ABSTRACT
OBJECTIVE: To evaluate the role of preradiosurgical embolization on obliteration rate, reduction of size, irradiation dose, and neurological outcome, in 90 patients presenting large arteriovenous malformations (AVMs). METHODS: Between October 1993 and October 2006, 90 radiosurgical procedures were performed to treat brain AVMs Spetzler-Martin (SM) grades III, IV, and V at the Department of Radiosurgery and Radiology of the Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, Brazil. Fifty-nine patients had embolization before radiosurgery and complete clinical and radiologic follow-up for at least 3 years. Inclusion criteria were as follow: SM grades III, IV, and V AVMs, no previous treatment, and clinical and radiological (angiogram and MRI) follow-up for at least 3 years. Obliteration rate, reduction of size, irradiation dose, and neurological outcome were compared in these two cohorts of patients. Mann-Whitney test, "Student's t-test," and χ(2) tests were used for statistical analysis, as appropriate. The level of significance was determined at p < 0.05. RESULTS: The mean size of the AVMs that underwent embolization was significantly greater when compared with non-embolized group (p < 0.05). Embolization significantly reduced the AVM diameter. Irradiation dose was significantly smaller in the embolized group (p < 0.05). No significant differences in final clinical outcomes, postprocedural radiological findings, rate of occlusion, and need for additional procedures were observed between the two groups (p < 0.05). CONCLUSION: Preradiosurgical embolization of large AVMs does not result in impaired obliteration rate compared with cases treated with radiosurgery alone. It did not add further morbidity and presented benefits of reducing size of the AVMs. Preradiosurgical embolization may facilitate the coverage of the AVM with the effective irradiation dose. Combined management may be effective for selected large lesions considered unsuitable for radiosurgery and otherwise untreatable.
ABSTRACT
Trata-se de um artigo com uma breve introdução sobre conceitos e técnicas de Radiocirurgia Estereotáxica, e suas indicações nos tratamentos de tumores malignos e benignos do sistema nervoso central, e também como terapêutica de obliteração das malformações arteriovenosas localizadas profundamente no cérebro, e patologias funcionais como neuralgia do trigêmeo e epilepsia
Subject(s)
Radiosurgery/statistics & numerical data , Glioma/therapy , Arteriovenous Malformations/therapy , Meningioma/therapy , Trigeminal Neuralgia/therapyABSTRACT
Apresentam-se do Serviço de Clínica Médica do Hospital A.C. Camargo na utilizaçäo do cisplatinum, enfatizando-se os aspectos da toxicidade renal da droga. Incluiram-se no estudo 31 pacientes portadores de tumores malignos com clearance de creatinina dentro dos valores normais. A droga foi administrada em 4 casos como monoquimioterapia, e nos demais casos integrando o esquema de poliquimioterapia. Todos os pacientes foram submetios a um regime de hidrataçäo prévia à administraçäo da droga e em seguida à diurese forçada pela furosemida e manitol
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Cisplatin/adverse effects , Kidney/drug effects , Neoplasms/drug therapy , Cisplatin/therapeutic useABSTRACT
Faz-se uma análise retrospectiva de 21 pacientes portadores de metástase cerebral de melanoma maligno atendidos no Hospital A. C. Camargo no período de janeiro de 1970 a janeiro de 1981. Definiram-se dois grupos: grupo A, representado por 12 pacientes submetidos a radioterapia em todo encéfalo com dose superior a 20Gy, associada ou näo a outras modalidades de tratamento; grupo B, constituído por 9 pacientes submetidos a radioterapia em dose inferior à efetiva, ou näo irradiados. Observou-se que o grupo irradiado apresentou sobrevida média de 3 meses, com melhora ou manutençäo da condiçäo neurológica em 2/3 dos pacientes. O grupo näo irradiado teve sobrevida inferior a 1 mês, com deterioraçäo progressiva do quadro neurológico
