID: 30792248 DOI: 10.3174/ajnr.a5972] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/31/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Increased CSF stroke volume through the cerebral aqueduct has been proposed as a possible indicator of positive surgical outcome in patients with idiopathic normal pressure hydrocephalus; however, consensus is lacking. In this prospective study, we aimed to compare CSF flow parameters in patients with idiopathic normal pressure hydrocephalus with those in healthy controls and change after shunt surgery and to investigate whether any parameter could predict surgical outcome. MATERIALS AND METHODS Twenty-one patients with idiopathic normal pressure hydrocephalus and 21 age- and sex-matched healthy controls were prospectively included and examined clinically and with MR imaging of the brain. Eighteen patients were treated with shunt implantation and were re-examined clinically and with MR imaging the day before the operation and 3 months postoperatively. All MR imaging scans included a phase-contrast sequence. RESULTS The median aqueductal CSF stroke volume was significantly larger in patients compared with healthy controls (103.5 μL; interquartile range, 69.8-142.8 μL) compared with 62.5 μL (interquartile range, 58.3-73.8 μL; P < .01) and was significantly reduced 3 months after shunt surgery from 94.8 μL (interquartile range, 81-241 μL) to 88 μL (interquartile range, 51.8-173.3 μL; P < .05). Net flow in the caudocranial direction (retrograde) was present in 11/21 patients and in 10/21 controls. Peak flow and net flow did not differ between patients and controls. There were no correlations between any CSF flow parameters and surgical outcomes. CONCLUSIONS Aqueductal CSF stroke volume was increased in patients with idiopathic normal pressure hydrocephalus and decreased after shunt surgery, whereas retrograde aqueductal net flow did not seem to be specific for patients with idiopathic normal pressure hydrocephalus. On the basis of the results, the usefulness of CSF flow parameters to predict outcome after shunt surgery seem to be limited.
Collapse
Affiliation(s)
- J Shanks
- From the Departments of Surgical Sciences and Radiology (J.S., M.F., E.-M.L.)
| | - K Markenroth Bloch
- Lund University Bioimaging Center (K.M.B.), Lund University, Lund, Sweden
| | - K Laurell
- Department of Pharmacology and Clinical Neuroscience (K.L.), Umeå University, Umeå, Sweden
| | | | - M Fahlström
- From the Departments of Surgical Sciences and Radiology (J.S., M.F., E.-M.L.)
| | - E-M Larsson
- From the Departments of Surgical Sciences and Radiology (J.S., M.F., E.-M.L.)
| | - J Virhammar
- Neuroscience and Neurology (J.V.), Uppsala University, Uppsala, Sweden
| |
Collapse
|
20
|
Agerskov S, Wallin M, Hellström P, Ziegelitz D, Wikkelsö C, Tullberg M. Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery. AJNR Am J Neuroradiol 2018; 40:74-79. [PMID: 30523139 DOI: 10.3174/ajnr.a5910] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have evaluated the use of MR imaging markers for the prediction of outcome after shunt surgery in idiopathic normal pressure hydrocephalus with conflicting results. Our aim was to investigate the predictive value of a number of earlier proposed morphologic MR imaging markers in a large group of patients with idiopathic normal pressure hydrocephalus. MATERIALS AND METHODS One hundred sixty-eight patients (mean age, 70 ± 9.3 years) with idiopathic normal pressure hydrocephalus, subjected to standardized quantification of clinical symptoms before and after shunt surgery, were included in the study. Outcome was calculated using a composite score. Preoperative T1, FLAIR, and flow-sensitive images were analyzed regarding the presence of 13 different morphologic MR imaging markers. RESULTS The median Evans index was 0.41 (interquartile range, 0.37-0.44). All patients had an aqueductal flow void sign present and white matter hyperintensities. The median callosal angle was 68.8° (interquartile range, 57.7°-80.8°). Dilated Sylvian fissures were found in 69%; focally dilated sulci, in 25%; and widening of the interhemispheric fissure, in 55%. Obliteration of the sulci at the convexity was found in 36%, and 36% of patients were characterized as having disproportionately enlarged subarachnoid space hydrocephalus. Sixty-eight percent of patients improved after surgery. None of the investigated MR imaging markers were significant predictors of improvement after shunt surgery. CONCLUSIONS Disproportionately enlarged subarachnoid space hydrocephalus, a small callosal angle, and the other MR imaging markers evaluated in this study should not be used to exclude patients from shunt surgery. These markers, though they may be indicative of idiopathic normal pressure hydrocephalus, do not seem to be a part of the mechanisms connected to the reversibility of the syndrome.
Collapse
Affiliation(s)
- S Agerskov
- From the Hydrocephalus Research Unit (S.A., M.W., P.H., C.W., M.T.), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology
| | - M Wallin
- From the Hydrocephalus Research Unit (S.A., M.W., P.H., C.W., M.T.), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology
| | - P Hellström
- From the Hydrocephalus Research Unit (S.A., M.W., P.H., C.W., M.T.), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology
| | - D Ziegelitz
- Department of Neuroradiology (D.Z.), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Wikkelsö
- From the Hydrocephalus Research Unit (S.A., M.W., P.H., C.W., M.T.), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology
| | - M Tullberg
- From the Hydrocephalus Research Unit (S.A., M.W., P.H., C.W., M.T.), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology
| |
Collapse
|
21
|
Ahmed AK, Luciano M, Moghekar A, Shin J, Aygun N, Sair HI, Rigamonti D, Blitz AM. Does the Presence or Absence of DESH Predict Outcomes in Adult Hydrocephalus? AJNR Am J Neuroradiol 2018; 39:2022-2026. [PMID: 30361433 DOI: 10.3174/ajnr.a5820] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/10/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The DESH (disproportionately enlarged subarachnoid-space hydrocephalus) pattern of "tight high-convexity and medial subarachnoid spaces, and enlarged Sylvian fissures with ventriculomegaly" is used to determine which patients undergo an operation for adult hydrocephalus at many centers. Our aim was to review adult hydrocephalus cases when DESH has not been a criterion for an operation to determine the prevalence of DESH among the cohort and compare the surgical outcomes in the presence or absence of DESH. MATERIALS AND METHODS A retrospective cohort study was conducted at a single institution (Johns Hopkins Hospital) to include patients surgically treated for adult hydrocephalus between 2003 and 2014 drawn from a data base of patients who had undergone standardized hydrocephalus protocol MR imaging. Preoperative imaging was reviewed by 2 blinded neuroradiologists to characterize the presence of DESH. Preoperative and postoperative clinical symptomatology was recorded. Frequencies were compared using the Fisher exact test, and nonparametric means were compared using the Mann-Whitney U Test. RESULTS One hundred thirty-three subjects were identified and included (96 DESH absent, 37 DESH present). Shunting led to significant improvement in gait and urinary and cognitive symptoms for the overall cohort and for patients with and without DESH (P < .05). The Fisher exact test did not demonstrate any significant differences in either gait or urinary or cognitive symptom improvement between patients with or without DESH (P > .05). CONCLUSIONS The current study demonstrated symptom improvement in patients with adult hydrocephalus following shunting, with no significant differences between subjects with and without DESH. Thus, shunt insertion for patients with adult hydrocephalus should not rely solely on the presence of preoperative DESH findings.
