BACKGROUND This study was designed to investigate the clinical efficacy and safety of Gamma Knife®combined with transarterial chemoembolization(TACE)and immunotherapy in the treatment of primary liver cancer.AIM ...BACKGROUND This study was designed to investigate the clinical efficacy and safety of Gamma Knife®combined with transarterial chemoembolization(TACE)and immunotherapy in the treatment of primary liver cancer.AIM To investigate the clinical efficacy and safety of Gamma Knife®combined with TACE and immune-targeted therapy in the treatment of primary liver cancer.METHODS Clinical data from 51 patients with primary liver cancer admitted to our hospital between May 2018 and October 2022 were retrospectively collected.All patients underwent Gamma Knife®treatment combined with TACE and immunotherapy.The clinical efficacy,changes in liver function,overall survival(OS),and progression-free survival(PFS)of patients with different treatment responses were evaluated,and adverse reactions were recorded.RESULTS The last follow-up for this study was conducted on October 31,2023.Clinical evaluation of the 51 patients with primary liver cancer revealed a partial response(PR)in 27 patients,accounting for 52.94%(27/51);stable disease(SD)in 16 patients,accounting for 31.37%(16/51);and progressive disease(PD)in 8 patients,accounting for 15.69%(8/51).The objective response rate was 52.94%,and the disease control rate was 84.31%.Alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,and alpha-fetoprotein isoform levels decreased after treatment compared with pretreatment(all P=0.000).The median OS was 26 months[95%confidence interval(95%CI):19.946-32.054]in the PR group and 19 months(95%CI:14.156-23.125)in the SD+PD group,with a statistically significant difference(P=0.015).The median PFS was 20 months(95%CI:18.441-34.559)in the PR group and 12 months(95%CI:8.745-13.425)in the SD+PD group,with a statistically significant difference(P=0.002).Common adverse reactions during treatment included nausea and vomiting(39.22%),thrombocytopenia(27.45%),and leukopenia(25.49%),with no treatment-related deaths reported.CONCLUSION Gamma Knife®combined with TACE and immune-targeted therapy is safe and effective in the treatment of primary liver cancer and has a good effect on improving the clinical benefit rate and liver function of patients.展开更多
AIM: To probe into problems existing in gamma knife treatment of ophthalmic branch of primary trigeminal neuralgia (TN), and propose a safe and effective solution to the problem. METHODS: Through sorting the literatur...AIM: To probe into problems existing in gamma knife treatment of ophthalmic branch of primary trigeminal neuralgia (TN), and propose a safe and effective solution to the problem. METHODS: Through sorting the literature reporting gamma knife treatment of refractory TN in recent years, this article analyzed the advantages and problems of gamma knife treatment of primary TN, and proposed reasonable assessment for existing problems and the possible solution. RESULTS: Gamma knife treatment of TN has drawn increasing attention of clinicians due to its unique non-invasion, safety and effectiveness, but there are three related issue; to be considered. The first one is the uncertainty of the optimal dose (70-90GY); the second one is the difference in radiotherapy target selection (using a single isocenter or two isocenters); and the third one is the big difference of recurrent pains (specific treatment methods need to be summarized and improved). CONCLUSION: For patients with refractory TN, gamma knife treatment can be selected when the medical treatment fails or drug side effects emerge. The analysis of a large number of TN patients receiving gamma knife treatment has shown that this is a safe and effective treatment method.展开更多
A total of 80 patients with refractory epilepsy were recruited from the Inner Mongolia Medical College Affiliated Hospital. The loci of 60% of the patients could be positioned using a combined positron emission tomogr...A total of 80 patients with refractory epilepsy were recruited from the Inner Mongolia Medical College Affiliated Hospital. The loci of 60% of the patients could be positioned using a combined positron emission tomography/CT imaging modality. Hyper- and hypometabolism foci were examined as part of this study. Patients who had abnormal metabolism in positron emission tomography/CT imaging were divided into intermittent-phase group and the seizure-phase group. The intermittent-phase group was further divided into a single-focus group and a multiple-foci group according to the number of seizure foci detected by imaging. Following gamma knife treatment, seizure frequency was significantly lower in the intermittent-phase group and the seizure-phase group. Wieser＇s classification reached Grade I or II in nearly 40% of patients. Seizure frequency was significantly lower following treatment, but Wieser＇s classification score was significantly higher in the seizure-phase group compared with the intermittent-phase group. Seizure frequency was significantly lower following treatment in the single-focus group, but Wieser＇s classification score was significantly higher in the single-focus group as compared with the multiple-foci group.展开更多
