bluuebunny/crossref_metadata_2025 huggingface dataset:
Thalamic lesions produced by gamma thalamotomy for movement disorders
Authors: Ohye Chihiro , Shibazaki Tohru , Zhang Jie , Andou Yoshitaka
Published: November 2018

Object. The treatment of Parkinson disease and other kinds of involuntary movement by gamma knife radiosurgery (GKS) is presented. This is an extension of previous work. The clinical course and thalamic lesions were the main factors examined.

Methods. Seventeen new cases were added to the previously reported 36 cases. The course and results for the whole series of 53 patients were examined. Treatment was undertaken using a single 4-mm collimator shot to deliver 130 Gy to the target. The target was determined in the previously treated patients by using classic methods involved in conventional stereotactic thalamotomy with microrecording. More recently, target localization has been performed by relating the target point to the total length of the thalamus. Points may then be defined as percentages of that length measured from the anterior pole. Targets can then be determined in relationship to the appropriate percentage.

Thirty-five patients have been followed for more than 2 years and the longest follow up was 8 years. Two kinds of thalamic lesion were seen after GKS. Volumetric analysis on MR imaging revealed that the larger lesion was 400 to 500 mm3 at the beginning and gradually decreased in size. The smaller lesion occupied approximately 200 mm3 and also shrank over several months. Eighty percent of the treated cases showed good results and no significant complications, with the tremor subsiding at 1 year (Type 1). Several cases deviated from this standard course in four different ways (Types 2–5). If tremor persisted, conventional stereotactic thalamotomy with microrecording was performed. During such operations, normal neuronal activity was recorded from the region adjacent to the GKS thalamotomy target. This was the region showing a high signal on MR imaging. The activity patterns included the rhythmical grouped discharge of tremor rhythm.

Conclusions. Gamma thalamotomy for functional disorders is still under development, but because the results with careful target planning are satisfactory, there are grounds for increasing optimism.
Leksell gamma knife treatment of uveal melanoma
Authors: s˘imonová Gabriela , Novotný Josef , Lis˘c˘ák Roman , Pilbauer Jir˘í
Published: November 2018

Object. The purpose of this study was to analyze treatment results, radiation-induced side effects, and prognostic survival factors for patients with uveal melanoma.

Methods. Eighty-one patients with uveal melanoma were treated using the Leksell gamma knife during a period of 6 years (1996–2001). There were 45 men and 36 women with a median age of 59 years (range 22–85 years). Seventyfive of these patients underwent minimal follow up 10 months after treatment. After patient eye immobilization, magnetic resonance (MR) imaging was performed to enable stereotactic localization. A scoring system was used to measure radiation side effects. The median target volume was 640 mm3, and the median applied minimal dose was 31.4 Gy. All patients were examined by an ophthalmologist and with MR imaging at regular intervals. Factors influencing posttreatment survival and side effects were statistically analyzed.

Conclusions. Local tumor control in the 75 patients who underwent minimal follow up after 10 months was achieved in 63 patients (84%), whereas progression was observed in 12 patients (16%). The most frequent side effect was secondary glaucoma, which was detected in 18 patients (25%). The incidence of this side effect was significantly higher when the total volume of peripheral isodose was greater than 1000 mm3 (p = 0.015). Toxicity in the optic nerve here was also significantly higher when the maximum dose to this structure was higher than 9 Gy (p = 0.011), in the cornea when the maximum dose was higher than 15 Gy (p = 0.010), and in the lens when the maximum dose was higher than 10 Gy (p = 0.035). Altogether three pretreatment variables (patient age, tumor location, and dissemination of the disease) and one treatment variable (the minimum dose applied) were identified as having a significant influence on a patient's survival.
Evaluation of gamma knife radiosurgery in the treatment of oligodendrogliomas and mixed oligodendroastrocytomas
Authors: Sarkar Atom , Pollock Bruce E. , Brown Paul D. , Gorman Deborah A.
Published: November 2018

Object. Radiosurgery is commonly used for the treatment of patients with glioma. The goal of this study was to evaluate the safety and efficacy of radiosurgery in the management of patients with oligodendrogliomas (ODGs) or mixed oligoastrocytomas (OGAs).

Methods. A retrospective chart review of patients treated between May 1990 and January 2000 identified 18 patients (21 tumors) with either an ODG (10) or a mixed OGA (11) who had undergone radiosurgery. The median patient age was 43 years (range 23–67 years). Sixteen patients had undergone one or more tumor resections before radiosurgery; in two patients biopsy sampling alone had been performed. Tumor grades at the most recent operation were Grade 1 (one), Grade 2 (one), Grade 3 (12), and Grade 4 (seven patients). Seventeen patients had undergone prior radiotherapy; 11 were treated with chemotherapy before radiosurgery, and one had undergone a prior linear accelerator—based radiosurgery treatment. The median tumor volume was 8.2 cm3 (range 1.9–47.7 cm3); the median margin dose was 15 Gy (range 12–20 Gy); and the median maximum dose was 32 Gy (range 24–50 Gy).

In this heterogeneous group, 12 patients died whereas six remain alive. Survival after radiosurgery was 78%, 61%, and 44% at 12, 24, and 48 months, respectively. Factors associated with an improved survival rate included younger age and smaller tumors.

