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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An overview of brain metastasis with respect to the pathological, diagnostic, and therapeutic aspects is presented. Management is almost always palliative, with cure being a rare exception. Evaluation of various therapeutic modalities--radiation, chemotherapy, or surgery--has been confounded by a lack of controlled, randomized studies whereby the relative benefit of the respective modalities can be assessed objectively. Despite these limitations, some progress is being made in the identification of those patients for whom therapy is likely to be of benefit. Apart from the use of steroids to control cerebral edema, radiotherapy is currently the most commonly employed therapeutic modality for cerebral metastasis. It is the treatment of choice for multiple intracranial metastases and it affords temporary improvement in neurological symptoms in about 60% of patients. For solitary metastases, combined therapy--surgical excision followed by whole brain radiotherapy--has been shown to result in a better quality and longer duration of survival than either modality alone. Except for patients who are terminally ill, aggressive treatment seems warranted, inasmuch as therapeutic results have been improving steadily over the years. Neither chemotherapy nor immunotherapy has been shown to be of benefit in the management of cerebral metastasis. An exception is choriocarcinoma, which responds well to a combination of radiation therapy and chemotherapy. Although the prognosis for meningeal carcinomatosis is poor, improved survival may be achieved by a combination of chemotherapy and radiotherapy. These are recommended guidelines for surgical intervention, usually followed by radiotherapy: (a) In general, surgical excision is recommended only for patients with relatively superficial, solitary lesions. It is reasonable, however, to consider the excision of a metastatic lesion that is immediately life-threatening or incapacitating, even though one or more other metastatic brain lesions may be present. This may be extended to the removal of multiple metastatic brain tumors if they are surgically accessible. (b) The second consideration is whether the primary tumor can or has been treated or if the primary tumor will permit reasonably long survival. (c) There should not be metastases elsewhere in the body, although their presence should not categorically exclude the patient as a surgical candidate. (d) The patient's general condition should be satisfactory. (e) Operation is recommended if the diagnosis of the intracranial lesion is uncertain. (f) A shunt should be considered for treatment of hydrocephalus secondary to obstruction of the cerebrospinal fluid pathway by tumor or edema. (Neurosurgery, 5: 617--631, 1979).
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PMID:Brain metastasis: current status and recommended guidelines for management. 9 55

A case of infantile metastasizing Wilms' tumor is described clinically and pathologically. The presenting feature was congenital hydrocephalus due to cerebral metastases. The literature is reviewed and four similar examples are found. The unusual pattern of clinical presentation and metastases is emphasized as it may be characteristic for this rare entity.
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PMID:Metastatic infantile Wilms' tumor and hydrocephalus; a case report with review of the literature. 19 48

Three cases of rare primary intracranial yolk sac tumor are reported. Two cases had a pineal location, whereas the third presented as a suprasellar mass. After the placement of ventriculoperitoneal shunts for relief of hydrocephalus, all of the patients developed metastases restricted to the peritoneum, as demonstrated by autopsy in one patient (Case 1) and clinical and radiographic evidence in two patients (Cases 2 and 3). The peritoneal metastases were directly associated with the death of one patient, but were successfully treated with chemotherapy in another patient, who is still alive more than 2.5 years after initial presentation. The value of ascitic fluid cytology and alpha-fetoprotein determination in the diagnosis of this complication was demonstrated in one patient. These cases emphasize the need for awareness of this mode of metastasis and its potentially lethal effect.
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PMID:Abdominal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases. 50 97

