RESULTS.The overall 5-year survival and local control rates were 81% and 79%, Mark K. Lyons, M.D. 6 respectively. No patient developed metastases. The 5-year local control rate was 70% for patients undergoing subtotal resection (STR) and 100% for those undergo-1 Mayo Clinic Scottsdale, Department of Radiaing gross total resection (GTR) (P Å 0.08). The 5-year survival rate was 77% for tion Oncology, Scottsdale, Arizona.patients undergoing STR and 90% for those undergoing GTR (P Å 0.44). The effect 2 Mayo Clinic Rochester, Department of Patholof RT was evaluated for patients undergoing STR. The 5-year local control rate ogy, Rochester, Minnesota.was 100% for patients who received RT after STR compared with 50% for those who did not (P Å 0.02). The 5-year survival rate was 88% for patients who received 3 Mayo Clinic Rochester, Department of Radiation Oncology, Rochester, Minnesota.RT after STR compared with 71% for those who did not (P Å 0.3). Three patients received salvage RT for local progression after resection. All were alive and free of 4 Mayo Clinic Rochester, Department of Neuroldisease 1 to 6 years after RT. ogy, Rochester, Minnesota. Central neurocytomas generally occupy the lateral ventricles of young adults. Hydrocephalus is a common feature because these lesions tend to obstruct the foramen of Monro. Most straddle the midline, being attached to the septum pellucidum or less often, the walls of the lateral ventricles. CONCLUSIONS. GTR results in a very high likelihood of local control and survival.3 A minority occur within brain parenchyma or arise in the spinal cord. 4,5 In approximately 50% of neurocytomas, calcification is evident on radiographic or histologic examination. occasional perinuclear halos, delicate ''salt and pepper'' chromatin, and small distinct nucleoli. Mitoses are absent or infrequent and
Deep brain stimulation (DBS) has developed during the past 20 years as a remarkable treatment option for several different disorders. Advances in technology and surgical techniques have essentially replaced ablative procedures for most of these conditions. Stimulation of the ventralis intermedius nucleus of the thalamus has clearly been shown to markedly improve tremor control in patients with essential tremor and tremor related to Parkinson disease. Symptoms of bradykinesia, tremor, gait disturbance, and rigidity can be significantly improved in patients with Parkinson disease. Because of these improvements, a decrease in medication can be instrumental in reducing the disabling features of dyskinesias in such patients. Primary dystonia has been shown to respond well to DBS of the globus pallidus internus. The success of these procedures has led to application of these techniques to multiple other debilitating conditions such as neuropsychiatric disorders, intractable pain, epilepsy, camptocormia, headache, restless legs syndrome, and Alzheimer disease. The literature analysis was performed using a MEDLINE search from 1980 through 2010 with the term deep brain stimulation, and several double-blind and larger case series were chosen for inclusion in this review. The exact mechanism of DBS is not fully understood. This review summarizes many of the current and potential future clinical applications of this technology.
Thirty patients with histologically confirmed posterior fossa ependymomas operated on between January 1976 and December 1988 were reviewed. The median age was 44 years (range, 1-69 yr). There were 7 children (aged 5 yr or younger) and 23 adults (aged 16 yr or older). There were 18 female patients and 12 male patients. Headache, nausea and vomiting, and disequilibrium were the most frequent symptoms. The most common findings were ataxia and nystagmus. Gross total resection was performed in 8 patients (27%), subtotal resection in 21 patients (70%), and biopsy in only 1 patient (3%), Tumors were low grade in 73% and high grade in 27%. Twenty-seven patients underwent posterior fossa radiotherapy (median dose, 5400 cGy). Fourteen patients also underwent spinal irradiation (median dose, 3520 cGy). Age was the only significant prognostic factor identified (P <0.01). The 5-year survival rates were 76% for adults and 14% for children. All 14 patients who died had recurrent or residual tumor at the primary site. This review suggests that in patients with primary posterior fossa ependymomas the following is true: 1) the young patient (5 yr old or younger) has a poor prognosis: 2) there was a trend toward a better 5-year survival rate with a gross total resection; 3) if recurrence occurs, it will be at the primary intracranial site; and 4) symptomatic spinal seeding does not occur frequently.
BACKGROUND. This study examined the outcome of patients with histologically
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