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Douglas Kondziolka, Mark Bernstein, Lothar Resch, Charles H. Tator, J. F. Ross Fleming, R. G. Vanderlinden and Hart Schutz

T he variety of clinical presentations which brain tumor patients may manifest is finite, but the temporal sequence of symptom progression covers a large spectrum, from imperceptibly slow, chronic syndromes to sudden apoplectic deterioration and coma. Tumor apoplexy has often been associated with tumoral hemorrhage, with reported hemorrhage rates ranging from 1.4% to 10.0%. 7, 21, 26, 29, 34–36, 42, 46 Wakai, et al. , 46 reported 45 cases of intracranial hemorrhage due to tumor in which symptoms could be related to the bleed in only 57%. Hemorrhage size was

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Douglas Kondziolka, Mark Bernstein, S. M. Spiegel and Karel ter Brugge

. Neurosurgery 12: 169–174, 1983 30. Zabramski JM , Spetzler RF , Bonstelle C : Chronic cerebral vasospasm: effect of volume and timing of hemorrhage in a canine model. Neurosurgery 18 : 1 – 6 , 1986 Zabramski JM, Spetzler RF, Bonstelle C: Chronic cerebral vasospasm: effect of volume and timing of hemorrhage in a canine model. Neurosurgery 18: 1–6, 1986

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L. Dade Lunsford, Douglas Kondziolka, John C. Flickinger, David J. Bissonette, Charles A. Jungreis, Ann H. Maitz, Joseph A. Horton and Robert J. Coffey

basilar artery aneurysm. Multiple embolizations and treatment of three isocenters with radiosurgery using the 18-mm collimator (16 Gy at the 45% isodose) failed to prevent repeat hemorrhage. Chronic headaches were present in 104 patients before treatment. This symptom was adequately re-evaluated in 73 patients during follow-up examination: 56 patients (75%) had improvement, 14 had no change, and three were worse. Improvement in headache usually accompanied decreased flow identified on serial MR studies. Forty-three of the 70 patients with seizures before radiosurgery

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Douglas Kondziolka, Thomas Lemley, John R. W. Kestle, L. Dade Lunsford, Gerhard H. Fromm and Peter J. Jannetta

2. Hassenbusch SJ , Kunkel RS , Kosmorsky GS , et al : Trigeminal cisternal injection of glycerol for treatment of chronic intractable cluster headaches. Neurosurgery 29 : 504 – 508 , 1991 Hassenbusch SJ, Kunkel RS, Kosmorsky GS, et al: Trigeminal cisternal injection of glycerol for treatment of chronic intractable cluster headaches. Neurosurgery 29: 504–508, 1991 3. Jannetta PJ : Trigeminal neuralgia: treatment by microvascular decompression , in Wilkins RH , Rengachary SS (eds

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Douglas Kondziolka, L. Dade Lunsford and John R. W. Kestle

from a cavernous malformation was relatively low, hemorrhage prevention should not be an absolute indication for surgical resection. They also acknowledged that the risk of rebleeding after an initial hemorrhage was unknown. 1 Tung, et al. , 12 reported 13 patients with recurrent hemorrhages from cavernous malformations located in all brain regions. The median interval from first to second hemorrhage was 12 months. They noted that all surgical specimens showed histological evidence of chronic and recent hemorrhage. In many patients multiple microscopic

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Bruce E. Pollock and Douglas Kondziolka

discharge from the left nostril and injection of the left eye. Her physical examination was normal with the exception of a noticeable injection of her left eye. She was unable to tolerate a trial of carbamazepine secondary to lightheadedness. Computerized tomography scans of the sinuses revealed no bone or soft-tissue abnormalities and no evidence of acute or chronic sinusitis. A series of three lidocaine blocks of the sphenopalatine ganglion gave consistent relief of the symptoms for several hours after the injections. Examination and First Radiosurgery The

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Todd P. Thompson, Douglas Kondziolka and A. Leland Albright

more than 20 years for the relief of chronic pain. More recently, use of DBS has been extended to functional neurosurgery, including stimulation of the thalamus, globus pallidus, and subthalamic nucleus as treatment for Parkinson's disease, tremor, and dystonia. Deep brain stimulation has the advantage of avoiding a permanent lesion and allowing multiple variations of current frequency and bandwidth between a combination of four electrodes, each 1.5 mm in length and separated by 1.5 mm. Its effectiveness without resorting to creation of a lesion and its potential to

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Satoshi Maesawa, Douglas Kondziolka, C. Edward Dixon, Jeffrey Balzer, Wendy Fellows and L. Dade Lunsford

, et al : Kainic acid induced hippocampal seizures in rats: comparisons of acute and chronic seizures using intrahippocampal versus systemic injections. Ital J Neurol Sci 16 : 39 – 44 , 1995 Babb TL, Pereira-Leite J, Mathern GW, et al: Kainic acid induced hippocampal seizures in rats: comparisons of acute and chronic seizures using intrahippocampal versus systemic injections. Ital J Neurol Sci 16: 39–44, 1995 2. Barcia-Salorio JL , Barcia JA , Hernández G , et al : Radiosurgery of epilepsy. Long-term results. Acta Neurochir Suppl 62 : 111 – 113

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Melvin Field, Timothy F. Witham, John C. Flickinger, Douglas Kondziolka and L. Dade Lunsford

of hemorrhage (p = 0.9484). Effect of Hypertension In our series, 105 patients (21%) exhibited either intraoperative hypertension (systolic blood pressure > 150 mm Hg) or a history of chronic hypertension at the time of biopsy. Perioperatively, all patients were treated for systolic blood pressure that was greater than 150 mm Hg with oral or intravenous antihypertension medications. Postbiopsy CT scanning revealed acute hemorrhages in nine (8.57%) of the patients with hypertension, but only one of these patients had a hemorrhage larger than 10 mm in

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Jason P. Sheehan, Douglas Kondziolka, John Flickinger and L. Dade Lunsford

documented tumor regression, the other patient whose vision deteriorated 18 months after CT-based GKS had a new defect in the temporal field of his right eye 7 months posttreatment. This patient underwent repeated resection to decompress the optic apparatus. Although headaches were not the sole reason for GKS treatment, nine patients experienced headaches that were thought to be associated with their pituitary adenoma at the time of GKS, and three of the nine experienced subsequent improvement of headache. Following GKS, one patient had a worsening of her chronic