Radiation dose response of normal brain.

Dose response relationships were determined after hemibrain x-irradiation of normal beagle dogs. Radiation doses of 11.5, 13.5, 14.3, and 17 Gy were delivered in a single dose and results were compared to previous studies using doses of 15 and 30 Gy. Brain injury was quantified using computed tomography (CT), with serial studies obtained monthly up to 1 year following irradiation. Quantitative endpoints included low density volume and contrast enhancement. Doses above 14.3 Gy resulted in high lethality 5-8 months following irradiation, and an LD50 of 14.9 Gy was calculated. At these lethal doses, low density volume representing edema, demyelination, and necrosis had a similar response with an ED50 of 14.6 Gy. Radiation-induced decreases in white matter density appeared 5-6 months after sublethal doses (less than or equal to 14.3 Gy) and the volume of tissue characterized by this low density increased with time and dose. This sublethal low density change had an ED50 of 12.8 Gy, and may reflect a loss or generalized atrophy of glial cells and/or myelin. These results show that: (a) the dose response curves obtained after hemibrain x-irradiation are extremely steep; and (b) at least two processes may be involved in the development of late radiation damage, one that is rapid upon onset (a "delayed acute" reaction) and the other which is a slower and more degenerative process.

Radiation brain damage induced by interstitial 125I sources: a canine model evaluated by quantitative computed tomography.

The canine brain is a good model of the human brain for studying radiation damage after megavoltage x-irradiation for brain tumors. We have further developed this model to study radiation damage induced by high activity interstitial 125I sources. Removable 125I sources were implanted in normal canine brains, and doses of 1,000 to 10,000 rads were delivered to a reference point at a 10-mm radius from the source; dose rates were 35 to 40 rads/hour at the reference point. Serial quantitative analysis of tissue damage (tissue density and contrast enhancement) was done using computed tomographic scanning up to 6 months after implantation and was compared to histopathological findings after the animals were killed. At doses greater than 19,000 rads (i.e., inside the reference point), frank coagulation necrosis was observed. Pronounced vessel-related changes, manifest as areas of contrast enhancement, corresponded to tissues receiving a minimum of 6,000 rads and a maximum of 19,000 rads. These results indicate that this model can be used in serial noninvasive studies to quantify the development of damage induced by interstitial irradiation and to provide dose-response information in individual animals.

Computerized tomography in the prognosis of malignant cerebral gliomas.

Ninety-seven patients with supratentorial malignant gliomas who received postoperative radiation therapy and chemotherapy at the University of California, San Francisco, from 1977 through 1984 showed improvement in their follow-up computerized tomography (CT) scans. Twenty-one of these 97 "CT responders" were designated "complete responders" because on serial CT scans they had complete disappearance of the tumor mass and contrast enhancement, which had been present postoperatively. In the remaining 76 patients, CT scans showed reduction in the size, but not disappearance, of the lesions, and these were designated "partial responders." Fifty-eight partial responders had glioblastoma multiforme (GM); their median survival time was 72 weeks. The median survival time for the 11 complete responders with GM has not yet been achieved, but survival at the 53rd percentile is 172 weeks. Among patients with highly anaplastic astrocytoma, the median survival time was 211 weeks for the 10 complete responders and 125 weeks for the 18 partial responders. Eleven of the 21 complete responders are alive at a median postoperative follow-up time of 163 weeks (range 114 to 470 weeks). Eighteen of these patients had subtotal resection of tumor; three patients had gross total tumor resections, but postoperative CT scans showed evidence of residual or possibly recurrent tumor within 1.5 to 4.5 months. Resolution of the tumor mass and contrast enhancement took 9 to 151 weeks; the time to resolution did not depend upon the configuration of the remaining tumor mass and contrast enhancement after surgery. In this study, patients with malignant gliomas whose CT scans eventually showed sustained complete disappearance of the tumor mass and contrast enhancement had a more favorable prognosis than did patients whose CT scans showed improvement, but not complete disappearance, of the tumor. These CT findings may prove useful in determining the prognosis of patients with malignant gliomas.

Quality of survival of patients with brain gliomas treated with postoperative CCNU and radiation therapy.

This prospective randomized clinical trial compared the effectiveness of combined treatment with CCNU and radiation therapy to the use of radiation therapy alone for the postoperative management of supratentorial brain gliomas (67% anaplastic) in 198 patients. The results were evaluated with the aid of a specially developed weighted neuropsychological test battery providing single-value estimation of "life quality" of patients, as well as with a clinical performance scale. Based on these methods, it was established that patients improved within 6 months following therapy. This improvement was maintained in surviving patients during the 2-year follow-up period. The patients led a relatively normal life, but when their condition deteriorated their decline was rapid. The median survival time of patients treated with radiotherapy did not differ significantly from that of patients receiving chemotherapy in addition. Nor did the analysis of life quality and of changes in clinical performance show any benefit in supplementing surgery and radiation therapy with CCNU chemotherapy at the dosage used.

[Familial gliomas]. / Glejaki rodzinne.

