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  • Journal of Neurosurgery Publishing Group (JNSPG)  (10)
  • 1
    Online Resource
    Online Resource
    Interstitial chemotherapy with drug polymer implants for the treatment of recurrent gliomas
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1991
    In:  Journal of Neurosurgery Vol. 74, No. 3 ( 1991-03), p. 441-446
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 74, No. 3 ( 1991-03), p. 441-446
    Abstract: ✓ Malignant gliomas have been difficult to treat with chemotherapy. The most effective agent, BCNU (carmustine), has considerable systemic toxicity and a short half-life in serum. To obviate these problems, a method has been developed for the local sustained release of chemotherapeutic agents by their incorporation into biodegradable polymers. Implantation of the drug-impregnated polymer at the tumor site allows prolonged local exposure with minimal systemic exposure. In this Phase I–II study, 21 patients with recurrent malignant glioma were treated with BCNU released interstitially by means of a polyanhydride biodegradable polymer implant. Up to eight polymer wafers were placed in the resection cavity intraoperatively, upon completion of tumor debulking. The polymer releases the therapeutic drug for approximately 3 weeks. Three increasing concentrations of BCNU were studied; the treatment was well tolerated at all three levels. There were no adverse reactions to the BCNU wafer treatment itself The average survival period after reoperation was 65 weeks for the first dose group, 64 weeks for the second dose group, and 32 weeks for the highest dose group. The overall mean survival time was 48 weeks from reoperation and 94 weeks from the original operation. The overall median survival times were 46 weeks postimplant and 87 weeks from initial surgery. Eighteen (86%) of 21 patients lived more than 1 year from the time of their initial diagnosis and eight (38%) of 21 patients lived more than 1 year after intracranial implantation of the polymer. Frequent hematology, blood chemistry, and urinalysis tests did not reveal any systemic effect from this interstitial chemotherapy. Since the therapy is well tolerated and safe, a placebo-controlled clinical trial has been started. The trial will measure the effect of the second treatment dose on survival of patients with recurrent malignant glioma.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1991.74.3.0441
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1991
    detail.hit.zdb_id: 2026156-1
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  • 2
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    Gangliocytoma masquerading as a prolactinoma : Case report
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1999
    In:  Journal of Neurosurgery Vol. 91, No. 3 ( 1999-09), p. 490-495
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 91, No. 3 ( 1999-09), p. 490-495
    Abstract: ✓ The authors describe the case of a 36-year-old man who presented with bitemporal hemianopsia and a serum prolactin concentration of 1440 ng/ml. Magnetic resonance imaging of the pituitary revealed a presumed macroadenoma with suprasellar and temporal lobe extension. Although the patient's prolactin level was lowered to 55 ng/ml by bromocriptine therapy, no tumor shrinkage occurred. Fourteen months later, progression of visual field defects necessitated transsphenoidal resection, which was incomplete. Immunocytochemical analysis of the biopsy tissue was positive for prolactin and, in view of the clinical picture, more detailed analysis was not performed. External-beam radiotherapy was given 2 years later because of enlargement of residual tumor. Subsequently, despite a fall in the serum prolactin concentration to less than 20 ng/ml in response to the course of bromocriptine, the mass displayed further extension into the temporal lobe. Nine years after the patient's initial presentation, he underwent transfrontal craniotomy for sudden deterioration in visual acuity caused by hemorrhage into the mass. No adenohypophyseal tissue was identified in the resected tissue. The mass was composed of dysplastic neurons that were strongly immunoreactive for synaptophysin and neurofilament (indicating neural differentiation) and prolactin. Review of the original biopsy specimen indicated that the prolactin-positive cells had striking neuronal morphological characteristics. The final diagnosis in this case is prolactin-secreting gangliocytoma. Although exceedingly rare, this disease must be added to the differential diagnosis in cases of “prolactinoma” when bromocriptine therapy is followed by a marked decline in serum prolactin that is not accompanied by significant tumor shrinkage. Furthermore, in such instances, consideration should be given to obtaining a biopsy sample prior to electing for radiotherapy.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1999.91.3.0490
