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Stereotactic radiosurgery and the linear accelerator: accelerating electrons in neurosurgery

Maryam Rahman, Gregory J. A. Murad, Frank Bova, William A. Friedman, and J Mocco

The LINAC is now the most frequently used device for delivery of conventional radiotherapy and radiosurgery. Radiosurgery is truly minimally invasive, delivering therapeutic energy to an accurately defined target without an incision. It has been used in the treatment of a wide variety of pathological conditions, including benign and malignant brain tumors, vascular lesions such as arteriovenous malformations, and pain syndromes such as trigeminal neuralgia. Radiosurgery is also being studied for the treatment of movement disorders and epilepsy. A tremendous amount

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Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery

Roberto Rey-Dios and Aaron A. Cohen-Gadol

6 cases . Neurosurg Rev 20 : 196 – 200 , 1997 10.1007/BF01105564 8 Chawla JC , Falconer MA : Glossopharyngeal and vagal neuralgia . BMJ 3 : 529 – 531 , 1967 10.1136/bmj.3.5564.529 9 Dandy WE : Concerning the cause of trigeminal neuralgia . Am J Surg 24 : 447 – 455 , 1934 10.1016/S0002-9610(34)90403-7 10 Dandy WE : Glossopharyngeal neuralgia (tic doloreaux). Its diagnosis and treatment . Arch Surg 15 : 198 – 214 , 1927 10.1001/archsurg.1927.01130200046002 11 De Simone R , Ranieri A , Bilo L , Fiorillo C , Bonavita V

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Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations

Angelo Franzini, Giuseppe Messina, Roberto Cordella, Carlo Marras, and Giovanni Broggi

central pain and TN being the most common forms. Trigeminal neuralgia is a pathological condition characterized by short, shock-like pain episodes, referred to as “electric bouts” by patients, that are limited to one or more of the territories innervated by the divisions of cranial nerve V. It usually begins in the second or third division of the trigeminal nerve and involves about 5% of patients with MS, usually beginning many years after the occurrence of nontrigeminal pain. The clinical characteristics of TN in patients with MS are similar to those in patients

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Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review

Vinayak Narayan, Amey R. Savardekar, Devi Prasad Patra, Nasser Mohammed, Jai D. Thakur, Muhammad Riaz, and Anil Nanda

W alter E. Dandy described the anatomical course of the superior petrosal vein (SPV), its relation to the trigeminal nerve and cerebellum, and its significance during surgery for trigeminal neuralgia (TN), in 1929. 5 SPV, also termed “the vein of Dandy,” is an important venous drainage system in the posterior cranial fossa because it drains the anterior aspect of the cerebellum and brainstem, and ultimately empties into the superior petrosal sinus (SPS). 19 Neurosurgeons commonly sacrifice this vein to widen the operative exposure at the apex of the

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A patient-specific, interactive, multiuser, online mixed-reality neurosurgical training and planning system

Jingyue Wang, Yining Zhao, Xinghua Xu, Qun Wang, Fangye Li, Shiyu Zhang, Zhichao Gan, Ruochu Xiong, Jiashu Zhang, and Xiaolei Chen

mixed-reality–based simulation might play a vital role in neurosurgery. 17 , 18 The ability to generate a holographic model for resident simulation-based training may improve teaching, increase trainee autonomy in technically challenging cases, and potentially enhance patient safety. 19 This study evaluated the technical feasibility of developing a patient-specific, multiuser, online, interactive mixed-reality neurosurgical training (NT) system. We took trigeminal neuralgia (TN), hemifacial spasm (HFS), and intracranial tumors as examples to verify the efficacy of

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Hydroxyurea for treatment of unresectable and recurrent meningiomas. II. Decrease in the size of meningiomas in patients treated with hydroxyurea

Uwe M. H. Schrell, Michael G. Rittig, Marc Anders, Uwe H. Koch, Rolf Marschalek, Franklin Kiesewetter, and Rudolf Fahlbusch

In this paper the authors present the first evidence that meningiomas respond to treatment with hydroxyurea. Hydroxyurea was administered as an adjunct chemotherapeutic treatment in patients with recurrent and unresectable meningiomas. Hydroxyurea was used because experimental data demonstrated that it inhibits growth of cultured human meningioma cells and meningioma transplants in nude mice by inducing apoptosis. The authors therefore treated four selected patients with hydroxyurea. All patients had undergone multiple gross resections and all except one received radiotherapy. Three patients with recurrent Grade I meningiomas assessed according to World Health Organization (WHO) guidelines received hydroxyurea because of an increased tumor growth rate, documented by magnetic resonance (MR) imaging, within a 6- or 12-month interval. A fourth patient with a malignant meningioma (WHO Grade III) began a course of treatment with hydroxyurea immediately after his sixth palliative operation without waiting for another relapse to be demonstrated on MR imaging. Because of their location and invasive growth behavior none of the meningiomas could have been removed completely by surgical intervention.

