Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2010
ReviewImaging of brain tumors: MR spectroscopy and metabolic imaging.
The utility of magnetic resonance spectroscopy (MRS) in diagnosis and evaluation of treatment response to human brain tumors has been widely documented. The role of MRS in tumor classification, tumors versus nonneoplastic lesions, prediction of survival, treatment planning, monitoring of therapy, and post-therapy evaluation is discussed. This article delineates the need for standardization and further study in order for MRS to become widely used as a routine clinical tool.
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Neuroimaging Clin. N. Am. · Aug 2010
ReviewRadiation oncology in brain tumors: current approaches and clinical trials in progress.
Radiation therapy remains a critical therapeutic modality in the treatment of adult brain tumors. However, its use continues to evolve depending on the histologic findings of the brain tumor. In high-grade gliomas, current trials focus on the addition of systemic agents and optimization of target delineation to improve the therapeutic ratio of radiotherapy. ⋯ With primary central nervous system lymphoma, the advent of high-dose methotrexate-based chemotherapy and the risk of severe early neurocognitive toxicity have brought the role of radiotherapy into question. With meningioma, the use of normal tissue-sparing techniques such as radiosurgery has allowed for the successful treatment of patients who are eminently curable and with a life expectancy that is generally no different than that of the general population. Particular attention in this review is paid to current approaches, contemporary trials, and modern therapeutic dilemmas.
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Epidural steroid injections have been used for decades as part of a rehabilitation program to relieve back or neck pain and the associated radicular nerve component that often accompanies these problems. These injections are minimally invasive and offer many patients substantial relief without the need for more invasive procedures. Although effective and generally simple, they must be performed accurately and properly for maximum benefit and complication avoidance. This article discusses the various technical aspects of the procedure that must be observed by the operator to accomplish these ends.
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Spinal cord stimulation has been used successfully for more than 40 years. The application of an electrical impulse field on to the spinal cord is used with a battery generator source and a variety of either cylindrical or paddle/plate leads. ⋯ Many clinical conditions such as complex regional pain syndrome, failed back spinal syndrome, and extremity neuropathic pain involving the trunk and limbs are approved for its use. This device allows patients to live a successful life without pain.
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Pain that develops in the cervical, thoracic, lumbar, and sacral spine is typically initiated from a clinical condition called spondylosis. Radiofrequency ablation is a key element in the treatment protocol of patients with spondylosis of the cervical, thoracic, lumbar, and sacroiliac joint pain. ⋯ Radiofrequency neurolysis is a common technique used in the treatment of chronic pain, particularly facet (zygapophyseal joint) arthralgia. The technique involves an insulated needlelike cannula; x-rays passing through the patient show the projected relative radioopaque bony landmarks and the metallic cannula.