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Background: epidermoid tumors (ETs) of the central nervous system (CNS) are rare tumors that typically occur in the 4th decade. They typically grow around vital neurovascular structures which makes surgical treatment difficult. The objective of this paper is to report on the effectiveness and safety in the management of epidermoid tumors with gamma knife surgery (GKS). Materials and methods: This is a retrospective study of the medical records of 8 patients treated with GKS for epidermoid tumors between July 2010 to June 2019. The median prescription dose was 11 Gy, ranging from 10 to 12 Gy, 5 patients received the total dose target to the 50% line and 3 to the 55% isodose line. The mean tumor volume was 12.4 cc ranging from 4.4 to 24.8cc. The median follow-up time was 33.7 months and ranged from 0.9 to 58.8 months. at follow-up, patients were evaluated for neurological signs and symptoms and radiographic evidence of progression of disease. Two patients were treated after failure of linac stereotactic radiosurgery. One patient underwent stereotactic radiosurgery prior to GKs, and the other had failed surgical resection prior to GKs. Results: The median age was 33 years old. There were two males and six females. The most common presenting manifestation was headaches followed by vision and hearing problems. symptoms were resolved in all cases, except for one who had partial control of trigeminal neuralgia. All patients were locally controlled by imaging and neurological examination at first follow-up. Conclusion: Gamma knife surgery is a safe and effective alternative treatment in patients with cNs epidermoid tumors and should be included in the initial recommendation. [ABSTRACT FROM AUTHOR]

The effects of human T-cell leukemia virus type I (HTLV-I) infection in primary cultures of human peripheral blood monocytes and brain-derived microglial cells were investigated. The results showed that these primary brain-derived cells are prone to productive HTLV-1 infection in vitro. Furthermore, HTLV-1 infection induced the production of tumor necrosis factor alpha and interleukin 6. These results suggest that cytokine release constitutes one of the steps in the neuropathology of HTLV-I infection.

Evaluates survival and local control of brain metastases in patients with renal cell carcinoma. Radiosurgical treatment using the Leksell gamma knife unit; Indications for treatment; Workup on computed tomography and magnetic resonance imaging; Range of the ages of the patients; Number of lesions treated; Requirement for aggressive management; Benefits of gamma knife radiosurgery.

Evaluates the results of gamma knife radiosurgery for the treatment of brain metastases from carcinoma of the breast. Duration of the actuarial survival; Presence of radiation-induced dementia; Effect of the number of lesions treated to the survival rate.

Glioblastoma (GBM) patients have an estimated survival of ~15 months with treatment, and the standard of care only modestly enhances patient survival. Identifying biomarkers representing vulnerabilities may allow for the selection of efficacious chemotherapy options to address personalized variations in GBM tumors. Irinotecan targets topoisomerase I (TOP1) by forming a ternary DNA–TOP1 cleavage complex (TOP1cc), inducing apoptosis. Tyrosyl-DNA phosphodiesterase 1 (TDP1) is a crucial repair enzyme that may reduce the effectiveness of irinotecan. We treated GBM cell lines with increasing concentrations of irinotecan and compared the IC50 values. We found that the TDP1/TOP1 activity ratio had the strongest correlation (Pearson correlation coefficient R = 0.972, based on the average from three sets of experiments) with IC50 values following irinotecan treatment. Increasing the TDP1/TOP1 activity ratio by the ectopic expression of wild-type TDP1 increased in irinotecan IC50, while the expression of the TDP1 catalytic-null mutant did not alter the susceptibility to irinotecan. The TDP1/TOP1 activity ratio may be a new predictive indicator for GBM vulnerability to irinotecan, allowing for the selection of individual patients for irinotecan treatment based on risk–benefit. Moreover, TDP1 inhibitors may be a novel combination treatment with irinotecan to improve GBM patient responsiveness to genotoxic chemotherapies. [ABSTRACT FROM AUTHOR]

We report the first case of debilitating lower back pain induced by spondylitis with end plate inflammation of the lumbar spine, treated successfully by bi-weekly intravenous injections of a sterile fraction (1ml) from human purified amniotic fluid (ViX001) obtained from thoroughly screened volunteers at the time of planned c-section at the term of normal pregnancies. Our product ViX001 was generated through a proprietary process and kept in frozen one milliliter (1 ml) cryvials (protein content was ~1mg/ml) and thawed just prior to injections. Pain improvement was recorded weekly, and inflammation suppression was confirmed by monthly MRIs of the lumbar spine. While our findings need to be reproduced with a larger cohort of patients, it is instructive that ViX001 resolved pain and inflammation for a patient with severe lower back pain, the most common form of pain reported by U.S. adults.

