Fractionated Stereotactic Radiosurgery for Brain Metastases Using the Novalis Tx® System

OBJECTIVE: To evaluate the efficacy of fractionated stereotactic radiosurgery (FSRS) performed using the Novalis Tx® system (BrainLAB AG, Feldkirchen, Germany; Varian Medical Systems, Palo Alto, CA, USA) for brain metastases.METHODS: Between March 2013 and July 2016, 23 brain metastases patients were admitted at a single institute. Twenty-nine lesions too large for single session stereotactic radiosurgery or located in the vicinity of eloquent structures were treated by FSRS. Based on the results obtained, we reviewed the efficacy and toxicity of FSRS for the treatment of brain metastases.RESULTS: The most common lesion origin was lung (55%) followed by breast (21%). Median overall survival was 10.0 months (95% confidence interval [CI], 4.9–15.0), and median progression-free survival was 10.0 months (95% CI, 2.1–13.9). Overall survival rates at 1 and 2 years were 58.6% and 36.0%, respectively. Local recurrence and neurological complications affecting morbidity each occurred in two cases.CONCLUSION: FSRS using the Novalis-Tx® system would appear to be an effective, safe noninvasive treatment modality for large and eloquently situated brain metastases. Further investigation is required on a larger number of patients.

Fractionated Stereotactic Radiosurgery for Brain Metastases Using the Novalis Tx® System

OBJECTIVE: To evaluate the efficacy of fractionated stereotactic radiosurgery (FSRS) performed using the Novalis Tx® system (BrainLAB AG, Feldkirchen, Germany; Varian Medical Systems, Palo Alto, CA, USA) for brain metastases. METHODS: Between March 2013 and July 2016, 23 brain metastases patients were admitted at a single institute. Twenty-nine lesions too large for single session stereotactic radiosurgery or located in the vicinity of eloquent structures were treated by FSRS. Based on the results obtained, we reviewed the efficacy and toxicity of FSRS for the treatment of brain metastases. RESULTS: The most common lesion origin was lung (55%) followed by breast (21%). Median overall survival was 10.0 months (95% confidence interval [CI], 4.9–15.0), and median progression-free survival was 10.0 months (95% CI, 2.1–13.9). Overall survival rates at 1 and 2 years were 58.6% and 36.0%, respectively. Local recurrence and neurological complications affecting morbidity each occurred in two cases. CONCLUSION: FSRS using the Novalis-Tx® system would appear to be an effective, safe noninvasive treatment modality for large and eloquently situated brain metastases. Further investigation is required on a larger number of patients.

Comparative Analysis of Adjacent Levels of Degeneration and Clinical Outcomes Between Conventional Pedicle Screws and Percutaneous Pedicle Screws in Treatment of Degenerative Disease at L3-5; A Preliminary Report

OBJECTIVE: This study was conducted to compare radiologic changes and clinical outcomes in adjacent level of percutaneous pedicle screws with those of conventional (open) pedicle screws. METHODS: From January 2007 to December 2009, 51 patients underwent L3-5 decompression and spinal fusion. Percutaneous pedicle screws were used in 22 patients, and open pedicle screws were used in the remaining patients. For estimation of instability, we performed measurements of change in the lordotic and adjacent segment angles. A retrospective evaluation of the patients' data and several assessment scales was conducted for determination of clinical outcomes. RESULTS: The radiological examinations revealed no significant differences, except the L2-3 sagittal angle change. The upper adjacent level angle change in the open group was larger than that in the percutaneous group. In the percutaneous group, the sagittal angle changed from 9.7+/-3.0degrees to 11.25+/-3.6degrees during the follow-up periods, and in the open group, the sagittal angle changed from 10.8+/-4.1degrees to 13.6+/-4.5degrees. Radiological instability was observed in 5 patients (17%) in the open group and in 2 patients (9%) in the percutaneous group. Both groups showed similar clinical outcomes. CONCLUSION: We suggest that open screws have a greater tendency to cause degenerative change in the upper segment than percutaneous screws. This may be because percutaneous screw fixation causes minimal injury to supporting structures and preserves adjacent facet joints.

