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Hasegawa T.,Komaki City Hospital | Kato T.,Komaki City Hospital | Kida Y.,Kamiiida Daiichi General Hospital | Hayashi M.,Tokyo Womens Medical University | And 8 more authors.
Journal of neurosurgery | Year: 2016

OBJECTIVE: The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs).METHODS: This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm(3), and the median prescription dose to the tumor margin was 12 Gy.RESULTS: The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of ≤ 50 dB before treatment retained serviceable hearing.CONCLUSIONS: GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing deterioration as an adverse effect of radiation was low. These results suggest that GKS is a safe alternative to resection.

Hirono S.,Chiba University | Iwadate Y.,Chiba University | Higuchi Y.,Chiba University | Serizawa T.,Tokyo Gamma Unit Center | And 3 more authors.
Journal of Neuro-Oncology | Year: 2015

The efficacy of stereotactic radiosurgery (SRS) instead of whole brain radiotherapy (WBRT) following high-dose methotrexate (HD-MTX) for primary central nervous system lymphoma (PCNSL) is unclear. To clarify whether SRS in combination with up-front HD-MTX supplements the effect of HD-MTX in remaining or refractory lesions after initial HD-MTX treatment. The authors conducted a retrospective review for newly diagnosed PCNSL patients who underwent SRS after HD-MTX as a first-line treatment. The local control (LC), the progression-free survival (PFS), the recurrence patterns, the salvage treatments, the overall survival (OS), the Karnofsky Performance Status (KPS), the activities of daily living (ADL) were analyzed as well as radiosurgical parameters. Twenty patients underwent SRS for 51 lesions with the median volume of 0.45 cm3. The median age at SRS was 67 (range 37–82). The median KPS at SRS was 90. The LC rate at 2 years was 86.0 %, the median PFS after SRS was 17 months, necessitating additional SRS and chemotherapy. The median OS was 52 months. No significant side effects related to SRS were observed. During follow-up period, the good ADL preservation was achieved for 13 months from SRS. Patients with KPS ≥ 90 at SRS demonstrated longer ADL preservation (32 months from SRS). SRS following up-front HD-MTX without WBRT provided excellent LC, acceptable OS and the long ADL preservation period. These benefits may be more emphasized especially in patients with good KPS, but should be validated in a large patient population. © 2015, Springer Science+Business Media New York.

Suzuki M.,Yamaguchi University | Ono J.,Chiba Cerebral and Cardiovascular Center | Ogawa T.,Jikei University School of Medicine | Suehiro E.,Yamaguchi University
Japanese Journal of Neurosurgery | Year: 2014

The Japan Neurotrauma Data Bank(JNTDB)was established in 1996, and has conducted 2-year studies to register patients presenting with serious neurological status as Glasgow Coma Scale 8 or less on admission three times in 1998, 2004, 2009, and ever since. Data for over 200 items were obtained from each patients. The total number of registered cases is approximately 3,000 to date. A new project consisting of 30 institutes will take off in 2015 under a newly arranged system. Fruitful results have been harvested as follows. We have found 1)a decrease in the number of cases presenting serious neurological status, 2) a decrease in the number of patients having diffuse injury, and 3) an increase in cases where fall/tumble are the causes of injury, instead of a decrease in traffic accident and vice versa. From the aspect of treatment, we have also found a couple of interesting results as 1) intracranial pressure(ICP)monitoring was performed in 30% and 2)any kind of surgery was performed in 50% of cases, and 3)management of body temperature was carried out in 40%. Further, overall mortality decreased but the number of patients showing a vegetative state categorized by Glasgow Outcome Scale increased inversely. The One Week Study(OWS), a cross-sectional nationwide registry of head injury that was also conducted by JNTDB, tried to validate patients’ selection bias regarding the JNTDB Project. Most factors of bias were denied but others such as age and incidence of multiple injuries remained to be considered. The relatively small number of cases registered with the JNTDB and OWS was a disadvantage and analyzing the real world scenario in Japan is an intricate and difficult task. To solve this problem several approaches could be fielded such as participation in the Japan Trauma Data Bank or National Clinical Database and founding an interoperable platform, or utilizing data from the Diagnosis Procedure Combination. A randomized controlled trial performed by JNTDB members themselves may be an alternative way to shape the future of research in neurotrauma in our country. © 2014, Japanese Congress of Neurological Surgeons. All rights reserved.

Kotani K.,Hamamatsu University School of Medicine | Tashiro J.,Chiba Cerebral and Cardiovascular Center | Yamazaki K.,Chiba Cerebral and Cardiovascular Center | Nakamura Y.,Chiba Cerebral and Cardiovascular Center | And 5 more authors.
Clinica Chimica Acta | Year: 2015

Background: Although increased circulating levels of malondialdehyde-modified low-density lipoprotein (MDA-LDL) are associated with coronary artery disease (CAD), there is no direct evidence that increased MDA-LDL is a prognostic factor for CAD. Methods: Forty-two patients (20 diabetic and 22 non-diabetic patients) who underwent percutaneous coronary intervention (PCI) were enrolled, and their baseline MDA-LDL levels were determined by immunoassay. Follow-up coronary angiography was performed at 2 to 7 months post-PCI. The patients were then divided into 2 groups, with in-stent restenosis (ISR) (n = 13) and without ISR (n = 29), and the baseline MDA-LDL levels were compared. We also studied 34 diabetics with CAD for up to 57 months until the onset of the next coronary event. Results: In the diabetic patients, the mean MDA-LDL level was significantly higher in those with ISR than in those without ISR (151 +/- 61 vs. 90 +/- 26 U/l, p = 0.010). A baseline MDA-LDL value of 110 U/l for differentiating between diabetics with and without ISR was defined as the cut-off value. Kaplan-Meier analysis demonstrated that a circulating MDA-LDL of ≥ 110 U/l correlated significantly with a higher prevalence of cardiac events than MDA-LDL < 110 U/l (p = 0.032). Conclusions: Circulating MDA-LDL is a useful prognostic marker for future cardiac event in diabetic patients with CAD. © 2015 Elsevier B.V.

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