Collapse
Affiliation(s)
- A K Ahmed
- From the Departments of Neurosurgery (A.K.A., M.L., D.R.)
| | - M Luciano
- From the Departments of Neurosurgery (A.K.A., M.L., D.R.)
| | | | - J Shin
- Department of Radiology (J.S.), University of California, San Francisco, School of Medicine, San Francisco, California
| | - N Aygun
- Radiology and Radiological Sciences (N.A., H.I.S., A.M.B.), Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - H I Sair
- Radiology and Radiological Sciences (N.A., H.I.S., A.M.B.), Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D Rigamonti
- From the Departments of Neurosurgery (A.K.A., M.L., D.R.)
| | - A M Blitz
- Radiology and Radiological Sciences (N.A., H.I.S., A.M.B.), Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
22
|
Radiation-induced overexpression of transthyretin inhibits retinol-mediated hippocampal neurogenesis. Sci Rep 2018; 8:8394. [PMID: 29849106 PMCID: PMC5976673 DOI: 10.1038/s41598-018-26762-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/17/2018] [Indexed: 12/20/2022] Open
Abstract
Cranial irradiation is the main therapeutic strategy for treating primary and metastatic brain tumors. However, radiation is well-known to induce several unexpected side effects including emotional disorders. Although radiation-induced depression may cause decreased quality of life after radiotherapy, investigations of its molecular mechanism and therapeutic strategies are still insufficient. In this study, we found that behavioral symptoms of depression on mice models with the decrease of BrdU/NeuN- and Dcx-positive populations and MAP-2 expression in hippocampus were induced by cranial irradiation, and transthyretin (TTR) was highly expressed in hippocampus after irradiation. It was shown that overexpression of TTR resulted in the inhibition of retinol-mediated neuritogenesis. PAK1 phosphorylation and MAP-2 expression were significantly reduced by TTR overexpression following irradiation. Moreover, we observed that treatment of allantoin and neferine, the active components of Nelumbo nucifera, interrupted irradiation-induced TTR overexpression, consequently leading to the increase of PAK1 phosphorylation, neurite extension, BrdU/NeuN- and Dcx-positive populations, and MAP-2 expression. Behavioral symptoms of depression following cranial irradiation were also relieved by treatment of allantoin and neferine. These findings demonstrate that TTR plays a critical role in neurogenesis after irradiation, and allantoin and neferine could be potential drug candidates for recovering the effects of radiation on neurogenesis and depression.
Collapse
|
23
|
Virhammar J, Laurell K, Ahlgren A, Larsson EM. Arterial Spin-Labeling Perfusion MR Imaging Demonstrates Regional CBF Decrease in Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2017; 38:2081-2088. [PMID: 28860216 DOI: 10.3174/ajnr.a5347] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/12/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Regional cerebral blood flow has previously been studied in patients with idiopathic normal pressure hydrocephalus with imaging methods that require an intravenous contrast agent or expose the patient to ionizing radiation. The purpose of this study was to assess regional CBF in patients with idiopathic normal pressure hydrocephalus compared with healthy controls using the noninvasive quantitative arterial spin-labeling MR imaging technique. A secondary aim was to compare the correlation between symptom severity and CBF. MATERIALS AND METHODS Differences in regional cerebral perfusion between patients with idiopathic normal pressure hydrocephalus and healthy controls were investigated with pseudocontinuous arterial spin-labeling perfusion MR imaging. Twenty-one consecutive patients with idiopathic normal pressure hydrocephalus and 21 age- and sex-matched randomly selected healthy controls from the population registry were prospectively included. The controls did not differ from patients with respect to selected vascular risk factors. Twelve different anatomic ROIs were manually drawn on coregistered FLAIR images. The Holm-Bonferroni correction was applied to statistical analyses. RESULTS In patients with idiopathic normal pressure hydrocephalus, perfusion was reduced in the periventricular white matter (P < .001), lentiform nucleus (P < .001), and thalamus (P < .001) compared with controls. Cognitive function in patients correlated with CBF in the periventricular white matter (r = 0.60, P < .01), cerebellum (r = 0.63, P < .01), and pons (r = 0.71, P < .001). CONCLUSIONS Using pseudocontinuous arterial spin-labeling, we could confirm findings of a reduced perfusion in the periventricular white matter, basal ganglia, and thalamus in patients with idiopathic normal pressure hydrocephalus previously observed with other imaging techniques.
Collapse
Affiliation(s)
- J Virhammar
- From the Departments of Neuroscience, Neurology (J.V.)
| | - K Laurell
- Department of Pharmacology and Clinical Neuroscience (K.L.), Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - A Ahlgren
- Department of Medical Radiation Physics (A.A.), Lund University, Lund, Sweden
| | - E-M Larsson
- Surgical Sciences, Radiology (E.-M.L.), Uppsala University, Uppsala, Sweden
| |
Collapse
|
24
|
Israelsson H, Carlberg B, Wikkelsö C, Laurell K, Kahlon B, Leijon G, Eklund A, Malm J. Vascular risk factors in INPH: A prospective case-control study (the INPH-CRasH study). Neurology 2017; 88:577-585. [PMID: 28062721 DOI: 10.1212/wnl.0000000000003583] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 10/14/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the complete vascular risk factor (VRF) profile of idiopathic normal pressure hydrocephalus (INPH) using a large sample of representative patients with INPH and population-based controls to determine the extent to which vascular disease influences INPH pathophysiology. METHODS All patients with INPH who underwent shunting in Sweden in 2008-2010 were compared to age- and sex-matched population-based controls. Inclusion criteria were age 60-85 years and no dementia. The 10 most important VRFs and cerebrovascular and peripheral vascular disease were prospectively assessed using blood samples, clinical examinations, and standardized questionnaires. Assessed VRFs were hypertension, hyperlipidemia, diabetes, obesity, psychosocial factors, smoking habits, diet, alcohol intake, cardiac disease, and physical activity. RESULTS In total, 176 patients with INPH and 368 controls participated. Multivariable logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 2.380; 95% confidence interval [CI] 1.434-3.950), diabetes (OR 2.169; 95% CI 1.195-3.938), obesity (OR 5.428; 95% CI 2.502-11.772), and psychosocial factors (OR 5.343; 95% CI 3.219-8.868) were independently associated with INPH. Hypertension, physical inactivity, and cerebrovascular and peripheral vascular disease were also overrepresented in INPH. Moderate alcohol intake and physical activity were overrepresented among the controls. The population-attributable risk percentage was 24%. CONCLUSIONS Our findings confirm that patients with INPH have more VRFs and lack the protective factors present in the general population. Almost 25% of cases of INPH may be explained by VRFs. This suggests that INPH may be a subtype of vascular dementia. Targeted interventions against modifiable VRFs are likely to have beneficial effects on INPH.
Collapse
Affiliation(s)
- Hanna Israelsson
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden.
| | - Bo Carlberg
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Carsten Wikkelsö
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Katarina Laurell
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Babar Kahlon
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Göran Leijon
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Anders Eklund
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Jan Malm
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| |
Collapse
|
25
|
Narita W, Nishio Y, Baba T, Iizuka O, Ishihara T, Matsuda M, Iwasaki M, Tominaga T, Mori E. High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2016; 37:1831-1837. [PMID: 27365329 DOI: 10.3174/ajnr.a4838] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although neuroimaging plays an important role in the diagnosis of idiopathic normal pressure hydrocephalus, its predictive value for response to shunt surgery has not been established. The purpose of the current study was to identify neuroimaging markers that predict the shunt response of idiopathic normal pressure hydrocephalus. MATERIALS AND METHODS Sixty patients with idiopathic normal pressure hydrocephalus underwent presurgical brain MR imaging and clinical evaluation before and 1 year after shunt surgery. The assessed MR imaging features included the Evans index, high-convexity tightness, Sylvian fissure dilation, callosal angle, focal enlargement of the cortical sulci, bumps in the lateral ventricular roof, and deep white matter and periventricular hyperintensities. The idiopathic normal pressure hydrocephalus grading scale total score was used as a primary clinical outcome measure. We used measures for individual symptoms (ie, the idiopathic normal pressure hydrocephalus grading scale subdomain scores, such as gait, cognitive, and urinary scores), the Timed Up and Go test, and the Mini-Mental State Examination as secondary clinical outcome measures. The relationships between presurgical neuroimaging features and postoperative clinical changes were investigated by using simple linear regression analysis. To identify the set of presurgical MR imaging features that best predict surgical outcomes, we performed multiple linear regression analysis by using a bidirectional stepwise method. RESULTS Simple linear regression analyses demonstrated that presurgical high-convexity tightness, callosal angle, and Sylvian fissure dilation were significantly associated with the 1-year changes in the clinical symptoms. A multiple linear regression analysis demonstrated that presurgical high-convexity tightness alone predicted the improvement of the clinical symptoms 1 year after surgery. CONCLUSIONS High-convexity tightness is a neuroimaging feature predictive of shunt response in idiopathic normal pressure hydrocephalus.
