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At least 19 recordsLinked to original sources
PubMed2024

Clinicogenomic predictors of survival and intracranial progression after stereotactic radiosurgery for colorectal cancer brain metastases.

OBJECTIVE: Brain metastases (BM) from colorectal cancer (CRC) are associated with dismal prognosis. When BM-directed therapy is considered, better methods are needed to identify patients at risk of poor oncological outcomes in order to optimize patient selection for closer surveillance or escalated therapy. The authors sought to identify clinicogenomic predictors of survival and intracranial disease progression after CRC BM have been treated with stereotactic radiosurgery (SRS). METHODS: Patients with newly diagnosed CRC BM treated with SRS between 2009 and 2022 who had next-generation genomic sequencing data available were included. Frameless SRS was delivered in 1-5 fractions, alone or after neurosurgical resection. Outcomes included overall survival (OS) and intracranial progression (IP), evaluated per patient treated with SRS, and local progression (LP), evaluated per BM. Associations between baseline clinicogenomic features and outcomes were evaluated with Cox regression and competing risk regression, with death as a competing risk. RESULTS: This analysis included 123 patients with 299 BM. At BM diagnosis, 111 patients (90%) had progressive extracranial disease, and 79 patients (64%) had ≥ 3 sites of extracranial metastasis. The median (IQR) number of BM was 2 (1-3) per patient. The median (IQR) biologically effective dose (BED) was 51.3 (51.3-65.1) Gy, corresponding to a prescription of 27 Gy in 3 fractions. OS, IP, and LP estimates at 1 year after SRS were 36%, 55%, and 12%, respectively. OS was independently associated with progressive extracranial disease (HR 4.26, 95% CI 1.63-11.2, p = 0.003) and ≥ 3 extracranial metastatic sites (HR 1.84, 95% CI 1.12-3.01, p = 0.02). LP was less likely when BM received BED ≥ 51.3 Gy (HR 0.24, 95% CI 0.07-0.78, p = 0.02), independent of BM diameter (HR 1.21/cm, 95% CI 0.8-1.84, p = 0.4). IP was independently associated with genomic alterations; TP53 driver alterations were associated with higher risk of IP (HR 2.71, 95% CI 1.26-5.79, p = 0.01), whereas MYC pathway alterations were associated with lower risk (HR 0.15, 95% CI 0.03-0.68, p = 0.01). CONCLUSIONS: The authors identified clinicogenomic features associated with adverse outcomes after SRS for CRC BM. Progressive and extensive extracranial metastases predicted worse OS. Insufficient SRS doses predicted greater risk of LP. Wild-type TP53 and alterations in the MYC pathway were independently associated with lower risk of IP. Patients at high risk of IP may be considered for closer surveillance or escalated therapy.

Humans↗
PubMed1977

Multiple progressive intracranial arterial occlusions ('moyamoya' disease).

Four adult female patients with moyamoya vessels are described. Hypertension and hyperlipidaemia were discovered in three patients. Vessels similar to moyamoya vessels were seen in the orbital and cortical collateral vessels as well as in the basal ganglia region. Attention should now be paid to the aetiological rather than the descriptive aspects of the disorder. An empirical trial of corticosteroids is worth while. Risk factors such as hypertension, hyperlipidaemia, and smoking should be eliminated.

Adrenal Cortex Hormones↗
PubMed1979

[Miniaturized methods to monitor intracranial pressure. Technical and clinical results (author's transl)].

