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Altamirano JM, Jimenez-Olvera M, Moreno-Jimenez S, Gutierrez-Aceves GA, Velasco-Campos F, Navarro-Olvera JL, Carrillo-Ruiz JD. Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study. Pain Pract 2024; 24:514-524. [PMID: 38071446 DOI: 10.1111/papr.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Microvascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse. OBJECTIVE This study aimed to compare long-term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN. METHODS To compare the results obtained by MVD, SRS, and RFR we chose a quasi-experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non-randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively. RESULTS MVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33-7.46; p = 0.009; and HR 4.26, 95% CI 1.77-10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group. CONCLUSION Concerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.
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Affiliation(s)
- Juan M Altamirano
- Research Direction, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
- Neurosurgery Department, Hospital Angeles Clínica Londres, Mexico City, Mexico
| | - Miguel Jimenez-Olvera
- Pain management Unit, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Radiosurgery Unit, Department of Neurosurgery, Neurological Center, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
| | - Guillermo A Gutierrez-Aceves
- Radiosurgery Unit, Department of Neurosurgery, Neurological Center, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
| | - Francisco Velasco-Campos
- Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - José L Navarro-Olvera
- Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - José D Carrillo-Ruiz
- Research Direction, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
- Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
- Neuroscience Coordination, Psychology Faculty, Mexico Anahuac University, México City, Mexico
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2
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Cruz L, Pacheco E, Soto W, Cong R, Suastegui R, Moreno-Jimenez S, Fleury A. Neurocysticercosis and hydrocephalus: the value of ventriculoperitoneal shunting in its management. Trans R Soc Trop Med Hyg 2023; 117:773-779. [PMID: 37204780 DOI: 10.1093/trstmh/trad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Hydrocephalus is the main complication of extraparenchymal neurocysticercosis (EP-NC). Its symptomatic management relies mainly on the placement of a ventriculoperitoneal shunt (VPS). Previous studies have shown that this surgical procedure is associated with a poor prognosis, but current information is lacking. METHODS We included 108 patients with a definitive diagnosis of EP-NC and hydrocephalus requiring VPS placement. We evaluated their demographic, clinical, and inflammatory characteristics, as well as the frequency of complications related to VPS placement. RESULTS Hydrocephalus was present at the time of NC diagnosis in 79.6% of patients. VPS dysfunction occurred in 48 patients (44.4%), mainly within the first year after placement (66.7%). The dysfunctions were not associated with the location of the cyst, the inflammatory characteristics of the cerebrospinal fluid or the administration of cysticidal treatment. They were significantly more frequent in patients in whom the decision to place a VPS was made in the emergency department. Two years after VPS, patients' Karnofsky score averaged 84.6±15 and only one patient died of a cause directly related to VPS. CONCLUSIONS This study confirmed the utility of VPS and showed a significant improvement in the prognosis of patients requiring VPS compared with previous studies.
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Affiliation(s)
- Lya Cruz
- Research Unit on Neuroinflammation, Departamento de Medicina Genomica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
| | - Edgar Pacheco
- Research Unit on Neuroinflammation, Departamento de Medicina Genomica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
| | - Walter Soto
- Research Unit on Neuroinflammation, Departamento de Medicina Genomica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
| | - Roberto Cong
- Research Unit on Neuroinflammation, Departamento de Medicina Genomica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
| | - Roberto Suastegui
- Epilepsy Clinic, Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
| | - Sergio Moreno-Jimenez
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
| | - Agnès Fleury
- Research Unit on Neuroinflammation, Departamento de Medicina Genomica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
- Neurocysticercosis clinic, Instituto Nacional de Neurología y Neurocirugía, Insurgentes sur 3877, Tlalpan, 14269, México City, México
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Chilaca-Rosas MF, Contreras-Aguilar MT, Garcia-Lezama M, Salazar-Calderon DR, Vargas-Del-Angel RG, Moreno-Jimenez S, Piña-Sanchez P, Trejo-Rosales RR, Delgado-Martinez FA, Roldan-Valadez E. Identification of Radiomic Signatures in Brain MRI Sequences T1 and T2 That Differentiate Tumor Regions of Midline Gliomas with H3.3K27M Mutation. Diagnostics (Basel) 2023; 13:2669. [PMID: 37627927 PMCID: PMC10453217 DOI: 10.3390/diagnostics13162669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Radiomics refers to the acquisition of traces of quantitative features that are usually non-perceptible to human vision and are obtained from different imaging techniques and subsequently transformed into high-dimensional data. Diffuse midline gliomas (DMG) represent approximately 20% of pediatric CNS tumors, with a median survival of less than one year after diagnosis. We aimed to identify which radiomics can discriminate DMG tumor regions (viable tumor and peritumoral edema) from equivalent midline normal tissue (EMNT) in patients with the positive H3.F3K27M mutation, which is associated with a worse prognosis. PATIENTS AND METHODS This was a retrospective study. From a database of 126 DMG patients (children, adolescents, and young adults), only 12 had H3.3K27M mutation and available brain magnetic resonance DICOM file. The MRI T1 post-gadolinium and T2 sequences were uploaded to LIFEx software to post-process and extract radiomic features. Statistical analysis included normal distribution tests and the Mann-Whitney U test performed using IBM SPSS® (Version 27.0.0.1, International Business Machines Corp., Armonk, NY, USA), considering a significant statistical p-value ≤ 0.05. RESULTS EMNT vs. Tumor: From the T1 sequence 10 radiomics were identified, and 14 radiomics from the T2 sequence, but only one radiomic identified viable tumors in both sequences (p < 0.05) (DISCRETIZED_Q1). Peritumoral edema vs. EMNT: From the T1 sequence, five radiomics were identified, and four radiomics from the T2 sequence. However, four radiomics could discriminate peritumoral edema in both sequences (p < 0.05) (CONVENTIONAL_Kurtosis, CONVENTIONAL_ExcessKurtosis, DISCRETIZED_Kurtosis, and DISCRETIZED_ExcessKurtosis). There were no radiomics useful for distinguishing tumor tissue from peritumoral edema in both sequences. CONCLUSIONS Less than 5% of the radiomic characteristics identified tumor regions of medical-clinical interest in T1 and T2 sequences of conventional magnetic resonance imaging. The first-order and second-order radiomic features suggest support to investigators and clinicians for careful evaluation for diagnosis, patient classification, and multimodality cancer treatment planning.
