Initial Experience with the Use of Remote Control Monitoring and General Anesthesia during Radiosurgery for Pediatric Patients

Kamata, Kotoe; Hayashi, Motohiro; Nagata, Osamu; Muragakı, Yoshihiro; Iseki, Hiroshi; Okada, Yoshikazu; Ozaki, Makoto

doi:10.1159/000330886

Cited by 10 publications

(3 citation statements)

References 55 publications

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“…There are various ways to secure propofol management. Firstly, the use of an electroencephalogram monitor (BIS monitor) 26 as an indicator of objective sedation during propofol administration may be effective, but it is desirable to develop new techniques and devices for evaluating airway patency in children with various responses to sedation. Secondly, regarding treatment and anaesthesia equipment, during PBT the treatment room and control room are completely isolated as in the case of a MRI examination.…”

Section: Discussionmentioning

confidence: 99%

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Shimazu

Otsuki

Murakami

et al. 2020

Sci Rep

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Proton therapy for paediatric cancer patients is an effective treatment; however, young children have may have difficulties staying still during irradiation. This study investigated the indication of general anaesthesia in paediatric proton therapy. Background information and anaesthesia/treatment protocols were retrospectively extracted from the medical records of cancer patients under 15 years who underwent proton therapy at Southern TOHOKU General Hospital, Fukushima, Japan between April 2016 and December 2018. The anaesthesia and non-anaesthesia groups were compared to evaluate factors determining the need for general anaesthesia. Thirty-two patients who received 285 irradiations were analysed. The median age was 5 years old (range: 1–15), and 13 patients (40.6%) were female. Twelve (37.5%) patients received general anaesthesia. In the general anaesthesia group, airway management using a laryngeal mask was performed in 11 patients (91.6%). Patient age was significantly lower in the general anaesthesia group than in the non-anaesthetised group (p < 0.001). Considering all background factors, only age was strongly associated with anaesthesia in the univariate logistic regression model (odds ratio 0.55 [95% confidence interval 0.35–0.86]; P < 0.01). Thus, age is one of the most important factors determining the need for general anaesthesia during proton therapy in children.

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Section: Discussionmentioning

confidence: 99%

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Shimazu

Otsuki

Murakami

et al. 2020

Sci Rep

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“…Therefore, this was defined as the most important target region in the treatment plan. An anesthesiologist had been administering non-intubated monitored anesthesia care, as described previously, 7 to all patients since 2017.…”

Section: Methodsmentioning

confidence: 99%

Gamma Knife treatment strategies for paediatric AVMs: approaches to refractory cases

Horiba,

Hayashi,

Oka

et al. 2024

J Radiother Pract

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Introduction: While paediatric arteriovenous malformations (AVMs) often require aggressive therapeutic intervention due to their high bleeding incidence, choosing a course of treatment for deep and eloquent areas and asymptomatic cases is difficult. Sequelae are a concern in children, as they survive for longer after treatment. The authors have long recommended and implemented staged Gamma Knife radiosurgery (GKRS) in their treatment guidelines to maximise therapeutic effects. Methods: Fifty-eight paediatric patients with AVM and ≤15 years old who underwent GKRS under general anesthesia from 2002 to 2020 were followed up for an average of 81·5 months. Obliteration dynamics and clinical outcomes were analysed. Results: The mean patient age was 10·5 years. The mean nidus volume was 6·6 cm3, the complete occlusion rate was 69%, the annual post-irradiation bleeding rate was 2·19% and nine (16%) cases had transient radiation-induced changes. One (1·7%) patient had sequela, and three (5·1%) developed encapsulated hematomas and cysts. Additionally, the 3- and 5-year cumulative occlusion rates were 39·0% and 53·3%, respectively. Multivariate analysis showed significantly higher occlusion rates in patients ≤12 years old and with a nidus volume of ≤4 cm3. Conclusions: GKRS is a useful treatment for paediatric AVM; however, its use poses some challenges.

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“…Before December 2002, radiosurgery was performed using the Leksell Gamma Knife model B, and later patients were treated with model 4C with the Automatic Positioning System (Elekta AB). General anesthesia with remote control monitoring was applied throughout all stages of the procedure in 3 children, 22 whereas in the others, manipulations were performed with the aid of local anesthesia. On the day of treatment, the Leksell G stereotactic frame (Elekta AB) was affixed to the patient's head.…”

Section: Radiosurgerymentioning

confidence: 99%

Outcome after Gamma Knife surgery for intracranial arteriovenous malformations in children

Tamura

Hayashi

Chernov

et al. 2012

JNS

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Object The focus of the present study was the evaluation of outcomes after unstaged and staged-volume Gamma Knife surgery (GKS) in children harboring intracranial arteriovenous malformations (AVMs). Methods Twenty-two children (median age 9.5 years) underwent GKS for AVMs and were followed up for at least 2 years thereafter. The disease manifested with intracranial hemorrhage in 77% of cases. In 68% of patients the lesion affected eloquent brain structures. The volume of the nidus ranged from 0.1 to 6.7 cm3. Gamma Knife surgery was guided mainly by data from dynamic contrast-enhanced CT scans, with preferential targeting of the junction between the nidus and draining vein. The total prescribed isodose volume was kept below 4.0 cm3, and the median margin dose was 22 Gy (range 20–25 Gy). If the volume of the nidus was larger than 4.0 cm3, a second radiosurgical session was planned for 3–4 years after the first one. Nine patients in the present series underwent unstaged radiosurgery, whereas staged-volume treatment was scheduled in 13 patients. Results Complete obliteration of the AVM was noted in 17 (77%) of 22 patients within a median period of 47 months after the last radiosurgical session. Complete obliteration of the lesion occurred in 89% of patients after unstaged treatment and in 62.5% after staged GKS. Four (67%) of 6 high-grade AVMs were completely obliterated. Complications included 3 bleeding episodes, the appearance of a region of hyperintensity on T2-weighted MR images in 2 patients who had no symptoms, and reappearance of the nidus in the vicinity of the completely obliterated AVM in 1 patient. Conclusions Radiosurgery is a highly effective management option for intracranial AVMs in children. For larger lesions, staged GKS may be applied successfully. Initial targeting of the nidus adjacent to the draining vein and application of a sufficient radiation dose to a relatively small volume (≤ 4 cm3) provides a good balance between a high probability of obliteration and a low risk of treatment-related complications.

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Initial Experience with the Use of Remote Control Monitoring and General Anesthesia during Radiosurgery for Pediatric Patients

Cited by 10 publications

References 55 publications

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Gamma Knife treatment strategies for paediatric AVMs: approaches to refractory cases

Outcome after Gamma Knife surgery for intracranial arteriovenous malformations in children

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