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1999
    detail.hit.zdb_id: 2026156-1
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  • 3
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    Treatment of patients with primary glioblastoma multiforme with standard postoperative radiotherapy and radiosurgical boost: prognostic factors and long-term outcome
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1999
    In:  Journal of Neurosurgery Vol. 90, No. 1 ( 1999-01), p. 72-77
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 90, No. 1 ( 1999-01), p. 72-77
    Abstract: Object. To assess the value of stereotactic radiosurgery (SRS) as adjunct therapy in patients suffering from glioblastoma multiforme (GBM), the authors analyzed their experience with 78 patients. Methods. Between June 1988 and January 1995, 78 patients underwent SRS as part of their initial treatment for GBM. All patients had undergone initial surgery or biopsy confirming the diagnosis of GBM and received conventional external beam radiotherapy. Stereotactic radiosurgery was performed using a dedicated 6-MV stereotactic linear accelerator. Thirteen patients were alive at the time of analysis with a median follow-up period of 40.8 months. The median length of actuarial survival for all patients was 19.9 months. Twelve- and 24-month survival rates were 88.5% and 35.9%, respectively. Patient age and Radiation Therapy Oncology Group (RTOG) class were significant prognostic indicators according to univariate analysis (p 〈 0.05). Twenty-three patients aged younger than 40 years had a median survival time of 48.6 months compared with 55 older patients who had 18.2 months (p 〈 0.001). Patients in this series fell into RTOG Classes III (27 patients), IV (29 patients), or V (22 patients). Class III patients had a median survival time of 29.5 months following diagnosis; this was significantly longer than median survival times for Classes IV and V, which were 19.2 and 18.2 months, respectively (p = 0.001). Only patient age ( 〈 40 years) was a significant prognostic factor according to multivariate analysis. Acute complications were unusual and limited to exacerbation of existing symptoms. There were no new neuropathies secondary to SRS. Thirty-nine patients (50%) underwent reoperation for symptomatic necrosis or recurrent tumor. The rate of reoperation at 24 months following SRS was 54.8%. Conclusions. The addition of a radiosurgery boost appears to confer a survival advantage to selected patients.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1999.90.1.0072
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1999
    detail.hit.zdb_id: 2026156-1
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  • 4
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    Delayed cerebral vasospasm is not reversible by aminophylline, nifedipine, or papaverine in a “two-hemorrhage” canine model
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1983
    In:  Journal of Neurosurgery Vol. 58, No. 1 ( 1983-01), p. 11-17
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 58, No. 1 ( 1983-01), p. 11-17
    Abstract: ✓ Angiographic spasm of cerebral arteries was produced in dogs by successive injections of cisternal blood 48 hours apart. Angiograms were taken before and after each cisternal injection. There was progressively greater angiographic vasospasm of the basilar artery. Intravenous aminophylline, 10 mg/kg/hr, reversed vessel constriction on the 1st and 3rd day after one injection of cisternal blood. On the 5th day after two blood injections (on Day 1 and Day 3), intravenous aminophylline, nifedipine (1 mg/kg), and intra-arterial bolus injection of 2 mg/kg papaverine failed to reverse the constriction. The intractable constriction produced in this model resembles that found in patients. The calcium antagonist, nifedipine, is as ineffective as the more traditional vasodilators in reversing vasospasm in this model.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1983.58.1.0011
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1983
    detail.hit.zdb_id: 2026156-1
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  • 5
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    Idiopathic pinealitis : Case report
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1999
    In:  Journal of Neurosurgery Vol. 91, No. 2 ( 1999-08), p. 330-334
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 91, No. 2 ( 1999-08), p. 330-334
