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Search Results: 1 - 10 of 242267 matches for " Alexander R. Mackay "
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Long-Term Survival after Gamma Knife Radiosurgery in a Case of Recurrent Glioblastoma Multiforme: A Case Report and Review of the Literature
Sudheer R. Thumma,Ameer L. Elaimy,Nathan Daines,Alexander R. Mackay,Wayne T. Lamoreaux,Robert K. Fairbanks,John J. Demakas,Barton S. Cooke,Christopher M. Lee
Case Reports in Medicine , 2012, DOI: 10.1155/2012/545492
Abstract: The management of recurrent glioblastoma is highly challenging, and treatment outcomes remain uniformly poor. Glioblastoma is a highly infiltrative tumor, and complete surgical resection of all microscopic extensions cannot be achieved at the time of initial diagnosis, and hence local recurrence is observed in most patients. Gamma Knife radiosurgery has been used to treat these tumor recurrences for select cases and has been successful in prolonging the median survival by 8–12 months on average for select cases. We present the unique case of a 63-year-old male with multiple sequential recurrences of glioblastoma after initial standard treatment with surgery followed by concomitant external beam radiation therapy and chemotherapy (temozolomide). The patient was followed clinically as well as with surveillance MRI scans at every 2-3-month intervals. The patient underwent Gamma Knife radiosurgery three times for 3 separate tumor recurrences, and the patient survived for seven years following the initial diagnosis with this aggressive treatment. The median survival in patients with recurrent glioblastoma is usually 8–12 months after recurrence, and this unique case illustrates that aggressive local therapy can lead to long-term survivors in select situations. We advocate that each patient treatment at the time of recurrence should be tailored to each clinical situation and desire for quality of life and improved longevity.
Long-Term Survival in a Patient with Multiple Brain Metastases from Small-Cell Lung Cancer Treated with Gamma Knife Radiosurgery on Four Occasions: A Case Report
Ameer L. Elaimy,Sudheer R. Thumma,Andrew F. Lamm,Alexander R. Mackay,Wayne T. Lamoreaux,Robert K. Fairbanks,John J. Demakas,Barton S. Cooke,Christopher M. Lee
Case Reports in Neurological Medicine , 2012, DOI: 10.1155/2012/276189
Abstract: Brain metastases are the most common cancerous neoplasm in the brain. The treatment of these lesions is challenging and often includes a multimodality management approach with whole-brain radiation therapy, stereotactic radiosurgery, and neurosurgery options. Although advances in biomedical imaging technologies and the treatment of extracranial cancer have led to the overall increase in the survival of brain metastases patients, the finding that select patients survive several years remains puzzling. For this reason, we present the case of a 70-year-old patient who was diagnosed with multiple brain metastases from small-cell lung cancer five years ago and is currently alive following treatment with chemotherapy for the primary cancer and whole-brain radiation therapy and Gamma Knife radiosurgery on four separate occasions for the neurological cancer. Since the diagnosis of brain metastases five years ago, the patient’s primary cancer has remained controlled. Furthermore, multiple repeat GKRS procedures provided this patient with high levels of local tumor control, which in combination with a stable primary cancer led to an extended period of survival and a highly functional life. Further analysis and clinical research will be valuable in assessing the durability of multiple GKRS for brain metastases patients who experience long-term survival.
Clinical Outcomes of Gamma Knife Radiosurgery in the Treatment of Patients with Trigeminal Neuralgia
Ameer L. Elaimy,Peter W. Hanson,Wayne T. Lamoreaux,Alexander R. Mackay,John J. Demakas,Robert K. Fairbanks,Barton S. Cooke,Sudheer R. Thumma,Christopher M. Lee
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/919186
Abstract: Since its introduction by Leksell, Gamma Knife radiosurgery (GKRS) has become increasingly popular as a management approach for patients diagnosed with trigeminal neuralgia (TN). For this reason, we performed a modern review of the literature analyzing the efficacy of GKRS in the treatment of patients who suffer from TN. For patients with medically refractory forms of the condition, GKRS has proven to be an effective initial and repeat treatment option. Cumulative research suggests that patients treated a single time with GKRS exhibit similar levels of facial pain control when compared to patients treated multiple times with GKRS. However, patients treated on multiple occasions with GKRS are more likely to experience facial numbness and other facial sensory changes when compared to patients treated once with GKRS. Although numerous articles have reported MVD to be superior to GKRS in achieving facial pain relief, the findings of these comparison studies are weakened by the vast differences in patient age and comorbidities between the two studied groups and cannot be considered conclusive. Questions remain regarding optimal GKRS dosing and targeting strategies, which warrants further investigation into this controversial matter.
