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

Targeted Local Therapy for Management of Intracranial High-Grade Gliomas.
Authors: Paldor I, Chaichana KL, Brem H, Tyler BM Abstract Systemic chemotherapy of malignant brain tumors has failed to achieve sufficient drug concentrations at the neoplasm site and frequently results in severe toxicities. Therefore, the local application of several anticancer agents, oncolytic viruses and vectors for gene therapy, immune-modifying preparations, and angiogenesis inhibitors has been investigated widely. Various modes of their administration were introduced, including intratumoral injections, implantation of reservoirs or pumps, convection-enhanced delivery, and use of nanocarriers, thermoreversib...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Extracellular Vesicles as a Platform for Glioma Therapeutic Development.
Authors: Santiago-Dieppa DR, Gonda DD, Cheung VJ, Steinberg JA, Carter BS, Chen CC Abstract Normal and pathologic cells secrete extracellular vesicles (EV), which are defined as 30-2,000 nm spherical organelles. It has been found that EV mediate various biological functions including cellular remodeling and export of biomolecules, extracellular communication, immune stimulation and suppression, and modulation of the cellular microenvironment. EV secreted by human glioma cells contain a wealth of tumor-specific proteins and nucleic acids that can be isolated from patients with these neoplasms. Thus, EV contribute to...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Alternating Electric Fields Therapy for Malignant Gliomas: From Bench Observation to Clinical Reality.
Authors: Wong ET, Lok E, Swanson KD Abstract Alternating electric fields of intermediate frequencies, also known as Tumor Treating Fields (TTFields or TTF) is a novel anticancer treatment modality that disrupts tumor cell mitosis at the metaphase-anaphase transition, leading to mitotic catastrophe, aberrant mitotic exit, and/or cell death. It is realized through alteration of the cytokinetic cleavage furrow by interference of proteins possessing large dipole moments, like septin heterotrimer complex and α/β-tubulin, and that results in disordered membrane contraction and failed cytokinesis. Aberrant mito...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Perspectives of Nanotechnology in the Management of Gliomas.
Authors: Yoon JW, Jiang W, Rutka JT, Huang Y, Kim BYS Abstract Significant advances in the design and understanding of the materials and systems of 1-100 nm have provided unprecedented tools to probe, diagnose, and treat diseases at the molecular level with greater efficiency and accuracy. In particular, optical and chemical properties of nanomaterials are being exploited to improve the effectiveness of neuro-oncological and neurosurgical interventions. Modern nanotechnology-driven clinical applications may have significant impact on management of brain tumors. PMID: 29990985 [PubMed - in process] (Source: Prog...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Fractionated Radiotherapy of Intracranial Gliomas.
Authors: Ghia AJ Abstract Fractionated radiotherapy (FRT) plays a critical role in the management of gliomas. For glioblastoma, the irradiation dose of 60 Gy in 30 fractions with concomitant and adjuvant temozolomide is currently considered as a standard of treatment, and further dose escalation has failed to be of benefit in clinical trials. Hypofractionated radiation schedules may be applied in elderly patients or those with poor performance status. For anaplastic gliomas, the high-risk region is typically irradiated to a total dose of approximately 60 Gy in 1.8-2 Gy per fraction. For patients with 1p/19q co-dele...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiosurgery in the Multimodality Management of Residual or Recurrent Glioblastoma Multiforme.
Authors: Niranjan A, Monaco Iii EA, Kano H, Flickinger JC, Lunsford LD Abstract Management options for residual or recurrent glioblastoma multiforme (GBM) are limited despite advances in surgical, chemotherapeutic, and radiotherapeutic techniques. Stereotactic radiosurgery (SRS) is often beneficial in such cases providing improved survival of patients, but still remains underutilized as part of the multimodality management of malignant gliomas. During the last 20 years, 297 patients with histologically proven residual or recurrent GBM underwent Gamma Knife surgery in the University of Pittsburgh. Retrospective anal...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiosurgery of Intracranial Low-Grade Gliomas.
Authors: Ganz JC Abstract Low-grade gliomas (LGG), corresponding to WHO grades I and II, are an uncommon and heterogeneous group of tumors, which include several distinct histopathological types and subtypes. Because of their rarity, acquiring adequate data on which to base therapeutic decisions in such cases is difficult. According to present knowledge, it is reasonable to consider radiosurgery (in particular, Gamma Knife surgery) as a therapeutic option for some LGG. Nevertheless, there is a clear need for multicenter cooperation in order to augment the currently scanty data. PMID: 29393177 [PubMed - in proce...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Brachytherapy of Intracranial Gliomas.