Conclusions. For patients with oligoastroglial tumors that have failed to respond to conventional therapies, radiosurgery may provide some survival benefit. Further study is needed to determine which subpopulation of these patients will have the best chances of enhanced survival from this treatment.
Gamma Knife surgery for metastatic brain tumors
Authors: Serizawa Toru , Yamamoto Masaaki , Nagano Osamu , Higuchi Yoshinori , Matsuda Shinji , Ono Junichi , Iwadate Yasuo , Saeki Naokatsu
Published: November 2018

Object

The authors compared results of Gamma Knife surgery (GKS) for brain metastases obtained at 2 institutions in Japan.

Methods

They analyzed a consecutive series of 2390 patients with brain metastases who underwent GKS from 1998 through 2005 in 2 institutes (1181 patients in Chiba; 1209 in Mito). In the 2 facilities, 1 neurosurgeon each was responsible for diagnosis, patient selection, GKS procedures, and follow-up (T.S. in Chiba, M.Y. in Mito). Even if tumor numbers exceeded 4, all visible lesions were irradiated with a total skull integral dose (TSID) of ≤ 10–12 J. No prophylactic whole-brain radiotherapy (WBRT) was applied. If new distant lesions were detected, salvage GKS was appropriately performed.

Results

The distributions of patient and treatment factors did not differ between institutes. The most common primary tumors were lung cancer (1572 patients), followed by gastrointestinal tract (316), breast (211), kidney (113), and other cancers (159). The median survival periods were 7.7 months in Chiba and 7.0 months in Mito (p = 0.0635). The significant poor prognostic factors for overall survival were active extracranial disease status, male sex, and low initial Karnofsky Performance Scale score on multivariate analysis (all p < 0.0001). The neurological survival rates at 1 year were 86.6% in Chiba and 84.2% in Mito (p = 0.3310).

Conclusions

This 2-institute study demonstrated no significant institutional differences in any of the treatment result items. Gamma Knife surgery for brain metastases without prophylactic WBRT prevents neurological death and allows a patient to maintain good brain condition. However, there is 1 important patient selection criterion: regardless of how many tumors there are, all lesions can be irradiated with a TSID of ≤12 J.
Complications of Gamma Knife surgery: an early report from 2 Canadian centers
Authors: Vachhrajani Shobhan , Fawaz Charbel , Mathieu David , Ménard Cynthia , Cusimano Michael D. , Gentili Fred , Hodaie Mojgan , Kenny Brendan , Kulkarni Abhaya V. , Laperriere Normand , Schwartz Michael , Tsao May , Bernstein Mark
Published: November 2018

Object

Gamma Knife surgery (GKS) is used to treat benign and malignant brain tumors, arteriovenous malformations, trigeminal neuralgia, and other conditions. Patients experience reduced neurological morbidity from GKS compared with open microneurosurgery, but risks of radiation injury and technical limitations persist. The authors report treatment complications from the early experience of 2 Canadian GKS programs in Toronto and Sherbrooke.

Methods

In Toronto, a prospective administrative database was searched for adverse events and incomplete treatment administrations. In Sherbrooke, data were acquired by chart review. Patients were accrued until August 1, 2007, and a total of 973 patients were included in this report.

Results

During the radiosurgical procedure, 19 patients (2%) suffered anxiety or syncopal episodes, and 2 patients suffered acute coronary events. Treatments were incompletely administered in 12 patients (1.2%). Severe pain was a delayed complication: 8 patients suffered unexpected headaches, and 9 patients developed severe facial pain. New motor deficits developed in 11 patients, including edema-induced ataxia in 4 and one case of facial weakness after treatment of a vestibular schwannoma. Four patients required shunt placement for symptomatic hydrocephalus, and 16 patients suffered delayed seizures.

Conclusions

Gamma Knife surgery is a minimally invasive treatment modality for many intracranial diseases. Treatment is not risk free, and some patients will develop complications; these are likely to decrease as institutional experience matures. Expanding availability and indications necessitate discussion of these risks with patients considering treatment.
Dosimetric comparison of the Leksell Gamma Knife Perfexion and 4C
Authors: Novotny Josef , Bhatnagar Jagdish P. , Niranjan Ajay , Quader Mubina A. , Huq M. Saiful , Bednarz Greg , Flickinger John C. , Kondziolka Douglas , Lunsford L. Dade
Published: November 2018

Object

The recently introduced Leksell Gamma Knife (LGK) Perfexion is an entirely new system with a different beam geometry compared with the LGK 4C. The new Perfexion system has 192 cobalt-60 sources that are fixed on 8 sectors (each sector has 24 sources). Each sector can be moved independently of the others and can be set to 1 of 5 different positions: 3 positions defining collimator sizes of 4, 8, and 16 mm; an off position (sources are blocked); and a home position. The purpose of this study is to compare the dosimetric characteristics of the GK 4C and the Perfexion models. This comparison is important especially for the treatment of functional disorders when only a single shot with the 4- or 8-mm collimator is used.

Methods

A 160-mm-diameter spherical polystyrene phantom was used for all measurements and calculations. The irradiation geometry consisted of the placement of a single shot at the center of this phantom. Comparisons were made among different dosimetric parameters obtained from calculations performed using Leksell GammaPlan v. 8.0 and measurements performed using film dosimetry. The dosimetric parameters investigated were dose profiles for all collimators in all 3 stereotactic planes (x, y, and z) including the full width at half maximum and the penumbra for each profile, cumulative dose–volume histograms, the volume encompassed by the 50% isodose surface, the mean doses delivered to a defined matrix volume, and relative output factors for all collimator sizes.

Results

There was excellent agreement between the dosimetric parameters of GK 4C and Perfexion for the 4- and 8-mm collimators.

