bluuebunny/crossref_metadata_2025_split huggingface dataset:
Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis
Authors: De la Garza Ramos Rafael , Nakhla Jonathan , Sciubba Daniel M. , Yassari Reza 
Published: November 2018

OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included—147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)—27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)—25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)—18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.
Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function
Authors: Feigl Günther Christian , Bonelli Christine Maria , Berghold Andrea , Mokry Michael 
Published: November 2018

Object. The authors undertook a retrospective analysis of the incidence and time course of pituitary insufficiency following gamma knife radiosurgery (GKS) for pituitary adenomas.
Methods. Pituitary adenomas in 92 patients were analyzed. There were 61 hormonally inactive tumors, 18 prolactinomas, and nine somatotropic and four adrenocorticotropic adenomas. The mean tumor volume was 3.8 cm3 (range 0.2–14.6 cm3). The mean prescription dose was 15 Gy. The mean prescription isodose was 50.7%.
The mean follow-up time was 4.6 years (range 1.2–10 years). The following new or deteriorating insufficiencies that did not require treatment were recorded for the different pituitary axes: follicle-stimulating hormone (FSH)/luteinizing hormone (LH) 19 (20.6%), thyroid-stimulating hormone (TSH) 32 (34.8%), adenocorticotropic hormone (ACTH) 10 (10.9%), and growth hormone (GH) 26 (28.3%). For new insufficiencies or deterioration requiring replacement therapy, the figures were as follows: FSH/LH 20 (21.7%), TSH 22 (23.9%), ACTH eight (8.7%), and GH 12 (13%). Spot dosimetry was performed in 59 patients in the hypothalamic region, the pituitary gland, and pituitary stalk. The pituitary stalks in patients with deterioration of pituitary function received a statistically higher dosage of radiation, 7.7 ± 3.7 Gy compared with 5.5 ± 3 Gy (p = 0.03).
Conclusions. The function of the residual normal pituitary gland is less affected following GKS of pituitary adenomas than after fractionated radiotherapy. Nonetheless, increased attention needs to be exercised to reduce the dose to the stalk and pituitary gland to minimize the incidence of these complications.
Gamma knife surgery for cancer pain—pituitary gland—stalk ablation: a multicenter prospective protocol since 2002
Authors: Hayashi Motohiro , Taira Takaomi , Chernov Mikhail , Fukuoka Seiji , Liscak Roman , Yu Chung Ping , Ho Robert T. K. , Regis Jean , Katayama Yoko , Kawakami Yoriko , Hori Tomokatsu 
Published: November 2018

Object. The authors have treated intractable pain, particularly cancer pain related to bone metastasis, with various protocols. Cancer pain has been treated by gamma knife radiosurgery (GKS), targeted to the pituitary gland—stalk, as an alternative new pain control method. The purpose of this study was to investigate a prospective multicenter protocol to prove the efficacy and the safety of this treatment.
Methods. Indications for patient inclusion in this treatment protocol were: 1) pain related to bone metastasis; 2) no other effective pain treatment options; 3) general condition rated as greater than 40 on the Karnofsky Performance Scale; 4) morphine effective for pain control; and 5) no previous treatment with radiation (GKS or conventional radiotherapy) for brain metastasis. The authors at one institution have treated two patients, who suffered from severe cancer pain related to bone metastasis, by using GKS. The target was the pituitary gland. The maximum dose was 160 Gy with one isocenter of an 8-mm collimator, keeping the radiation dose to the optic nerve less than 8 Gy. At another institution two patients were treated in the same way; an additional five patients were treated similarly with targeting of the pituitary gland with two isocenters of 4-mm collimator.
In all nine cases, pain resolved without significant complication. Pain relief was observed within several days, and this effect was prolonged until the day that they died. At a follow up of 1 to 24 months, no recurrences and no hormonal dysfunction were observed.
Conclusions. Despite insufficient experience, the efficacy and the safety of GKS for intractable pain were demonstrated in nine patients. This treatment has the potential to ameliorate cancer-related pain, and GKS will play a more important role in the treatment of intractable pain. More experience and additional refined study protocols are needed to evaluate which parameters are important, to determine what treatment strategy is the best, and to clarify the safest option for patients with intractable cancer pain.
Successful treatment of spindle cell sarcoma of the sella turcica
Authors: Alpert Tracy E. , Hahn Seung S. , Chung Chung T. , Bogart Jeffrey A , Hodge Charles J. , Montgomery Craig 
Published: November 2018

