Neurosurgery practice最新文献

{"title":"The ClearPoint Prism® Laser Ablation System: A New Platform for Laser Interstitial Thermal Therapy (LITT) in Neuro-Oncology.","authors":"Hannah Wilson, Sanjay Dhawan, Truong Huy Do, Samuel H Jones, Clark C Chen","doi":"10.1227/neuprac.0000000000000084","DOIUrl":"10.1227/neuprac.0000000000000084","url":null,"abstract":"<p><strong>Background and objectives: </strong>Laser interstitial thermal therapy (LITT) has advanced the surgical treatment of brain cancer. However, technical constraints in the first-generation laser ablation systems limit the full potential of this technology. The ClearPoint Prism® Laser Ablation System was developed to overcome many of these limitations, including a larger ablation window, a faster refresh rate for magnetic resonance thermometry, and integration with an MRI-compatible stereotactic system. This system was US Food and Drug Administration-cleared for neurosurgical use in 2022.</p><p><strong>Methods: </strong>As an IDEAL Stage 1 study, we prospectively followed the first 3 patients who underwent LITT using the ClearPoint Prism® Laser Ablation System in the United States to establish feasibility and safety of this technology platform.</p><p><strong>Results: </strong>Three patients underwent procedures involving MRI-guided needle biopsy followed by LITT. The radial error of stereotaxis relative to the intended target ranged from 0.8 to 1.6 mm (with a median of 1.0 mm). Definitive diagnosis was achieved in all cases. The average time required to establish the trajectories was 98.7 ± 16.6 minutes. The average time required to perform the biopsy and LITT was 110 ± 19.3 minutes. These times are not statistically different from our published results for comparable procedures using other available LITT systems. The average LITT time required to achieve ablation of >1 cm radius was 49 seconds (range: 29-133 seconds). There were no procedural complications. All patients were discharged home by postoperative day 3. The postoperative MRIs demonstrated expected ablation findings consistent with intraoperative thermometric assessment. With a median follow-up of 219 days (range: 185-259 days), there were no 30-day readmission, 90-day emergency visits, or wound complications.</p><p><strong>Conclusion: </strong>In this study, we introduced the design rationale for the ClearPoint Prism® Laser Ablation System, theoretical considerations for its technical merits relative to other existing systems, and to share our initial experience.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00084"},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcome of Patients With Intraoperative Aneurysm Rupture: A Retrospective Cohort Study From Nepal.","authors":"Mohan R Sharma, Sandeep Bohara, Dipendra K Shrestha, Deepak R Joshi, Shreejana Singh, Ritesh Lamsal, Subhash P Acharya, Prakash Kafle, Amit B Pradhanang, Gopal Sedain, Farrokh Farrokhi, Gerald A Grant","doi":"10.1227/neuprac.0000000000000083","DOIUrl":"10.1227/neuprac.0000000000000083","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intraoperative aneurysm rupture (IAR) is a significant complication during microsurgical clipping of cerebral aneurysms. The timing of rupture during surgery, morphology of the aneurysm, and strategies to mitigate risk are the key factors that influence the outcome.</p><p><strong>Methods: </strong>Consecutive patients with the diagnosis of ruptured cerebral aneurysms were retrospectively reviewed at a single University Hospital in Kathmandu, Nepal. Variables analyzed included age, sex, presenting symptoms, Hunt and Hess grades, the location of aneurysms, the timing of surgery, and intraoperative rupture status. Outcomes were assessed at 6 months after surgery.</p><p><strong>Results: </strong>A total of 199 patients with 231 ruptured cerebral aneurysms from July 2014 to December 2022 were reviewed. Surgery was performed within 3 days in 60 (30.1%) patients. Twenty aneurysms ruptured intraoperatively in 20 patients (10% per patient and 8.6% per aneurysm). Patients with IAR were significantly younger (mean age 52 years) than those without IAR (mean age 58 years) (<i>P</i> < .001, 95% CI: 3.72-8.28). There was no difference in IAR rate in early vs late surgery. Anterior communicating artery complex aneurysms were noted as the most common. However, posterior inferior cerebellar and posterior cerebral artery aneurysms had the highest IAR rate, albeit with the smallest total number. Rupture during dissection was noted in 10 (50%) and during clipping in 9 (45%) procedures. Strategies for handling IAR included direct definitive clip application in 9, temporary clip-aided permanent clipping in 8, and trapping of the parent vessel in 1 patient. Although postoperative complications were significantly higher in the IAR group (<i>P</i> < .000129), the neurological outcomes using the modified Rankin scale in 6 months were similar (<i>P</i> = .877).