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Stereotactic Radiosurgery in the Management of Intractable Seizure Due to Hypothalamic Hamartoma 立体定向放射外科手术治疗下丘脑滨状瘤引起的顽固性癫痫发作
Pub Date : 2024-07-22 DOI: 10.46889/jnor.2024.4206
J. H. Wijaya
The occurrence of severe seizure is almost always present in hypothalamic hamartomas (HH) cases and surgery is an option to control the condition. Stereotactic radiosurgery (SRS) is among of alternative treatments. Our objective is to provide current evidence for seizure treatment with SRS in HHs patients. From EuroPMC, PubMed, ScienceDirect and the Cochrane Library, each author carried out literature searches on seizure treatment for HH using SRS between 1971 and 2021 using the following terms: stereotactic radiosurgery, radiosurgery, CyberKnife, Gamma Knife, linear accelerator, radiotherapy and hypothalamic hamartoma. We included any patients with seizure onset less than 18 years of age, regardless of age when SRS was performed. This systematic review included 17 out of 31 studies, three of which were observational studies. The study included 131 individuals, with a median age of onset of 7.4 years old and a male-to-female ratio of 34.3% (n=45). The isodose at the margin was 19 Gy. The median lesion volume at the time of diagnosis was 0.8 mL (0.1 – 48.3 mL). The median follow-up after SRS was 34.3 months (3 – 77 months). Only eight of the 90 HHs had a change in MR and 12 patients, SRS had no effect on the seizure frequency. The authors concluded that SRS is beneficial for the treatment of HH. However, the authors could not deny that current evidence is too early to construct a systematic review and a more prospective study design is required.
下丘脑仓鼠神经瘤(HH)患者几乎都会出现严重的癫痫发作,而手术是控制病情的一种选择。立体定向放射外科手术(SRS)是可供选择的治疗方法之一。我们的目标是提供当前用 SRS 治疗 HHs 患者癫痫发作的证据。在 EuroPMC、PubMed、ScienceDirect 和 Cochrane 图书馆中,每位作者使用以下术语对 1971 年至 2021 年期间使用 SRS 治疗 HHs 癫痫发作的文献进行了检索:立体定向放射外科、放射外科、CyberKnife、伽玛刀、直线加速器、放射治疗和下丘脑火腿肠瘤。我们纳入了所有癫痫发作年龄小于 18 岁的患者,而不考虑进行 SRS 时的年龄。本系统综述包括了 31 项研究中的 17 项,其中 3 项为观察性研究。研究共纳入 131 人,发病年龄中位数为 7.4 岁,男女比例为 34.3%(n=45)。边缘等剂量为 19 Gy。诊断时病灶体积的中位数为 0.8 mL(0.1 - 48.3 mL)。SRS 后的中位随访时间为 34.3 个月(3 - 77 个月)。90 名 HHs 中只有 8 名患者的 MR 发生了变化,12 名患者的 SRS 对癫痫发作频率没有影响。作者认为,SRS 对治疗 HH 有益。不过,作者也不能否认,目前的证据还为时过早,无法进行系统回顾,因此需要进行更具前瞻性的研究设计。
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引用次数: 0
Pilot Testing of CAN Digital Apps to Improve the Quality of Life of Cancer and Benign Brain Tumor Survivors 提高癌症和良性脑肿瘤幸存者生活质量的 CAN 数字应用程序试点测试
Pub Date : 2024-06-11 DOI: 10.46889/jnor.2024.4204
Claudia Rebola
Objective: Vestibular Schwannoma (VS) and breast cancer patients experience negative Quality of Life (QoL) impacts. VS patients struggle with mood disorders, whereas breast cancer patients experience treatment-related cognitive impairment. Improving QoL in these patient populations is the objective of these digital app technologies involving music, art and robotic pet therapies.Methods: Active Receptive Music for Cancer (ARMCan) recruited ten breast cancer patients who were randomized into an interactive music therapy group and a receptive music therapy group, occurring daily for 15 minutes over 6 months. The primary endpoint was Functional Assessment of Cancer Therapy – Cognitive Function (FACT-Cog) scores. Sensory Integrative Therapy with Art and Robots (SITAR) recruited ten VS patients to undergo art therapy alone or art therapy and robotic companion therapy weekly for twelve weeks. One patient in each group completed the study. The primary endpoint was Mental Health Quality of Life Questionnaire (MHQOL) surveys with a secondary endpoint of Hamilton Depression scale (HAM-D).Results: For ARMCan, integrative music therapy led to an increase in FACT-Cog scores of 44.2% and 12.4% for the interactive (n = 3) and receptive music (n = 3) groups, respectively. For SITAR, there were 106% and 63.6% increases in MHQOL scores for the art intervention (n = 1) and combined therapy groups (n = 1), respectively. There was an average decrease of 80% in HAM-D scores.Conclusion: This pilot study primarily demonstrates feasibility for digital applications to improve QoL in breast cancer and VS patients. There is preliminary data to support that integrative music therapy can improve treatment-induced cognitive impairment in breast cancer patients. Similarly, art and robotic animal companion therapy may improve overall QoL and reduce depressive symptoms in vestibular schwannoma patients.