✓ A primary spindle cell sarcoma of the sella turcica in a patient without a history of radiation treatment is a very rare occurrence. Only one other case has been reported to date, with local recurrence 7 months after the patient underwent subtotal resection and stereotactic radiosurgery of the tumor.
The authors present a case of spindle cell sarcoma of the sella turcica successfully treated by surgery, external-beam radiotherapy, and gamma knife radiosurgery. After 24 months of follow up, the patient continues to show no evidence of disease.
Radiosurgery as palliation for brain metastases: a retrospective review of 72 patients harboring multiple lesions at presentation
Authors: Amendola Beatriz E. , Wolf Aizik , Coy Sammie R. , Amendola Marco A. 
Published: November 2018

Object. The purpose of this study was to determine the outcome of palliative gamma knife radiosurgery (GKS) in a group of poor-risk patients with multiple brain metastases.
Methods. The medical records of 72 patients with multiple brain metastases treated with GKS between October 1993 and November 9, 2001, were reviewed retrospectively. All patients presented with more than 10 lesions. There were 26 men and 46 women. The median age was 60 years (range 24–84 years). There were 39 patients with lung cancer, 18 with breast cancer, nine with metastatic melanomas, two with metastatic renal cell carcinomas, and four with other primary tumors. A total of 147 treatment sessions were required to treat 1304 sites in 72 patients. A mean of 10.4 isocenters per treatment was used. The mean tumor volume was 1.7 cm3. All patients had extracranial disease. The variables included in this study were the patient's Karnofsky Performance Scale score, age, sex, the radiation dose, initial number of lesions, and tumor volume and histopathology.
Conclusions. Radiosurgery can be a powerful tool in the palliative management of advanced metastatic disease even in patients presenting with multiple brain metastases. A median of two outpatient treatments was required, allowing the advanced cancer patient to avoid protracted fractionated radiotherapy and to undergo other therapeutic treatment with an acceptable quality of life.
Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication
Authors: Matsuda Shinji , Serizawa Toru , Sato Makato , Ono Junichi 
Published: November 2018

Object. The purpose of this paper is to report a unique complication of gamma knife radiosurgery (GKS) for trigeminal neuralgia (TN). The nature of this complication and its related factors are discussed.
Methods. Forty-one medically refractory patients with TN were treated with GKS. All patients received 80 Gy to the proximal trigeminal nerve root, using a 4-mm collimator and a single isocenter. Follow up consisted of three monthly outpatient sessions after GKS. Improvement, recurrence, complications, and changes in magnetic resonance imaging were recorded. To evaluate the factors behind the complications, a subgroup of 33 patients was assessed in whom the follow-up duration was more than 9 months.
The follow-up duration was 3 to 36 months (mean 13 months). The results were excellent in 20 patients, good in 11, and fair in seven. No patient had a poor result. Three patients suffered recurrences. Seven patients suffered complications 9 to 24 months after GKS. All seven patients complained of facial numbness and hypesthesia was recorded. Three of them also complained of “dry eye” with diminution or absence of corneal reflex but no other abnormalities of the cornea and conjunctiva were found on ophthalmological examination. In these three patients, hypesthesia of the first division of the trigeminal nerve area had been found before their “dry eye” symptoms appeared. The irradiated volume on the brainstem was significantly related to this complication.
Conclusions. The dry eye symptom seems to be a special form of sensory disturbance. An overdose of radiation to the brainstem may play an important role in the manifestation of this complication.
Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis
Authors: Rogers C. Leland , Shetter Andrew G. , Ponce Francisco A. , Fiedler Jeffrey A. , Smith Kris A. , Speiser Burton L. 
Published: November 2018