Conclusions

The results of this study suggest that consistent treatments of functional disorders will be delivered using either GK 4C or Perfexion.
A new classification of head injury based on computerized tomography
Authors: Marshall Lawrence F. , Marshall Sharon Bowers , Klauber Melville R. , Clark Marjan van Berkum , Eisenberg Howard M. , Jane John A. , Luerssen Thomas G. , Marmarou Anthony , Foulkes Mary A.
Published: November 2018

✓ A new classification of head injury based primarily on information gleaned from the initial computerized tomography (CT) scan is described. It utilizes the status of the mesencephalic cisterns, the degree of midline shift in millimeters, and the presence or absence of one or more surgical masses. The term “diffuse head injury” is divided into four subgroups, defined as follows: Diffuse Injury I includes all diffuse head injuries where there is no visible pathology; Diffuse Injury II includes all diffuse injuries in which the cisterns are present, the midline shift is less than 5 mm, and/or there is no high- or mixed-density lesion of more than 25 cc; Diffuse Injury III includes diffuse injuries with swelling where the cisterns are compressed or absent and the midline shift is 0 to 5 mm with no high- or mixed-density lesion of more than 25 cc; and Diffuse Injury IV includes diffuse injuries with a midline shift of more than 5 mm and with no high- or mixed-density lesion of more than 25 cc. There is a direct relationship between these four diagnostic categories and the mortality rate. Patients suffering diffuse injury with no visible pathology (Diffuse Injury I) have the lowest mortality rate (10%), while the mortality rate in patients suffering diffuse injury with a midline shift (Diffuse Injury IV) is greater than 50%. When used in conjunction with the traditional division of intracranial hemorrhages (extradural, subdural, or intracerebral), this categorization allows a much better assessment of the risk of intracranial hypertension and of a fatal or nonfatal outcome. This more accurate categorization of diffuse head injury, based primarily on the result of the initial CT scan, permits specific subsets of patients to be targeted for specific types of therapy. Patients who would appear to be at low risk based on a clinical examination, but who are known from the CT scan diagnosis to be at high risk, can now be identified.
Treatment of essential trigeminal neuralgia with gamma knife surgery
Authors: Urgosik Dusan , Liscak Roman , Novotny Josef , Vymazal Josef , Vladyka Vilibald
Published: November 2018

Object. The authors present the long-term follow-up results (minimum 5 years) of patients with essential trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS).

Methods. One hundred seven patients (61 females and 46 males) underwent GKS. The median follow up was time was 60 months (range 12–96 months). The target was the trigeminal root, and the maximum dose was 70 to 80 Gy. Repeated GKS was performed in 19 patients for recurrent pain, and the same dose was used.

Initial successful results were achieved in 96% of patients, with complete pain relief in 80.4%. Relief was achieved after a median latency of 3 months (range 1 day–13 months). Gamma knife surgery failed in 4% of patients. Pain recurred in 25% of patients after a median latent interval of 36 months (6–94 months). The initial success rate after a second GKS was 89% and 58% of patients were pain free. Pain relapse occurred in only one patient in this group. Hypesthesia was observed in 20% of patients after the first GKS and in 32% after the second GKS. The median interval to hypaesthesia was 35 months (range 3–94 months) after one treatment and 21 months (range 1–72 months) after a second treatment.

Conclusions. The initial success rate of pain relief was high and comparable to that reported in other studies. A higher than usual incidence of sensory impairment after GKS could be the long duration of follow-up study and due to the detailed neurological examination.
Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome
Authors: Hayashi Motohiro , Taira Takaomi , Ochiai Taku , Chernov Mikhail , Takasu Yuichi , Izawa Masahiro , Kouyama Nobuo , Tomida Mihoko , Tokumaru Osamu , Katayama Yoko , Kawakami Yoriko , Hori Tomokatsu , Takakura Kintomo
Published: November 2018

Object. Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain.

Methods. Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months.

Conclusions. An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.
The effect of gamma knife irradiation on functions of striatum in rats
Authors: Tokumaru Osamu , Tomida Mihoko , Katayama Yoko , Hayashi Mootohiro , Kawakami Yoriko , Kouyama Nobuo
Published: November 2018

Object. An animal model has been developed to study the effect of gamma knife surgery(GKS) on cerebral function.

Methods. A rat was fixed in a newly developed Régis—Valliccioni frame that enables the target region to be planned directly on the magnetic resonance images. The left striatum was irradiated with 150 Gy via a 4-mm collimator of the Leksell gamma knife. Apomorphine (dopamine agonist) was administered to elicit a circling behavior (apomorphine test) after the GKS so as to examine the time course of the changes in dopaminergic functions of irradiated striatum. After a series of behavioral analyses, irradiated brains were subjected to histological examination.

Necrosis was observed in the irradiated area surrounded by hemorrhage and gliosis. The distance between the histologically estimated and planned centers of the irradiation areas was 1.0 ± 0.5 mm. The extent of the distance was due to errors along dorsoventral axis. The distribution of the irradiation areas influenced the activity and the circling behaviors in apomorphine test, which was suggestive of involvement of the nigrostriatal pathway.

Conclusions. Targeting by using the Régis—Valliccioni frame was very accurate compared with targeting with coordinates based on brain maps used hitherto. Although targeting improved the accuracy, further effort will still be necessary to reduce errors along dorsoventral axis. The apomorphine test indicated a reduced dopaminergic function of the irradiated area including striatum, which accompanied histological changes after a high dose of irradiation (150 Gy).
Analysis of long-term outcomes and prognostic factors in patients with non—small cell lung cancer brain metastases treated by gamma knife radiosurgery
Authors: Gerosa Massimo , Nicolato Antonio , Foroni Roberto , Tomazzoli Laura , Bricolo Albino
Published: November 2018

Object. The authors conducted a study to evaluate the long-term outcomes and prognostic factors for survival in a large series of patients treated by gamma knife surgery (GKS) for non—small cell lung cancer (NSCLC) brain metastases.