As a contribution to the present discussion on genetic determination of gliomas two cases of gliomas in father and son are reported. Familial occurrence of gliomas suggests a possible role of genetic factors in the development of intracranial gliomas.

[ABO blood groups in glioblastoma multiforme]. / Grupy krwi ABO w glejakach wielopostaciowych.

The distribution of ABO blood groups was analysed statistically in 271 patients treated for glioblastoma multiforme. The control group included 500 patients treated for craniocerebral trauma. A statistically significant difference was observed in the distribution of ABO blood groups between these patient groups, with higher frequency of group A and lower of group O in the patients with glioblastoma multiforme.

[Drawings by patients with unilateral visuospatial agnosia]. / Rysunki chorych z jednostronna agnozja wzrokowo-przestrzenna.

Drawings made by 25 patients with neurosurgical diseases causing focal lesions in the posterior areas of the right, not dominant cerebral hemisphere due to expanding changes. Experimental clinical investigations by the method of Luria demonstrated in these cases presence of left-sided visuospatial agnosia. The material was analysed from the point of view of the features of drawings characteristic for the syndrome of disturbances and the localizatory and diagnostic value of drawings. Characteristic disturbances of drawings and their placement were observed suggesting that the patients ignored the left half of the visual space due to damage to the right parieto-occipital non-dominant cerebral hemisphere. The drawing test is regarded as a valuable method for the diagnosis and localization of lesions in the neurological and neuropsychological practice.

[Value of the neuropsychological examinations in the diagnosis of supratentorial gliomas]. / Wartosc badania neuropsychologicznego w diagnostyce glejaków nadnamiotowych mózgu.

The authors report an analysis of the results of neuropsychological investigations of patients treated for supratentorial gliomas. A syndrome of the most frequently observed disturbances of higher nervous activity has been outlined. The diagnostic, localizatlry and differential diagnostic value of neuropsychological investigations has been assessed and found to a useful auxiliary clinical method.

[Giant osteoma of the skull]. / Olbrazymi kostniak czaszki.

A case of giant osteoma of the external lamina of the cranial bone is reported. The report is published as a contribution to the discussion on the methods of surgical removal of these tumours. The authors confirm the validity of the view that osteomas should be removed radically from the external lamina leaving the internal lamina intact if it is free of osteoma.

[Brachytherapy of brain gliomas]. / Brachyterapia glejopochodnych nowotworów mózgu.

Radiotherapy is considered presently the most advantageous supplementary method after surgical treatment for gliomas. The limitations of classical teletherapy cause that interstitial radiation may become preferable. The authors present the theoretical principles and practical application of brachytherapy in 10 cases of glioma. Closed radioactive sources were used in form of I125 implanted stereotactically into brain tumours for a period sufficient for providing therapeutic radiation dose to the border of the tumour. The doses received by tumour borders ranged from 812 to 4560 cGy, and the mean dose was 2064 cGy. Five patients were given additionally 6000 cGy by teleradiotherapy.

[Serum neuraminic acid level in patients with cerebrovascular disorders]. / Zawartosc kwasu neuraminowego w surowicy krwi chorych z naczyniowym uszkodzeniem mózgu

The authors determined the level of neuraminic acid in the serum of 50 patients with encephalomalacia and 25 patients with cerebral haemorrhages on the 1st, 3d and 7th days of the disease. Twenty healthy subjects served as controls. A statistically significant rise in the concentration of this substance was observed in both groups of patients throughout the whole period of observations.

[Chronic bilateral subdural hematoma]. / Przewlekle dwustronne krwiaki podtwardówkowe.

The authors report 31 patients treated surgically for chronic bilateral subdural haematomas stressing the diagnostic difficulties in such cases and discussing the value of radiological investigations and surgical methods, especially multipoint trepanation.

[Results of surgical treatment of post-traumatic intracerebral hematoma]. / Wyniki leczenia operacyjnego pourazowych krwiaków sródmózgowych.

The authors discuss the results of surgical treatment of traumatic intracerebral haematomas on the basis of own material of 44 cases and a survey of literature. The rarity of this complication of injuries and the diagnostic difficulties are stressed, the usefulness of surgical approach is analysed and the prognostic importance of such factors as the clinical course of haematoma, severity of the patient's condition, and coexistence of other intracranial injuries is discussed.

[Results of surgical treatment of intracranial epidural hematoma]. / Wyniki leczenia operacyjnego wewnatrzczaszkowych krwiaków nadtwardówkowych.

The authors discuss the results of surgical treatment of intracranial epidural haematomas in the light of own material of 84 cases. In relation to reports in the literature the authors call attention to diagnostic difficulties in atypical cases and discuss the importance of signs of prognostic value for the life of the patient and factors increasing mortality. The signs of poor prognosis include: respiratory disturbances, bilateral pupillary dilatation, coma with disturbances of basic vital functions and decerebrate rigidity. The mortality is increased by co-existent intracranial injuries, especially brain lacerations. The prognosis was best in cases operated upon during the lucid interval. Very good and good results of treatment were achieved in 86% of cases, satisfactory in 8%, with a general mortality of 26%, which was highest in the group with acute haematomas reaching 43%.

