Search for More Effective Chemotherapeutic Regimens for Gliomas: Challenges and Hopes.
Authors: Hu J, Kesari S
Abstract
Are truly effective therapies for glioma finally within reach? An explosion of technologies and treatments in recent years brings with it the hope that the revolution is nigh, but decades of gains that can at best be considered incremental understandably temper optimism. Concepts such as "targeted therapy" and "personalized medicine" have grabbed the attention of the oncology community for over a decade; yet when applied to glioblastoma, our initial efforts have amounted to running into battle with limited armaments and an incomplete understanding of the enemy. Still, there...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Physical and Psychological Rehabilitation of Patients with Intracranial Glioma.
Authors: Andrejeva J, Volkova OV
Abstract
Patients with brain tumor frequently experience a combination of physical, cognitive, and communication deficits. These may cause severe psycho-emotional stress altering biological and mental conditions and complicating the course of the primary disease, and thus necessiate physical and psychological rehabilitation. While existing data on the effectiveness of such treatment in patients with intracranial glioma are limited and inconsistent, it is possible to suggest that systematic and multidisciplinary rehabilitation plays a very important therapeutic role and lead...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Palliative and Supportive Care of Patients with Intracranial Glioma.
Authors: Pace A, Villani V
Abstract
Clinicians dealing with patients affected by malignant brain tumors are frequently involved in providing palliative and supportive care, particularly at the end of life. It requires a multidisciplinary approach by a well-trained specialized neuro-oncology team. Early initiation of palliative care integrated with standard anticancer therapy may be effective for symptom management and results in improvement of the quality of life. However, studies specifically addressing these issues are very limited, thus do not allow the creation of any reliable evidence-based guidelines...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Pathology and Genetics of Gliomas.
Authors: Komori T, Muragaki Y, Chernov MF
Abstract
Current World Health Organization (WHO) classification of the neuroepithelial tumors is cell lineage-oriented and based on a presumed developmental tree of the central nervous system (CNS). It defines three main groups of gliomas, namely astrocytomas, oligodendrogliomas, and ependymomas, and additionally presumes their 4-tiered histopathological grading (WHO grades I to IV). Nevertheless, the impact of tumor pathology on clinically related parameters may be frequently much better predicted by genetics, than by histological appearance of the lesion. Recent ...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
The History of Movement Disorder Brain Surgery.
Authors: Lunsford LD, Niranjan A
Abstract
The first surgical procedures for abnormal movement disorders began in the 1930s, when surgeons first proposed ablative techniques of the caudate nucleus or transection of motor (pyramidal) pathways to reduce involuntary movements in patients with Parkinson's related tremor. During the 50-year interval between 1945 and 1995, the development of precise intracranial guiding devices, brain maps, and advanced imaging led to the refinement of appropriate deep brain targets affecting extrapyramidal pathways. Lesional surgery and subsequent neuroaugmentation using deep br...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Pathophysiologic Basis of Movement Disorders.
Authors: Wichmann T
Abstract
Movement disorders are common and functionally disabling neurologic diseases. Studies over the last decades have investigated the pathophysiology of these diseases in considerable detail, leading to significant insights into their generation of motor disability. While genetically and clinically heterogeneous, most of them are accompanied by prominent and characteristic changes in firing rates and patterns in the basal ganglia, thalamus, and cortex. In recent years, researchers have placed increasing emphasis on the importance of oscillatory changes in firing in these structures...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Clinical Presentation and Prognosis of Common Movement Disorders.
Authors: Han J, Jain S
Abstract
Great progress has been made in expanding our understanding of the natural history of movement disorders, leading to impressive advancements in their medical and surgical management. Movement disorders are a diverse group of diseases, varying widely in clinical characteristics and evolution. Some are monosymptomatic while others have associated motor and nonmotor features. Some are static while others follow a progressive course. This chapter will review common primary and secondary movement disorders: Parkinson disease and other forms of Parkinsonism, essential tremor and i...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Medical Management of Movement Disorders.
Authors: Picillo M, Munhoz RP
Abstract
Pharmacological treatment is the cornerstone in the management of movement disorders. Although most available treatment options have no impact on the underlying process of each movement disorder, symptomatic therapies can significantly improve patient's quality of life and level of disability. Here, we review the current knowledge on clinical symptomatic management of Parkinson's disease (both early and advanced stages), essential tremor, dystonia, and chorea. Ideally, treatment should be carried out by specialists with reasonable experience in movement disorders, as ...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Functional Anatomy of Basal Ganglia Circuits with the Cerebral Cortex and the Cerebellum.