Methods. The study is based on the retrospective analysis of clinical and radiological records obtained during a 10-year period (1993–2003), concerning 836 lesions in 504 patients. The lesions were primary in 86% and recurrent 14% of the cases; they were solitary in 31%, single in 29%, and multiple in 40%. The mean follow-up period was 16 months (range 4–113 months). The most common histological types were adenocarcinoma (51%) and squamous cell carcinoma (27%). Dose planning parameters were as follows: mean target volume 6.2 cm3 (range 0.06–22.5 cm3); mean prescription dose 21.4 Gy (range 15.5–28 Gy); and mean number of isocenters 6.7 (range one–18). Progression-free and actuarial survival curves were calculated using the Kaplan—Meier method. The main factors affecting survival were determined by unimultivariate analysis (log-rank test and Cox proportional hazard models).

Analysis of long-term outcomes seemed to confirm that GKS is a primary therapeutic option in these patients. The 1-year local tumor control rate was 94%. The overall median survival was 14.5 months, with extremely rewarding quality of life indices. The recursive partitioning analysis classification was the dominant prognostic factor.

Conclusions. Gamma knife surgery is a useful treatment for brain metastases from NSCLC.
Low-dose radiosurgery for large vestibular schwannomas: long-term results of functional preservation
Authors: Inoue Hiroshi K.
Published: November 2018

Object. The author conducted a study to assess the long-term results obtained in patients who underwent GKS for large vestibular schwannomas (> cochlear nerve functions were evaluated.

Methods. Twenty consecutive large tumors in 18 patients (including two cases of neurofibromatosus Type 2 [NF2]) were followed for more than 6 years. There were eight tumors that were more than 4 cm in maximum diameter. Microsurgery had already been performed prior to GKS in 11 patients (nine recurrent and two residual tumors).

Four patients (including one with NF2) died during the follow-up period of other diseases or by accident. Fourteen of 15 tumors were stable or decreased in size. Microsurgery was performed in one patient 2 years after radiosurgery. Facial nerve function was preserved in all patients and hearing preserved in four of five patients with cochlear nerve function prior to radiosurgery. No adverse effects of radiosurgery have been observed to date.

Conclusions. Gamma knife surgery seems to have a place in the low-dose treatment of selected large vestibular schwannoma in patients with a reasonable chance of retaining facial function and pretreatment hearing level. Patients with severe brainstem compression should first be undergo microsurgery.
Glossopharyngeal neuralgia treated with gamma knife surgery: treatment outcome and failure analysis
Authors: Stieber Volker W. , Bourland J. Daniel , Ellis Thomas L.
Published: November 2018

✓ Glossopharyngeal neuralgia (GPN) is a rare condition in which patients present with intractable deep throat pain. Similar to trigeminal neuralgia (TN), treatment with microvascular decompression (MVD) has been successful in both. Because gamma knife surgery (GKS) has also been shown to be effective in treating TN, it seemed reasonable to apply it to GPN. The authors present the first report of GKS-treated GPN in a patient who presented with severe, poorly controlled GPN and who refused MVD.
Volume reduction in meningiomas after gamma knife surgery
Authors: Feigl Guenther C. , Bundschuh Otto , Gharabaghi Alireza , Samii Madjid , Horstmann Gerhard A.
Published: November 2018

Object. The purpose of this study was to evaluate the volume-reducing effects of gamma knife surgery (GKS) of meningiomas with and without previous surgical treatment.

Methods. A group of 127 patients with a mean age of 57.1 years (range 9–81 years) with 142 meningiomas (128 World Health Organization Grade I and 14 Grade II) were included in this study. The management strategy reduces tumor volume with surgery when necessary (81 patients). Stereotactic GKS with a Gamma Knife model C was performed in all tumors of suitable size. Magnetic resonance imaging follow-up examinations with volumetric tumor analysis was performed 6 months after treatment and annually thereafter.

The mean tumor volume was 5.9 cm3 (range < 5 to > 40 cm3). The mean follow-up time after GKS was 29.3 months (range 11–61 months). The mean prescription dose was 13.8 Gy (range 10–18 Gy). A reduction in volume occurred in 117 (82.4%) of all tumors, and in 20 tumors (14.1%) growth ceased. The overall tumor control rate of 96.4%. The mean volume reduction achieved with GKS was more than 46.1%. Only five tumors (3.5%) showed a volume increase.

Conclusions. Gamma knife surgery was effective in reducing meningioma volume at short-term follow up. Further studies are needed to examine the development of these findings over a longer period.
The long-term results of gamma knife radiosurgery for hemangioblastomas of the brain
Authors: Wang En-Min , Pan Li , Wang Bing-Jiang , Zhang Nan , Zhou Liang-Fu , Dong Ya-Fei , Dai Jia-Zhong , Cai Pei-Wu , Chen Hong
Published: November 2018

Object. The authors assessed the long-term result of gamma knife surgery (GKS) for hemangioblastomas of the brain (HABs) and show histopathological findings after GKS.

