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Alberto Franzin, Pietro Panni, Giorgio Spatola, Antonella del Vecchio, Alberto L. Gallotti, Carmen R. Gigliotti, Andrea Cavalli, Carmine A. Donofrio and Pietro Mortini

) Grades III to V were independent risk factors for poor outcome after embolization. 17 Theoretically, volume-staged radiosurgery could have the benefit of administering a high margin dose to the AVM nidus while maintaining a safe risk-profile. A few series report promising results using volume-staged radiosurgery for large cerebral AVMs. 2 , 3 , 6 , 11 , 13 , 23 , 26 , 27 We think volume-staged radiosurgery should be considered the first line of treatment for these formidable cerebral vascular malformations, and here we report the results of our experience with such a

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Jordan S. Terner, Roberto Travieso, Su-shin Lee, Antonio J. Forte, Anup Patel and John A. Persing

superimposed deformational plagiocephaly. D and E: Frontal (D) and lateral (E) views of a patient with combined sagittal and metopic craniosynostosis showing a deceivingly less severe–appearing deformity. In the normal pediatric skull, ICV, BTV, and CSF volume continually increase through early childhood. Yet, this increase is most rapid during the first 2.5 years of life, allowing the brain to reach more than 80% of its adult size in this period. Untreated craniosynostosis may lead to an inhibition of brain growth and in some cases an increase in intracranial

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Jason G. Mandell, Kenneth L. Hill, Dan T. D. Nguyen, Kevin W. Moser, Robert E. Harbaugh, James McInerney, Brian Kaaya Nsubuga, John K. Mugamba, Derek Johnson, Benjamin C. Warf, Warren Boling, Andrew G. Webb and Steven J. Schiff

changes and reduction in volume of the sclerotic mesial temporal lobe. When concordant with semiology and encephalography (EEG) findings, this has high prognostic value for resection of the deep temporal structures having significant benefit in reducing seizures and improving quality of life. 4 , 14 , 16 , 23 , 31 , 34 , 35 , 39 However, most developing countries have limited or no access to MRI. Furthermore, there is no literature suggesting the use of CT as a prognostic indicator for resection. Evidence from structural MRI suggests that CT could be used as an

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Michael C. Dewan, Abbas Rattani, Graham Fieggen, Miguel A. Arraez, Franco Servadei, Frederick A. Boop, Walter D. Johnson, Benjamin C. Warf and Kee B. Park

neurosurgical disease. Obtaining a reliable estimate of the volume of neurosurgical disease requires addressing numerous challenges including sparse epidemiological data, heterogeneous literature reporting, and even competing definitions of disease entities. Furthermore, quantifying the existing workforce of surgeons capable of safely addressing neurological disease is difficult. There exists neither a single worldwide registry of neurosurgeons, nor even a consensus as to the requisite training and competencies of a neurosurgeon. Despite debate about the nature of

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Paulo Roberto Lacerda Leal, Charlotte Barbier, Marc Hermier, Miguel Angelo Souza, Gerardo Cristino-Filho and Marc Sindou

morphological changes are difficult to describe objectively. Recently, some authors 5 , 11 , 13 showed that in patients with TN, the affected TGN has a smaller volume (V) and cross-sectional area (CSA) than the unaffected nerve. Some works have established the notion that the outcome of microvascular decompression (MVD) depends on the severity of the NVC. 1 , 2 , 21 According to our data, when clear-cut and marked vascular compression was present at surgery, the long-term cure rate was 90% after a 15-year follow-up. Conversely, when the vessel was merely in contact with

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Dong Liu, Yanhe Li, Yipei Zhang, Zhiyuan Zhang, Guoxiang Song and Desheng Xu

or wrap around the optic nerve, the difficulty of treatment is significantly increased and the lesions are prone to recurrence. Improper management may lead to a variety of serious complications, such as bleeding, injury of the optic nerve, venous thrombosis, and infection as well as increasing the risk of relapse. 5 , 7 Volume-staged Gamma Knife radiosurgery (GKRS) has been commonly used in the management of large arteriovenous malformations, and it could potentially increase rates of obliteration and reduce damage to normal tissue in the treatment of OVMs. From

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Lijun Ma, Arjun Sahgal, Ke Nie, Andrew Hwang, Aliaksandr Karotki, Brian Wang, Dennis C. Shrieve, Penny K. Sneed, Michael McDermott and David A. Larson

B efore an SRS procedure commences, accurate determination of the target volume is critical to ensure the suitability of performing SRS and the dose selection. During SRS treatment planning, volumes of contoured structures of interest are important in evaluating treatment plan quality and commonly comprise various treatment planning criteria such as Paddick indices, 18 , 19 mean dose and integral dose, and various dose-volume histogram criteria (for example, the 12-Gy volume). After SRS, changes in target volume are the means by which treatment responses

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Kimon Bekelis, Ian D. Connolly, Huy M. Do and Omar Choudhri

in adults, such as moyamoya disease and vein of Galen malformations. 7–9 Although several investigators have found an association between procedural volume and outcomes for several surgical procedures, 5 , 6 , 14 this association has not been shown in pediatric patients who have undergone cerebrovascular neurosurgery. Previous studies have examined the relationship between volume and outcomes in adults who were undergoing interventions for several cerebrovascular pathologies and have demonstrated conflicting results. The results of single-center series 13 , 15

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Jinyu Xue, H. Warren Goldman, Jimm Grimm, Tamara LaCouture, Yan Chen, Lesley Hughes and Ellen Yorke

T he brainstem is a critical structure of dosimetric concern for most intracranial radiation treatments. For conventional fractionated radiation therapy, the Radiation Therapy Oncology Group's Protocol 0539 introduced a brainstem dose tolerance limit of a maximum dose of 60 Gy delivered in 30 fractions to a volume greater than 0.03 cm 3 for intermediate- and high-risk meningiomas. This protocol represents the dose constraint for a low-complication risk in patients anticipating long survival. The QUANTEC report 17 concluded that for conventional

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Zachary A. Seymour, Penny K. Sneed, Nalin Gupta, Michael T. Lawton, Annette M. Molinaro, William Young, Christopher F. Dowd, Van V. Halbach, Randall T. Higashida and Michael W. McDermott

for AVMs to surgical series is not straightforward, as total AVM volume rather than SM grade is the most important factor for SRS risk stratification. 5 Select small AVMs (< 10 ml) have a 3-year obliteration rate of 70%–95%. 18 , 27 , 28 Single-session SRS for the treatment of SM Grade I–II AVMs using a median radiation dose of 22 Gy can have an obliteration rate as high as 90% at 5 years. 16 Radiation dose and treatment volume play important roles in the rates of AVM obliteration; Pan et al. reported only a 25% overall obliteration rate at 40 months for single