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Affiliation(s)
- Maria-Fatima Chilaca-Rosas
- Radiotherapy Department, Hospital de Oncología, Centro Medico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Mexico City 06720, Mexico; (M.-F.C.-R.); (D.-R.S.-C.)
| | - Manuel-Tadeo Contreras-Aguilar
- Radiotherapy Department, Hospital de Oncología, Centro Medico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Mexico City 06720, Mexico; (M.-F.C.-R.); (D.-R.S.-C.)
| | - Melissa Garcia-Lezama
- Directorate of Research, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City 06720, Mexico;
| | - David-Rafael Salazar-Calderon
- Radiotherapy Department, Hospital de Oncología, Centro Medico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Mexico City 06720, Mexico; (M.-F.C.-R.); (D.-R.S.-C.)
| | | | - Sergio Moreno-Jimenez
- Neurological Center, Neurosurgery Department of National Institute of Neurology and Neurosurgery, Mexico City 14269, Mexico;
- Neurological Center, Neurosurgery Department of American British Cowdray Medical Center, Mexico City 01120, Mexico
| | - Patricia Piña-Sanchez
- Oncology Diagnostic, Unidad de Investigacion Medica en Enfermedades Oncologicas U.I.M.E.O, Hospital de Oncología, Centro Medico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Mexico City 06720, Mexico;
| | - Raul-Rogelio Trejo-Rosales
- Medical Oncology, Hospital de Oncología, Centro Medico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Mexico City 06720, Mexico;
| | - Felipe-Alfredo Delgado-Martinez
- Magnetic Resonance Service, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico;
| | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City 06720, Mexico;
- Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia
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Gonzalez-Hermosillo DC, Gonzalez-Hermosillo LM, Villaseñor-Almaraz M, Ballesteros-Herrera D, Moreno-Jimenez S, Corona-Cedillo R, Velasco-Campos F, Carrillo-Ruiz JD, Roldan-Valadez E. Current concepts of pain pathways: a brief review of anatomy, physiology, and medical imaging. Curr Med Imaging 2023:CMIR-EPUB-131942. [PMID: 37211855 DOI: 10.2174/1573405620666230519144112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Although the essential components of pain pathways have been identified, a thorough comprehension of the interactions necessary for creating focused treatments is still lacking. Such include more standardised methods for measuring pain in clinical and preclinical studies and more representative study populations. OBJECTIVE This review describes the essential neuroanatomy and neurophysiology of pain nociception and its relation with currently available neuroimaging methods focused on health professionals responsible for treating pain. METHODS Conduct a PubMed search of pain pathways using pain-related search terms, selecting the most relevant and updated information. RESULTS Current reviews of pain highlight the importance of their study in different areas from the cellular level, pain types, neuronal plasticity, ascending, descending, and integration pathways to their clinical evaluation and neuroimaging. Advanced neuroimaging techniques such as fMRI, PET, and MEG are used to better understand the neural mechanisms underlying pain processing and identify potential targets for pain therapy. CONCLUSIONS The study of pain pathways and neuroimaging methods allows physicians to evaluate and facilitate decision-making related to the pathologies that cause chronic pain. Some identifiable issues include a better understanding of the relationship between pain and mental health, developing more effective interventions for chronic pain's psychological and emotional aspects, and better integrating data from different neuroimaging modalities for the clinical efficacy of new pain therapies.
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Affiliation(s)
| | | | | | | | - Sergio Moreno-Jimenez
- Neurosurgery Department. National Institute of Neurology and Neurosurgery. Mexico City, Mexico
| | - Roberto Corona-Cedillo
- Neuroimaging Department. National Institute of Neurology and Neurosurgery. Mexico City, Mexico
| | - Francisco Velasco-Campos
- Department of Neurosurgery, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
| | | | - Ernesto Roldan-Valadez
- Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, Moscow, Russia
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Mamani R, Jacobo JA, Guinto-Nishimura GY, Hernández-Hernández A, Moreno-Jimenez S. Motor outcome after resective surgery for the central lobe gliomas. Surg Neurol Int 2022; 13:325. [PMID: 36128124 PMCID: PMC9479616 DOI: 10.25259/sni_363_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Extent of resection (EOR) plays a major role in the prognosis on patients with gliomas, although the postoperative functionality of the patient is of great importance as well. It is why many surgeons advocate to not operate extensively on tumors that involve eloquent regions such as the central lobe. Recent series have demonstrated that it is possible to achieve extensive resections in this area without significantly affecting the functional outcome for these patients. We illustrate this issue with the experience obtained at the National Institute of Neurology and Neurosurgery in Mexico City. Methods: This is an observational and retrospective study that included patients that received surgical resection for intracranial gliomas that involved the central lobe at the National Institute of Neurology and Neurosurgery of Mexico, between January 2017 and May 2020. Demographic and clinical variables of the patients at the time of diagnosis were collected as well as tumor morphological variables, surgical adjuncts, and clinical outcomes. Statistical analysis was performed with SPSS software. Results: A total of 28 patients were included in the study with 43% of patients having a motor deficit before surgery. The average EOR was 88.6%. Patients presented with worsening of their motor status in the immediate postoperative period in 21% of the cases, although most of the patients recovered within the 1st month of follow-up. After analyzing all variables, not having a presurgical motor deficit was a statistically significant risk factor for developing a new motor deficit in the immediate postoperative period (P: 0.02). Conclusion: A resective surgery for gliomas near or within the central lobe can be performed safely and a satisfactory motor outcome for patients can be achieved without sacrificing the EOR. An intact presurgical motor status is a risk factor for developing a new deficit after surgery.