</p><p><strong>Conclusion: </strong>The demographic and clinical characteristics and rates of IAR in our patient population are similar to those in the contemporary literature. In patients with IAR, the outcome is not worse than those without IAR.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00083"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Quality Metrics in Neurosurgery: A Spinal Surgery 3-Year Case Review.","authors":"Christina Nicoll Feller, Erin M Bodenbach, Julie M Kolinski, Grant P Sinson","doi":"10.1227/neuprac.0000000000000071","DOIUrl":"10.1227/neuprac.0000000000000071","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite the known importance of accurate clinical documentation as a companion to quality patient care, this is not often prioritized in practice and leads to a variety of downstream consequences. Inaccurate documentation leads to missed opportunities in full, accurate coding. In turn, it also negatively influences hospital and physician quality ranking, medical center profiling, and revenue captured. The aim of this study is to highlight the opportunity for continuous improvement in clinical documentation and the significance accurate clinical documentation has on outcome measures, such as expected length of stay (eLOS).</p><p><strong>Methods: </strong>A single-center retrospective chart review took place for patients undergoing spinal surgery from 2019 to 2021. Based on Vizient's diagnosis-related group risk model for eLOS, 192 charts spanning 10 unique diagnosis-related groups were reviewed to identify ICD-10 diagnosis and procedure codes that were not coded or not clearly documented by a physician. A new eLOS for each patient was recalculated with the addition of the newly identified variables and then compared with the original eLOS.</p><p><strong>Results: </strong>Overall, there was a significant difference between the original eLOS and new eLOS when the newly identified variables were added (<i>P</i> < .001). Of 192 patient charts, 89.5% had at least one new variable contributing to eLOS, with an average of 2.60 (0, 12) new variables. This resulted in an average increase in eLOS of 2.869 days (-0.160, 35.129). Compared with the observed LOS, the new eLOS was significantly different (<i>P</i> < .001), whereas the original LOS was not (<i>P</i> = .5661).</p><p><strong>Conclusion: </strong>Incomplete documentation and coding can misrepresent the quality of patient care provided and the complexity of their cases. This represents an opportunity for improvement for both the clinicians, clinical documentation improvement specialists, and coders to improve quality metrics and hospital rankings.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00071"},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Contralateral Progression of a Vestibular Schwannoma After Resection in a Patient with Neurofibromatosis Type 2.","authors":"Ihika Rampalli, Collin William English, Tyler Lazaro, Benjamin Daniel Lovin, Sungho Lee, Andrew Tsao Huang, Ali Jalali, Kathleen Kelly Gallagher, Jacob J Mandel, Alex Daniel Sweeney, Akash J Patel","doi":"10.1227/neuprac.0000000000000082","DOIUrl":"10.1227/neuprac.0000000000000082","url":null,"abstract":"<p><strong>Background and importance: </strong>Bilateral vestibular schwannomas (VS) are a distinctive feature of neurofibromatosis type 2 (NF2) that result in a serious reduction in the quality of life for patients. The growth rates of these schwannomas are variable, and the early detection of increased growth is fundamental for improving outcomes.</p><p><strong>Clinical presentation: </strong>A 17-year-old man with NF2 and bilateral VS presented with complete right facial paralysis and sudden right hearing loss less than 1 month after resection of a left VS. Imaging revealed rapid growth of the right VS with intratumoral hemorrhage, and the patient underwent urgent surgical resection with some improvement in symptoms.</p><p><strong>Discussion: </strong>Existing literature indicates a similar phenomenon after a longer post-operative period; however, none have shown such rapid symptomatology. Multiple etiologies were explored for this presentation, including the sudden decompression from the primary resection, paracrine factors, and hypervascularity from prior radiation.</p><p><strong>Conclusion: </strong>VS resection in a patient with NF2 may be followed by rapid growth in the contralateral VS, leading to severe symptom presentation. Patients should be counseled regarding this risk to enable early detection and intervention.