Effect of cervical spinal cord stimulation on regional blood flow and oxygenation in advanced head and neck tumours

Clavo, Bernardino; Robaina, Francisco; Catalá, L.; Pérez, Julio; Lloret, M.; Caramés, Miguel A.; Morera, Jesús Pérez; Mora, Laura; Suárez, Gerardo; Macías, David; Rivero, José Casas; Hernández, María Antonia Gil

doi:10.1093/annonc/mdh189

Cited by 28 publications

(21 citation statements)

References 25 publications

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“…Clavo and colleagues [56][57][58][59][60] explored a potential novel application of SCS, investigating the effects of cervical SCS on CBF in patients with high-grade gliomas and head and neck tumors. These malignancies have a decreased locoregional blood flow resulting in reduced delivery of chemotherapy and oxygen, as well as an increase in radiation resistance to radiotherapy, and represent an important adverse prognostic factor.…”

Section: Clinical Trials On Hypoperfusion Syndromes In Humansmentioning

confidence: 99%

Spinal Cord Stimulation and Cerebral Hemodynamics: Updated Mechanism and Therapeutic Implications

Visocchi

Pepa

Esposito

et al. 2011

Stereotact Funct Neurosurg

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The effects of spinal cord stimulation (SCS) on cerebral blood flow (CBF) are well known based on experimental investigations, and its vasodilator effect on peripheral arteries is widely used in clinical settings in the treatment of peripheral vascular disease. Since Hosobuchi’s [Appl Neurophysiol 1985;48:372–376] first observations on the effects of SCS on CBF were published 22 years ago, many advances have been made in understanding SCS-mediated effects on CBF. This paper reviews the main laboratory observations and analyzes the most significant neurophysiological theories on the SCS-mediated effect on CBF. Most significant experimental data have been discussed, with specific reference to possible mechanisms such as ‘functional reversible sympathectomy’, cerebral infarction and related ischemic edema, hemodynamic deterioration in experimental combined ischemic-traumatic brain injury and cerebral vasospasm. The authors revised the published experiences in humans with hypoperfusion syndromes and ‘adjuvant’ locoregional CBF increase in chemotherapy of brain tumors. SCS represents a new perspective in challenging neurosurgical clinical fields such as cerebral ischemia and vasospasm, and seems promising as a new trend of functional neurosurgery in cerebrovascular diseases.

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Section: Clinical Trials On Hypoperfusion Syndromes In Humansmentioning

confidence: 99%

Spinal Cord Stimulation and Cerebral Hemodynamics: Updated Mechanism and Therapeutic Implications

Visocchi

Pepa

Esposito

et al. 2011

Stereotact Funct Neurosurg

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“…SCS has been shown to augment CBF and speculated to protect the brain from focal ischemia in a large series of experiments, both on animals and on humans [47,48,49,50,51,52,53], and has been proposed for the treatment of several cerebral low-perfusion syndromes [54,55,56,57,58,59,60,61,62,63,64,65,66,67]. However, there is not yet an ultimate scientific explanation; moreover, a clear understanding of the mechanisms elicited by SCS is still lacking [4,53,68].…”

Section: Discussionmentioning

confidence: 99%

Neuromodulation of Vegetative State through Spinal Cord Stimulation: Where Are We Now and Where Are We Going?

Pepa

Fukaya

Rocca

et al. 2013

Stereotact Funct Neurosurg

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Background: Vegetative state (VS) is a complex condition that represents a challenging frontier for medicine and neuroscience research. Nowadays there is no scientifically validated treatment for VS patients, and their chronic long-term assistance is very demanding for healthcare systems worldwide. Objectives: The present paper is a systematic review of the role of spinal cord stimulation (SCS) as a treatment of patients with VS. Methods: Published literature on this topic was analyzed systematically. Clinical and epidemiological characteristics of VS, present therapeutic options and social costs of VS were also evaluated. Results: Only 10 papers have been published since 1988, and overall 308 VS patients have been treated with SCS worldwide; 51.6% displayed a clinical improvement and an amelioration of the environmental interaction. These effects are probably mediated by the stimulation of the reticular formation-thalamus-cortex pathway and by cerebral blood flow augmentation induced by SCS. Conclusions: The experience on this topic is still very limited, and on this basis it is still hard to make any rigorous assessment. However, the most recent experiments represent significant progress in the research on this topic and display SCS as a possible therapeutic tool in the treatment of VS.