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Affiliation(s)
- Rocio Mamani
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurológicas, Lima, Peru,
| | - Javier A. Jacobo
- Department of Surgical Neuro-Oncology, La Cardio, Bogota, Colombia,
| | | | - Alan Hernández-Hernández
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
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Andonegui-Elguera S, Silva-Román G, Peña-Martínez E, Taniguchi-Ponciano K, Vela-Patiño S, Remba-Shapiro I, Gómez-Apo E, Espinosa-de-los-Monteros AL, Portocarrero-Ortiz LA, Guinto G, Moreno-Jimenez S, Chavez-Macias L, Saucedo R, Basurto-Acevedo L, Lopez-Felix B, Gonzalez-Torres C, Gaytan-Cervantes J, Ayala-Sumuano JT, Burak-Leipuner A, Marrero-Rodríguez D, Mercado M. The Genomic Landscape of Corticotroph Tumors: From Silent Adenomas to ACTH-Secreting Carcinomas. Int J Mol Sci 2022; 23:ijms23094861. [PMID: 35563252 PMCID: PMC9106092 DOI: 10.3390/ijms23094861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022] Open
Abstract
Corticotroph cells give rise to aggressive and rare pituitary neoplasms comprising ACTH-producing adenomas resulting in Cushing disease (CD), clinically silent ACTH adenomas (SCA), Crooke cell adenomas (CCA) and ACTH-producing carcinomas (CA). The molecular pathogenesis of these tumors is still poorly understood. To better understand the genomic landscape of all the lesions of the corticotroph lineage, we sequenced the whole exome of three SCA, one CCA, four ACTH-secreting PA causing CD, one corticotrophinoma occurring in a CD patient who developed Nelson syndrome after adrenalectomy and one patient with an ACTH-producing CA. The ACTH-producing CA was the lesion with the highest number of single nucleotide variants (SNV) in genes such as USP8, TP53, AURKA, EGFR, HSD3B1 and CDKN1A. The USP8 variant was found only in the ACTH-CA and in the corticotrophinoma occurring in a patient with Nelson syndrome. In CCA, SNV in TP53, EGFR, HSD3B1 and CDKN1A SNV were present. HSD3B1 and CDKN1A SNVs were present in all three SCA, whereas in two of these tumors SNV in TP53, AURKA and EGFR were found. None of the analyzed tumors showed SNV in USP48, BRAF, BRG1 or CABLES1. The amplification of 17q12 was found in all tumors, except for the ACTH-producing carcinoma. The four clinically functioning ACTH adenomas and the ACTH-CA shared the amplification of 10q11.22 and showed more copy-number variation (CNV) gains and single-nucleotide variations than the nonfunctioning tumors.
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Affiliation(s)
- Sergio Andonegui-Elguera
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Gloria Silva-Román
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Eduardo Peña-Martínez
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Keiko Taniguchi-Ponciano
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Sandra Vela-Patiño
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Ilan Remba-Shapiro
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Erick Gómez-Apo
- Área de Neuropatología, Servicio de Anatomía Patológica, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de Mexico 06720, Mexico; (E.G.-A.); (L.C.-M.)
| | - Ana-Laura Espinosa-de-los-Monteros
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Lesly A. Portocarrero-Ortiz
- Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Ciudad de Mexico 14269, Mexico; (L.A.P.-O.); (S.M.-J.)
| | - Gerardo Guinto
- Centro Neurológico, Centro Medico ABC, Ciudad de Mexico 01120, Mexico;
| | - Sergio Moreno-Jimenez
- Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Ciudad de Mexico 14269, Mexico; (L.A.P.-O.); (S.M.-J.)
- Centro Neurológico, Centro Medico ABC, Ciudad de Mexico 01120, Mexico;
| | - Laura Chavez-Macias
- Área de Neuropatología, Servicio de Anatomía Patológica, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de Mexico 06720, Mexico; (E.G.-A.); (L.C.-M.)
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de Mexico 04360, Mexico
| | - Renata Saucedo
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Lourdes Basurto-Acevedo
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Blas Lopez-Felix
- Servicio de Neurocirugía, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico;
| | - Carolina Gonzalez-Torres
- Laboratorio de Secuenciacion, Division de Desarrollo de la Investigacion, Centro Medico Nacional Siglo XXI, Ciudad de Mexico 06720, Mexico; (C.G.-T.); (J.G.-C.)
| | - Javier Gaytan-Cervantes
- Laboratorio de Secuenciacion, Division de Desarrollo de la Investigacion, Centro Medico Nacional Siglo XXI, Ciudad de Mexico 06720, Mexico; (C.G.-T.); (J.G.-C.)
| | | | - Andres Burak-Leipuner
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
| | - Daniel Marrero-Rodríguez
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
- Correspondence: (D.M.-R.); (M.M.); Tel.: +52-54401021 (D.M.-R.)
| | - Moisés Mercado
- Unidad de Investigación Medica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico 06720, Mexico; (S.A.-E.); (G.S.-R.); (E.P.-M.); (K.T.-P.); (S.V.-P.); (I.R.-S.); (A.-L.E.-d.-l.-M.); (R.S.); (L.B.-A.); (A.B.-L.)
- Correspondence: (D.M.-R.); (M.M.); Tel.: +52-54401021 (D.M.-R.)
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7
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Taniguchi-Ponciano K, Portocarrero-Ortiz LA, Guinto G, Moreno-Jimenez S, Gomez-Apo E, Chavez-Macias L, Peña-Martínez E, Silva-Román G, Vela-Patiño S, Ordoñez-García J, Andonegui-Elguera S, Ferreira-Hermosillo A, Ramirez-Renteria C, Espinosa-Cardenas E, Sosa E, Espinosa-de-Los-Monteros AL, Salame-Khouri L, Perez C, Lopez-Felix B, Vargas-Ortega G, Gonzalez-Virla B, Lisbona-Buzali M, Marrero-Rodríguez D, Mercado M. The kinome, cyclins and cyclin-dependent kinases of pituitary adenomas, a look into the gene expression profile among tumors from different lineages. BMC Med Genomics 2022; 15:52. [PMID: 35260162 PMCID: PMC8905767 DOI: 10.1186/s12920-022-01206-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background Pituitary adenomas (PA) are the second most common intracranial tumors and are classified according to hormone they produce, and the transcription factors they express. The majority of PA occur sporadically, and their molecular pathogenesis is incompletely understood. Methods Here we performed transcriptome and proteome analysis of tumors derived from POU1F1 (GH-, TSH-, and PRL-tumors, N = 16), NR5A1 (gonadotropes and null cells adenomas, n = 17) and TBX19 (ACTH-tumors, n = 6) lineages as well as from silent ACTH-tumors (n = 3) to determine expression of kinases, cyclins, CDKs and CDK inhibitors. Results The expression profiles of genes encoding kinases were distinctive for each of the three PA lineage: NR5A1-derived tumors showed upregulation of ETNK2 and PIK3C2G and alterations in MAPK, ErbB and RAS signaling, POU1F1-derived adenomas showed upregulation of PIP5K1B and NEK10 and alterations in phosphatidylinositol, insulin and phospholipase D signaling pathways and TBX19-derived adenomas showed upregulation of MERTK and STK17B and alterations in VEGFA-VEGFR, EGF-EGFR and Insulin signaling pathways. In contrast, the expression of the different genes encoding cyclins, CDK and CDK inhibitors among NR5A1-, POU1F1- and TBX19-adenomas showed only subtle differences. CDK9 and CDK18 were upregulated in NR5A1-adenomas, whereas CDK4 and CDK7 were upregulated in POUF1-adenomas. Conclusions The kinome of PA clusters these lesions into three distinct groups according to the transcription factor that drives their terminal differentiation. And these complexes could be harnessed as molecular therapy targets. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01206-y.
