Critical appraisal of endovascular treatment of brain arteriovenous malformation using Onyx in a series of 92 consecutive patients.

BACKGROUND: The introduction of Onyx has led us to adopt a new treatment approach for brain arteriovenous malformation (AVM), using endovascular embolization with Onyx as the first line treatment with a curative intent. The aim of the present report is to evaluate our results using this strategy, with special emphasis on angiographic characteristics affecting treatment risks and success rates. METHODS: From October 2006 to December 2009, 92 consecutive patients harboring brain AVM were treated with Onyx during 177 procedures. RESULTS: Endovascular treatments were completed in 68 out of 92 patients. Median number of procedures was two. Complete obliteration using embolization exclusively was achieved in 25 patients, resulting in a 37 % cure rate in patients who concluded treatments (25/68), and 27 % in the cohort. In Spetzler-Martin grades 1 & 2 AVMs, complete obliteration was achieved in 48 % of the cases. Complete obliteration rates were significantly higher in lesions with superficial big feeding arteries. There were 15 bleeding complications during 177 embolization sessions (8.4 % per procedure); seven cases resolved in less than 3 months. Permanent disability rate was 6.5 %; mortality rate was 2.2 %. Bleeding was related to the use of the microcatheter/guidewire in six cases and to the use of the embolization material in nine, the amount of Onyx injected was significantly higher in those nine cases. CONCLUSIONS: Embolization of brain AVM using Onyx and detachable tip microcatheters results in a relatively high rate of complete obliteration. Angioarchitecture of the lesion can predict treatment success. Higher amounts of Onyx injected per session increase the bleeding risk.

Synergy-S stereotactic radiosurgery for spinal tumors.

BACKGROUND: Radiation treatment of spinal and paraspinal tumors has been limited by the tolerance of the spinal cord. As such, therapeutic options are restricted to surgically accessible lesions or the use of suboptimal dosing of external beam irradiation. OBJECTIVES: To evaluate the safety and applicability of the Elekta Synergy-S radiation unit for the treatment of spinal tumors. METHODS: We retrospectively reviewed all patients treated with stereotactic radiosurgery for spinal tumors between November 2007 and June 2011. RESULTS: Thirty-four patients were treated for 41 lesions. Treatment indications were local tumor control and pain palliation. The mean follow-up was 10.8 +/- 11.6 months (range 0.5-38 months). No acute radiation toxicity or new neurological deficits occurred during the follow-up period. Local tumor control was achieved in 21 of the 24 lesions (87.5%) available for radiological follow-up at a median of 9.8 months (range 3-32 months). Good analgesia was achieved in 24/30 lesions (80%) that presented with intractable pain. CONCLUSIONS: The safety and feasibility of delivering single and multiple-fraction stereotactic spinal irradiation was demonstrated and became a standard treatment option in our institution.

An animal model for chemotherapy-associated steatohepatitis and its prevention by the oral administration of fatty acid bile acid conjugate.

BACKGROUND: Preoperative chemotherapy for hepatic resection of colorectal liver metastases is associated with the development of chemotherapy-associated steatohepatitis (CASH). This increases the risk of perioperative morbidity and mortality. To the authors' knowledge, an animal model for CASH has not been described previously. It has been established that fatty acid bile acid conjugates (FABACs) prevent the formation of diet-induced fatty liver. The current study was designed to establish an animal model of CASH and to use that model to study the effect of FABACs on its occurrence. METHODS: C57BL/6 mice were given different doses of oxaliplatin and irinotecan. Oxaliplatin administered once weekly at a dose of 6 mg/kg for a total dose of 24 mg/kg was tolerated best and was associated most consistently with CASH. Thus, that dose was chosen as the induction model for CASH. Subsequently, mice were divided into a control group (no treatment), an oxaliplatin group, and a CASH-prevention group, which received oxaliplatin and C20-FABAC at a dose of 150 mg/kg daily. The animals were killed after 28 days. RESULTS: Liver fat content was significantly lower (P < .0001) in the control group (51.63 mg/g) and the prevention group (62.13 mg/g) compared with the oxaliplatin group (95.35 mg/g). This difference was mainly because of the accumulation of liver triglycerides in the oxaliplatin group. CONCLUSIONS: The current results indicated that C57BL/6 mice receiving weekly oxaliplatin can be used as a model for CASH. Oral FABAC therapy reduced the development of CASH in animals that received oxaliplatin. To the authors' knowledge, this report is the first description of a model and a potential preventive treatment for CASH.