Introduction:

Aggressiveness has a high prevalence in psychiatric disorders, with significant consequences for patients and community. Amygdala and the hypothalamus are involved in the neural network of aggressiveness. Although there are different ablative management techniques in these two structures, to our knowledge, this is the first report of hypothalamotomy plus amygdalectomy with GKR to control impulsive aggressive disorder.

Case presentation:

A 36-year-old man with a background of paranoid schizophrenia, consumption of high doses of antipsychotics, and high-severity episodes of self, and hetero-aggression. MOAS: 33/40, ABS: 8/12, and GAF Scale: 20/100. Management with GKR was proposed, with a first time in the left posteromedial hypothalamus (125 Gy) and the left central nucleus of the amygdala (120Gy). A second time was performed in the right posteromedial hypothalamus (125 Gy). At follow up, a significant improvement was found in the patient's manifestations of aggression and functionality (MOAS: 0/40, ABS 2/12, GAF: 70/100).  No complications secondary to treatment occurred.

Final comments

Despite the variety of antipsychotics used to treat aggressiveness, some individuals do not respond adequately. Interventional management targeting the amygdala or hypothalamus have been proposed, with a variable range of effectiveness and complications. GKR is a non-invasive, effective, and safe treatment in the management of impulsive aggressive disorder.

Introduction: Glomus jugulare tumors (GJT) are rare and mainly affect women between the 5th and 6th decade of life. Its localization and anatomic relationships make conventional surgical treatment difficult and with a considerable risk of complications.

Methods: 77 patients with GJT tumors were included. Pre-treatment clinical variables and follow-up data were collected from medical charts and phone interviews. The short-form-36 scale was applied to assess the quality of life.

Results: The mean age was 53.2 years. The median hospital stay was 4.92 hours. For the clinical follow-up, information of 47 patients was obtained. An improvement in pre-treatment symptoms was described in 58%, with general symptomatic control of 97%. The tumor control rate was 95%, and there were statistically significant differences in 6 of the 9 Short Form-36 scale domains.

Conclusions: GKR is an effective, safe, and cost-effective technique that offers a high degree of symptomatic and tumor size control in patients with GJT

Objective: In recent years, stereotactic radiosurgery has gained an increasing role in controlling progression of atypical WHO grade 2 meningiomas. This study evaluates a large, multi-institutional database of European Gamma Knife centers to present the outcomes of WHO grade 2 meningiomas treated with SRS. Our aim was to investigate the long-term tumor control rate and durable morbidity of SRS.

 Methods: At 15 participating centers, 217 consecutive patients with 304 WHO grade 2 meningiomas treated between 1992 and 2003 were enrolled in the study. Clinical and imaging data were collected by each center and uniformly entered into a multicenter database.

Results: Detailed results of 255 meningiomas (83,9%) were analyzed. The median age of the patients upon SRS treatment was 57 years. The median tumor volume was 6.1 cm³ and the median dose at the tumor margin was 15 Gy (50% isodose). All tumors were treated by surgery before SRS. The median follow-up time at imaging was 48 months. The volume of treated tumors decreased in 99 (38.8%), remained unchanged in 70 (27.5%), and increased in 86 lesions (33.3%), corresponding to a control rate of 66.3%. The five-year progression-free survival (PFS) rate was 45.0%. The morbidity rate at last follow-up was 6.7%.

Conclusion: We demonstrated that Gamma Knife SRS for previously resected WHO grade 2 meningiomas has a reasonable tumor control rate that also compares favorably with the literature in the medium to long term. W