Malignant Brain Lesions Research Articles

Diagnostic Accuracy of Magnetic Resonance Spectroscopy for Differentiation of Benign and Malignant Brain lesions using Histopathology as a Gold Standard

Diagnostic Accuracy of Magnetic Resonance Spectroscopy for Differentiation of Benign and Malignant Brain lesions using Histopathology as a Gold Standard

Sol Brain, Pre-Operative Magnetic Resonance Spectroscopy and Surgical Biopsy Yield

Objective: To ascertain the positive predictive value (PPV) of magnetic resonance spectroscopy (MRS) in diagnosing neoplastic intracranial masses by taking histopathology as a benchmark.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jan 2019 to Jun 2021.
 Methodology: After approval from the Ethical Review Committee, 64 patients with neoplastic intracranial mass lesions on MRI were incorporated into the study. Patients with a history of brain surgery done previously, breastfeeding females, claustrophobia, already diagnosed type of tumour, and contraindication to MRI were excluded. MR Spectroscopy was performed, and findings were correlated with histopathology.
 Results: Of 64 patients, 39(60.94%) were males, and 25(39.06%) were females. Magnetic Resonance Spectroscopy (MRS) supported the diagnosis of neoplastic brain lesions in all 64 patients. Histopathology confirmed malignant brain lesions in 59 cases, whereas 05 cases had benign lesions. PPV of MRS in the diagnosis of neoplastic brain lesions was 92.19%.
 Conclusion: This study concluded that MRS is a non-invasive option having a very good PPV in determining neoplastic brain lesions.

Low-Dose Bevacizumab for the Treatment of Focal Radiation Necrosis of the Brain (fRNB): A Single-Center Case Series.

Focal radiation necrosis of the brain (fRNB) is a late adverse event that can occur following the treatment of benign or malignant brain lesions with stereotactic radiation therapy (SRT) or stereotactic radiosurgery (SRS). Recent studies have shown that the incidence of fRNB is higher in cancer patients who received immune checkpoint inhibitors. The use of bevacizumab (BEV), a monoclonal antibody that targets the vascular endothelial growth factor (VEGF), is an effective treatment for fRNB when given at a dose of 5-7.5 mg/kg every two weeks. In this single-center retrospective case series, we investigated the effectiveness of a low-dose regimen of BEV (400 mg loading dose followed by 100 mg every 4 weeks) in patients diagnosed with fRNB. A total of 13 patients were included in the study; twelve of them experienced improvement in their existing clinical symptoms, and all patients had a decrease in the volume of edema on MRI scans. No clinically significant treatment-related adverse effects were observed. Our preliminary findings suggest that this fixed low-dose regimen of BEV can be a well-tolerated and cost-effective alternative treatment option for patients diagnosed with fRNB, and it is deserving of further investigation.

Diagnostic Accuracy of Apparent Diffusion Coefficient Value in Differentiating Benign and Malignant Brain Lesions Keeping Histopathology as Gold Standard

Objective: The purpose of this study was to assess the competence of preoperative Apparent Diffusion Coefficient (ADC) values in predicting brain tumors as benign or malignant, keeping histopathology as the gold standard.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Diagnostic Radiology, POF Hospital, Wah Cantt, Pakistan, from December 12th 2020 to June 9th 2021.Materials and Methods: The apparent diffusion coefficient (ADC) sequence is based on the diffusion properties of water molecules within tissues and correlates with tissue cellularity. ADC may have a role in predicting tumor grade for gliomas and may in turn, assist in identifying tumor biopsy sites.A total of 140 patients were enrolled in the study. In all the images, the slice thickness was taken as 3mm, and the slice gap of 10. The mean age of the patients was 46.5±14.0 years. Males were predominant. The mean BMI was 26.8±5.5 kg/m2, and the mean duration of symptoms was 2.0±1.4 months.Results: The mean age of the patients enrolled in the study was 46.5±14.0 years. Males were predominant; there were 85 males (60.7%) and 55 females (39.3%). The mean duration of symptoms was 2.0±1.4 months. A history of chronic headache was found in 100 patients (71.4%), a history of seizures in 20 (14.3%), and a history of focal deficit was present in 111 patients (79.3%). Apparent diffusion coefficient (ADC) value in differentiating benign and malignant brain lesions showed sensitivity 77.5%, specificity 91.6%, PPV 92.5%, NPV 75.3% and diagnostic accuracy 83.5%.Conclusion: Overall, malignant brain lesions display lower ADC values than benign ones. Apparent diffusion coefficient (ADC) values improved our abilities to differentiate benign from malignant brain lesions.

