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Results: 1 to 20 of 143

Surgery or radiosurgery for solitary brain metastases from non‐small cell lung cancer

A solitary brain metastasis is the spread of cancer to the brain some time after successful treatment of the primary cancer. When the metastasis is caused by non‐small cell lung cancer there are two main treatment options: surgery and radiosurgery. Radiosurgery consists of the use of high dose radiotherapy to the affected area guided by a three‐dimensional computer and keeping the patient's head fixed, giving such precise treatment that it is considered "surgical". This review set out to compare both techniques. Our literature search has shown that a well‐designed randomised trial comparing surgery and radiosurgery for patients with solitary brain metastasis has never been performed. Therefore, this review has been unable to show any advantage of one treatment over the other for this group of patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Cooling the brain during surgery for preventing death or severe disability in patients with brain aneurysms

Intracranial aneurysms are bulges on the cerebral arterial wall. Rupture of an intracranial aneurysm is often life‐threatening. Such patients are classified as good‐grade or poor‐grade based on their clinical manifestations. Surgery is a common option to treat this problem but it can cause further damage to the brain. Theoretically, intraoperative mild hypothermia reduces the metabolic activity of the brain thus protecting it during an operation. Research on animals supports this theory in general. We conducted a systematic review on clinical trials examining the effect of intraoperative mild hypothermia in preventing death and handicap in patients undergoing open‐skull surgery for cerebral aneurysms. We found only three randomised controlled trials with a total of 1158 patients for inclusion in the review. Data primarily came from one high‐quality study with 1000 patients. Our analysis showed that, for patients with good‐grade aneurysmal subarachnoid haemorrhage, intraoperative mild hypothermia may have the potential to prevent death or dependency in activities of daily living in a few of them. However, the effect cannot be proven statistically. Although no harm of intraoperative mild hypothermia was documented, this treatment should not be applied routinely. In patients with poor‐grade aneurysmal subarachnoid haemorrhage or without subarachnoid haemorrhage, the effect is unclear. A high‐quality randomised clinical trial of intraoperative mild hypothermia for postoperative neurological deficits in patients with poor‐grade aneurysmal subarachnoid haemorrhage might be feasible.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Surgery and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases

For patients with single brain metastasis there is good evidence from randomised controlled trials (RCTs) that surgery in addition to whole brain radiation therapy (WBRT) does not improve overall survival.Treatment of brain metastasis is usually palliative although in selected patients ‐ particularly those with only a single metastasis to the brainsurgery could be considered. This review analysed the evidence from three RCTs, enrolling a select group of patients, and found that the combination of surgery and WBRT did not improve overall survival compared with WBRT alone. The addition of surgery may improve the length of time patients remained independent from others for support and there is a suggestion it may also reduce the risk of death due to neurological causes. Patients undergoing surgery were not reported have a higher risk of adverse events than patients who only had WBRT. Decisions on the treatment for an individual patient are best made as part of a multidisciplinary team.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

There is no evidence to recommend that patients with non‐small cell lung cancer receive prophylactic radiotherapy to the brain following potentially curative treatment with surgery or radiotherapy

Patients with non‐small cell lung cancer have a significant risk of developing tumour spread (metastases) to the brain after potentially curative treatment. To date, four research trials have been published in full; they included different groups of patients who had different doses of radiotherapy, and different outcomes were measured. None of the trials showed that patients who had received prophylactic radiotherapy to the brain lived longer than those who had not, although fewer of them developed brain metastases. A fifth trial (RTOG 0214) has not yet been published in full and is discussed in the results section.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Cooling for cerebral protection during brain surgery

The brain is at risk of low blood flow during a variety of neurosurgical procedures and this can lead to devastating results. Induced hypothermia is the controlled lowering of the core body temperature in order to avoid the problems associated with low blood flow. Brain surgery may lead to severe complications due to factors such as trauma from retracting the brain, vessel occlusion, and intraoperative haemorrhage. Many anaesthetists believe that induced hypothermia is indicated to protect the central nervous system during surgery. We found four studies that enrolled 1219 participants for this review.There was no evidence of any important differences in outcome for hypothermia for cerebral protection and normothermia during brain surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

The benefits and side effects of adding upfront whole brain radiotherapy to surgery or radiosurgery for treatment of brain metastases