BACKGROUND： Apoptosis and necrosis are cellular death mechanisms that are induced in glioma cells following gamma knife irradiation. Increased apoptosis is essential for maintaining and enhancing treatment efficacy. ...BACKGROUND： Apoptosis and necrosis are cellular death mechanisms that are induced in glioma cells following gamma knife irradiation. Increased apoptosis is essential for maintaining and enhancing treatment efficacy. OBJECTIVE： To observe apoptotic and necrotic mechanisms of rat glioma models induced by gamma knife treatment and to analyze the influences of irradiation doses on apoptosis and necrosis. DESIGN： Controlled animal experiment. SETTING： Cancer Hospital of Tianjin Medical University and Gamma Knife Center of Hefei Brain Hospital. MATERIALS： Eighteen female specific pathogen free Sprague Dawley rats, weighing 180 210 g and 5 6 weeks old, were purchased from the Experimental Animal Center, Medical College of Suzhou University. Rat C6 glioma cells were purchased from the cell bank of Chinese Academy of Sciences. Annexin V-FITC Reagent Kit （Bender Med System. Company, USA） and a flow cytometer （Becton Dickinson FACSCalibur） were provided. METHODS： The experiment was conducted at the Cancer Hospital of Tianjin Medical University and Gamma Knife Center of Hefei Brain Hospital from December 2006 to May 2007. All rats were inoculated with C6 glioma cells, i.e., 4 μL of a C6 glioma cell suspension was injected 5 mm deep in the cortex. All rats were divided randomly into a model group, 9-Gy treatment group, and 12-Gy treatment group. There were six rats in each group. MAIN OUTCOME MEASURES： Apoptosis and necrosis of normal brain tissue and glioma were observed by Flow Cytometry one week after irradiation, and pathological changes to tumor tissue were identified by HE staining. RESULTS： Eighteen rats were initially selected for the study： two rats from the model and 12-Gy treatment groups died from accidental anesthesia. The remaining 16 rats were included in the final result analysis. Cellular apoptosis and necrosis： apoptosis and necrosis were significantly increased in the treatment groups after gamma knife irradiation, compared to the model group （P 〈 0.05）. Apoptosis was greater in the 9-Gy treatment group compared to the 12-Gy treatment group （P 〈 0.01 ）. Necrosis was significantly reduced in the 9-Gy treatment group compared to the 12-Gy treatment group （P 〈 0.01）. Pathological changes： The necrosis of the center of tumor tissue appeared in the 9, 12 Gy treatment group. Cells dispersed in the necrosis region and the density of cells was higher with the longer distance from the necrosis region. There were patches of pycnotic cells with different period between the edge and center of the necrosis region, and the cellular dropsy could be seen. Moreover, the amount of necrosis was greater with increasing doses of irradiation. CONCLUSION： Apoptosis and necrosis are cellular death mechanisms induced by gamma knife treatment of gliomas. Cellular necrosis increased with greater irradiation doses.展开更多
Microsurgery and gamma knife are the mainly ways to treat arteriovenous malformation of brain in grade Spetzler-Martin I -III; however, therapeutic effects of them need to be further studied. OBJECTIVE： To compare th...Microsurgery and gamma knife are the mainly ways to treat arteriovenous malformation of brain in grade Spetzler-Martin I -III; however, therapeutic effects of them need to be further studied. OBJECTIVE： To compare the therapeutic effects between microsurgery and gamma knife on the treatment of arteriovenous malformation of brainin grade Spetzler-Martin I-III. DESIGN： Retrospective analysis. SETTING： Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University; Guangdong Microinvasion Center. PARTICIPANTS： A total of 86 patients with arteriovenous malformation of the brain were selected from the Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University and Guangdong Microinvasion Center from January 1997 to February 2007. After DSA, CT and/or MRI examinations, patients were evaluated in grade Spetzler-Martin I -III. All patients were divided into microsurgery group （n = 34） and gamma knife group （n =52）. There were 22 males and 12 females in the microsurgery group and their mean age was 26 years, while there were 34 males and 18 females in the gamma knife group and their mean age was 28 years. The grade of Spetzler-Martin was comparable in the two groups. All their relatives provided the confirmed consent and the study was allowed by ethics committee of our hospital. METHODS： Under complete anesthesia, patients were given microsurgery and the operative approach was chosen based on diseased regions. Firstly, feeding artery was blocked; secondly, it was separated along band of gliosis between malformation vessel mass and brain tissue; finally, draining vein was cut off and malformation vessel mass was resected. On the other hand, patients in the gamma knife group received Leksell-2300B gamma knife treatment. Leksell-G stereotaxis headframe was installed; GEl .STMR scanning device was used for localization; r-PlanS.2 workstation was used for target design and dosage program; Leksell B gamma knife was used during the whole operative procedure. The target was l - 4 and peripheral dosage was 12- 28 Gy. At 0.5, l and 2 years after operation, angiography was used to detect vascular occlusion in the two groups. Meanwhile, focal hemorrhage and new neurological function defect （including hemiplegic paralysis, language disorder, cerebellar function disorder, increasing frequency of epilepsy, etc.） were also observed. MAIN OUTCOME MEASURES： Rate of vascular occlusion, focal hemorrhage and neurological function defect at different time points after operation. RESULTS： All 86 patients were involved in the final analysis. Vascular nest of patients in the microsurgery group disappeared completely; while, two patients （6%, 2/34） had new neurological function defect but did not have rehaemorrhagia and death after operation. On the other hand, vascular nest of 43 patients （83%, 43/52） in the gamma knife group disappeared completely, and 8 （l 5%, 8/52） had new neurological function defect. There was significant difference between the two groups （ x^2=2.63, P 〈 0.05）. Six patients （12%, 6/52） in the gamma knife group had rehaemorrhagia after operation, and one （2%, 1/52） died. CONCLUSION： Both microsurgery and gamma knife have great effects on the treatment of arteriovenous malformation of brain in grade Spetzler-Martin I-III;however, the therapeutic effects ofmicrosurgery are superior to those of gamma knife.展开更多
