scholarly journals Medical Adjuvants in the Treatment of Surgically Refractory Arteriovenous Malformations of the Head and Face: Case Report and Review of Literature

2021 ◽  
pp. 1-7
Author(s):  
Vaidya Govindarajan ◽  
Joshua D. Burks ◽  
Evan M. Luther ◽  
John W. Thompson ◽  
Robert M. Starke
Keyword(s):  
Arteriovenous Malformations ◽  
Mtor Inhibitors ◽  
Molecular Target ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Early Results ◽  
Number Of Patients ◽  
Initiation Of Therapy ◽  
The Brain ◽  
Radiographic Improvement

<b><i>Background:</i></b> Arteriovenous malformations (AVMs) of the brain and face present unique challenges for clinicians. Cerebral AVMs may induce hemorrhage or form aneurysms, while facial AVMs can cause significant disfigurement and pain. Moreover, facial AVMs often draw blood supply from arteries providing critical blood flow to other important structures of the head which may make them impossible to treat curatively. Medical adjuvants may be an important consideration in the management of these patients. <b><i>Summary:</i></b> We conducted a systematic review of the literature to identify other instances of molecular target of rapamycin (mTOR) inhibitors used as medical adjuvants for the treatment of cranial and facial AVMs. We also present 2 cases from our own institution where patients were treated with partial embolization, followed by adjuvant therapy with rapamycin. After screening a total of 75 articles, 7 were identified which described use of rapamycin in the treatment of inoperable cranial or facial AVM. In total, 21 cases were reviewed. The median treatment duration was 12 months (3–24.5 months), and the highest recorded dose was 3.5 mg/m<sup>2</sup>. 76.2% of patients demonstrated at least a partial response to rapamycin therapy. In 2 patients treated at our institution, symptomatic and radiographic improvement were noted 6 months after initiation of therapy. <b><i>Key Messages:</i></b> Early results have been encouraging in a small number of patients with inoperable AVM of the head and face treated with mTOR inhibitors. Further study of medical adjuvants such as rapamycin may be worthwhile.

Outcomes of Radiosurgery for Brainstem Arteriovenous Malformations

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Tomoyuki Koga ◽  
Masahiro Shin ◽  
Atsuro Terahara ◽  
Nobuhito Saito
Keyword(s):  
Arteriovenous Malformations ◽  
Additional Treatment ◽  
Surgical Morbidity ◽  
Factors Associated ◽  
Obliteration Rate ◽  
Early Results ◽  
Number Of Patients ◽  
The Mean ◽  
Risk Of Hemorrhage

Abstract BACKGROUND: Arteriovenous malformations (AVMs) in the brainstem yield a high risk of hemorrhage. Although stereotactic radiosurgery (SRS) is accepted, because of high surgical morbidity and mortality, outcomes are still unclear. OBJECTIVE: We previously reported the early results of SRS for brainstem AVMs. Here, we obtained data from a longer follow-up for a larger number of patients and present precise outcomes based on the latest follow-up data. METHODS: Forty-four patients with brainstem AVMs were treated by SRS. Outcomes such as the rates of obliteration, hemorrhage after treatment, and adverse effects were retrospectively analyzed. RESULTS: The annual hemorrhage rate before SRS was 17.5%. The mean follow-up period after SRS was 71 months (range, 2-168 months). The actuarial obliteration rate confirmed by angiography was 52% at 5 years. Factors associated with higher obliteration rate were previous hemorrhage (P = .048) and higher margin dose (P = .048). For patients treated with a margin dose of ≥ 18 Gy, the obliteration rate was 71% at 5 years. Persistent worsening of neurological symptoms was observed in 5%. The annual hemorrhage rate after SRS was 2.4%. Four patients died of rebleeding, and disease-specific survival rate was 86% at 10 years after treatment. CONCLUSION: Nidus obliteration must be achieved for brainstem AVMs because they possibly cause lethal hemorrhage even after SRS. Treatment with a high margin dose is desirable to obtain favorable outcomes for these lesions. Additional treatment should be considered for an incompletely obliterated nidus.

