Breno Nery, Rodrigo Antônio Fernandes Costa, Eduardo Quaggio, Ricardo Lopes Araújo, Bernardo Alves Barbosa, Diogo Fabricio Coelho de Melo, Carolina Salviano de Abreu Nery, F. Bernardes Filho, George Peter Stevens
{"title":"Jugular Foramen Paragangliomas","authors":"Breno Nery, Rodrigo Antônio Fernandes Costa, Eduardo Quaggio, Ricardo Lopes Araújo, Bernardo Alves Barbosa, Diogo Fabricio Coelho de Melo, Carolina Salviano de Abreu Nery, F. Bernardes Filho, George Peter Stevens","doi":"10.5772/intechopen.84232","DOIUrl":"https://doi.org/10.5772/intechopen.84232","url":null,"abstract":"Jugular foramen paragangliomas are rare neoplasms occurring with a myriad of symptoms originating from paraganglionic tissue derived from the neural crest, comprising about 0.03% of all human tumors. Patients usually present with symptoms of dysfunction of VI, VII, VIII, IX, X, XI, XII nerves and sympathetic trunk. Depending on the tumor’s topography, various approaches might be used to obtain its gross total resection. Jugular Foramen’s paraganglioma classification, nuances of the approaches, pathology, postoperative complications, and outcomes are revised as follows. In conclusion, anatomical knowledge and the disease’s comprehension are essential when dealing with such tumors, and despite their rarity, we must be obstinately committed to the surgical technique and devoted to the patient’s functional postoperative outcome.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128501696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Trojan, H. Kasprzak, O. Gutierrez, P. Penagos, I. Briceño, Heber Siachoque, D. Anthony, Alvaro Alvarez, J. Trojan.
{"title":"Neoplastic Brain, Glioblastoma, and Immunotherapy","authors":"A. Trojan, H. Kasprzak, O. Gutierrez, P. Penagos, I. Briceño, Heber Siachoque, D. Anthony, Alvaro Alvarez, J. Trojan.","doi":"10.5772/intechopen.84726","DOIUrl":"https://doi.org/10.5772/intechopen.84726","url":null,"abstract":"IGF-I, insulin-like growth factor 1, is present in normal fetal/neonatal brain development and reappears in the mature brain participating in the development of malignant tumor, glioblastoma multiforme. Targeting the IGF-I system has emerged as a useful method to reduce glial malignant development. Downregulation in the expression of IGF-I using antigene anti-IGF-I technology (antisense, AS, and triple helix, TH) applied in glioma cell culture established from glioblastoma biopsies induces the expression of B7 and MHC-I antigens in transfected cells (immuno-genicity). The transfected cancer cells, “vaccines,” after subcutaneous injection, initiated an immune response mediated by T CD8+ lymphocytes, followed by tumor regression (immunotherapy). The median survival of patients treated by surgery followed by radiotherapy and immunotherapy was 21–24 months. On the other side, the experimental work has demonstrated that IGF-I AS or TH transfected tumor cells fused with activated dendritic cells, DC, showing more striking immunogenic character. Using IGF-I TH/DC “vaccination,” the efficiency in suppressing rat glioma tumors is not only relatively higher than that obtained using IGF-I TH cells but is also more rapid.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129804667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intradural Extramedullary Spinal Tumors","authors":"S. Rasras, A. Kiani","doi":"10.5772/intechopen.85360","DOIUrl":"https://doi.org/10.5772/intechopen.85360","url":null,"abstract":"Intradural extramedullary (IDEM) spinal tumors are common pathologies, and despite their name, they can extend beyond dural confinements. IDEMs can have both sporadic and syndromic patterns, and various genetic abnormalities are believed to be responsible for these mainly benign pathologies. Meningiomas, nerve sheath tumors (NST), and ependymomas are the three most common subtypes, and due to their pathologically benign nature, surgical total resection plays the most important role in their management. These tumors have always been challenging entities to neurosurgeons, and many surgical techniques have been described in order to achieve gross total resection, and these techniques have continued to evolve over time. Adjuvant therapies such as radiotherapy or radiosurgery are usually considered when total resection is not possible or sometimes in syndromic patients in order to avoid multiple surgical procedures in a short period of time.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131532925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Yerramneni, R. Kanala, Vasundhara S. Rangan, Thirumal Yerragunta