For certain patients with a single brain metastasis, surgery to remove the single brain metastasis may be undertaken.  For certain patients with small brain metastatic disease, a highly focused single radiation treatment called radiosurgery, may be used.  It is unclear the benefits and side effects of adding upfront (i.e. a therapy given to previously untreated patients) whole brain radiation to surgery or radiosurgery.  We wanted to establish whether adding upfront whole brain radiation to surgery or radiosurgery was a useful treatment for brain metastases.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Surgery versus medication for treating acid reflux in brain‐damaged children having a feeding tube inserted

Children with cerebral palsy often have oral motor impairment and need help with eating and drinking. Frequently this entails surgery to place a feeding tube (gastrostomy) directly into their stomach. They may also be found to have gastro‐oesophageal reflux (where stomach acid flows back up into the feeding tube (oesophagus)), which can be made worse by gastrostomy surgery. Reflux can be treated either with additional surgery at the same time as the gastrostomy (a fundoplication) or with antireflux medications. We carried out this review to determine which was the safest and most effective form of treatment. We found no randomised controlled trials that provided scientific evidence on which to base a conclusion, highlighting the need for a trial comparing the two interventions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Mannitol versus hypertonic saline for intraoperative brain relaxation in patients undergoing surgery for brain tumour

Review question: We reviewed evidence on the effectiveness of mannitol and hypertonic saline for brain relaxation in people having surgery (craniotomy) for brain tumour.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Stimulating the brain without surgery in the management of chronic pain

Various devices are available that can electrically stimulate the brain without the need for surgery or any invasive treatment in order to manage chronic pain. There are four main treatment types: repetitive transcranial magnetic stimulation (rTMS) in which the brain is stimulated by a coil applied to the scalp, cranial electrotherapy stimulation (CES) in which electrodes are clipped to the ears or applied to the scalp, transcranial direct current stimulation (tDCS) and reduced impedance non‐invasive cortical electrostimulation (RINCE) in which electrodes are applied to the scalp. These have been used to try to reduce pain by aiming to alter the activity of the brain, but the efficacy of these treatments is uncertain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Imaging guided surgery for brain tumours

Surgery has a key role in the management of many types of brain tumour. In some types of brain tumour the amount that can be removed by the surgeon is very important in helping patients live longer and feel better. However, sometimes removing a brain tumour can be difficult, because it either looks like normal brain tissue or is near brain tissue that is very important to making people function normally. New methods of visualising tumours during surgery have been developed to help surgeons better identify tumour from normal brain tissue.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

The effects of anaesthetic agents on cortical mapping during neurosurgical procedures involving eloquent areas of the brain

There are discrete areas in the brain that are responsible for sensation (sensory), control of movement (motor) and language functions. In patients with surgically removable lesions involving, or adjacent to, these areas, it is important to achieve a near complete resection without damaging the functional areas (normal brain tissue). Electrical properties of the brain cells are often monitored during these surgical procedures to accurately identify the functional areas. This technique is called electrophysiological mapping. Anaesthetic agents are known to affect the mapping techniques. The authors of this review aimed to identify and evaluate randomised controlled trials (RCTS) assessing the effect of anaesthetic agents on electrophysiological mapping of these functional areas of the brain. We were not able to find any RCTs. Good quality evidence is lacking and hence there is a need for well‐designed RCTs to determine the effects of anaesthetic agents on electrophysiological mapping in this specific surgical population.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Childhood Brain Stem Glioma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood brain stem glioma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 29, 2014

Induced hypotension with propofol under anaesthesia during endoscopic sinus surgery

