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David Weaver, Scott Vandenberg, T. S. Park and John A. Jane

8. Shuangshoti S , Netsky MG , Jane JA : Neoplasms of mixed mesenchymal and neuroepithelial type, with consideration of the relationship between meningioma and neurilemmoma. J Neurol Sci 14 : 277 – 291 , 1971 Shuangshoti S, Netsky MG, Jane JA: Neoplasms of mixed mesenchymal and neuroepithelial type, with consideration of the relationship between meningioma and neurilemmoma. J Neurol Sci 14: 277–291, 1971 9. Smith DR , Hardman JM , Earle KM : Metastasizing neuroectodermal tumors of the central

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John A. Persing, John A. Jane, Paul A. Levine and Robert W. Cantrell

C raniofacial resection for tumors with both a cranial and a facial component is an established operative approach. 3, 14 Common tumor types treated in this manner include the esthesioneuroblastoma, invasive tumors of the nasopharynx and paranasal sinuses, mesenchymal tumors of the cranial base, and benign intracranial tumors, such as the tuberculum meningioma with extension into the facial skeleton. Specific treatments of these tumor types, however, are varied. Most of the surgical approaches described previously require a frontal craniotomy; 4, 8, 11, 12

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Edward R. Laws Jr., T. Glenn Pait and John A. Jane Sr.

:1949 491 Norlén Stockholm, Sweden “Arteriovenous aneurysms of brain” 6:1949 495 Gordy, Peet, & Kahn Ann Arbor, MI “Surgery of craniopharyngioma” 6:1949 499 Craig & Horrax Rochester, MN & “Hemangioblastomas in members of a family” 6:1949  Boston, MA 506 Craig & Gogela Rochester, MN “Meningioma of optic foramen as a cause of slowly progressive blindness” 7:1950 577 Cooper, MacCarty, & Rynearson Rochester, MN “Gynecomastia in paraplegic males” 7:1950 672 French, Wild, & Neal Minneapolis

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Paul T. Boulos, Aaron S. Dumont, James W. Mandell and John A. Jane Sr.

Meningiomas are the most frequently occurring benign intracranial neoplasms. Compared with other intracranial neoplasms they grow slowly, and they are potentially amenable to a complete surgical cure. They cause neurological compromise by direct compression of adjacent neural structures. Orbital meningiomas are interesting because of their location. They can compress the optic nerve, the intraorbital contents, the contents of the superior orbital fissure, the cavernous sinus, and frontal and temporal lobes. Because of its proximity to eloquent neurological structures, this lesion often poses a formidable operative challenge. Recent advances in techniques such as preoperative embolization and new modifications to surgical approaches allow surgeons to achieve their surgery-related goals and ultimately optimum patient outcome. Preoperative embolization may be effective in reducing intraoperative blood loss and in improving intraoperative visualization of the tumor by reducing the amount of blood obscuring the field and allowing unhurried microdissection. Advances in surgical techniques allow the surgeon to gain unfettered exposure of the tumor while minimizing the manipulation of neural structures. Recent advances in technology—namely, frameless computer-assisted image guidance—assist the surgeon in the safe resection of these tumors. Image guidance is particularly useful when resecting the osseous portion of the tumor because the tissue does not shift with respect to the calibration frame. The authors discuss their experience and review the contemporary literature concerning meningiomas of the orbit and the care of patients harboring such lesions.

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Jason P. Sheehan, Ajay Niranjan, Jonas M. Sheehan, John A. Jane Jr., Edward R. Laws, Douglas Kondziolka, John Flickinger, Alex M. Landolt, Jay S. Loeffler and L. Dade Lunsford

fractionated radiation therapy for pituitary tumors still carries a 1 to 3% risk of delayed optic neuropathy and a 50 to 100% rate of long-term pituitary hormone deficiency. 4, 123 Conventional radiation must be administrated in 20 to 25 fractions and, as such, is less convenient for the patient. More importantly, radiation-induced neoplasms (for example, glioblastoma multiforme or meningioma) develop at a rate of 2.7% by 10 years posttreatment, and the actuarial incidence of a cerebrovascular accident following conventional radiotherapy is 4% at 5 years. 7 Although the

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Edward R. Laws, Adam S. Kanter, John A. Jane Jr. and Aaron S. Dumont

sound. Using a midline approach for midline tumors makes very good sense, and using the time-tested techniques of skull base surgery to remove bone instead of retracting brain to expose such lesions is logical for effective surgery. The trajectory afforded by the transsphenoidal anterior skull-base approach allows the surgeon to work along the axis of the tumor and permits removal of tumors with minimal displacement or distortion of surrounding structures. In the case of meningiomas, as has been well demonstrated, this approach allows devascularization of the

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Edward C. Nemergut, Zhiyi Zuo, John A. Jane Jr. and Edward R. Laws Jr.

and pathological diagnosis in 881 patients* Clinical Disease No. of Patients nonfunctioning adenoma 348 CD 183 acromegaly 121 prolactinoma 87 craniopharyngioma 39 RCC 33 arachnoid cyst 11 clival chordoma 9 meningioma 8 LH/FSH—secreting lesion 8 CSF leak 5 metastatic carcinoma 4 colloid cyst 3 epidermoid cyst 3 lymphoma 3 thyrotropic (TSH-secreting) lesion 3 plasma cell tumor 2 other 11 total 881

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John A. Jane Jr., Daniel M. Prevedello, Tord D. Alden and Edward R. Laws Jr.

1 355 – 366 , 2006 14 Dusick JR , Esposito F , Kelly DF , Cohan P , DeSalles A , Becker DP , : The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors . J Neurosurg 102 : 832 – 841 , 2005 15 Dusick JR , Fatemi N , Mattozo C , McArthur D , Cohan P , Wang C , : Pituitary function after endonasal surgery for nonadenomatous parasellar tumors: Rathke's cleft cysts, craniopharyngiomas, and meningiomas . Surg Neurol 70 : 482 – 491 , 2008 16 Fahlbusch R , Honegger J , Paulus

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John A. Jane Jr., Erin Kiehna, Spencer C. Payne, Stephen V. Early and Edward R. Laws Jr.

, : The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors . J Neurosurg 102 : 832 – 841 , 2005 6 Dusick JR , Fatemi N , Mattozo C , McArthur D , Cohan P , Wang C , : Pituitary function after endonasal surgery for nonadenomatous parasellar tumors: Rathke's cleft cysts, craniopharyngiomas, and meningiomas . Surg Neurol 70 : 482 – 491 , 2008 7 Fahlbusch R , Honegger J , Paulus W , Huk W , Buchfelder M : Surgical treatment of craniopharyngiomas: experience with 168 patients . J Neurosurg