ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

OBJECTIVE:Despite advances in conventional therapy, the prognosis for most glioma patients remains dismal. This has prompted an intensive search for effective treatment alternatives. Immunotherapy, one such alternative, has long been recognized as a potentially potent cancer treatment but has been limited by an inadequate understanding of the immune system. Now, increased insight into immunology is suggesting more rational approaches to immunotherapy. In this article, we explore key aspects of modern immunology and discuss their implications for glioma therapy.METHODS:A thorough literature review of glioma immunology and immunotherapy was undertaken to inquire into the basic immunology, central nervous system immunology, glioma immunobiology, standard glioma immunotherapy, and recent immunotherapeutic advances in glioma treatment.RESULTS:Although gliomas express tumor-associated antigens and appear potentially sensitive to immune responses, many factors work together to inhibit antiglioma immunity. Not surprisingly, most clinical attempts at glioma immunotherapy have met with little success to date. However, novel immunostimulatory strategies, such as immunogene therapy, directed cytokine delivery, and dendritic cell manipulation, have recently yielded dramatic preclinical results in glioma models. This suggests that glioma-derived immunosuppression can be overcome.CONCLUSION:Modern molecular biology and immunology techniques have yielded a wealth of new data about glioma immunobiology. Armed with this information, many investigators have proposed novel means to stimulate antiglioma immune responses. Although definitive clinical results remain to be seen, the current renaissance in glioma immunology and immunotherapy shows great promise for the future.

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

OBJECTIVE:Spontaneous intracranial hemorrhage is the primary danger for patients with cerebral arteriovenous malformations (AVMs). Associated aneurysms are considered weak points that increase the risk of intracranial hemorrhage. Aneurysms are classified as proximal aneurysms (PROXs) or intranidal aneurysms (INs).METHODS:The present study was based on a series of 662 patients who presented with AVMs between 1985 and 1995. Its purpose was to evaluate prestated hypotheses using prospectively collected data. In 305 of these 662 patients, 372 INs and 313 PROXs were observed and analyzed with respect to their shapes, locations, and sizes. Partial targeted endovascular treatment withn-butylcyanoacrylate was performed for 450 of the 662 patients (68%) in this series, using a standard protocol. Of 450 treated patients, 181 (40%) had at least one IN and 138 (30.7%) had at least one PROX. Analysis of changes in the sizes of PROXs was based on the follow-up data for 83 treated patients, with a total of 149 PROXs. Changes in the sizes of PROXs in treated patients were analyzed with respect to PROX shapes, PROX locations, and treated AVM occlusion rates. Univariate and multivariate event data analyses were used to study factors influencing aneurysm shrinkage. False aneurysms were excluded from the series.RESULTS:Presentation with intracranial hemorrhage was not correlated with any type of aneurysm. However, INs demonstrated a higher rebleeding rate (P< 0.002) before treatment. Among 181 patients, 92.2% of INs were occluded, together with the related portions of the AVM nidi. In cases of PROXs, embolization of the cerebral AVM compartment fed by the artery with the aneurysm was a priority. During follow-up monitoring of 83 treated patients with 149 PROXs, 100% shrinkage was observed for 12 PROXs and more than 50% shrinkage was observed for 33 PROXs. The median time required for more than 50% shrinkage was 3.5 years. The shrinkage of PROXs was influenced by the degree of AVM occlusion (P= 0.027) and occurred faster for PROXs on midline structures, such as the anterior cerebral artery and the circle of Willis, compared with arteries distal to the circle of Willis (P= 0.004). No rupture of untreated PROXs was observed after partial targeted treatment of AVMs.CONCLUSION:PROXs are not primary treatment targets, compared with AVMs themselves. INs should be primary targets of endovascular therapy, because of their increased risk of rebleeding.