The Investigation of Personality in Patients Treated by Prefrontal Leucotomy

1942 ◽  
Vol 88 (371) ◽  
pp. 275-281 ◽  
Author(s):  
E. L. Hutton
Keyword(s):  
Mental States ◽  
Clinical Results ◽  
Review Of The Literature ◽  
Empirical Methods ◽  
Early Results ◽  
Psychological Medicine ◽  
First Time ◽  
The Brain ◽  
Mere Addition

I have been fortunate in having the opportunity of studying several of the 15 patients treated by prefrontal leucotomy in connection with the Burden Neurological Institute. I do not propose to discuss the clinical results; it is much too early as yet for any authoritative opinion to be given, and a brief review of the literature and of the early results of the first 8 cases in this series was recently published in the Lancet. It may be mentioned, however, that the results are such as to justify the cautious adoption of this operation for therapeutic purposes. Although obviously any procedure of this kind is only justifiable on therapeutic grounds, its value for psychological medicine is far more than the mere addition of another effective therapeutic method, since for the first time in history an opportunity has been presented for the study of changes in personality produced by a relatively standardized local lesion of the brain, enabling us to investigate as never before the role of the frontal lobe in normal and abnormal mental states. This investigation involves the study and correlation of both neurological and psychological data, and encounters all the difficulties inherent in such correlation.I am only too well aware of the extremely hypothetical nature of much that follows, and of the crying need for experimental evidence to confirm or refute the view here propounded, but I believe that our knowledge of mental disorders would be immeasurably advanced could we but discover the rationale underlying our present empirical methods of therapy.

scholarly journals SURG-08. GASTROINTESTINAL STROMAL TUMOR WITH INTRACRANIAL METASTASIS: CASE REPORT AND SYSTEMATIC REVIEW OF LITERATURE

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i32-i32 ◽  
Author(s):  
Akash Patel
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Stromal Tumors ◽  
Primary Site ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Patient Case ◽  
Intracranial Metastasis ◽  
Stromal Tumors ◽  
Metastatic Gist ◽  
The Brain

Abstract BACKGROUND: Intracranial metastasis of Gastrointestinal Stromal Tumors (GIST) is rare but presents unique treatment challenges. We present a case of intracranial metastasis of GIST with a systematic review of the literature regarding this rare clinical scenario. METHODS: A systematic review of the literature was performed to identify cases of intradural GIST metastases to the brain. Additionally, a patient case of GIST is discussed. RESULTS: Out of the 18 articles included for analysis in this review and our present case, fifteen of nineteen patients were male, and mean age was 58 years old (range 15–80 years, median 60 years). The primary site of the GIST along with site of intraperitoneal metastasis was variable. There was a large predilection for brain metastasis to the cerebrum with only one to infratentorial elements. The tumors in seven of the cases involved the dura, and there was one case with metastasis to the pituitary. Eight patients died following treatment of their intracranial disease. CONCLUSIONS: Surgery remains the mainstay of intracranial metastatic GIST, however there are many reports of good responses to radiation or chemotherapy alone. More investigation is required to determine the best course of treatment for patients with this unusual sequela of GIST.

scholarly journals Wyburn-Mason or Bonnet-Dechaume-Blanc as Cerebrofacial Arteriovenous Metameric Syndromes (CAMS)

2001 ◽  
Vol 7 (1) ◽  
pp. 5-17 ◽  
Author(s):  
J.J. Bhattacharya ◽  
C.B. Luo ◽  
D.C. Suh ◽  
H. Alvarez ◽  
G. Rodesch ◽  
...  
Keyword(s):  
Developmental Biology ◽  
Diagnostic Criteria ◽  
Arteriovenous Malformations ◽  
Phenotypic Expression ◽  
High Flow ◽  
Review Of The Literature ◽  
Life Threatening ◽  
Underlying Disorder ◽  
The Brain ◽  
Rational Classification

The diagnosis of Bonnet-Dechaume-Blanc or Wyburn-Mason syndrome encompasses a spectrum of phenotypic expression. Features of the syndrome as originally described, and common to all, include arteriovenous malformations of the brain and orbit (with retinal and/or retrobulbar lesions). A portion of these patients manifest the complete expression of the disease with additional high-flow arteriovenous malformations of the maxillofacial or mandibular regions. These present the distinct and additional risks of life-threatening epistaxis or gingival haemorrhage. We suggest new diagnostic criteria for the syndrome. Applying insights from modern developmental biology to our series of 15 patients (the largest to date), together with a review of the literature, we have recognised metameric patterns of involvement in what we believe to be a disease of the neural crest or adjacent cephalic mesoderm. This allows us to propose a new rational classification reflecting the putative, underlying disorder and to suggest a new name: Cerebrofacial Arteriovenous Metameric Syndrome (CAMS).

