Anatomy of Trigeminal Neuromodulation Targets: From Periphery to the Brain.
Authors: Goellner E, Rocha CE Abstract The trigeminal nerve complex is a very important and somewhat unique component of the nervous system. It is responsible for the sensory signals that arise from the most part of the face, mouth, nose, meninges, and facial muscles, and also for the motor commands carried to the masticatory muscles. These signals travel through a very complex set of structures: dermal receptors, trigeminal branches, Gasserian ganglion, central nuclei, and thalamus, finally reaching the cerebral cortex. Other neural structures participate, directly or indirectly, in the transmission and modulation...
Source: Progress in Neurological Surgery - October 8, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Motor Cortex Stimulation for Facial Pain.
Authors: Teton ZE, Raslan AM Abstract Motor cortex stimulation (MCS) has been used in the treatment of intractable neuropathic facial pain for nearly 30 years. While efficacy rates have been noted as high as 88% in some studies, considerable variability in treatment response remains. Additionally, MCS is often cited as providing diminishing relief over time, and there are few long-term studies on efficacy. Complications are generally mild and include infection, hardware complication, seizure, and transient neurological deficit. Despite relatively minimal use, MCS remains a viable treatment option for the appropriat...
Source: Progress in Neurological Surgery - September 30, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Cervical Spinal Cord Stimulation for Facial Pain.
Authors: Jones MR, Baskaran AB, Rosenow JM Abstract Neuropathic facial pain can be exceedingly difficult to manage with conventional therapies. Since this pain may be excruciating and often debilitating and some patients do not respond or do not tolerate conventional treatments, the interest in neuromodulation therapies is increasing. One of the most commonly used neuromodulation therapies, spinal cord stimulation, has recently shown promise in treating facial pain. We reviewed the current literature to determine usefulness of spinal cord stimulation in management of refractory facial pain. Our review indicates tha...
Source: Progress in Neurological Surgery - September 15, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

High-Frequency Peripheral Nerve Stimulation for Craniofacial Pain.
Authors: Finch P, Drummond P Abstract Since the first successful use of high-frequency electrical stimulation of trigeminal branches for treatment of facial pain in 1962, neuromodulation techniques become well established but remain greatly underutilised. Most subsequent implantation techniques and commercial devices for peripheral nerve stimulation, available until the last decade, utilised frequencies in the range 1-100 Hz. With the commercial introduction of 10-kHz spinal cord stimulation, there has been renewed interest in peripheral applications of kHz frequency neuromodulation. High-frequency biphasic stimula...
Source: Progress in Neurological Surgery - September 11, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Deep Brain Stimulation for Facial Pain.
Authors: Singleton WGB, Ashida R, Patel NK Abstract Electro-modulation of subcortical deep brain structures by surgically implanted electrodes is now standard evidence-based treatment for movement disorders such as Parkinson's disease and essential tremor and is approved for dystonia and obsessive-compulsive disorder under a humanitarian exemption. Historically, deep brain stimulation (DBS) for multiple indications has demonstrated acceptable complication rates, rare mortality, and reducing morbidity as the technology and the techniques of its application have advanced. DBS for the amelioration of pain has been per...
Source: Progress in Neurological Surgery - September 11, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Neurosurgical Management of Cancer Facial Pain.
Authors: Mirzadeh Z, Sheehy JP, Ben-Haim S, Rosenberg WS Abstract Facial pain occurs in approximately 80% of patients with head and neck cancers. Pain in these settings may result directly from the tumor, or indirectly as a side effect of oncological treatment of the tumor. Optimizing treatment for cancer pain of the face, therefore, involves a variety of diagnostic and treatment considerations, with the development of a successful treatment algorithm dependent on accurate diagnosis of the anatomical location of the pain, its relationship to the facial pain pathway, the type of pain being treated and, finally, pati...
Source: Progress in Neurological Surgery - August 20, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Peripheral Nerve Stimulation for Facial Pain Using Conventional Devices: Technique and Complication Avoidance.