The prognosis of numerous diseases of the central nervous system is essentially determined by the intracranial pressure (ICP) and its therapeutic influencing. Long-term monitoring of the ICP must therefore be the objective in neurological and neurosurgical patients at risk. For this purpose, miniaturized methods were tested and developed. To monitor the intracranial pressure in patients who were not operated on, a miniature pressure transducer the size of a match head was used which was directly implanted 'percutaneously' in the intensive care unit: After a stab wound had been made in the skin, a 5-mm burrhole is made; the specially constructed miniature coaxial burr which disengages as soon as it touches the dura automatically enables coplanar epidural implantation of the transducer by means of an adapter capsule. The skin is closed without tension. For monitoring the pressure after trepanation, a spiralled miniature pressure transducer is implanted. The equally flattened receiver with lateral membranes is placed intracranially as desired, e.g., epidurally or subdurally, durin the operation. The zero point can be checked from outside without danger of infection. After the end of the measurements the recorder is easily extracted. Up to the present time, the epidural pressure has been reliably monitored for several weeks by this method in 86 patients. Ten comparative measurements showed corresponding cerebrospinal fluid pressures to within a few mm Hg with very good reproduction of frequency and amplitude. Small zero drift and the external zero control give an accuracy of measurement +/- 5 mm Hg independently of the time of measurement. The measurement permits early recognition of progressive intracranial space-occupying lesions. In 14 patients (16%) a measured rise in intracranial pressure was an essential basis for indication for neurosurgical operations. In addition, the pressure measurement provides an objective assessment of the effect of measures to lower the ICP; progressive increases in intracranial pressure which cannot be influenced conservatively can be brought for surgical decompression in good time before the brain has been irreversibly damaged by pressure. In craniocerebral traumata, monitoring the intracranial pressure permits the differentiation of primary damage to the brain stem with uniform, normal intracranial pressure from secondary constrictions of the brain stem with considerable rise of intracranial pressure and disturbed autoregulation. Only in chronic subdural haematomata are considerable displacements of intracranial masses to be seen with only slightly increased ICP ( less than 30 mm Hg). Besides space-occupying lesions, the measurement of pressure also detects generalised epileptic attakcs due to a considerable rise in intracranial pressure caused by hyperemia. Also disorders of respiration are recognised by supervision of ICP. The procedures described seem suitable for routine monitoring of ICP in patients at risk, with little operative effort and minimum danger...

Adolescent↗
PubMed1978

[Indication and treatment of frontobasal rhinoliquorrhoea from the ent-surgical and neurosurgical point of view (author's transl)].

This paper deals with some special questions based on joint neuro-rhinosurgical diagnostic and treatment of frontobasal injuries with rhinoliquorrhoea. The indications of the rhinosurgical transfronto-orbital approach with debridement of paranasal sinuses in the same stage are defined. Detailed technical instructions are given for treatment of "midline fractures". The transfrontal intradural approach of the neurosurgeon should be prefered: 1. If there is rhinoliquorrhoea combined with an extensive fracture of anterior skull base. 2. In cases of frontobasal liquor fistual--no matter of localisation and extension--with increasing spaceoccupation should the intracranial decompression be combined with duraplasty. Cerebral lesions with no progressive intracranial pressure should be treated first of all conservatively. The operative treatment of paranasal sinuses is not necessary in every case after transfrontal intradural surgery. X-ray controls have shown the spontaneous healing.

Cerebrospinal Fluid Rhinorrhea↗
PubMed2025

Intracranial and systemic progression on amivantamab in platinum-treated epidermal growth factor receptor exon 20 insertion-mutated advanced non-small cell lung cancer.

BACKGROUND: Amivantamab, an epidermal growth factor receptor (EGFR)-MET bispecific antibody, is approved as monotherapy and as combination therapy for patients with advanced non-small cell lung cancer (NSCLC) harboring various EGFR mutations in first-line and refractory settings. Sites of progressive disease on amivantamab monotherapy are not well understood and could be instructive for treatment management. METHODS: CHRYSALIS (NCT02609776) enrolled participants with NSCLC, including those with treated brain metastases. Brain magnetic resonance imaging was required at screening but performed per local practice after enrollment (conducted postbaseline every 6 [±1] weeks after Cycle 1 Day 1). Sites of target, non-target, and new lesion progression were reported. This analysis includes 114 participants with EGFR exon 20 insertion (Ex20ins) NSCLC after disease progression on platinum-based chemotherapy who received amivantamab monotherapy on or before June 4, 2020. RESULTS: As of March 30, 2021, the median follow-up was 12.5 months (range, 0.2-30.5). Among 114 participants, the objective response rate by blinded independent central review was 43 %; median duration of response was 10.8 months, and median progression-free survival was 6.7 months. RECIST-defined progressive disease occurred in 72/114 participants (63 %); 25/72 (35 %) continued amivantamab after progression (4.2 median additional months; range, 1.0-12.5). The most common first sites of progression were the lungs/pleura (29 %), followed by bone (21 %), brain (15 %), and lymph node (12 %). Thirteen participants (11 %) had intracranial-only first progression. Six of these 13 participants underwent stereotactic radiosurgery (SRS) while continuing amivantamab. The median duration of amivantamab treatment post-progression in these 6 participants was 4.0 months (range, 2.3-6.0). SRS was well tolerated, with 2 adverse events reported (nausea and fatigue, n = 1 each). CONCLUSIONS: Amivantamab monotherapy in post-platinum Ex20ins NSCLC demonstrated meaningful antitumor activity in participants, and intracranial-only progression was infrequent. Treatment of brain progression with SRS while continuing amivantamab appears feasible and tolerable.

