Saturday, September 13, 2014

Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes

Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents

Journal of Neurosurgery, Volume 121, Issue 3, Page 505-510, September 2014.
Object Cavernous sinus (CS) invasion is the most important preoperative predictor of remission in the surgical treatment of growth hormone–producing pituitary adenomas. The purpose of this study was to evaluate the effectiveness of an aggressive technique for removal of tumors invading the CS in patients with acromegaly. Methods The authors retrospectively reviewed the cases of 150 consecutive patients with acromegaly who underwent primary transsphenoidal surgery in 2010 and 2011. The authors reviewed preoperative Knosp grade, intraoperative findings, histology of the medial wall of the CS, and surgical outcome according to the current consensus criteria for acromegaly. Results Cavernous sinus invasion was identified in 55 patients (36.7%): definite CS involvement by the tumor was observed under direct vision in 41 patients (74.5%), while invasion was histologically verified in 39 patients (70.9%). Invasion increased in frequency with the higher Knosp grade but was observed in 14.4% (13 of 90) of Grade 0 and 1 tumors. Overall, the remission rate fulfilling stringent criteria was 84.7% (127 of 150). Although CS invasion was significantly associated with an unfavorable outcome (p < 0.0001), remission was achieved in 69.1% (38 of 55) of patients with invasion. No major complications occurred in this series. Conclusions Cavernous sinus invasion is the most significant, independent predictor of unfavorable outcome. Confirmation of invasion requires direct observation within the CS regardless of the microscope or endoscope used. Particularly in cases in which only the medial wall is involved, histological verification is always necessary to detect the occult invasion. Direct removal of the invading tumor, by sharp excision of the medial wall of the CS, is effective and safe and increases the chance of remission.

Original Article: http://thejns.org/doi/abs/10.3171/2014.3.JNS132214?ai=ru&mi=0&af=R

Friday, September 12, 2014

Fwd: I Simpósio de Neuro-Oncologia

To: Serviço de Apoio ao Medico <sam@bpsp.org.br>
Subject: I Simpósio de Neuro-Oncologia

 

Saturday, September 6, 2014

Handheld scanner could make brain tumor removal more complete, reducing recurrence

Handheld scanner could make brain tumor removal more complete, reducing recurrence
Neurology News & Neuroscience News from Medical News Today

Cancerous brain tumors are notorious for growing back despite surgical attempts to remove them - and for leading to a dire prognosis for patients.

Original Article: http://www.medicalnewstoday.com/releases/282033.php

Tuesday, September 2, 2014

Resection of spinal hemangioblastoma

Resection of spinal hemangioblastoma
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents

Neurosurgical Focus, Volume 37, Issue Suppl2, Page Video 15, September 2014.
Spinal cord hemangioblastomas occur as sporadic lesions or in the setting of Von Hippel-Lindau disease. In this intraoperative video we present a case of sporadic cervical cord hemangioblastoma and illustrate the main surgical steps to achieve safe and complete resection which include: identification and division of the feeding arteries; careful circumferential dissection of the tumor from the surrounding gliotic cord; identification, isolation and division of the main venous drainage and single piece removal of the tumor. The video can be found here: http://youtu.be/I7DxqRrfTxc.

Original Article: http://thejns.org/doi/abs/10.3171/2014.V3.FOCUS14379?ai=rw&mi=3ba5z2&af=R

Microsurgical technique in excision of intramedullary craniocervical ependymomas. Video report

Microsurgical technique in excision of intramedullary craniocervical ependymomas. Video report
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents

Neurosurgical Focus, Volume 37, Issue Suppl2, Page Video 17, September 2014.
We present the microsurgical technique in excision of intramedullary craniocervical ependymomas. A 27-year-old female came presenting with neck pain and parasthesia in her both arms and hands, where MRI was performed showing intramedullary lesion that extend in the medulla just beyond the foramen magnum to the level of C5–6 disc. Tumor was totally excised using irrigation-dissection microscopic technique with favorable outcome. The video can be found here: http://youtu.be/Yj1yvZOaz58.