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

OBJECTIVE:To investigate whether angiograms obtained 2 years after radiosurgery, proving total arteriovenous malformation (AVM) occlusion, represent the final state of treated AVMs and adjacent normal vessels.METHODS:Angiograms were obtained for 48 patients 5 to 24 years after gamma knife radiosurgery and 4 to 17 years after the AVMs had been proven to be totally occluded after the treatment; changes in normal vessels and signs of recanalization were recorded. Ten of the patients developed clinical symptoms attributable to the AVMs or the treatment after having been declared cured, whereas the other patients did not exhibit symptoms.RESULTS:There was evidence of AVM nidi at the sites of previously occluded AVMs for two patients and of nidi adjacent to those sites for another two patients. Three of the four recurrent AVMs were associated with hemorrhaging. All patients who experienced hemorrhaging from previously occluded AVMs were ≤14 years of age at the time of gamma knife radiosurgery. There were signs of segmental narrowing in normal vessels that had been irradiated with high doses (nine patients) or a low dose (one patient). The segmental narrowing decreased with time for four of these patients, was unchanged for four, and increased for two. These vascular changes did not produce clinical symptoms in any of the patients.CONCLUSION:There is a small possibility that AVMs may reappear after having been totally occluded after radiosurgery, especially in pediatric patients. Segmental narrowing in normal arteries after radiosurgery is a benign condition that rarely progresses and does not produce clinical symptoms.

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

OBJECTIVE:Micro-arteriovenous malformations (AVMs) represent approximately 8 to 10% of surgically treated brain AVMs. We examined the clinical presentations, radiological features, principles of surgical resection, and factors affecting outcomes for micro-AVM lesions.METHODS:Twelve patients with micro-AVMs that had been treated by surgical resection were retrospectively analyzed. The mean follow-up monitoring period was 35 months (range, 2–76 mo). Outcomes, as assessed in follow-up visits and telephone interviews (using a questionnaire), were classified according to the Glasgow Outcome Scale.RESULTS:All 12 patients presented with intracranial hemorrhage, which was intraparenchymal and superficially situated in 10 patients (83%) and intraventricular in 2 patients (17%). Hemorrhages were large (mean volume, 23 ml3; range, 1–58 ml3) and were associated with neurological deficits for 10 of 12 patients (83%). The identification of an arterialized draining vein during surgery and stereotactic angiography greatly facilitated surgical localization of the lesions. One patient (8%) developed a mild permanent deficit as a result of surgery. Although Glasgow Outcome Scale scores were excellent for all except one patient, nine patients (75%) experienced long-term neurological problems.CONCLUSION:Micro-AVMs typically present with large hemorrhages and are associated with significant neurological deficits. If a superficial clot is present, surgical resection of the lesion is strongly advocated. The ultimate clinical outcomes are determined primarily by deficits present after the initial hemorrhaging episodes.

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

OBJECTIVE:To describe the neuro-ophthalmic findings in patients with orbital drainage from cerebral arteriovenous malformations (AVMs).METHODS:We reviewed the records of 100 consecutive adult patients with cerebral AVMs who presented to our institution during a 4-year period. All patients with orbital drainage were identified, and their neuro-ophthalmic evaluations were reviewed.RESULTS:Three patients (3%) were identified with orbital drainage from a cerebral AVM. The first patient presented with typical chiasmal syndrome (reduced visual acuity, bitemporal hemianopia, and optic atrophy). Magnetic resonance imaging demonstrated a large left temporal and parietal lobe AVM with compression of the chiasm between a large pituitary gland and a markedly enlarged carotid artery. The second patient presented with headaches and postural monocular transient visual obscurations. Examination revealed normal visual function with minimal orbital congestion and asymmetrical disc edema, which was worse in the left eye. Magnetic resonance imaging revealed a large right parietal and occipital lobe AVM without mass effect or hemorrhage and an enlarged left superior ophthalmic vein. The third patient had no visual symptoms and a normal neuro-ophthalmic examination; a right parietal lobe AVM was discovered during an examination for the cause of headaches.CONCLUSION:Orbital drainage from cerebral AVMs is rare. Manifestations may include anterior visual pathway compression, dilated conjunctival veins, orbital congestion, and asymmetrical disc swelling.

ISSN:0148-396X    

出版商:OVID    

年代:2000

数据来源: OVID