{"title":"Surgery for Recurrent Glioblastoma","authors":"V. Yerramneni, R. Kanala, Vasundhara S. Rangan, Thirumal Yerragunta","doi":"10.5772/intechopen.87524","DOIUrl":"https://doi.org/10.5772/intechopen.87524","url":null,"abstract":"Recurrence of glioblastoma (GB) is inevitable. As the optimal management for recurrent glioblastoma continues to evolve, clear treatment guidelines for are lacking. Existing literature does not clarify the role that second surgery plays in the treatment of these patients. Although few studies report that second surgery is beneficial in select patients and leads to longer overall survival (OS), other studies have demonstrated the limited impact that repeat surgery has on the eventual patient outcome. Maximal safe resection (high extent of resection—EOR) has been proven to improve the OS at reoperation, even when undertaken for cases where the first surgery achieved only a limited EOR. Karnofsky Performance Score (KPS) and age at presentation are valuable prognostic factors that predict better OS and aid in better patient selection for surgical management. The true value of reoperation versus systemic treatment, their effects the patient’s QoL and the added increase in overall survival is better judged after detailed investigation by means of a prospec-tive, randomized trial.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123539872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexa Semonche, D. Eichberg, Ashish H. Shah, Michael E. Ivan
{"title":"Laser Ablation for Gliomas","authors":"Alexa Semonche, D. Eichberg, Ashish H. Shah, Michael E. Ivan","doi":"10.5772/INTECHOPEN.86829","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86829","url":null,"abstract":"Laser interstitial thermal therapy (LITT) is a novel minimally invasive neurosurgical procedure in which laser light is delivered through a stereotactically positioned probe to an intracranial lesion for controlled thermal ablation of the pathological tissue. LITT is considered for patients who are poor candidates for open surgical resection due to (1) location of lesion (e.g., deep-seated or near critical structures), (2) history of intracranial interventions or medical comorbidities that increase surgical risk, or (3) lesion refractoriness to prior conventional therapies. The use of LITT was initially limited by concerns over off-target thermal damage; however, recent advances in magnetic resonance imaging-based thermal imaging have enabled real-time monitoring of tissue ablation dynamics, thereby improving its safety profile. Accordingly, the past two decades have seen a rapid expansion in the use of LITT for a variety of intracranial pathologies, including neoplasms, radiation necrosis, and epilepsy. This chapter focuses on the novel application of LITT to both newly diagnosed and recurrent glioblastoma multiforme (GBM). We first review the technological developments that enabled the safe use of LITT for GBM. We then review recent evidence regarding the indications, outcomes, and limitations of LITT as a novel adjuvant treatment for GBM.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122939350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advances in the Systemic Treatment of Melanoma Brain Metastases","authors":"Philip Friedlander","doi":"10.5772/INTECHOPEN.85673","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85673","url":null,"abstract":"It is estimated that up to 40% of patients with distantly metastatic melanoma develop clinically detectable brain metastases. The prognosis for these patients is very poor with an historical median overall survival of approximately 4 months. Targeted surgical and radiotherapy-based approaches can improve outcomes in certain patients. Over the past decade, the efficacy of systemic treatments for metastatic melanoma has improved with the development of anti-CTLA-4 and anti-PD-1-based immunotherapies (checkpoint inhibitors) that provide survival benefit. In patients whose melanoma expresses a V600 BRAF mutation which activates the MAPK signaling pathway, the targeted inhibition of BRAF and MEK also confers survival benefit. These immunomodulatory and molecular-targeted approaches have recently been studied in patients with melanoma brain metastases to determine efficacy of these approaches in treating the brain metastases. Advances in use of chemotherapy, immune checkpoint inhibitors, and BRAF plus MEK inhibitors to treat melanoma brain metastases are discussed.