Original Article: http://thejns.org/doi/abs/10.3171/2014.V3.FOCUS14391?ai=rw&mi=3ba5z2&af=R

The natural history of AVM hemorrhage in the posterior fossa: comparison of hematoma volumes and neurological outcomes in patients with ruptured infra- and supratentorial AVMs

The natural history of AVM hemorrhage in the posterior fossa: comparison of hematoma volumes and neurological outcomes in patients with ruptured infra- and supratentorial AVMs
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents

Neurosurgical Focus, Volume 37, Issue 3, Page E6, September 2014.
Object Patients with posterior fossa arteriovenous malformations (AVMs) are more likely to present with hemorrhage than those with supratentorial AVMs. Observed patients subject to the AVM natural history should be informed of the individualized effects of AVM characteristics on the clinical course following a new, first-time hemorrhage. The authors hypothesize that the debilitating effects of first-time bleeding from an AVM in a previously intact patient with an unruptured AVM are more pronounced when AVMs are located in the posterior fossa. Methods The University of California, San Francisco prospective registry of brain AVMs was searched for patients with a ruptured AVM who had a pre-hemorrhage modified Rankin Scale (mRS) score of 0 and a post-hemorrhage mRS score obtained within 2 days of the hemorrhagic event. A total of 154 patients met the inclusion criteria for this study. Immediate post-hemorrhage presentation mRS scores were dichotomized into nonsevere outcome (mRS ≤ 3) and severe outcome (mRS > 3). There were 77 patients in each group. Univariate and multivariate logistic regression analyses using severe outcome as the binary response were run. The authors also performed a logistic regression analysis to measure the effects of hematoma volume and AVM location on severe outcome. Results Posterior fossa location was a significant predictor of severe outcome (OR 2.60, 95% CI 1.20–5.67, p = 0.016) and the results were strengthened in a multivariate model (OR 4.96, 95% CI 1.73–14.17, p = 0.003). Eloquent location (OR 3.47, 95% CI 1.37–8.80, p = 0.009) and associated arterial aneurysms (OR 2.58, 95% CI 1.09, 6.10; p = 0.031) were also significant predictors of poor outcome. Hematoma volume for patients with a posterior fossa AVM was 10.1 ± 10.1 cm3 compared with 25.6 ±28.0 cm3 in supratentorial locations (p = 0.003). A logistic analysis (based on imputed hemorrhage volume values) found that posterior fossa location was a significant predictor of severe outcome (OR 8.03, 95% CI 1.20–53.77, p = 0.033) and logarithmic hematoma volume showed a positive, but not statistically significant, association in the model (p = 0.079). Conclusions Patients with posterior fossa AVMs are more likely to have severe outcomes than those with supratentorial AVMs based on this natural history study. Age, sex, and ethnicity were not associated with an increased risk of severe outcome after AVM rupture, but posterior fossa location, associated aneurysms, and eloquent location were associated with poor post-hemorrhage mRS scores. Posterior fossa hematomas are poorly tolerated, with severe outcomes observed even with smaller hematoma volumes. These findings support an aggressive surgical posture with respect to posterior fossa AVMs, both before and after rupture.

Original Article: http://thejns.org/doi/abs/10.3171/2014.7.FOCUS14211?ai=rw&mi=3ba5z2&af=R

Saturday, August 30, 2014

Effect of Direct Neuroradiologist Participation in Physician Marketing on Imaging Volumes in Outpatient Radiology

Effect of Direct Neuroradiologist Participation in Physician Marketing on Imaging Volumes in Outpatient Radiology
AJNR Blog

Editor's Choice

August 2014

(2 of 3)

This study assessed the benefits of using a sales representative and a neuroradiologistas a marketing and sales team for referrals in outpatient imaging. When referring practices were visited by the 2-person team, referral volumes were 2.5 times greater than when they were visited by the sales representative alone. This impact on imaging referral volumes with the use of the neuroradiologist for direct physician-to-physician marketing supports the concept that neuroradiologist visits are important in establishing and maintaining a relationship with the referring clinician's office and maximizing imaging referrals.

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Abstract

BACKGROUND AND PURPOSE
Over the past several years, decreased demand for and increased supply of imaging services has increased competition among outpatient imaging centers in the United States. This study hypothesizes that using a radiology sales representative and neuroradiologist as a team in marketing and sales will increase imaging referrals in outpatient imaging.

MATERIALS AND METHODS
From January to December 2009, baseline monthly physician referral data of CT and MR scans of 19 referring clinicians (neurologists, neurosurgeons, and anesthesiologists) to an outpatient radiology group were collected. During that time, a nonphysician radiology sales representative visited the referring clinicians' offices every 2 weeks. From January to June 2010, the same radiology sales representative visited the referring clinicians' offices every 2 weeks but was accompanied by a neuroradiologist once a month. From July 2010 to June 2011, the same radiology sales representative visited the referring clinicians' offices twice a month without a neuroradiologist.

RESULTS
Cross-sectional imaging referral volumes were approximately 2.5 times greater during the 6-month period using the neuroradiologist for direct physician-to-physician marketing when compared with the volumes achieved with the sales representative alone, and continued neuroradiologist involvement in marketing and sales is required to maintain referral volumes over time.

