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Hey guys,
I'm a dental student hoping to specialize in oral-maxillofacial surgical oncology, and I'm currently in a discussion on the ENT forum about percutaneous interventions and immunoconjugates to treat H&N cancer. http://forums.studentdoctor.net/threads/interventional-treatments-for-oral-cancer.1057627/
I also was reading about the results Dr Riina has had with superselective intra-arterial cerebral infusion of Avastin in treating GBM: http://www.ncbi.nlm.nih.gov/pubmed/20377982
What I'm wondering is whether this could be used to treat GBM or meningioma or other brain tumors:
1. Perform cerebral angiography to define the tumor's volume and vascular anatomy.
2. Inject an equal volume of absolute ethanol into the feeder arteries to sclerose the tumor's vasculature and necrose the cells
3. Place an EVD to deal with the post-op increase in ICP from the necrosis and inflammation
It should be much cheaper than using Avastin + mannitol, and directly kills the tumor, instead of just stopping angiogenesis.
Also, here's another question: since most interventional neuroradiologists are trained to perform burr hole craniotomies to place EVDs, and do immediate post-op care, and they have the neuroimaging expertise, why don't they also perform stereotactic brain biopsies and ablations?
They have the procedural and imaging skills, and stereotactic brain surgery is almost entirely dependant on accurate neuroimaging to properly place the biopsy needle or ablation probe. If an epidural bleed occurs during the burr hole, they can easily cauterize it.
Maybe they should have a similar pathway for INR as they do for general IR: 1 year GS internship, 1 year NS, 2 years DR, 1 year DNR, and 2 years INR. 3 month of INR rotations should be done from years 2-5. That would be 4+ years of clinical and surgical training, and 3 years of diagnostic imaging training. The ABR should have a separate certification for interventional neuroradiology, and this pathway should allow a candidate to sit for the diagnostic radiology, diagnostic neuroradiology, and interventional neuroradiology certs.
Then our future INRs will be properly prepared for the rigors of providing continuous care for complex neuro patients using the latest percutaneous techniques. And, unlike the neurology- and neurosurgery-trained INRs, they will have 3 years of diagnostic imaging training.
And if you're going to commit yourself to INR, a 7 year residency doesn't seem so bad. DIRECT for general IR is 6 years, neurosurgery is 7, and interventional neurology is 6 years. The regular INR pathway is 8 years, and they come out of it with only three years of clinical training (and the internship is usually IM rather than GS), and no NS training.
Well, thanks for listening.
I'm a dental student hoping to specialize in oral-maxillofacial surgical oncology, and I'm currently in a discussion on the ENT forum about percutaneous interventions and immunoconjugates to treat H&N cancer. http://forums.studentdoctor.net/threads/interventional-treatments-for-oral-cancer.1057627/
I also was reading about the results Dr Riina has had with superselective intra-arterial cerebral infusion of Avastin in treating GBM: http://www.ncbi.nlm.nih.gov/pubmed/20377982
What I'm wondering is whether this could be used to treat GBM or meningioma or other brain tumors:
1. Perform cerebral angiography to define the tumor's volume and vascular anatomy.
2. Inject an equal volume of absolute ethanol into the feeder arteries to sclerose the tumor's vasculature and necrose the cells
3. Place an EVD to deal with the post-op increase in ICP from the necrosis and inflammation
It should be much cheaper than using Avastin + mannitol, and directly kills the tumor, instead of just stopping angiogenesis.
Also, here's another question: since most interventional neuroradiologists are trained to perform burr hole craniotomies to place EVDs, and do immediate post-op care, and they have the neuroimaging expertise, why don't they also perform stereotactic brain biopsies and ablations?
They have the procedural and imaging skills, and stereotactic brain surgery is almost entirely dependant on accurate neuroimaging to properly place the biopsy needle or ablation probe. If an epidural bleed occurs during the burr hole, they can easily cauterize it.
Maybe they should have a similar pathway for INR as they do for general IR: 1 year GS internship, 1 year NS, 2 years DR, 1 year DNR, and 2 years INR. 3 month of INR rotations should be done from years 2-5. That would be 4+ years of clinical and surgical training, and 3 years of diagnostic imaging training. The ABR should have a separate certification for interventional neuroradiology, and this pathway should allow a candidate to sit for the diagnostic radiology, diagnostic neuroradiology, and interventional neuroradiology certs.
Then our future INRs will be properly prepared for the rigors of providing continuous care for complex neuro patients using the latest percutaneous techniques. And, unlike the neurology- and neurosurgery-trained INRs, they will have 3 years of diagnostic imaging training.
And if you're going to commit yourself to INR, a 7 year residency doesn't seem so bad. DIRECT for general IR is 6 years, neurosurgery is 7, and interventional neurology is 6 years. The regular INR pathway is 8 years, and they come out of it with only three years of clinical training (and the internship is usually IM rather than GS), and no NS training.
Well, thanks for listening.
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