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00082"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parry-Romberg Syndrome and an Associated Complex Vascular Lesion Managed With Hybrid Strategies: A Case Report.","authors":"Rory Hagstrom, Howard A Riina, Gavin W Britz, Vera Sharashidze, Charlotte Chung, Hannah Weiss, Robert F Spetzler, Peter Kim Nelson","doi":"10.1227/neuprac.0000000000000080","DOIUrl":"10.1227/neuprac.0000000000000080","url":null,"abstract":"<p><strong>Background and importance: </strong>Parry-Romberg syndrome (PRS) is a condition of unknown etiology, most commonly characterized by progressive facial hemi-atrophy due to breakdown of the underlying skin and soft tissues. PRS has been associated with neurologic disease such as intracranial aneurysms and vascular malformations. However, its exact role in the incidence of neurovascular disease remains unknown.</p><p><strong>Clinical presentation: </strong>We present a case of a complex fusiform aneurysm involving the A1 segment of the left anterior cerebral artery in a 21-year-old man with PRS. The patient initially presented with a left giant fusiform/dissecting internal carotid artery aneurysm initially managed with overlapping flow diverters. His post-flow diverter treatment course was confounded by progressive growth of the aneurysm with worsening mass effect on the optic chiasm leading to complete visual loss in the left eye and a right hemifield cut. To manage the aneurysm recurrence, retreatment with surgical bypass-supported carotid occlusion was performed. Thereafter, visual symptoms improved, but complete normalization of vision was not achieved. The patient remained clinically stable for several years until follow-up imaging demonstrated a novel adjacent recurrence involving the ipsilateral A1 segment, previously noted to be angiographically normal. The patient underwent superselective angiography followed by endovascular occlusion of the new fusiform lesion.</p><p><strong>Discussion: </strong>The case presented here illustrates the hybrid roles of endovascular and surgical treatment modalities in treating complex vascular lesions. The recurrence of the lesion following initial treatment strategies introduces questions about how the nature and development of the lesion affected the success of treatment at each stage. Considerations for the efficacy of each stage of treatment in this case include the patients underlying connective tissue disorder, the pediatric etiology of the lesion, and the timing of each treatment option given these factors.</p><p><strong>Conclusion: </strong>In addition to understanding the biological behavior of flow diversion for complex intracranial aneurysms, the role of PRS in the incidence of neurovascular disease should also be considered when applicable. More research into the mechanisms of PRS in neurovascular disease is needed.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00080"},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internal Carotid Artery Injury in Endoscopic Endonasal Surgery: The Value of Intraoperative Magnetic Resonance Imaging.","authors":"Abdulrazag Ajlan, Emad M Babateen, Ashwag Alqurashi","doi":"10.1227/neuprac.0000000000000073","DOIUrl":"10.1227/neuprac.0000000000000073","url":null,"abstract":"<p><strong>Background and importance: </strong>Internal carotid artery (ICA) injury is a devastating complication of endoscopic endonasal surgery. We report a case of completely resected clival chordoma using endoscopic endonasal surgery despite intraoperative ICA injury. Intraoperative MRI (iMRI) was used to localize the bleeding site, confirm resection degree and ICA patency distal to the injury site, and rule out intraoperative ischemia.</p><p><strong>Clinical presentation: </strong>A 16-year-old girl presented with right-sided facial paresthesia and was diagnosed with a large, invasive skull base lytic lesion centered in the clivus. The patient's neurological examination was normal, except for decreased sensation on the right side of the face. During tumor resection, massive bleeding occurred from the ICA paraclival segment, which was by applying direct pressure using hemostatic agents. Partial tumor resection, no clear signs of ischemic injury, and a patent flow distal to the ICA injury site were observed using iMRI. These findings helped in the decision to proceed with surgery and complete gross total resection. Postoperative angiography immediately performed after surgery revealed a pseudoaneurysm that was successfully embolized with coils. After discharge with no new neurological deficits, the postoperative imaging showed complete resection and no evidence of ischemic stroke in the injured ICA distribution.