Object. The authors assessed the efficacy and complications from gamma knife radiosurgery (GKS) for multiple sclerosis (MS)-associated trigeminal neuralgia (TN).
Methods. There were 15 patients with MS-associated TN (MS—TN). Treatment involved three sequential protocols, 70 to 90-Gy maximum dose, using a single 4-mm isocenter targeting the ipsilateral trigeminal nerve at its junction with the pons with the 50% isodose. Pain was appraised by each patient by using Barrow Neurological Institute (BNI) Scores I through IV: I, no pain; II, occasional pain not requiring medication; IIIa, no pain but continued medication; IIIb, some pain, controlled with medication; IV, some pain, not controlled with medication; and V, severe pain/no pain relief.
With a mean follow up of 17 months (range 6–38 months), 12 (80%) of 15 patients experienced pain relief. Three patients (20%) reported no relief (BNI Score V). For responders, the mean latency from treatment to the onset of pain relief was 13 days (range 1–61 days). Maximal relief was achieved after a mean latency of 56 days (range 1–157 days). Five patients underwent a second GKS after a mean interval of 534 days (range 231–946 days). The mean maximum dose at this second treatment was 48 Gy. The target was unchanged from the first treatment. All five patients who underwent repeated GKS improved. Complications were limited to delayed facial hypesthesias. Two (13%) of 15 patients experienced onset of numbness after the first GKS, as well as two of five patients following a second GKS. The patients found this mild and not bothersome. Each patient who developed hypesthesias also experienced complete pain relief.
Conclusions. Gamma knife radiosurgery is an effective treatment for MS—TN. Radiosurgery carries an acceptable small risk of mild facial hypesthesias, and hypesthesia appears predictive of a favorable outcome.
Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery
Authors: Chang Jin Woo , Choi Jae Young , Yoon Young Sul , Park Yong Gou , Chung Sang Sup 
Published: November 2018

✓ The purpose of this paper was to present two cases of secondary trigeminal neuralgia (TN) with an unusual origin and lesion location. In two cases TN was caused by lesions along the course of the trigeminal nerve within the pons and adjacent to the fourth ventricle. Both cases presented with typical TN. Brain magnetic resonance imaging revealed linear or wedge-shaped lesions adjacent to the fourth ventricle, extending anterolaterally and lying along the pathway of the intraaxial trigeminal fibers.
The involvement of the nucleus of the spinal trigeminal tract and of the principal sensory trigeminal nucleus with segmental demyelination are suggested as possible causes for trigeminal pain in these cases. It is postulated that these lesions are the result of an old viral neuritis. The patients underwent gamma knife radiosurgery and their clinical responses have been encouraging to date.
Gamma knife subthalamotomy for Parkinson disease: the subthalamic nucleus as a new radiosurgical target
Authors: Keep Marcus F. , Mastrofrancesco Lois , Erdman Daniel , Murphy Brent , Ashby Lynn S. 
Published: November 2018

✓ The authors present the neuroimaging, treatment planning, and radiosurgical technique for the first reported case of unilateral radiosurgical subthalamotomy, which was performed to control motor symptoms associated with advanced Parkinson disease (PD) in a patient who had undergone previous contralateral radiofrequency (RF) pallidotomy.
A 73-year-old woman with end-stage PD had undergone RF pallidotomy of the right globus pallidus with resolution of symptoms. Two years following this procedure, due to the natural progression of her disease, she suffered recurrent motor fluctuations, dyskinesia, and worsening bradykinesia of the right side. Her Parkinson's Disease Disability Rating (PDDR) score was 28. Computerized tomography and magnetic resonance (MR) imaging were used to localize the left subthalamic nucleus (STN). The patient underwent gamma knife radiosurgery—a single shot of 120 Gy was administered using the 4-mm collimator helmet.
The patient was evaluated up to 42 months after the procedure. The dyskinesia became minimal. Right-sided motor control improved as did her balance. At 3 months after treatment MR imaging demonstrated the radiosurgical lesion in the left STN. At 3.5 years postradiosurgery, she experienced minimal focal (oral) dyskinesia, no bradykinesia or rigidity, and her PDDR score was 11.
Radiosurgery of the STN in this case was safe and effective. The STN is a readily localized anatomical target with neuroimaging. Radiosurgery avoids the risks of open procedures.
A planned combined stereotactic approach for cystic intracranial tumors
Authors: Reda Wael Abdel Halim , Hay Alla Abdel , Ganz Jeremy C. 
Published: November 2018