Fifty-one patients with medulloblastoma have been treated at the Children's Memorial Hospital during the past 11 years. The ratio between males and females was 2:1. The ages ranged from 4 months to 12 years; 7 patients were less than 12 months old at the time of diagnosis. After 1969, prior to definitive surgery, all patients were given a ventriculo-peritoneal shunt to decompress the hydrocephalus which was invariably present. There were no cases of systemic metastasis related to these shunts. Subsequently, posterior fossa craniotomy was performed, with total or radical resection of tumour in 13 cases, subtotal resection in 20 cases, and partial resection or biopsy in 14 cases. After completion of surgical treatment and radiotherapy, the three-year survival rate was 45.6 per cent and the five-year survival 34.5 per cent. The survival of children given total resection of the tumour was significantly longer, and females survived longer than males. Local recurrence and spinal cord or systemic metastases are discussed. Reexploration of the posterior fossa for recurrences failed to improve the prognosis. Recurrent or metastatic medulloblastoma should be treated by radiotherapy or chemotherapy, or both.
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PMID:Medulloblastoma in childhood. 51 84

Internal drainage of cerebrospinal fluid utilizing a mechanical tube has been an increasingly common and effective procedure for the relief of non-communicating hydrocephalus with intracranial tumor. However, several cases have recently been reported in which extraneural metastases of the tumor were initiated through the shunt tube implanted. The purpose of this paper is to present two cases with malignant brain tumor metastasizing extraneurally through ventriculoperitoneal shunt, and to review the reported cases in the literature. Case 1 The patient, a 9-year-old boy, had been suffering from headache and vomiting for 3 months prior to admission to the Neurosurgical Clinic, Gumma University Hospital. On admission, he had choked discs and cerebellar dysfunction with a staggering gait. The clinical diagnosis was a 4th ventricle tumor. On November 29, 1971, a suboccipital craniectomy was performed. A medullary tumor in the 4th ventricle was partially removed, and ventriculoperitoneal shunt was also performed. Subsequently postoperative irradiation was given, and the symptoms were abated. Histological diagnosis was ependymoblastoma. Thirteen months later, he was again admitted because of visual disturbance, psychic change and pituitary hypofunction. Bilateral frontal craniotomy revealed a large mass over the midline of the anterior skull base, accompanied by numerous meningeal neoplastic deposits. The tumor was partially removed and histologically proven to be meningeal metastases of ependymoblastoma. Irradiation was again given and the symptoms improved. But the 4th ventricle tumor recurred 5 months after the 2nd operation, and then a massive intraperitoneal effusion appeared. Cytological examination revealed clusters of tumor cells in the ascites. The patient died on September 8, 1974, namely 22 months after the ventriculoperitoneal shunt was implanted. Postmortem examination showed a solid tumor in the 4th ventricle which was accompanied by diffuse meningeal dissemination, and metastases were present throughout the peritoneal surface...
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PMID:[Extraneural metastases of malignant brain tumors through ventriculoperitoneal shunt--report of two autopsy cases and a review of the literature (author's transl)]. 55 82

Permanent (CSF-drainages for treatment of hydrocephalus in posterior fossa tumors have been used in the last few years, increasingly. The rare incidence of extracranial metastases and it's higher frequency in the same period of time has been remarkable. An additional case of metastasis via ventriculoperitoneal shunt is presented. Such deleterious complications of malignant CNS-tumors should be avoided, as progressively improving results with combined radio-chemotherapy have established a more encouraging prognosis.
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PMID:Shunt metastases in posterior fossa tumors. 58 68

Computed tomography proved insensitive to leptomeningeal spread of hematologic malignancies including leukemia, lymphoma, and malignant histiocytosis. In only 3% of patients did it directly demonstrate leptomeningeal tumor. In comparison, the detection rate of leptomeningeal tumor secondary to carcinoma was 44% and for melanoma, 100%. Intracranial subarachnoid seeding from primary brain gliomas was detected in each instance. The simultaneous presence of parenchymal metastases with leptomeningeal carcinomatosis occurred in 18% of patients with nonhematologic malignancies. Computed tomography evidence of communicating hydrocephalus, previously thought to be a major factor in clinical symptomatology, occurred in only 11% of patients.
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PMID:Computed tomography in leptomeningeal spread of tumor. 70 24