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Affiliation(s)
- Keiko Taniguchi-Ponciano
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | | | | | - Sergio Moreno-Jimenez
- Instituto Nacional de Neurología Y Neurocirugía "Manuel Velasco Suarez", Mexico, Mexico.,Centro Neurológico, Centro Medico ABC, Mexico, Mexico
| | - Erick Gomez-Apo
- Área de Neuropatología, Servicio de Anatomía Patológica, Hospital General de México Dr. Eduardo Liceaga, Mexico, Mexico
| | - Laura Chavez-Macias
- Área de Neuropatología, Servicio de Anatomía Patológica, Hospital General de México Dr. Eduardo Liceaga, Mexico, Mexico.,Facultad de Medicina, Universidad Nacional Autonoma de México, Mexico, Mexico
| | - Eduardo Peña-Martínez
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Gloria Silva-Román
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Sandra Vela-Patiño
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Jesús Ordoñez-García
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Sergio Andonegui-Elguera
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Aldo Ferreira-Hermosillo
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.,Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Claudia Ramirez-Renteria
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.,Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Etual Espinosa-Cardenas
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Ernesto Sosa
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Ana Laura Espinosa-de-Los-Monteros
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Latife Salame-Khouri
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Carolina Perez
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Blas Lopez-Felix
- Servicio de Neurocirugia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Guadalupe Vargas-Ortega
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Baldomero Gonzalez-Virla
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Marcos Lisbona-Buzali
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Daniel Marrero-Rodríguez
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.
| | - Moisés Mercado
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.
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Jacobo JA, Vazquez-Gregorio R, Moreno-Jimenez S, Mejia-Perez S. Decompressive craniectomy: A salvage treatment for patients with central nervous system tumors. CIR CIR 2021; 89:603-610. [PMID: 34665170 DOI: 10.24875/ciru.20000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Decompressive craniectomy (DC) has been used for the treatment of refractory increased intracranial pressure (ICP) in patients with brain trauma and stroke; its beneficial role is still a matter of debate. Little has been written on the role of DC in the setting of patients with intracranial tumors. METHODS We retrospectively reviewed our institutional tumor registry for all adult patients treated with a DC as an emergency treatment between January 2012 and June 2019. RESULTS A total of 61 patients were taken into surgery for a DC secondary to raised ICP related to a central nervous system tumor. The Kaplan-Meier curves in the study showed that 18.9 months was the mean survival time (MST) of the global population, 40 patients died (65.5%) during the follow-up period. Patients in the group of over 60 years had a worst survival time than younger patients (p = 0.01). Patients with intracerebral hemorrhage had the worst MST compared with the patients with other etiologies (p = 0.04). CONCLUSION Our data show that in some selected cases DC is a viable option as a salvage treatment for patients with intracranial tumors.
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Affiliation(s)
- Javier A Jacobo
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery
| | | | - Sergio Moreno-Jimenez
- Direction of the department of Radioneurosurgery, National Institute of Neurology and Neurosurgery. Mexico City, Mexico
| | - Sonia Mejia-Perez
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery
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Ramirez-Renteria C, Albarran-Sanchez A, Hernandez-Calderon DE, Cardenas PEE, Sosa E, Lopez-Juarez N, Irisson IM, Noyola-Garcia ME, Portocarrero-Ortiz LA, Moreno-Jimenez S, Melgar-Manzanilla V, Almeida-Gutierrez E, Mercado M. Paragangliomas the Forgotten Neuroendocrine Neoplasms: A Retrospective Review of 237 Cases From 2 Centers in 2 Years. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: paragangliomas (PGN) (including adrenal PGN or pheochromocytomas) are uncommon neuroendocrine neoplasias. Their ubiquity and lack of uniform nomenclature has resulted in systematic sub-registry and limited resources for patients and clinicians. However, 40% of them are hereditary, 10–20% are hormonally active and 50% result in treatment-related complications.
Objectives: to describe the clinical and biochemical characteristics of PGN in two referral centers in a 2-year period.
Materials and Methods: a retrospective review of the files of patients evaluated in the Centro Medico Nacional Siglo XXI or the Instituto Nacional de Neurología y Neurocirugia between June 2018 and May 2020, even if diagnosis was prior to those dates. The search was performed using ICD-10 terms in the outpatient registries. Data is described using non-parametric statistics, including medians (interquartilic ranges, IQR). According to the reported incidences we expected to find 35 new cases per year in each hospital.
Results: 237 patients, 86.4% female with a median age at diagnosis of 54 years (IQR 45–64) were found. The tumors were located in the head 23.9%, neck 63.3%, thorax 0.4%, adrenal in 11.1%, other sites in the abdomen 1.3%. The most common symptoms in head PGN were hypoacusia (85.2%) and cranial nerve palsies (39.3%), in the neck, a visible mass and pain (30.6%) while the “classic” catecholaminergic symptoms were more common in thoracic and abdominal tumors (>50%). Tumors were large or invasive in 50.1% of the cases and at least one hormone was above the upper limit of normal (ULN) in 40.6% of the 64 evaluated cases, mostly urinary dopamine (70% of cases tested, 1.1–2.1 ULN) and plasma and urine metanephrines (60% of cases tested, 1.1- 33.7 ULN and 50% cases, 1.1–22 ULN, respectively). Severe systolic hypertension was more frequent in male patients <30 years of age and 41.6% were candidates to genetic testing due to the tumor characteristics or patient history. Surgery was performed in 55.6%, radiotherapy in 25.2% and 12.1% are under surveillance or pending surgery, 7.1% were lost to follow up. Only 5 cases with metastasis were documented in 1215 patient-years of follow-up. Treatment-related complications were reported in 14.7% and persistence in 32.2%.