Objective： To evaluate the therapeutic efficacy of low-grade glioma （WHO grades Ⅰ-Ⅱ） patients treated with gamma knife radiosurgery and study on the efficacy evaluation method and radiobiological effect. Methods...Objective： To evaluate the therapeutic efficacy of low-grade glioma （WHO grades Ⅰ-Ⅱ） patients treated with gamma knife radiosurgery and study on the efficacy evaluation method and radiobiological effect. Methods： 140 MRI data of 52 patients after gamma knife radiosurgery were analyzed in tumor size, necrosis or cyst formation, radiation-induced edema and MRI contrast enhancement and circumsciption change for therapeutic efficacy was evaluated. Results： The efficiency rate was 84.3%. The salient efficiency rates were 54.3% for total and 30%, 36.4%, 50%, 68%, 69.2%, and 73.1% for segmenting, respectively. Aggrandizement of tumor related to MRI contrast enhancement and necrosis or cyst formation. Radiation-induced oedema occurred for 32.7%. The MRI contrast enhancement occurred for 57.7% and showed special lace-like ring while some piece-like. Conclusion： Evaluation by MRI has showed gamma knife radiosurgery is efficient for low-grade glioma. The segmenting salient efficiency rate that increase with time is better for evaluation than the efficiency rate especially for long-term MRI follow-up. Radiobiological effect affect the efficacy evaluation. MRI contrast enhancement appears after therapy and shows special as lace-like ring and partly minificates or vanishes subsequently.展开更多
Objective: To determine the best follow-up period with regard to curative effect for acoustic neuroma treated with a gamma knife. Methods: Sixty cases of acoustic neuroma were treated with a gamma knife. The follow-up...Objective: To determine the best follow-up period with regard to curative effect for acoustic neuroma treated with a gamma knife. Methods: Sixty cases of acoustic neuroma were treated with a gamma knife. The follow-up period was from 3 to 102 months. Changes in the lesions and peripheral tissues and clinical symptoms were compared and the curative effectiveness of gamma knife treatment was evaluated. Results: The highest total effective rate (92.3%) was in the third period. There was a significant difference in the tumor size postoperatively. There was no edema in the peripheral tissues surrounding the tumor. It was not obvious that clinical symptoms changed. Conclusion: In this report, the best follow-up period was 24-36 months. Gamma knife treatment was still effective after 60 months post-operation.展开更多
Objective:To explore the effects of microsurgical vascular decompression(MVD)and gamma knife respectively on the treatment of pain,anxiety and depression in patients with primary trigeminal neuralgia.Methods:From Febr...Objective:To explore the effects of microsurgical vascular decompression(MVD)and gamma knife respectively on the treatment of pain,anxiety and depression in patients with primary trigeminal neuralgia.Methods:From February 2011 to June 2017,we treated 108 patients with primary trigeminal neuralgia.According to the treatment plan of the patients,they were divided into an observation group and a control group,54 cases each.The observation group underwent microsurgical vascular decompression(MVD)for the treatment of primary trigeminal neuralgia,while the control group received gamma knife treatment.The effects of pain,improvement of anxiety and depression were compared between two groups at 1 week,3 months,and 6 months after treatment.Results:The pain,anxiety and depression scores of the observation group was significantly lower than that of the control group(P<0.05).Conclusion:MVD can relieve patients'pain,anxiety and depression symptoms,as well as improve quality of life and restore self-confidence in life.展开更多
Objective:To compare the clinical effectiveness of gamma knife radiosugery combined with acupuncture therapy and microvascular decompression in the treatment of idiopathic trigeminal neuralgia.Methods:A total of 93 pa...Objective:To compare the clinical effectiveness of gamma knife radiosugery combined with acupuncture therapy and microvascular decompression in the treatment of idiopathic trigeminal neuralgia.Methods:A total of 93 patients with primary trigeminal neuralgia added to Nanchang University Hospital from November 2016 to October 2018 were selected,it was divided randomly into the control group(45 cases)and the study group(48 cases).The control group was treated with microvascular decompression and the study group used gamma knife radiosurgery combined with acupuncture therapy.The study compared the immediate pain relief rate,Visual Analogue Scale(VAS)scores,completion rate,recurrence rate,hospitalization days,total treatment duration,total treatment cost and total effective rate of treatment in 2 groups.Results:Comparison of the same group after treatment:the VAS score with 24 hours of treatment in the control group was(5.33±0.49),with a significant difference from the pre-treatment VAS score(8.62±0.13);The VAS score with 24 hours of treatment in the study group was(5.96±0.58),with a significant difference from the pre-treatment VAS score(8.54±0.25).After treatment,immediate effect,parent effect,acute and chronic complements of the control group was 25,5,2 and 7 cases,and the study group was 6,25,7 and 1,respectively.There were significant differences between the two groups;The comparison of hospitalization days,total treatment duration,total treatment cost was statistically significant(P<0.05);There were no significant difference in immediate pain rate,VAS score,total incidence of complications,recurrence rate,and total effectiveness of treatment between the two groups(P>0.05).Conclusion:Both microvascular decompression and gamma knife radiosurgery combined with acupuncture therapy can safe and effective treatment idiopathic trigeminal neuralgia patients,and for patients with good health,can tolerance all-hemp surgery,there are contraindicaindications to acupuncture therapy,microvascular decompression treatment can be chosen,while patients who are weak,cannot tolerante all-hemp surgery or resist surgery,economic difficulties,and can choose gamma knife radiosurgery combined with acupuncture therapy treatment.展开更多
Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority ...Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKRS) salvage therapy. Following a Pub Med search for studies usingGKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKRS for rG BM before the possibility of selection bias can be dismissed.展开更多
The Stupp protocol has become standard of care for the treatment of glioblastoma (GBM) (since its publication in 2005) and has led to some limited survival improvements. This protocol, consists of radiotherapy and con...The Stupp protocol has become standard of care for the treatment of glioblastoma (GBM) (since its publication in 2005) and has led to some limited survival improvements. This protocol, consists of radiotherapy and concomitant chemotherapy with temozolomide, an alkylating agent. Temozolomide + radiation, compared to radiation alone had added in average 3 months additional life span, 16 percent improved survival at 2 years. That said since 2005, the standard of care has not changed in regards to the treatment of early diagnosed aggressive or multifocal GBM, and unfortunately the expected survival is still poor with 75 percent of patients dying in less than 2 years and average survival of 15 months. In patients with multifocal tumors (such as the case below) the average survival is even worse with less than 4 months at her age [1]. Here we present a case study of a patient with advanced multifocal, and rapidly progressing Glioblastoma Multiforme treated with STUPP protocol in combination with IV Quercetin. The patient experienced improved quality of life and response, compared to historical data. It is our recommendation to investigate such combinational approach in patients with Glioblastoma, as in our case it proved to be safe and effective with improved quality of life and performance as well as clinical response and survival.展开更多
Objective To review the applications of magnetic resonance imaging （MRI） techniques in assessing treatment response to gamma knife radiosurgery for brain tumors. Data sources Published articles about assessing treat...Objective To review the applications of magnetic resonance imaging （MRI） techniques in assessing treatment response to gamma knife radiosurgery for brain tumors. Data sources Published articles about assessing treatment response to gamma knife radiosurgery for brain tumors were selected using PubMed. The search terms were ＂MRr＇, ＂gamma knife＂ and ＂brain tumors＂. Study selection Articles regarding the MRI techniques using for early assessment of treatment response of gamma knife were selected. Results MRI techniques, especially diffusion weighted imaging, perfusion weighted imaging, magnetic resonance spectroscopy, are useful for early assessment of treatment response of gamma knife by detecting the hemodynamic, metabolic, and cellular alterations. Moreover, they can also provide important information on prognosis. Conclusions Diffusion weighted imaging, perfusion weighted imaging and magnetic resonance spectroscopy can provide early assessment of treatment response of gamma knife for brain tumors, and also information of tumor progression or recurrence earlier than conventional MRI. But there are still many questions to be answered which should be based on the development and advancement of MRI and related disciplines.展开更多
Central neurocytoma （CN）, first described by Hassoun et al in 1982, is a rare neuronal tumor of the centralnervous system, and accounts for 0.25%-0.5% of all intracranial tumors. CN commonly occurs as an intraventri...Central neurocytoma （CN）, first described by Hassoun et al in 1982, is a rare neuronal tumor of the centralnervous system, and accounts for 0.25%-0.5% of all intracranial tumors. CN commonly occurs as an intraventricular mass but may also occur as a periventricular parenchymal mass or even in locations remote from the ventricles, in which case it is termed as an extraventricular neurocytoma （EVN） （cerebral）. EVNs show a wide variability with regard to morphologic features, cellularity, and proliferation rate and are more frequently associated with poorer clinical outcomes than CNs. 1 To our knowledge, little is known regarding the treatment of atypical neurocytomas.展开更多
BACKGROUND Entrapment of the temporal horn (ETH) is a rare pathologic condition. It is a kind of focal hydrocephalus caused by obstruction of flow pathway of cerebrospinal fluid. It is caused by various conditions, bu...BACKGROUND Entrapment of the temporal horn (ETH) is a rare pathologic condition. It is a kind of focal hydrocephalus caused by obstruction of flow pathway of cerebrospinal fluid. It is caused by various conditions, but ETH secondary to postoperative gamma-knife radiosurgery (GKS) is extremely rare. CASE SUMMARY A 52-year old previously healthy woman underwent resection of a large intraventricular meningioma. A small fragment of residual tumor with no obvious enlargement of the temporal horn was observed 3 mo after surgery, and she was referred for GKS. Two months after GKS, she complained of headache and progressive paralysis of the left limb. Magnetic resonance imaging revealed enlargement of the temporal horn. There was a second procedure to resect the residual tumor 8 mo after GKS. After the second procedure, she recovered smoothly. As of the date of this writing, she has remained in good condition. CONCLUSION This case reminds us that ETH should be considered in the treatment of intraventricular meningiomas, especially before GKS.展开更多