[Factors affecting the quality of life of patients treated by a combined method for poorly differentiated supratentorial glioma]. / Czynniki wplywajace na zmiany jakosci zycia chorych leczonych w sposób skojarzony z powodu niskozróznicowanych, nadnamiotowych glejaków mózgu.

The quality of life of patients treated for brain tumours and the length of survival are important factors making possible the evaluation of treatment effectiveness. Changes of life quality evaluated by the Karnofsky scale were analysed in a group of 56 patients who have received combined treatment for poorly differentiated supratentorial gliomas. Life quality changes were evaluated after completion of surgical and radiological treatment in relation to preoperative status. The influence of various clinical factors on life quality changes was evaluated. Surgical treatment and tumour site had a significant effect on the stabilization or slight improvement of life quality. The direction and extent of life quality changes were related to surgery, with further change after radiotherapy.

[Experience of the Lublic center with the combined treatment of supratentorial glial brain tumors. Preliminary report]. / Doswiadczenia osrodka lubelskiego w skojarzonym leczeniu nadnamiotowych glejopochodnych nowotworów mózgu. Doniesienie wstepne.

The results of combined treatment were analysed in 38 cases of cerebral gliomas. In the group of 14 patients with glioblastoma multiforme treated surgically and by later radiotherapy and chemotherapy by the schedule of Hildebrand a mean arrival time of 116 weeks was obtained and the one-year survival rate was 71%. In the group of inoperable gliomas (16 cases) treated by radiotherapy and chemotherapy the mean survival time was 47 weeks and the one-year survival rate was 44%.

[Neuropsychological evaluation of the results of treatment of hydrocephalus using a ventriculo-atrial valve]. / Neuropsychologiczna ocena wyników leczenia wodoglowia zastawka komorowo-przedsionkowa.

In 25 patients with hydrocephalus of various grades and aetiology treated by insertion of ventriculoatrial valves neuropsychological investigations were carried out before and after this operation using the method of Luria and certain psychometric tests. The obtained results made possible isolation of three grades of impairment of higher nervous functions: III--afunction--10 patients, II--dysfunction--12 patients, I--eufunction--3 patients. Control neuropsychological examination two weeks after the operation demonstrated improvement of higher nervous functions in 6 cases with grade III and 11 patients with grade II impairment. In these cases radiological investigations demonstrated evidence of normotensive and hypertensive hydrocephalus and this was confirmed by measurements of intraventricular pressure of the cerebrospinal fluid. In 5 cases with grades III and II of damage no improvement was found. Radiograms and measurements of intraventricular pressure suggested in these cases hydrocephalus due to brain atrophy.

[The early results of surgical treatment of chronic subdural hematomas in computerized tomography imaging]. / Wczesne wyniki leczenia operacyjnego przewleklych krwiaków podtwardówkowych w obrazie tomografii komputerowej.

Since the introduction of computerized tomography (CT) it has been possible to trace the image of the brain after removal of subdural haematoma. Postoperative studies demonstrated often presence of residual haematoma. This raises the problem of establishing indication to reoperation, especially of patients with good clinical condition. The clinical condition and CT images before and after operation were assessed in 20 patients treated surgically for chronic subdural haematoma. A statistically significant correlation was found between the magnitude of the effect of the space occupying lesion in CT image and the severity of the clinical condition. A high-grade mass effect with major ventricular system shifting was more often connected with presence of partly haemolysed haematoma in CT. Subdural haematoma thickness exceeding 20 mm correlated with serious clinical condition of the patient, and increased the likelihood of hemiparesis persisting after the operation. Finding of residual haematoma in postoperative CT should not be an indication to reoperation, if not associated with high-grade mass effect and if the clinical condition is good. In our material out of 15 patients with good clinical condition postoperatively residual haematoma was detected by CT in 12 cases, but only one had to be reoperated because of persistent high-grade mass effect.

[Early results of surgical treatment of chronic subdural hematoma in CT images]. / Wczesne wyniki leczenia operacyjnego przewleklych krwiaków podtwardówkowych w obrazie tomografii komputerowej.

Since the introduction of CT it has become possible to trace the pattern of brain changes after removal of subdural haematoma. Postoperative studies show frequently presence of haematoma residues, and this is connected with the problem of deciding about establishing of indications to reoperation, especially difficult if the patient is in a good clinical condition. The clinical status was compared with CT findings preoperatively and postoperatively in 20 patients subjected to operations for chronic subdural haematomas. A statistically significant correlation was found between the size of the mass effect in CT before and after the operation and the severity of the clinical condition. Major mass effect with high-grade ventricular shifting is more frequently connected with partially haemolysed haematoma in CT. The thickness of subdural haematoma exceeding 20 mm correlated with severe clinical condition, and increased the probability of hemiparesis persistence after the operation. Finding of residual haematoma in CT imaging after the operation, especially when not associated with high-grade mass effect, and with good clinical condition should not be accepted as an indication to repeated operation. In the presented material out of 15 patients with good clinical condition 12 had CT evidence of residual haematoma, and only one had reoperation in view of persisting evident mass effect.