</p><p><strong>Conclusion: </strong>Although not commonly used to detect skull base lesions, iMRI was valuable in our chordoma case and enabled the surgical team to proceed with a complete surgical resection. It provided real-time evaluation of the injury and possible complications. Thus, iMRI should be considered for high-risk skull base ICA injuries.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00073"},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiological Outcomes of Full-Endoscopic Decompression for Lumbar Spinal Stenosis With Grade I Degenerative Spondylolisthesis: A Retrospective Study With a Minimum 1-Year Follow-up.","authors":"Sang-Soo Choi, Geon Ahn, Il-Tae Jang, Hyeun Sung Kim","doi":"10.1227/neuprac.0000000000000078","DOIUrl":"10.1227/neuprac.0000000000000078","url":null,"abstract":"<p><strong>Background and objectives: </strong>Decompression without fusion is a surgical option for the treatment of lumbar spinal stenosis (LSS) with grade I degenerative spondylolisthesis (DS). However, the outcomes of full-endoscopic decompression remain unknown. This study aimed to investigate the clinical and radiological outcomes of lumbar full-endoscopic decompression for spinal stenosis with grade I DS.</p><p><strong>Methods: </strong>A total 43 patients with LSS with grade I DS who underwent lumbar full-endoscopic unilateral laminotomy for bilateral decompression and were followed up for a minimum of 1 year were retrospectively reviewed. Data on demographic characteristics, operative details, radiological images, clinical outcomes, and complications were analyzed.</p><p><strong>Results: </strong>Pain, evaluated using the visual analog scale, was significantly reduced in patients undergoing full-endoscopic decompression in both the leg and back; the Oswestry Disability Index scores also improved (<i>P</i> < .001). MacNab's outcome classification was excellent or good in 95% of patients. One patient eventually needed the fusion surgery, and two patients required further diskectomy surgery because of recurrent symptoms. During follow-up, an increase in the vertebral slip was observed in 46.5% of the patients, but it was not statistically significant (<i>P</i> = .46). The progression of DS, defined as percentage of slip >5%, was observed only in 7% of the patients. An increase in vertebral slip was not associated with the clinical outcomes. There was no difference in radiological outcomes, such as angular motion (<i>P</i> = .36) and translation (<i>P</i> = .13), compared with the preoperative state. The operation did not exacerbate spinal instability. Rather, fewer patients had spinal instability postoperatively.</p><p><strong>Conclusion: </strong>Endoscopic decompression alone has comparably good clinical outcomes with those of other surgical techniques in patients with LSS and DS. Few postoperative spinal instability occurred. Rather, the number of patients with instability decreased postoperatively. Full-endoscopic decompression may be a treatment option for patients with grade 1 DS.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00078"},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Clival Resorption and Pontine Pneumatosis Secondary to Severe Cocaine-Induced Midline Destructive Lesion: A Case Report.","authors":"Abdulrahman Almansouri, Alex Tham, Abdulaziz Abobotain, Mashael Almarwani, Marc Tewfik, Denis Sirhan","doi":"10.1227/neuprac.0000000000000076","DOIUrl":"10.1227/neuprac.0000000000000076","url":null,"abstract":"<p><strong>Background and importance: </strong>Cocaine-induced midline destructive lesions manifest as various degrees of distortion to normal anatomy. We present a rare case of substance-induced clival defect that underwent surgical repair.</p><p><strong>Clinical presentation: </strong>This patient presented with transient neurological deficits and was found to have severe clival destruction and pontine pneumatosis secondary to prolonged cocaine use. Surgical reconstruction of the clival defect was performed using a combined open and endoscopic approach.</p><p><strong>Discussion: </strong>When anatomical integrity is severely compromised, defects of the clival region can be repaired using a hybrid open-endoscopic approach. In this case, the lack of local mucosal tissue for reconstruction led to the use of a pedicled pericranial flap.</p><p><strong>Conclusion: </strong>Complete clival resorption secondary to cocaine use is uncommon. In advanced cases, pontine inflammation is present on imaging studies. Combined endoscopic and open clival reconstruction is effective in restoring anatomic integrity.