Brain metastases: surgery, radiosurgery and whole-brain radiation therapy

The brain is a preferred site of metastatic spread in cancer patients. Once a brain metastasis has been diagnosed, the median life expectancy is less than one year. The prognosis of patients with brain metastases predominantly depends on age and Kamofsky performance status, as well as extracranial disease activity. There is still much controversy conceming the optimum treatment for metastatic brain disease. In many patients, aggressive treatment of metastatic disease has been shown to restore neurological function and prevent further neurological manifestations. Selection of patients for aggressive treatment strategies should thus be based on objective criteria. The emphasis of this review is on currently relevant factors for diagnosis, surgery, whole-brain radiation therapy and methods of radiosurgery

Interstitial radiosurgery for the treatment of hypothalamic hamartomas

Patients presenting with hypothalamic hamartomas often are not only compromised by pharmacoresistant epileptic seizures, typically [gelastic epilepsy,] but also by behavioural problems and cognitive dysfunction. We report here on the effect of treatment using stereotactic interstitial radiosurgery with placement of [125] l-seeds into hypothalamic hamartomas in a pilot series of 9 patients. Outcome in terms of seizure reduction was complete seizure freedom or simple partial seizures only in 4 patients, significant reduction in seizure frequency in another 3 patients. Two patients did not profit from seed implantation. In patients rendered seizure free or suffering only from auras, improvement of behaviour was reported by parents and colleagues or schoolteachers. Parents' rating according to the Child Behaviour Checklist showed improvements with regard to social problems and attention. Self-rating of quality of life by adult patients showed improvements in activities, working situation, and self perception. There were no major side effects