objective: Two groups of rats were microinjected with kainic acid (KA) and irradiated with gam ma knife respectively on unilateral nucleus caudate-putamen to compare the response of astrocytes. Methods: The astrocytes...objective: Two groups of rats were microinjected with kainic acid (KA) and irradiated with gam ma knife respectively on unilateral nucleus caudate-putamen to compare the response of astrocytes. Methods: The astrocytes were identified with anti-GFAP immunohistochemical ABC method and the progress of their reaction to the 2 insults was examined from 3 h to 30 d after the lesion. Results: Both lesions could induce hyperplasia and hypertrophy of astrocytes and 2 types of GFAP-ir cells were found, one with small cell body and thin process, and the other with hypertrophic cell body and thick and long process. The timecourse of GFAP expression in the 2 groups was different. In KA microinjection group, large necrotic area was ob served in the target within 24 h. Three days later, a few astrocytes appeared around the necrosis. With in crease of the survival time, hyperplasia and hypertrophy of astrocytes began to increase. Whereas in gamma knife group, hyperplasia and hypertrophy were evident from 3 h to 7 d and necrotic dots could be seen in the target on day 14. On day 30, necrosis was tnore obvious with gradual variations in GFAP expression around the necrotic area. Conclusion: The above results indicated that GFAP could be used as a marker for CNS in jury; the difference in their timing and distribution pattern suggested different mechanisms in KA microinjec tion group and gamma-knife irradiation group.展开更多
文摘BACKGROUND This study was designed to investigate the clinical efficacy and safety of Gamma Knife®combined with transarterial chemoembolization(TACE)and immunotherapy in the treatment of primary liver cancer.AIM To investigate the clinical efficacy and safety of Gamma Knife®combined with TACE and immune-targeted therapy in the treatment of primary liver cancer.METHODS Clinical data from 51 patients with primary liver cancer admitted to our hospital between May 2018 and October 2022 were retrospectively collected.All patients underwent Gamma Knife®treatment combined with TACE and immunotherapy.The clinical efficacy,changes in liver function,overall survival(OS),and progression-free survival(PFS)of patients with different treatment responses were evaluated,and adverse reactions were recorded.RESULTS The last follow-up for this study was conducted on October 31,2023.Clinical evaluation of the 51 patients with primary liver cancer revealed a partial response(PR)in 27 patients,accounting for 52.94%(27/51);stable disease(SD)in 16 patients,accounting for 31.37%(16/51);and progressive disease(PD)in 8 patients,accounting for 15.69%(8/51).The objective response rate was 52.94%,and the disease control rate was 84.31%.Alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,and alpha-fetoprotein isoform levels decreased after treatment compared with pretreatment(all P=0.000).The median OS was 26 months[95%confidence interval(95%CI):19.946-32.054]in the PR group and 19 months(95%CI:14.156-23.125)in the SD+PD group,with a statistically significant difference(P=0.015).The median PFS was 20 months(95%CI:18.441-34.559)in the PR group and 12 months(95%CI:8.745-13.425)in the SD+PD group,with a statistically significant difference(P=0.002).Common adverse reactions during treatment included nausea and vomiting(39.22%),thrombocytopenia(27.45%),and leukopenia(25.49%),with no treatment-related deaths reported.CONCLUSION Gamma Knife®combined with TACE and immune-targeted therapy is safe and effective in the treatment of primary liver cancer and has a good effect on improving the clinical benefit rate and liver function of patients.
基金Zhengzhou Municipal Science and Technology Projects of Development,China (No.0910SGYS33377-1)
文摘AIM: To probe into problems existing in gamma knife treatment of ophthalmic branch of primary trigeminal neuralgia (TN), and propose a safe and effective solution to the problem. METHODS: Through sorting the literature reporting gamma knife treatment of refractory TN in recent years, this article analyzed the advantages and problems of gamma knife treatment of primary TN, and proposed reasonable assessment for existing problems and the possible solution. RESULTS: Gamma knife treatment of TN has drawn increasing attention of clinicians due to its unique non-invasion, safety and effectiveness, but there are three related issue; to be considered. The first one is the uncertainty of the optimal dose (70-90GY); the second one is the difference in radiotherapy target selection (using a single isocenter or two isocenters); and the third one is the big difference of recurrent pains (specific treatment methods need to be summarized and improved). CONCLUSION: For patients with refractory TN, gamma knife treatment can be selected when the medical treatment fails or drug side effects emerge. The analysis of a large number of TN patients receiving gamma knife treatment has shown that this is a safe and effective treatment method.
基金supported by the Natural ScienceFoundation of Inner Mongolia, No. 20080404Zd29
文摘A total of 80 patients with refractory epilepsy were recruited from the Inner Mongolia Medical College Affiliated Hospital. The loci of 60% of the patients could be positioned using a combined positron emission tomography/CT imaging modality. Hyper- and hypometabolism foci were examined as part of this study. Patients who had abnormal metabolism in positron emission tomography/CT imaging were divided into intermittent-phase group and the seizure-phase group. The intermittent-phase group was further divided into a single-focus group and a multiple-foci group according to the number of seizure foci detected by imaging. Following gamma knife treatment, seizure frequency was significantly lower in the intermittent-phase group and the seizure-phase group. Wieser＇s classification reached Grade I or II in nearly 40% of patients. Seizure frequency was significantly lower following treatment, but Wieser＇s classification score was significantly higher in the seizure-phase group compared with the intermittent-phase group. Seizure frequency was significantly lower following treatment in the single-focus group, but Wieser＇s classification score was significantly higher in the single-focus group as compared with the multiple-foci group.