Diagnostic Accuracy of Magnetic Resonance Spectroscopy in Differentiating Malignant and Benign Brain Lesions

The aim of this study is to determine the diagnostic ability of magnetic resonance spectroscopy in separating malignant and benign cerebral masses, when histopathology taken as gold standard. The results of my study will not only resolve this controversy but also If MRS diagnostic accuracy will be found high in distinguishing ring enhancing lesions of brain, then this non-invasive modality can be applied routinely in our general practice for proper treatment selection the lesions in order to reduce the morbidity and mortality of these particular patients. Materials & Methods: We included around 141 cases presenting to us at the Radiology department of Sir Ganga Ram Hospital, Lahore, fulfilling the inclusion criteria was selected after we got approval for the study from IRB committee of university. Informed consent was taken from each patient. We performed magnetic resonance spectroscop in each case using 1.5 Tesla MR system having graded power of 33 mT/m and results of MRS were read and reported by one radiology consultant. Malignant or benign lesions were noted on MRS. After this, each patient was undergone biopsy in the concerned ward by the consultant neurosurgeon and tissue was sent to institutional pathology laboratory for histopathology. Histopathology results were interpreted by the consultant histopathologist (at least 3 years of post-fellowship experience) and benign or malignant lesion was noted Results: All the included cases underwent standard magnetic resonance spectroscopy (MRS) of brain. MRS strengthened the suspicion of malignant brain lesions in 94 (66.67%) cases. Histopathology findings confirmed malignant brain lesions in 90 (63.83%) cases. Conclusion: This study concluded that MRS is the non-obstrusive method of imaging with greater diagnostic accuracy in differentiating malignant and benign brain lesions, and that it has not only made drastically better our capability to identify malignant brain lesions preoperatively, and moreover assists neurosurgeons in taking much better decisions. As a result, we urge that MRS be performed habitually in all suspected instances of intracranial mass lesion for reliable pre-operative identification of malignant brain lesions and selection of appropriate surgical technique. Keywords: MRS. MRI. Brain lesions, brain tumor, CNS tumor, Magnetic resonance spectroscopy

Diagnostic accuracy of magnetic resonance spectroscopy (MRS) for diagnosis of focal brain lesions taking histopathology as gold standard.

Objective: To determine diagnostic accuracy of MRS for diagnosis of malignant brain lesions taking histopathology as gold standard. Study Design: Cross Sectional Validation study. Setting: Department of Radiology, Lahore General Hospital, Lahore. Material & Methods: A total number of 127 patients who were referred for the diagnosis of focal brain lesions were included. In all patients, MRS was done by consultant radiologist to diagnose malignancy. All patients underwent surgery in the neurosurgery department and after surgery biopsy specimen were taken for diagnosis of malignancy using histopathology findings. Results: Mean age of patients was 40.88±11.37 years. There were 88 (69.29%) males and 39 (30.71%) female patients. On MRS, malignancy was diagnosed in 99 (77.95%) patients and on histopathology malignancy was diagnosed in 102 (80.31%) patients. Regarding diagnostic accuracy, MRS was 97.00% sensitive, 94.10% specific, with PPV of 78.60% and NPV of 88.00%. Conclusion: Magnetic resonance spectroscopy (MRS) has good sensitivity and specificity in differentiating neoplasm from non-neoplastic focal brain lesions.

Dynamic Contrast-Enhanced MR Perfusion in Differentiation of Benign and Malignant Brain Lesions.