目的:前庭神经管瘤(VS)和乳腺癌患者的生活质量(QoL)会受到负面影响。前庭神经丛神经瘤患者会出现情绪障碍,而乳腺癌患者则会出现与治疗相关的认知障碍。改善这些患者群体的生活质量是这些涉及音乐、艺术和机器人宠物疗法的数字应用技术的目标:方法:Active Receptive Music for Cancer(ARMCan)招募了 10 名乳腺癌患者,将他们随机分为交互式音乐治疗组和接受式音乐治疗组,每天治疗 15 分钟,为期 6 个月。主要终点是癌症治疗功能评估--认知功能(FACT-Cog)评分。艺术与机器人感官综合疗法(SITAR)招募了 10 名 VS 患者,让他们接受单独的艺术疗法或艺术疗法与机器人辅助疗法,每周一次,为期 12 周。每组各有一名患者完成研究。研究的主要终点是心理健康生活质量问卷调查(MHQOL),次要终点是汉密尔顿抑郁量表(HAM-D):对于 ARMCan,综合音乐疗法使互动组(3 人)和接受音乐组(3 人)的 FACT-Cog 分数分别提高了 44.2% 和 12.4%。对于 SITAR,艺术干预组(n = 1)和综合治疗组(n = 1)的 MHQOL 分数分别提高了 106% 和 63.6%。HAM-D 评分平均下降了 80%:这项试点研究主要证明了数字应用改善乳腺癌和 VS 患者 QoL 的可行性。有初步数据支持综合音乐疗法可以改善乳腺癌患者因治疗引起的认知障碍。同样,艺术和机器人动物伴侣疗法可改善前庭裂隙瘤患者的整体生活质量,减轻抑郁症状。
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引用次数: 0
Plueral Effusion and Ovarian Cancer 浆膜腔积液与卵巢癌
Pub Date : 2024-04-23 DOI: 10.46889/jnor.2024.4106
Mohammad Haydar
Pleural effusion, the pathological accumulation of fluid in the pleural space, is very common. Its causes vary widely, ranging from fairly harmless effusions accompanying viral pleuritis to prognostically highly relevant ones due to congestive heart failure or malignances. Pleural effusions are classified by their biochemical properties into exudative and transudative effusions but can also be due to blood, pus and chyle. Applying Light’s criteria may be helpful to diagnose an exudative effusion.Exudative effusions are commonly caused by infection, malignancy and inflammatory disorders, such as rheumatoid arthritis.In this case we presented 39 women that was admentes with only short of breath and Pleural effusion, During the hospitalization, a pleural fluid puncture was performed and a cytological result was obtained for ovarian cancer and CA-125 was high in the pleural fluid, the patient underwent chemotherapy and her condition improved hourly.In this case, we present a rare case in which the patient complained of shortness of breath without surgical or gynecological complaints and was finally diagnosed with ovarian cancer, which raises the importance of ruling out malignancy every time a new pleural fluid is aspirated.