Adult↗
PubMed1979

Primary cutaneous malignant melanoma metastatic to the iris.

We describe a case of cutaneous malignant melanoma metastatic to the iris as the first presenting sign of metastases 10 years after excision of the primary tumour. The histology of the excised iris metastases and the primary skin melanoma are compared. Progressive intracranial metastatic growth did not correlate with the observed regression of the residual intraocular melanoma cells during cyclical cytotoxic therapy.

Adult↗
PubMed1977

Systemic vascular responses to increased intracranial pressure. 1. Effects of progressive epidural ballon expansion on intracranial pressure: and systemic circulation.

This paper details the results of experimental studies, on 16 dogs with artificially-induced intracranial space-occupying lesions, of the systemic vascular responses and the intracranial pressure changes (both in the supratentorial and infratentorial compartments) induced by increasing intracranial pressure. The changes produced were divided into two phases such that phase 1 detailed the alterations observed from the start of the balloon inflation up to the initiation of the systemic pressor response. Phase 2 recorded those alterations which occurred during, and immediately after, the period of systemic hypertension (see Fitch et al., 1977). The changes observed during phase 1, and presented in this communication, were those of increasing intracranial pressures and decreasing mean arterial pressure and heart rate. These alterations were associated with decreases in supratentorial perfusion pressure and increases in transtentorial pressure gradient and arrhythmia index.

Animals↗
PubMed1978

Bilateral carotid-cavernous fistulae of mixed types with unusual radiological and neuropathological findings.

This report describes a case of bilateral post-traumatic carotid-carotid-cavernous fistulae (CCF), of both typical and atypical types, with delayed clinical deterioration. Unusual neuropathological lesions, distinctive from those due to direct cerebral trauma, are related to combined arterial ischemia and venous hypertension. Atypical CCF is not necessarily a benign disorder. Radiological monitoring is essential to detect spontaneous progressive intracranial shunting, to predict areas that are at risk from venous hypertension, and to identify remote sites of circulatory vulnerability.

Arteriovenous Fistula↗
PubMed1977

Optic disc edema in raised intracranial pressure. I. Evolution and resolution.

Progressively growing intracranial space-taking lesions were simulated in 32 rhesus monkeys by balloons introduced into the subarachnoid space of the temporal region. Optic disc edema (ODE) first appeared at the lower pole, then the upper pole, then the nasal part, and last the temporal part of the disc; severity of edema generally followed sult, most severe at the lower pole (P less than .005). Fluorescein fundus angiography showed that swelling of the optic disc preceded the vascular changes associated with ODE. Raised intracranial pressure for 24 hours, or less, could cause ODE. The atrophic part of the optic disc did not develop ODE. The studies indicate that swelling of the optic disc is the first sign of raised intracranial pressure and is due to swelling of the nerve fibers in the optic disc; the various associated vascular changes are secondary.

Animals↗
PubMed1979

An unusual case of multiple intracranial aneurysms.

A 49-year-old female patient with six intracranial aneurysms, all of which were treated successfully by direct surgery, is reported. She had a major subarachnoid haemorrhage 10 years ago. Because of difficulty in identifying the offending aneurysm she was not surgically treated at that time. The natural progression of intracranial aneurysms, the problem of identifying the lesion in a patient with multiple aneurysms, and an example of excellent recovery of visual function following surgical treatment are discussed.