Authors: Nachbichler SB, Kreth FW Abstract Interstitial implantation of radioactive materials (brachytherapy [BT]) has been designed to protractedly deliver a high radiation dose to a well-defined target volume, while minimizing irradiation of the adjacent normal tissues. Even though promising results have been reported over time, the role of this treatment modality in the management of brain tumors is still poorly defined, and only a few centers worldwide apply it in clinical practice. Nevertheless, temporary or permanent interstitial implantation of low activity (
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Irradiation of Intracranial Gliomas in Children.
Authors: Kortmann RD, Seidel C, Müller K, Hirsch FW Abstract Attainment of local control is a cornerstone in the management of brain tumors in children. Treatment of progressive low-grade and all high-grade gliomas traditionally includes resection followed by fractionated radiotherapy (FRT) or FRT alone in neoplasms not amenable to surgical removal. While in younger children chemotherapy is typically used as a first-line non-surgical management option, FRT in such patients remains the standard of salvage therapy. Recent improvements in techniques for radiation treatment planning and delivery allow conformal an...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Role of Radiosensitizers in Radiation Treatment of Gliomas.
Authors: Cohen RJ, Mehta MP Abstract Malignant gliomas are the most common primary brain tumors and have devastatingly high mortality rates. Most recurrences are close to the surgical bed, despite adjuvant fractionated radiotherapy (FRT). Localized FRT to total dose of 60 Gy with concurrent and adjuvant temozolomide (TMZ) resulted in a statistically significant survival improvement of patients with newly diagnosed glioblastoma compared to those treated with FRT alone, and has emerged as the cornerstone of therapy. Despite this progress, long-term survival remains poor. Various signaling pathways have become the tar...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of High-Grade Astrocytomas in Adults.
Authors: Puduvalli VK, Hoang N Abstract Malignant gliomas have been historically considered unresponsive to chemotherapy due to their intrinsic resistance to conventional anticancer medications and the role of the blood-brain barrier in preventing access of the cytotoxic agents to the tumor. However, recent studies have demonstrated the efficacy of specific drugs in subsets of patients with high-grade astrocytomas that has revived the enthusiasm for the role of systemic chemotherapy against these neoplasms. Temozolomide, a monofunctional alkylator, was the first chemotherapeutic agent to definitively improve surviv...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of Diffuse Astrocytoma (WHO grade II) in Adults.
Authors: Narita Y Abstract The effectiveness of chemotherapy or chemoradiotherapy for diffuse astrocytoma (DA) has been largely unknown until recently. However, a randomized controlled study (RTOG 9802) showed that adding of procarbazine, CCNU, and vincristine (PCV) chemotherapy to fractionated radiotherapy (FRT) in patients with "high-risk" WHO grade II gliomas, including DA, has significant positive impact on both progression-free survival and overall survival. Effectiveness of temozolomide (TMZ) in cases of low-grade gliomas was also reported, and a randomized phase III trial comparing FRT alone or in ...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of Oligodendrogliomas.
Authors: Drappatz J, Lieberman F Abstract Oligodendrogliomas are therapy-responsive tumors, which have better prognosis compared to their astrocytic counterparts. The goal of treatment in such cases is not only prolongation of the patients' survival, but maintaining high neurologic functioning and quality of life. Traditionally, after maximal surgical resection fractionated radiation therapy was given. However, prospective randomized trials comparing irradiation alone and its combination with chemotherapy demonstrated strong impact of the latter on prolongation of overall survival in 1p/19q co-deleted anaplastic an...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of Intracranial Gliomas in Children.
Authors: Terashima K Abstract Under specific indications, chemotherapy may play an important role in the treatment of pediatric patients with intracranial gliomas. It can be effectively administered in inoperable low-grade tumors, particularly with the use of combination regimens based on carboplatin and vincristine. In very young children with high-grade gliomas (HGG), chemotherapy may result in control of tumor growth, which allows to postpone fractionated radiation therapy (FRT). At the same time, in difference with adults, there is no current evidence that addition of chemotherapy to aggressive surgical resecti...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Perspectives of Personalized Chemotherapy of Gliomas Based on Molecular Tumor Profiling.