胸腔积液是胸膜腔内液体的病理性积聚,非常常见。胸腔积液的病因千差万别,既有病毒性胸膜炎引起的无害积液,也有充血性心力衰竭或恶性肿瘤引起的与预后高度相关的积液。胸腔积液按其生化性质可分为渗出性和透出性积液,但也可能是血液、脓液和糜烂性积液。本病例中,39 名女性患者仅因气短和胸腔积液入院,住院期间进行了胸腔积液穿刺,细胞学检查结果为卵巢癌,胸腔积液中 CA-125 偏高,患者接受了化疗,病情每小时都有好转。在本病例中,我们介绍了一个罕见的病例,患者主诉呼吸急促,无外科或妇科主诉,最终确诊为卵巢癌,这提高了每次抽吸新胸腔积液时排除恶性肿瘤的重要性。
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引用次数: 0
The Effect of Ketogenic Metabolic Therapy on Recurrent High-Grade Gliomas: Case Series 生酮代谢疗法对复发性高级别胶质瘤的影响:病例系列
Pub Date : 2024-04-14 DOI: 10.46889/jnor.2024.4103
High-grade gliomas represent the most prevalent primary malignant brain tumors in the adult population. Despite extensive efforts dedicated to advance in therapeutic modalities, treatment options remain very limited in this field, leading to a worse prognosis for affected patients. Moreover, a considerable number of cases exhibit refractory disease following the initial management. Ketogenic Metabolic Therapy (KMT) has emerged as a promising adjunctive approach for recurrent high-grade gliomas, offering them a synergistic effect enhancement of the effectiveness of conventional therapies against this type of cancer. The underlying hypothesis relies on the use of high-fat, low-carbohydrate diet, with adequate protein content can potentially induce metabolic reprogramming in cancer cells. Currently, the use of KMT is on the rise and has shown positive effects on the control of selected neurological symptoms and improvements in patient’s quality of life. This is a descriptive observational multicenter study (case series) that includes patients with recurrent high-grade gliomas who underwent Ketogenic Metabolic Therapy (KMT) and were supplemented with a liquid ketogenic formula (in a 3:1 ratio) as a complementary treatment to the ongoing medical regimen for recurrence. The results show a positive impact on seizure control, as well as significant improvements in cognition, memory and functionality, as reported by patients and/or their families (caregivers). Regarding the disease status, assessed by the RANO criteria, the 12-month follow-up evaluation indicated stable disease in 55% and a partial response in 20% of cases. Although the results of this work are promising, more conclusive clinical data are still needed to support the use of KMT in the treatment of high-grade gliomas.
高级别胶质瘤是成年人群中最常见的原发性恶性脑肿瘤。尽管在治疗方法方面做出了大量努力,但这一领域的治疗方案仍然非常有限,导致患者的预后较差。此外,相当多的病例在接受初步治疗后表现出难治性疾病。生酮代谢疗法(KMT)已成为治疗复发性高级别胶质瘤的一种很有前景的辅助方法,它能增强常规疗法对这类癌症的疗效。其基本假设依赖于使用高脂肪、低碳水化合物饮食,其中充足的蛋白质含量有可能诱导癌细胞的代谢重编程。目前,KMT 的使用呈上升趋势,对控制特定神经症状和改善患者生活质量产生了积极影响。这是一项描述性多中心观察研究(病例系列),研究对象包括接受了生酮代谢疗法(KMT)的复发性高级别胶质瘤患者,他们补充了液体生酮配方(比例为 3:1),作为目前治疗复发的药物疗法的补充。结果表明,该疗法对控制癫痫发作有积极影响,而且患者和/或其家属(护理人员)报告称,该疗法在认知、记忆和功能方面也有显著改善。关于疾病状况,根据 RANO 标准进行评估,12 个月的随访评估显示,55% 的患者病情稳定,20% 的患者有部分反应。尽管这项研究的结果很有希望,但仍需要更多确凿的临床数据来支持将 KMT 用于治疗高级别胶质瘤。
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引用次数: 0
Scrotal Migration of The Distal End of The Ventriculoperitoneal Shunt: Is There a Role for Early Closure of Patent Processus Vaginalis in The Pediatric Population? 脑室腹腔分流术远端阴囊移位:早期关闭阴道前突在儿科人群中是否有作用?
Pub Date : 2024-02-23 DOI: 10.46889/jnor.2024.4102
Houssein Darwish
Background: Ventriculoperitoneal shunt (VP) insertion is one of the surgical treatments for patients with hydrocephalus. Infection, malfunction, catheter migration, hernia development, equipment failure, CSF subcutaneous collection and peritoneal pseudocyst formation are considered to be the main complications of this procedure.Case Description: A 6-months-old boy known to have congenital aqueductal stenosis with VP shunt insertion at the age of 1 month, presented with scrotal swelling and generalized hypotonia. He was found to have catheter migration into the scrotum.Conclusion: Scrotal migration of the distal end of the ventriculoperitoneal shunt is a rare but threatening complication that can present with either signs of hydrocephalus or scrotal swelling or hydrocele. Accordingly, we recommend performing a scrotal exam with an ultrasound early upon evaluation of any infant presenting with scrotal swelling or hydrocele after VP shunt insertion. There haven’t been clear recommendations in the literature concerning closure of patent processus vaginalis upon placing a VP shunt in patients below the age of 3 months. Thus, we question whether early closure could help reduce the complications of catheter migration in infants.
