ABSTRACT
AIM: In patients with space-occupying lesions of the pineal region, increased intracranial pressure is due to direct compression of the sylvian aqueduct. Based on results of the recent literature, neuroendoscopic management of obstructive hydrocephalus, secondary to tumors of the pineal gland, has gained a preeminent role respect to shunting procedures. METHODS: In 14 select cases, hydrocephalus was secondary to midline and pineal lesions. The patient's age ranged from 1 to 56 years (mean 47.3+/-12.5), with a follow-up ranged from 3 months to 5 years after discharge. In 9 cases the endoscopic procedure represented the only surgical treatment. In 5 cases, microsurgical removal of the lesions and/or ventriculo-peritoneal shunts placement were performed, as additional treatment, while adjuvant radiotherapy was utilized in 4 cases; high dose chemotherapy followed by bone marrow transplantation was performed in 3 cases. RESULTS: In our series, obstructive hydrocephalus secondary to midline and pineal lesions, was successful treated by neuroendoscopic approach alone in 9 cases, with an unremarkable course and good outcome, except in 1 case. CONCLUSIONS: Neuroendoscopic approach affords a minimally invasive way to obtain 4 objectives by one-step surgical approach, such as resolution of obstructive hydrocephalus by endoscopic third ventriculostomy (ETV), cerebrospinal fluid sample to detect tumor markers and to perform cytological analysis, biopsy specimens and tissue diagnosis, associated to absence of shunt-related complications. Therefore, in experienced hands, ETV should be the treatment of first choice, in cases of hydrocephalus secondary to lesions of the pineal gland.
Subject(s)
Brain Neoplasms/complications , Hydrocephalus/etiology , Hydrocephalus/surgery , Neuroendoscopy , Pinealoma/complications , Adolescent , Adult , Brain Neoplasms/therapy , Chemotherapy, Adjuvant , Child , Child, Preschool , Combined Modality Therapy , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Middle Aged , Neuroendoscopy/methods , Neurosurgical Procedures , Pinealoma/therapy , Radiotherapy , Treatment Outcome , Ventriculoperitoneal Shunt , VentriculostomyABSTRACT
We evaluated the tolerance of a single dose of 800-1500 cGy, delivered with an electron beam from an IOERT-dedicated linear accelerator to the tumour bed in patients with breast cancer undergoing conservative treatment, instead of the traditional boost. We enrolled 27 patients (cT1-2, cN0). The first 6 received a dose of 800 cGy, 6 1000 cGy, 10 1200 cGy and 5 1500 cGy. External beam radiation therapy (EBRT) with a conventional schedule, 4000 cGy total dose, was performed after wound healing. The median gap between IOERT and EBRT was 8 weeks. Three patients with adverse prognostic factors undergoing chemotherapy, including doxorubicin or taxanes, received EBRT after completion of chemotherapy. One patient with a prosthesis implant had yielding of the surgical scar 8 months after IOERT (after 4 cycles of doxorubicin and 4 cycles of CMF complicated by frequent mastitis). Another patient with a large serum collection in the axilla manifested delayed scar formation. In the others no significant increase in healing time or surgery-related morbidity was observed. Another 4 patients developed mastitis. The cosmetic outcome was good in 26/27 patients. This treatment is well tolerated at all IOERT doses delivered. In the follow-up, to date, there have been no local relapses.