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00076"},"PeriodicalIF":0.0,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Characteristics of Patients Undergoing Awake Craniotomy With Dexmedetomidine: A Retrospective Analysis.","authors":"Maddalena Irma Cassa, Eleonora Francesca Orena, Mirella Seveso, Francesco Acerbi, Mikael Gian Andrea Izzo, Marco Gemma","doi":"10.1227/neuprac.0000000000000075","DOIUrl":"10.1227/neuprac.0000000000000075","url":null,"abstract":"<p><strong>Background and objectives: </strong>Only few studies have investigated the psychological profile of patient candidates for awake craniotomy (AC). The aim of this study was to describe the multidisciplinary clinical protocol adopted in our hospital and to retrospectively explore differences in psychological characteristic of 51 patients, analyzing association with the tolerability of the procedure.</p><p><strong>Methods: </strong>During the preoperative neuropsychological assessment, the Pain Anxiety Symptoms Scale was administered to assess pain-related anxiety. Clinical characteristics and anesthesiological management were retrospectively recollected. The AC procedure was classified as \"optimal\" or \"suboptimal\" based on administration of rescue sedative midazolam doses because of psychomotor agitation or emotional distress in excess with respect to our anesthesiological protocol.</p><p><strong>Results: </strong>The awake procedure was considered optimal in 33 cases (64.7% of total sample). General anesthesia was never required in our patients. No significant differences between optimal and suboptimal groups were found. No single variable was significant as a predictor of outcome on the univariate analysis, and no multivariate predictive model was possible.</p><p><strong>Conclusion: </strong>Although in our experience the Pain Anxiety Symptoms Scale score was not useful in identifying candidates for AC procedures, our multidisciplinary approach provided good results with respect to the tolerability of AC surgery. However, more studies are required to identify psychological profiles and preoperative possible warning signs to find the best course of surgery for each patient.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00075"},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Radiosurgery and Highly Active Antiretroviral Therapy for HIV-Related Primary Central Nervous System Lymphomas: A Prospective Study Analyzing the Efficacy and Safety.","authors":"Andres M Alvarez Pinzon, Jose Ramon Alonso, Aizik Wolf, Felipe Ramirez-Velandia, Jose E Valerio","doi":"10.1227/neuprac.0000000000000072","DOIUrl":"10.1227/neuprac.0000000000000072","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) has been well established and considered a safe alternative for primary central nervous system lymphomas (PCNSLs). However, in HIV-related PCNSL, the use of SRS remains controversial. The purpose of this study was to evaluate the efficacy and safety of SRS in HIV-related PCNSL.</p><p><strong>Methods: </strong>Forty-two adult patients with confirmed PCNSL and no previous radiotherapy or chemotherapy were selected, with 16 receiving Gamma Knife Radiosurgery (GKRS) alone and 26 receiving Highly Active Antiretroviral Therapy (HAART) before GKRS. Follow-up evaluations were conducted at 3, 6, 12, and 24 months post-treatment using clinical and imaging techniques. Statistical analyses were performed using SPSS v22, assessing for new lesions, changes in lesion size, progression-free survival, and overall survival.</p><p><strong>Results: </strong>HAART/GKRS showed a significantly higher rate of complete response compared with the GKRS group, with 53.8% vs 18.8% (<i>P</i> = .048). The mean progression-free survival for the HAART/GKRS group and the GKRS group was 39.7 months and 31.2 months, respectively (<i>P</i> = .0051). Patients with a delayed HAART initiation (>6 months) exhibited an increased burden of T2 white matter lesions and a higher number of large lesions (odds ratio = 1.9, 95% CI = 1.44-2.42, <i>P</i> = .001). However, no significant difference was observed between the two groups regarding radionecrosis.</p><p><strong>Conclusion: </strong>The study highlights the potential benefits of adding HAART to GKRS for patients with PCNSL, leading to improved survival outcomes. An early initiation of HAART was associated with less tumor progression, underscoring the importance of timely administration of HAART in patients with AIDS-related PCNSL.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00072"},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}