Tag: Efficacy

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Factors Affecting Long-Term Pain Control After Gamma Knife Radiosurgery in Secondary Tumor-Related Trigeminal Neuralgia

Neurosurgery 97:1003–1011, 2025

This clinical study evaluates long-term pain outcomes after Gamma Knife radiosurgery (GKRS) for secondary tumor-related trigeminal neuralgia in 156 patients, reporting complete pain relief (BNI 1) in 38.8% and adequate relief (BNI 2–3) in 47.4% over a median 48.5-month follow-up. The cohort—predominantly schwannomas and meningiomas—received tumor-targeted single-session GKRS with a median dose of 12 Gy and facial hypesthesia noted in 8.3%.

Multivariable analysis identified age ≥50 years and decreased or stable tumor volume at follow-up as strong predictors of favorable pain outcomes, while tumor progression and younger age predicted failure. The authors conclude tumor control contributes to pain relief but is not the sole mechanism, and targeting tumor alone achieved similar BNI 1–3 rates as reports that also targeted the nerve.

• Gamma Knife Radiosurgery (GKRS) Efficacy: GKRS provides complete pain relief (BNI 1) in 38.8% and adequate pain relief (BNI 2-3) in 47.4% of patients with secondary tumor-related trigeminal neuralgia, with a median follow-up of about 48.5 months.

• Predictors of Pain Relief: Age ≥50 years (odds ratio: 6.95) and decreased or stable tumor volume at follow-up (odds ratio: 40.38) significantly predict successful pain relief (BNI 1-3) after GKRS.

• Tumor Control and Pain Relief Relationship: While tumor control (stable or reduced volume) strongly correlates with pain relief, pain relief can still occur without significant tumor shrinkage, indicating other contributing mechanisms.

• Most Common Tumor Types: Schwannomas (67.9%) and meningiomas (29.6%) are the most frequent causes of secondary tumor-related trigeminal neuralgia treated with GKRS.

• Complications: Facial hypesthesia is the most common complication post-GKRS, affecting 8.3% of patients; no cases of anesthesia dolorosa or worsening pain were reported.

• Tumor Volume Impact: Larger pre-treatment tumor volume is associated with higher rates of pain relief failure; patients with pain relief failure had a median tumor volume of 5.9 cc versus 3.1–4 cc in those with successful outcomes.

• Prior Procedures: Previous interventions (such as radiofrequency ablation, rhizotomy, or tumor resection) do not significantly affect pain relief outcomes after GKRS.

• Alternative Approaches: Targeting the tumor alone with GKRS is effective; nerve targeting may be reserved for cases where tumor-targeted GKRS fails.

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Surgical versus Nonsurgical Treatment for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

World Neurosurg. (2022) 159:1-11

OBJECTIVE: To systematically evaluate the efficacy and safety of surgical and nonsurgical methods for the treatment of adult spinal deformity (ASD).

METHODS: The PubMed, Embase, and Cochrane Library databases were searched for relevant controlled studies of surgical and nonsurgical approaches for the treatment of ASD; all studies reported from database creation to October 2021 were eligible for inclusion. Stata 11.0 software was used for the metaanalysis. Publication bias was assessed using a Begg test. Heterogeneity was assessed using the I2 test, and fixed-effects or random-effects models were used, as appropriate. Meta-regression was used to determine the cause of heterogeneity. Subgroup analyses were performed to assess the effects of age on the outcomes. –

RESULTS: Eleven articles comprising 1880 participants met the inclusion criteria. Meta-analysis showed that surgical treatment was associated with a better improvement in function than was nonsurgical treatment (Scoliosis Research Society 22 questionnaire score change value: weighted mean difference [ 0.696; 95% confidence interval [CI], 0.686e0.705; P < 0.0001; Oswestry Dysfunction Index change value: WMD [ 11.222; 95% CI, 10.801e11.642; P < 0.0001). Surgical treatment was more effective in relieving pain and correcting the deformity (numeric rating scale pain score: WMD[3.341; 95% CI, 2.832e3.85; P < 0.0001; Cobb angle change value: WMD [ 15.036 ; 95% CI, 13.325e16.747; P < 0.0001). The complication rate in the surgical group was 17.6%e80.3%.