Comparative Analysis of Adjacent Levels of Degeneration and Clinical Outcomes Between Conventional Pedicle Screws and Percutaneous Pedicle Screws in Treatment of Degenerative Disease at L3-5; A Preliminary Report

OBJECTIVE: This study was conducted to compare radiologic changes and clinical outcomes in adjacent level of percutaneous pedicle screws with those of conventional (open) pedicle screws. METHODS: From January 2007 to December 2009, 51 patients underwent L3-5 decompression and spinal fusion. Percutaneous pedicle screws were used in 22 patients, and open pedicle screws were used in the remaining patients. For estimation of instability, we performed measurements of change in the lordotic and adjacent segment angles. A retrospective evaluation of the patients' data and several assessment scales was conducted for determination of clinical outcomes. RESULTS: The radiological examinations revealed no significant differences, except the L2-3 sagittal angle change. The upper adjacent level angle change in the open group was larger than that in the percutaneous group. In the percutaneous group, the sagittal angle changed from 9.7+/-3.0degrees to 11.25+/-3.6degrees during the follow-up periods, and in the open group, the sagittal angle changed from 10.8+/-4.1degrees to 13.6+/-4.5degrees. Radiological instability was observed in 5 patients (17%) in the open group and in 2 patients (9%) in the percutaneous group. Both groups showed similar clinical outcomes. CONCLUSION: We suggest that open screws have a greater tendency to cause degenerative change in the upper segment than percutaneous screws. This may be because percutaneous screw fixation causes minimal injury to supporting structures and preserves adjacent facet joints.

A Case of Intraspinal Gas-containing Cyst associated with Severe Lumbar Spondylosis

Intraspinal gas collection is rare and also can be a cause of lumbar radiculopathy. Occasionally, the gas formation makes a severe pain which results from nerve root compression. We report a patient who had a radiculopathy caused by the gascontaining cyst in L3-L4 associated with severe spondylosis.

Comparative Analysis of Clinical Outcomes and Adjacent Level Angle Change on Single-level Lumbar 4-5 Fusion Using Percutaneous Screw Fixation and Open Screw Fixation

OBJECTIVE: Percutaneous pedicle screw fixation is one of treatment option in lumbar degenerative disease. The advantage of percutaneous pedicle screw fixation is to minimize iatrogenic injury of supporting structures in spine. This study compares clinical outcomes and radiologic changes in adjacent level of percutaneous pedicle screw fixation with those of open pedicle screw fixation. METHODS: Total 54 lumbar degenerative spine patients underwent screw fixation and interbody fusion after decompression. Percutaneous pedicle screw was used in 23 patients, other patients underwent open pedicle screw fixation. Patients' age, sex, diagnosis and, operative results were collected retrospectively. Clinical outcomes were measured by Visual Analogue Scale, Odom's criteria and Oswestry Disability Index. We measured lordotic angle and adjacent segment angle in follow-up radiologic study. RESULTS: Clinical outcomes showed no obvious differences in both percutaneous and open screw fixation groups. In radiologic finding, both groups revealed no significant differences in lordotic angles. On the other hand, L3-4 adjacent level angle change in open group was larger than in percutaneous group. The percutaneous group's sagittal angle changed from 10.2+/-2.4 to 11.6+/-2.7 in follow-up periods, and The open group's sagittal angle changed from 9.9+/-2.4 to 13.4+/-2.9. This difference has a statistical significance. But there is no significant difference in L5-S1 adjacent level angle change between two groups. CONCLUSION: We guess open screw fixation tend to make degenerative change in adjacent segment than percutaneous screw fixation. This suggestion may be related on minimal injury of supporting structures and preservation of adjacent facet joints in percutaneous screw fixation. But it can be confirmed through additional follow-up periods.