Objective Gamma Knife® radiosurgery (GKRS) has been demonstrated to be a well-known approach for treating patients with medical refractory trigeminal neuralgia (TN). Herein, the authors review the outcomes of pain among a large cohort of patients who had undergone a second GKRS delivered at a significantly reduced dose. Methods The authors conducted a prospective analysis of patients who have undergone two GKRS procedures between the years 2012 to 2021 at one institution. Baseline characteristics, radiosurgical dosimetry and technique, pain outcomes, and adverse effects were reviewed. Pain outcomes were measured with the Barrow Neurological Institute (BNI) pain intensity scale, which included the best BNI attained after the last treatment and recurrence. Results A total of 202 patients were identified, including 55 males and 147 females. Pain recurrence was reported in all patients prior to the second GKRS treatment (median = 4 months). Pain recurrence in the preceding Japan Neuroscience Society (JNS) 2021 study was also reported in all patients after each GKRS with a median value of 20 months between the second and third procedures. Complete to partial pain relief (BNI ≤ III) was achieved in 80% of patients after the second treatment. Over a median of 12 months of follow-up, 60% of patients maintained complete to partial pain relief compared to 77% of patients over the course of three treatments. In the present study, one patient developed facial spasms while 10 patients experienced persistent facial tingling. Subjective mild numbness was also found to be present in 16% of patients, with only 2% being bothersome, as compared to the JNS study, where subjective mild numbness was found to be present in 14%, with only 14.3% being bothersome. Among the 202 patients, 74 (37%) patients had undergone subsequent additional procedures such as a third GKRS, microvascular decompression (MVD), or other percutaneous procedures. Conclusion The authors describe the largest study to date of patients undergoing a second GKRS treatment for type 1 medical refractory trigeminal neuralgia. A reduced dose of radiation for a second treatment may produce outcomes similar to those of three consecutive treatments in regard to limiting recurrence and adverse effects., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Marquez et al.)

Background: Primary central nervous system lymphoma (PCNSL) is a rare cancer accounting for less than 3% of primary brain and central nervous system (CNS) tumors. Tissues involved include the brain parenchyma, leptomeninges, eyes, and spinal cord. High-dose methotrexate (MTX) is the gold standard for newly diagnosed PCNSL. However, Gamma Knife radiosurgery (GKRS) may be efficacious as a co-adjuvant treatment. The purpose of this prospective observational cohort study is to determine the effectiveness of MTX in combination with GKRS in the treatment of PCNSL., Methods: This is a prospective, observational cohort study evaluating the treatment of histologically confirmed PCNSL with MTX as a single agent in a dose of 8 g/m2 (control) and treatment with MTX, plus GKRS. Strict inclusion and exclusion criteria were employed. Primary outcomes were measured by survival rate. Secondary outcomes were assessed by the tumor's responsiveness to treatment and reduction in size as noted on imaging., Results: Between January 2007 and January 2012, 128 charts were evaluated. Included in this evaluation were 73 chemotherapy (control) and 55 chemotherapy, plus GKRS, patients (variable). The follow-up period was 24 to 49 months (mean: 36.9 months). There were no statistically significant differences in patient demographics or histology diagnosis. Patients were treated with GK doses ranging from 11 Gy to 16 Gy (median: 11 Gy). The median survival rate from initial diagnosis was 26.8 months in the chemotherapy group and 47.6 in the chemotherapy, plus GKRS, group (p-value: 0.0034). All lesions showed a complete response after GKRS when evaluated using magnetic resonance imaging after three to eight weeks (mean range: 6.3 weeks)., Conclusions: The use of GKRS is non-invasive, safe, and shows rapid success, improving the prognosis of the patient. This noninvasive treatment modality should be considered as an option for patients with PCNSL. In our study, GKRS as a co-adjuvant therapy to high-dose methotrexate was statistically significant for greater tumor control, enhanced overall survival period, and a lesser number of complications., Competing Interests: The authors have declared that no competing interests exist.

Unlabelled: OBJECTIVE : To describe a surgical technique and to report using a retrospective study the efficacy of peritoneal shunts for the treatment of recurrent/chronic subdural hematoma (CSDH). We describe the considerations, complications, and outcomes related to this technique. METHODS : In a retrospective cohort study, 125 charts with a diagnosis of subacute/chronic subdural hematoma were assigned for evaluation. Of the charts reviewed, 18 charts were found from subjects with a diagnosis of recurrent sub-acute or chronic subdural hematoma. All patients had undergone initial surgical treatment of their condition followed by peritoneal shunt placement to help alleviate intracranial pressure. Factors including the age, size of subdural hematoma, number of previous events, BMI, complications, survival, and clinical course were analyzed. RESULTS : After subdural peritoneal shunt placement all patients had full neurological recovery with no complaints of headaches, lethargy, weakness, confusion or seizures. None of the cases had new subdural hematoma episodes after placement for a minimum of a two-year period (mean 26.1 months) (range 24.3-48.6 months). No postoperative complications were reported. The rates of postoperative hemorrhage, infection, distal catheter revision, and perioperative seizures was found to be zero percent. Shunt drainage was successful in all cases, draining 85% of the blood in the first 48 hours. There was no significant relationship between complications and the use of anticoagulants four weeks after surgery., Conclusions: Peritoneal shunts, though rarely used, are a viable option in the treatment of sub-acute/chronic subdural hematomas. When pursuing this treatment, this technique is recommended to mitigate the risks of repeat surgical intervention and lessen perioperative time in high-risk patients.