Conclusions: despite the retrospective nature of the study and sub registry, we found more tumors than expected. The frequency of hormonal production was high, but it is likely related to patient selection bias (mostly symptomatic cases studied). Dopamine and metanephrines are useful in the evaluation of PGN. Endocrinologists should be aware of these common tumors and be part of the multidisciplinary team.
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Affiliation(s)
- Claudia Ramirez-Renteria
- UIM en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional S.XXI, Mexico City, Mexico
| | | | | | | | - Ernesto Sosa
- Endocrinology, Hospital de Especialidades, CMN SXXI Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Nitzia Lopez-Juarez
- Hospital de Cardiologia CMN SXXI Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Irene Mora Irisson
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suárez, Mexico City, Mexico
| | - Maura E Noyola-Garcia
- Internal Medicine Hospital de Especialidades, Centro Medico Nacional S.XXI, Mexico City, Mexico
| | | | - Sergio Moreno-Jimenez
- Radiocirugia Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | | | | | - Moises Mercado
- UIM en Enfermedades Endocrinas, Hospital de Especialidades, Centro Medico Nacional S.XXI, Mexico City, Mexico
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10
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Gutierrez-Aceves GA, Rodriguez-Camacho A, Celis-Lopez MA, Moreno-Jimenez S, Herrera-Gonzalez JA. Frameless radiosurgical third ventriculostomy: Technical report. Surg Neurol Int 2020; 11:398. [PMID: 33282458 PMCID: PMC7710479 DOI: 10.25259/sni_247_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
Background: We describe the technical report and results of the first image-guided, linear accelerator, frameless radiosurgical third ventriculostomy. Methods: We report a 20 years old man, with diplopia, balance disturbances, and limitation for gaze supraversion. Magnetic resonance imaging resonance imaging of the brain and cranial computed tomography showed showed a left thalamic-midbrain lesion that caused partial compression of the Silvio aqueduct and mild ventricular dilatation. The biopsy revealed the diagnosis of pleomorphic xanthoastrocytoma. Before radical treatment of the tumor with fractionated stereotactic radiotherapy, the patient underwent to frameless radiosurgical third ventriculostomy, on the TrueBeam STX® platform with the ExacTrac localization system. The target used was the one defined on the floor of the third ventricle, at the midpoint between the mammillary bodies and the infundibular recess. The prescription dose was 120 Gy, given using a monoisocentric technique of multiple noncoplanar circular arches. The geometric arrangement of the plan consisted of 15 arches, with a 4 mm cone, distributed over a 110° table. Results: There was symptomatic and image improvement two days after radiosurgery. On CT, a reduction in ventricular dilation was observed with a reduction in the Evans index from 0.39 (initial CT) to 0.29 (CT at 15 days). In 3.0T magnetic resonance image at 3 months, we showed the third ventriculostomy. There have been no treatment failures or complications. Conclusion: It is possible to effectively perform the frameless radiosurgical third ventriculostomy without associated morbidity in the short term.
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Affiliation(s)
| | - Alejandro Rodriguez-Camacho
- Radio Neurosurgery Unit, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
| | - Miguel Angel Celis-Lopez
- Radio Neurosurgery Unit, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Radio Neurosurgery Unit, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
| | - Jose Alfredo Herrera-Gonzalez
- Radio Neurosurgery Unit, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
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11
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Jacobo JA, Mejia-Perez S, Moreno-Jimenez S. The Role of Neoadjuvant Therapy to Improve the Extent of Resection in "Unresectable" Gliomas. World Neurosurg 2020; 146:53-58. [PMID: 33137511 DOI: 10.1016/j.wneu.2020.10.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical resection plays a pivotal role in the management of glial tumors and a greater extent of resection (EOR) should be the goal in most surgeries to improve overall survival. Many factors may limit the EOR. A potential role for preoperative chemotherapy to decrease the volume and/or infiltration of gliomas, thereby facilitating a safe radical resection, has been recently suggested. This review aims to provide an overview of the current state of neoadjuvant therapy in the field of glioma surgery. METHODS A systematic review was conducted according to PRISMA guidelines to identify articles of low- and high-grade gliomas that received neoadjuvant chemotherapy prior to surgery to improve the EOR from 2000 to 2020. Full-text articles that addressed this subject were included for evaluation. RESULTS Case reports and clinical trials have been published for the use of chemotherapy as a neoadjuvant therapy to improve surgical resection in low-grade gliomas. More scarce information exists regarding this strategy for high-grade glioma surgery. CONCLUSIONS Neoadjuvant chemotherapy has played a role in overcoming obstacles that limit the EOR in patients with complex gliomas, especially low-grade gliomas.
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Affiliation(s)
- Javier A Jacobo
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Sonia Mejia-Perez
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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12
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Jacobo JA, Avendaño J, Moreno-Jimenez S, Nuñez S, Mamani R. Basic Principles of Intraoperative Ultrasound Applied to Brain Tumor Surgery. Indian Journal of Neurosurgery 2020. [DOI: 10.1055/s-0040-1705289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractIntraoperative ultrasound (US) has been shown to possess great value in assessing tumor volume and localization, especially for primary resection of gliomas and metastatic lesions. Given that US is a technology that is highly user dependent, many surgeons have encountered problems with the usage of this technology, as well as interpretation of intraoperative US images, limiting its full potential. This article focuses on the basic knowledge a neurosurgeon must acquire to properly use and interpret intraoperative US to improve tumor localization and extent of resection during brain tumor surgery.
