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Albalkhi I, Shafqat A, Bin-Alamer O, Mallela AN, Kuminkoski C, Labib MA, Lang MJ, Lawton MT, Morcos JJ, Couldwell WT, Abou-Al-Shaar H. Long-term functional outcomes and complications of microsurgical resection of brainstem cavernous malformations: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:252. [PMID: 37726558 DOI: 10.1007/s10143-023-02152-8] [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: 08/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Brainstem cavernous malformations (CMs) encompass up to 20% of all intracranial CMs and are considered more aggressive than cerebral CMs because of their high annual bleeding rates. Microsurgical resection remains the primary treatment modality for CMs, but long-term functional outcomes and complications are heterogenous in the literature. The authors performed a systematic review on brainstem CMs in 4 databases: PubMed, EMBASE, Cochrane library, and Google Scholar. We included studies that reported on the long-term functional outcomes and complications of brainstem CMs microsurgical resection. A meta-analysis was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search yielded 4781 results, of which 19 studies met our inclusion criteria. Microsurgery was performed on 940 patients (mean age 35 years, 46.9% females). Most of the brainstem CMs were located in the pons (n = 475). The pooled proportions of improved, stable, and worsened functional outcomes after microsurgical resection of brainstem CMs were 56.7% (95% CI 48.4-64.6), 28.6% (95% CI 22.4-35.7), and 12.6% (95% CI 9.6-16.2), respectively. CMs located in the medulla were significantly (p = 0.003) associated with a higher proportion of improved outcome compared with those in the pons and midbrain. Complete resection was achieved in 93.3% (95% CI 89.8-95.7). The immediate postoperative complication rate was 37.2% (95% CI 29.3-45.9), with new-onset cranial nerve deficit being the most common complication. The permanent morbidity rate was 17.3% (95% CI 10.5-27.1), with a low mortality rate of 1% from the compiled study population during a mean follow-up of 58 months. Our analysis indicates that microsurgical resection of brainstem CMs can result in favorable long-term functional outcomes with transient complications in the majority of patients. Complete microsurgical resection of the CM is associated with a lower incidence of CM hemorrhage and the morbidity related to it.
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Affiliation(s)
- Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chloe Kuminkoski
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mohamed A Labib
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J Lang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jacques J Morcos
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Ogasawara C, Watanabe G, Young K, Kwon R, Conching A, Palmisciano P, Kan P, de Oliveira Sillero R. Laser Interstitial Thermal Therapy for Cerebral Cavernous Malformations: A Systematic Review of Indications, Safety, and Outcomes. World Neurosurg 2022; 166:279-287.e1. [PMID: 35760323 DOI: 10.1016/j.wneu.2022.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/14/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cerebral cavernous malformations (CCM) in deep eloquent areas present a surgical challenge. Laser interstitial thermal therapy (LITT) may present itself as a safe minimally invasive treatment option. OBJECTIVE To systematically review the indications, safety, and outcomes of LITT for CCM. METHODS Electronic databases were searched from inception to October 7, 2021 for articles with CCM and LITT keywords. Studies describing CCMs treated with LITT were included. RESULTS A total of 32 patients with CCMs in lobar (79%), basal ganglia (12%), and brainstem (9%) locations were treated with LITT. Indications for LITT included drug-resistant seizures (75%), unacceptable surgical risk (22%), recurrent hemorrhage (16%), and early intervention to discontinue antiepileptic drugs (3%). No death or CCM-associated intracranial hemorrhage occurred intraoperatively or postoperatively, and most patients experienced no adverse effects or transient effects that resolved at follow-up (84%). Of those treated for CCM-associated epilepsy, 83% experienced Engel class I seizure freedom and most were class IA (61%). Most patients experienced symptomatic improvement (93%), and a decrease in antiepileptic drugs was reported in more than half of patients (56%), with 28% able to discontinue all antiepilepsy medications after LITT. CONCLUSIONS LITT seems to be a safe treatment for CCMs located in deep eloquent areas and in lesions presenting with medically refractory seizures or recurrent hemorrhages. Randomized studies are needed to further elucidate its efficacy in treating CCM.