Gamma knife radiosurgery for essential tremor: A Case report and review of the literature
Ameer L Elaimy, John J Demakas, Benjamin J Arthurs, Barton S Cooke, Robert K Fairbanks, Wayne T Lamoreaux, Alexander R Mackay, David R Greeley, Christopher M Lee
World Journal of Surgical Oncology , 2010, DOI: 10.1186/1477-7819-8-20
Abstract: Essential tremor is a common type of movement disorder that normally affects people over the age of 65; however, this illness can occur in younger patients as well. In recent years, ET has been categorized as a heritable condition, which can be transferred to family members in an autosomal dominant fashion [1]. The primary symptom of ET involves shaking of the hands during voluntary movements, but it may also present with movements of the head, face, tongue, and lower limbs [1-3]. Other than tremors, there are no other direct medical symptoms associated with ET and it does not decrease life expectancy. However, many patients with ET have difficulties accomplishing their daily tasks or other activities that affect quality of life, which is how this disorder elicits a negative impact on the social and mental wellness of the patients who bear this illness [1,4].There are multiple treatment options for ET patients. The most common medications utilized are beta-blockers. Unfortunately, these are contraindicated for many patients with asthma, diabetes, and certain heart conditions. Anti-seizure medications and botulinum toxin injections are also used, but they are known to cause unwanted side effects. Stereotactic RF thalamotomy is the most common neurosurgical procedure for treating ET. It involves MR imaging of the thalamic target (ventralis intermedius nucleus), placement of an electrode neurosurgically, stimulation of the target, and creation of a lesion through tissue ablation [5]. DBS is also an invasive surgical procedure performed as an alternative to RF thalamotomy. DBS involves the implantation of a device that utilizes electrical impulses to block abnormal nerve signals [5,6].Even though surgical treatments such as RF thalamotomy and DBS are effective in many patients with ET, there are those who are not qualified candidates for invasive neurosurgery because of comorbid medical conditions. These include patients who use anticoagulants, who have advanced cardiac
Effect of pretreatment clinical factors on overall survival in glioblastoma multiforme: a Surveillance Epidemiology and End Results (SEER) population analysis
Sudheer R Thumma, Robert K Fairbanks, Wayne T Lamoreaux, Alexander R Mackay, John J Demakas, Barton S Cooke, Ameer L Elaimy, Peter W Hanson, Christopher M Lee
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-75
Abstract: We used the Surveillance, Epidemiology, and End Results (SEER) database of the US National Cancer Institute (NCI) to investigate various patient-related and treatment- related factors that could influence the long term survival in patients diagnosed with glioblastoma. A total of 34,664 patients aged 20?years or older with a diagnosis of GBM during the years 1973 to 2008 were studied. Overall survival outcomes were examined with Kaplan-Meier survival analysis and Cox hazard models.Asian/Pacific Islanders had a better survival compared to the white population (P?=?<0.001). Patients diagnosed with GBM during the years 2000 to 2008 had a superior survival rate when compared with earlier decades (P?=?<0 .001). Statistically significant improvements in overall survival were also found for patients who received surgical resections, and adjuvant radiation treatment versus no radiation (P-values <0.001). Young age was also found to be highly predictive of improved overall survival rates when separated into age groups as well as when studied as a continuous variable.Clinical pretreatment and treatment factors, including young age at diagnosis, Asian/Pacific Islander ethnicity, recent year of diagnosis, surgical resection and the use of adjuvant radiation therapy favorably influence survival in patients diagnosed with glioblastoma.All data were obtained from the United States Surveillance Epidemiology and End Results (SEER) database.
