Journal of neurosurgery
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Journal of neurosurgery · Dec 2010
Quality-of-life outcomes after Gamma Knife surgery for trigeminal neuralgia.
Gamma Knife surgery (GKS) is an important part of the neurosurgical armamentarium for treatment of patients with trigeminal neuralgia (TN) and is regarded as the first-line treatment in patients with TN who have serious medical comorbidities. In this study, the authors investigated the efficacy of GKS on TN in patients with serious medical comorbidities. ⋯ Gamma Knife surgery produced significant pain relief in severely ill patients who had TN without causing appreciable morbidity. The effect of reduced pain significantly paralleled an improvement in SF-36 quality-of-life indices.
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Journal of neurosurgery · Dec 2010
Large vestibular schwannomas treated by Gamma Knife surgery: long-term outcomes.
Although radiosurgery has been well accepted as a treatment for small- to medium-sized vestibular schwannomas (VSs), its application in the treatment of large VSs remains controversial because of unfavorable effects such as tumor swelling and potential compression of the brainstem. The authors present a retrospective study spanning 17 years, during which 21 patients underwent Gamma Knife surgery (GKS) for large VSs. Long-term outcomes are reported, and possible factors affecting tumor responses to GKS are analyzed. ⋯ Treatment of large VSs remains a challenge to neurosurgeons regardless of whether they perform microsurgery or radiosurgery. Control of tumor growth and preservation of neurological function are the main goals of treatment. Although delayed microsurgery was required in 2 patients (9.5%), the satisfactory tumor control rate and excellent preservation of facial and trigeminal nerve function are the great advantages of radiosurgery. Radiosurgery is not only a practical treatment for patients with small- to medium-sized VSs, but it is also an excellent tool for treating larger tumors up to 25 cm(3). In selected cases, radiosurgery plays an important role in treating large VSs with satisfactory results.
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Journal of neurosurgery · Dec 2010
ReviewStereotactic lesions for the treatment of psychiatric disorders.
The use of deep brain stimulation (DBS) has recently been expanded to the investigational treatment of specific psychiatric disorders. Much like movement disorders, the targets selected for DBS are based on past experience with stereotactic lesions. A literature review of past studies incorporating stereotactic lesions for psychiatric disorders was performed to provide historical context and possible guidance for current and future attempts at treating psychiatric disorders with DBS. ⋯ This study provides retrospective data that suggest which anatomical focus may be effective to lesion or stimulate for the treatment of each of several psychiatric disorders.
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Journal of neurosurgery · Dec 2010
Gamma Knife surgery for metastatic brain tumors from primary breast cancer: treatment indication based on number of tumors and breast cancer phenotype.
The goal of this study was to analyze prognostic factors for local tumor control and survival and indications for initial treatment with the Gamma Knife in patients with up to 10 metastatic brain tumors from primary breast cancer. ⋯ Initial GKS resulted in excellent local tumor control rates, which were associated with prolonged survival and a low risk of neurological death for patients with up to 10 metastatic brain tumors from primary breast cancer. The authors recommend periodic clinical and neuroradiological follow-up examinations after GKS in patients with 5 or more lesions at initial GKS, because they carry a high risk of development of new brain metastases, and in patients with the HER2-positive phenotype, because they tend to have a favorable prognosis in overall survival. Last, the authors recommend additional GKS or whole-brain radiation treatment for salvage treatment if new brain metastases occur.
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Journal of neurosurgery · Dec 2010
Gamma Knife surgery in vestibular schwannomas: impact on the anterior and posterior labyrinth.
During the past decades, in small-to-medium size vestibular schwannomas, Gamma Knife surgery (GKS) has become a reliable therapeutic option because of either excellent local tumor control or minimal morbidity, with cranial neuropathy becoming increasingly rare. Although still insufficiently analyzed in larger cohorts of patients with long-term follow-ups, adequate chances of hearing preservation and vestibular sparing seem clinically guaranteed. However, deeper investigations are needed in this regard, expanding the number of cases and the follow-up period. ⋯ Using appropriate radiodosimetry planning, GKS seems to guarantee not only adequate tumor growth control rates, but also better levels of hearing preservation, with a documented, long-lasting improvement in vestibular functions.