Methods. Thirty-five patients, 28 men and seven women, with a mean age of 36 years underwent GKS. Eighteen patients presented with multiple tumors and 17 with a solitary tumor. Twenty-one patients had von Hippel—Lindau (VHL) disease. The mean tumor diameter was 13 mm (range 5–55 mm). The mean follow up after GKS was 66 months (range 24–114 months). The mean prescription dose was 17.2 Gy (range 12–24 Gy) at the tumor margin. For tumors close to or within the brainstem a prescription dose of 12 to 13 Gy was used.

At the most recent follow up, 29 patients were alive, six were dead, and satisfactory tumor control had been achieved in 29. A stable or improved neurological status was obtained in 21 patients. Eight patients underwent open surgery because of tumor-associated cyst enlargement or the development of new tumors after GKS. Seven patients developed new tumors and five of them required a second GKS. The 1-year tumor control rate was 94%; 2 years, 85%; 3 years, 82%; 4 years, 79%; and 5 years, 71%. Histopathology showed that no tumor cells were found and there was degeneration and necrosis in a tumor nodule 48 months after GKS with a prescription dose of 18 Gy.

Conclusions. Gamma knife surgery was a useful choice for small- or medium-sized, solid HAB in the long term, especially when the tumor margin dose was 18 Gy. Although GKS can treat multiple tumors in a single session, for HABs associated with VHL disease, GKS faces the dual problems of tumor recurrence or development of a new tumor.
Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors
Authors: Sheehan Jason , Kondziolka Douglas , Flickinger John , Lunsford L. Dade
Published: November 2018

Object. Lung carcinoma is the leading cause of death from cancer. More than 50% of those with small cell lung cancer develop a brain metastasis. Corticosteroid agents, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, median survival for patients with small cell lung carcinoma metastasis is approximately 4 to 5 months after cranial irradiation. In this study the authors examine the efficacy of gamma knife surgery for treating recurrent small cell lung carcinoma metastases to the brain following tumor growth in patients who have previously undergone radiation therapy, and they evaluate factors affecting survival.

Methods. A retrospective review of 27 patients (47 recurrent small cell lung cancer brain metastases) undergoing radiosurgery was performed. Clinical and radiographic data obtained during a 14-year treatment period were collected. Multivariate analysis was utilized to determine significant prognostic factors influencing survival.

The overall median survival was 18 months after the diagnosis of brain metastases. In multivariate analysis, factors significantly affecting survival included: 1) tumor volume (p = 0.0042); 2) preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time between initial lung cancer diagnosis and development of brain metastasis (p = 0.0127). Postradiosurgical imaging of the brain metastases revealed that 62% decreased, 19% remained stable, and 19% eventually increased in size. One patient later underwent a craniotomy and tumor resection for a tumor refractory to radiosurgery and radiation therapy. In three patients new brain metastases were demonstrating on follow-up imaging.

Conclusions. Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases provided effective local tumor control in the majority of patients. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can extend survival.
Long-term outcomes after Gamma Knife surgery for vestibular schwannomas: a 10-year experience
Authors: Liu Dong , Xu Desheng , Zhang Zhiyuan , Zhang Yipei , Zheng Ligao
Published: November 2018

Object

The authors sought to assess the results of Gamma Knife surgery (GKS) in patients with vestibular schwannomas (VSs).

Methods

Seventy-four consecutive patients (33 men and 41 women) were evaluated by means of serial imaging studies, clinical examinations, and questionnaires. Nineteen patients had undergone resection of their VS. Facial nerve function was normal in 63 patients (85.1%) before GKS, and 63.5% of them had useful hearing. The prescription peripheral dose varied between 10 and 14 Gy (mean 12.27 ± 0.96 Gy); the corresponding central dose was 21 to 30 Gy (mean 24.9 ± 2.18 Gy). The mean volume of the tumor at GKS was 10.79 ± 5.52 ml (range 0.11–27.8 ml). A mean of eight isocenters (range 3–17) was used for treating these lesions.

At a median follow-up period of 68.3 months (range 30–122 months), tumor shrinkage was observed in 60 patients (81.1%), and the tumor size was stable in 11 (14.8%). Persistent neuroimaging demonstrated evidence of progression in only three patients (4.1%): two underwent repeated GKS after an interval of 18 months and one continues to be observed. Five patients experienced trigeminal dysfunction: in three the dysfunction was transient and in the other two the dysfunction persists. Three patients suffered facial palsy. Useful hearing was preserved in 34 patients. Thirteen patients experienced some degree of hearing improvement. Deterioration of hearing was found in 13 of 62 patients who had Class I or II hearing before treatment.

Conclusions

Gamma Knife surgery prevents tumor growth; it achieves excellent neurological function preservation and produces few treatment-related complications.
Intracranial glomus jugulare tumors: volume reduction with Gamma Knife surgery
Authors: Feigl Guenther Christian , Horstmann Gerhard A.
Published: November 2018

Object

Glomus jugulare tumors (GJTs) are slow-growing benign tumors arising from paraganglion cells of the superior vagal ganglion. Involvement of cranial nerves and extensive erosion of the jugular foramen and petrous bone are typically seen in patients with GJTs. Advances in microsurgical techniques have improved patient outcomes, but tumors involving the petrous bone remain difficult to treat effectively. The aim of our study was to further evaluate the role of Gamma Knife surgery (GKS) in the management of intracranial GJTs.