Authors: Bostan AC, Dum RP, Strick PL
Abstract
The neural connections of the basal ganglia provide important insights into their function. Here, we discuss the current perspective on basal ganglia connections with the cerebral cortex and with the cerebellum. We review the evidence that the basal ganglia participate in functionally segregated circuits with motor and non-motor areas of the cerebral cortex. We then discuss the data that the basal ganglia are interconnected with the cerebellum. These results provide the anatomical substrate for basal ganglia contributions not only to the control of movement, b...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Diffusion Tensor Imaging of the Basal Ganglia for Functional Neurosurgery Applications.
Authors: Sammartino F, Hodaie M
Abstract
Since its introduction, diffusion tensor imaging (DTI) has become an important tool in neuroscience given its unprecedented ability to image brain white matter in vivo. The interest in understanding the mechanisms of action of Deep Brain Stimulation in different targets and indications, together with the constant drive towards the improvement in long-term clinical outcomes, has found a logical complement in the application of tractography in this field. Diffusion tensor imaging has been traditionally associated with an increased susceptibility to MRI artifacts, and ...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Patient Evaluation and Selection for Movement Disorders Surgery: The Changing Spectrum of Indications.
This report summarizes the state-of-the-art and controversies around patient selection for deep brain stimulation (DBS) for various conditions. Parkinson's disease (PD): several class I studies have shown superiority of DBS over best medical treatment for advanced PD with fluctuations and further inclusion criteria. One class I study suggests that PD patients with early motor complications might gain more quality of life if operated within 3 years after the onset of fluctuations. The subthalamic nucleus (STN) is still the standard target. STN DBS has an impact on impulse control disorders though the exact mechanism is uncl...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Image-Guided, Asleep Deep Brain Stimulation.
Authors: Ko AL, Burchiel KJ
Abstract
Deep brain stimulation (DBS) has become an established treatment for medically refractory movement disorders including Parkinson's disease, essential tremor, and dystonia. The field of DBS continues to evolve with advances in patient selection, target identification, electrode and pulse generator technology, and the development of more effective stimulation paradigms such as closed-loop stimulation. Furthermore, as the safety and efficacy of DBS improves through better hardware design and deeper understanding of its mechanisms of action, the indications for DBS will con...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Stereotactic Radiofrequency Lesioning for Movement Disorders.
Authors: Taira T, Horisawa S, Takeda N, Ghate P
Abstract
During the past 2 decades, deep brain stimulation (DBS) took over the position of radiofrequency (RF) lesioning of thalamic or pallidal targets for control of movement disorders. Superiority of DBS over RF lesioning is widely accepted, and most neurosurgeons even regard RF lesioning to be old-fashioned and dangerous. Such concepts emerged from the data of old stereotactic operations with ventriculography and without computerized planning. Hardware-related complications are not negligible in long-term DBS therapy, and DBS only controls the symptoms. L...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Magnetic Resonance-Guided High Intensity Focused Ultrasound for Treating Movement Disorders.
Authors: Kim YG, Kweon EJ, Chang WS, Jung HH, Chang JW
Abstract
Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) surgery has recently gained favor as a novel, noninvasive alternative to conventional neurosurgery. In contrast to traditional ablative interventions, transcranial MRgFUS surgery is entirely imaging-guided and uses continuous temperature measurements at the target and surrounding tissue taken in real-time. Unlike Gamma Knife radiosurgery, MRgFUS surgery can make a lesion immediately and does not use ionizing radiation. Moreover, since no metallic device is implanted, MR imaging...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Radiosurgical Thalamotomy.
Authors: Monaco Iii EA, Shin SS, Niranjan A, Lunsford LD
Abstract
Tremor is a common movement disorder that can be disabling, and its initial treatment is in the form of medical therapies. Often patients are refractory and seek surgical intervention. Treatment options for these patients include surgical radiofrequency thalamotomy and deep brain stimulation. There are a subset of patients who, for various reasons, are not candidates for open surgical procedures, or who opt to avoid them. For these patients, radiosurgical thalamotomy is a safe and useful alternative. Herein, we provide a review of the use of...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