Authors: Mogilner AY Abstract The introduction of peripheral neuromodulation to treat headache and facial pain two decades ago opened up the field to non-neurosurgical practitioners, given the relatively low risk and technical ease of the procedure. These procedures, primarily occipital nerve stimulation (ONS) and trigeminal branch stimulation such as supra- and infraorbital nerve stimulation, are now established to be effective in a number of facial pain and headache syndromes, despite their lack of approval by regulatory agencies such as the US Food and Drug Administration (FDA). For that reason and others, dedic...
Source: Progress in Neurological Surgery - August 20, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Targeted Drug Delivery (Intrathecal and Intracranial) for Treatment of Facial Pain.
Authors: Dupoiron D Abstract Despite the high incidence of facial pain, targeted drug delivery remains a rarely used technique for treatment of otherwise refractory pain. Two distinct paths have been described. The intraventricular route allows direct access to intracerebral opioid receptors. The more recently introduced upper cervical or cisternal intrathecal route, is based on the same theories as classical intrathecal route. Intraventricular route was first described by A.K. Ommaya; its use remains limited, mostly with morphine, despite a high clinical efficiency, probably because of the invasive nature of the p...
Source: Progress in Neurological Surgery - August 20, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Classification of Facial Pain: A Clinician's Perspective.
Authors: Hupe CAG, Slavin KV Abstract Successful management of facial pain starts with making correct diagnosis. Diagnostic errors, particularly early on in evaluation of facial pain patients are not uncommon, and some of this may be related to the lack of uniform classification that would satisfy needs of different specialists. Here, we critically review several most common classification schemes and try to compare and contrast their strength and unique features. We also attempt to link multiple terminologies describing same clinical conditions and provide a rationale for developing a unified nosological approach....
Source: Progress in Neurological Surgery - August 3, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Gasserian Ganglion Stimulation for Facial Pain.
Authors: Yin D, Slavin KV Abstract Non-neuralgic trigeminal neuropathic pain can be challenging in terms of treatment as pharmacological interventions often tend to be ineffective. Within the pain-transmitting pathway, the Gasserian ganglion (GG) is a rather unique anatomical and physiological structure where the sensory (including pain) information from the entire half of the face undergoes primary processing in a very compact and clearly defined entity. Moreover, GG is positioned in a completely immobile intradural location (the Meckel's cave) and is insulated from the brain by a layer of dura. As a confluence of...
Source: Progress in Neurological Surgery - July 31, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Peripheral Nerve Stimulation for Facial Pain Using Wireless Devices.
Authors: Stokey BG, Weiner RL, Slavin KV, Hayek SM Abstract Since its original introduction several decades ago, peripheral nerve stimulation (PNS) of the craniofacial region has been traditionally performed using devices intended for spinal cord stimulation applications with inevitably high rate of technical challenges and procedural complications. The lower invasiveness of recently developed wireless neurostimulation systems makes them much better suited for craniofacial applications. Here, we discuss the preliminary clinical data from several published reports and the ongoing multicenter prospective study of wir...
Source: Progress in Neurological Surgery - July 31, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Transcutaneous Electrical Nerve Stimulation for Facial Pain.
Authors: Zayan K, Felix ER, Galor A Abstract Transcutaneous electrical nerve stimulation (TENS) has been used for its analgesic effects for chronic pain, including facial pain. Here, we summarize how the electrical stimulation of branches of the trigeminal nerve via TENS has been utilized to reduce pain resulting from trigeminal neuralgia, temporomandibular joint disorder, migraine and other headache types, and ocular pain sensations. TENS has been used for both short-term (one session) and long-term (multiple sessions) pain control with little to no adverse effects reported by subjects. The results of the summariz...
Source: Progress in Neurological Surgery - July 24, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Sphenopalatine Ganglion Stimulation for Chronic Headache Syndromes.
Authors: Vesper J, Santos Piedade G, Hoyer R, Slotty PJ Abstract Neuropathic facial pain is notoriously difficult to treat, regardless of its origin and duration. Since the first reported sphenopalatine ganglion blockade by Sluder in 1908, this ganglion has assumed an important role among the structures targeted for the treatment of facial pain. Recent years have witnessed the rise of neuromodulation over ablative procedures, including the development of an implantable stimulation device specially designed for use in the pterygopalatine fossa. Sphenopalatine ganglion stimulation has been demonstrated as effective a...