Methods

Twelve consecutive patients (mean age 51.7 years) with intracranial GJTs were included in this study. The treatment strategy was either multimodal, with microsurgical tumor volume reduction followed by GKS in patients suffering from brainstem compression, or GKS as the only treatment. Follow-up examinations included thorough neurological examinations and neuroradiological quantitative volumetric tumor analysis. Five patients (41.6%) underwent microsurgery before GKS. Tumor volumes ranging from 1.6 to 24.8 cm3 were treated using prescription doses of 14 to 20 Gy (nine–28 isocenters). The achieved overall tumor control rate after GKS was 100% (33 months mean follow up) with only mild side effects observed. A tumor volume reduction (mean 41.1%; 3.2 cm3) was achieved in all patients.

Conclusions

Gamma Knife surgery is a safe and effective treatment for intracranial GJTs. The tumor volume reductions achieved are comparable to those achieved using microsurgery but with a much lower rate of side effects. More studies with longer follow-up times are necessary to confirm these very promising results.
Geometrical accuracy of a 3-tesla magnetic resonance imaging unit in Gamma Knife surgery
Authors: Watanabe Yoichi , Lee Chung K. , Gerbi Bruce J.
Published: November 2018

Object

The authors sought to evaluate and improve the geometrical accuracy of a 3-tesla magnetic resonance (MR) imaging unit used for Gamma Knife surgery (GKS).

Methods

To evaluate the geometrical accuracy of a Siemens Magnetom Trio 3-tesla MR imaging unit, two phantoms were used. Both phantoms were imaged with computed tomography (CT), a 1.5-tesla MR imaging unit (Siemens Avanto), and the 3-tesla MR imaging unit. A pair of orthogonal films was obtained with a radiotherapy simulator to validate the spatial coordinates of the marker positions determined with CT. The coordinates of the markers were measured using the GammaPlan treatment planning software. Magnetic resonance imaing was performed using three-dimensional (3D) magnetization-prepared rapid acquisition gradient echo (MPRAGE) and fast low-angle shot sequence (FLASH) pulse sequences. The voxel size was 1 × 1 × 1 mm3.

Conclusions

The root-mean-square error of MR images was 2 ± 0.73 mm for 3D MPRAGE. The error was reduced to 1.5 ± 0.64 mm for FLASH. The errors were decreased further by applying an image distortion correction method (the field-of-view filter) to the images acquired with FLASH. The mean errors were 1.3 ± 0.39 mm and 1.5 ± 0.77 mm for the two phantoms. The errors increased from 1 mm to 3.1 mm as the measurement points approached the caudal edge of the head coil (larger z value). Proper selection of a pulse sequence together with a geometrical distortion correction improved the geometrical accuracy of MR images. However, further study is needed to increase the geometrical accuracy of 3-tesla MR imaging units for radiosurgical applications.
Radiosurgery of isolated cerebral vessels following administration of paclitaxel in the rat
Authors: Major Otto , Walton Lee , Goodden John , Radatz Matthias , Szeifert Georg Tamas , Hanzely Zoltan , Kocsis Bela , Nagy Zoltan , Kemeny Andras
Published: November 2018

Object

Progressive obliteration occurs in arteriovenous malformations (AVMs) after radiosurgery; however, the risk of hemorrhage remains until the obliteration process is complete. The authors sought to enhance the radiation effect and reduce the risk of hemorrhage by facilitating faster vessel obliteration. To that end, a combination of a lower radiation dose with the addition of a radiosensitizing agent was compared with the effect of a higher radiation dose alone.

Methods

Using a method described by Mulvany and Halpern, isometric myography measurements were made on isolated rat middle cerebral artery specimens. The vessels were treated with 200 Gy, 80 Gy, 50 Gy, 25 Gy, 20 Gy, or 15 Gy by using Gamma Knife surgery. Taxol (paclitaxel 3 mg/kg/body weight) was administered intravenously to the animals. Survival times posttreatment were 24 hours, 6 weeks, 12 weeks, 12 months, or 18 months. After dissection, the middle cerebral arteries were mounted on a small-vessel myograph, and contraction and relaxation studies were performed.

In a second series of experiments these results were validated in human fibroblast culture. When the cultures were 75 to 80% colonized, the samples were treated in vitro with 60Co gamma radiation in similar doses with or without paclitaxel.

Conclusions

Constriction responses were generally decreased in the paclitaxel-treated vessels. Differences were significant at 6 weeks (p < 0.05) and at 1 year (p < 0.05). After 1 year, in the paclitaxel-treated groups vascular reactivity was completely abolished in vessels receiving 50 Gy. In comparison, it took 6 months longer (18 months) for this reaction to be abolished in vessels without paclitaxel treatment.

In tissue cultures Giemsa staining and immunohistochemical reactions for p53, Ki-67, CD-34, and SMA antigens revealed marked fibroblast hypertrophy in all of the paclitaxel-treated groups. Paclitaxel-treated vessels demonstrated decreased reactivity at significantly earlier stages than vessels that had not been treated. It would appear that paclitaxel causes acceleration in the time course of the late biological effect of gamma radiation. This beneficial effect could be used in Gamma Knife surgery in patients with AVMs, thus reducing the risk of posttreatment hemorrhage.
Gamma Knife surgery targeting the centromedian nucleus of the thalamus for the palliative management of thalamic pain: durable response in stroke-induced thalamic pain syndrome
Authors: Keep Marcus F. , Mastrofrancesco Lois , Craig Arthur D. , Ashby Lynn S.
Published: November 2018

✓The authors report the neuroimaging features, treatment planning, and outcome in a case of radiosurgical thalamotomy targeting the centromedian nucleus (CMN) for stroke-induced thalamic pain.