Collapse
Affiliation(s)
- W Narita
- From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
| | - Y Nishio
- From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
| | - T Baba
- From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
| | - O Iizuka
- From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
| | - T Ishihara
- From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
| | - M Matsuda
- From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
| | - M Iwasaki
- Neurosurgery (M.I., T.T.), Tohoku University School of Medicine, Sendai, Japan
| | - T Tominaga
- Neurosurgery (M.I., T.T.), Tohoku University School of Medicine, Sendai, Japan
| | - E Mori
- From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
| |
Collapse
|
26
|
Halperin JJ, Kurlan R, Schwalb JM, Cusimano MD, Gronseth G, Gloss D. Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2016; 85:2063-71. [PMID: 26644048 DOI: 10.1212/wnl.0000000000002193] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated evidence for utility of shunting in idiopathic normal pressure hydrocephalus (iNPH) and for predictors of shunting effectiveness. METHODS We identified and classified relevant published studies according to 2004 and 2011 American Academy of Neurology methodology. RESULTS Of 21 articles, we identified 3 Class I articles. CONCLUSIONS Shunting is possibly effective in iNPH (96% chance subjective improvement, 83% chance improvement on timed walk test at 6 months) (3 Class III). Serious adverse event risk was 11% (1 Class III). Predictors of success included elevated Ro (1 Class I, multiple Class II), impaired cerebral blood flow reactivity to acetazolamide (by SPECT) (1 Class I), and positive response to either external lumbar drainage (1 Class III) or repeated lumbar punctures. Age may not be a prognostic factor (1 Class II). Data are insufficient to judge efficacy of radionuclide cisternography or aqueductal flow measurement by MRI. RECOMMENDATIONS Clinicians may choose to offer shunting for subjective iNPH symptoms and gait (Level C). Because of significant adverse event risk, risks and benefits should be carefully weighed (Level B). Clinicians should inform patients with iNPH with elevated Ro and their families that they have an increased chance of responding to shunting compared with those without such elevation (Level B). Clinicians may counsel patients with iNPH and their families that (1) positive response to external lumbar drainage or to repeated lumbar punctures increases the chance of response to shunting, and (2) increasing age does not decrease the chance of shunting being successful (both Level C).
Collapse
Affiliation(s)
- John J Halperin
- From the Overlook Medical Center (J.J.H., R.K.), Atlantic Neuroscience Institute, Summit, NJ; Department of Neurosurgery (J.M.S., M.D.C.), Henry Ford Medical Group, West Bloomfield, MI; Division of Neurosurgery (M.D.C.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; and Department of Neurology (D.G.), Geisinger Medical Center, Danville, PA
| | - Roger Kurlan
- From the Overlook Medical Center (J.J.H., R.K.), Atlantic Neuroscience Institute, Summit, NJ; Department of Neurosurgery (J.M.S., M.D.C.), Henry Ford Medical Group, West Bloomfield, MI; Division of Neurosurgery (M.D.C.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; and Department of Neurology (D.G.), Geisinger Medical Center, Danville, PA
| | - Jason M Schwalb
- From the Overlook Medical Center (J.J.H., R.K.), Atlantic Neuroscience Institute, Summit, NJ; Department of Neurosurgery (J.M.S., M.D.C.), Henry Ford Medical Group, West Bloomfield, MI; Division of Neurosurgery (M.D.C.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; and Department of Neurology (D.G.), Geisinger Medical Center, Danville, PA
| | - Michael D Cusimano
- From the Overlook Medical Center (J.J.H., R.K.), Atlantic Neuroscience Institute, Summit, NJ; Department of Neurosurgery (J.M.S., M.D.C.), Henry Ford Medical Group, West Bloomfield, MI; Division of Neurosurgery (M.D.C.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; and Department of Neurology (D.G.), Geisinger Medical Center, Danville, PA
| | - Gary Gronseth
- From the Overlook Medical Center (J.J.H., R.K.), Atlantic Neuroscience Institute, Summit, NJ; Department of Neurosurgery (J.M.S., M.D.C.), Henry Ford Medical Group, West Bloomfield, MI; Division of Neurosurgery (M.D.C.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; and Department of Neurology (D.G.), Geisinger Medical Center, Danville, PA
| | - David Gloss
- From the Overlook Medical Center (J.J.H., R.K.), Atlantic Neuroscience Institute, Summit, NJ; Department of Neurosurgery (J.M.S., M.D.C.), Henry Ford Medical Group, West Bloomfield, MI; Division of Neurosurgery (M.D.C.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; and Department of Neurology (D.G.), Geisinger Medical Center, Danville, PA
| |
Collapse
|
27
|
Yamada S, Ishikawa M, Yamamoto K. Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease. AJNR Am J Neuroradiol 2016; 37:1249-55. [PMID: 26915568 DOI: 10.3174/ajnr.a4695] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/07/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CSF volumes in the basal cistern and Sylvian fissure are increased in both idiopathic normal pressure hydrocephalus and Alzheimer disease, though the differences in these volumes in idiopathic normal pressure hydrocephalus and Alzheimer disease have not been well-described. Using CSF segmentation and volume quantification, we compared the distribution of CSF in idiopathic normal pressure hydrocephalus and Alzheimer disease. MATERIALS AND METHODS CSF volumes were extracted from T2-weighted 3D spin-echo sequences on 3T MR imaging and quantified semi-automatically. We compared the volumes and ratios of the ventricles and subarachnoid spaces after classification in 30 patients diagnosed with idiopathic normal pressure hydrocephalus, 10 with concurrent idiopathic normal pressure hydrocephalus and Alzheimer disease, 18 with Alzheimer disease, and 26 control subjects 60 years of age or older. RESULTS Brain to ventricle ratios at the anterior and posterior commissure levels and 3D volumetric convexity cistern to ventricle ratios were useful indices for the differential diagnosis of idiopathic normal pressure hydrocephalus or idiopathic normal pressure hydrocephalus with Alzheimer disease from Alzheimer disease, similar to the z-Evans index and callosal angle. The most distinctive characteristics of the CSF distribution in idiopathic normal pressure hydrocephalus were small convexity subarachnoid spaces and the large volume of the basal cistern and Sylvian fissure. The distribution of the subarachnoid spaces in the idiopathic normal pressure hydrocephalus with Alzheimer disease group was the most deformed among these 3 groups, though the mean ventricular volume of the idiopathic normal pressure hydrocephalus with Alzheimer disease group was intermediate between that of the idiopathic normal pressure hydrocephalus and Alzheimer disease groups. CONCLUSIONS The z-axial expansion of the lateral ventricle and compression of the brain just above the ventricle were the common findings in the parameters for differentiating idiopathic normal pressure hydrocephalus from Alzheimer disease.