Gamma knife radiosurgery for movement disorders: a concise review of the literature
Ameer L Elaimy, Benjamin J Arthurs, Wayne T Lamoreaux, John J Demakas, Alexander R Mackay, Robert K Fairbanks, David R Greeley, Barton S Cooke, Christopher M Lee
World Journal of Surgical Oncology , 2010, DOI: 10.1186/1477-7819-8-61
Abstract: Pharmacotherapy is the general treatment method for patients who suffer from movement disorders. Even though a large proportion of patients are able to manage their condition with medication, there is still a small amount of patients who do not experience significant relief from pharmaceuticals, thus, seek out other treatment modalities. Deep brain stimulation (DBS) and surgical lesioning of the thalamus and basal ganglia are respected and well-studied neurosurgical procedures that come with a low incidence of potential side-effects. However, there is a subset of patients with movement disorders who are not qualified candidates for invasive neurosurgery. This population of patients consists of those who use anticoagulants, those who have advanced cardiac or respiratory disease, those who are known to be noncompliant, those who are of advanced age, and those who elect to not proceed with neurosurgery. Despite the fact that radiofrequency (RF) neurosurgical lesioning has shown success in many patients, there is still a possibility for patients to encounter a wide array of side-effects. These include intracerebral or extracerebral hemorrhage, seizures, infection, brain displacement, tension pnemocephalus, and direct injury from probe placement [1]. Stereotactic radiosurgery using the gamma knife (GK) is a non-invasive alternative modality for lesioning intracranial structures.The first cobalt-60-based GK device dates back to Sweden in 1968, where Professor Lars Leksell's intention was to create precisely located, well-circumscribed lesions in the brain in a minimally-invasive fashion [2]. Between 1968 and 1982, a total of 762 patients underwent treatment with the cobalt-based GK unit. Only 5 of the 762 patients were treated for Parkinsonism, but this historic study shows that the idea of treating movement disorders using radiosurgical techniques is not a recent advance and has evolved considerably over the past four decades.In recent years, thalamotomy and pallidotomy
Long-Term Survival in a Patient with Multiple Brain Metastases from Small-Cell Lung Cancer Treated with Gamma Knife Radiosurgery on Four Occasions: A Case Report
Ameer L. Elaimy,Sudheer R. Thumma,Andrew F. Lamm,Alexander R. Mackay,Wayne T. Lamoreaux,Robert K. Fairbanks,John J. Demakas,Barton S. Cooke,Christopher M. Lee
Case Reports in Neurological Medicine , 2012, DOI: 10.1155/2012/276189
Abstract: Brain metastases are the most common cancerous neoplasm in the brain. The treatment of these lesions is challenging and often includes a multimodality management approach with whole-brain radiation therapy, stereotactic radiosurgery, and neurosurgery options. Although advances in biomedical imaging technologies and the treatment of extracranial cancer have led to the overall increase in the survival of brain metastases patients, the finding that select patients survive several years remains puzzling. For this reason, we present the case of a 70-year-old patient who was diagnosed with multiple brain metastases from small-cell lung cancer five years ago and is currently alive following treatment with chemotherapy for the primary cancer and whole-brain radiation therapy and Gamma Knife radiosurgery on four separate occasions for the neurological cancer. Since the diagnosis of brain metastases five years ago, the patient’s primary cancer has remained controlled. Furthermore, multiple repeat GKRS procedures provided this patient with high levels of local tumor control, which in combination with a stable primary cancer led to an extended period of survival and a highly functional life. Further analysis and clinical research will be valuable in assessing the durability of multiple GKRS for brain metastases patients who experience long-term survival. 1. Introduction The treatment of brain metastases remains a uniformly challenging issue for neurosurgeons and oncologists due to the numerous factors that must be taken into account when prescribing treatment regimens. Today, it is well known that clinical outcomes are dependent on Karnofsky performance status (KPS), age, control of primary cancer, and the presence of extracranial metastases [1]. In addition, treatments must be further tailored to the individual patient based on the number, location, and size of brain metastases they present with at the time of diagnosis. The combination of these variables makes treating these cancerous lesions a very complex issue that requires experience and extensive knowledge of the evolving body of world literature. Although several randomized controlled trials have been published analyzing the efficacy of whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), neurosurgery, and combinations of the three modalities in the management of patients with brain metastases, many questions remain unanswered because the Phase III clinical evidence is often limited by studies with poor patient accrual and conflicting results [2–5]. On average, patients diagnosed with
Clinical Outcomes of Gamma Knife Radiosurgery in the Treatment of Patients with Trigeminal Neuralgia
Ameer L. Elaimy,Peter W. Hanson,Wayne T. Lamoreaux,Alexander R. Mackay,John J. Demakas,Robert K. Fairbanks,Barton S. Cooke,Sudheer R. Thumma,Christopher M. Lee
