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Background and Purpose: Hemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx-18 through diminutive external carotid artery (ECA) feeders., Methods: A retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002-November 2014) and Anonymous University #2 (January 2014-November 2014) is presented., Results: Fifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4±10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9±26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0±34.6%; n=4) versus polyvinyl alcohol particles (33.3±15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=-0.71; p=0.005). There were no embolization-related complications., Conclusions: The extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

The currently accepted standard of care for primary glioblastoma (GBM) consists of maximal surgical resection followed by fractionated external beam radiotherapy (EBRT) with concomitant temozolomide chemotherapy. The role of stereotactic radiosurgery (SRS) in the treatment of GBM is not well defined, but SRS has typically been applied as a salvage therapy for GBM recurrence. This paper reviews our single institution experience using gamma knife radiosurgery (GKRS) for the treatment of GBM. Thirty-six patients treated with GKRS for pathologically proven GBM at LSU Health in Shreveport from February 2000 to December 2013 were identified and analyzed. Patient characteristics, treatment variables, and survival were correlated. Seven patients received GKRS in the immediate postoperative period for an average tumor volume of 10.9 cm(3), and 29 patients were treated for a recurrent average tumor volume of 11.4 cm(3) with a prescribed dose ranging from 10 to 20 Gy at the 50 % isodose line. The median overall survival was significantly higher in recurrence group compared to up-front group [7.9 months (0.77-32.1 months) vs. 3.5 months (range 0.23-11.7 months) respectively, (p = 0.018)]. The predictive factors for improved survival in the patients with GBM were as follows: Karnofsky performance scale (KPS) > 70 (p = 0.026), age ≤ 50 years (p = 0.006), absence of neurodeficits (p = 0.01), and initial postoperative treatment with EBRT (p = 0.042). Adjuvant therapy with GKRS following GBM recurrence demonstrates statistical superiority over immediate postoperative boost therapy.

Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) has emerged as an important treatment option for metastatic brain tumors (MBT). However, the long term outcome of GKRS on MBT is not well understood. We reviewed the treatment of MBT with GKRS at our institution. We performed a retrospective review (2000-2013) of 298 patients with MBT who received GKRS. The study population was monitored clinically and radiographically after GKRS treatment. Survival benefits and predictive factors of the outcome were analyzed using the Kaplan-Meier test and Cox regression model, respectively. GKRS in MBT showed significant variation in tumor growth control (decreased in 135 [45%] patients, arrested growth in 91 [37%] patients and increased tumor size in 72 [24%] patients). The median survival in the study population was 17 months. Overall and progression free survival after 3 years were 25% and 45%, respectively. The predictive factors for improving survival in the patients with MBT were recursive partitioning analysis class I (p<0.0001), absence of hydrocephalus (p<0.0001), Karnofsky Performance Status (KPS) >80 (p=0.007) and absence of recurrent MBT (p=0.01). Forty (12%), 15 (4.3%) and two (0.6%) patients required GKRS, resection and whole brain radiation, respectively, after initial GKRS due to tumor progression and worsening of signs and symptoms. Our findings revealed that GKRS offers a high rate of tumor control and good survival benefits in both new and recurrent patients with MBT. Thus, GKRS is an effective treatment option for new patients with MBT, as well as an adjuvant therapy in patients with recurrent MBT., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Intracranial intraparenchymal Schwannomas are very rare. Twenty-eight cases of frontal intraparenchymal Schwannomas have been reported so far. These generally present with seizures, raised intracranial pressure, nasal stuffiness and epistaxis. We present a patient with frontal intraparenchymal Schwannoma who underwent frontal craniotomy and excision. At follow-up the patient is seizure free and is relieved of his symptoms.