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To predict radiation-induced lung injury and outcome in non-small cell lung cancer (NSCLC) patients treated with robotic stereotactic body radiation therapy (SBRT) from radiomic features of the primary tumor. In all, 110 patients with primary stage I/IIa NSCLC were analyzed for local control (LC), disease-free survival (DFS), overall survival (OS) and development of local lung injury up to fibrosis (LF). First-order (histogram), second-order (GLCM, Gray Level Co-occurrence Matrix) and shape-related radiomic features were determined from the unprocessed or filtered planning CT images of the gross tumor volume (GTV), subjected to LASSO (Least Absolute Shrinkage and Selection Operator) regularization and used to construct continuous and dichotomous risk scores for each endpoint. Continuous scores comprising 1–5 histogram or GLCM features had a significant (p = 0.0001–0.032) impact on all endpoints that was preserved in a multifactorial Cox regression analysis comprising additional clinical and dosimetric factors. At 36 months, LC did not differ between the dichotomous risk groups (93% vs. 85%, HR 0.892, 95%CI 0.222–3.590), while DFS (45% vs. 17%, p

To study the caregivers' perception of their own well-being 1 year after subthalamic deep brain stimulation (STN-DBS) surgery in Parkinson's disease (PD) patients, using a qualitative and quantitative approach. 25 patients and caregivers, living together in partnerships, were examined before and at 3-month and 1-year follow-up (FU) after STN-DBS surgery. Semi-structured FU interviews concerning caregivers' own well-being under STN-DBS were conducted and analyzed: caregivers were accordingly assigned to positive or negative outcome groups. Quality of life (QoL), depression, apathy and anxiety of caregivers and patients were measured. These quantitative data were compared to the 1-year FU interview outcomes. Multiple comparisons analyzed caregiver group assignments based on these measurements. Logistic regression was used to find predictors. Additionally, patients' mood ratings were used in multiple comparisons with caregivers' subjective outcome, to analyze the interaction of patient and caregiver ratings. At 3-month FU, caregivers were more indecisive concerning their own well-being than at 1-year FU. At 1-year FU, caregivers from the negative group had greater depression, anxiety and lower QoL ratings. They were significantly older compared to the positive group. Patients' depression showed significantly stronger improvement in the positive outcome group. Patients' apathy and depression ratings were significant covariates of caregivers' QoL. Our results show that at 1-year FU over 50 % of the caregivers rated their subjective well-being as negative. Especially older and more depressed caregivers are at risk. These caregivers and their partners should be monitored more closely to identify possible problems and help them adapt following surgery.

Treatment options for inoperable glioblastoma are limited. Low-dose-rate stereotactic iodine-125 brachytherapy (SBT) has been reported as an effective and low-risk treatment option for circumscribed low-grade gliomas and brain metastases. The present study evaluates this treatment approach for patients with inoperable glioblastoma. Between 1990 and 2012, 201 patients with histologically proven glioblastoma were treated with SBT (iodine-125 seeds; median cumulative surface dose, 60 Gy; median dose-rate, 6 cGy/h; median gross-tumor-volume, 17 ml) either as primary treatment (n = 103) or at recurrence (n = 98). In addition to SBT, 90.3 % of patients in the primary treatment group received external boost radiotherapy (median dose, 25.2 Gy). Adjuvant chemotherapy was added for 30.8 % of patients following SBT and consisted of temozolomide for the majority of cases (88.7 %). Procedure-related complications, clinical outcome, progression-free and overall survival (PFS, OS) were evaluated. Median follow-up was 9.8 months. The procedure-related mortality was zero. During follow-up, transient and permanent procedure-related morbidity was observed in 7.5 and 2.0 %, respectively. Calculated from the time of SBT, median OS and PFS rates were 10.5 and 6.2 months, with no significant differences among primary and recurrent tumors (11.1 vs.10.4 months for OS and 6.2 vs. 5.9 months for PFS). For OS, multivariate analysis revealed Karnofsky performance score, age, and adjuvant chemotherapy as independent prognostic factors (all p