CONCLUSIONS: Surgical treatment is better than nonsurgical methods for improving the function of patients with ASD and achieving good pain improvement and deformity correction. Elderly patients with ASD can also obtain good symptomatic improvement through surgery

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Stimulation of the Anterior nuclei of Thalamus for Epilepsy

Neurosurgical Review (2019) 42:287–296

Despite the use of first-choice anti-epileptic drugs and satisfactory seizure outcome rates after resective epilepsy surgery, a considerable percentage of patients do not become seizure free. ANT-DBS may provide for an alternative treatment option in these patients. This literature review discusses the rationale, mechanism of action, clinical efficacy, safety, and tolerability of ANT-DBS in drug-resistant epilepsy patients.

A review using systematic methods of the available literature was performed using relevant databases including Medline, Embase, and the Cochrane Library pertaining to the different aspects ANT-DBS. ANTDBS for drug-resistant epilepsy is a safe, effective and well-tolerated therapy, where a special emphasis must be given to monitoring and neuropsychological assessment of both depression and memory function.

Three patterns of seizure control by ANT-DBS are recognized, of which a delayed stimulation effect may account for an improved long-term response rate. ANTDBS remotely modulates neuronal network excitability through overriding pathological electrical activity, decrease neuronal cell loss, through immune response inhibition or modulation of neuronal energy metabolism. ANT-DBS is an efficacious treatment modality, even when curative procedures or lesser invasive neuromodulative techniques failed. When compared to VNS, ANTDBS shows slightly superior treatment response, which urges for direct comparative trials. Based on the available evidence ANTDBS and VNS therapies are currently both superior compared to non-invasive neuromodulation techniques such as t-VNS and rTMS. Additional in-vivo research is necessary in order to gain more insight into the mechanism of action of ANT-DBS in localization-related epilepsy which will allow for treatment optimization.

Randomized clinical studies in search of the optimal target in well-defined epilepsy patient populations, will ultimately allow for optimal patient stratification when applying DBS for drug-resistant patients with epilepsy.

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Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature

Acta Neurochirurgica 2017 (159) 33–49

To define the efficacy, complication profile and cost of surgical options for treating idiopathic intracranial hypertension (IIH) with respect to the following endpoints: vision and headache improvement, normal CSF pressure restoration, papilloedema resolution, relapse rate, operative complications, cost of intervention and quality of life.

Methods

A systematic review of the surgical treatment of IIH was carried out. Cochrane Library, MEDLINE and EMBASE databases were systematically searched from 1985 to 2014 to identify all relevant manuscripts written in English. Additional studies were identified by searching the references of retrieved papers and relative narrative reviews.

Results

Forty-one (41) studies were included (36 case series and 5 case reports), totalling 728 patients. Three hundred forty-one patients were treated with optic nerve sheath fenestration (ONSF), 128 patients with lumboperitoneal shunting (LPS), 72 patients with ventriculoperitoneal shunting (VPS), 155 patients with venous sinus stenting and 32 patients with bariatric surgery. ONSF showed considerable efficacy in vision improvement, while CSF shunting had a superior headache response. Venous sinus stenting demonstrated satisfactory results in both vision and headache improvement along with the best complication profile and low relapse rate, but longer follow-up periods are needed. The complication rate of bariatric surgery was high when compared to other interventions and visual outcomes have not been reported adequately. ONSF had the lowest cost.

Conclusions

No surgical modality proved to be clearly superior to any other in IIH management. However, in certain contexts, a given approach appears more justified. Therefore, a treatment algorithm has been formulated, based on the extracted evidence of this review. The traditional treatment paradigm may need to be re-examined with sinus stenting as a first-line treatment modality.

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Biopsy of the Superficial Cortex: Predictors of Effectiveness and Outcomes

Biopsy of the Superficial Cortex

Neurosurgery 73:224–232, 2013 

Brain biopsies of superficial cortex are performed for diagnosis of neurological diseases, but preoperative predictors of successful diagnosis and risks are lacking.

