Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal beta-emitting radioactive sources

OBJECTIVE: Long-term follow-up data were analyzed to assess the value of intracavitary irradiation with stereotactically applied beta-emitting radioisotopes for the treatment of craniopharyngioma cysts. METHODS: Sixty-two of 70 consecutive patients with predominantly cystic craniopharyngiomas were selected for retrospective analysis. Beta-Emitting isotopes were injected intracystically using a computed tomography-guided and computer-assisted three-dimensional stereotactic treatment planning and application system (cumulative dose to the inner surface of the cyst wall, 200 Gy). RESULTS: The tumor response rate gained with yttrium-90-labeled silicate (66 of 78 cysts) or phosphorous-32-labeled chromic phosphate (8 of 78 cysts) was 79.5%. Four cysts treated with rhenium-186-labeled sulfate did not respond. Mean survival after intracavitary irradiation was 9.0 +/- 0.9 years (median follow-up, 11.9 yr). In patients with solitary cysts, the mean survival was 12.5 +/- 1.4 years (actuarial 5- and 10-yr survival rates, 80 and 64%, respectively). Six months postoperatively, visual deficits (38 of 62 patients) had improved in 23 patients and were stable in 15 patients. The side effects that occurred 6 to 12 months after treatment with yttrium-90 were complete blindness (three patients), worsening of visual field cuts (one patient), third nerve palsy (one patient), and diabetes insipidus and/or panhypopituitarism (three patients). CONCLUSIONS: Intracavitary irradiation using yttrium-90 or phosphorous-32 is highly effective in the treatment of cystic craniopharyngiomas. If applied as initial treatment in patients with solitary cysts, it is the only required therapy over a long period.     

Correlation of glucose consumption and tumor cell density in astrocytomas. A stereotactic PET study

To determine histological correlates of the variability of glucose consumption in astrocytomas, the authors performed positron emission tomography (PET) with 18F-2-fluoro-2-deoxy-D-glucose (FDG) and matched the PET scans three-dimensionally with computerized tomography scans obtained in a stereotactic frame before biopsy. Ten patients with astrocytomas of World Health Organization Grade 2 or 3 were studied; patients with glioblastomas, oligodendrogliomas, or oligoastrocytomas were excluded from the study to avoid any confounding effects of different cell types and necroses. In samples of pure tumor, glucose consumption correlated significantly with cell density, but not with nuclear polymorphism. It is concluded that tumor cell density is a major determinant of glucose consumption in astrocytomas. The use of PET with FDG may help to locate the highest cell density and thus improve the diagnostic yield of stereotactic biopsy.     

Implementing a Built-In Self-Test PLA Design

An NMOS implementation of a new built-in self-test PLA design is presented. The layouts for its additional test circuitry result in appoximately 15-percent overhead for most large PlAS, a significantly better overhead than that of any existing scheme. Both the input test patterns and the output responses, which are compressed intoastring of parity bits, are independent of the functions that the PLA realizes, and the 15-percent overhead includes the storage needed for the fault-free compressed output data. The fault coverage of this approach consists of all single and (1-2 -( 2n + m)) of all multiple stuck, crosspoint, and bridging faults in the original PLA and the additional test circuitry (n and m are the number of input variables and product terms, respectively). The article begins with a short review of existing design schemes.     

Built-in self-diagnosis for repairable embedded RAMs

A method of built-in self-diagnosis (BISD) for repairable, embedded static RAMs (SRAMs) is presented. The BISD circuit, with self-repair, requires about 5% extra area in a 64-kb SRAM. The circuit contains a small reduced-instruction-set processor, which executes diagnosis algorithms stored in a ROM. These algorithms employ hybrid serial/parallel operations when external repair is available or modular operations when self-repair is required. The algorithms, hardware design, and design costs and tradeoffs are discussed     

Swing-up of the double pendulum on a cart by feedforward and feedback control with experimental validation

The swing-up maneuver of the double pendulum on a cart serves to demonstrate a new approach of inversion-based feedforward control design introduced recently. The concept treats the transition task as a nonlinear two-point boundary value problem of the internal dynamics by providing free parameters in the desired output trajectory for the cart position. A feedback control is designed with linear methods to stabilize the swing-up maneuver. The emphasis of the paper is on the experimental realization of the double pendulum swing-up, which reveals the accuracy of the feedforward/feedback control scheme.     

Risk analysis of linear accelerator radiosurgery

PURPOSE: To evaluate the toxicity of stereotactic single-dose irradiation and to compare the own results with already existing risk prediction models. METHODS AND MATERIALS: Computed tomography (CT) or magnetic-resonance (MR) images, and clinical data of 133 consecutive patients treated with linear accelerator radiosurgery were analyzed retrospectively. Using the Cox proportional hazards model the relevance of treatment parameters and dose-volume relationships on the occurrence of radiation-induced tissue changes (edema, localized blood-brain barrier breakdown) were assessed. RESULTS: Sixty-two intraparenchymal lesions (arteriovenous malformation (AVM): 56 patients, meningioma: 6 patients) and 73 skull base tumors were selected for analysis. The median follow-up was 28.1 months (range: 9.0-58.9 months). Radiation-induced tissue changes (32 out of 135, 23.7%) were documented on CT or MR images 3.6-58.7 months after radiosurgery (median time: 17.8 months). The actuarial risk at 2 years for the development of neuroradiological changes was 25.8% for all evaluated patients, 38.4% for intraparenchymal lesions, and 14.6% for skull base tumors. The coefficient: total volume recieving a minimum dose of 10 Gy (VTREAT10) reached statistical significance in a Cox proportional hazards model calculated for all patients, intraparenchymal lesions, and AVMs. In skull base tumors, the volume of normal brain tissue covered by the 10 Gy isodose line (VBRAIN10) was the only significant variable. CONCLUSIONS: These results demonstrate the particular vulnerability of normal brain tissue to single dose irradiation. Optimal conformation of the therapeutic isodose line to the 3D configuration of the target volume may help to reduce side effects.