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Affiliation(s)
- Christian Ogasawara
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA.
| | - Gina Watanabe
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Kurtis Young
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Royce Kwon
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Andie Conching
- Division of Neurosurgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
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Priore P, Giovannetti F, Scagnet M, Mussa F, Arcovio E, Di Giorgio D, Primavera M, Valentini V, Genitori L. Endoscopic Endonasal Treatment of Intra-Axial Ventral Brainstem Cavernomas: Case Experience and Literature Review. Pediatr Neurosurg 2022; 57:376-384. [PMID: 35793616 DOI: 10.1159/000525914] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/15/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cavernous malformations of the ventral brainstem are a challenging disease to treat. From an anatomical perspective, the best surgical options are endoscopic endonasal approaches. The first reports of their usage for this purpose date back to 2012. In this study, we gathered data on the subject, share our experience, and outline technical notes and tips for this surgery. CASE PRESENTATION We report a 14-year-old female with a ventral pons cavernoma, treated using an endoscopic endonasal transclival approach and followed-up for 5.9 years. This is the longest reported follow-up for this condition to date. Written informed consent was obtained from the patient for publication of this case report and the accompanying images. DISCUSSION An endoscopic endonasal transclival approach was used. The skull base was reconstructed using the multilayer grafting technique and a nasoseptal flap. There was no postoperative cerebrospinal fluid leakage. In a literature review, we identified 8 patients who were treated endoscopically: 1 transplanum-transtuberculum, 1 transtuberculum-transclival, and 6 transclival approaches were employed. Skull base closure was achieved using multilayer grafting and a nasoseptal flap in 4 cases, a gasket seal technique combined with nasoseptal flap in 3 cases and a periumbilical fat graft, fibrin sealant patch, and fibrin glue in 1 case. There were 2 cases of leakage, which resolved completely with revision surgery. CONCLUSION Endoscopic surgery is a reliable alternative to traditional open surgery. It may be the preferred choice for intra-axial ventral brain cavernomas.
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Affiliation(s)
- Paolo Priore
- Department of Oncological, Reconstructive Maxillofacial Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Filippo Giovannetti
- Department of Oncological, Reconstructive Maxillofacial Surgery, "Sapienza" University of Rome, Rome, Italy.,Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Mirko Scagnet
- Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Federico Mussa
- Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Elena Arcovio
- Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Danilo Di Giorgio
- Department of Oncological, Reconstructive Maxillofacial Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Marco Primavera
- Department of Oncological, Reconstructive Maxillofacial Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Valentino Valentini
- Department of Oncological, Reconstructive Maxillofacial Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Lorenzo Genitori
- Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
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Panda A, Diehn FE, Kim DK, Bydon M, Goyal A, Benson JC, Carr CM, Rinaldo L, Flemming KD, Lanzino G. Spinal Cord Cavernous Malformations: MRI Commonly Shows Adjacent Intramedullary Hemorrhage. J Neuroimaging 2020; 30:690-696. [PMID: 32462668 DOI: 10.1111/jon.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/15/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE There is a relative paucity of radiology literature on spinal cord cavernous malformations (SCMs). We hypothesized that the classic MRI features of cavernous malformations are not highly prevalent. The purpose was to review MR imaging findings of SCMs with a focus on prevalence of hemorrhagic features, including adjacent intramedullary hemorrhage at initial presentation. METHODS In this single-institution study, 78 SCMs in 76 patients diagnosed on imaging/pathology were retrospectively evaluated for size, location, cord expansion, exophytic component, popcorn morphology, signal characteristics, including T1 weighted (T1w) and T2w rims, blood-fluid levels, and adjacent intramedullary hemorrhage. Intramedullary hemorrhage was defined as centrally and/or eccentrically located linear or flame shaped non-edematous signal abnormality extending longitudinally away from SCMs, distinct from lesional rim. RESULTS Sixty-three percent (49/78) of SCMs measured <1 cm in length, 78% (61/78) extended to the cord surface, 65% (51/78) were expansile, and 32% (25/78) were exophytic. Popcorn morphology was seen in 15% (12/78) on T1w and 22% (17/78) on T2w. Internal blood-fluid levels were evident in 4% (3/78). Sixty-nine percent (54/78) showed T2w hypointense rims; the T2w rim was complete/near-complete in 37% (29/78). A rim on T1w was visible in 49% (38/78); this was hyperintense in 58% (22/38). Adjacent intramedullary hemorrhage was seen in 45/78 (58%), was most commonly bidirectional in 67% (30/45) and eccentric in 68% (30/44). Cord edema was seen in 22% (17/78); 53% (9/17) also demonstrated intramedullary hemorrhage with edema. CONCLUSIONS The classically described popcorn morphology, internal blood-fluid levels, and complete/near-complete T2w hypointense rims are often absent on MRIs in SCMs. Adjacent intramedullary hemorrhage is frequently present, often eccentric and bidirectional.