We aimed to differentiate Glioblastoma Multiforme (GBM) from benign lesions like Developmental Venous Anomaly (DVA) and Cavernous Malformation (CM) by Dynamic Contrast-Enhanced MR Perfusion (DCE-MRP) markers such as Ktrans, Ve, Kep, and IAUC. We retrospectively evaluated 20 patients; 10 GBM as the malignant group, 5 CM and 5 DVA as the benign group. Ktrans, Kep, Ve, and IAUC parameters were measured by DCE-MRP, within the lesion, at perilesional nonenhancing white matter (PLWM) and contralateral normal appearing white matter (CLWM). All benign and malignant lesions exhibited significantly increased Ktrans, Ve, and IAUC values compared to PLWM and CLWM (p < 0.001, p=0.006 and p<0.001). Subtracted Kep values between lesion and PLWM were significantly different between the benign and malignant groups, as the malignant group exhibited higher subtracted Kep values (p 0.035). For the malignant group; Ktrans and IAUC values at the lesion were positively correlated (r 0.911), while Kep and Ve at CLWM were negatively and strongly correlated (r 0.798). For the benign group; Ktrans with Ve and Ktrans with IAUC at lesion (r 0.708 and r 0.816 respectively), Ktrans and IAUC at PLWM (r 0.809), Ktrans and IAUC at CLWM(r 0.798) were strongly and positively correlated. Ktrans, Ve, and IAUC values can be used to restrict the lesion in both groups. Ktrans strongly correlates with IAUC and they can be used instead of each other in both benign and malignant lesions. Classical DCE-MRP parameters cannot be used in the differentiation of malignant lesions from benign vascular lesions. However, subtracted Kep values can be used to differentiate GBM from benign vascular lesions.

MiRNAs in Serum Exosomes for Differential Diagnosis of Brain Metastases.

Simple SummaryCurrent methods for the detection of brain malignancies often display low sensitivity and specificity. Noninvasive biomarkers can complement imaging techniques to improve the diagnosis of these tumors. The aim of this study was to identify circulating miRNAs in serum exosomes useful in all phases of the diagnostic and therapeutic path of patients with malignant brain lesions. Our data show a signature of exosomal miRNAs useful for the differential diagnosis of brain metastases and for monitoring tumor evolution over time.Circulating miRNAs are increasingly studied and proposed as tumor markers with the aim of investigating their role in monitoring the response to therapy as well as the natural evolution of primary or secondary brain tumors. This study aimed to evaluate the modulation of the expression of three miRNAs, miR-21, miR-222 and miR-124-3p, in the serum exosomes of patients with high-grade gliomas (HGGs) and brain metastases (BMs) to verify their usefulness in the differential diagnosis of brain masses; then, it focused on their variations following the surgical and/or radiosurgical treatment of the BMs. A total of 105 patients with BMs from primary lung or breast cancer, or melanoma underwent neurosurgery or radiosurgery treatment, and 91 patients with HGGs were enrolled, along with 30 healthy controls. A significant increase in miR-21 expression in serum exosomes was observed in both HGGs and BMs compared with healthy controls; on the other hand, miR-124-3p was significantly decreased in BMs, and it was increased in HGGs. After the surgical or radiosurgical treatment of patients with BMs, a significant reduction in miR-21 was noted with both types of treatments. This study identified a signature of exosomal miRNAs that could be useful as a noninvasive complementary analysis both in the differential diagnosis of BMs from glial tumors and in providing information on tumor evolution over time.

Evaluation of Central Nervous System Tuberculomas by Using Modern Diagnostic Techniques

Aim: To assess central nervous system tuberculomas by using modern MRI techniques such as Diffusion MRI (dMRI), Nuclear magnetic resonance spectroscopy (NMR spectroscopy) and BOLD venographic imaging. Study design: A retrospective study design Study setting: From 5th Feb 2021 to 5th Feb 2022 at the department of Neurology of Ibe-e-Siena Hospital, Multan. Methods: A retrospective study was conducted in the neurology department of Ibe-e-Siena Hospital &amp; Research Institute Multan from 5th February 2021 to 5th February 2022. A total of 100 patients with suspected intracranial tuberculomas were included in the study. Advanced MRI techniques, including Diffusion MRI (dMRI), Nuclear magnetic resonance spectroscopy (NMR spectroscopy) and BOLD venographic imaging and conventional MRI, was performed on the patients. The study was approved by the ethical committee of the hospital, and all the patients provided their written consent for inclusion in the study Results: NMR spectroscopy evaluation showed that N-acetylaspartate /Creatine and N-acetylaspartate /Choline ratios of tuberculomas did not differ significantly from malignant brain lesions (p&gt;0.04). But the malignant brain lesion (2.59) were significantly higher than the Choline/Creatine ratio of tuberculomas(1.29). BOLD venographic imaging evaluation showed no hypointense peripheral ring in malignant brain lesions but showed complete and regular rings in 36 (58.1%) of tuberculomas. Conclusion: Diffusion MRI did not help distinguish tuberculomas from metastasis and gliomas. However, NMR spectroscopy did offer this advantage by evaluating their unique metabolite pattern. BOLD venographic imaging showed the presence of a complete peripheral hypointense ring helping in diagnosing tuberculomas Keywords: Intracranial tuberculomas, Nuclear magnetic resonance spectroscopy, diffusion MRI,

The utility of 18F-FDG PET/CT in brain tumours diagnosis.