Der Begriff Stereotaxie kommt aus dem Griechischen – στeρeός (stereos, „starr, hart“) und τάξις (taxis, „Einrichtung, Anordnung“) – und wird meist im Zusammenhang mit neurochirurgischen, aber auch strahlentherapeutischen Techniken zur minimalinvasiven und hochprazisen Behandlung hauptsachlich zerebraler Pathologien verwendet. Hierfur wird der Kopf des Patienten in einem stereotaktischen Rahmensystem fixiert (Abb. 1), um darin ein Koordinatensystem fur die hochprazise Fuhrung und Platzierung von neurochirurgischen Instrumenten (Biopsienadeln; Elektroden; radioaktive Partikel etc.) oder hoch gebundelte Strahlung applizieren zu konnen (Infobox 1). Abb. 1 Stereotaktischer Rahmen und Illustration des damit verbundenen kartesischen Koordinatensystems Historisch begann die Entwicklung dieser Technik im Jahre 1908 mit der Einfuhrung eines „stereotaxic apparatus“ durch Sir Victor Horsley (Neurochirurg und Neurophysiologe) sowie Robert Clarke (Mathematiker und Neurochirurg). Sie entwickelten einen Rahmen, der nach Fixierung auf dem Kopf eines Versuchstieres die Durchfuhrung genauer Punktionen oder Schnitte zur Durchfuhrung elektrophysiologischer Experimente, geleitet durch den Rahmen, ermoglichte [5]. Hierbei etablierten sie unter Verwendung von 3 Koordinaten (x, y, z; entsprechend Lateral-, a.-p.- und Vertikalebene) ein kartesisches Koordinatensystem zur Definition eines speziellen Punktes im Raum. In den folgenden Jahrzehnten folgte neben der Weiterentwicklung der Stereotaxieapparatur die Verknupfung des Koordinatensystems mit anatomischen Atlanten sowie die zunehmende Integration modernster zerebraler Schnittbildgebung (Abb. 2, Abb. 3). Abb. 2 Stereotaktischer CT-Lokalisator (a) und dazugehoriges stereotaktisches CT-Bild mit den entsprechenden „Landmarken“ (b) Abb. 3 Landmarkengestutzte Bildfusion von CT und MRT (T1 nach Kontrastmittelgabe) und Definition des Behandlungsvolumens (hier: zerebrale Filia bei Adenokarzinom der Lunge) Heutzutage ermoglichen stereotaktisch gefuhrte Operationen die Implantation von Elektroden zur Tiefenhirnstimulation bei Bewegungsstorungen (M. Parkinson, Dystonien etc.) wie auch in zunehmendem Mase bei psychiatrischen Erkrankungen (Zwangsstorungen, Tourette-Syndrom sowie im Rahmen von Studien bei Depressionen und Suchtverhalten) oder zur Tiefenableitung pathologischer elektrophysiologischer Potenziale bei Epilepsie. Auf dem Gebiet der Neuroonkologie erlaubt diese Operationsmethode die Durchfuhrung hochpraziser, minimalinvasiver Biopsien, geleitet durch moderne strukturelle und metabolische Bildgebung(MRT und PET). Diese Technik findet jedoch auch eine wesentliche Anwendung in sog. stereotaktischen Bestrahlungsverfahren, auf die im Folgenden genauer eingegangen werden soll.

Tourette’s Syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics, often associated with behavioral disorders. Symptoms often disappear before or during adulthood. The pathophysiology of TS is still a matter of considerable debate. Current knowledge of cortico—basal ganglia—thalamocortical circuits provide explanations for the beneficial effects of deep brain stimulation (DBS) on tics. When conservative treatment fails in patients with severe TS, DBS may be a therapeutic option. In 1999, thalamic DBS was introduced for intractable TS. Since then, multiple targets have been used in a small number of patients, including the globus pallidus pars interna and the nucleus accumbens. Inclusion and exclusion criteria have been formulated to identify good candidates for DBS.

Penile erection is a complex neurovascular event. The neuronal system involved is often divided into a spinal (generator) and supraspinal (controller) network. Little is known about the supraspinal control. The recent finding of changes in penile erection following deep brain stimulation of the thalamus in two patients has raised the question as to what extent the thalamus is involved in erectile function. The thalamus has generally been regarded as a group of relay nuclei that served as a 'gate' for sexual information from the spinal cord towards higher centres. Recent evidence, however, suggests a more integrated regulatory function. Our review of the literature from 1960 until 2003 revealed 13 reports describing original data (preclinical and clinical). Various thalamic regions, varying from the midline thalamus to the posterior thalamus, have been reported to be activated during erection. The majority of the reports, however, showed that mainly the mediodorsal (MD) nucleus and the centromedian-parafascicular nucleus (Cm-Pf complex) are involved in penile erection. MD is the second largest nuclear aggregation located within the medial part of the thalamus. Anatomically, the MD is closely related to the Cm-Pf complex. The Cm-Pf complex is one of the most important relay stations in which the anterolateral spinothalamic pathway is further processed. This pathway is thought to transmit peripheral sexual sensations. On the whole, the present data on the role of the thalamus in erection are far from complete and future experiments are required to delineate its involvement.

Objective. To report our experience on hardware-related infections following deep brain stimulation (DBS). Methods. The present article presents the retrospective clinical notes review of gained in a two-centre, single-surgeon study experience of 108 consecutive DBS cases between 1996 and 2002. In all patients the minimum follow-up was six months. One hundred and eight patients received an intracerebral electrode implantation and 106 underwent internalization. Results. In total 178 electrodes were implanted with a mean follow-up of 42.6 months and a cumulative follow-up of 367.7 patient-years. Four patients (3.8%) developed an infection related to the DBS-hardware and all were initially treated with antibiotics. Two patients eventually required additional surgical treatment. Conclusion. Infections due to DBS-hardware can result in considerable levels of morbidity. In certain cases antibiotic therapy may be adequate. In others, surgical intervention to externalise the electrodes may be necessary. In our experience, there was never a need to remove the electrodes.

We thank Dr. Fiorentino and colleagues for their interest in our article comparing dosimetric treatment plan quality in intracranial stereotactic radiosurgery (SRS) [12]. The purpose of our study was to test whether robotic radiosurgery can create at least equivalent treatment plans when compared to classical SRS with a linear accelerator (linac-SRS). Linac-SRS with conical collimators or a micro-multileaf collimator is widely used and a well-established clinical standard for the treatment of small intracranial target volumes [7, 10]. Treatment plan comparisons allow, if they are carried out properly, reliable statements to be made about the clinical utility of a new irradiation method or new radiation device [9]. Since plan comparisons can generally be carried out using a matched pair analysis, the required number of cases investigated can be kept low. Usually about 10 cases (range 1–15) are used in the literature [1, 3, 5, 6, 8, 9]. Vice versa, methodological requirements for meaningful plan

A new consensus statement, written by an international panel of experts, seeks to standardize the use of neurosurgery for psychiatric disorders and to enhance patient safety. Although the approach is noble, some recommendations are overly conservative, whereas others might be more appropriate for regulatory authorities.