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Affiliation(s)
- Ananya Panda
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Felix E Diehn
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Dong Kun Kim
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | - Anshit Goyal
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | - John C Benson
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Carrie M Carr
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
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Hassani FD, Karekezi C, El Abbadi N. Rare case of giant pediatric cavernous angioma of the temporal lobe: A case report and review of the literature. Surg Neurol Int 2020; 11:7. [PMID: 31966926 PMCID: PMC6969371 DOI: 10.25259/sni_468_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Giant cavernous malformations of the central nervous system are quite rare. They are more common in children and may be misdiagnosed as other intracranial neoplasms. Here, we presented a very rare giant cavernous angioma mimicking a neoplastic temporal lobe lesion in an 18-month-old male. Case Description: An 18-month-old male presented with two initial seizures. Although the clinical examination was normal, the computed tomography (CT) scan showed a large left temporal mass (66 mm diameter) exerting significant mass effect and midline shift. The brain magnetic resonance (MR) imaging demonstrated a large left temporal heterogeneously enhancing lesion with significant perilesional edema and mass effect. The patient underwent gross total removal of the lesion that proved to be an intracranial cavernous angioma. Postoperatively, he did well, exhibiting no residual neurological deficit, and has remained lesion and seizure-free. Conclusion: This and 12 other cases in the literature focus on intracranial cavernous angiomas that could have been readily misdiagnosed as tumors. It confirms why obtaining appropriate preoperative MR and CT studies, followed by surgical intervention, is essential to confirm the correct underlying pathology and appropriately and optimally treat the patient.
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Affiliation(s)
- Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International University Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Claire Karekezi
- Department of Neurosurgery, Cheikh Zaid International University Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Najia El Abbadi
- Department of Neurosurgery, Cheikh Zaid International University Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
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Chester AN, Tan CH, Muthurajah V, Parker AJ. Concurrent Pituicytoma, Meningioma, and Cavernomas After Cranial Irradiation for Childhood Acute Lymphoblastic Leukemia. World Neurosurg 2020; 136:28-31. [PMID: 31904435 DOI: 10.1016/j.wneu.2019.12.144] [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: 11/09/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The majority of patients with acute lymphoblastic leukaemia develop disease relapse in the central nervous system in the absence of central nervous system-directed prophylactic therapy. In the past, prophylactic cranial irradiation was commonly used in the form of whole-brain radiotherapy in patients with acute lymphoblastic leukemia to prevent the development of intracranial diseases. However, in addition to the inherent risk of toxicity, this type of therapy has several delayed side effects including the development of secondary intracranial tumors. CASE DESCRIPTION We report a rare case of a patient with concurrent pituicytoma, meningioma, and cavernomas 44 years after prophylactic cranial irradiation for childhood acute lymphoblastic leukemia. The patient presented with visual disturbance, headache, and features of hypopituitarism. Endoscopic transsphenoidal resection of the pituicytoma and meningioma was performed. Subsequent regrowth of the residual meningioma necessitated further surgery and adjuvant treatment with radiotherapy. CONCLUSIONS This case report highlights the unusual case of a patient with 3 concurrent intracranial lesions of distinct pathologies after prophylactic cranial irradiation therapy for childhood acute lymphoblastic leukemia.
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Affiliation(s)
- Aaron N Chester
- Department of Surgery and Anaesthesia, Otago Medical School, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - Chi Hau Tan
- Department of Surgery Neurosurgery, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand.
| | - Vanaja Muthurajah
- Department of Pathology, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - Andrew J Parker
- Department of Surgery Neurosurgery, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand
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Apra C, Dumot C, Bourdillon P, Pelissou-Guyotat I. Could propranolol be beneficial in adult cerebral cavernous malformations? Neurosurg Rev 2019; 42:403-8. [PMID: 30610500 DOI: 10.1007/s10143-018-01074-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Surgery is the only therapeutic option for cerebral cavernous malformations (CCM) and is proposed, whenever possible, after haemorrhagic events, neurological symptoms, or epilepsy, radiosurgery being a controversial alternative in some cases. However, there is no treatment for non-accessible lesions, such as brainstem CCM, multiple CCM, or those located in functional areas. Propranolol, a non-selective beta-blocker used as first-line treatment for infantile haemangiomas, has proved spectacularly effective in a few cases of adult patients with CCM. We herein review the histological, in vitro data and clinical findings that support the idea of propranolol as a potential treatment for CCM. Since one retrospective study has not been conclusive, we support the idea that prospective trials are necessary.