A 79-year-old man, with embolic occlusion of the left middle cerebral artery and large hemispheric infarction involving the thalamus, suffered a right hemiplegia and expressive aphasia. One year poststroke, severe right-sided facial, scalp, arm, and trunk pain developed and was exacerbated by any tactile contact. Medical treatment had failed. Medical illness, including mandatory anticoagulation therapy for atrial fibrillation, precluded surgical procedures. Minimally invasive radiosurgery was offered as an alternative. Magnetic resonance imaging and computed tomography were used to localize the left CMN. A single shot of 140 Gy was delivered to the 100% isodose line by using the 4-mm collimator helmet.

The patient was evaluated at regular intervals. By 12 weeks posttreatment, he had significant improvements in pain control and his ability to tolerate physical contact during activities of daily living. Magnetic resonance imaging demonstrated baseline encephalomalacia from his prior stroke, and signal changes in the left CMN consistent with gamma irradiation–based thalamotomy. Currently, nearly 7 years after radiosurgery, he continues to enjoy a marked reduction in pain without the need of analgesic medications.

Thalamic pain syndrome is generally refractory to conventional treatment. Neurosurgical interventions provide modest benefit and carry associated risks of invasive surgery and anesthesia. The CMN is readily localized with neuroimaging and is an approximate target to reduce the suffering aspect of pain. In this case, radiosurgery was a safe and effective treatment, providing durable symptom control and improved quality of life.
Repeated Gamma Knife surgery for refractory trigeminal neuralgia
Authors: Huang Chuan-Fu , Chuang Jim-Chao , Tu Hsien-Tang , Lin Long-Yau
Published: November 2018

Object

Repeated Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) is an acceptable method for refractory cases but not well established in terms of dose effect and nerve tolerance. The authors report their experience in 28 patients over 3.5 years of follow up.

Methods

Between 1999 and 2004, a total of 28 patients with recurrent or residual TN underwent repeated GKS. The median follow-up periods were 52 and 43 months after the first and repeated procedures, respectively. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 40 to 76 Gy as maximal dose. Additive doses ranged between 110 and 152 Gy. The median duration of symptoms was 4.86 years. There were 12 women (46%) and 16 men (54%).

At the last evaluation, a total of 19 patients (68%) reported pain relief. Of these patients, 13 were no longer taking pain medications. Significant recurrent or residual pain was noted in nine patients after a median follow up of 12 months (range 6–48 months). New onset of facial numbness was noted in 10 patients. An additive dose above 115 Gy was found to be associated with facial numbness and nonfacial numbness (p = 0.047). No definite additive dose correlation with pain relief was noted (p = 0.23).

Conclusions

Repeated GKS established durable pain relief in a majority of patients, and a higher additive dose (> 115 Gy) tended to cause facial numbness. However, a prospective trial is needed to fully assess the efficacy and late complications of GKS.
Glioma and Alzheimer’s Disease
Authors: Lehrer Steven
Published: November 2018

Background:

Cancer mortality and Alzheimer’s disease (AD) mortality increase with age, but some studies have shown an inverse relationship of the two diseases, that is, older persons with cancer have a reduced risk of AD and vice versa. However, other analyses suggest that AD and brain tumor might be positively correlated.

Objective:

In the current study, we wished to determine the relationship of AD mortality to malignant brain tumor mortality in US states and counties.

Methods:

Data and maps of malignant brain tumor mortality and Alzheimer’s disease mortality (1999–2016) are from the CDC Wonder tool (https://wonder.cdc.gov/cmf-icd10.html). Data on malignant brain tumor types and their frequencies are from the Surveillance, Epidemiology, and End Results Program (SEER, https://seer.cancer.gov). Data on the genetics of lower grade glioma are from the TCGA Lower Grade Glioma (LGG) dataset in TCGA (The Cancer Genome Atlas).

Results:

SEER data indicate that astrocytomas make up 58.2% of malignant brain tumors in patients 65 and older; glioblastoma and anaplastic astrocytoma make up 41.6%. We found a significant positive correlation between AD mortality rate and malignant brain tumor mortality rate 1999–2016 in persons age 65 and older in A) 1,101 US counties, p <  0.001 and B) 50 US states, p <  0.001.

Conclusion:

Adult malignant brain tumors may share some environmental risks with AD. Malignant brain tumors and AD also have some genes in common: TREM2, SPI1, CD33, and INPP5D. The interaction of environment and genetics is complex and overlaps in malignant brain tumors and AD.
A Survey on Hierarchical Cluster Based Secure Routing Protocols and Key Management Schemes in Wireless Sensor Networks
Authors: Bhadane Yugashree , Kadam Pooja
Published: November 2018

Now days, wireless technology is one of the center of attention for users and researchers. Wireless network is a network having large number of sensor nodes and hence called as “Wireless Sensor Network (WSN)”. WSN monitors and senses the environment of targeted area. The sensor nodes in WSN transmit data to the base station depending on the application. These sensor nodes communicate with each other and routing is selected on the basis of routing protocols which are application specific. Based on network structure, routing protocols in WSN can be divided into two categories: flat routing, hierarchical or cluster based routing, location based routing. Out of these, hierarchical or cluster based routing is becoming an active branch of routing technology in WSN. To allow base station to receive unaltered or original data, routing protocol should be energy-efficient and secure. To fulfill this, Hierarchical or Cluster base routing protocol for WSN is the most energy-efficient among other routing protocols. Hence, in this paper, we present a survey on different hierarchical clustered routing techniques for WSN. We also present the key management schemes to provide security in WSN. Further we study and compare secure hierarchical routing protocols based on various criteria.
KONFLIK ELIT POLITIK LOKAL DALAM PROSES PILKADA KABUPATEN BANYUWANGI
Authors: Irtanto Irtanto
Published: November 2018