Source: Progress in Neurological Surgery - July 24, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Transcranial Direct Current Stimulation in the Treatment of Facial Pain.
Authors: Antal A Abstract Non-invasive neuromodulation techniques such as transcranial direct current stimulation (tDCS) enable researchers and health care professionals to gain unique insight into brain functions and to treat a number of neurological and psychiatric conditions. Repeated applications of anodal tDCS over the primary motor cortex (M1) have been shown to produce long-lasting relief of neuropathic pain. tDCS is a technique that can induce and modulate brain plasticity and thus be suitable for treating diverse chronic pain conditions, disorders associated with substantial reorganization of central nervo...
Source: Progress in Neurological Surgery - July 24, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Preface.
Authors: Slavin KV PMID: 32698186 [PubMed - as supplied by publisher] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - July 24, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Percutaneous Electrical Nerve Stimulation for Facial Pain.
Authors: Vajramani G Abstract Percutaneous electrical nerve stimulation (PENS) is a novel, minimally invasive and useful treatment modality. Its use in complex facial pain has been on the rise, and its utility will further increase with the advances in the technology and renewed interest in the field of peripheral neuromodulation. PENS therapy can be used both as diagnostic and therapeutic option. The precise mechanism of action is not known, although a combination of electrical neuromodulation and release of endogenous morphine-like substance in the central nervous system appears as plausible explanation. We analy...
Source: Progress in Neurological Surgery - July 24, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Peripheral Nerve Stimulation for Facial Pain Using Conventional Devices: Indications and Results.
Authors: Winfree CJ Abstract Trigeminal branch stimulation is a type of peripheral nerve stimulation (PNS) used to treat a variety of craniofacial pain disorders. Common indications include trigeminal neuralgia, trigeminal neuropathic pain, trigeminal deafferentation pain, trigeminal postherpetic neuralgia, supraorbital neuralgia, and migraine headaches. Supraorbital and infraorbital arrays are the most common electrode configurations, although preauricular, mandibular branch, and subcutaneous peripheral nerve field stimulation arrays have also been described. Trigeminal branch stimulation may be used as a stand-al...
Source: Progress in Neurological Surgery - July 21, 2020 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Leksell Radiosurgery for Vestibular Schwannomas.
Authors: Bowden GN, Niranjan A, Lunsford LD Abstract Vestibular schwannomas (VS) are benign tumors predominantly originating from the balance portion of cranial nerve VIII. These tumors have an incidence of 1-2 per 100,000 people. The growth of these tumors is approximately 1-2 mm per year. A VS can result in significant neurologic dysfunction from continued growth or the management paradigms designed to control this predominantly benign tumor. The impacts on the critical space within the auditory canal and cerebellopontine angle can lead to hearing deficits, tinnitus, vestibular dysfunction, facial nerve deficits,...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Targeted Therapies for Brain Metastases.
Authors: Niranjan A, Lunsford LD, Ahluwalia MS Abstract The most common primary cancers that metastasize to the brain are lung cancer, breast cancer, and melanoma. The established management approaches for brain metastasis include stereotactic radiosurgery, fractionated radiation therapy, and surgical resection. In the past the role of medical therapies in brain metastases was limited. In the last decade, our understanding of molecular drivers of brain metastases and CNS penetration of drugs across the blood-brain barrier has improved. The molecular targeted tyrosine kinase inhibitors have shown effectiveness in br...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Frame versus Frameless Leksell Stereotactic Radiosurgery.
Authors: Lunsford LD, Niranjan A, Fallon K, Kim JO Abstract For more than 65 years localization of brain targets suitable for stereotactic radiosurgery has been performed after application of an intracranial guiding device to the cranial vault. After imaging and dose planning the same frame is used to secure the target at the focus of the intersection of the ionizing radiation beams that create the radiobiological effect. Non-invasive immobilization systems first proposed for linear accelerator or proton radiation technologies have now been developed for the Leksell Gamma Knife ICON radiosurgical system. The ICON t...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

The Role of Leksell Radiosurgery in the Management of Craniopharyngiomas.