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Barzaghi LR, Capitanio JF, Giudice L, Panni P, Acerno S, Mortini P. Usefulness of Ultrasound-Guided Microsurgery in Cavernous Angioma Removal. World Neurosurg 2018; 116:e414-20. [PMID: 29751184 DOI: 10.1016/j.wneu.2018.04.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Primary elements of surgical treatment of cavernous angiomas (CAs) are precise lesion identification and optimal trajectory determination. Navigation techniques allow for better results compared to microsurgery alone. In this study, we examined the benefits of intraoperative ultrasound (IOUS) use as an adjunct to standard localization systems. METHODS We retrospectively analyzed 59 CAs, comparing outcomes in 2 groups of patients: 34 who underwent frame-based or frameless navigation-assisted microsurgery (no-IOUS group) and 25 who underwent IOUS-guided microsurgery associated with these techniques (IOUS group). RESULTS The use of IOUS did not significantly increase the surgery time (mean, 172 ± 1.7 minutes in the IOUS group and 192.6 ± 11.5 in no-IOUS group; P = 0.08). In all 25 patients in the IOUS group, IOUS allowed for ready identification of CA as a hyperechoic mass. At the last follow-up (mean, 41.7 ± 3.5 months postsurgery), 95.2% of the IOUS group and 80.8% of the no-IOUS group had a modified Rankin Scale score of 0-1 and an Extended Glasgow Outcome Scale score of 7-8 (P = 0.2), with 100% and 64%, respectively, included in Engel outcome scale class IA (P = 0.006). Complete removal, as confirmed on postoperative magnetic resonance imaging, was achieved in all patients in the IOUS group and in almost all (97.1%; P = 0.4) patients in the no-IOUS group. CONCLUSIONS IOUS is a valid tool for the intraoperative identification of CAs. Implementation of standard localization methods with IOUS guidance was associated with complete resection in all cases, without increasing surgical time. Compared with microsurgery without IOUS guidance, long-term functional outcomes showed better trends, and the epilepsy-free rate was significantly higher.
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Passos J, Nzwalo H, Valente M, Marques J, Azevedo A, Netto E, Mota A, Borges A, Nunes S, Salgado D. Microbleeds and cavernomas after radiotherapy for paediatric primary brain tumours. J Neurol Sci 2016; 372:413-416. [PMID: 27856004 DOI: 10.1016/j.jns.2016.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 07/14/2016] [Revised: 10/30/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the expected growth and aging of the population of primary central nervous system tumours (PCNST) survivors, attention to the radiation-induced late brain injury is fundamental. Late focal hemosiderin deposition (FHD) lesions, namely microbleeds and cavernomas, are among the presumable late cerebrovascular complications associated with radiotherapy for PCNST. OBJECTIVE To explore association between PCNST radiotherapy and the occurrence FHD lesions and to address the correlation between the topographic location of these microvascular lesions with the focal radiotherapy location. METHODS Retrospective cohort study of 190 paediatric patients being followed for PCNST in a single referral oncological centre. The frequency of FHD lesions was compared between paediatric PCNST treated (n=132) and not treated (n=58) with brain radiation. Microbleed Anatomical Rating Scale (MARS) was used for systematic identification of these cerebrovascular lesions and to address the consistency between the topographic location of each lesion and the location of the focal radiotherapy area. Univariate analysis to address the role of variables such as tumour histology, location, gender and age of children at the beginning of radiotherapy, duration of follow-up and chemotherapy was performed. RESULTS FHD lesions (microbleeds and cavernomas) occurred exclusively and in a high percentage (41.6%) in PCNST survivors treated with brain radiation. Younger age at the diagnosis (p=0.031), duration of follow-up (p=0.010) and embryonal histology (p=0.003) positively correlated with the occurrence FHD lesions. FHD lesions were topographically concordant with the brain focal irradiation area in 3/19 (15.8%) patients from the focal RT subgroup and in 22/111 (19.8%) patients from the WBRT plus focal RT subgroup. CONCLUSION Our study, which is one of the largest to date on the topic, shows that FHD lesions are a common complication after radiotherapy for childhood PCNST. The young brain is probably more susceptible to radiation-induced late cerebrovascular injury. Diffuse small vessel disease and ceiling effect may account for the low topographic concordance we found. The clinical implications of FHD lesions in this specific population are yet to be clarified.