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Affiliation(s)
- Javier A. Jacobo
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Javier Avendaño
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Santiago Nuñez
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Rocio Mamani
- Department of Surgical Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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13
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Flores-Alvarez E, Durand-Muñoz C, Cortes-Hernandez F, Muñoz-Hernandez O, Moreno-Jimenez S, Roldan-Valadez E. Clinical Significance of Fractional Anisotropy Measured in Peritumoral Edema as a Biomarker of Overall Survival in Glioblastoma: Evidence Using Correspondence Analysis. Neurol India 2020; 67:1074-1081. [PMID: 31512638 DOI: 10.4103/0028-3886.266284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction Fractional anisotropy (FA), a diffusion tensor image (DTI) derived biomarker is related to invasion, infiltration, and extension of glioblastoma (GB). We aimed to evaluate FA values and their association with intervals of overall survival (OS). Materials and Methods Retrospective study conducted in 36 patients with GB included 23 (63.9%) males, 46 ± 14 y; and 13 (36.1%) females, 53 ± 13; followed up for 36 months. We measured FA at edema, enhancing rim, and necrosis. We created two categorical variables using levels of FA and intervals of OS to evaluate their relationships. Kaplan-Meier method and correspondence analysis evaluated the association between OS (grouped in 7 six-month intervals) and FA measurements. Results Median FA values were higher in healthy brain regions (0.351), followed by peritumoral edema (0.190), enhancing ring (0.116), and necrosis (0.071). Pair-wise comparisons among tumor regions showed a significant difference, P < 0.001. The median OS for all patients was 19.3 months; variations in the OS curves among subgroups was significant χ2 (3) = 8.48, P = 0.037. Correspondence analysis showed a significant association between FA values in the edema region and the survival intervals χ2 (18) = 30.996, P = 0.029. Conclusions Alternative multivariate assessment using correspondence analysis might supplement the traditional survival analysis in patients with GB. A close follow-up of the variability of FA in the peritumoral edema region is predictive of the OS within specific six-month interval subgroup. Further studies should focus on predictive models combining surgical and DTI biomarkers.
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Affiliation(s)
- Eduardo Flores-Alvarez
- Department of Neurosurgery, Hospital General de Mexico Eduardo Liceaga (HGMEL), Mexico City, Mexico
| | - Coral Durand-Muñoz
- Department of Internal Medicine, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | | | - Onofre Muñoz-Hernandez
- Direction of Research, Hospital Infantil de Mexico Federico Gomez (HIMFG), National Health Institute, Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, Moscow, Russia
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14
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Durand-Muñoz C, Flores-Alvarez E, Moreno-Jimenez S, Roldan-Valadez E. Pre-operative apparent diffusion coefficient values and tumour region volumes as prognostic biomarkers in glioblastoma: correlation and progression-free survival analyses. Insights Imaging 2019; 10:36. [PMID: 30887267 PMCID: PMC6423260 DOI: 10.1186/s13244-019-0724-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/20/2019] [Indexed: 02/08/2023] Open
Abstract
Objectives Glioblastoma (GB) contains diverse histologic regions. Apparent diffusion coefficient (ADC) values are surrogates for the degree of number of cells within the tumour regions. Because an assessment of ADC values and volumes within tumour sub-compartments of GB is missing in the literature, we aimed to evaluate these associations. Methods A retrospective cohort of 48 patients with GB underwent segmentation to calculate tumour region volumes (in cubic centimetre) and ADC values in tumour regions: normal tissue, enhancing tumour, proximal oedema, distal oedema, and necrosis. Correlation, Kaplan-Meier, and Cox hazard regression analyses were performed. Results We found a statistically significant difference among ADC values for tumour regions: F (4, 220) = 166.71 and p ≤ .001 and tumour region volumes (necrosis, enhancing tumour, peritumoural oedema): F (2, 141) = 136.3 and p ≤ .001. Post hoc comparisons indicated that the only significantly different mean score was the peritumoural volume in oedema region (p < .001). We observed a positive significant correlation between ADC of distal oedema and peritumoural volume, r = .418, df = 34, and p = .011. Cox proportional hazards regression analysis considering only tumour region volumes provided an almost significant model: − 2 log-likelihood = 146.066, χ2 (4) = 9.303, and p = .054 with a trend towards significance of the hazard function: p = .067 and HR = 1.077 for the non-enhancing tumour volume. Conclusions ADC values together with volumes of oedema region might have a role as predictors of progression-free survival (PFS) in patients with GB; we recommend a routine MRI assessment with the calculation of these biomarkers in GB.
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Affiliation(s)
- Coral Durand-Muñoz
- Department of Internal Medicine, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Eduardo Flores-Alvarez
- Department of Neurosurgery, Secretariat of Health, General Hospital of Mexico, Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Radioneurosurgery Unit, The National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, Secretariat of Health, General Hospital of Mexico, Mexico City, Mexico. .,Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str., 8, b. 2, Moscow, Russia, 119992.
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15
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Martínez-Canabal A, López-Oropeza G, Gaona-Gamboa A, Ballesteros-Zebadua P, de la Cruz OG, Moreno-Jimenez S, Sotres-Bayon F. Hippocampal neurogenesis regulates recovery of defensive responses by recruiting threat- and extinction-signalling brain networks. Sci Rep 2019; 9:2939. [PMID: 30814555 PMCID: PMC6393575 DOI: 10.1038/s41598-019-39136-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/18/2019] [Indexed: 12/26/2022] Open
Abstract
Safe exposure to a context that was previously associated with threat leads to extinction of defensive responses. Such contextual fear extinction involves the formation of a new memory that inhibits a previously acquired contextual fear memory. However, fear-related responses often return with the simple passage of time (spontaneous fear recovery). Given that contextual fear and extinction memories are hippocampus-dependent and hippocampal neurogenesis has been reported to modify preexisting memories, we hypothesized that neurogenesis-mediated modification of preexisting extinction memory would modify spontaneous fear recovery. To test this, rats underwent contextual fear conditioning followed by extinction. Subsequently, we exposed rats to an enriched environment or focal X-irradiation to enhance or ablate hippocampal neurogenesis, respectively. Over a month later, rats were tested to evaluate spontaneous fear recovery. We found that enhancing neurogenesis after, but not before, extinction prevented fear recovery. In contrast, neurogenesis ablation after, but not before, extinction promoted fear recovery. Using the neuronal activity marker c-Fos, we identified brain regions recruited in these opposing neurogenesis-mediated changes during fear recovery. Together, our findings indicate that neurogenesis manipulation after extinction learning modifies fear recovery by recruiting brain network activity that mediates the expression of preexisting contextual fear and extinction memories.