    Abstract: ✓ This 63-year-old man presented with complaints of “having a feeling of falling backward” over a 3-month period. Results of his general physical examination, laboratory studies, and neurological examination were unremarkable. A magnetic resonance image revealed a 1.8 × 1.4 × 1.2—cm enhancing mass in the posterior third ventricle just above the corpora quadrigemina. The pineal gland was found to be diffusely enlarged at operation and separable from the posterior thalamus and was totally resected. The patient had an uneventful postoperative course but continues to be somewhat confused. The lesion consisted of a remarkable chronic inflammatory cell infiltrate permeating the pineal lobules and was composed of T and B lymphocytes, macrophages, eosinophils, and mast cells. Immunoperoxidase studies did not demonstrate Langerhans cells, and a search for microorganisms was unrevealing. There was no evidence of neoplasia; results of immunostaining for germ cell markers and other tumor-associated antigens were negative.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1999.91.2.0330
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1999
    detail.hit.zdb_id: 2026156-1
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  • 6
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    Dual isotope single-photon emission computerized tomography used for prediction of histology and survival in patients after high-dose radiotherapy for malignant astrocytoma
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1996
    In:  Neurosurgical Focus Vol. 1, No. 3 ( 1996-09), p. E3-
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 1, No. 3 ( 1996-09), p. E3-
    Abstract: This study was conducted to determine the sensitivity of dual-isotope single-photon emission computerized tomography (SPECT) in predicting tumor recurrence and survival in patients treated with high-dose radiotherapy for malignant gliomas. Studies using SPECT with thallium-201 (Tl-201) and technetium-99m (Tc-99m) hexamethypropyleneamine oxime (HMPAO) in 50 consecutive patients with malignant astrocytomas treated by surgery and high-dose radiotherapy were performed 1 day before reoperation. Maximum uptake of Tl-201 in the lesion was expressed as a ratio to that of the contralateral scalp, and uptake of Tc-99m HMPAO was expressed as a ratio to that of the cerebellar cortex. Patients were stratified into groups based on maximum radioisotope uptake values in their tumor beds. Differences in tumor histopathology at reoperation and 1-year survival between SPECT groups were determined by using chi-square analysis. The majority of patients in Group IA (Tl-201 ratio less than 2 or Tc-99m HMPAO ratio less than 0.5) showed radiation changes in their biopsy specimens (85.7%); they had an 85.7% 1-year survival rate. Group II (Tl-201 ratio between 2 and 3.5) had predominantly infiltrating tumor (78.6%); they had a 42% 1-year survival rate. Almost all of the patients in Group III (Tl-201 ratio greater than 3.5) had solid tumor (93.3%) and they had a 6.7% 1-year survival. Survival and pathological data differed significantly among groups (p less than 0.009). Dual-isotope SPECT data correlates with histological findings on reoperation and postoperative survival in patients with malignant gliomas.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/foc.1996.1.3.3
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1996
    detail.hit.zdb_id: 2026589-X
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  • 7
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    Biochemical characterization of pediatric brain tumors by using in vivo and ex vivo magnetic resonance spectroscopy
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2002
    In:  Journal of Neurosurgery Vol. 96, No. 6 ( 2002-06), p. 1023-1031
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 96, No. 6 ( 2002-06), p. 1023-1031
    Abstract: Object. Magnetic resonance (MR) spectroscopy provides biochemical information about tumors. The authors sought to determine the relationship between in vivo and ex vivo biochemical characterization of pediatric brain tumors by using MR spectroscopy. Their hypothesis was that ex vivo MR spectroscopy provides a link between in vivo MR spectroscopy and neuropathological analysis. Methods. In vivo proton MR spectroscopy was performed before surgery in 11 patients with neuroepithelial tumors. During resection, a total of 40 tumor biopsy samples were obtained from within the volume of interest identified on in vivo MR spectroscopy and were frozen immediately in liquid nitrogen. High-Resolution Magic Angle Spinning (HRMAS) was used to perform ex vivo MR spectroscopy in these 40 tumor biopsy samples. Neuropathological analysis was performed using the same biopsy samples, and the tumors were classified as ependymoma, choroid plexus carcinoma, pineoblastoma (one each), and pilocytic astrocytoma, medullobastoma, low-grade glioma, and glioblastoma multiforme (two each). Ex vivo HRMAS MR spectroscopy improved line widths and line shapes in the spectra, compared with in vivo MR spectroscopy. Choline (Cho) detected in vivo corresponded to three different peaks ex vivo (glycerophosphocholine, phosphocholine [PCho], and Cho). Metabolite ratios from in vivo spectra correlated with ratios from ex vivo spectra (Pearson correlation coefficient range r = 0.72–0.91; p ≤ 0.01). Metabolite ratios from ex vivo spectra, such as PCho/total creatine (tCr) and lipid/tCr, correlated with the percentage of cancerous tissue and percentage of tumor necrosis, respectively (r = 0.84; p ≤ 0.001). Conclusions. Agreement between in vivo and ex vivo MR spectroscopy indicates that ex vivo HRMAS MR spectroscopy can improve resolution of this modality and provide a link between in vivo MR spectroscopy and neuropathological analysis.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.2002.96.6.1023