Penelitian ini bersifat kualitatif dengan metode pengumpulan data “indepth interview”. Tujuan penelitian adalah ingin mengetahui faktor-faktor menonjol yang menyebabkan terjadinya konflik dan implikasinya terhadap kinerja pemerintah. Hasil penelitian memperlihatkan bahwa konflik disebabkan oleh faktor maturitas elit politik rendah dan hanya cenderung mementingkan kepentingan ekonomi politik. Konflik elit politik lokal menyebabkan terganggunya birokrasi, APBD berlarut-larut, terjadi politisasi birokrasi, dan pelayanan terhadap publik terganggu.
ANALISIS GELOMBANG UNTUK PERENCANAAN PEMBANGUNAN BREAKWATER DI PANGKALAN PENDARATAN IKAN (PPI) BULU KABUPATEN TUBAN
Authors: Prasetyo Eko
Published: November 2018

Sebagai pelabuhan perikanan di bawah pengelolaan Pemerintah Propinsi Jawa Timur, PPI Bulu Strategis karena letaknya berbatasan dengan Propinsi Jawa Tengah. Pelabuhan ini diarahkan menjadi Pelabuhan Perikanan Nusantara (PPN). Tipe pasang surut perairan Bulu adalah harian tunggal. Pola arus cenderung ke arah barat pada jam 11.00-12.00 dan akan berubah ke utara pada jam 15.00-16.00. Arus pasang surutnya memiliki pola arus bolak-balik utara-selatan. Pada saat pasang, arus mengalir dari utara ke selatan, sedangkan pada saat surut, arus mengalir dari arah selatan ke utara. Berdasarkan pasang surut , arus dan gelombang datang serta draft kapal terbesar yang memasuki kolampelabuhan, maka breakwater sebaiknya dibangun menghadap arah utara dengan celah selebar 168.2 meter menghadap timur, panjang lengan pertama 890 meter dan lengan kedua 500 meter dari pantai, jarak antara dua lengan breakwater 348 meter, letak ujung pada kedalaman 4 meter dengan elevasi puncak 2.80 meter di atas MSL. Hasil perhitungan difraksigelombang menunjukkan bahwa breakwater yang akan dibangun dapat meredam gelombang datang ±20% sehingga kolam pelabuhan lebih tenang.
PENGETAHUAN DAN PENGALAMAN MASYARAKAT DALAM MENGHADAPI BENCANA ALAM
Authors: Raharjo Tri Weda
Published: November 2018

Bencana merupakan rangkaian peristiwa yang disebabkan oleh alam, manusia dan/atau oleh keduanya yang mnegakibatkan korban penderitaan manusia, kerugian harta benda, kerusakan lingkungan serta menimbulkan gangguan terhadap tata kehidupan dan penghidupan masyarakat.
PERKEMBANGAN PELESTARIAN DAN PEMANFAATAN PLASMA NUTFAH DI JAWA TIMUR
Authors: Purnomo Sudarmadi , Baswarsiati Baswarsiati
Published: November 2018

Jawa Timur memiliki berbagai kekayaan plasma nutfah tanaman pangan dah hortikultura (buah-buahan, sayuran, tanaman hias dan biofarmaka) serta ternak yang mempunyai ciri spesifik dan keunggulan yang berbeda sesuai dengan agroekologi spesifik. Persebaran plasma nutfah yang terdapat di hutan, di desa-desa atau di tengah-tengah ekologi manusia merupakan kekayaan aset negara dan masyarakat yang dapat digunakan sebagai sumber pangan, sandang, papan, obat-obatan, aneka industri dan pariwisata. Masalah yang dihadapi adalah belum banyak daerah dan masyarakatnya yang telah menyadari dan memahami dengan baik arti, fungsi dan pentingnya plasma nutfah. Kekayaan plasma nutfah yang ada belum banyak digali bahkan cenderung kurang diperhatikan sehingga belum banyak tindakan pelestariannya. Masih ingat diperlukan data base yang lengkap tentang keberadaan plasma nutfah tersebut baik dalm segi jenisnya, jumlahnya, kualitasnya, manfaatnya yang bernilai ekonomis maupun untuk pelestarian serta kelangkaanya. Beberapa plasma nutfah unggulan Jawa Timur telah dilepas oleh Menteri Pertanian menjadi varietas unggul nasional. Plasma nutfah unggulan maupun yang tidak bernilai ekonomis (bernilai pelestarian) tetap perlu dilestarikan secara insitu maupun ex situ sehingga perlu adanya dukungan pemeliharaan dan prasarana serta sarananya yang disesuaikan dengan agroekologinya, untuk itu perlu ditentukan wilayah yang akan digunakan untuk pelestarian ex situ tersebut. Varietas unggul yang telah dilepas perlu dikembangkan ke masyarakat dimana pengembangan tersebut perlu didukung oleh berbagai pihak seperti Pemprop, Pemkab, Litbang, swasta dan masyarakat. Pengembangan varietas unggul sangat tergantung pada keberadaan benih bermutu sehingga sangat diperlukan penanganan benih yang perlu didukung kerjasama seperti Pemprop, Pemba, Litbang, swasta dan masyarakat. Sosialisasi pentingnya plasma nutfah serta varietas unggul sangat diperlukan melalui berbagai media serta berbagai tujuan dan sasaran.