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Affiliation(s)
- João Passos
- Neurology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Hipólito Nzwalo
- Biomedical Science and Medicine Department, Universidade do Algarve, Portugal.
| | - Mariana Valente
- Neurology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Joana Marques
- Neurology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Ana Azevedo
- Neurology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Eduardo Netto
- Radiotherapy Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - António Mota
- Radiotherapy Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Alexandra Borges
- Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Sofia Nunes
- Paediatric Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal; Paediatric Neuro-Oncology Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Duarte Salgado
- Neurology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal; Paediatric Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
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Abstract
Background: Treatment of cavernomas remains a challenge in surgically inaccessible regions. The purpose of this study was to evaluate outcomes after gamma-knife surgery (GKS) for these patients. Materials and Methods: A retrospective review of 100 patients treated between 2003 and 2011 was conducted in order to evaluate hemorrhage rates, complications, radiation effects after GKS. Dosage at the tumor margin was stratified into two groups: those that received ≤13 Gy; and those who received >13 Gy. The demographic and clinical characteristics of patients including age, gender, and hemorrhage rates were extracted from care records. Results: The median age was 32.5 years (ranging from 15 to 79). 44% were female. The median follow-up time was 42.2 months (ranging from 24 to 90). The median volume of the lesions was 1050.0 mm3 (ranging from 112.0 to 4100.0) before GKS. A reduction of 27.5% in median size of cavernomas was achieved at the last follow-up. There was 12% treatment-related morbidity after GKS. The hemorrhage rate in the first 2 years after GKS was 4.1% and 1.9% thereafter. There was no mortality due to GKS, and 93 patients were alive at the last follow-up. The radiation-related complication developed with marginal dose 13 Gy. Conclusion: The GKS for cavernomas appears to be a safe and beneficial in carefully selected patients. Low-dose GKS may be effective for the management of cavernous malformations.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Shahzadi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Maziar Azar
- Department of Neurosurgery, Tehran University of Medical science, Tehran, Iran
| | - Mazdak Alikhani
- Department of Neurosurgery Iran Gamma-Knife Center, Tehran, Iran
| | - Alireza Zali
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Campero A, Ajler P, Garategui L, Goldschmidt E, Martins C, Rhoton A. Pterional transsylvian-transinsular approach in three cavernomas of the left anterior mesiotemporal region. Clin Neurol Neurosurg 2015; 130:14-9. [PMID: 25576880 DOI: 10.1016/j.clineuro.2014.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/15/2014] [Accepted: 12/20/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe the pterional transsylvian-transinsular approach for cavernomas of the left anterior mesiotemporal region in three patients. METHODS A retrospective analysis of patients who underwent surgery for cavernous angiomas in the temporal lobe was performed via the left mesiotemporal lobe (MTL). The technique was as follows: using the pterional approach, the Sylvian fissure was widely opened, distally to proximally. The temporal branch of the middle cerebral artery was displaced medially, and once the limiting sulcus of the insula was located, an 8mm long corticotomy was performed, just behind the limen insulae. The dissection was extended through the white matter until the anterior portion of the temporal horn was reached. Finally, lesion resection was performed. RESULTS Three patients presented with cavernomas in the anterior sector of the MTL and underwent the transsylvian-transinsular approach. There were no deaths in this series. One patient sustained a permanent postoperative deficit, a right homonymous quadrantanopia. CONCLUSION The pterional transsylvian-transinsular approach allows for selective resection of lesions located in the anterior mesiotemporal region (MTR) of the dominant hemisphere, while avoiding damage to the lateral or basal cortex of the temporal lobe or to structures in the dominant hemisphere.
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