✓ The records of 124 patients treated for acoustic neurilemoma at the University of California, San Francisco, from 1945 through 1983 were reviewed. Patients were classified by the extent of surgical resection: total, nearly total (90% to 99% resection), subtotal (< 90% resection), or biopsy. Thirty-one patients received irradiation as part of their primary treatment. Total resection of tumor, without irradiation, was associated with a 3% chance of local recurrence. One of 15 patients who had nearly total resection of their tumor and did not receive postoperative irradiation suffered a recurrence, compared with neither of the two patients who received postoperative irradiation (> 45 Gy) following nearly total resection. Postoperative irradiation (> 45 Gy) decreased the recurrence rate after subtotal resection from 46% (six of 13 cases without irradiation) to 6% (one of 17 cases: p = 0.01). All three patients treated by biopsy alone received postoperative irradiation (> 45 Gy), and none had a recurrence. Six patients were treated with preoperative irradiation because of excessive tumor vascularity; four are without evidence of disease 12 to 23 years later. Only three of seven patients treated with irradiation for tumor recurrence after surgical resection survived. It is concluded that postoperative irradiation significantly decreased the chance for local tumor progression following subtotal resection of acoustic neurilemoma, and that postoperative irradiation may be effective therapy following treatment by biopsy. Patients with total or nearly total resection appeared not to benefit from postoperative irradiation.
Kent E. Wallner, Glenn E. Sheline, Lawrence H. Pitts, William M. Wara, Richard L. Davis and Edwin B. Boldrey
John Calogero, David C. Crafts, Charles B. Wilson, Edwin B. Boldrey, Alan Rosenberg and K. Jean Enot
✓The authors present three patients who, after excision and irradiation of their brain tumors, were treated with BCNU for recurrence. All three patients responded well and now are without evidence of tumor, 37, 30, and 36 months after BCNU was stopped. Although these patients represent only a small fraction of those treated with BCNU, they indicate the potential role of chemotherapy in the management of glial tumors.
Robert F. Spetzler, David Winestock, Hans T. Newton and Edwin B. Boldrey
✓ A case is reported in which a left frontopolar artery aneurysm was demonstrated, disappeared, and then reappeared in a series of angiographic studies obtained during the conservative management of two episodes of subarachnoid hemorrhage. Only 23 days separated the first and last angiograms; three days later the aneurysm was successfully clipped.
A. R. Vasantha Kumar, Justin Renaudin, Charles B. Wilson, Edwin B. Boldrey, K. Jean Enot and Victor A. Levin
✓ A series of 43 patients, all of whom were deteriorating due to progression of primary or metastatic brain tumors, were treated daily with n-isopropyl-α-(2-methylhydrazine)-p-toluamide hydrochloride (matulane, Procarbazine hydrochloride: NSC-77213, 150 mg./m2) for 30 consecutive days, with a 30-day rest interval between treatments. Of 29 patients evaluated, 12 showed a definite clinical response to therapy and two a probable response, for a response rate of 48%. Reversible myelosuppression was the major toxic effect encountered. Combination with other chemotherapeutic agents may enhance the drug's effectiveness against brain tumors.
Anthony D. Oliver, Charles B. Wilson and Edwin B. Boldrey
✓ Two cases of spinal arteriovenous malformation (AVM) are reported because of a previously unobserved clinical feature: recurrent transient postprandial paresis of the legs. The authors believe the paresis was caused by chronic shunting of blood away from the cord and into the low-resistance AVM. Symptomatic cord ischemia might then be precipitated by vasodilatation in other areas of the body such as the splanchnic, brachial, or uterine vessels. We believe that in some instances this mechanism should be considered as an explanation for episodic neurological deficits seen in association with spinal AVM's.
Justin Renaudin, Derek Fewer, Charles B. Wilson, Edwin B. Boldrey, John Calogero and K. Jean Enot
✓ Twenty patients seriously ill following subtotal excision of brain tumors were given unusually large doses of Decadron to restrain peritumoral edema. The prompt clinical effect was strikingly favorable in 11. The dosage of Decadron above which no additional anti-edema effect occurs must be established for each individual patient. No significant complications occurred under dosages ranging from 32 to 96 mg/day. Brain scintiscans performed after rapid clinical improvement in five cases showed no change.