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Introduction: Cranial nerve surgery

Roberto C. Heros

caused by an epidermoid tumor of the cerebellopontine angle that was clearly compressing the trigeminal nerve. We found this case report interesting because the etiology of this syndrome has not been clear, and this paper suggests that compression of the trigeminal nerve may be one of the causes. We thought that the excellent review of this topic the authors provide to us is important because neurosurgeons are so frequently called upon to treat trigeminal neuralgia, and we must be able to differentiate that condition from this interesting syndrome. Ross and

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CyberKnife rhizotomy for facetogenic back pain: a pilot study

Gordon Li, Chirag Patil, John R. Adler, Shivanand P. Lad, Scott G. Soltys, Iris C. Gibbs, Laurie Tupper, and Maxwell Boakye

degrees of freedom using image guidance technology. It employs real-time imaging that allows tracking of and adjustment for patient movements, ensuring submillimetric accuracy of targeting. 8 It provides conformal radiosurgery capability to cranial as well as spinal and paraspinal targets. 7 , 15 It has been used safely and successfully in the treatment of benign and malignant lesions of the spine, 15 , 33 as well as trigeminal neuralgia. 23 In this study, we report preliminary results using CyberKnife (Accuray, Inc.) radiosurgical facetectomy for the treatment of

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Stereotactic radiosurgery: quo vadis?

Jason Sheehan and Nader Pouratian

option for many patients with intracranial and spinal disorders. Lars Leksell originally proposed to use radiosurgery for the treatment of patients with intractable pain or movement disorders. 5 , 6 , 9 Ironically, these applications represent only a small fraction of contemporary radiosurgical practice. In modern practice, the most common indications for intracranial radiosurgery include meningiomas, metastases, schwannomas, pituitary adenomas, trigeminal neuralgia, hemangiopericytomas, ependymomas, chordomas, arteriovenous malformations, craniopharyngiomas, and

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The history of skull base surgery

Charles J. Prestigiacomo and T. Forcht Dagi

the skull base. To trace the history of skull base surgery along its full expanse is to begin with Horsley and pituitary tumors (unless one wants to start even earlier with the treatment of trigeminal neuralgia); to move to Cushing's work in the same arena (but also that of many others as well); to emphasize the impact of microsurgical techniques and new imaging modalities; to outline once radically innovative, but now widely practiced anatomical approaches to the skull base; to emphasize the importance of team approaches; to discuss emerging therapeutic strategy

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Facial nerve motor evoked potentials during skull base surgery to monitor facial nerve function using the threshold-level method

Johannes Sarnthein, Nader Hejrati, Marian C. Neidert, Alexander M. Huber, and Niklaus Krayenbühl

FNMEP (mA) FNMEP Increase > 20 mA 1 20, M vestibular schwannoma I I no 110 110 no 2 37, F trigeminal neuralgia I I no 140 140 no 3 54, M vestibular schwannoma I I no 75 80 no 4 67, M vestibular schwannoma I II yes 135 140 no 5 56, F vestibular schwannoma I I no 85 92 no 6 36, M vestibular schwannoma I I no 100 110 no 7 70, F vestibular schwannoma II II no 90 100 no 8 46, F trigeminal neuralgia I I no 60 70

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The evolution of a clinical registry during 25 years of experience with Gamma Knife radiosurgery in Pittsburgh

Oren Berkowitz, Douglas Kondziolka, David Bissonette, Ajay Niranjan, Hideyuki Kano, and L. Dade Lunsford

trigeminal neuralgia (currently a volume of 1239 patients). Category II consists of patients with vascular disorders, who have arteriovenous malformations, dural arteriovenous fistulas, and cavernous malformations (currently 1561 patients). Category III includes patients who have had GKS for skull base schwannomas (currently 1687 patients). The University of Pittsburgh provides institutional review board approval that includes a consent waiver for maintenance and use of the registry. Access to the database is provided only by an institutional review board

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Making the “inoperable” tumors “operable”: Harvey Cushing's contributions to the surgery of posterior fossa tumors

Mahdi Malekpour and Aaron A. Cohen-Gadol

art in the surgical treatment of posterior fossa tumors. Courtesy of the Cushing Center at Yale University Department of Neurosurgery. Advances in posterior fossa surgery were also made possible due to contributions of other neurosurgical giants. Fedor Krause (1856–1937) was a German pioneer in neurosurgery who is recognized as the father of neurological surgery in Germany. He described an extradural approach for the treatment of trigeminal neuralgia. He also established an intradural posterior fossa approach to treat tinnitus; he later used this technique to

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Patient-specific 3-dimensionally printed models for neurosurgical planning and education

Sandip S. Panesar, Michael Magnetta, Debraj Mukherjee, Kumar Abhinav, Barton F. Branstetter, Paul A. Gardner, Michael Iv, and Juan C. Fernandez-Miranda

images (inferosuperior view). Red arrows indicate tumor consistent with petroclival meningioma. Surrounding vascular structures are readily visible. Case 3: Trigeminal Neuralgia Secondary to Vascular Impingement A 67-year-old woman presented with a 4-year history of right-sided, sudden-onset, stabbing, paroxysmal facial pain in the V3 distribution. There was chronic background V3 soreness and she underwent a tooth-extraction procedure without relief of the pain. Her pain was initially medically managed with carbamazepine, but she could not tolerate increased doses

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Stereotactic radiation treatment for benign meningiomas

Andrew E. H. Elia, Helen A. Shih, and Jay S. Loeffler

isodose line 45%, and median number of isocenters six. Patients were followed for a median of 7.9 years, and the 5- and 10-year PFS rates were excellent at 98.5 and 97.2%, respectively. Preexisting neurological symptoms (such as visual field deficits, diplopia, trigeminal neuralgia, exophthalmos, and vertigo) improved in 41.5% of patients, remained stable in 54%, and deteriorated in only 4.5%. Radiological tumor regression occurred in 57% and tumor stability in 42%. Complications occurred in five patients (2.5%), four of whom had transient deficits of increased seizure

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Small (< 10-mm) incidentally found intracranial aneurysms, Part 1: reasons for detection, demographics, location, and risk factors in 212 consecutive patients

Ioannis Loumiotis, Anne Wagenbach, Robert D. Brown Jr., and Giuseppe Lanzino

(63.3%) with 272 small incidental aneurysms are the focus of this study. Reasons for performing the imaging study that led to the discovery of the aneurysms are summarized in Table 1 . TABLE 1: Reasons leading to the diagnosis of small incidental UIAs in 212 consecutive patients * Reason for Imaging No. of Patients (%) evaluation for a known/probable head or neck pathology (tumor, carotid disease, multiple sclerosis, giant cell arteritis, refractory epistaxis, trigeminal neuralgia, thyroid disease, ENT pathology, etc.) 51 (24