L ow-grade glioma (LGG) is a slowly progressive yet invasive tumor that generally arises in young adults. 11 However, about half of all LGG cases eventually progress to malignant transformation, and in such cases, the prognosis is dismal. 8 There was no standard therapeutic strategy for LGG; however, the tumor is often resected with or without subsequent fractionated radiotherapy (RT) and chemotherapy using nitrosourea or temozolomide. 5 , 9 , 15 Recently, the significance of the extent of resection (EOR) has been reported for LGG, 12 , 14 , 18 , 19
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Masayuki Nitta, Yoshihiro Muragaki, Takashi Maruyama, Soko Ikuta, Takashi Komori, Katsuya Maebayashi, Hiroshi Iseki, Manabu Tamura, Taiichi Saito, Saori Okamoto, Mikhail Chernov, Motohiro Hayashi, and Yoshikazu Okada
Ricky Medel, Stephen J. Monteith, R. Webster Crowley, and Aaron S. Dumont
cancer. 23 , 30 , 36 While the presence of such factors can provide some indication of the possible outcome, reliable prediction is impossible—which in turn complicates therapeutic strategies. When infection and trauma represented the most common causes, therapy involved watchful waiting and antibiotics. And while trauma remains a frequent cause, aseptic thrombosis occurring as a result of a multitude of factors (puerperium, malignancy, dehydration, oral contraceptives, and thrombophilia) is now more common than infection. 71 This change in etiology has shifted
Tej D. Azad, James Pan, Ian D. Connolly, Austin Remington, Christy M. Wilson, and Gerald A. Grant
and modulate the BBB. In this section we detail current efforts in each of these therapeutic strategies. BBB Disruption Osmotic Disruption The concept of hyperosmolar BBB disruption was first reported by Rapoport et al. in 1972. 93 Following delivery of the hyperosmotic agent, water leaves endothelial cells, resulting in shrinkage and tight-junction dysfunction, leading to increased permeability of the BBB allowing for a therapeutic window of several hours. 94 A variety of substances have been used as osmotic disruptors of the BBB, but mannitol has been
Hugues Duffau
contributions of perilesional versus contrahemispheric compensatory structures. 8 These different individual fingerprints can result in distinct therapeutic strategies, since prominent recruitment of functional areas around the surgical cavity will prevent subsequent connectome-based reoperation and will increase the risks of neurocognitive deficits in case of adjuvant locoregional radiation therapy. 16 By contrast, if the functional compensation is mainly sustained by the contralesional hemisphere, repeated operation(s) with optimization of the extent of resection while
Toshiaki Bando, Yasushi Ueno, Narihide Shinoda, Yukihiro Imai, Kazuhito Ichikawa, Yoji Kuramoto, Takahiro Kuroyama, Daisuke Shimo, Kazuyuki Mikami, Shinya Hori, Masato Matsumoto, and Osamu Hirai
. Cancer 78 : 2564 – 2571 , 1996 10.1002/(SICI)1097-0142(19961215)78:12<2564::AID-CNCR16>3.0.CO;2-U 8952565 26 Schild SE , Scheithauer BW , Schomberg PJ , Hook CC , Kelly PJ , Frick L , : Pineal parenchymal tumors. Clinical, pathologic, and therapeutic aspects . Cancer 72 : 870 – 880 , 1993 8334641 10.1002/1097-0142(19930801)72:3<870::AID-CNCR2820720336>3.0.CO;2-X 27 Shimada K , Nakamura M , Kuga Y , Taomoto K , Ohnishi H , Konishi N : Cytologic feature by squash preparation of pineal parenchyma tumor of intermediate
Praveen K. Belur, Jason J. Chang, Shuhan He, Benjamin A. Emanuel, and William J. Mack
secondary mechanisms of injury following hematoma expansion. The pathophysiological basis of cerebral edema and cell death has been examined in the laboratory. Putative agents targeting mechanisms of secondary brain injury have been assessed in animal ICH models and clinical trials. Our paper reviews these treatments. We discuss the pathophysiological mechanisms underlying secondary brain injury in ICH, review the virtues and limitations of the major animal models, and survey emerging therapeutic strategies targeting secondary mechanisms of injury in the setting of ICH
Arnold B. Etame, Roberto J. Diaz, Christian A. Smith, Todd G. Mainprize, Kullervo Hynynen, and James T. Rutka
between tumors and normal brain. 3 , 5 , 6 , 16 , 34 , 46 , 47 , 55 Potential solutions require either structural modifications of therapeutic agents or transient, safe, and reversible modifications of the BBB to enable delivery into the brain. The latter strategy of BBB modification appears practically more appealing given the complexities of redesigning and modifying molecular therapeutic agents. Ideally, strategies that transiently increase BBB permeability should be focal, safe, reversible, and noninvasive. Focused ultrasound disruption of the BBB is emerging as
Thoracolumbar spinal deformity: Part II. Developments from 1990 to today
Historical vignette
Fred C. Lam, Adam S. Kanter, David O. Okonkwo, James W. Ogilvie, and Praveen V. Mummaneni
I n the first part of this 2-part historical review, we outlined the early diagnostic and therapeutic strategies used in the management of spinal deformity. This review expands upon those early innovations and further details the advances from 1990 to the modern era. We begin with a review of the contemporary classification systems for spinal deformity. We will then discuss the surgical techniques and technologies that have become available over the last 2 decades for the correction and maintenance of spinal deformity. These major advances have been
Huan Wang and Darren B. Orbach
, may be associated with a high risk of delayed recanalization. For these reasons, the possibility that therapeutic parent vessel occlusion would be necessary in this case was carefully discussed with the patient's parents before the procedure began. The treatment strategy described in this report was the result of close collaboration between the cerebrovascular neurosurgeons and the endovascular group, and the high risk associated with any treatment modality in this case was made clear as part of the informed consent process. Placement of a stent, another tool from
Nicholas F. Marko, Emily LaSota, Amir H. Hamrahian, and Robert J. Weil
tables represent nonweighted arithmetic means. Choice of Treatment Strategies A management decision tree was constructed based on current treatment recommendations and on data regarding efficacy and prevalence for several therapeutic modalities commonly used in the management of acromegaly caused by a pituitary microadenoma ( Fig. 1 ). 24 , 33 , 59 Based on this tree, 5 unique strategies, each consisting of up to 4 potential steps, were selected for further analysis ( Table 1 ). For each strategy, proceeding to a subsequent step is only necessary if and when the