BackgroundThe purpose of the study was to discuss whether 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) study protocol should include brain imaging.Materials and methodsAnalysis of international societies recommendations compared with the original data obtained in over 1000 consecutive torso and brain 18F-FDG PET/CT studies collected in 2010.ResultsAccording to the international societies recommendations, the 18F-FDG should not be the radiotracer of choice considering the brain region PET/CT study. However, it can be performed as an additional brain imaging tool. Based on at least a 3-year follow-up, we detected 8 cases of suspicious brain findings and no primary lesion among over 1000 consecutive torso and brain 18F-FDG PET/CT scans performed in 2010. However, in 5 out of 8 patients, the brain lesion was the only metastasis detected, affecting further therapy.ConclusionsThe 18F-FDG PET/CT study may help detect malignant brain lesions and, therefore, including brain region imaging into the study protocol should be considered.

Diagnostic Value of Diffusion-weighted Magnetic Resonance (MR) Imaging and MRS in Assessment of Malignant Brain Lesions

Background: The purpose of the study is to evaluate the diagnostic value of DWI and MRS in assessment of the malignant brain lesions. Materials and methods: The study was conducted in Department of Diagnostic Radiology from March 2021, to December 2021 in Lahore General Hospital. Sample size selected was 50 patients referred to the Department of Diagnostic Radiology for their suspected brain lesion assessments. The patients were evaluated by the DWI magnetic resonance imaging and MRS. Classifications of lesions were benign and malignant on the basis of radiological findings. The data was compared with the histopathological results as a gold standard. Results: The malignant lesions from benign lesions were differentiated with DWI images and ADC mapping. Lower ADC values with restricted diffusion was considered malignant and higher ADC value with no restricted diffusion was considered benign. DWI images findings had the 77% sensitivity and 75% specificity. Cho/Cr, Cho/ NAA ratios has highest sensitivity and specificity at short TE (96%,86%) Conclusion: DWI and MRS are helpful noninvasive techniques in detecting the malignant brain lesions and can help to avoid unnecessary biopsy in the patients suspecting brain lesions. Keywords: Brain lesion, Diffusion weighted image, Malignant, Benign, MRS

371P Low-dose bevacizumab for the treatment of focal post-radiation necrosis of the brain

Focal radiation necrosis of the brain (fRNB) is an adverse event (AE) following the treatment of benign or malignant brain lesions with stereotactic radiation therapy (SRT) or stereotactic radiosurgery (SRS). An increased incidence of fRNB has been reported in cancer patients (pts) treated with immune checkpoint inhibitors. Bevacizumab (BEV), a vascular endothelial growth factor-neutralizing monocolonal antibody, has shown to be an effective treatment for fRNB at a dose of 5-7.5 mg/kg Q2W x4. Based on pharmacokinetic/-dynamic data, a “low-dose regimen” of BEV (400 mg loading dose followed by 100 mg Q4W) was investigated in pts diagnosed with fRNB.

The vicious interplay between disrupted sleep and malignant brain tumors: a narrative review

Malignant brain tumors are among the most aggressive human neoplasms. One of the most common and severe symptoms that patients with these malignancies experience is sleep disruption. Disrupted sleep is known to have significant systemic pro-tumor effects, both in patients with other types of cancer and those with malignant brain lesions. We therefore provide a review of the current knowledge on disrupted sleep in malignant diseases, with an emphasis on malignant brain tumors. More specifically, we review the known ways in which disrupted sleep enables further malignant progression. In the second part of the article, we also provide a theoretical framework of the reverse process. Namely, we argue that due to the several possible pathophysiological mechanisms, patients with malignant brain tumors are especially susceptible to their sleep being disrupted and compromised. Thus, we further argue that addressing the issue of disrupted sleep in patients with malignant brain tumors can, not just improve their quality of life, but also have at least some potential of actively suppressing the devastating disease, especially when other treatment modalities have been exhausted. Future research is therefore desperately needed.

Diagnostic Value of Diffusion-weighted Magnetic Resonance (MR) Imaging, MR Perfusion, and MR Spectroscopy in Addition to Conventional MR Imaging in Intracranial Space-occupying Lesions.