Authors: Niranjan A, Lunsford LD Abstract Management of craniopharyngiomas remains challenging due to the tumor's often intimate relationship with the optic apparatus, the hypothalamus, and the pituitary gland. Often multimodal management is needed to achieve the best treatment outcome: tumor control coupled with endocrine, visual, and neurocognitive preservation. Many surgeons favor initial subtotal resection followed by adjunctive therapy to improve quality of life in a tumor with potentially long-term survival even if coupled with a need for periodic new interventions. During the patient's subsequent follow-up, ...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgery for Behavioral Disorders.
Authors: Martínez-Álvarez R Abstract Psychiatric illnesses create great suffering for patients and the medical solution is sometimes limited. The experience observed after treating patients with obsessive-compulsive disorder (OCD), depression, and anorexia nervosa by Gamma Knife radiosurgery (GKRS) is presented. Ten patients with medically refractory OCD, 3 patients with depression resistant to medical treatment and electroconvulsive therapy, and 5 patients with refractory anorexia nervosa have been treated. Bilateral anterior capsulotomy has been performed to treat OCD and bilateral cingulotomy has b...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Leksell Radiosurgery for Ependymomas and Oligodendrogliomas.
This report examines the role of SRS in these less common glial tumors. PMID: 31096227 [PubMed - as supplied by publisher] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Leksell Radiosurgery for Orbital, Uveal, and Choroidal Tumors.
Authors: Ares WJ, Flickinger JC, Lunsford LD Abstract Stereotactic radiosurgery using the Leksell Gamma Knife has proven to be a valuable alternative to orbital enucleation or fractionated radiation therapy for primary tumors of the orbit, metastatic tumors to the choroid, and primary uveal melanomas. With this approach in a single outpatient setting, the eye is immobilized by a local block after which high-definition MRI or CT is performed to define the target. After rapid dose planning, radiation delivery is completed before the local block dissipates. The tumor response is often dramatic. The risk of acute narro...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Pituitary Tumor Radiosurgery.
Authors: Trifiletti DM, Dutta SW, Lee CC, Sheehan JP Abstract Pituitary adenomas represent a common intracranial pathology, usually resulting in the systemic secretion of hormones and compression of local endocrine and optic structures, causing a wide variety of clinical sequelae. While they are typically treated with upfront endocrine and/or surgical decompressive therapy, in patients with residual, recurrent, or refractory disease, decades of data support management with stereotactic radiosurgery. This modality offers favorable local tumor control, endocrine remission rates, and infrequent toxicity. In the future...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

The First North American Clinical Gamma Knife Center.
This report summarizes the rationale for acquisition, the challenges and the early years, and then the evolution of our center which installed the first US 201 source Gamma Knife. PMID: 31096232 [PubMed - as supplied by publisher] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Leksell Radiosurgery for Movement Disorders.
Authors: Niranjan A, Raju SS, Lunsford LD Abstract Tremor is the most prevalent movement disorder in adults. Patients who are refractory to medical management can explore surgical intervention. Deep-brain stimulation (DBS) and radiofrequency thalamotomy (RFT) are surgical procedures for intractable tremor that target the ventralis intermedius (VIM) nucleus to relieve contralateral tremor. For patients who are not candidates for surgical procedures, stereotactic radiosurgery (SRS) is a minimally invasive management option for tremor relief. SRS has been used for the elderly, those considered high surgical risk for o...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Re-Evaluating Clinical Outcomes for AVM Stereotactic Radiosurgery.
Authors: Tonetti DA, Gross BA Abstract Traditional outcome measures after stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations (AVMs) have focused predominantly on angiographic obliteration and general neurologic complications. Several grading scales attempting to predict the outcome for specific patients have previously been proposed and validated, and are outlined here. These have largely been based on both AVM and patient characteristics and attempt to predict obliteration. However, the most practical and clinically oriented goal in the management of AVMs is the prospective avoidance of neuro...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgery for Chordoma and Chondrosarcoma.
This report examines the role of SRS in these skull base tumors. PMID: 31096236 [PubMed - as supplied by publisher] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Adverse Radiation Effects.
