Embolic Agents For The Treatment Of Tumors

Tumor Vessel Embolization

Endovascular treatment of benign and malignant intracranial tumors is focused on superselective intraarterial delivery of chemotherapeutic agents and pedicle embolization for tumor devascularization. Endovascular techniques are particularly valuable in the preoperative embolization of tumors that are highly vascular as well as those involving difficult surgical exposures, such as skull base neoplasms. Vascular metastatic lesions, such as renal cell carcinoma, are also routinely referred for...

References

Present status of oncolytic virus studies. NY Acad Sci 1960 22 656-673. 2. Martuza RL, Malick A, Markert JM, et al. Experimental therapy of human glioma by means of a genetically engineered virus mutant. Science 1991 252 854-856. 3. On-line database found at the website for The Journal of Gene Medicine. Updated September 2001. 4. Mulligan RC, Berg P. Selection for animal cells that express the Escherichia coli gene coding for xanthineguanine phosphoribosyltransferase. Proc Natl Acad...

Convection Enhanced Delivery

Mathematical modeling, physiological studies, and increasing numbers of animal and clinical studies have helped to establish CED as one of the most promising of future strategies for the treatment of CNS disorders. The perpetual efforts to improve on local delivery techniques have helped move this method to the forefront, as it has distinct advantages over other local treatment modalities. CED has been described in the scientific literature by different names, including convection-enhanced...

Minimally Invasive Anterior Approaches Thoracoscopy And Anterior Lumbar Interbody Fusion Alif

Thoracoscopic surgery is a standard tool in thoracic surgery for a variety of indications (43,44) owing to the lower rates of morbidity compared with open thoracotomy. In the early 1950s, spinal indications for thoracoscopy were limited to accessing the spine in cases of Potts disease (45). However, improvements in thoracoscopy have permitted improved access to the disc space, vertebral bodies, spinal cord, nerve roots, and sympathetic chain, allowing neurosurgeons to utilize endoscopic...

Implantable Polymers

The use of biodegradable wafers and microspheres combined with a variety of chemotherapeutic and immunotherapeutic agents has established this local treatment modality as a versatile investigative approach for interstitial treatment of CNS lesions. The investigation culminated with US Food and Drug Fig. 2. Gliadel wafers placed into a tumor cavity following resection of a recurrent malignant glioma. Administration (FDA) approval of wafers (Gliadel) impregnated with 1,3-bis...

Ganciclovirtriphosphate

Chemical structure of the acyclic nucleoside ganciclovir (GCV), which is monophosphorylated by the enzyme herpes simplex thymidine kinase (HSV-TK). Further phosphorylation by cellular kinases leads to the creation of the toxic metabolite ganciclovir-triphosphate. Glioma cells transduced and selected to express HSV-TK are 5000-fold more sensitive to GCV than their nontransduced counterparts (37), suggesting that transduction leads to enough HSV-TK expression to...

Manish Aghi md PhD and E Antonio Chiocca md PhD Introduction

Disappointing results in the treatment of aggressive central nervous system (CNS) neoplasms such as glioblastoma multiforme have fueled a search for novel treatment modalities. New drugs and new radiation modalities have and are being tested. Biological materials have also been explored as potential anticancer agents. Such biological materials include immunotoxins, engineered cells that release diffusible anticancer factors, proteins, stem cells, immune- or vaccine-based modalities, and...

Dt0f

Example of a CSF flow study using the phase contrast technique to determine whether there is increased flow through the aqueduct. rf, radiofrequency. velocity and is therefore a direct measurement of flow, compared with TOF, is that three dataset acquisitions are necessary in three orthogonal directions, therefore tripling the imaging time (30). The advantage of this technique is that it is a true measure of velocity and is invaluable in distinguishing slow flow from thrombus (in which...

Percutaneous Tracheostomy And Gastrostomy

Percutaneous Trach

Two basic supportive therapies frequently necessary for neurotrauma patients are mechanical ventilation and enteral nutrition. Patients with (TBI requiring early endotracheal intubation include those with altered sensorium resulting in respiratory depression, hypoventilation, apnea, or inability to maintain or protect the airway. Patients with agitation or disorientation requiring sedative medications may also require mechanical ventilatory support. In those patients with spinal cord injury,...

Icp Monitoring

Integra Ventriculostomy

ICP monitors can be placed early in the care of severe TBI with relatively low risk. Generally, the upper threshold for treatment of intracranial hypertension is 20-25 mmHg. Pressure transducers are commercially available in sterile packages and can be inserted to determine ICP rapidly. With the patient supine, the head is raised to approx 30 The preferred insertion site is the right frontal cortex at Kocher's point 1-2 cm anterior to the coronal suture, which can be palpated, and 2-3 cm off...

Surgical Procedure

After careful assessment of the different types of endoscopic approaches to the carpal tunnel, it is the author's preference to use the biportal technique described by Brown. This section depicts that procedure in detail. As with any open technique, the type of anesthesia used is the surgeon's choice. Local, regional (Bier block), or general nonendotracheal anesthesia can be used. Insertion of the endoscopic instrumentation can cause discomfort and pain to the patient, making local anesthesia...

Early Strategies For Local Delivery

Direct injection of therapeutic compounds into the CNS is one of the earliest forms of local delivery for CNS lesions. This treatment modality includes intrathecal and intraventricular injections and has been successful in the control of patient pain and in the treatment of leptomeningeal metastases. Direct injection has also been used to facilitate recent advances in gene therapy with viral vectors and immunotherapy with activated lymphocytes. Improved engineering of injection catheters,...

Plif

Much has changed since Mercer's contention in 1936 (20) that although the ideal operation for fusing the spine would be an interbody fusion . . . the surgical difficulties encountered in performing such a feat would make the operation technically impossible (21). Cloward popularized the technique and described the earliest large case series a few years later, reporting an 85 rate of satisfactory outcomes among 331 patients. His published indications were the treatment of low back pain with or...

Vagoglossopharyngeal Neuralgia

Vagoglossopharyngeal neuralgia is described as pain in the ear, tonsillar fossa, throat, larynx, pharynx, or tongue, typically with periods of long remissions. Pain is triggered by swallowing and by other movements of the face or mouth (e.g., chewing, sneezing, coughing) (23). Vagoglossopharyngeal neuralgia occurs for many reasons, mostly compression or irritation of the nervous tissue by surrounding structures that include abscess, tumor, aneurysm, tonsillitis, arachnoiditis, styloid process,...

Hemorrhage

The appearance of hematoma on MRI depends on the oxidized state of the hemoglobin and iron and whether it is within or outside the erythrocyte, which in turn translates into factors such as age, location, and source of the hematoma. The term magnetic susceptibility describes the magnetic response or induced magnetic field that a substance generates when placed in a constant magnetic field. A diamagnetic material generates a weak field that is opposite to the applied field, whereas a...