Authors: Soffietti R, Franchino F, Magistrello M, Pellerino A, Rudà R Abstract Histopathological typing and grading are the cornerstones of the World Health Organization classification of the central nervous system tumors. It provides clinicians with information on the natural course of the disease and thus guides therapeutic choices. Nonetheless, patients with histologically identical tumors may have different outcomes and response to therapy. In recent years, extensive research has been done on three molecular markers in adult gliomas, namely MGMT promoter methylation, 1p/19q co-deletion, and IDH1/IDH2 mut...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Antiangiogenic Therapy of High-Grade Gliomas.
Authors: Jo J, Wen PY Abstract Angiogenesis plays a critical pathologic role in malignant gliomas. In the past few years, numerous studies using bevacizumab (BEV), a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), have been conducted in patients with brain tumors. Current evidence suggests that such treatment produces favorable results in patients with recurrent glioblastoma multiforme (GBM), but is not associated with any benefits in newly diagnosed GBM and recurrent WHO grade III gliomas. Initial experience using BEV for management of central nervous system radiation necrosis demo...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Search for More Effective Chemotherapeutic Regimens for Gliomas: Challenges and Hopes.
Authors: Hu J, Kesari S Abstract Are truly effective therapies for glioma finally within reach? An explosion of technologies and treatments in recent years brings with it the hope that the revolution is nigh, but decades of gains that can at best be considered incremental understandably temper optimism. Concepts such as "targeted therapy" and "personalized medicine" have grabbed the attention of the oncology community for over a decade; yet when applied to glioblastoma, our initial efforts have amounted to running into battle with limited armaments and an incomplete understanding of the enemy. S...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Physical and Psychological Rehabilitation of Patients with Intracranial Glioma.
Authors: Andrejeva J, Volkova OV Abstract Patients with brain tumor frequently experience a combination of physical, cognitive, and communication deficits. These may cause severe psycho-emotional stress altering biological and mental conditions and complicating the course of the primary disease, and thus necessiate physical and psychological rehabilitation. While existing data on the effectiveness of such treatment in patients with intracranial glioma are limited and inconsistent, it is possible to suggest that systematic and multidisciplinary rehabilitation plays a very important therapeutic role and leads to impr...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Palliative and Supportive Care of Patients with Intracranial Glioma.
Authors: Pace A, Villani V Abstract Clinicians dealing with patients affected by malignant brain tumors are frequently involved in providing palliative and supportive care, particularly at the end of life. It requires a multidisciplinary approach by a well-trained specialized neuro-oncology team. Early initiation of palliative care integrated with standard anticancer therapy may be effective for symptom management and results in improvement of the quality of life. However, studies specifically addressing these issues are very limited, thus do not allow the creation of any reliable evidence-based guidelines. Therefo...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Pathology and Genetics of Gliomas.
Authors: Komori T, Muragaki Y, Chernov MF Abstract Current World Health Organization (WHO) classification of the neuroepithelial tumors is cell lineage-oriented and based on a presumed developmental tree of the central nervous system (CNS). It defines three main groups of gliomas, namely astrocytomas, oligodendrogliomas, and ependymomas, and additionally presumes their 4-tiered histopathological grading (WHO grades I to IV). Nevertheless, the impact of tumor pathology on clinically related parameters may be frequently much better predicted by genetics, than by histological appearance of the lesion. Recent studies h...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

The History of Movement Disorder Brain Surgery.
Authors: Lunsford LD, Niranjan A Abstract The first surgical procedures for abnormal movement disorders began in the 1930s, when surgeons first proposed ablative techniques of the caudate nucleus or transection of motor (pyramidal) pathways to reduce involuntary movements in patients with Parkinson's related tremor. During the 50-year interval between 1945 and 1995, the development of precise intracranial guiding devices, brain maps, and advanced imaging led to the refinement of appropriate deep brain targets affecting extrapyramidal pathways. Lesional surgery and subsequent neuroaugmentation using deep brain stimu...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Pathophysiologic Basis of Movement Disorders.
Authors: Wichmann T Abstract Movement disorders are common and functionally disabling neurologic diseases. Studies over the last decades have investigated the pathophysiology of these diseases in considerable detail, leading to significant insights into their generation of motor disability. While genetically and clinically heterogeneous, most of them are accompanied by prominent and characteristic changes in firing rates and patterns in the basal ganglia, thalamus, and cortex. In recent years, researchers have placed increasing emphasis on the importance of oscillatory changes in firing in these structures, and hav...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Clinical Presentation and Prognosis of Common Movement Disorders.