Collapse
Affiliation(s)
- S Yamada
- From the Normal Pressure Hydrocephalus Center (S.Y., M.I.) Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
| | - M Ishikawa
- From the Normal Pressure Hydrocephalus Center (S.Y., M.I.) Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| | - K Yamamoto
- Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| |
Collapse
|
28
|
|
29
|
Jaraj D, Agerskov S, Rabiei K, Marlow T, Jensen C, Guo X, Kern S, Wikkelsø C, Skoog I. Vascular factors in suspected normal pressure hydrocephalus: A population-based study. Neurology 2016; 86:592-9. [PMID: 26773072 DOI: 10.1212/wnl.0000000000002369] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/04/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE We examined clinical and imaging findings of suspected idiopathic normal pressure hydrocephalus (iNPH) in relation to vascular risk factors and white matter lesions (WMLs), using a nested case-control design in a representative, population-based sample. METHODS From a population-based sample, 1,235 persons aged 70 years or older were examined with CT of the brain between 1986 and 2000. We identified 55 persons with hydrocephalic ventricular enlargement, i.e., radiologic findings consistent with iNPH. Among these, 26 had clinical signs that fulfilled international guideline criteria for probable iNPH. These cases were labeled suspected iNPH. Each case was matched to 5 controls from the same sample, based on age, sex, and study cohort. Data on risk factors were obtained from clinical examinations and the Swedish Hospital Discharge Register. History of hypertension, diabetes mellitus (DM), smoking, overweight, history of coronary artery disease, stroke/TIA, and WMLs on CT were examined. Risk factors associated with iNPH with a p value <0.1 in χ2 tests were included in conditional logistic regression models. RESULTS In the regression analyses, suspected iNPH was related to moderate to severe WMLs (odds ratio [OR] 5.2; 95% confidence interval [CI]: 1.5-17.6), while hydrocephalic ventricular enlargement was related to hypertension (OR 2.7; 95% CI: 1.1-6.8), moderate to severe WMLs (OR 6.5; 95% CI: 2.1-20.3), and DM (OR 4.3; 95% CI: 1.1-16.3). CONCLUSIONS Hypertension, WMLs, and DM were related to clinical and imaging features of iNPH, suggesting that vascular mechanisms are involved in the pathophysiology. These findings might have implications for understanding disease mechanisms in iNPH and possibly prevention.
Collapse
Affiliation(s)
- Daniel Jaraj
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
| | - Simon Agerskov
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| | - Katrin Rabiei
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| | - Thomas Marlow
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| | - Christer Jensen
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| | - Xinxin Guo
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| | - Silke Kern
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| | - Carsten Wikkelsø
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| | - Ingmar Skoog
- From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden
| |
Collapse
|
30
|
Virhammar J, Warntjes M, Laurell K, Larsson EM. Quantitative MRI for Rapid and User-Independent Monitoring of Intracranial CSF Volume in Hydrocephalus. AJNR Am J Neuroradiol 2015; 37:797-801. [PMID: 26705322 DOI: 10.3174/ajnr.a4627] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/25/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative MR imaging allows segmentation of different tissue types and automatic calculation of intracranial volume, CSF volume, and brain parenchymal fraction. Brain parenchymal fraction is calculated as (intracranial volume - CSF volume) / intracranial volume. The purpose of this study was to evaluate whether the automatic calculation of intracranial CSF volume or brain parenchymal fraction could be used as an objective method to monitor volume changes in the ventricles. MATERIALS AND METHODS A lumbar puncture with drainage of 40 mL of CSF was performed in 23 patients under evaluation for idiopathic normal pressure hydrocephalus. Quantitative MR imaging was performed twice within 1 hour before the lumbar puncture and was repeated 30 minutes, 4 hours, and 24 hours afterward. For each time point, the volume of the lateral ventricles was manually segmented and total intracranial CSF volume and brain parenchymal fraction were automatically calculated by using Synthetic MR postprocessing. RESULTS At 30 minutes after the lumbar puncture, the volume of the lateral ventricles decreased by 5.6 ± 1.9 mL (P < .0001) and the total intracranial CSF volume decreased by 11.3 ± 5.6 mL (P < .001), while brain parenchymal fraction increased by 0.78% ± 0.41% (P < .001). Differences were significant for manual segmentation and brain parenchymal fraction even at 4 hours and 24 hours after the lumbar tap. There was a significant association using a linear mixed model between change in manually segmented ventricular volume and change in brain parenchymal fraction and total CSF volume, (P < .0001). CONCLUSIONS Brain parenchymal fraction is provided rapidly and fully automatically with Synthetic MRI and can be used to monitor ventricular volume changes. The method may be useful for objective clinical monitoring of hydrocephalus.
Collapse
Affiliation(s)
- J Virhammar
- From the Departments of Neuroscience, Neurology (J.V.)
| | - M Warntjes
- Center for Medical Imaging Science and Visualization (M.W.), Linköping University, Linköping, Sweden SyntheticMR (M.W.), Linköping, Sweden
| | - K Laurell
- Department of Pharmacology and Clinical Neuroscience (K.L.), Umeå University, Umeå, Sweden
| | - E-M Larsson
- Surgical Sciences, Radiology (E.-M.L.), Uppsala University, Uppsala, Sweden
| |
Collapse
|
31
|
Yamada S, Ishikawa M, Yamamoto K. Optimal Diagnostic Indices for Idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space. AJNR Am J Neuroradiol 2015; 36:2262-9. [PMID: 26359148 DOI: 10.3174/ajnr.a4440] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/01/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite the remarkable progress of 3D graphics technology, the Evans index has been the most popular index for ventricular enlargement. We investigated a novel reliable index for the MR imaging features specified in idiopathic normal pressure hydrocephalus, rather than the Evans index. MATERIALS AND METHODS The patients with suspected idiopathic normal pressure hydrocephalus on the basis of the ventriculomegaly and a triad of symptoms underwent the CSF tap test. CSF volumes were extracted from a T2-weighted 3D spin-echo sequence named "sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE)" on 3T MR imaging and were quantified semiautomatically. Subarachnoid spaces were divided as follows: upper and lower parts and 4 compartments of frontal convexity, parietal convexity, Sylvian fissure and basal cistern, and posterior fossa. The maximum length of 3 axial directions in the bilateral ventricles and their frontal horns was measured. The "z-Evans Index" was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. These parameters were evaluated for the predictive accuracy for the tap-positive groups compared with the tap-negative groups and age-adjusted odds ratios at the optimal thresholds. RESULTS In this study, 24 patients with tap-positive idiopathic normal pressure hydrocephalus, 25 patients without response to the tap test, and 23 age-matched controls were included. The frontal horns of the bilateral ventricles were expanded, with the most excessive expansion being toward the z-direction. The CSF volume of the parietal convexity had the highest area under the receiver operating characteristic curve (0.768), the z-Evans Index was the second (0.758), and the upper-to-lower subarachnoid space ratio index was the third (0.723), to discriminate the tap-test response. CONCLUSIONS The CSF volume of the parietal convexity of <38 mL, upper-to-lower subarachnoid space ratio of <0.33, and the z-Evans Index of >0.42 were newly proposed useful indices for the idiopathic normal pressure hydrocephalus diagnosis, an alternative to the Evans Index.