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/919186
Abstract: Since its introduction by Leksell, Gamma Knife radiosurgery (GKRS) has become increasingly popular as a management approach for patients diagnosed with trigeminal neuralgia (TN). For this reason, we performed a modern review of the literature analyzing the efficacy of GKRS in the treatment of patients who suffer from TN. For patients with medically refractory forms of the condition, GKRS has proven to be an effective initial and repeat treatment option. Cumulative research suggests that patients treated a single time with GKRS exhibit similar levels of facial pain control when compared to patients treated multiple times with GKRS. However, patients treated on multiple occasions with GKRS are more likely to experience facial numbness and other facial sensory changes when compared to patients treated once with GKRS. Although numerous articles have reported MVD to be superior to GKRS in achieving facial pain relief, the findings of these comparison studies are weakened by the vast differences in patient age and comorbidities between the two studied groups and cannot be considered conclusive. Questions remain regarding optimal GKRS dosing and targeting strategies, which warrants further investigation into this controversial matter. 1. Introduction Trigeminal neuralgia (TN) is a disorder of cranial nerve (CN) V that results in severe episodes of shock-like or lancinating pain in one or more of its three divisions (V1–V3). TN can be classified into two categories based on etiology: classical and symptomatic [1]. Idiopathic TN and cases due to vascular compression of CN V are categorized as classical TN [1]. Patients diagnosed with symptomatic TN experience trigeminal-related facial pain secondary to a brain tumor, skull deformity, or multiple sclerosis (MS) [1]. Evidence suggests that the majority of cases of TN are the consequence of focal compression of the entry zone of the root of the trigeminal nerve [2], while only 2% of cases are observed in patients diagnosed with MS [3]. Other than excruciating facial pain, there are no other direct medical symptoms associated with TN, and the condition does not decrease life expectancy. However, many patients with TN struggle with accomplishing tasks that affect quality of life, which is how this disorder elicits a negative impact on the social and mental wellness of the patients who suffer from this illness. Following the diagnosis of TN, pharmacotherapy is often the initial management approach in achieving facial pain control. However, many patients experience only limited relief from medication or are unable to
Long-Term Survival of a Patient with Brainstem and Recurrent Brain Metastasis from Stage IV Nonsmall Cell Lung Cancer Treated with Multiple Gamma Knife Radiosurgeries and Craniotomies: A Case Report and Review of the Literature
Andrew F. Lamm,Ameer L. Elaimy,Alexander R. Mackay,Robert K. Fairbanks,John J. Demakas,Barton S. Cooke,Christopher M. Lee,Blake S. Taylor,Wayne T. Lamoreaux
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/621641
Abstract: The prognosis of patients diagnosed with stage IV nonsmall cell lung cancer that have brain and brainstem metastasis is very poor, with less than a third surviving a year past their initial date of diagnosis. We present the rare case of a 57-year-old man who is a long-term survivor of brainstem and recurrent brain metastasis, after aggressive treatment. He is now five and a half years out from diagnosis and continues to live a highly functional life without evidence of disease. Four separate Gamma Knife stereotactic radiosurgeries in conjunction with two craniotomies were utilized since his initial diagnosis to treat recurrent brain metastasis while chemoradiation therapy and thoracic surgery were used to treat his primary disease in the right upper lung. In his situation, Gamma Knife radiosurgery proved to be a valuable, safe, and effective tool for the treatment of multiply recurrent brain metastases within critical normal structures.
Feasibility of Multiple Repeat Gamma Knife Radiosurgeries for Trigeminal Neuralgia: A Case Report and Review of the Literature
Guy C. Jones,Ameer L. Elaimy,John J. Demakas,Hansi Jiang,Wayne T. Lamoreaux,Robert K. Fairbanks,Alexander R. Mackay,Barton S. Cooke,Christopher M. Lee
Case Reports in Medicine , 2011, DOI: 10.1155/2011/258910
Abstract: Treatment options for trigeminal neuralgia (TN) must be customized for the individual patient, and physicians must be aware of the medical, surgical, and radiation treatment modalities to prescribe optimal treatment courses for specific patients. The following case illustrates the potential for gamma knife radiosurgery (GKRS) to be repeated multiple times for the purpose of achieving facial pain control in cases of TN that have been refractory to other medical and surgical options, as well as prior GKRS. The patient described failed to achieve pain control with initial GKRS, as well as medical and surgical treatments, but experienced significant pain relief for a period of time with a second GKRS procedure and later underwent a third procedure. Only a small subset of patients have reportedly undergone more than two GKRS for TN; thus, further research and long-term clinical followup will be valuable in determining its usefulness in specific clinical situations.
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