OBJECTIVE Stereotactic radiosurgery (SRS) is an important alternative management option for patients with small- and medium-sized vestibular schwannomas (VSs). Its use in the treatment of large tumors, however, is still being debated. The authors reviewed their recent experience to assess the potential role of SRS in larger-sized VSs. METHODS Between 2000 and 2014, 35 patients with large VSs, defined as having both a single dimension > 3 cm and a volume > 10 cm, underwent Gamma Knife radiosurgery (GKRS). Nine patients (25.7%) had previously undergone resection. The median total volume covered in this group of patients was 14.8 cm (range 10.3-24.5 cm). The median tumor margin dose was 11 Gy (range 10-12 Gy). RESULTS The median follow-up duration was 48 months (range 6-156 months). All 35 patients had regular MRI follow-up examinations. Twenty tumors (57.1%) had a volume reduction of greater than 50%, 5 (14.3%) had a volume reduction of 15%-50%, 5 (14.3%) were stable in size (volume change < 15%), and 5 (14.3%) had larger volumes (all of these lesions were eventually resected). Four patients (11.4%) underwent resection within 9 months to 6 years because of progressive symptoms. One patient (2.9%) had open surgery for new-onset intractable trigeminal neuralgia at 48 months after GKRS. Two patients (5.7%) who developed a symptomatic cyst underwent placement of a cystoperitoneal shunt. Eight (66%) of 12 patients with pre-GKRS trigeminal sensory dysfunction had hypoesthesia relief. One hemifacial spasm completely resolved 3 years after treatment. Seven patients with facial weakness experienced no deterioration after GKRS. Two of 3 patients with serviceable hearing before GKRS deteriorated while 1 patient retained the same level of hearing. Two patients improved from severe hearing loss to pure tone audiometry less than 50 dB. The authors found borderline statistical significance for post-GKRS tumor enlargement for later resection (p = 0.05, HR 9.97, CI 0.99-100.00). A tumor volume ≥ 15 cm was a significant factor predictive of GKRS failure (p = 0.005). No difference in outcome was observed based on indication for GKRS (p = 0.0761). CONCLUSIONS Although microsurgical resection remains the primary management choice in patients with VSs, most VSs that are defined as having both a single dimension > 3 cm and a volume > 10 cm and tolerable mass effect can be managed satisfactorily with GKRS. Tumor volume ≥ 15 cm is a significant factor predicting poor tumor control following GKRS.

Background: There is controversy about the effects of statins on plasma adiponectin, and the impact of percutaneous coronary intervention (PCI) on plasma adiponectin level is still unknown. We investigated the impact of Atorvastatin on plasma adiponectin levels in coronary artery disease (CAD) patients with stable angina and normal lipid profiles after PCI. Methods: Sixty CAD patients with stable angina and normal lipid profiles scheduled for PCI, and not on statins, were randomly assigned to either no treatment (control group) or the Atorvastatin treatment (Atorvastatin group). Atorvastatin administration was started immediately after PCI. Blood samples were obtained immediately after PCI and again 3 and 6 mo later. Fasting plasma adiponectin concentrations were measured using a radioimmunoassay kit. Results: After PCI, there were statistically significant decreases in adiponectin levels in the Atorvastatin group at 3 and 6 mo (8.66±0.69 versus 6.87±0.55 and 7.12±0.71 µg/mL at 0, 3, and 6 mo, respectively), despite the anti-inflammation and lipid-lowering effects of Atorvastatin. There were no statistically significant changes in adiponectin levels in the control group. There was significant positive association between baseline plasma adiponectin and high-density lipoprotein (HDL) levels. Changes of adiponectin level were not associated with the changes of high-sensitivity C-reactive protein (hs-CRP) and lipid profiles in the Atorvastatin group. Conclusions: Our study confirmed the benefits of Atorvastatin on anti-inflammation and anti-atherosclerosis, but we also found that Atorvastatin had a negative effect on the adiponectin system. The anti-inflammatory, anti-atherogenic effects of Atorvastatin are not affected by decreased adiponectin levels.

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The purpose of this study was to investigate the nutritional status of dementia patients and examine the correlation with sarcopenia, frailty, depression, and quality of life. We enrolled patients aged 60 years and over with Mini Mental State Examination (MMSE) scores ≤ 26 (Taiwan), and dementia diagnosed by a neurologist or psychiatrist. Nutritional status was assessed with the Mini Nutritional Assessment (MNA). Muscle mass was measured by dual-energy X-ray absorptiometry. Muscle strength and endurance were evaluated by handgrip, leg-back strength, dumbbell curls, sit to stand test, and gait speed. Quality of life, frailty, and depression status were measured by questionnaires. Patients with moderate dementia (MMSE ≤ 20) had a significantly lower MNA score, muscle function, and quality of life than patients with mild dementia (p < 0.01). A lower MNA score was significantly associated with the risk of frailty (odds ratio: 4.76, p < 0.01), depression (odds ratio: 3.17, p = 0.03), and poor quality of life (odds ratio: 2.73, p < 0.05), and sarcopenia (odds ratio: 3.97, p = 0.03) after adjusting for potential confounders. In conclusion, patients with dementia were at risk of malnutrition, and nutritional status was associated to the risk of sarcopenia, frailty, depression, and quality of life.