文摘BACKGROUND： Apoptosis and necrosis are cellular death mechanisms that are induced in glioma cells following gamma knife irradiation. Increased apoptosis is essential for maintaining and enhancing treatment efficacy. OBJECTIVE： To observe apoptotic and necrotic mechanisms of rat glioma models induced by gamma knife treatment and to analyze the influences of irradiation doses on apoptosis and necrosis. DESIGN： Controlled animal experiment. SETTING： Cancer Hospital of Tianjin Medical University and Gamma Knife Center of Hefei Brain Hospital. MATERIALS： Eighteen female specific pathogen free Sprague Dawley rats, weighing 180 210 g and 5 6 weeks old, were purchased from the Experimental Animal Center, Medical College of Suzhou University. Rat C6 glioma cells were purchased from the cell bank of Chinese Academy of Sciences. Annexin V-FITC Reagent Kit （Bender Med System. Company, USA） and a flow cytometer （Becton Dickinson FACSCalibur） were provided. METHODS： The experiment was conducted at the Cancer Hospital of Tianjin Medical University and Gamma Knife Center of Hefei Brain Hospital from December 2006 to May 2007. All rats were inoculated with C6 glioma cells, i.e., 4 μL of a C6 glioma cell suspension was injected 5 mm deep in the cortex. All rats were divided randomly into a model group, 9-Gy treatment group, and 12-Gy treatment group. There were six rats in each group. MAIN OUTCOME MEASURES： Apoptosis and necrosis of normal brain tissue and glioma were observed by Flow Cytometry one week after irradiation, and pathological changes to tumor tissue were identified by HE staining. RESULTS： Eighteen rats were initially selected for the study： two rats from the model and 12-Gy treatment groups died from accidental anesthesia. The remaining 16 rats were included in the final result analysis. Cellular apoptosis and necrosis： apoptosis and necrosis were significantly increased in the treatment groups after gamma knife irradiation, compared to the model group （P 〈 0.05）. Apoptosis was greater in the 9-Gy treatment group compared to the 12-Gy treatment group （P 〈 0.01 ）. Necrosis was significantly reduced in the 9-Gy treatment group compared to the 12-Gy treatment group （P 〈 0.01）. Pathological changes： The necrosis of the center of tumor tissue appeared in the 9, 12 Gy treatment group. Cells dispersed in the necrosis region and the density of cells was higher with the longer distance from the necrosis region. There were patches of pycnotic cells with different period between the edge and center of the necrosis region, and the cellular dropsy could be seen. Moreover, the amount of necrosis was greater with increasing doses of irradiation. CONCLUSION： Apoptosis and necrosis are cellular death mechanisms induced by gamma knife treatment of gliomas. Cellular necrosis increased with greater irradiation doses.
基金the National Natural Science Foundation of China, No. 30672152the Natural Science Foundation of Guangdong Province, No. 021862the Scientific and Technological Foundation of Guangdong Province, No.2006B36003023
文摘Microsurgery and gamma knife are the mainly ways to treat arteriovenous malformation of brain in grade Spetzler-Martin I -III; however, therapeutic effects of them need to be further studied. OBJECTIVE： To compare the therapeutic effects between microsurgery and gamma knife on the treatment of arteriovenous malformation of brainin grade Spetzler-Martin I-III. DESIGN： Retrospective analysis. SETTING： Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University; Guangdong Microinvasion Center. PARTICIPANTS： A total of 86 patients with arteriovenous malformation of the brain were selected from the Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University and Guangdong Microinvasion Center from January 1997 to February 2007. After DSA, CT and/or MRI examinations, patients were evaluated in grade Spetzler-Martin I -III. All patients were divided into microsurgery group （n = 34） and gamma knife group （n =52）. There were 22 males and 12 females in the microsurgery group and their mean age was 26 years, while there were 34 males and 18 females in the gamma knife group and their mean age was 28 years. The grade of Spetzler-Martin was comparable in the two groups. All their relatives provided the confirmed consent and the study was allowed by ethics committee of our hospital. METHODS： Under complete anesthesia, patients were given microsurgery and the operative approach was chosen based on diseased regions. Firstly, feeding artery was blocked; secondly, it was separated along band of gliosis between malformation vessel mass and brain tissue; finally, draining vein was cut off and malformation vessel mass was resected. On the other hand, patients in the gamma knife group received Leksell-2300B gamma knife treatment. Leksell-G stereotaxis headframe was installed; GEl .STMR scanning device was used for localization; r-PlanS.2 workstation was used for target design and dosage program; Leksell B gamma knife was used during the whole operative procedure. The target was l - 4 and peripheral dosage was 12- 28 Gy. At 0.5, l and 2 years after operation, angiography was used to detect vascular occlusion in the two groups. Meanwhile, focal hemorrhage and new neurological function defect （including hemiplegic paralysis, language disorder, cerebellar function disorder, increasing frequency of epilepsy, etc.） were also observed. MAIN OUTCOME MEASURES： Rate of vascular occlusion, focal hemorrhage and neurological function defect at different time points after operation. RESULTS： All 86 patients were involved in the final analysis. Vascular nest of patients in the microsurgery group disappeared completely; while, two patients （6%, 2/34） had new neurological function defect but did not have rehaemorrhagia and death after operation. On the other hand, vascular nest of 43 patients （83%, 43/52） in the gamma knife group disappeared completely, and 8 （l 5%, 8/52） had new neurological function defect. There was significant difference between the two groups （ x^2=2.63, P 〈 0.05）. Six patients （12%, 6/52） in the gamma knife group had rehaemorrhagia after operation, and one （2%, 1/52） died. CONCLUSION： Both microsurgery and gamma knife have great effects on the treatment of arteriovenous malformation of brain in grade Spetzler-Martin I-III;however, the therapeutic effects ofmicrosurgery are superior to those of gamma knife.
