1,721,086 research outputs found
Commentary: Single-Session Gamma Knife Radiosurgery for Patients With 20 or More Brain Metastases
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Cyberknife radio-neurosurgery for secreting pituitary adenomas treated with single fraction radio-neurosurgery: A systematic review and<i> meta</i>-analysis
Full text linkIntroduction: Stereotactic radiosurgery (SRS) is one of the treatment options for the management of residual or recurrent secreting pituitary adenomas (PA). While the role of radiosurgery (RS) by Gamma Knife (GK) has been clearly established, Cyberknife (CK) RS has been evaluated in fewer series. Material and methods: To perform a systematic review of the literature and meta-analysis, with the aim of focusing on the effect of CK RS on secreting PA. Using PRISMA guidelines, we reviewed articles published between January 1994 and January 2024. The inclusion criteria contained: single fraction RS, biochemical remission, tumor control and complication appearance (hypopituitarism). Results: Were incorporated 8 studies including 152 secreting PA. Vast majority were treated in single fraction 115 (75.6 %), with an overall rate of 59.9 % (p < 0.001). Total remission was encountered in 44/108 patients, for an overall rate of 50.2 % (p < 0.001). Partial remission was inconsistently reported among studies for 25/55 patients, for an overall rate of 38.8 % (p = 0.003). Uncontrolled disease was encountered in 36/108 patients, for an overall rate of 32.7 % (p < 0.001). Tumor control was not separately reported for secreting or non-secreting PA, but attained overall high rates. Conclusion: Single fraction CK radiosurgery is common practice for secreting PA. Our meta-analysis suggests high rates of both total and partial remission (as high as 89 % if both taken together), with a complete remission rate of 50.2 %. These results encourage the use of single fraction CK RS for secreting PA. To reach high rates of biochemical control, high doses of irradiation should be used.LTS
Single fraction and hypofractionated radiosurgery for perioptic meningiomas-tumor control and visual outcomes: a systematic review and meta-analysis
Full text linkPerioptic meningiomas, defined as those that are less than 3 mm from the optic apparatus, are challenging to treat with stereotactic radiosurgery (SRS). Tumor control must be weighed against the risk of radiation-induced optic neuropathy (RION), as both tumor progression and RION can lead to visual decline. We performed a systematic review and meta-analysis of single fraction SRS and hypofractionated radiosurgery (hfRS) for perioptic meningiomas, evaluating tumor control and visual preservation rates. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 8, 2022. We retained 5 studies reporting 865 patients, 438 cases treated in single fraction, while 427 with hfRS. For single fraction SRS, the overall rate of tumor control was 95.1%, with actuarial rates at 5 and 10 years of 96% and 89%, respectively; tumor progression was 7.7%. The rate of visual stability was 90.4%, including visual improvement in 29.3%. The rate of visual decline was 9.6%, including blindness in 1.2%. For hfRS, the overall rate of tumor control was 95.6% (range 92.1-99.1, p < 0.001); tumor progression was 4.4% (range 0.9-7.9, p = 0.01). Overall rate of visual stability was 94.9% (range 90.9-98.9, p < 0.001), including visual improvement in 22.7% (range 5.0-40.3, p = 0.01); visual decline was 5.1% (range 1.1-9.1, p = 0.013). SRS is an effective and safe treatment option for perioptic meningiomas. Both hypofractionated regimens and single fraction SRS can be considered.LTS
Resection of the contrast-enhancing tumor in diffuse gliomas bordering eloquent areas using electrophysiology and 5-ALA fluorescence: evaluation of resection rates and neurological outcome—a systematic review and meta-analysis
Full text linkIndependently, both 5-aminolevulinic acid (5-ALA) and intraoperative neuromonitoring (IONM) have been shown to improve outcomes with high-grade gliomas (HGG). The interplay and overlap of both techniques are scarcely reported in the literature. We performed a systematic review and meta-analysis focusing on the concomitant use of 5-ALA and intraoperative mapping for HGG located within eloquent cortex. Using PRISMA guidelines, we reviewed articles published between May 2006 and December 2022 for patients with HGG in eloquent cortex who underwent microsurgical resection using intraoperative mapping and 5-ALA fluorescence guidance. Extent of resection was the primary outcome. The secondary outcome was new neurological deficit at day 1 after surgery and persistent at day 90 after surgery. Overall rate of complete resection of the enhancing tumor (CRET) was 73.3% (range: 61.9-84.8%, p < .001). Complete 5-ALA resection was performed in 62.4% (range: 28.1-96.7%, p < .001). Surgery was stopped due to mapping findings in 20.5% (range: 15.6-25.4%, p < .001). Neurological decline at day 1 after surgery was 29.2% (range: 9.8-48.5%, p = 0.003). Persistent neurological decline at day 90 after surgery was 4.6% (range: 0.4-8.7%, p = 0.03). Maximal safe resection guided by IONM and 5-ALA for high-grade gliomas in eloquent areas is achievable in a high percentage of cases (73.3% CRET and 62.4% complete 5-ALA resection). Persistent neurological decline at postoperative day 90 is as low as 4.6%. A balance between 5-ALA and IONM should be maintained for a better quality of life while maximizing oncological control