✓ Cyst-associated tumors are classified as cysts with neoplastic mural nodules and intratumoral cysts. The solid component of many of these tumors may be appropriate for gamma knife radiosurgery (GKS). At present there is no systematic protocol for GKS treatment of patients harboring tumors with a cystic component. The purpose of this paper is to suggest such a program.
Two cases are presented. One patient had a hemangioblastoma with a cyst and a mural nodule. The second patient had a craniopharyngioma with one large and two small intratumoral cysts. The course in both cases has been satisfactory in the short term. Although the 1-year follow-up period, however, does not provide a basis for determining the correct overall management of such tumors, the treatment strategy does illustrate a program for the management of tumors with associated cysts.
Cysts with tumor nodules in their walls should first be treated with GKS followed by aspiration of the cyst contents, unless special circumstances make this unsuitable. This strategy enables treatment planning to take advantage of the natural barrier a cyst may place between a tumor and important surrounding structures.
Intratumoral cysts may be aspirated and then treated with GKS, with every attempt made to cover the entire target volume including any residual cyst with the prescription dose. This form of treatment requires very careful follow up.
It is probable that in some cases reaccumulation of cyst fluid may require the insertion of an Ommaya reservoir for repeated aspiration or the installation of cytotoxic agents such as bleomycin. This form of treatment is much less traumatic than surgery and does not hinder the performance of subsequent surgery, should this become necessary.
Leksell gamma knife lesioning of the rat hippocampus: the relationship between radiation dose and functional and structural damage
Authors: Lis˘c˘ák Roman , Vladyka Vilibald , Novotný Josef , Broz˘ek Gustav , Námĕstková Kater˘ina , Mares˘ Vladislav , Herynek Vít , Jirák Daniel , Hájek Milan , Syková Eva 
Published: November 2018

Object. The goals of the study were to determine at what dosage and after what interval impairment of hippocampal function occurs after Leksell gamma knife radiosurgery (GKS) of the rat hippocampus and to assess the associated structural changes.
Methods. Long—Evans rats were irradiated with maximum doses of 25, 50, 75, 100, and 150 Gy, and four 4-mm isocenters were used to cover the hippocampus bilaterally. The impairment of hippocampal function, which is associated with a loss of memory, was measured by testing the impairment of the rats' orientation in a Morris water maze. Changes in the irradiated tissue were measured using magnetic resonance imaging (Bruker 4.7/20 experimental spectrometer). The data were compared with histologically demonstrated changes.
Significantly higher incidences of edema, necrosis, and behavioral changes were observed following administration of doses higher than 50 Gy. No edema, necrosis, or behavioral changes were observed when doses were 25 Gy.
Conclusions. It would seem that rats can be used for experiments involving the induction of complex brain lesions by using four 4-mm isocenters. Testing retention memory for behavioral changes after bilateral GKS of the whole hippocampus proved insensitive; acquisition memory should be tested to assess functional changes of hippocampus. Significantly higher incidences of edema, necrosis, and behavioral changes were observed for doses higher than 50 Gy. There seems to be a therapeutic window during which doses may affect epilepsy without impairing the memory of the rat.
A validation study of a new prognostic index for patients with brain metastases: the Graded Prognostic Assessment
Authors: Sperduto Christina Maria , Watanabe Yoichi , Mullan John , Hood Terry , Dyste Gregg , Watts Charles , Bender Gail Papermaster , Sperduto Paul 
Published: November 2018

Object
The purpose of this study was to validate a new prognostic index for patients with brain metastases. This index, the Graded Prognostic Assessment (GPA), is based on an analysis of 1960 patients whose data were extracted from the Radiation Therapy Oncology Group (RTOG) database. The GPA is based on 4 criteria: age, Karnofsky Performance Scale score, number of brain metastases, and the presence/absence of extracranial metastases. Each of the 4 criteria is given a score of 0, 0.5, or 1.0, so the patient with best prognosis would have a GPA score of 4.0.

Methods
Between April 2005 and December 2006, 140 eligible patients with brain metastases were treated at the Gamma Knife Center at the University of Minnesota. The GPA score was calculated for each patient, and the score was then correlated with survival. Survival duration was calculated from the date treatment began for the brain metastases. Eligibility criteria included patients treated with whole-brain radiation therapy, stereotactic radiosurgery, or both.