Authors: Han J, Jain S Abstract Great progress has been made in expanding our understanding of the natural history of movement disorders, leading to impressive advancements in their medical and surgical management. Movement disorders are a diverse group of diseases, varying widely in clinical characteristics and evolution. Some are monosymptomatic while others have associated motor and nonmotor features. Some are static while others follow a progressive course. This chapter will review common primary and secondary movement disorders: Parkinson disease and other forms of Parkinsonism, essential tremor and its differ...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Medical Management of Movement Disorders.
Authors: Picillo M, Munhoz RP Abstract Pharmacological treatment is the cornerstone in the management of movement disorders. Although most available treatment options have no impact on the underlying process of each movement disorder, symptomatic therapies can significantly improve patient's quality of life and level of disability. Here, we review the current knowledge on clinical symptomatic management of Parkinson's disease (both early and advanced stages), essential tremor, dystonia, and chorea. Ideally, treatment should be carried out by specialists with reasonable experience in movement disorders, as it needs ...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Functional Anatomy of Basal Ganglia Circuits with the Cerebral Cortex and the Cerebellum.
Authors: Bostan AC, Dum RP, Strick PL Abstract The neural connections of the basal ganglia provide important insights into their function. Here, we discuss the current perspective on basal ganglia connections with the cerebral cortex and with the cerebellum. We review the evidence that the basal ganglia participate in functionally segregated circuits with motor and non-motor areas of the cerebral cortex. We then discuss the data that the basal ganglia are interconnected with the cerebellum. These results provide the anatomical substrate for basal ganglia contributions not only to the control of movement, but also t...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Diffusion Tensor Imaging of the Basal Ganglia for Functional Neurosurgery Applications.
Authors: Sammartino F, Hodaie M Abstract Since its introduction, diffusion tensor imaging (DTI) has become an important tool in neuroscience given its unprecedented ability to image brain white matter in vivo. The interest in understanding the mechanisms of action of Deep Brain Stimulation in different targets and indications, together with the constant drive towards the improvement in long-term clinical outcomes, has found a logical complement in the application of tractography in this field. Diffusion tensor imaging has been traditionally associated with an increased susceptibility to MRI artifacts, and expensive...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Patient Evaluation and Selection for Movement Disorders Surgery: The Changing Spectrum of Indications.
This report summarizes the state-of-the-art and controversies around patient selection for deep brain stimulation (DBS) for various conditions. Parkinson's disease (PD): several class I studies have shown superiority of DBS over best medical treatment for advanced PD with fluctuations and further inclusion criteria. One class I study suggests that PD patients with early motor complications might gain more quality of life if operated within 3 years after the onset of fluctuations. The subthalamic nucleus (STN) is still the standard target. STN DBS has an impact on impulse control disorders though the exact mechanism is uncl...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Image-Guided, Asleep Deep Brain Stimulation.
Authors: Ko AL, Burchiel KJ Abstract Deep brain stimulation (DBS) has become an established treatment for medically refractory movement disorders including Parkinson's disease, essential tremor, and dystonia. The field of DBS continues to evolve with advances in patient selection, target identification, electrode and pulse generator technology, and the development of more effective stimulation paradigms such as closed-loop stimulation. Furthermore, as the safety and efficacy of DBS improves through better hardware design and deeper understanding of its mechanisms of action, the indications for DBS will continue to ...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiofrequency Lesioning for Movement Disorders.
Authors: Taira T, Horisawa S, Takeda N, Ghate P Abstract During the past 2 decades, deep brain stimulation (DBS) took over the position of radiofrequency (RF) lesioning of thalamic or pallidal targets for control of movement disorders. Superiority of DBS over RF lesioning is widely accepted, and most neurosurgeons even regard RF lesioning to be old-fashioned and dangerous. Such concepts emerged from the data of old stereotactic operations with ventriculography and without computerized planning. Hardware-related complications are not negligible in long-term DBS therapy, and DBS only controls the symptoms. Living wit...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Magnetic Resonance-Guided High Intensity Focused Ultrasound for Treating Movement Disorders.