Radiosurgery for Benign Vertebral Body Hemangiomas of the Spine: A Systematic Review and Meta-Analysis
Full text linkOBJECTIVE: Spinal vertebral hemangiomas (SVHs) are the most common benign tumors of the spine. We performed a systematic review and meta-analysis of radiosurgery (RS) for SVHs.METHODS: We reviewed articles published between January 1990 and December 2020 on PubMed. Tumor control, pain relief, and damage to surrounding tissues were evaluated with separate meta-analyses. This study was performed in accordance with the published Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 23 patients with 24 SVHs were reported in 3 studies.RESULTS: Follow-up time was 7.3-84 months. The vast majority of lesions were located at dorsal level (n = 18; 75%). In 20 (83.3%) patients, pain was the initial clinical presentation. Complete, partial, and stable responses after radiation were reported in 45.7% (P < 0.001), 23.6% (P = 0.02), and 37.2% (P = 0.7) of cases. Overall response was reported in 94.1% (P = 0.7). No progressive disease was reported. Pain relief was achieved in 87.5% of patients (P = 0.2). Damage to surrounding tissue caused by irradiation was reported in 22.3% (P = 0.02) of cases in 1 study, in which higher doses of radiation were delivered.CONCLUSIONS: Radiosurgery is safe and effective for SVHs. Pain relief after RS in symptomatic patients was extremely high, while no progressive disease was reported. Damage to surrounding tissues was reported in only 1 series and included osteitis, osteonecrosis, or soft tissue injury after higher radiation doses
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
GAMMA KNIFE RADIOSURGERY OF THE VIM: FROM THE LESIONAL EFFECT TOWARDS NEUROMODULATION
No full textGamma Knife radiosurgery (GKR) is a neurosurgical stereotactic procedure, combining image guidance, with high-precision convergence of multiple gamma rays, currently emitted by 192 sources of Cobalt-60 (Leksell Gamma Knife ICON®, Elekta Instruments, AB, Sweden). The intimate mechanisms of action are not all very well understood and vary according to the treated pathological condition. In functional disorders, GKR is used either to target a specific anatomical point [e.g. thalamus- ventro-intermediate nucleus (Vim) for tremor] or to target a larger zone, such as an epileptic focus.
The present thesis focuses on Vim GKR for drug-resistant essential tremor (ET). Essential tremor is the most common movement disorder, with the predominant clinical finding being kinetic tremor of the arms. Radiosurgery (RS) has several limitations in this indication: (1) indirect targeting (Vim is not visible on current MR acquisitions), with (2) no intraoperative confirmation of the target, (3) delayed clinical effect, (4) inability to predict the radiological response and a (5) lack of understanding of its radiobiological effect. Moreover, despite a standard radiosurgical procedure, there is a variability of clinical effect, with a lower efficacy rate as compared to standard deep-brain stimulation, the reference technique. Gamma Knife radiosurgery has no access to tissue analysis, and targeting and follow-up evaluation are based only on neuroimaging. We addressed the limitation of the indirect targeting by using high-field 7 Tesla (T) MRI, and combining multimodal imaging for Vim definition, at both 3 and 7 T. The central core of this thesis was the understanding of radiobiology of RS for tremor, using both structural [e.g. T1 weighted (T1-w), voxel-based morphometry (VBM)] and functional resting- state functional MRI (rs-fMRI).
We aimed for a direct Vim visualization using ultra-high field 7 T. The former allows an increased signal to noise ratio, an improved spatial resolution, as well as a superior sensitivity to magnetic susceptibility engendered contrast. Susceptibility-weighted images (SWI) might be an important step to allow a direct visualization of thalamic subparts (including the Vim). We explored 7T SWI advantages, which were done in a qualitative manner. We combined several different methodologies for Vim definition (in healthy subjects of different ages): manual delineation on 7T, quadrilatere of Guiot used in common clinical practice and automated segmentation based on diffusion weighted imaging and atlases (last two performed by and in collaboration with Dr Najdenovska). We concluded that although 7T SWI, alone or in combination with other neuroimaging modalities, is useful, several limitations need to be overcome yet, precluding a standardization of a direct Vim visualization, with the current state-of- the art.