Results
The median survival time in months observed in the RTOG and Minnesota data by GPA score was as follows: GPA 3.5–4.0, 11.0 and 21.7; GPA 3.0, 8.9 and 17.5; GPA 1.5–2.5, 3.8 and 5.9; and GPA 0–1.0, 2.6 and 3.0, respectively.

Conclusions
The University of Minnesota data correlate well with the RTOG data and validate the use of the GPA as an effective prognostic index for patients with brain metastases. Clearly, not all patients with brain metastases have the same prognosis, and treatment decisions should be individualized accordingly. The GPA score does appear to be as prognostic as the RPA and is less subjective (because the RPA requires assessment of whether the primary disease is controlled), more quantitative, and easier to use and remember. A multiinstitutional validation study of the GPA is ongoing.
Neuroimaging and quality-of-life outcomes in patients with brain metastasis and peritumoral edema who undergo Gamma Knife surgery
Authors: Pan Hung-Chuan , Sun Ming-Hsih , Chen Clayton Chi-Chang , Chen Chun-Jung , Lee Chen-Hui , Sheehan Jason 
Published: November 2018

Object
Gamma Knife surgery (GKS) has been shown to be effective for treating many patients with brain metastasis. Some brain metastases demonstrate significant peritumoral edema; radiation may induce cerebral edema or worsening preexisting edema. This study was conducted to evaluate the imaging and neurobehavioral outcomes in patients with preexisting peritumoral edema who then undergo GKS.

Methods
Between August 2003 and January 2008, 63 cases of brain metastasis with significant peritumoral edema (> 20 cm3) were prospectively studied. The study inclusion criteria were as follows: 1) a single metastatic lesion with significant edema (perilesional edema signal volume on FLAIR > 20 cm3); and 2) inclusion of only 1 lesion > 20 cm3 in the study (in cases of multiple lesions noted on FLAIR images). All patients received MR imaging with pulse sequences including T1-weighted imaging and FLAIR with or without contrast and T2-weighted imaging at an interval of 3 months. A neurological assessment and Brain Cancer Module (BCM-20) questionnaire were obtained every 2–3 months. Kaplan–Meier, Cox regression, and logistic regression were used for analysis of survival and associated factors.

Results
At the time of GKS, the median Karnofsky Performance Scale (KPS) score was 70 (range 50–90), and the mean BCM-20 score was 45.5 ± 6.1. The mean tumor volume (± standard deviation) was 5.2 ± 4.6 cm3 with corresponding T2-weighted imaging and FLAIR volumes of 59.25 ± 37.3 and 62.1 ± 38.8 cm3, respectively (R2 = 0.977, p < 0.001). The mean edema index (volume of peritumoral edema/tumor volume) was 17.5 ± 14.5. The mean peripheral and maximum GKS doses were 17.4 ± 2.3 and 35 ± 4.7 Gy, respectively. The median survival was 11 months. The longer survival was related to KPS scores ≥ 70 (p = 0.008), age < 65 years (p = 0.022), and a reduction of > 6 in BCM-20 score (p = 0.007), but survival was not related to preexisting edema or tumor volume. A reduction in BCM-20 score of > 6 was related to decreased volume in T1-weighted and FLAIR imaging (p < 0.001). Thirty-eight (79.2%) of 48 patients demonstrated decreased tumor volume and accompanied by decreased T2-weighted imaging and FLAIR volume. Eight (16.7%) of the 48 patients exhibited increased or stable tumor volume. A margin dose > 18 Gy was more likely to afford tumor reduction and resolution of peritumoral edema (p = 0.005 and p = 0.006, respectively). However, prior external-beam radiation therapy correlated with worsened preexisting peritumoral edema (p = 0.013) and longer maintenance of corticosteroids (p < 0.001).

Conclusions
Patients demonstrating a reduction in the BCM-20 score > 6, age < 65 years, and KPS score ≥ 70 exhibited longer survival. Significant preexisting edema did not influence the tumor response or clinical outcome. The resolution of edema was related to better quality of life but not to longer survival.