Collapse
Affiliation(s)
- S Yamada
- From the Normal Pressure Hydrocephalus Center (S.Y., M.I.) Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
| | - M Ishikawa
- From the Normal Pressure Hydrocephalus Center (S.Y., M.I.) Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| | - K Yamamoto
- Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| |
Collapse
|
32
|
Cho KR, Lee MH, Kong DS, Seol HJ, Nam DH, Sun JM, Ahn JS, Ahn MJ, Park K, Kim ST, Lim DH, Lee JI. Outcome of gamma knife radiosurgery for metastatic brain tumors derived from non-small cell lung cancer. J Neurooncol 2015; 125:331-8. [PMID: 26373297 DOI: 10.1007/s11060-015-1915-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 08/29/2015] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to analyze outcomes in patients treated with gamma knife radiosurgery (GKS) for brain metastases from non-small cell lung cancer (NSCLC). We retrospectively reviewed the medical records of 817 patients who underwent GKS for brain metastases from NSCLC between January 2002 and December 2012. A total of 1363 GKS procedures were performed for 2970 lesions. The median overall survival time from the initial GKS was 13 months and the salvage treatment-free survival from the first GKS was 6.5 months. Younger age (≤65 years), female sex, better RPA class, higher DS-GPA score, adenocarcinoma, synchronous onset, and lower integrated value of the "numbers and cumulative volume of tumors" were associated with better outcomes. Among the 601 patients with an available follow up image, the pattern of the first progression after initial GKS was the development of new lesions in 356 patients (59.2 %), regrowth of treated lesions in 106 patients (17.6 %), and leptomeningeal seeding (LMS) in 51 patients (8.5 %). Among the deceased, the last MRI performed prior to death was evaluated in 409 patients and showed progression in 263 patients (64.3 %), despite multiple salvage treatments. LMS was identified in 63 patients (15.4 %); a rate much higher than the incidence at first progression. Intracranial tumor burden, defined as the integrated value of the "number of the lesions and cumulative tumor volume", is a new prognostic factor of greater significance than tumor volume or number alone when analyzed as separate factors. Although the cause of death was not progression of brain lesions in the majority of patients, the brain lesions tended to have been persistently progressive in most patients, despite repeated salvage treatment. LMS is an important pattern of treatment failure, in addition to local progression or development of new lesions, particularly in the terminal phase of the disease.
Collapse
Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam Gu, Seoul, 135-710, Korea
| | - Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam Gu, Seoul, 135-710, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam Gu, Seoul, 135-710, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam Gu, Seoul, 135-710, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam Gu, Seoul, 135-710, Korea
| | - Jong-Mu Sun
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keunchil Park
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hun Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam Gu, Seoul, 135-710, Korea.
| |
Collapse
|
33
|
Son Y, Yang M, Wang H, Moon C. Hippocampal dysfunctions caused by cranial irradiation: a review of the experimental evidence. Brain Behav Immun 2015; 45:287-96. [PMID: 25596174 DOI: 10.1016/j.bbi.2015.01.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 12/11/2022] Open
Abstract
Cranial irradiation (IR) is commonly used for the treatment of brain tumors but may cause disastrous brain injury, especially in the hippocampus, which has important cognition and emotional regulation functions. Several preclinical studies have investigated the mechanisms associated with cranial IR-induced hippocampal dysfunction such as memory defects and depression-like behavior. However, current research on hippocampal dysfunction and its associated mechanisms, with the ultimate goal of overcoming the side effects of cranial radiation therapy in the hippocampus, is still very much in progress. This article reviews several in vivo studies on the possible mechanisms of radiation-induced hippocampal dysfunction, which may be associated with hippocampal neurogenesis, neurotrophin and neuroinflammation. Thus, this review may be helpful to gain new mechanistic insights into hippocampal dysfunction following cranial IR and provide effective strategies for potential therapeutic approaches for cancer patients receiving radiation therapy.
Collapse
Affiliation(s)
- Yeonghoon Son
- Department of Veterinary Anatomy, College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, South Korea
| | - Miyoung Yang
- Department of Physiology and Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA
| | - Hongbing Wang
- Department of Physiology and Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA
| | - Changjong Moon
- Department of Veterinary Anatomy, College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, South Korea.
| |
Collapse
|
34
|
Hawasli AH, Bagade S, Shimony JS, Miller-Thomas M, Leuthardt EC. Magnetic resonance imaging-guided focused laser interstitial thermal therapy for intracranial lesions: single-institution series. Neurosurgery 2014; 73:1007-17. [PMID: 24056317 PMCID: PMC3871404 DOI: 10.1227/neu.0000000000000144] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging–guided focused laser interstitial thermal therapy (LITT) offers a minimally invasive surgical treatment option for such lesions. OBJECTIVE: To review treatments and results of patients treated with LITT for intracranial lesions at Washington University School of Medicine. METHODS: In a review of 17 prospectively recruited LITT patients (34-78 years of age; mean, 59 years), we report demographics, treatment details, postoperative imaging characteristics, and peri- and postoperative clinical courses. RESULTS: Targets included 11 gliomas, 5 brain metastases, and 1 epilepsy focus. Lesions were lobar (n = 8), thalamic/basal ganglia (n = 5), insular (n = 3), and corpus callosum (n = 1). Mean target volume was 11.6 cm3, and LITT produced 93% target ablation. Patients with superficial lesions had shorter intensive care unit stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep venous thrombosis, and fatal meningitis. Postoperative magnetic resonance imaging showed blood products within the lesion surrounded by new thin uniform rim of contrast enhancement and diffusion restriction. In conjunction with other therapies, LITT targets often showed stable or reduced local disease. Epilepsy focus LITT produced seizure freedom at 8 months. Preliminary overall median progression-free survival and survival from LITT in tumor patients were 7.6 and 10.9 months, respectively. However, this small cohort has not been followed for a sufficient length of time, necessitating future outcomes studies. CONCLUSION: Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients. ABBREVIATION: LITT, laser interstitial thermal therapy
Collapse
Affiliation(s)
- Ammar H Hawasli
- Departments of Neurosurgery and Mallinckrodt Institute of Radiology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | | | | | | | | |
Collapse
|
35
|
Esmaeilzadeh M, Majlesara A, Faridar A, Hafezi M, Hong B, Esmaeilnia-Shirvani H, Neyazi B, Mehrabi A, Nakamura M. Brain metastasis from gastrointestinal cancers: a systematic review. Int J Clin Pract 2014; 68:890-9. [PMID: 24666726 DOI: 10.1111/ijcp.12395] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Brain metastases (BM) from the gastrointestinal tract (GIT) cancers are relatively rare. Despite those advances in diagnostic and treatment options, life expectancy and quality of life in these patients are still poor. In this review, we present an overview of the studies which have been previously performed as well as a comprehensive strategy for the assessment and treatment of BM from the GIT cancers. METHOD To obtain information on brain metastases from GIT, we performed a systematic review of Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The collected data included patient characteristics, primary tumor data and brain metastases data. RESULT In our search of the literature, we found 74 studies between 1980 and 2011, which included 2538 patients with brain metastases originated from gastrointestinal cancer. Analysis of available data showed that among 2538 patients who had brain metastases from GIT, a total of 116 patients (4.57%) had esophageal cancer, 148 patients (5.83%) had gastric cancer, 233 patients (9.18%) had liver cancer, 13 patients had pancreas cancer (0.52%) and 2028 patients (79.90%) had colorectal cancer. The total median age of the patients was 58.9 years. CONCLUSION Brain metastases have been considered the most common structural neurological complication of systemic cancer. Due to poor prognosis they influence the survival rate as well as the quality of life of the patients. The treatment of cerebral metastasis depends on the patients' situation and the decisions of the treating physicians. The early awareness of a probable metastasis from GI to the brain will have a great influence on treatment outcomes as well as the survival rate and the quality-of-life of the patients.