Carotid Artery, Internal↗
PubMed1978

The influence of intravenous anaesthetic agents on primarily increased intracranial pressure.

In the choice of anaesthetics and techniques the danger of a possible progressive increase of intracranial pressure (ICP) should be considered. Therefore the influence of intravenous anaesthetic agents on mean arterial pressure, ICP, and cerebral perfusion pressure (CPP) in patients with primarily increased ICP was observed under standard conditions for 20-40 minutes. Etomidate, thiopentone, propanidid, and ketamine showed remarkable effects on ICP, even in patients with disturbed cerebro-vascular reactivity. Etomidate and thiopentone cause a fall of ICP by 26%. Because of its stabilizing effects on circulation etomidate does not induce a reduction of CPP, whereas thiopentone will do so because of its depressing effect on blood pressure. Propanidid appears to be a less suitable agent when there is raised ICP, because it induces fluctuations of ICP and blood pressure up to the third minute after injection. According to our results, monoanaesthesia with ketamine cannot be recommended when there is increased ICP because it causes a prolonged increase in ICP, and reduction of blood pressure and CPP.

Adolescent↗
PubMed1977

Sclerosteosis - an autosomal recessive disorder.

Sclerosteosis is a rare, potentially lethal skeletal disorder in which massive bony over-growth leads to facial distortion, cranial nerve compression and progressive rise in intracranial pressure. Gigantism and syndactyly of the 2nd and 3rd fingers are associated features. In a nationwide investigation in South Africa, 25 affected individuals in 15 Afrikaner kindreds have been studied. The minimum prevalence of the contition in this community is 1 in 75,000. Analysis of pedigree data confirms that sclerosteosis is an autosomal recessive condition. The gene frequency in the Afrikaner people is estimated at 0.0035, with 10,000 clinically normal heterozygotes in this population. Heterozygote detection may be possible on a basis of recognition of minor changes which are apparent on skull radiographs.

Abnormalities, Multiple↗
PubMedDate not supplied

Lactate and pyruvate concentrations, and acid-base balance of cerebrospinal fluid in experimentally induced intracerebral and subarachnoid hemorrhage in dogs.

The effect of blood injected into either subarachnoid space or subcortical brain tissue upon lactate and pyruvate concentrations as well as acid-base balance of cerebrospinal fluid (CSF) was studied in the anesthetized dog. CSF lactate and lactate/pyruvate ratio (L/P ratio) increased progressively following the intracranial injection of blood and reached the maximum level at six hours after injection. These changes were significantly greater in animals with intracerebral hematoma than in those with subarachnoid hemorrhage (SAH). An increase in CSF lactate and L/P ratio in hemorrhagic CSF seems to be caused by two different factors. Shed blood cells per se produce lactate and pyruvate, and blood in the subarachnoid space and intracerebral hematomas cause secondary changes in brain tissue metabolism by a probable reduction of cerebral blood flow. Therefore, an increase in CSF lactate with a concomitant rise in CSF L/P ratio is a useful indicator for brain tissue hypoxia, even when CSF is hemorrhagic. The association of an increase in CSF lactate to a disproportionate decrease in CSF HCO-3 was also observed in these animals.

Acid-Base Imbalance↗
PubMed1979

Prognostic signs during continuous monitoring of the ventricular fluid pressure in patients with severe brain injury.

The presence of CSF in cases with intracranial hypertension is a favourable prognostic sign; its absence is indicative of a progressive and potentially lethal intracranial hypertension. 2. A series of characteristic changes in the absolute value of the VFP as well as in the amplitude and rate of the cerebral pulse can provide reliable evidence of the integrity of the cerebral circulation. 3. Short-lasting disappearance of the diastolic pressure towards the end of the ultimate plateau wave and subsequent significant lowering of both the systolic and diastolic pressures is an additional bad prognostic sign.

Adolescent↗
PubMed1978

Hydrocephalus caused by increased intracranial venous pressure: a clinicopathological study.