Authors: Cheok SK, Chiang VL Abstract Here we discuss the low risk of radiation-related complications after Leksell radiosurgery, as well as its diagnosis and management. Using multimodality imaging in the context of clinical suspicion of radiation injury clinicians can now start management with agents designed to reduce the progression of radiation vasculopathy. In more severe cases both medical and surgical management options can be offered. PMID: 31096237 [PubMed - as supplied by publisher] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Non-Vestibular Schwannoma Radiosurgery.
Authors: Peker S Abstract There is a growing body of studies regarding the effects of Gamma Knife radiosurgery on vestibular schwannomas. However, due to their rare presence and variability, our experience with the management of non-vestibular schwannomas is relatively limited. Management strategies include radiological monitoring, microsurgical resection, microsurgery combined with radiosurgery, or upfront radiosurgery. The lack of large series and heterogeneous data makes it difficult to suggest a definitive treatment strategy and management should be tailored for each patient's radiological and clinical characte...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Guidelines for Multiple Brain Metastases Radiosurgery.
Authors: Niranjan A, Monaco E, Flickinger J, Lunsford LD Abstract Stereotactic radiosurgery (SRS) is an effective treatment for patients with multiple brain metastases. Three decades of increasingly powerful scientific studies have shown that SRS improves outcomes and reduces toxicity when it replaces whole-brain radiation therapy (WBRT). Expert opinion surveys of clinicians have reported that the total intracranial tumor volume rather than the number of brain metastases is related to outcomes. As a result, an increasing number of treating and referring physicians have replaced the reflex use of WBRT with SRS, unle...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiosurgery for Patients with 10 or More Brain Metastases.
Authors: Yamamoto M, Higuchi Y, Sato Y, Aiyama H, Kasuya H, Barfod BE Abstract The JLGK0901 study showed the non-inferiority of stereotactic radiosurgery (SRS) alone as the initial treatment for 5-10 as compared to 2-4 brain metastases (BM) in terms of overall survival and most secondary endpoints [Lancet Oncol 2014;15:387-395]. A trend for patients with 5-10 tumors to undergo SRS alone has since become apparent. The next step is to reappraise whether results of SRS treatment alone for tumor numbers ≥10 differ from those for 2-9 tumors. During the past 2 decades, several retrospective studies have demonstrated t...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Trigeminal Neuralgia and Other Facial Neuralgias.
Authors: Wolf A, Kondziolka D Abstract Radiosurgery is an effective treatment approach for the management of type 1 trigeminal neuralgia (TN), comparable to other ablative techniques. Also, radiosurgery can effectively treat TN secondary to other causes, including multiple sclerosis, tumor-related TN, as well as other craniofacial neuralgias in select cases with minimal complications. An increasing number of patients favor radiosurgery over other more invasive approaches in order to avoid a general anesthetic, a prolonged hospital stay, and a higher risk of complications. PMID: 31096245 [PubMed - as supplied by...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Gamma Knife Radiosurgery of Arteriovenous Malformations: Long-Term Outcomes and Late Effects.
Authors: Pollock BE Abstract Gamma Knife radiosurgery (GKRS) of cerebral arteriovenous malformations (AVM) is an accepted treatment option that has been performed for more than 40 years. The goal of AVM GKRS is nidus obliteration to eliminate the risk of intracranial hemorrhage while minimizing the risk of short- and long-term adverse radiation effects (ARE). Nidus obliteration typically occurs between 1 and 5 years after GKRS. The most important factor associated with nidus obliteration is the prescribed radiation dose. The chance of obliteration ranges from 60 to 70% for margin doses of 15-16 Gy to 90% or more fo...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Gamma Knife Radiosurgery for Meningioma.
Authors: Flannery T, Poots J Abstract Since its first reported use in 1976 in Sweden, Gamma Knife (GK) radiosurgery has become an accepted treatment option for intracranial meningioma, either upfront, in combination with planned subtotal resection, or as adjuvant/salvage treatment. Initially, GK was used in patients unfit for a major surgical procedure or for high-risk meningiomas adjacent to critical neurovascular structures. However, with the availability of larger and increasingly long-term follow-up studies, the proven durability of GK in the treatment of meningiomas means that it has become a treatment option ...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Leksell Radiosurgery for the 3 H Tumors: Hemangiomas, Hemangioblastomas, and Hemangiopericytomas.
