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

Proton and Carbon Ion Therapy of Intracranial Gliomas.
Authors: Combs SE Abstract In comparison to photon irradiation, particle therapy of cancer performed either with protons or with carbon ions, offers the advantage of their distinct physical characteristics, and through delivery of high linear energy transfer (LET) particles, exploits greater relative biological effectiveness (RBE). There is strong rationale for applying such treatment in patients with intracranial gliomas. In cases of low-grade tumors, the main benefits may be related to potential decrease of long-term morbidity, whereas in cases of high-grade neoplasms, the use of modalities with greater RBE may l...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Novel and Prospective Molecular Targets for Therapy of Intracranial Gliomas.
Authors: Butowski N Abstract Multiple alterations in the expression levels of genes or proteins have been identified in gliomas, including activation of oncogenes and silencing of tumor suppressor genes. Illuminating these molecular mechanisms of tumorigenesis and treatment resistance is necessary for the development of new therapies. With the promise of better effectiveness and less toxicity, the emphasis in drug development has moved from cytotoxic, non-specific chemotherapies to molecular targeted agents. However, despite progress in other areas of oncology, targeted therapy success stories in cases of brain tum...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Cytokine Therapy of Gliomas.
Authors: Iwami K, Natsume A, Wakabayashi T Abstract Cytokines are a heterogeneous group of soluble small polypeptides or glycoproteins, which exert pleiotropic and redundant effects that promote growth, differentiation, and activation of cells. Cytokine production plays a profound role in the modulation of the tumor microenvironment, including the host of heterogeneous neoplastic cells, immune cells, and extracellular matrix, which is essential for progression of the neoplasm. Depending on specific conditions, the cytokines can either upregulate or downregulate anti-inflammatory and immunosuppressive activities. Th...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Cell-Based Immunotherapy of Gliomas.
Authors: Everson RG, Antonios JP, Liau LM Abstract Current cell-based immunotherapeutic strategies attempt to produce and maintain an immune response against glioma cells by artificially stimulating the immune system using passive and/or active approaches. Cellular immunotherapy is taken to mean the administration of live immune cells that either have immune effector capabilities themselves (passive immunotherapy) or engender a downstream antitumor response (active immunotherapy). Passive cellular immunotherapy most often takes the form of the adoptive transfer of a range of cell types, whereby antitumor immune cel...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Vaccine Therapy of High-Grade Gliomas.
Authors: Ishikawa E, Muragaki Y, Yamamoto T, Ohno T, Matsumura A Abstract Multiple phase II clinical trials on the use of tumor vaccines in cases of high-grade gliomas (HGG), in particular autologous formalin-fixed tumor vaccine (AFTV), demonstrated the safety and potential efficacy of such therapy. There is evidence that maximal resection of neoplasm provides optimal conditions for enhancement of the tumor-specific immune reactions induced by vaccine administration, and thus aggressive surgery may be an important prerequisite for treatment success. Irradiation and chemotherapy may also enhance the effectiveness of...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Gene Therapy and Virotherapy of Gliomas.
Authors: Kim JW, Chang AL, Kane JR, Young JS, Qiao J, Lesniak MS Abstract Despite many recent advances in the management of gliomas, such as aggressive surgical resection, chemoradiotherapy, antiangiogenic therapy, and molecular targeted therapy, the survival of patients with high-grade neoplasms remains dismal. Gene therapy and oncolytic virotherapy have emerged as highly promising strategies for treatment of malignant brain tumors due to recent progress in understanding of the underlying cancer biology as well as improved techniques for genetic modification of potential therapeutics. PMID: 29990979 [PubMed - ...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stem Cell Therapy of Gliomas.
Authors: Parker Kerrigan BC, Hossain A, Yamashita S, Lang FF Abstract Stem cells (SC) are the seeds of tissue repair and regeneration that have been extensively investigated as tumor-tropic vectors for gene delivery to solid cancers. SC have an inherent glioma tropism that supports their use as reliable vehicles to deliver therapeutic gene products to brain neoplasms. Several types of adult SC (ASC) have been used to carry antiglioma agents, and neural SC (NSC) and mesenchymal SC (MSC) are the most studied. The therapeutic cargoes that have been tested include secreted proteins, converting enzyme/prodrug suicide co...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Convection-Enhanced Delivery for Management of Malignant Gliomas.
Authors: Prabhu SS Abstract Convection-enhanced delivery (CED) is a novel method of bypassing the blood-brain barrier for administration of therapeutic agents directly into brain with a potential to provide concentrations that cannot be achieved with systemic drug delivery. This technique has grown significantly over the last 20 years with better understanding of the biomechanics of infusion and of the delivery process. Though clinical trials of CED in malignant brain tumors have not yielded the desired results, a number of new biologically active compounds and pharmaceutical preparations, their carriers, modes of ...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research