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Affiliation(s)
- Alonso Martínez-Canabal
- Instituto de Fisiología Celular - Neurociencias, Universidad Nacional Autónoma de México, 04510, Ciudad de México, Mexico
| | - Grecia López-Oropeza
- Instituto de Fisiología Celular - Neurociencias, Universidad Nacional Autónoma de México, 04510, Ciudad de México, Mexico
| | - Abril Gaona-Gamboa
- Instituto de Fisiología Celular - Neurociencias, Universidad Nacional Autónoma de México, 04510, Ciudad de México, Mexico
| | | | | | - Sergio Moreno-Jimenez
- Instituto Nacional de Neurología y Neurocirugía - Radioneurocirugía, Ciudad de México, Mexico
| | - Francisco Sotres-Bayon
- Instituto de Fisiología Celular - Neurociencias, Universidad Nacional Autónoma de México, 04510, Ciudad de México, Mexico.
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Roldan-Valadez E, Rios C, Motola-Kuba D, Matus-Santos J, Villa AR, Moreno-Jimenez S. Choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios together with age assemble a significant Cox's proportional-hazards regression model for prediction of survival in high-grade gliomas. Br J Radiol 2016; 89:20150502. [PMID: 27626830 DOI: 10.1259/bjr.20150502] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE A long-lasting concern has prevailed for the identification of predictive biomarkers for high-grade gliomas (HGGs) using MRI. However, a consensus of which imaging parameters assemble a significant survival model is still missing in the literature; we investigated the significant positive or negative contribution of several MR biomarkers in this tumour prognosis. METHODS A retrospective cohort of supratentorial HGGs [11 glioblastoma multiforme (GBM) and 17 anaplastic astrocytomas] included 28 patients (9 females and 19 males, respectively, with a mean age of 50.4 years, standard deviation: 16.28 years; range: 13-85 years). Oedema and viable tumour measurements were acquired using regions of interest in T1 weighted, T2 weighted, fluid-attenuated inversion recovery, apparent diffusion coefficient (ADC) and MR spectroscopy (MRS). We calculated Kaplan-Meier curves and obtained Cox's proportional hazards. RESULTS During the follow-up period (3-98 months), 17 deaths were recorded. The median survival time was 1.73 years (range, 0.287-8.947 years). Only 3 out of 20 covariates (choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios and age) showed significance in explaining the variability in the survival hazards model; score test: χ2 (3) = 9.098, p = 0.028. CONCLUSION MRS metabolites overcome volumetric parameters of peritumoral oedema and viable tumour, as well as tumour region ADC measurements. Specific MRS ratios (Cho/Naa, L-L/Cr) might be considered in a regular follow-up for these tumours. Advances in knowledge: Cho/Naa ratio is the strongest survival predictor with a log-hazard function of 2.672 in GBM. Low levels of lipids-lactate/Cr ratio represent up to a 41.6% reduction in the risk of death in GBM.
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Affiliation(s)
- Ernesto Roldan-Valadez
- 1 Direccion de Investigacion, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Camilo Rios
- 2 Department of Neurochemistry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Juan Matus-Santos
- 3 Oncology Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Antonio R Villa
- 4 Division de Investigacion, Facultad de Medicina, UNAM, Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- 5 Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Cortez-Conradis D, Rios C, Moreno-Jimenez S, Roldan-Valadez E. Partial correlation analyses of global diffusion tensor imaging-derived metrics in glioblastoma multiforme: Pilot study. World J Radiol 2015; 7:405-414. [PMID: 26644826 PMCID: PMC4663379 DOI: 10.4329/wjr.v7.i11.405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/13/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine existing correlates among diffusion tensor imaging (DTI)-derived metrics in healthy brains and brains with glioblastoma multiforme (GBM).
METHODS: Case-control study using DTI data from brain magnetic resonance imaging of 34 controls (mean, 41.47; SD, ± 21.94 years; range, 21-80 years) and 27 patients with GBM (mean, SD; 48.41 ± 15.18 years; range, 18-78 years). Image postprocessing using FSL software calculated eleven tensor metrics: fractional (FA) and relative anisotropy; pure isotropic (p) and anisotropic diffusions (q), total magnitude of diffusion (L); linear (Cl), planar (Cp) and spherical tensors (Cs); mean (MD), axial (AD) and radial diffusivities (RD). Partial correlation analyses (controlling the effect of age and gender) and multivariate Mancova were performed.
RESULTS: There was a normal distribution for all metrics. Comparing healthy brains vs brains with GBM, there were significant very strong bivariate correlations only depicted in GBM: [FA↔Cl (+)], [FA↔q (+)], [p↔AD (+)], [AD↔MD (+)], and [MD↔RD (+)]. Among 56 pairs of bivariate correlations, only seven were significantly different. The diagnosis variable depicted a main effect [F-value (11, 23) = 11.842, P≤ 0.001], with partial eta squared = 0.850, meaning a large effect size; age showed a similar result. The age also had a significant influence as a covariate [F (11, 23) = 10.523, P < 0.001], with a large effect size (partial eta squared = 0.834).
CONCLUSION: DTI-derived metrics depict significant differences between healthy brains and brains with GBM, with specific magnitudes and correlations. This study provides reference data and makes a contribution to decrease the underlying empiricism in the use of DTI parameters in brain imaging.