Purpose: Our aim was to determine the diagnostic performance of the combined usage of diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS) and perfusion MR (MRP) imaging for the differential diagnosis of benign and malignant intracranial lesions.Materials and methods: A total of 30 patients with intracranial lesions who were prospectively evaluated with contrast-enhanced magnetic resonance imaging (MRI), DWI, MRS, and MRP were included in this study. The lesions were classified as benign and malignant according to the radiologic findings. All imaging data were compared with the histopathologic results and follow-up of the patients. We used the Pearson chi-square test and Fischer’s exact t-test for statistical analysis.Results: For the differentiation of benign and malignant brain lesions, CBV and choline/creatine (Cho/Cr) ratio at short echo time (TE) had the highest sensitivity (87%-88%), Cho/N‐acetyl aspartate (NAA) at short TE had the highest specificity (86%). DWI predicted 77% sensitivity, 75% specificity; MRP presented 91% sensitivity, 88% specificity; MRS yielded 77% sensitivity, 63% specificity. The combination of either DWI and MRS, MRP and MRS or DWI+MRS+MRP revealed 100% sensitivity, 100% specificity.Conclusion: For the differentiation of benign and malignant brain lesions, the combination of DWI, MRS, and MRP predicted 100% sensitivity. Invasive procedures like transcranial biopsy were not required via the usage of these advanced MRI techniques.

Outcomes in Patients Treated with Laser Interstitial Thermal Therapy for Primary Brain Cancer and Brain Metastases

Laser interstitial thermal therapy (LITT) is an emerging modality to treat benign and malignant brain lesions. LITT is a minimally invasive method to ablate tissue using laser-induced tissue heating and serves as both a diagnostic and therapeutic modality for progressive brain lesions. We completed a single-center retrospective analysis of all patients with progressive brain lesions treated with LITT since its introduction at our center in August of 2015. Twelve patients have been treated for a total of 13 procedures, of which 10 patients had brain metastases and 2 patients had primary malignant gliomas. Biopsies were obtained immediately prior to laser-induced tissue heating in 10 procedures (76.9%), of which seven biopsies showed treatment-related changes without viable tumor. After laser ablation, two of three patients previously on steroids were successfully weaned on first attempt. The results of this analysis indicate that LITT is a well-tolerated procedure enabling some patients to discontinue steroids that may be effective for diagnosing and treating radiation necrosis and tumor progression.

Status Epilepticus among Older Adults in the United States.

Objective: This study aimed to identify temporal time trends and risk factors associated with mortality for hospitalized older adults with status epilepticus (SE). Design: A retrospective study was performed. Setting: Hospitalized patients were identified utilizing an administrative database—The Nationwide Inpatient Sample database from 1998 through September 2015. Patients: Patients were older adults 65 years and older with SE. Interventions: No interventions were undertaken. Measurements and Main Results: Demographic, temporal trends, clinical characteristics, and outcome data were abstracted. The results indicated that hospitalized elderly Americans with SE increased over the 11-year study period. Univariate and multivariate analyses were performed to evaluate risk factors associated with mortality in the study cohort. From the weighted sample, 130,109 subjects were included. Overall mortality was 19%. For age subgroups, the mortality was highest for the >85 years age group (24.1%) compared to the 65–75 years (19%) and 75–85 years (23%) age groups. Among investigated etiologies, the three most common causes of SE were acute ischemic stroke (11.2% of total) followed by non-traumatic brain hemorrhage (5.4%) and malignant brain lesions (4.9%). The highest mortality by etiology was noted for acute traumatic brain injury (TBI) (31.5%), non-traumatic brain hemorrhage (31%), and acute ischemic stroke (AIS) (30.1%). Multivariate analysis indicated that non-survivors when compared to survivors were more like to have the following characteristics: older age group, acute TBI, brain neoplasms, non-traumatic brain hemorrhage, AIS and central nervous system (CNS) infections, and utilization of mechanical ventilation. Associated conditions significantly increasing risk of mortality were sodium imbalance, cardiac arrest, anoxic brain injury, pneumonia, and sepsis. Comorbidities associated with increased risk of mortality included valvular heart disease, renal failure, liver disease, and neoplasms. Conclusions: The number of hospitalized elderly Americans with SE increased over the 11-year study period. Overall mortality was 19%, with even higher mortality among various patient subsets. Several demographic and co-morbid factors are associated with increased mortality in this age group.

