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Intraoperative MRI for the microsurgical resection of meningiomas close to eloquent areas or dural sinuses: patient series

Constantin Tuleasca, Rabih Aboukais, Quentin Vannod-Michel, Xavier Leclerc, Nicolas Reyns, and Jean-Paul Lejeune

Meningiomas are the most commonly encountered nonglial primary intracranial tumors, with an incidence of approximately 20% of all intracranial tumors. 1 They are more frequent in adults during the fourth through sixth decades of life. 2 , 3 The clinical presentation is variable, unspecific, and depends on tumor anatomical location. 1 Magnetic resonance imaging (MRI) is currently considered the imaging technique of choice and allows assessment of potential mass effect, vascular supply, or degree of the peritumoral edema, as well as accurate localization of

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Long-term survival in patients with long-segment complex meningiomas occluding the dural venous sinuses: illustrative cases

Zhishuo Wei, Arka N. Mallela, Andrew Faramand, Ajay Niranjan, and L. Dade Lunsford

Meningiomas are the most common primary benign intracranial neoplasm, with an annual incidence of 15 cases per 100,000 persons. 1 Complete resection of the tumor and its dural origin remains the primary treatment option for larger, growing, or symptomatic meningiomas. Prolonged survival of patients with meningiomas that occlude venous sinuses is rare. 2–4 Even histologically slow-growing grade I meningiomas can exhibit more aggressive behavior when they invade dura, bone, or critical venous sinuses. 5 Although resection is an important initial strategy in

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Treatment of adverse radiation effects with Boswellia serrata after failure of pentoxifylline and vitamin E: illustrative cases

Ronald E. Warnick

syndrome presented with multiple meningiomas. Serial MRI scans showed gradual enlargement of an anterior frontal falcine meningioma (1.8 cm maximal diameter). The patient underwent Novalis (Brainlab) single-fraction, frameless stereotactic radiosurgery (13 Gy prescription dose). Five months after SRS, the patient returned with frontal headaches, and repeat MRI showed a rim of parenchymal enhancement and significant bifrontal edema ( Fig. 1 ). He was started on dexamethasone 4 mg four times a day, pentoxifylline 400 mg three times a day, and vitamin E 400 IU twice a day

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Three decades of progress from surgery to medical therapy for isolated neuroaxis BRAF V600E–positive Langerhans cell histiocytosis management: illustrative case

Nallammai Muthiah, Kamil W. Nowicki, Jennifer L. Picarsic, Michael P. D’Angelo, Daniel F. Marker, Edward G. Andrews, Edward A. Monaco III, and Ajay Niranjan

without contrast. T2, FLAIR, and T1 c+ showing new parietal dural-based lesion ( red circle ). FIG. 3. A: MRI with and without contrast. T2, FLAIR, and T1 c+ showing mass effect and edema from right parietal dural lesion ( red circle ). B: MRI with and without contrast. T2, FLAIR, and T1 c+ showing resolved mass effect and edema 1 year after parietal meningioma resection. A left frontal meningioma was also noted ( red circle ). After discussion with her primary caregivers, the decision was made to resect the new lesion via a right frontotemporal

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Stereotactic radiosurgery for the treatment of a distant recurrence of ependymoma on the optic nerve: illustrative case

Eduardo Orrego González, M. Beatriz Lopes, Gabriel Anibal Ramos, and Jason P Sheehan

ependymal cells lining the spinal cord’s ventricular system and central canal. 3 The incidence of anaplastic ependymoma is higher in age groups 0 to 4 years, with 0.43 cases per 100,000, compared to all other age groups. 4 Spinal ependymoma seldom recurs in distant CNS regions after dissemination through the neuroaxis. 4 , 5 The optic nerve and orbit are occasionally affected by CNS neoplasms, most commonly meningiomas and gliomas in the background of genetic syndromes such as neurofibromatosis type 1. 6 , 7 Ependymomas are resected, and some cases benefit from