The T1-w and rs-fMRI based studies analyzed the radiobiology effects of Vim GKR for intractable tremor and led to several important contributions. The most relevant and novel was the presence of a visually-sensitive structural and functional network, involved in tremor generation and further arrest after Vim GKR. The patients with this network more integrated pretherapeutically benefited more from RS. The candidate had shaped the term “cerebello- thalamo-cortical” into the “cerebello-thalamo-visuo-motor” network, as a step forward in the understanding of essential tremor’s pathophysiology. Two structures were proposed as main calibrators of this network, in the light of the present thesis: the cerebellum (as the most probable) versus the thalamus itself. Moreover, a more classical basal ganglia network, interconnected with a salience one, as well as a cerebellar, interconnected with the motor and visual one, were reported. Other longitudinal changes involved dorsal attention, insular or supplementary motor area circuitries. Particular phenotypes of ET, including patients with head tremor, were analyzed and discussed. As a perspective and future work, in progress, the dynamics of the extrastriate cortex was further analyzed, using co-activation patterns.
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La radio-neurochirurgie par Gamma Knife (GK) est une procédure de neurochirurgie stéréotaxique, combinant l’utilisation d’une imagerie multimodale, avec la convergence de multiples rayons Gamma émis par 192 sources of Cobalt-60 (Leksell Gamma Knife ICON®, Elekta Instruments, AB, Suède). Ses mécanismes pathophysiologiques ne sont pas complètement élucidés et varient selon la condition traitée. Lors des procédures fonctionnelles, le GK est utilisé pour irradier avec une haute précision, soit un point précis (par exemple, le noyau ventro- intermediare, Vim, du thalamus pour le tremblement), soit une zone plus large, comme un foyer d’épilepsie.
La présente thèse a comme sujet principal la radiochirugie du Vim (RC du Vim) pour le tremblement essentiel (TE). Le TE est un des mouvements anormaux le plus commun, manifesté principalement avec un tremblement d’action de la main. Toutefois, la RC du Vim a plusieurs limitations: (1) le ciblage est indirect (le Vim n’est pas visible sur les séquences IRM classiques),
(2) elle ne permet pas la confirmation électrophysiologique de la cible, (3) l’effet clinique est délayé dans le temps, (4) la réponse radiologique est difficile à prédire et, (5) il manque une compréhension claire de son effet radiobiologique. De plus, malgré le fait que la procédure soit standardisée, il y a une variabilité de son effet clinique. La RC ne permet pas d’analyser le tissu et, le ciblage ainsi que le suivi, sont réalisés uniquement sur la base de la neuroimagerie. Nous avons analysé la limitation du ciblage indirect en utilisant l’IRM à haut champs [7 Tesla (T)] et en la combinant avec une imagerie multimodale, incluant des séquences 3T et 7T, pour la définition du Vim. La partie centrale de la thèse se focalise sur la compréhension de l’effet radiobiologique de la RC du Vim dans le TE. Cette partie se base tant de l’analyse de l’imagerie structurelle (séquence classique T1) que sur l’imagerie fonctionnelle (IRM de repos).
Le but de la première partie de la thèse est la visualisation directe du Vim en utilisant l’IRM 7T, qui a plusieurs avantages par rapport à l’IRM 3T, y compris une meilleure résolution spatiale. Notamment, la séquence SWI a un intérêt particulier, mais elle n’avait encore jamais été explorée que de manière quantitative au niveau du thalamus (qui contient le Vim). Nous avons combinée plusieurs modalités pour définir le Vim (chez des sujets sains de différents âges): visualisation directe sur la 7T, quadrilatère de Guiot tel qu’utilisé en pratique clinique courante, ainsi que segmentation automatique en imagerie de diffusion ou par des atlas (ces dernières deux approches ont été réalisées par, et en collaboration avec, Dr Najdenovska). Nous avons conclu que la séquence 7T SWI, malgré certains avantages, et utilisée seule ou combinée avec d’autres modalités, présente certaines limitations qui ne permettent pas, à l’heure actuelle, de l’utiliser d’une manière standardisée, tant chez les sujets sains que chez les patients atteints de TE.
Dans la deuxième partie, l’étude de la radiobiologie de la radiochirugie pour le TE a permis d’apporter plusieurs contributions. La plus importante est la mise en évidence d’un
« réseau visuel » structurel et fonctionnel, impliqué dans la genèse du tremblement et dans son amélioration après une RC du Vim. Les patients dont ce réseau est mieux intégré avant la procédure ont de meilleures chances d’amélioration clinique du TE. Dans ce contexte, nous avons proposé d’adapter le terme classique d’ «axe cérébello-thalamo-moteur» en le modifiant en « axe cérébello-thalamo-visuo-moteur», ce qui pourrait aider à une meilleure compréhension de la pathophysiologie du TE. Nous proposons également que deux structures puissent jouer le rôle de neuromodulateur de ce réseau, le cervelet et le thalamus. Une autre contribution est la description de l’interconnexion entre le réseau classique impliquant les noyaux de la base et celui l’attention, ainsi que de l’interconnexion entre le réseau cérébelleux et celui des cortex moteur primaire et visuel associatif. Des phénotypes particuliers du tremblement ont été analysés, incluant par exemple des tremblements du chef. Des travaux en cours incluent l’étude de la dynamique du cortex extra-strié en utilisant de nouvelles approches, comme les patterns de co-activation
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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