OBJECTIVE: We evaluated effectiveness and outcomes of superficial cortical biopsies and determined preoperative predictors of diagnosis, outcomes, morbidities, and mortality.

METHODS: A single-institution retrospective analysis of 170 patients who underwent open brain biopsies of superficial cortex was performed. Clinical predictors of effectiveness and outcomes were determined using univariate/multivariate analyses and a system for risk-benefit stratification was created and tested.

RESULTS: Brain biopsies led to successful diagnosis in 122 of 170 (71.8%) and affected management in 97 of 170 (57.1%) cases. Factors increasing the odds of diagnostic pathology included age older than 45 years (odds ratio [OR]: 2.67, 95% confidence interval [CI]: 1.34-5.27, P < .01), previous cancer diagnosis (OR: 3.64, 95% CI: 1.69-7.85, P < .001), focal (OR: 3.90, 95% CI: 1.91-8.00, P< .001) and enhancing (OR: 5.03, 95% CI: 2.41-10.52, P< .001) lesions on magnetic resonance imaging, biopsy of specific lesions on magnetic resonance imaging (OR: 9.34, 95% CI: 4.29-20.33, P < .001), and use of intraoperative navigation (OR: 6.59, 95% CI: 3.04-14.28, P < .001). Brain biopsies led to symptomatic intracranial hemorrhage, seizures, other significant morbidities, and perioperative mortality in 12.4%, 16.2%, 37.1%, and 8% of cases, respectively. Risk of postoperative intracranial hemorrhage was increased by a history of aspirin use (OR: 2.51, 95% CI: 1.23-5.28, P < .05) and age older than 60 years (OR: 2.66, 95% CI: 1.36-5.18, P < .01).

CONCLUSION: Effectiveness and risk of morbidity/mortality can be estimated preoperatively for patients undergoing open brain biopsies of the superficial cortex. Older age and specific imaging characteristics increase the odds of diagnostic biopsy. Conversely, older age and aspirin use increases the risk of postoperative complications.

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Safety and efficacy of Gliadel wafers for newly diagnosed and recurrent glioblastoma

Acta Neurochir (2012) 154:1371–1378

Combining Gliadel wafers and radiochemotherapy with TMZ may carry the risk of increased adverse events (AE). We analyzed the efficacy and safety in patients with glioblastoma who underwent multimodal treatment with implantation of Gliadel wafers.

Methods One hundred sixty-five consecutive patients with newly diagnosed (77 patients) or recurrent (88 patients) glioblastoma were studied. Forty-seven patients underwent surgery + Gliadel. The impact of age (≥65 vs. <65), resection extent (gross total vs. partial), use of Gliadel and adjuvant treatment (TMZ vs. other schemes/no adjuvant therapy) on overall survival (OS, for patients with newly diagnosed glioblastoma) and on recurrence-survival (for patients with recurrent glioblastoma) was analyzed with Cox regression. The impact of age, history (newly diagnosed vs. recurrent glioblastoma), number of Gliadel wafers implanted (0 vs. <8 vs. 8), resection extent (gross-total vs. partial) and adjuvant treatment (TMZ vs. other schemes/no adjuvant therapy) on the occurrence of AE and on the occurrence of implantation site-related AE (ISAE) was analyzed with the logistic regression model. Significance was set at p<0.05.

Results Multivariate analysis showed the only factor associated with longer survival, both for newly diagnosed and for recurrent GBM, was resection extent. Both patients with a higher number of wafers implanted and patients with recurrent tumors were significantly at risk for AE and ISAE. Patients with eight Gliadel wafers implanted had a 3-fold increased risk of AE and a 5.6-fold increased risk of ISAE, and patients with recurrent tumor had a 2.8-fold increased risk of AE and a 9.3-fold increased risk of ISAE.

Conclusions Adding Gliadel to standard treatment did not significantly improve the outcome. The toxicity after Gliadel use was significantly higher, both for patients with newly diagnosed and patients with recurrent glioblastoma.

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