基金Guangzhou Medical Science Project (No. 2006-YB-169)
文摘Objective： To evaluate the therapeutic efficacy of low-grade glioma （WHO grades Ⅰ-Ⅱ） patients treated with gamma knife radiosurgery and study on the efficacy evaluation method and radiobiological effect. Methods： 140 MRI data of 52 patients after gamma knife radiosurgery were analyzed in tumor size, necrosis or cyst formation, radiation-induced edema and MRI contrast enhancement and circumsciption change for therapeutic efficacy was evaluated. Results： The efficiency rate was 84.3%. The salient efficiency rates were 54.3% for total and 30%, 36.4%, 50%, 68%, 69.2%, and 73.1% for segmenting, respectively. Aggrandizement of tumor related to MRI contrast enhancement and necrosis or cyst formation. Radiation-induced oedema occurred for 32.7%. The MRI contrast enhancement occurred for 57.7% and showed special lace-like ring while some piece-like. Conclusion： Evaluation by MRI has showed gamma knife radiosurgery is efficient for low-grade glioma. The segmenting salient efficiency rate that increase with time is better for evaluation than the efficiency rate especially for long-term MRI follow-up. Radiobiological effect affect the efficacy evaluation. MRI contrast enhancement appears after therapy and shows special as lace-like ring and partly minificates or vanishes subsequently.
文摘Objective: To determine the best follow-up period with regard to curative effect for acoustic neuroma treated with a gamma knife. Methods: Sixty cases of acoustic neuroma were treated with a gamma knife. The follow-up period was from 3 to 102 months. Changes in the lesions and peripheral tissues and clinical symptoms were compared and the curative effectiveness of gamma knife treatment was evaluated. Results: The highest total effective rate (92.3%) was in the third period. There was a significant difference in the tumor size postoperatively. There was no edema in the peripheral tissues surrounding the tumor. It was not obvious that clinical symptoms changed. Conclusion: In this report, the best follow-up period was 24-36 months. Gamma knife treatment was still effective after 60 months post-operation.
文摘Objective:To explore the effects of microsurgical vascular decompression(MVD)and gamma knife respectively on the treatment of pain,anxiety and depression in patients with primary trigeminal neuralgia.Methods:From February 2011 to June 2017,we treated 108 patients with primary trigeminal neuralgia.According to the treatment plan of the patients,they were divided into an observation group and a control group,54 cases each.The observation group underwent microsurgical vascular decompression(MVD)for the treatment of primary trigeminal neuralgia,while the control group received gamma knife treatment.The effects of pain,improvement of anxiety and depression were compared between two groups at 1 week,3 months,and 6 months after treatment.Results:The pain,anxiety and depression scores of the observation group was significantly lower than that of the control group(P<0.05).Conclusion:MVD can relieve patients'pain,anxiety and depression symptoms,as well as improve quality of life and restore self-confidence in life.
基金Science and Technology Plan Project of Jiangxi Provincial Health and Health Commission(20200506).
文摘Objective:To compare the clinical effectiveness of gamma knife radiosugery combined with acupuncture therapy and microvascular decompression in the treatment of idiopathic trigeminal neuralgia.Methods:A total of 93 patients with primary trigeminal neuralgia added to Nanchang University Hospital from November 2016 to October 2018 were selected,it was divided randomly into the control group(45 cases)and the study group(48 cases).The control group was treated with microvascular decompression and the study group used gamma knife radiosurgery combined with acupuncture therapy.The study compared the immediate pain relief rate,Visual Analogue Scale(VAS)scores,completion rate,recurrence rate,hospitalization days,total treatment duration,total treatment cost and total effective rate of treatment in 2 groups.Results:Comparison of the same group after treatment:the VAS score with 24 hours of treatment in the control group was(5.33±0.49),with a significant difference from the pre-treatment VAS score(8.62±0.13);The VAS score with 24 hours of treatment in the study group was(5.96±0.58),with a significant difference from the pre-treatment VAS score(8.54±0.25).After treatment,immediate effect,parent effect,acute and chronic complements of the control group was 25,5,2 and 7 cases,and the study group was 6,25,7 and 1,respectively.There were significant differences between the two groups;The comparison of hospitalization days,total treatment duration,total treatment cost was statistically significant(P<0.05);There were no significant difference in immediate pain rate,VAS score,total incidence of complications,recurrence rate,and total effectiveness of treatment between the two groups(P>0.05).Conclusion:Both microvascular decompression and gamma knife radiosurgery combined with acupuncture therapy can safe and effective treatment idiopathic trigeminal neuralgia patients,and for patients with good health,can tolerance all-hemp surgery,there are contraindicaindications to acupuncture therapy,microvascular decompression treatment can be chosen,while patients who are weak,cannot tolerante all-hemp surgery or resist surgery,economic difficulties,and can choose gamma knife radiosurgery combined with acupuncture therapy treatment.