CONCLUSIONS
The impact on imaging referral volumes during the 6-month use of the neuroradiologist for direct physician-to-physician marketing in this study supports the assertion that neuroradiologist visits are an important element in establishing and maintaining a relationship with the referring clinician's office and thereby maximizing imaging referrals.

Full text

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Original Article: http://www.ajnrblog.org/2014/08/30/effect-direct-neuroradiologist-participation-physician-marketing-imaging-volumes-outpatient-radiology/

Friday, August 29, 2014

Após um tumor cerebral - iBook e Android

APÓS UM TUMOR CEREBRAL

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APÓS UM TUMOR CEREBRAL

Júlio Pereira

Category: Medical

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Cancer survivors' uptake and adherence in diet and exercise intervention trials: An integrative data analysis

Cancer survivors' uptake and adherence in diet and exercise intervention trials: An integrative data analysis
Cancer

BACKGROUND

The health benefits of diet and exercise interventions for cancer survivors are well documented. However, little is known regarding demographic and medical predictors of survivors' willingness to participate in diet and exercise intervention trials, study enrollment, intervention adherence, and study completion. To assist in interpreting the generalizability of trial findings and to improve the design of future trials, this study examined predictors of these process measures.

METHODS

An integrative data analysis was performed on data from 3 of the largest home-based diet and exercise intervention trials for cancer survivors (n = 23,841). Demographic and medical factors (ie, sex, race, age, time since diagnosis, and cancer type) were examined as predictors of willingness to participate, study enrollment, intervention adherence, and study completion in the pooled sample. A 99% confidence interval was used to determine statistical significance.

RESULTS

Across trials, 11.1% of contacted survivors were willing to participate, and 5.7% were eligible and enrolled. Among enrollees, 53.4% demonstrated ≥75% adherence to the intervention, and 91.1% completed the study. Race (Caucasian vs others), age, time since diagnosis, and cancer type predicted survivors' willingness to participate (P < .01). All examined predictors were associated with the likelihood of study enrollment (P < .01). No significant predictors of intervention adherence or study completion were found among study enrollees (P ≥ .01).

CONCLUSIONS

Cancer survivors' demographic and medical characteristics predicted their interest and participation in diet and exercise intervention trials. These findings have implications for the generalizability of results and can help to guide procedures used in future trials to enhance patient representation. Cancer 2014. © 2014 American Cancer Society.



Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28978

Evaluation of high-fidelity simulation training in radiation oncology using an outcomes logic model

Evaluation of high-fidelity simulation training in radiation oncology using an outcomes logic model
Radiation Oncology - Latest Articles

Purpose: To evaluate the feasibility and educational value of high-fidelity, interprofessional team-based simulation in radiation oncology. Methods: The simulation event was conducted in a radiation oncology department during a non-clinical day. It involved 5 simulation scenarios that were run over three 105 minute timeslots in a single day. High-acuity, low-frequency clinical situations were selected and included HDR brachytherapy emergency, 4D CT artifact management, pediatric emergency clinical mark-up, electron scalp trial set-up and a cone beam CT misregistration incident. A purposive sample of a minimum of 20 trainees was required to assess recruitment feasibility. A faculty radiation oncologist (RO), medical physicist (MP) or radiation therapist (RTT), facilitated each case. Participants completed a pre event survey of demographic data and motivation for participation. A post event survey collected perceptions of familiarity with the clinical content, comfort with interprofessional practice, and event satisfaction, scored on a 1-10 scale in terms of clinical knowledge, clinical decision making, clinical skills, exposure to other trainees and interprofessional communication. Means and standard deviations were calculated. Results: Twenty-one trainees participated including 6 ROs (29%), 6 MPs (29%), and 9 RTTs (43%). All 12 cases (100%) were completed within the allocated 105 minutes. Nine faculty facilitators, (3MP, 2 RO, 4 RTTs) were required for 405 minutes each. Additional costs associated with this event were 154 hours to build the high fidelity scenarios, 2 standardized patients (SPs) for a total of 15.5 hours, and consumables.The mean (+/-SD) educational value score reported by participants with respect to clinical knowledge was 8.9 (1.1), clinical decision making 8.9 (1.3), clinical skills 8.9 (1.1), exposure to other trainees 9.1 (2.3) and interprofessional communication 9.1 (1.0). Fifteen (71%) participants reported the cases were of an appropriate complexity. The importance of further simulation events was rated highly at 9.1/10. Conclusions: High-fidelity simulation training is feasible and effective in a radiation oncology context. However, such educational activities require significant resources, including personnel and equipment.

Original Article: http://www.ro-journal.com/content/9/1/189