Functional endoscopic sinus surgery (FESS) is a minimally invasive technique used to treat patients with chronic sinusitis (defined as inflammation of the mucous membrane in the paranasal sinuses (air cavities within the facial bones) and fluid within the sinus cavity that lasts longer than 12 weeks). The surgeon uses a small endoscope (miniature camera) in the nose to get a close‐up view of the sinuses. The main problem with FESS in practice is bleeding during the operation. Blood fills up the nose or gets on the lens of the camera, obscuring the surgeon's view. If bleeding is severe, the surgeon may be forced to abandon the operation without achieving the aim. Bleeding can cause the procedure to take longer or can accidentally damage surrounding structures, including the eyes and the brain. One method for reducing bleeding under general anaesthesia is induced hypotension, which involves deliberately lowering the patient's blood pressure to below normal. Lowering the mean arterial blood pressure in patients with normal blood pressure aims to improve the surgical field and limit blood loss. However, lowering the blood pressure carries its own risks. Complications include permanent brain damage, delayed awakening, cerebral thrombosis (a blood clot in the brain), cerebral ischaemia (insufficient blood flow to the brain) and death. Propofol (an anaesthetic drug given intravenously) could be given to reduce blood pressure during the anaesthetic period. We compared propofol with inhalational (gas) anaesthetics and other drugs for induced hypotension in adults and children. We included in our review four studies consisting of 278 participants. We found that propofol did not reduce measured overall blood loss in children and adults. Propofol might improve the quality of the surgical field a little, but no difference in operation time has been noted. Propofol was more reliable in achieving induced hypotension. No studies reported any adverse effects from induced hypotension with propofol. Because we found only four studies with a small total number of participants, these results should be interpreted with caution. More studies are needed to confirm whether any important benefit is associated with the use of propofol.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of various childhood brain tumors.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 22, 2014

Adult Brain Tumors Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of adult brain tumors.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 14, 2014

Anti‐epileptic drugs for preventing seizures in patients with long‐term bleeding around the brain (subdural haematoma)

Chronic subdural haematoma (CSH) is a serious condition in which blood collects under the thickest membrane that surrounds the brain, known as the dura mater. CSH is usually caused by minor head injuries in which a vein has torn, and this happens in particular in older patients and patients with other brain problems. A CSH may cause seizures which can be dangerous. Some doctors give patients anti‐epileptic drugs such as phenytoin or phenobarbital to try to prevent seizures. However, most patients with CSH will not have seizures and anti‐epileptic drugs can have serious side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Whole brain radiotherapy for the treatment of multiple brain metastases

Radiotherapy is commonly used to treat patients with cancer that has spread to the brain. The aim of this review was to determine the effectiveness and adverse effects of whole brain radiotherapy (WBRT) alone or in combination with other treatments in adult patients with multiple brain metastases. Thirty‐nine trials involving 10,835 participants were included following the update in 2012. There does not appear to be any additional benefit of altered WBRT dose schedules compared to standard doses. The use of chemotherapy or radiosensitizers in conjunction with WBRT has not yet been shown to confer any additional benefit. Radiosurgery boost with WBRT does not improve survival in selected patients with multiple brain metastases but local control may be improved with the addition of radiosurgery boost to WBRT. WBRT when added to radiosurgery improves local and distant brain control but neurocognitive outcomes may be better in patients treated with radiosurgery alone as compared to WBRT and radiosurgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Early versus delayed mobilisation to prevent further bleeding after spontaneous bleeding on the surface of the brain

Aneurysmal subarachnoid haemorrhage (SAH) is a serious event where spontaneous bleeding on the surface of the brain is usually caused by the rupture of an abnormal swelling of an artery (aneurysm). If effective treatment is not provided (e.g. surgery or drug therapy) rebleeding may occur, causing death or disability for the patient. Some researchers observed that the highest risk period for rebleeding in people with a SAH was between two and four weeks after symptom onset, if they did not receive effective treatment. Total bedrest for four to six weeks has, therefore, been considered to be one of the basic interventions to avoid rebleeding. However, despite comprehensive searching, we did not identify any suitable studies that provided evidence for or against staying in bed for at least four weeks after symptom onset in people who did not, or could not, have any treatment for their ruptured aneurysm. Treatment strategies to reduce the risk of rebleeding in SAH patients before aneurysm repair, or in those patients not suitable for surgical treatment, or who prefer conservative treatments, deserve further attention.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Temozolomide for brain cancer

High grade glioma (HGG) is a rapidly progressive form of brain cancer with a poor survival rate even after standard treatment with surgery and radiotherapy. Temozolomide is an oral anti‐cancer drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Does giving chemotherapy, radiotherapy or both improve survival in people with rare (anaplastic oligodendrogliomas and oligoastrocytomas) brain tumours?

Traditionally, the standard of care for people with rare anaplastic oligodendrogliomas and anaplastic oligoastrocytomas (brain tumours) has been surgery followed by radiotherapy. However, the benefit of adjuvant (post‐surgery) chemotherapy and radiotherapy is still unclear. In addition, the value of chromosome markers is also under investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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