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129034293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Innovations in Metastatic Brain Tumor Treatment","authors":"C. Stewart, B. Stewart, M. Ware","doi":"10.5772/INTECHOPEN.86047","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86047","url":null,"abstract":"Metastatic brain tumors (MBTs) are the most common intracranial tumor and occur in up to 40% of patients with certain cancer diagnoses. The most common and frequent primary locations are cancers originating from the lung, breast, kid-ney, gastrointestinal tract or skin, and also may arising from any part of the body. Treatment for brain metastasis management includes surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and chemotherapy. Standard treatment for MBTs includes surgery and SRS which offer the best outcomes, while the WBRT is still an important treatment option for patients who cannot tolerate surgery and SRS or patients with multiple brain metastases. Newer approaches such as immunotherapy and molecularly targeted therapy (e.g., small molecules and monoclonal antibodies) are currently being evaluated for the treatment of MBTs. In this chapter, we will review current available treatments for MBTs and discuss treatments that are undergoing active investigation.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123521202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical Principles for Spinal and Paraspinal Neurofibromas","authors":"F. Sarica","doi":"10.5772/INTECHOPEN.85760","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85760","url":null,"abstract":"Neurofibromas are the most prevalent seen tumor in the neurofibromatosis type 1 (NF1) disease. Spinal neurofibromas, which are the major diagnostic criteria of disease, are seen in approximately 60% of the patients with NF1. They constitute 23% of all of the spinal tumors. While the spinal neurofibromas most frequently show a location in thoracic region, it is followed by their predilection in cervical and lumbar regions, respectively. The spinal neurofibromas located in the sacral region are quite rarely observed and show an asymptomatic course until reaching to the big sizes. Of these spinal neurofibromas, 72% were with intradural extramedullary, 14% with extradural, and 13% with intradural and extradural “dumbbell formation.” Only 1% of the spinal neurofibromas are intramedullary located. The total taking of the single solitary neurofibroma surgically is relatively easier. But, the difficulties can be encountered in taking these tumors surgically since they are characterized by the multiple tumors in the plexiform neurofibromas, especially accompanying to the NF1. In this chapter, the surgical difficulties encountered in the region in which the tumor is localized and different surgical approaches are developed in the course of time in order to exceed these difficulties are described.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121864682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Toxicity of Cranial and Spinal Cord Irradiation","authors":"J. Naziri, S. DiBiase","doi":"10.5772/INTECHOPEN.85396","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85396","url":null,"abstract":"Along with surgery and chemotherapy, radiation therapy is an essential treatment option for metastatic and primary tumors of the central nervous system. Radiation toxicity may be compartmentalized into three subcategories including acute toxicities, early-delayed and late delayed effects. Radiation induced toxicity spans from self-limiting fatigue to more serious delayed side effects of radionecrosis. Stereotactic radiosurgery has recently emerged as a highly focused delivery method of tumoricidal irradiation with promising results compared to whole brain irradiation in many cases. Recognizing and understanding toxicity from cranial irradiation can help guide therapy as ever evolving new technologies develop within this integral component of cancer treatment.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122102018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pediatric Medulloblastoma: A Radiation Oncologist Perspective","authors":"Meenu Gupta, Mushtaq Ahmad","doi":"10.5772/INTECHOPEN.84344","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84344","url":null,"abstract":"Pediatric medulloblastomas are radiosensitive and mostly curable tumors if they are non-metastasized. Postsurgery adjuvant radiation therapy remains the corner-stone therapy in the curative intent treatment. In case of children less than three years, pre-irradiation chemotherapy is given to defer radiotherapy till the child is three year old. Introduction of conformal radiotherapy in addition to technical improvements in surgery and radiotherapy, risks definition and molecular analysis of prognostic factors has most likely contributed to the improved survival rates. Children should ideally be referred in time to an appropriate higher center with adequate infrastructure, expertise and radiotherapy facilities for better outcome of the disease.","PeriodicalId":243134,"journal":{"name":"Brain and Spinal Tumors - Primary and Secondary","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129064252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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