All patients received hydroxyurea at a dosage level of 1000 to 1500 mg/day (approximately 20 mg/kg/day). In a man with a large sphenoid wing meningioma invading the right cavernous sinus and the temporal base, the intracranial tumor mass was reduced by 60% during 6 months of treatment. A woman with a large ball-shaped meningioma of the right sphenoid wing invading the cavernous sinus exhibited a 74% decrease of the initial tumor volume in 10 months of treatment with oral hydroxyurea. Serial MR images obtained monthly revealed that the process of size reduction was continuous and proportionate. The shrinkage of the tumor was accompanied by a complete remission of symptomatic trigeminal neuralgia after 2 months and by improved abducent paresis after 5 months. The third patient had a slowly growing meningioma that exhibited a 15% reduction in mass when reassessed after 5 months of hydroxyurea treatment. The fourth patient with the malignant meningioma in the left cerebellopontine angle has had no recurrence for 24 months. Long-term treatment with hydroxyurea may result in full remission of tumors in meningioma patients.

The preliminary data indicate that hydroxyurea provides true medical treatment in patients with unresectable and recurrent meningiomas, replacing palliative surgery and radiotherapy in the management of this disease.

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Stereotactic Radiosurgery

Lawrence S. Chin and N. Scott Litofsky

psychiatric disease. The physics of radiosurgery is reviewed, followed by 3 articles that describe methods of delivering stereotactic radiation different from the well-documented Gamma Knife technique. These include linear accelerator, proton beam, and the application of robotics to SRS. The results of SRS in the treatment of large volume AVMs are presented next, followed by 2 papers that examine treatment results in typical and atypical trigeminal neuralgia. This issue closes with a series of papers that describe treatment of relatively uncommon intracranial tumors

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Introduction: Venous brain circulation disorders

Hiroyuki Nakase

aggressive thrombolysis and thrombectomy in the setting of acute thrombosis in the selected patients in whom the disorder is unresponsive to adequate anticoagulation. 3–5 This issue of Neurosurgical Focus covers many aspects related to venous brain circulation and disorders in the field of neurosurgery: anatomy of the diploic venous system, cerebral venous sinus thrombosis (pathophysiology, natural history, and appropriate and new treatment), vein of Galen malformation, vascular malformation, radiosurgery of parasagittal meningioma, trigeminal neuralgia by venous

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Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome secondary to an epidermoid tumor in the cerebellopontine angle

Case report

Shaun D. Rodgers, Bryan J. Marascalchi, Russell G. Strom, and Paul P. Huang

of attacks. The SUNCT syndrome is more common in males, and the mean age at onset (in both sexes) is approximately 50 years. 10 Attacks last 2–600 seconds, with a mean length of roughly 1 minute. 2 , 5 , 10 Attacks lasting longer than 240 seconds often comprise closely grouped stabs or saw-tooth attacks. 2 Attack frequency may range from a single episode to hundreds per day. Some patients have so many attacks that they are unable to quantify the actual number. 2 , 10 The most common differential diagnosis of SUNCT is trigeminal neuralgia. 3 Both SUNCT

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Peripheral trigeminal nerve field stimulation

Report of 6 cases

Alberto Feletti, Giannantonio Zanata Santi, Francesco Sammartino, Marzio Bevilacqua, Piero Cisotto, and Pierluigi Longatti

mos >50% pain relief none * AFP = atypical facial pain; ETN = essential trigeminal neuralgia; FU = follow-up; HA = headache; ION = infraorbital nerve; MN = mandibular nerve; ON = occipital nerve; PH = postherpetic; PS = postsurgical; PT = posttraumatic; pts = patients; SON = supraorbital nerve. † Patients treated since 2000; data are the mean values referring to a wider series including occipital PNS. TABLE 2: Patients treated with PNFS for TNP at Treviso Hospital Case No. Age (yrs), Sex Etiology Pain Region