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2002
    detail.hit.zdb_id: 2026156-1
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  • 8
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    Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1998
    In:  Journal of Neurosurgery Vol. 89, No. 1 ( 1998-07), p. 60-68
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 89, No. 1 ( 1998-07), p. 60-68
    Abstract: Object. The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. Methods. Studies in which SPECT with 201 Tl and 99m Tc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201 Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99m Tc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan—Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I ( 201 Tl ratio 〈 2 and 99m Tc-HMPAO ratio 〈 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients ( 201 T1 ratio 〈 2 and 99m Tc-HMPAO ratio of ≥ 0.5 or 201 Tl ratio between 2 and 3.5 regardless of 99m Tc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III ( 201 Tl ratio 〉 3.5 and 99m Tc-HMPAO ratio ≥ 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p 〈 0.01); however, SPECT grouping was more closely associated with 1-year survival (p 〈 0.001) and was the only variable significantly associated with long-term survival (p 〈 0.005). Conclusions. Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.
    Type of Medium: Online Resource
    ISSN: 0022-3085
    URL: Article
    DOI: 10.3171/jns.1998.89.1.0060
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1998
    detail.hit.zdb_id: 2026156-1
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  • 9
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    Detection of unanticipated intracranial hemorrhage during intraoperative magnetic resonance image–guided neurosurgery : Report of two cases
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2007
    In:  Journal of Neurosurgery: Pediatrics Vol. 106, No. 5 ( 2007-05), p. 398-400
    Details
    In: Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 106, No. 5 ( 2007-05), p. 398-400
    Type of Medium: Online Resource
    ISSN: 1933-0707
    URL: Article
    DOI: 10.3171/ped.2007.106.5.398
    RVK:
    XA 55270.2
    Language: English
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2007
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  • 10
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    Neurosurgical considerations in supratentorial low-grade gliomas: experience with 175 patients
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1998
    In:  Neurosurgical Focus Vol. 4, No. 4 ( 1998-04), p. E6-
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 4, No. 4 ( 1998-04), p. E6-
    Abstract: The authors reviewed 175 low-grade hemispheric gliomas surgically treated by one surgeon (P.B.) between 1987 and 1996: 74 astrocytomas (42%), 35 oligodendrogliomas (20%), 52 mixed gliomas (30%), 12 gangliogliomas (7%), and two ependymomas (1%). Patient age ranged from 7.5 to 81.9 years (mean 39.2 years); 84 patients (48%) were males and 91 (52%) females. Postsurgical follow-up review ranged from 0.1 to 225.2 months (mean 36.2 months, median 24.9 months). Either T 2 -weighted or contrast-enhanced T 1 -weighted magnetic resonance (MR) images were used to evaluate the percentage of resection achieved and volume of residual disease postoperatively. The majority of patients (55%) had seizures as the presenting symptom, and 45% experienced preoperative symptoms for more than 12 months. Tumor enhancement was present in 21% of cases. In 66% of surgical procedures at least one of the following technical adjuncts was used: monitored local anesthesia, real-time MR imaging, stereotactic guidance with computerized tomography, three dimensional reconstruction, cortical mapping with cortical stimulation, somatosensory or visual evoked potential recording, corticography, or intraoperative ultrasound. Intraoperative MR imaging was used for 40 (22.9%) of the craniotomies and nine (5.14%) biopsies. There were no surgery-related deaths. Complications appeared in 6% of the patients. Progression to a higher-grade tumor occurred in 9.2% of patients within the 3-year follow-up period.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/foc.1998.4.4.7
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 1998
    detail.hit.zdb_id: 2026589-X
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