A simple treatment planning strategy for patients with multiple metastases treated with Gamma Knife surgery

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 2-4 ◽  
Author(s):  
James G. Douglas ◽  
Robert Goodkin
Keyword(s):  
Mr Imaging ◽  
Treatment Planning ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Planning Method ◽  
Cns Metastases ◽  
Cell Lung Carcinoma ◽  
Dose Volume Histograms ◽  
Number Of Patients ◽  
The Brain

ObjectIn a substantial number of patients treated at the authors' facility for brain metastases, additional lesions are identified at the time of Gamma Knife surgery (GKS). These lesions are often widely dispersed and may number over 10, which is the maximal number of matrices that can be currently placed for treatment with Leksell Gamma-Plan 4C. The authors describe a simple planning method for GKS in patients with multiple, widely dispersed central nervous system (CNS) metastases.MethodsTwo patients presented with three to five identified recurrent metastases from non–small cell lung carcinoma and breast carcinoma after having received whole-brain radiotherapy. At the time of treatment with GKS in each patient, spoiled-gradient Gd-enhanced magnetic resonance (MR) imaging revealed substantially more metastases than originally thought, which were widely scattered throughout all regions of the brain. The authors simplified the treatment planning approach by dividing the entire CNS contents into six contiguous, nonoverlapping matrices, which allowed for the planning, calculation, and treatment of all lesions.Two patients were successfully treated with GKS for more than 10 CNS metastases by using this simple planning method. Differing peripheral doses to varied-size lesions were delivered by prescribing to different isodose curves within any given matrix when required. Dose–volume histograms showed brain doses as follows: 10% of the total brain volume received 5 to 6.4 Gy; 25% received 3.8 to 4.8 Gy; 50% received 2.7 to 3.1 Gy; and 75% received 2.2 to 2.5 Gy.Conclusions The delineation of more metastases than appreciated on the diagnostic MR imaging is a common occurrence at the time of GKS at the authors' institution. The treatment of multiple (>10), widely dispersed CNS metastases can be simplified by the placement of multiple, contiguous, non-overlapping matrices, which can be employed to treat lesions in all areas of the brain when separate matrices cannot be utilized.

Meconium peritonitis: review of literature and own clinical observations

2020 ◽  
Author(s):  
E.N. Glavatskaya , O.V. Pribushenya , N.A. Venchikova
Keyword(s):  
Prenatal Diagnosis ◽  
Premature Birth ◽  
Surgical Care ◽  
Intestinal Wall ◽  
Meconium Peritonitis ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Clinical Observations ◽  
Loop Expansion ◽  
The Impact

Two clinical cases of meconium peritonitis in the fetuses are presented. The diagnosis was made prenatally at 30+5 and 20+1 weeks of gestation. The main ultrasound signs were ascites, loop expansion and thickening of the intestinal wall, peritoneal calcifications, meconium pseudocysts. In one case, pregnancy was complicated by polyhydramnios. In both cases, the pregnancy ended in premature birth, followed by surgical treatment during the first days of life. A review of the literature on the topic are discussed the etiology, the spectrum and frequency of ultrasound signs suggesting this condition in the fetus, the effectiveness of prenatal diagnosis, the prognosis for the life and health of the newborn, as well as the impact of the quality and timeliness of the prenatal diagnosis on the management of pregnancy and timeliness of surgical care for the newborn.

Possibility that the Onset of Autism Spectrum Disorder is Induced by Failure of the Glutamine-Glutamate Cycle

2020 ◽  
Vol 14 (2) ◽  
pp. 170-174
Author(s):  
Koichi Kawada ◽  
Nobuyuki Kuramoto ◽  
Seisuke Mimori
Keyword(s):  
Autism Spectrum Disorder ◽  
Endoplasmic Reticulum ◽  
Environmental Factors ◽  
Endoplasmic Reticulum Stress ◽  
Synapse Formation ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Neurodevelopmental Disease ◽  
Number Of Patients ◽  
The Brain

: Autism spectrum disorder (ASD) is a neurodevelopmental disease, and the number of patients has increased rapidly in recent years. The causes of ASD involve both genetic and environmental factors, but the details of causation have not yet been fully elucidated. Many reports have investigated genetic factors related to synapse formation, and alcohol and tobacco have been reported as environmental factors. This review focuses on endoplasmic reticulum stress and amino acid cycle abnormalities (particularly glutamine and glutamate) induced by many environmental factors. In the ASD model, since endoplasmic reticulum stress is high in the brain from before birth, it is clear that endoplasmic reticulum stress is involved in the development of ASD. On the other hand, one report states that excessive excitation of neurons is caused by the onset of ASD. The glutamine-glutamate cycle is performed between neurons and glial cells and controls the concentration of glutamate and GABA in the brain. These neurotransmitters are also known to control synapse formation and are important in constructing neural circuits. Theanine is a derivative of glutamine and a natural component of green tea. Theanine inhibits glutamine uptake in the glutamine-glutamate cycle via slc38a1 without affecting glutamate; therefore, we believe that theanine may prevent the onset of ASD by changing the balance of glutamine and glutamate in the brain.

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