Authors: Kim YG, Kweon EJ, Chang WS, Jung HH, Chang JW Abstract Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) surgery has recently gained favor as a novel, noninvasive alternative to conventional neurosurgery. In contrast to traditional ablative interventions, transcranial MRgFUS surgery is entirely imaging-guided and uses continuous temperature measurements at the target and surrounding tissue taken in real-time. Unlike Gamma Knife radiosurgery, MRgFUS surgery can make a lesion immediately and does not use ionizing radiation. Moreover, since no metallic device is implanted, MR imaging-based di...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgical Thalamotomy.
Authors: Monaco Iii EA, Shin SS, Niranjan A, Lunsford LD Abstract Tremor is a common movement disorder that can be disabling, and its initial treatment is in the form of medical therapies. Often patients are refractory and seek surgical intervention. Treatment options for these patients include surgical radiofrequency thalamotomy and deep brain stimulation. There are a subset of patients who, for various reasons, are not candidates for open surgical procedures, or who opt to avoid them. For these patients, radiosurgical thalamotomy is a safe and useful alternative. Herein, we provide a review of the use of radiosur...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgical Pallidotomy for Parkinson's Disease.
Authors: Cahan LD, Young RF, Li F Abstract Deep brain stimulation (DBS) has been widely accepted as a tool for treating many symptoms of Parkinson's disease (PD); pallidotomy has been nearly abandoned. Concerns about both the safety and efficacy of pallidotomy are based on small series, isolated case reports, and techniques that would now be considered obsolete. The senior author recently reviewed long-term follow-up of a series of patients who had gamma knife pallidotomy (GKP) for advanced PD. GKP leads to durable, clinically significant benefit. Bilateral GKP adds incremental improvement. The complication rate wa...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Radiosurgical Subthalamic Nucleotomy.
Authors: Régis J, Carron R, Witjas T Abstract Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is the reference technique in Parkinson's disease (PD) at different stages of complications. Some patients cannot afford DBS due to anticoagulation or comorbidities or due to pecuniary reasons. Radiosurgery is a minimally invasive stereotactic technique, with no craniotomy and subsequently no risk of bleeding or infection. Its good safety efficacy profile has been established in the treatment of tremor, and the postoperative care issues are simple with a much shorter hospital stay (mean 48 h). The appl...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Frameless Functional Stereotactic Approaches.
Authors: Palys V, Holloway KL Abstract The stereotactic frame has served as the gold standard apparatus for accurate and precise targeting of deep brain structures since 1947. Despite passing the test of time, the stereotactic frame has several limitations from the perspective of both neurosurgeons and patients. Therefore, there was a need to develop a frameless system that had equivalent accuracy and reliability to the frame. This need was met with 3 commercially available frameless stereotactic systems designed specifically for deep brain stimulation surgery: Nexframe, STarFix, and ClearPoint. Over the past decad...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Deep Brain Stimulation: Interventional and Intraoperative MRI Approaches.
Authors: Larson PS, Starr PA, Martin AJ Abstract Interventional and intraoperative MRI approaches to deep brain stimulator implantation are relatively new, and in their purest form represent a distinct departure from traditional stereotactic techniques. They employ a novel means of stereotaxis based on regions of interest in the MR space and simple geometric principles, which eliminate the need for a stereotactic frame. This approach is appropriate for targets that are MR visible, and for whom the local anatomy and function are well characterized. It may also be appropriate for targets that do not have a well-descr...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Thalamic Deep Brain Stimulation.
Authors: Whiting BB, Whiting AC, Whiting DM Abstract The use of deep brain stimulation (DBS) of the thalamus has been proven to be a safe and efficacious treatment for the management of many diseases. The most common indication for thalamic DBS remains essential tremor (ET), one of the most common movement disorders in the world. ET patients should be considered for surgical intervention when their tremor has demonstrated to be refractory to medication, a characteristic estimated to be present in roughly 50% of ET cases. Advantages of DBS over thalamotomy include its reversibility, the ability to adjust stimulation...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Deep Brain Stimulation of the Subthalamic Nucleus and Globus Pallidus for Parkinson's Disease.
Authors: Lee PS, Crammond DJ, Richardson RM Abstract The concept of deep brain stimulation (DBS) for Parkinson's disease (PD) was introduced over 20 years ago, but our understanding of the nuances of this procedure continues to improve. The average motor outcomes of internal segment of the globus pallidus (GPi) and subthalamic nucleus (STN) DBS appear to be similar, although GPi DBS may allow greater recovery of verbal fluency and may provide greater relief of depression symptoms and improvement in the quality of life, and STN DBS appears more likely to result in decrease in levodopa equivalent doses. Despite the l...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research