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偉倫 羅This document discusses the application of Perfexion Gamma Knife radiosurgery for infra-skull base lesions. It presents 14 cases where Perfexion Gamma Knife was used to treat lesions located in challenging areas such as the foramen magnum, neck region, and extracranial spaces. The results showed tumor shrinkage, stabilization or improvement in symptoms for all cases. Precise immobilization was important to minimize motion error, especially for extracranial lesions. In conclusion, Perfexion Gamma Knife can effectively treat infra-skull base lesions while overcoming previous technical limitations of location.
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Intra operative monitoring facial nerve
This document discusses intraoperative neurophysiological monitoring during surgery. It describes monitoring brain and nerve pathways to reduce risks from surgery and protect the brain, nerves, and spinal cord. Specific techniques are covered, including electrical stimulation of pathways to identify changes from surgery and ensure integrity. Placement of recording electrodes and how they are used to monitor facial and other cranial nerves is also summarized.
Pulsed radiofrequency ablation of pudendal nerve for treatment of a case of r...
This case report describes a 51-year-old woman suffering from chronic pelvic pain due to pudendal neuralgia. Various medication trials provided only limited pain relief. Diagnostic pudendal nerve blocks and MR neurography imaging revealed pudendal neuropathy as the cause. The patient underwent pulsed radiofrequency ablation of the pudendal nerve, resulting in over 6 weeks of significant pain relief. This report adds to evidence that PRF ablation and MR neurography can effectively treat and diagnose pudendal neuralgia.
e84
The letter discusses a case report by Dr. Palma about using susceptibility-weighted MR phase imaging (SWI) to evaluate patients with cerebral cavernous malformation. While SWI is highly sensitive for detecting magnetic susceptibility, it can also produce false positives from other substances like fat or pneumoencephalus. The authors provide an example of a patient where multiple low signal intensity foci on SWI turned out to be fat deposits from a ruptured epidermoid tumor. To avoid false positives, they recommend evaluating the magnitude and phase images in addition to minimum intensity projection images from SWI sequences.
Ophthalmic indications of_gk
The document discusses ophthalmic indications for gamma knife surgery including uveal melanomas, eye metastases, advanced glaucoma, age-related macular degeneration, hemangioblastoma, angioreticuloma, and pseudotumors. It describes immobilizing the eye using retrobulbar anesthetic block and fixation of the four rectus muscles to the frame. It notes gamma knife radiosurgery is usually performed in the prone position and reports a 94% 3-5 year tumor control rate for uveal melanoma when prescribing 40 Gy to the 50% isodose line. It also mentions assessing accuracy in ophthalmic radiosurgery and avoiding complications such as chronic painful glaucoma refractory
craniospinal irradiation
This document discusses craniospinal irradiation (CSI) techniques. It defines CSI as radiation delivered to the entire cranial-spinal axis. The document outlines the indications for CSI including various types of brain tumors. It then discusses the challenges of CSI due to the large irregular target volume and proximity to critical structures. The document focuses on the 3D conformal technique in supine position used at the author's department. It describes patient positioning, immobilization, simulation, target and organ at risk delineation, and treatment planning. Complications of CSI and the role of chemotherapy are also reviewed. Alternative CSI techniques like IMRT and proton therapy are mentioned but have limitations. Dosimetric studies find modern
A Case Report of Bilateral Trigeminal Neuralgia Combined with Bilateral Gloss...
A Case Report of Bilateral Trigeminal Neuralgia Combined with Bilateral Gloss...Crimsonpublisherssmoaj
A Case Report of Bilateral Trigeminal Neuralgia Combined with Bilateral Glossopharyngeal Neuralgia by Ahmed N Ghanem* in Crimson Publishers: Open access journal of surgery impact factor
The patient was a 63-year-old-aged female, who experienced 7 years of bilateral cheek and oropharyngeal burning and stabbing pain. Touching the mouth and bilateral throat or swallowing could provoke the pain. Each episode of pain lasted a few seconds to a few minutes, and in severe cases could last for hours. Oral administration of carbamazepine and radiofrequency treatment before hospitalization had only poor effects. We diagnosed the patient as bilateral trigeminal neuralgia combined with bilateral glossopharyngeal neuralgia. After hospitalization, brain MRI examination was performed and did not reveal any occupational lesions. The bilateral pain of pharyngeal pain disappeared after the treatment of 1% butanocaine respectively, and this confirmed the diagnosis of bilateral glossopharyngeal neuralgia. The patient complained that the pain of right side was more serious than the other side.