A treatment planning comparison between a novel rotating gamma system and robotic linear accelerator based intracranial stereotactic radiosurgery/radiotherapy

To compare the dosimetric parameters of a novel rotating gamma ray system (RGS) with well-established CyberKnife system (CK) for treating malignant brain lesions. RGS has a treatment head of 16 cobalt-60 sources focused to the isocenter, which can rotate 360° on the ring gantry and swing 35° in the superior direction. We compared several dosimetric parameters in 10 patients undergoing brain stereotactic radiosurgery including plan normalization, number of beams and nodes for CK and shots for RGS, collimators used, estimated treatment time, D 2 cm and conformity index (CI) among two modalities. The median plan normalization for RGS was 56.7% versus 68.5% (p = 0.002) for CK plans. The median number of shots from RGS was 7.5 whereas the median number of beams and nodes for CK was 79.5 and 46. The median collimator’s diameter used was 3.5 mm for RGS as compared to 5 mm for CK (p = 0.26). Mean D 2 cm was 5.57 Gy for CyberKnife whereas it was 3.11 Gy for RGS (p = 0.99). For RGS plans, the median CI was 1.4 compared to 1.3 for the CK treatment plans (p = 0.98). The average minimum and maximum doses to optic chiasm were 21 and 93 cGy for RGS as compared to 32 and 209 cGy for CK whereas these were 0.5 and 364 cGy by RGS and 18 and 399 cGy by CK to brainstem. The mean V12 Gy for brain predicting for radionecrosis with RGS was 3.75 cm3 as compared to 4.09 cm3 with the CK (p = 0.41). The dosimetric parameters of a novel RGS with a ring type gantry are comparable with CyberKnife, allowing its use for intracranial lesions and is worth exploring in a clinical setting.

Novel Cancer Stem Marker and Its Applicability for Grading Primary Human Gliomas.

Poorly differentiated cell populations including tumor-initiating stem cells have been demonstrated to display a unique ability to natively internalize fragmented double-stranded DNA. Using this feature as a marker, we show that 0.1% to 6% of human glioblastoma cells from the bioptates can effectively internalize a fluorescently labeled DNA probe. Of these, using samples from 3 patients, 66% to 100% cells are also positive for CD133, a well-established surface marker of tumor-initiating glioma stem cells. Using the samples from primary malignant brain lesions (33 patients), we demonstrate that tumor grading significantly correlates (R = .71) with the percentage of DNA-internalizing cells. No such correlation is observed for relapse samples (18 patients).

A prospective patient-focused evaluation of the tolerance and acceptability of a stereotactic radiosurgery procedure

Stereotactic radiosurgery (SRS) is a frequently used non-surgical procedure to treat benign and malignant brain lesions. Few studies have focused on patient perceptions of SRS. The aims of this patient-focused study were to assess patient experiences of SRS, and changes in patient-reported symptoms over 12weeks post-SRS. Using the 6-point Likert Scoring Scale in a diary-format for a less discriminatory evaluation, patients self-reported presence or absence, and severity of physical and psychological symptoms within 24h, 1-week, and 12-weeks post-SRS. Non-parametric repeated measures ANOVA was used to evaluate changes in symptoms. Of the 748 recruited patients, 690 returned the first diary (92%), while 564 patients returned all three diaries for matched responses analysis (82%). Three-quarters of 690 patients reported receiving clear verbal explanations and printed material prior to their procedure, and 99% reported the clinical team were ‘very supportive’ or gave ‘wonderful care’. Fatigue (82%) and headaches (65%) were the most frequently reported symptoms within 24-h post-SRS. Over 12weeks, patients reported significant reductions in headache, nausea, fatigue, anxiety and tension (p<0.001); loss of balance and concentration significantly increased by 12-weeks post-SRS (p<0.001). Some patients attributed symptoms such as fatigue or headaches to the demands of the procedure day. Findings of this study reflect the need to further research patients’ physical and psychological symptoms post-SRS, which may differ from the clinicians’ perception of the effects of treatment.

Is There a Role for Stereotactic Biopsy of Unresectable Malignant Brain Lesions? An Analysis of Short-Term Morbidity and Mortality

Is There a Role for Stereotactic Biopsy of Unresectable Malignant Brain Lesions? An Analysis of Short-Term Morbidity and Mortality