This is a review of primary and secondary tumors of the optic nerve. The emphasis is an optic nerve gliomas and meningiomas. Optic nerve gliomas are slowly growing astrocytic neoplasms of the anterior visual pathways, the majority of which occur within the first two decades of life, with equal sex incidence in about 1 of 200,000 patients presenting with eye complaints. The incidence is greater in neurofibromatosis. The typical presentation is visual impairment in a verbal pre-school child with optic canal enlargement and optic atrophy. An intraorbital location of the tumor leads to axial, irreducible, non-pulsatile proptosis. An intracranial location may disturb hypothalamic and pituitary function and produce hydrocephalus. Ocular findings may also include limited motility on a mechanical-restrictive basis, a pupillary relative afferent defect, nystagmus, and variable, non-specific visual field defects. Roentgenographic studies may show concentric unilateral enlargement of the optic canal with preservation of a well corticated margin, a fossa under the anterior clinoid process in continuity with the optic canal ('J'-shaped sella), and findings of increased intracranial pressure. On pathologic examination the tumor is a smooth, fusiform, intradural enlargement of the optic nerve. Histologically there is proliferation of elongated (pilocytic) astrocytes in reticulated patterns with intervening microcystic spaces containing mucosubstance and surrounding reactive hyperplasia of the arachnoid. Mitoses are not found. The diagnosis is clinical X-ray studies and brain scan should be performed. The differential diagnosis is that of unilateral proptosis in a child and includes acute ethmoiditis, hyperthyrobidism, craniostenosis, other neoplasms, Hand-Schuller-Christian disease, and orbital hemorrhage due to trauma. Surgical resection is performed in cases with unilateral optic nerve involvement, the surgical approach being determined by tumor location. Bilateral or chiasmal cases are treated with radiotherapy when progression occurs. Malignant optic nerve gliomas and optic nerve hyperplasia are also discussed. Optic nerve meningiomas arise from the nerve sheath and are to be distinguished from orbital meningiomas arising from ectopic arachnoidal cells or those secondarily involving the orbit by extension from adjacent sites. Up to 80% of orbital meningiomas occur in females, in two age peaks, 25% in the first decade, and the rest in the 5th decade. Meningiomas present with visual loss and may produce proptosis, papilledema and/or optic atrophy, retinal striae, opticociliary shunts, limitation of extra-ocular movements, and lid edema, Signs of von Recklinghausen's disease should be sought. X-rays are the mainstay of diagnosis. Orbital meningiomas are composed of cells in sheets or in whorls with some spindle shaped cells. Calcifications are typical. Usually the dura is penetrated and the orbit invaded. Primary orbital meningiomas are locally infiltrating but do not metastasize. Complete local excision en bloc is recommended...
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PMID:Tumors of the optic nerve. 77 17

Computed tomography has been found to be a more accurate diagnostic tool in the analysis of brain metastases than radionuclide scanning. Of 1,100 patients studied by CT scan, 57 showed evidence of intracerebral metastasis, and 14 showed evidence of hydrocephalus. Density levels below that of normal brain tissue were found in cases of metastases from the lung (13), breast (7), melanoma (4), kidney (3), lymphoma (3), and nasopharynx (1); levels above normal were found in cases of metastases from melanoma (8), lung (3), colon (3), chorionic carcinoma (2), osteogenic sarcoma (1), and kidney (1).
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PMID:Computed tomography in metastatic disease of the brain. 94

The authors have routinely inserted a ventriculoperitoneal shunt in all patients with a posterior fossa tumor and hydrocephalus some 7-10 days prior to craniotomy. Forty-one patients with medulloblastoma were treated in this fashion and of these, four metastasized through the shunt and died of systemic metastases without evidence of recurrent tumor in their central nervous system. A millipore filter which can be incorporated in the shunt has been used by the authors during the past 18 months in an effort to prevent metastatic spread through the shunt.
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PMID:Metastasis via ventriculoperitoneal shunt in patients with medulloblastoma. 126 15


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