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Ultrasound guided pulsed radiofrequency treatment of the pudendal nerve in ch...
This case report summarizes the effectiveness of ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in three patients with chronic pelvic pain. The three patients, two males with interstitial cystitis and one female with pudendal neuralgia, underwent ultrasound-guided pudendal nerve blocks followed by pulsed radiofrequency treatment of the pudendal nerve. All three patients experienced reduced pain scores and decreased analgesic use following the treatment. No complications occurred. The report concludes pulsed radiofrequency treatment of the pudendal nerve under ultrasound guidance provided effective analgesia for chronic pelvic pain in these cases without adverse effects.
Ultrasound guided pulsed radiofrequency treatment of the pudendal nerve in ch...
This case report summarizes the effectiveness of ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in three patients with chronic pelvic pain. The three patients, two males with interstitial cystitis and one female with pudendal neuralgia, underwent ultrasound-guided pudendal nerve blocks followed by pulsed radiofrequency treatment of the pudendal nerve. All three patients experienced reduced pain scores and decreased analgesic use following the treatment. No complications occurred. The report concludes pulsed radiofrequency treatment of the pudendal nerve under ultrasound guidance provides adequate analgesia for chronic pelvic pain.
COMEXANE BRAIN RELAXATION.pptx
This document discusses strategies for brain relaxation in neurocritical patients. It begins by defining brain relaxation as a balanced relationship between brain volume and cranial capacity after craniectomy. It then covers physiological bases, diagnosis and classification. Risk factors for inadequate brain relaxation are discussed from two studies, including tumor size and location. Interventions to achieve brain relaxation are also summarized, including pharmacological options like mannitol, hypertonic saline and steroids as well as non-pharmacological techniques like patient positioning, ventilation strategies and CSF drainage. Overall, the document provides an overview of concepts and current approaches for brain relaxation in neurosurgical patients.
Vision for future of Nuclear medicine department.pptx
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Intracranial dural av fistula with spinal perimedullary venous drainage rare ...
A 26-year-old male presented with gradually worsening quadriparesis over 3 weeks and decreased respiratory drive over 2 days. MRI showed cord swelling and central hyperintensity on T2 images, resembling central grey matter. Contrast MRI showed dilated enhanced perimedullary veins on the spinal cord surface. The final diagnosis was an intracranial DAVF fed by the meningohypophyseal trunk and middle meningeal artery with spinal perimedullary venous drainage. Treatment with occlusion of the fistula using Onyx liquid embolic agent was planned.
Journal review 1 perineural spread nmsc
This document discusses perineural invasion (PNI), which refers to tumor growth along or around nerves. It is more common in squamous cell carcinomas than basal cell carcinomas. The presence of PNI confers an increased risk of recurrence and metastasis. Diagnosis involves clinical, radiological, and histopathological assessment. Incidental PNI detected on histology carries a better prognosis than clinical PNI detected by symptoms or imaging. Treatment of incidental PNI involves aggressive excision such as Mohs micrographic surgery along with adjuvant radiotherapy to improve local control rates.
JOURNAL CLUB NEW.ppt
This document summarizes guidelines developed by a consensus of expert pediatric radiation oncologists for target volume delineation for craniospinal irradiation in children. It describes in detail the recommended delineation of the cranial and spinal clinical target volumes to encompass the entire arachnoid space and extensions of cerebrospinal fluid along cranial nerves and nerve roots. Potential organs at risk are also outlined. The goal is to promote standardization when using high-precision photon and proton radiotherapy techniques to minimize the risk of marginal recurrence.
Managememt of Carcinoma Nasopharynx
Management of carcinoma nasopharynx presents many challenges:
1) Detection is difficult due to its deep, silent location and treatment is challenging due to proximity to critical structures.
2) Radiotherapy alone was historically used but results in 5-year OS of only 35-50%.
3) The current standard of care is chemoradiotherapy which provides excellent tumor control and improves outcomes over radiotherapy alone, with 5-year OS of 70-80% for early stages and 50% for advanced stages.
IGRT & IMRT In Head Neck Cancer
This document discusses intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) for head and neck cancers. It provides details on contouring targets and organs at risk for treatment planning. It summarizes evidence from trials on reducing xerostomia with IMRT. It also discusses the benefits of daily imaging with IGRT for accurate treatment delivery and potentially reducing planning target volume margins. Adaptive planning is mentioned as an area that continues to be explored to account for anatomical changes over the course of radiation treatment.