背景:脑室腹腔分流术(VP)是脑积水患者的手术治疗方法之一。感染、故障、导管移位、疝气形成、设备故障、CSF 皮下聚集和腹膜假性囊肿形成被认为是该手术的主要并发症:一名 6 个月大的男孩,已知患有先天性导水管狭窄,在 1 个月大时植入了 VP 分流器,出现阴囊肿胀和全身肌张力低下。他被发现导管移入阴囊:脑室腹腔分流管远端阴囊移位是一种罕见但具有威胁性的并发症,可表现为脑积水或阴囊肿胀或积水。因此,我们建议在对插入 VP 分流管后出现阴囊肿胀或积水的婴儿进行评估时,尽早用超声波检查阴囊。关于为 3 个月以下的患者植入 VP 分流器后关闭阴道前突的问题,文献中还没有明确的建议。因此,我们怀疑早期关闭是否有助于减少婴儿导管移位的并发症。
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引用次数: 0
Osimertinib in Combination with Bevacizumab for EGFR Mutated Recurrent Glioblastoma (GBM): A Case Report 奥希替尼联合贝伐单抗治疗表皮生长因子受体(EGFR)突变的复发性胶质母细胞瘤(GBM):病例报告
Pub Date : 2024-01-16 DOI: 10.46889/jnor.2024.4101
Soma Sengupta
Glioblastoma is the most common primary, malignant adult brain tumor with a median overall survival of 12-15 months after diagnosis. The standard of care includes maximal safe resection, chemoradiation, adjuvant chemotherapy with the DNA alkylator, temozolomide and tumor-treating fields. Given the recent advances in targeted molecular therapeutics and tissue sequencing, there is a growing opportunity for precision medicine in GBM treatment. In this case report, we present two patients who were found to have EGFR amplifications on molecular analysis and were treated with the EGFR inhibitor, osimertinib (Tagrisso), in combination with bevacizumab (Avastin) after tumor progression. One patient received osimertinib at first GBM progression, while the other patient received osimertinib after two other treatment regimens had failed. Both patients displayed radiographic stability several months after the expected median overall survival rate of 15 months post-diagnosis for GBM. This case report offers clinical vignettes in support of the use of EGFR inhibitors and bevacizumab in recurrent GBM with EGFR mutations.
胶质母细胞瘤是最常见的原发性成人恶性脑肿瘤,确诊后的中位总生存期为 12-15 个月。标准治疗包括最大限度安全切除、化学放疗、DNA 烷化剂替莫唑胺辅助化疗和肿瘤治疗领域。鉴于分子靶向治疗和组织测序的最新进展,GBM 治疗中的精准医疗机会越来越多。在本病例报告中,我们介绍了两名在分子分析中发现表皮生长因子受体扩增的患者,他们在肿瘤进展后接受了表皮生长因子受体抑制剂奥西替尼(Tagrisso)联合贝伐珠单抗(Avastin)的治疗。其中一名患者在 GBM 首次进展时接受了奥希替尼治疗,另一名患者则在其他两种治疗方案失败后接受了奥希替尼治疗。这两名患者都在 GBM 诊断后 15 个月的预期中位总生存率之后数月才显示出放射学上的稳定性。本病例报告提供了一些临床案例,支持将表皮生长因子受体抑制剂和贝伐单抗用于表皮生长因子受体突变的复发性 GBM。
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引用次数: 0
Diagnosis and Minimally-Invasive Treatment of Posterior Fossa Dural Arteriovenous Fistula Presenting Clinically as A Carotid-Cavernous Fistula 临床表现为颈动脉-海绵状静脉瘘的后窝硬脑膜动静脉瘘的诊断与微创治疗
Pub Date : 2023-12-31 DOI: 10.46889/jnor.2023.3304
O. Algın
A posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula is a very rare and relatively unknown situation. They present with several clinical symptoms due to abnormal or excessive blood flowing into the cavernous sinuses. Although abnormal shunts between two vascular domains near each other may be expected (as in carotid-cavernous fistulas), an abnormal shunt from a distant artery to a cavernous venous sinus would be something unusual. Endovascular treatment is now the first-line, safest and cost-effective treatment for this type of fistula. In this paper, we report a very rare situation (a spontaneous posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula) that is treated with endovenous intervention and coil embolization. The importance of other cavernous sinus-related fistulas, their diagnostic features and therapeutic options will also be discussed in this paper.