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“…We have not, as yet, established the optimum stimulation schedule to obtain a maximal effect in tumor blood flow, or oxygenation. Our previous experiences with contact-thermography technique in non-cancer patients 24 and in two H&N cancer patients 5 showed that up to an hour of stimulation may be necessary to obtain the maximal effect in these tissues. Further studies are needed to optimize the this effect and the impact of cSCS on the survival of patients with brain tumors needs be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Cerebral blood flow increase in cancer patients by applying cervical spinal cord stimulation

Clavo

Robaina²,

Catalá³

et al. 2007

Neurocirugía

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Introduction. Generally, high-grade gliomas and head and neck tumors have decreased loco-regional blood flow resulting in reduced delivery of chemotherapy and oxygen, as well as an increases in radiation resistance to radiotherapy. The aim of this study was to analyze the effect of cervical spinal cord electrical stimulation (cSCS) on cerebral blood flow in patients with those tumors.Patients and methods. We have evaluated 27 cancer patients with 12 with high grade gliomas and 15 with advanced head and neck tumors, who had cSCS devices placed after tumor diagnoses and before the commencementinitiating of radio-chemotherapy. They were 12 high grade gliomas and 15 advanced head and neck tumors. Before and after cSCS, cerebral blood flow was assessed bilaterally by transcranial Doppler.Results. During cSCS there was a significant (p<0.001) increase in systolic (mean >22%) and diastolic (>29%) blood-flow velocities in both, healthy and tumor middle cerebral arteries. The analyses by subgroup of tumors showed similarly significant outcomesfindings.Conclusions. The results suggest that neuro-stimulationspinal cord electrical stimulation can increase cerebral blood flow in cancer patients. The implication is that this technique could be useful in modifying locoregional ischemia in brain tumors thus improveing the outcomes of after radio-chemotherapy. Further research is in progress to confirm the advantages of the technique. Introducción. Los gliomas de alto grado y los tumores avanzados de cabeza y cuello generalmente tienen un flujo sanguíneo disminuido. Esto produce una disminución de la llegada de quimioterapia agentes quimioterápicos y oxígeno, lo que lleva a un aumento de la resistencia a la radioterapia y a la quimioterapia. El objetivo de este estudio fue analizar el efecto de la electroestimulación epidural de la médula espinal cervical (EME) sobre el flujo cerebral en pacientes con esos tumores.Material y métodos. Hemos evaluado 27 pacientes oncológicos portando dispositivos de EME, que fueron colocados después del diagnóstico y antes de empezar el tratamiento con radio-quimioterapia. Se trata de 12 pacientes con gliomas de alto grado y 15 pacientes con tumores avanzados de cabeza y cuello. Antes y después de la EME se determinó bilateralmente el flujo sanguí-neo en las arterias cerebrales medias mediante Doppler transcraneal.Resultados. Durante la EME se produjo un aumento significativo (p<0.001) de la velocidad sistólica (mean media ≥22%) y diastólica (≥29%) del flujo en la arteria cerebral media, tanto del hemisferio ipsilateral al tumor como del hemisferio sano. El análisis por subgrupos de tumores mostró también resultados semejantes.Discusión. Los resultados sugieren que la EME es capaz de aumentar el flujo sanguíneo cerebral en pacientes oncológicos. La principal implicación de este hallazgo sería su potencial utilidad para modificar la isquemia local y regional de los tumores cerebrales, y así intentar mejorar el efecto de la radioterapia y quimioterapia. Están en marcha estudios adicionales para conf...

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Effect of cervical spinal cord stimulation on regional blood flow and oxygenation in advanced head and neck tumours

Abstract: Cervical-SCS increased tumour oxygenation and CCA blood flow, and could enhance the loco-regional delivery of oxygen, radiosensitising and chemotherapeutic drugs. Cervical-SCS as adjuvant in chemoradiotherapy of these tumours warrants further investigation.

Cited by 28 publications

References 25 publications

Spinal Cord Stimulation and Cerebral Hemodynamics: Updated Mechanism and Therapeutic Implications

Spinal Cord Stimulation and Cerebral Hemodynamics: Updated Mechanism and Therapeutic Implications

Neuromodulation of Vegetative State through Spinal Cord Stimulation: Where Are We Now and Where Are We Going?

Cerebral blood flow increase in cancer patients by applying cervical spinal cord stimulation

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