CT-Guided Percutaneous Pulse-Dose Radiofrequency for Pudendal Neuralgia
This document describes a study evaluating CT-guided pulse-dose radiofrequency (PDRF) for treating pudendal neuralgia (PN). 30 patients with PN were treated with PDRF of the pudendal nerve under CT guidance. Patients reported significant reductions in pain after 1 week, with further reductions at 6 months and 1 year. The study concluded that CT-guided PDRF should be recommended for PN due to satisfactory results and tolerability of the procedure.
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Mr imaging guided focused ultrasound - Dr. P. Seynaeve
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Pulsed radiofrequency ablation of pudendal nerve for treatment of a case of r...
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A Case Report of Bilateral Trigeminal Neuralgia Combined with Bilateral Gloss...
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Ultrasound guided pulsed radiofrequency treatment of the pudendal nerve in ch...
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Vision for future of Nuclear medicine department.pptx
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Intracranial dural av fistula with spinal perimedullary venous drainage rare ...
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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Breast cancer: Post menopausal endocrine therapy
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Endocrine Therapy
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
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Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
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Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
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Asian gks meeting version
- 1. Neurosurgery Department Shuang Ho Hospital New Taipei City, Taiwan Wei-Lun Lo, M.D. THE APPLICATION OF PERFEXION GAMMA KNIFE RADIOSURGERY FOR INFRA-SKULL BASE LESIONS
- 2. TECHNICAL LIMIT OF GKS Traditional lower limit of treatment related to lesion locations: Foramen mangnum Kondziolka et al: Radiosurgery of meningiomas. Neurosurg Clin N Am 3:219–230, 1992 However, the data from new Perfexion version was not included. J Craniovertebr Junction Spine. 2010 Jan-Jun; 1(1): 23-28
- 3. • Primary lesion at neck • Extracranial ↑↓ Intracranial POSTING DIFFICULTY FOR GKS
- 4. COMPARISON OF GK SYSTEMS
- 5. CASE DISTRIBUTION (N = 14) Meningioma Paraganglioma Low brain stem cavernoma Trigeminal neuroma Low cranial nerve neuroma Skull base metastasis Dural arteriovenous fistula 3 4 1 3
- 6. Paraganglioma 39 y/o female horseness and dysphonia; paraganglioma from posterior fossa with extension to neck region s/p partial resection by ENT doctor 2013/10/15 TV: 18.3 2014/4/22 TV: 7 Volume: 18.3c.c. RV: 23.5c.c. PD: 12.5 Gy MD: 22.3 Gy ID: 56% Mean dose: 16.7 Gy
- 7. Foramen Mangnum Meningioma 37 year-old female Meningiomatosis in petroclival, foramen magnum , and ventral C5 regions s/p surgical excision of C5 meningioma 2013/8/23 TV: 1.2 2014/2/24 TV: 1.2 Volume: 1.2 c.c. RV: 3.3 c.c. PD: 12 Gy MD: 21.8 Gy ID: 55% Mean dose: 16.6 Gy
- 8. Skull Base Metastasis 74 year-old female Hx of breast cancer s/p operation; facial numbness, difficult swallowing, tongue atrophy 2013/7/11 TV: 27.2 2014/7/24 TV: 3.5 Marked regression Improvement of tongue atrophy & swallowing function Volume: 27.2 c.c. RV: 35.2 c.c. PD: 12.8 Gy MD: 24.6 Gy ID: 52% Mean dose: 17.5 Gy
- 9. PRELIMINARY RESULT Tumor • Tumor shrinkage, stationary, or loss of central enhancement in all cases Vascular lesion • No interval hemorrhage in follow up period
- 10. MOTION ERROR J Neurosurg (Suppl) 117: 211-216, 2012 Cervical Immobilization !!
- 11. GKS FOR EXTRACRANIAL LESION: CAROTID BODY TUMOR C2 C3
- 12. PRE-TREATMENT MANAGEMENT Cervical immobilizationFeasibility evaluation
- 13. TV: 3.2 c.c. Radiation volume: 4.8 c.c. Peripheral dose: 15.5 Gy Maximum dose: 28.2 Gy Isodose level at periphery: 55% Mean dose: 22.4 Gy
Editor's Notes
- 06279082 江秋萍
- 05971899 樂嘉芳
- 張簡秀琴 06014146