Authors: Johnson S, Niranjan A, Kano H, Lunsford LD Abstract Leksell stereotactic radiosurgery has proven to be effective for less common tumors encountered in the brain, including hemangiomas of the orbit or cavernous sinus, recurrent hemangiopericytomas, and both sporadic hemangioblastomas as well as those encountered in the context of von Hippel-Lindau (VHL) disease. While all three tumors are responsive to single-session radiosurgery, hemangiomas and hemangiopericytomas are the most likely to demonstrate tumor regression. Hemangiopericytomas that recur after initial resection can be lower grade or anaplastic an...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgery for Glomus Tumors.
Authors: Lee CC, Trifiletti DM, Sheehan JP Abstract Glomus tumors of the head and neck typically compress adjacent blood vessels and cranial nerves and result in varied clinical presentations. Moreover, they are seldom encountered, even at large medical centers, and specialists in neurosurgery, otolaryngology, and radiation oncology have yet to reach a generalized consensus regarding the optimal management approach. In an effort to summarize the available data and better elucidate optimal treatment and management strategies for glomus tumors, we conducted a review of the published literature on this topic with emph...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiosurgery for Low-Grade Gliomas.
Authors: Niranjan A, Faramand A, Lunsford LD Abstract Low-grade gliomas represent a heterogeneous group of tumors. The goals of treatment include prolonged survival and reduced morbidity. Treatment strategies vary depending upon tumor histology, anatomic location, age, and the general medical condition of the patient. Safe surgical resection remains the first choice for the treatment of resectable tumors. In cases of unresectable lesions, adjuvant radiotherapy and chemotherapy are considered. Several reports in recent years have documented the safety and effectiveness of stereotactic radiosurgery (SRS) in controlli...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Leksell Stereotactic Radiosurgery for Cavernous Malformations.
Authors: Lunsford LD, Niranjan A, Kano H, Monaco Iii EA, Flickinger JC Abstract Cavernous malformations (CM) represent a distinct subgroup of brain vascular malformations that are characterized by small sinusoidal vascular channels with hyaline degeneration and old blood pigments. Because of the increasing availability of magnetic resonance imaging (MRI) they are detected much more frequently in the present era. CM may be solitary or found in the context of a familial variant that results in an increasing number of CM developing as the patient ages. Because of the variable risk of subacute bleeding, their managemen...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Salvage Leksell Stereotactic Radiosurgery for Malignant Gliomas.
Authors: Niranjan A, Kano H, Monaco Iii EA, Lunsford LD Abstract The outcome of patients with malignant gliomas has not substantially improved, even with advances in imaging, neurosurgery, molecular subtyping, and radiation, and newer oncologic options. Maximal safe resection when feasible remains the initial treatment of choice for most malignant gliomas. These tumors often recur and require additional therapy to control the tumor growth. Leksell stereotactic radiosurgery (SRS) is offered as salvage therapy in patients with recurrent or residual malignant gliomas. SRS is well tolerated and is associated with a rel...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgery for Central Neurocytoma.
Authors: Nakamura A, Kano H, Niranjan A, Lunsford LD Abstract The classification of central neurocytoma (CN) by the WHO was upgraded to grade 2 in 1993 as it was recognized that at least some of these tumors can exhibit more aggressive behavior. Currently, as of 2016, CN is classified as WHO grade 2. Indeed, some atypical variants have been reported and residual postsurgical tumor is believed to have the potential for malignant transformation. Although gross total resection is usually curative for CN (5-year survival rate 99%), it is achieved in nearly 30-50% of cases due to its central location. Adjuvant treatment...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgery for Dural Arteriovenous Fistulas.