Collapse
Affiliation(s)
- M Esmaeilzadeh
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Lee MH, Kong DS, Seol HJ, Nam DH, Lee JI. Risk of seizure and its clinical implication in the patients with cerebral metastasis from lung cancer. Acta Neurochir (Wien) 2013; 155:1833-7. [PMID: 23982228 DOI: 10.1007/s00701-013-1826-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/18/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The prevalence, risk factors, and clinical implication of seizure development were investigated in patients with metastatic brain tumors. METHODS Medical records and radiological findings were analyzed retrospectively in 258 patients with brain metastasis from lung cancer who underwent Gamma Knife radiosurgery (GKS) between January 2008 and December 2009. RESULTS During the follow-up period 32 patients (12.4 %) experienced seizure episodes. Coexistence of leptomeningeal seeding was a significant risk factor related to development of seizure (p < 0.001). Prophylactic use of anticonvulsants was not correlated with reduction of seizure incidence (p = 0.818). Continued use of anticonvulsants was necessary in nine of the 258 patients (3.5 %) because of recurrent seizures. Imaging studies performed immediately after seizure attacks in the patients with known metastatic brain lesions revealed tumor progression or complications related to treatment in 35 of 42 episodes of seizure (77.8 %). CONCLUSIONS Patients with metastatic lesions have a substantial risk of developing seizure. Seizure in known metastatic brain tumor patients are usually related to disease progression or complications of treatment. Follow-up imaging should be considered for each seizure episode and adequate multimodal treatment needs to be added to antiepileptic medication.
Collapse
Affiliation(s)
- Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
37
|
Maschio M. Brain tumor-related epilepsy. Curr Neuropharmacol 2012; 10:124-33. [PMID: 23204982 PMCID: PMC3386502 DOI: 10.2174/157015912800604470] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 11/19/2011] [Accepted: 12/21/2011] [Indexed: 01/12/2023] Open
Abstract
In patients with brain tumor (BT), seizures are the onset symptom in 20-40% of patients, while a further 20-45% of patients will present them during the course of the disease. These patients present a complex therapeutic profile and require a unique and multidisciplinary approach. The choice of antiepileptic drugs is challenging for this particular patient population because brain tumor-related epilepsy (BTRE) is often drug-resistant, has a strong impact on the quality of life and weighs heavily on public health expenditures.In BT patients, the presence of epilepsy is considered the most important risk factor for long-term disability. For this reason, the problem of the proper administration of medications and their potential side effects is of great importance, because good seizure control can significantly improve the patient's psychological and relational sphere. In these patients, new generation drugs such as gabapentin, lacosamide, levetiracetam, oxcarbazepine, pregabalin, topiramate, zonisamide are preferred because they have fewer drug interactions and cause fewer side effects. Among the recently marketed drugs, lacosamide has demonstrated promising results and should be considered a possible treatment option. Therefore, it is necessary to develop a customized treatment plan for each individual patient with BTRE. This requires a vision of patient management concerned not only with medical therapies (pharmacological, surgical, radiological, etc.) but also with emotional and psychological support for the individual as well as his or her family throughout all stages of the illness.
Collapse
Affiliation(s)
- Marta Maschio
- Center for Tumor-Related Epilepsy, Neurology Unit, Department of Neuroscience and Cervical-Facial Pathology, National Institute for Cancer “Regina Elena” Via Elio Chianesi, 53 00144 Roma, Italy
| |
Collapse
|
38
|
Moroni R, Cipelletti B, Inverardi F, Regondi M, Spreafico R, Frassoni C. Development of cortical malformations in BCNU-treated rat, model of cortical dysplasia. Neuroscience 2011; 175:380-93. [DOI: 10.1016/j.neuroscience.2010.11.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 11/25/2010] [Accepted: 11/30/2010] [Indexed: 01/30/2023]
|
39
|
Cognitive Sparing during the Administration of Whole Brain Radiotherapy and Prophylactic Cranial Irradiation: Current Concepts and Approaches. JOURNAL OF ONCOLOGY 2010; 2010:198208. [PMID: 20671962 PMCID: PMC2910483 DOI: 10.1155/2010/198208] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 04/07/2010] [Indexed: 12/25/2022]
Abstract
Whole brain radiotherapy (WBRT) for the palliation of metastases, or as prophylaxis to prevent intracranial metastases, can be associated with subacute and late decline in memory and other cognitive functions. Moreover, these changes are often increased in both frequency and severity when cranial irradiation is combined with the use of systemic or intrathecal chemotherapy. Approaches to preventing or reducing this toxicity include the use of stereotactic radiosurgery (SRS) instead of WBRT; dose reduction for PCI; exclusion of the limbic circuit, hippocampal formation, and/or neural stem cell regions of the brain during radiotherapy; avoidance of intrathecal and/or systemic chemotherapy during radiotherapy; the use of high-dose, systemic chemotherapy in lieu of WBRT. This review discusses these concepts in detail as well as providing both neuroanatomic and radiobiologic background relevant to these issues.
Collapse
|
40
|
Dong Y, Chin SF, Blanco E, Bey EA, Kabbani W, Xie XJ, Bornmann WG, Boothman DA, Gao J. Intratumoral delivery of beta-lapachone via polymer implants for prostate cancer therapy. Clin Cancer Res 2009; 15:131-9. [PMID: 19118040 DOI: 10.1158/1078-0432.ccr-08-1691] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE beta-Lapachone (ARQ 501, a formulation of beta-lapachone complexed with hydroxypropyl-beta-cyclodextrin) is a novel anticancer agent with selectivity against prostate cancer cells overexpressing the NAD(P)H:quinone oxidoreductase-1 enzyme. Lack of solubility and an efficient drug delivery strategy limits this compound in clinical applications. In this study, we aimed to develop beta-lapachone-containing polymer implants (millirods) for direct implantation into prostate tumors to test the hypothesis that the combination of a tumor-specific anticancer agent with site-specific release of the agent will lead to significant antitumor efficacy. EXPERIMENTAL DESIGN Survival assays in vitro were used to test the killing effect of beta-lapachone in different prostate cancer cells. beta-Lapachone release kinetics from millirods was determined in vitro and in vivo. PC-3 prostate tumor xenografts in athymic nude mice were used for antitumor efficacy studies in vivo. RESULTS beta-Lapachone killed three different prostate cancer cell lines in an NAD(P)H:quinone oxidoreductase-1-dependent manner. Upon incorporation of solid-state inclusion complexes of beta-lapachone with hydroxypropyl-beta-cyclodextrin into poly(D,L-lactide-co-glycolide) millirods, beta-lapachone release kinetics in vivo showed a burst release of approximately 0.5 mg within 12 hours and a subsequently sustained release of the drug ( approximately 0.4 mg/kg/d) comparable with that observed in vitro. Antitumor efficacy studies showed significant tumor growth inhibition by beta-lapachone millirods compared with controls (P < 0.0001; n = 10 per group). Kaplan-Meier survival curves showed that tumor-bearing mice treated with beta-lapachone millirods survived nearly 2-fold longer than controls, without observable systemic toxicity. CONCLUSIONS Intratumoral delivery of beta-lapachone using polymer millirods showed the promising therapeutic potential for human prostate tumors.