后窝硬脑膜动静脉瘘临床表现为颈动脉-海绵窦瘘是一种非常罕见且相对未知的情况。由于异常或过多的血液流入海绵窦,它们会表现出多种临床症状。虽然两个相近的血管域之间的异常分流是可以预料的(如颈动脉-海绵瘘),但从远处的动脉到海绵静脉窦的异常分流则是不寻常的。血管内治疗是目前治疗此类瘘管最安全、最经济的一线方法。在本文中,我们报告了一个非常罕见的病例(自发性后窝硬脑膜动静脉瘘,临床表现为颈动脉-海绵窦瘘),该病例采用了静脉腔内介入治疗和线圈栓塞治疗。本文还将讨论其他海绵窦相关瘘管的重要性、诊断特点和治疗方案。
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引用次数: 0
Breast Cancer Awareness 关注乳腺癌
Pub Date : 2023-12-18 DOI: 10.46889/jnor.2023.3303
Breast Cancer (BC) is a global health issue and it impacts women around the world. Breast Cancer accounts for 11.7% of all newly diagnosed cancer cases and has become the leading cause of cancer worldwide. In the earliest stages, the survival rate is nearly 100 percent. However, for tumors detected in later stages, that rate drops to around 25 percent. Breast Cancer Research Foundation indicated that due to the progress in advocacy, awareness, early intervention, prompt diagnosis and treatment, there has been an overall 40 percent decline in breast cancer deaths over the last 30 years.
乳腺癌(BC)是一个全球性的健康问题,影响着全世界的妇女。乳腺癌占所有新诊断癌症病例的 11.7%,已成为全球癌症的首要病因。在早期阶段,患者的存活率接近 100%。然而,对于晚期发现的肿瘤,存活率则降至 25% 左右。乳腺癌研究基金会指出,由于在宣传、提高认识、早期干预、及时诊断和治疗方面取得了进展,在过去 30 年中,乳腺癌死亡人数总体下降了 40%。
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引用次数: 0
Behavioral Medicine: A New Perspective in the Field of Health 行为医学:健康领域的新视角
Pub Date : 2023-08-31 DOI: 10.46889/jnor.2023.3204
P. Theofilou
The interest of the Health Sciences and Psychology in the relationships between illness and a person’s behavior is certainly not late. Questions and concerns about the interaction between a biological disorder and the way one lives, feels, thinks, etc. the person who suffers, have occupied both medicine and clinical-psychological research and practice for many years. But mainly within the framework of a very new interdisciplinary direction (behavioral medicine – Verhal-tensmedizin), a more thorough investigation of the importance of behavior for the genesis and formation of many diseases and disorders – mental and/or physical – began [1,2]. Forerunners of this direction, with which Behavioral Medicine often collaborates even now, are Psychosomatic Medicine and Medical Psychology. These branches of course emphasize the importance of behavioral factors around health and disease issues, but they give different weight to their investigations, they mainly have a different theoretical background and do not deal so thoroughly with the experimental investigation of the importance of behavior for etiology, form, course and treatment of various diseases [1,2].
健康科学和心理学对疾病和人的行为之间关系的兴趣当然不晚。多年来,医学和临床心理学的研究和实践一直关注生物障碍与患者的生活、感受、思考等方式之间的相互作用。但主要是在一个非常新的跨学科方向(行为医学- Verhal-tensmedizin)的框架内,开始对行为对许多疾病和障碍(精神和/或身体疾病)的发生和形成的重要性进行更彻底的调查[1,2]。这一方向的先驱是身心医学和医学心理学,直到现在行为医学也经常与之合作。这些分支当然强调行为因素对健康和疾病问题的重要性,但它们对研究的权重不同,它们主要有不同的理论背景,并且没有那么彻底地处理行为对各种疾病的病因、形式、过程和治疗的重要性的实验研究[1,2]。
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引用次数: 0
Cannabis-Based Products and Medical Propaganda: It Cuts Both Ways 以大麻为基础的产品和医疗宣传:有利有弊
Pub Date : 2023-05-25 DOI: 10.46889/jnor.2023.3203
P. Mei
Cannabis species’ historical use for relieving medical symptoms, through various preparations like smoking, edibles, ointments, balms and others, dates back over 3,000 years ago, initially in the Far East (especially India and China). Subsequent trading routes brought the herb to the Western World, where its consumption reached significant levels, leading to prohibitions in certain situations, such as in 1764 when Emperor Napoleon of France, having encountered the plant during his Egyptian campaign, observed a decrease in combative behaviour among soldiers, prompting restrictions.
大麻在历史上用于缓解医学症状,通过各种制剂,如吸烟、食用、软膏、香脂和其他,可追溯到3000多年前,最初在远东(特别是印度和中国)。随后的贸易路线将这种草药带到了西方世界,在那里,它的消费量达到了相当大的水平,导致在某些情况下禁止使用,比如在1764年,法国皇帝拿破仑在埃及战役中遇到这种植物,观察到士兵的战斗行为减少,促使限制。
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引用次数: 0
期刊
Journal of neuro and oncology research
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