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Soriano-Baron H, Vales-Hidalgo O, Arvizu-Saldana E, Moreno-Jimenez S, Revuelta-Gutierrez R. Hemifacial spasm: 20-year surgical experience, lesson learned. Surg Neurol Int 2015; 6:83. [PMID: 26015871 PMCID: PMC4443403 DOI: 10.4103/2152-7806.157443] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/02/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemifacial spasm is characterized by unilateral, paroxysmal, and involuntary contractions. It is more common in women on the left side. Its evolution is progressive, and it rarely improves without treatment. METHODS Microvascular decompressions (N = 226) were performed in 194 Hispanic patients (May 1992-May 2011). Outcomes were evaluated on a 4-point scale: Excellent (complete remission); good (1-2 spasms/day); bad (>2 spasms/day); and recurrence (relapse after initial excellent/good response). RESULTS Most patients were female (n = 123); 71 were male. Mean (±SD) age was 49.4 (±11.7) years; age at onset, 43.9 (±11.9) years; time to surgery, 5.7 (±4.7) years. The left side was affected in 114 patients. Typical syndrome occurred in 177 (91.2%); atypical in 17 (8.8%). Findings were primarily vascular compression (n = 185 patients): Anterior inferior cerebellar artery (n = 147), posterior inferior cerebellar artery (n = 12), basilar artery (n = 10), superior cerebellar artery (n = 8), and 2 vessels (n = 8); 9 had no compression. Postsurgical results were primarily excellent (79.9% [n = 155]; good, 4.6% [n = 9]; bad, 15.5% [n = 30]), with recurrence in 21 (10.8%) at mean 51-month (range, 1-133 months) follow-up. Complications included transient hearing loss and facial palsy. CONCLUSIONS The anterior inferior cerebellar artery is involved in most cases of hemifacial spasm. Failure to improve postsurgically after 1 week warrants reoperation. Sex, side, and onset are unrelated to treatment response. Microvascular decompression is the preferred treatment. It is minimally invasive, nondestructive, and achieves the best long-term results, with minor morbidity. To our knowledge, this series is the largest to date on a Hispanic population.
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Affiliation(s)
- Hector Soriano-Baron
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, U.S.A
| | - Olivia Vales-Hidalgo
- Division of Neurological Surgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Mexico City, Mexico
| | | | - Sergio Moreno-Jimenez
- Division of Neurological Surgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Mexico City, Mexico
| | - Rogelio Revuelta-Gutierrez
- Division of Neurological Surgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Mexico City, Mexico
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Serrano-Rubio AA, Martinez-Manrique JJ, Revuelta-Gutierrez R, Gomez-Amador JL, Martinez-Anda JJ, Ponce-Gomez JA, Moreno-Jimenez S. [Linear accelerator-based stereotactic radiosurgery for the treatment of trigeminal neuralgia. Nine years' experience in a single institution]. Rev Neurol 2014; 59:249-254. [PMID: 25190337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION. Pharmacological treatment is the first therapeutic step towards controlling pain in trigeminal neuralgia, but 25-50% of patients become medication resistant. There are currently several surgical alternatives for treating these patients. AIM. To evaluate the effectiveness and safety of stereotactic radiosurgery for the treatment of patients with trigeminal neuralgia. PATIENTS AND METHODS. A follow-up study was conducted on 30 patients who underwent radiosurgery using a Novalis linear accelerator. Eighty per cent of the dosage was calculated at the isocentre, the entry zone of the root of the trigeminal nerve. The mean follow-up time was 27.5 months (range: 1-65 months). RESULTS. The mean age was 66 years (range: 36-87 years), with a time to progression of 7.1 years (range: 4-27 years). The distribution of the pain was from the right side (63.3%). Of the 30 patients, 27 experienced an improvement (90%) 1.6 months (range: 1 week-4 months) after the treatment; 10 patients (33.3%) scored grade I, and 17 patients (56.6%) obtained a score of grade II. During the follow-up, four patients (14.2%) suffered a relapse; two underwent re-irradiation. Time without recurrence was 62.7 months (range: 54.6-70.8 months). The rate of side effects was 76.7% and only three patients developed facial anaesthesia with loss of the corneal reflex. CONCLUSIONS. The use of the linear accelerator is an effective therapeutic option in the treatment of trigeminal neuralgia, since it provides adequate long-term control of the pain, reduces the use of medication and improves the quality of life.
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Affiliation(s)
- A A Serrano-Rubio
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico DF, Mexico
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Moreno-Jimenez S, Celis MA, Larraga-Gutierrez JM, Suarez-Campos JDJ, Garcia-Garduñno A, Hernandez-Bojorquez M, Gutiérrez-Aceves GA. Intracranial arteriovenous malformations treated with LINAC-based conformal radiosurgery: validation of the radiosurgery-based arteriovenous malformation score as a predictor of outcome. Neurol Res 2013; 29:712-6. [PMID: 17659161 DOI: 10.1179/016164107x208040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To validate the radiosurgery-based arteriovenous malformation score (RBAS) as a predictor of outcome in patients with arteriovenous malformations (AVMs) treated with LINAC-based conformal radiosurgery. METHODS We analysed 40 patients with a mean follow-up of 22 months. One patient (2.5%) pertained to Spetzler-Martin Grade I, 11 (27.5%) to Grade II, 19 (47.5%) to Grade III, eight (20%) to Grade IV and one (2.5%) to grade V. The mean RBAS was 2.0 (range: 0.76-5.56). The mean obliteration prediction index (OPI) and the Karlsson index (KI) were 0.74 (range: 0.2-2.86) and 109.48 (range: 3.0-350.7) respectively. Outcomes were analysed according to the OPI, KI and RBAS. RESULTS We analysed different cutoff points in the RBAS and found a significant difference to predict the outcome in four scores: 1.2, 1.6, 1.7 and 1.8. In the group with RBAS < or = 1.8, 13 (68%) had an excellent outcome and six (33%) did not, while with RBAS>1.8, seven (32%) had an excellent outcome and 14 (67%) did not (p = 0.02). We did not find any correlation between Spetzler-Martin grading scale or OPI and outcome (p = 0.7 and p = 0.3 respectively). The KI predicted the excellent outcome in 8/9 patients (89%) with KI < or = 27 and in 12/31 patients (39%) with KI>27 (p = 0.08). CONCLUSION The RBAS seems to be a good predictor of outcome in patients with AVMs treated with LINAC-based conformal radiosurgery as in patients treated with Gamma Knife. It remains only to find the best cutoff point based on a larger series and longer follow-up.
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Affiliation(s)
- Sergio Moreno-Jimenez
- Department of Radiosurgery, Instituto Nacional de Neurología y Neurocirugía MVS, Insurgentes Sur 3877 Col. La Fama, Tlalpan, México City 14269, Mexico
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