Collapse
Affiliation(s)
- Ying Dong
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Higuchi Y, Serizawa T, Nagano O, Matsuda S, Ono J, Sato M, Iwadate Y, Saeki N. Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors. Int J Radiat Oncol Biol Phys 2009; 74:1543-8. [PMID: 19135317 DOI: 10.1016/j.ijrobp.2008.10.035] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 09/14/2008] [Accepted: 10/13/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the efficacy and toxicity of staged stereotactic radiotherapy with a 2-week interfraction interval for unresectable brain metastases more than 10 cm(3) in volume. PATIENTS AND METHODS Subjects included 43 patients (24 men and 19 women), ranging in age from 41 to 84 years, who had large brain metastases (> 10 cc in volume). Primary tumors were in the colon in 14 patients, lung in 12, breast in 11, and other in 6. The peripheral dose was 10 Gy in three fractions. The interval between fractions was 2 weeks. The mean tumor volume before treatment was 17.6 +/- 6.3 cm(3) (mean +/- SD). Mean follow-up interval was 7.8 months. The local tumor control rate, as well as overall, neurological, and qualitative survivals, were calculated using the Kaplan-Meier method. RESULTS At the time of the second and third fractions, mean tumor volumes were 14.3 +/- 6.5 (18.8% reduction) and 10.6 +/- 6.1 cm(3) (39.8% reduction), respectively, showing significant reductions. The median overall survival period was 8.8 months. Neurological and qualitative survivals at 12 months were 81.8% and 76.2%, respectively. Local tumor control rates were 89.8% and 75.9% at 6 and 12 months, respectively. Tumor recurrence-free and symptomatic edema-free rates at 12 months were 80.7% and 84.4%, respectively. CONCLUSIONS The 2-week interval allowed significant reduction of the treatment volume. Our results suggest staged stereotactic radiotherapy using our protocol to be a possible alternative for treating large brain metastases.
Collapse
Affiliation(s)
- Yoshinori Higuchi
- Department of Neurosurgery, Chiba Cardiovascular Center, Ichihara, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Cell proliferation index predicts relapse of brain metastases in non-irradiated patients. Acta Neurochir (Wien) 2008; 150:1043-8; discussion 1048. [PMID: 18773139 DOI: 10.1007/s00701-008-0020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 01/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Brain metastasis is a common complication and a major cause of morbidity and mortality in human malignancies. We investigated whether the proliferating cell index of surgically treated single brain metastasis would predict the relapse at a location remote from the initial resection site within 2 months of the excision in patients with uncontrolled systemic disease and not subjected to adjuvant whole brain radio-therapy. MATERIALS AND METHODS Tissue biopsies derived from 25 patients with brain metastases specifically selected to be a single totally resected lesion and not treated subsequently by radiotherapy to the whole brain were stained by immunohistochemistry for the marker CDC47 and the proliferation index was calculated. The index was then analysed with respect to clinical parameters, including the incidence of brain relapse within 2 months of the first resection, the timing of diagnosis of brain metastasis as compared to the primary cancer diagnosis, and the perifocal brain oedema. RESULTS Statistical evaluation of the indexes in the patients with brain metastases relapsing within 2 months after the first craniotomy (n = 13) revealed significantly higher values as compared to the patients with lesions which had not relapsed or which had relapsed more than 2 months after first craniotomy (n = 12). The synchronous brain metastasis (that is, those occurring before or within 2 months of the primary cancer diagnosis) had a significantly higher proliferation index than the metachronous lesions (those occurring more than 2 months after primary cancer diagnosis). CONCLUSIONS The synchronous brain metastasis relapses within 2 months of primary resection and have a significantly higher proliferation index than the metachronous lesions which did not recur within 2 months. These results indicate that the estimation of the proliferation index of metastatic brain tumours may be helpful in predicting the course of disease progression.
Collapse
|
43
|
Rowley HA, Scialfa G, Gao PY, Maldjian JA, Hassell D, Kuhn MJ, Wippold FJ, Gallucci M, Bowen BC, Schmalfuss IM, Ruscalleda J, Bastianello S, Colosimo C. Contrast-enhanced MR imaging of brain lesions: a large-scale intraindividual crossover comparison of gadobenate dimeglumine versus gadodiamide. AJNR Am J Neuroradiol 2008; 29:1684-91. [PMID: 18599575 DOI: 10.3174/ajnr.a1185] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The higher relaxivity of gadobenate dimeglumine compared with gadodiamide is potentially advantageous for contrast-enhanced brain MR imaging. This study intraindividually compared 0.1-mmol/kg doses of these agents for qualitative and quantitative lesion enhancement. MATERIALS AND METHODS Adult patients with suggested or known brain lesions underwent 2 identical MR imaging examinations at 1.5T, one with gadobenate dimeglumine and the other with gadodiamide. The agents were administered in randomized order separated by 3-14 days. Imaging sequences and postinjection acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images qualitatively for diagnostic information (lesion extent, delineation, morphology, enhancement, and global preference) and quantitatively for contrast-to-noise ratio (CNR). RESULTS One hundred thirteen of 138 enrolled patients successfully underwent both examinations. Final diagnoses were intra-axial tumor, metastasis, extra-axial tumor, or other (47, 27, 18, and 21 subjects, respectively). Readers 1, 2, and 3 demonstrated global preference for gadobenate dimeglumine in 63 (55.8%), 77 (68.1%), and 73 (64.6%) patients, respectively, compared with 3, 2, and 3 patients for gadodiamide (P < .0001, all readers). Highly significant (P < .0001, all readers) preference for gadobenate dimeglumine was demonstrated for all qualitative end points and for CNR (increases of 23.3%-34.7% and 42.4%-48.9% [spin-echo and gradient-refocused echo sequences, respectively] for gadobenate dimeglumine compared with gadodiamide). Inter-reader agreement was good for all evaluations (kappa = 0.47-0.69). Significant preference for gadobenate dimeglumine was demonstrated for all lesion subgroup analyses. CONCLUSION Significantly greater diagnostic information and lesion enhancement are achieved on brain MR imaging with 0.1-mmol/kg gadobenate dimeglumine compared with gadodiamide at an equivalent dose.
Collapse
Affiliation(s)
- H A Rowley
- Department of Radiology, University of Wisconsin, Madison, WI 53792-3252, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Moroni RF, Inverardi F, Regondi MC, Panzica F, Spreafico R, Frassoni C. Altered spatial distribution of PV-cortical cells and dysmorphic neurons in the somatosensory cortex of BCNU-treated rat model of cortical dysplasia. Epilepsia 2008; 49:872-87. [DOI: 10.1111/j.1528-1167.2007.01440.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Picozzi P, Kirchin MA. Improving lesion detection and visualization: implications for neurosurgical planning and follow-up. Neuroradiology 2007; 49 Suppl 1:S27-34. [PMID: 17665155 DOI: 10.1007/s00234-007-1470-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Contrast-enhanced magnetic resonance (MR) imaging is considered the most sensitive method for detecting tumors in the central nervous system (CNS). The primary objective is to improve lesion detection, delineation, and characterization (benign or malignant) in order to more accurately define the location, extent, and type of disease and the appropriate treatment option for improved patient outcome (surgical intervention, radiation therapy or cytotoxic chemotherapy). This article reviews the various types of tumor occurring in the brain and the specific role of contrast-enhanced MR imaging for the evaluation of these tumors. Emphasis is placed on the value of contrast-enhanced MR imaging in the evaluation of primary intra-axial brain lesions and how high relaxivity contrast agents such as MultiHance (Bracco Imaging, Milan, Italy) might improve detection, treatment planning, and follow-up.