A child developed progressive communicating nonobstructive hydrocephalus as a result of increased intracranial venous pressure. The child had been treated for congenital heart disease at age 3 weeks by surgical creation of an anastomosis between his superior vena cava and right pulmonary artery. Although his cardiac symptoms were alleviated, intracranial venous hypertension resulted, giving rise to progressive head enlargement and other signs of hydrocephalus. Postmortem examination at age 3 years disclosed no other lesions that could have caused the hydrocephalus. Increased intracranial venous pressure can lead to either pseudotumor cerebri or hydrocephalus, the former in children 3 years or older, the latter in infants 18 months or less. Possible mechanisms accounting for these differences are discussed.

Aorta↗
PubMed1978

Fatal BCG infection in an immunocompetent girl.

A 6-year-old girl developed progressive symptoms of increased intracranial pressure starting 5 months after BCG vaccination. Thirteen months later craniotomy revealed an epithelioid cell granuloma of the arachnoid occluding the foramen of Magendie. No tubercle bacilli were found on histological examination. Insertion of a Pudenz shunt relieved the symptoms. Six months later generalized BCG infection developed, and in spite of treatment with ethambutol, rifampicin and isoniazid for 10 weeks, death occurred during an episode of increased intracranial pressure. Mycobacterium BCG could be cultured from several organs. The patient showed no obvious evidence of immuno-deficiency as judged on the basis of previous disease history, particle concentration of granulocytes, B and T lymphocytes in peripheral blood, concentration of immunoglobulins in serum, response of lymphocytes to transformation with mitogens and antigens, and histological findings in the thymus and BCG granulomas.

BCG Vaccine↗
PubMed1976

Heart rate and rhythm and intracranial pressure.

Cardiac slowing during elevated intracranial pressure (ICP) could be due to direct activation of central nervous system (CNS) centers or it may be secondary to baroreceptor reflexes activated by the associated pressor response. In five pentobarbital-anesthetized dogs when ICP was raised to 50 mmHg the heart rate decreased 34.4 beats/min (+/-4.8 SE). This cardiac slowing occurred when ICP was elevated after sinoaortic denervation (-24 +/- 4.43 beats/min) and also during elevated ICP when changes in arterial pressure were prevented (-32.3 +/- 4.25 beats/min). These results indicate that the cardiac slowing is largely of CNS origin. In dogs given morphine with pentobarbital to achieve slower heart rates, raising ICP to 50 mmHg by left-sided intracranial balloon inflation led to cardiac dysrhythmias in 9 of 12 dogs. By contrast, raising ICP to 50 mmHg by right-sided intracranial balloon inflation only produced progressive sinus bradycardia. These responses were related to a combined enhancement of vagal and sympathetic activity. Differences observed between right- and left-sides balloon inflation may be partly related to asymmetrical engagement of the cardiac autonomic nerves. The results suggest that left-sided intracranial lesions are more likely to produce cardiac dysrhythmias.

Animals↗
PubMed1979

Superficial temporal-middle cerebral artery bypass. A detailed analysis of multiple pre- and postoperative angiograms in 40 consecutive patients.

Pre- and postoperative angiograms on 40 patients undergoing superficial temporal-middle cerebral artery (STA-MCA) bypass surgery have been examined in detail. Multiple postoperative angiograms have been obtained to evaluate the change in both the bypass circuit and the intracranial circulation over time. A reproducible system for evaluating the degree of intracranial vascular filling via the bypass is introduced. The study shows that the STA and its anastomotic branch increase in size over time, measured in months, in the majority of patients. This is paralleled by a progressive increase in the degree of intracranial vascular filling. These changes are proportional to the severity of the vascular disease before surgery. The pattern of preoperative collateral circulation may change over time following the addition of the bypass circuit. The progressive change over time suggests that a static analysis at one time may belie the true effect of the surgery. The change of collateral circulation with augmentation of blood supply to areas of the brain other than those affected by the recent ischemic event, means that a total cerebral evaluation including neuropsychological testing may be necessary for adequate evaluation of the effect of the bypass surgery.

Brain Ischemia↗