文摘Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKRS) salvage therapy. Following a Pub Med search for studies usingGKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKRS for rG BM before the possibility of selection bias can be dismissed.
文摘The Stupp protocol has become standard of care for the treatment of glioblastoma (GBM) (since its publication in 2005) and has led to some limited survival improvements. This protocol, consists of radiotherapy and concomitant chemotherapy with temozolomide, an alkylating agent. Temozolomide + radiation, compared to radiation alone had added in average 3 months additional life span, 16 percent improved survival at 2 years. That said since 2005, the standard of care has not changed in regards to the treatment of early diagnosed aggressive or multifocal GBM, and unfortunately the expected survival is still poor with 75 percent of patients dying in less than 2 years and average survival of 15 months. In patients with multifocal tumors (such as the case below) the average survival is even worse with less than 4 months at her age [1]. Here we present a case study of a patient with advanced multifocal, and rapidly progressing Glioblastoma Multiforme treated with STUPP protocol in combination with IV Quercetin. The patient experienced improved quality of life and response, compared to historical data. It is our recommendation to investigate such combinational approach in patients with Glioblastoma, as in our case it proved to be safe and effective with improved quality of life and performance as well as clinical response and survival.
文摘Objective To review the applications of magnetic resonance imaging （MRI） techniques in assessing treatment response to gamma knife radiosurgery for brain tumors. Data sources Published articles about assessing treatment response to gamma knife radiosurgery for brain tumors were selected using PubMed. The search terms were ＂MRr＇, ＂gamma knife＂ and ＂brain tumors＂. Study selection Articles regarding the MRI techniques using for early assessment of treatment response of gamma knife were selected. Results MRI techniques, especially diffusion weighted imaging, perfusion weighted imaging, magnetic resonance spectroscopy, are useful for early assessment of treatment response of gamma knife by detecting the hemodynamic, metabolic, and cellular alterations. Moreover, they can also provide important information on prognosis. Conclusions Diffusion weighted imaging, perfusion weighted imaging and magnetic resonance spectroscopy can provide early assessment of treatment response of gamma knife for brain tumors, and also information of tumor progression or recurrence earlier than conventional MRI. But there are still many questions to be answered which should be based on the development and advancement of MRI and related disciplines.
文摘Central neurocytoma （CN）, first described by Hassoun et al in 1982, is a rare neuronal tumor of the centralnervous system, and accounts for 0.25%-0.5% of all intracranial tumors. CN commonly occurs as an intraventricular mass but may also occur as a periventricular parenchymal mass or even in locations remote from the ventricles, in which case it is termed as an extraventricular neurocytoma （EVN） （cerebral）. EVNs show a wide variability with regard to morphologic features, cellularity, and proliferation rate and are more frequently associated with poorer clinical outcomes than CNs. 1 To our knowledge, little is known regarding the treatment of atypical neurocytomas.
文摘BACKGROUND Entrapment of the temporal horn (ETH) is a rare pathologic condition. It is a kind of focal hydrocephalus caused by obstruction of flow pathway of cerebrospinal fluid. It is caused by various conditions, but ETH secondary to postoperative gamma-knife radiosurgery (GKS) is extremely rare. CASE SUMMARY A 52-year old previously healthy woman underwent resection of a large intraventricular meningioma. A small fragment of residual tumor with no obvious enlargement of the temporal horn was observed 3 mo after surgery, and she was referred for GKS. Two months after GKS, she complained of headache and progressive paralysis of the left limb. Magnetic resonance imaging revealed enlargement of the temporal horn. There was a second procedure to resect the residual tumor 8 mo after GKS. After the second procedure, she recovered smoothly. As of the date of this writing, she has remained in good condition. CONCLUSION This case reminds us that ETH should be considered in the treatment of intraventricular meningiomas, especially before GKS.
文摘objective: Two groups of rats were microinjected with kainic acid (KA) and irradiated with gam ma knife respectively on unilateral nucleus caudate-putamen to compare the response of astrocytes. Methods: The astrocytes were identified with anti-GFAP immunohistochemical ABC method and the progress of their reaction to the 2 insults was examined from 3 h to 30 d after the lesion. Results: Both lesions could induce hyperplasia and hypertrophy of astrocytes and 2 types of GFAP-ir cells were found, one with small cell body and thin process, and the other with hypertrophic cell body and thick and long process. The timecourse of GFAP expression in the 2 groups was different. In KA microinjection group, large necrotic area was ob served in the target within 24 h. Three days later, a few astrocytes appeared around the necrosis. With in crease of the survival time, hyperplasia and hypertrophy of astrocytes began to increase. Whereas in gamma knife group, hyperplasia and hypertrophy were evident from 3 h to 7 d and necrotic dots could be seen in the target on day 14. On day 30, necrosis was tnore obvious with gradual variations in GFAP expression around the necrotic area. Conclusion: The above results indicated that GFAP could be used as a marker for CNS in jury; the difference in their timing and distribution pattern suggested different mechanisms in KA microinjec tion group and gamma-knife irradiation group.