Collapse
Affiliation(s)
- Piero Picozzi
- Department of Neurosurgery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
| | | |
Collapse
|
46
|
Ku GY, Krol G, Ilson DH. Successful Treatment of Leptomeningeal Disease in Colorectal Cancer With a Regimen of Bevacizumab, Temozolomide, and Irinotecan. J Clin Oncol 2007; 25:e14-6. [PMID: 17470852 DOI: 10.1200/jco.2006.10.3317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
47
|
Gallego JM, Barcia JA, Barcia-Mariño C. Fatal outcome related to carmustine implants in glioblastoma multiforme. Acta Neurochir (Wien) 2007; 149:261-5; discussion 265. [PMID: 17334672 DOI: 10.1007/s00701-006-1097-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 12/13/2006] [Indexed: 12/01/2022]
Abstract
Following the resection of newly diagnosed or recurrent glioblastomas, local implantation of carmustine-impregnated biodegradable wafers (Gliadel) in the resection cavity constitutes an adjuvant therapy that can improve the possibilities of survival. However, some precautions should be taken regarding Gliadel implantation. We report three cases in whom patients with glioblastoma multiforme were implanted with fibrin glue-secured Gliadel after the lateral ventricles had been opened, and who later developed severe hydrocephalus leading to death. Although Gliadel may be an important adjunct to treatment, opening of the ventricles during surgery as part of its application should be considered a contra-indication.
Collapse
Affiliation(s)
- J M Gallego
- Servicio de Neurocirugía, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | | |
Collapse
|
48
|
DiLuna ML, King JT, Knisely JPS, Chiang VL. Prognostic factors for survival after stereotactic radiosurgery vary with the number of cerebral metastases. Cancer 2007; 109:135-45. [PMID: 17133440 DOI: 10.1002/cncr.22367] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Little is understood about the factors that influence survival in patients who undergo gamma-knife stereotactic radiosurgery (SRS) for brain metastases. METHODS Demographic, disease, treatment, and survival data on 334 patients with intracranial metastases who underwent initial SRS from 1998 to 2004 were abstracted from treatment records and from the Connecticut Tumor Registry. Multivariate survival analysis was used to identify factors that independently affected survival. RESULTS The median age of the patient population was 57.3 years. The median number of lesions treated in a single session was 2 (range, 1-36 lesions treated). The most common tumor histologies were nonsmall cell lung carcinoma (36%), breast cancer (16%), and melanoma (16%). Three hundred patients (90%) had confirmed deaths; the median survival after SRS was 8.1 months. Survival was significantly better in patients who had from 1 to 3 metastases (median, 8.5 months) compared with patients who had > or =4 metastases (median, 6.3 months; hazard ratio [HR], 0.65; P = .003). In the subgroup of patients who had from 1 to 3 metastases, systemic control (HR, 0.49; P < .001), breast cancer (HR, 0.57; P = .003), and total tumor volume < 5 cc (HR, 0.65; P = .002) were associated independently with increased survival, and esophageal cancer (HR, 2.36; P = .042) was associated with decreased survival. In the subgroup of patients who had > or =4 metastases, only age <45 years was associated independently with increased survival (HR, 0.39; P = .006); and melanoma (HR, 2.32; P = .008) and the receipt chemotherapy (HR, 2.59; P = .077) were associated with decreased survival. Sex, race, metastases location, whole-brain radiation, and cranial surgery had no independent associations with altered survival. CONCLUSIONS The data from this study suggested that different factors affected survival in patients who had from 1 to 3 metastases and patients who had > or =4 metastases. Further research into this area may clarify causes for this discrepancy and improve prognostication.
Collapse
Affiliation(s)
- Michael L DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | |
Collapse
|
49
|
Peacock KH, Lesser GJ. Current therapeutic approaches in patients with brain metastases. Curr Treat Options Oncol 2007; 7:479-89. [PMID: 17032560 DOI: 10.1007/s11864-006-0023-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The development of brain metastases is often viewed as the end stage of a disease course and engenders skepticism about the efficacy of treatment. Aggressive management of brain metastases is effective in both symptom palliation and the prolongation of life. The majority of patients with controlled intracranial metastases will expire from systemic disease rather than from recurrence of these metastases. Single brain metastases should be treated with surgical resection or stereotactic radiosurgery, though it is unclear at this time if one modality is more effective than the other. Surgical resection is preferred when a pathologic diagnosis is needed, for tumors larger than 3.5 cm, or when immediate tumor mass decompression is required. Stereotactic radiosurgery (SRS) should be applied for single tumors less than 3.5 cm in surgically inaccessible areas and for patients who are not surgical candidates. Small tumors (ie, < 3.5 cm) that cause minimal edema and are surgically accessible may be treated with either surgery or SRS. There is controversy over whether whole brain radiation therapy (WBRT) can be omitted following surgical resection or SRS. Omission of WBRT increases intracranial tumor recurrence; however, this has not been correlated with decreased survival. Clinicians who choose to omit upfront WBRT are obligated to monitor the patient closely for intracranial recurrence, at which time further salvage therapy in the form of surgery, SRS, or WBRT may be considered. Histology is of particular importance when considering WBRT for patients with radioresistant tumors such as melanoma, renal cell carcinoma, or sarcoma. WBRT may be of less clinical benefit in this setting. Chemotherapy has been demonstrated to improve response rates when used as an adjunct to radiation therapy. These improvements in response rates have not been correlated with an improvement in median survival. Noncytotoxic radiosensitizing agents such as motexafin and efaproxiral show promise. Phase III trials to assess the benefit of motexafin in patients with metastatic lung cancer and efaproxiral in patients with metastatic breast cancer are ongoing. Targeted therapies offer promise in achieving therapeutic efficacy while minimizing side effects. Surgical adjuncts such as BCNU (carmustine) wafers and the GliaSite Radiation System (Cytyc Corporation, Marlborough, MA) may be useful in the future in achieving optimal local tumor control.
Collapse
Affiliation(s)
- Kevin H Peacock
- Section of Hematology and Oncology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | | |
Collapse
|
50
|
Rades D, Veninga T, Stalpers LJA, Basic H, Rudat V, Karstens JH, Dunst J, Schild SE. Outcome After Radiotherapy Alone for Metastatic Spinal Cord Compression in Patients With Oligometastases. J Clin Oncol 2007; 25:50-6. [PMID: 17194905 DOI: 10.1200/jco.2006.08.7155] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate outcome and prognosis of metastatic spinal cord compression (MSCC) patients with oligometastatic disease treated with radiotherapy alone. Patients and Methods Oligometastatic disease was defined as involvement of three or fewer vertebrae and lack of other bone or visceral metastases. Five hundred twenty-one patients with oligometastatic disease and MSCC were evaluated for functional outcome, ambulatory status, local control of MSCC, and survival. Furthermore, seven potential prognostic factors were investigated. Results Motor function improved in 40% (n = 207), remained stable in 54% (n = 279), and deteriorated in 7% (n = 35) of patients. Fifty-eight (54%) of 107 nonambulatory patients became ambulatory, and 388 (94%) of 414 ambulatory patients remained ambulatory. Improved functional outcome was significantly associated with tumor type and slower development of motor deficits (> 14 days). Local control at 1, 2, and 3 years was 92%, 88%, and 78%, respectively. Improved local control was significantly associated with long-course radiotherapy. Survival at 1, 2, and 3 years was 71%, 58%, and 50%, respectively. Better survival was significantly associated with tumor type, ambulatory status, slower development of motor deficits, and long-course radiotherapy. Patients who developed motor deficits slowly (onset > 14 days before initiating treatment) were further analyzed. In this subgroup, the best results were observed for myeloma/lymphoma and breast cancer patients. No patient had progression of motor deficits. One hundred percent (myeloma/lymphoma) and 99% (breast cancer) of patients were ambulatory after radiotherapy. One-year local control was 100% and 98%, 1-year survival was 94% and 89%. Conclusion Given the limitations of a retrospective review, improved outcome of patients with oligometastatic MSCC was associated with myeloma/lymphoma and breast cancer, slower development of motor deficits, and a more prolonged course of radiation.
Collapse
Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany.
| | | | | | | | | | | | | | | |
Collapse
|