Authors: Yang HC, Lee CC, Pan DHC, Chung WY Abstract Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous connections within the dura, in which meningeal arteries shunt blood directly into the dural sinus or leptomeningeal veins. Among all the treatment options for the treatment of DAVFs, stereotactic radiosurgery (SRS) is a safe and effective modality. SRS provides a minimally invasive therapy for patients who harbor less aggressive DAVFs without cortical vein drainage (CVD), but who suffer from intolerable headache, bruit, or ocular symptoms. For more aggressive DAVFs with CVD associated w...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Preface.
Authors: Lunsford LD, Niranjan A, Kano H PMID: 31096258 [PubMed - as supplied by publisher] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiosurgery for Pineal Region Tumors.
Authors: Mathieu D, Iorio-Morin C Abstract Pineal region tumors represent a heterogeneous group of different histologic entities, for which the management can be a significant challenge, due to their critical location and frequent aggressive behavior. Traditional management includes surgical resection, fractionated radiation therapy, and chemotherapy. Stereotactic radiosurgery (SRS) is being increasingly used in the treatment of these tumors. It is used as primary therapy for pineocytomas and papillary tumors of the pineal region, as an adjuvant radiation boost in combination with radiation or chemotherapy for pine...
Source: Progress in Neurological Surgery - May 18, 2019 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Photodynamic Therapy of Malignant Gliomas.
Authors: Kaneko S, Fujimoto S, Yamaguchi H, Yamauchi T, Yoshimoto T, Tokuda K Abstract Recently, the clinical applications of photodynamic therapy (PDT) in the management of malignant brain tumors have attracted significant attention. Meta-analysis of the observational studies on this treatment in high-grade gliomas (Eljamel, 2010) included more than 1,000 patients and reported median survival in cases of newly diagnosed and recurrent glioblastoma multiforme (GBM) of 16.1 and 10.3 months, respectively. In some series, increase in the long-term survival rates was also observed. Few controlled trials demonstrated sta...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Laser-Induced Interstitial Thermotherapy of Gliomas.
Authors: Karampelas I, Sloan AE Abstract Laser-induced interstitial thermotherapy (LITT) is a modern minimally invasive treatment modality applied for management of a variety of diseases. Recent developments of techniques for precise targeting of the lesion, accurate delivery of the prescribed therapeutically effective thermal doses, and real-time visualization of the induced tissue damage during the procedure by means of intraoperative MR thermometry have stimulated a number of clinical studies testing LITT in cases of different brain pathologies, including gliomas. This modality is particularly attractive in pati...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Cryodestruction of Gliomas.
Authors: Martynov BV, Kholyavin AI, Nizkovolos VB, Parfenov VE, Trufanov GE, Svistov DV Abstract Surgical resection of gliomas affecting functionally important brain structures is associated with high risk of permanent postoperative neurological deficit and deterioration of the patient's quality of life. The availability of modern neuroimaging and neuronavigation permits the application of minimally invasive stereotactic cryodestruction of the tumor in such cases. The authors used this treatment in 88 patients with supratentorial gliomas of various WHO histopathological grades not suitable for microsurgical resecti...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

High-Intensity Focused Ultrasound Ablation Therapy of Gliomas.
Authors: Alkins RD, Mainprize TG Abstract Ultrasound in clinical medicine is most commonly associated with imaging, but can be harnessed to yield an array of biological effects, including thermal ablation of brain tumors. Therapeutic ultrasound has been studied for many years, but only within the last decade has the technology reached a point where it is safe and practical for clinical adoption. Using large, multi-element arrays, ultrasound can be focused through the skull, and combined with MRI for image guidance and real-time thermometry, to create lesions in the brain with millimeter accuracy. Using this technol...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Boron Neutron Capture Therapy of Malignant Gliomas.
Authors: Miyatake SI, Kawabata S, Hiramatsu R, Kuroiwa T, Suzuki M, Ono K Abstract Boron neutron capture therapy (BNCT) is a promising modality for biochemically targeted, highly selective radiation treatment of various cancers, including malignant gliomas. Currently available results demonstrate the beneficial effect of such therapy on survival of patients with both recurrent and newly diagnosed glioblastomas. The main drawback of BNCT in cases of previously irradiated neoplasms is high rates of symptomatic pseudoprogression and radiation necrosis. For prevention of these complications, concurrent administration o...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research