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L. Dade Lunsford

A s we proceed into the second century of diagnosis and management of intracranial meningiomas, the proper mixture of definitive surgery and radiation therapy techniques continues to be analyzed. Both the reports of Goldsmith, et al. , 8 and Maroon, et al. , 13 define a series of patients who benefited from a judicious balance of multimodality management strategies for their meningeal tumors. Modern microsurgical techniques, cranial nerve electrophysiological monitoring, enhanced neuroanesthesia regimens, and superior postoperative rehabilitative services

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L. Dade Lunsford

strategies, neurosurgeons could effectively treat a vast array of vascular malformations or tumors and that they could even create well-circum­scribed brain lesions capable of inactivating movement disorders, chronic pain conditions, and epilepsy. Gamma Knife surgery (GKS) has pretty much fol­lowed the QRS complex noted by Mullan. Leksell’s ini­tial P wave, as it were, occurred in the 1950s and 1960s when he first used an orthovoltage x-ray generator. He then dabbled in proton radiosurgery using cross-fired (rather than Bragg peak) proton beams. To have the technology

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Anterior surgery for cervical disc disease

Part 2: Treatment of cervical spondylotic myelopathy in 32 cases

L. Dade Lunsford, David J. Bissonette and David S. Zorub

C ervical spondylotic myelopathy (CSM) is the most serious consequence of cervical intervertebral disc degeneration, especially when associated with a narrow spinal canal due to laminar, dural, or ligamentous hypertrophy. Since the early studies of the 19th century, the etiology, pathogenesis, natural history, and clinical spectrum have been lucidly defined 2, 5, 7, 10, 23, 24, 26, 28–36, 44 and even reproduced experimentally. 18, 19, 25 Despite earlier recognition and improved surgical techniques, not all authors agree that surgery significantly improves

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Anterior surgery for cervical disc disease

Part 1: Treatment of lateral cervical disc herniation in 253 cases

L. Dade Lunsford, David J. Bissonette, Peter J. Jannetta, Peter E. Sheptak and David S. Zorub

S ince its introduction in the treatment of cervical disc disease by Bailey and Badgley in 1952, 3 the anterior surgical approach has gained increasing popularity as a means of relieving cervical nerve root and spinal cord compression. The pioneering efforts of Cloward, 5–8 Dereymaeker and Mulier, 12 Robinson, et al. , 31, 32, 38 and Verbiest, 41 among others, must be recognized. In properly selected patients, 63% to 100% of patients have improved after anterior cervical surgery. 2, 6, 11, 21 Although the therapeutic efficacy of anterior surgery in

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JC , Lunsford LD , Coffey RJ , et al : Radiosurgery of acoustic neurinomas. Cancer 67 : 345 – 353 , 1991 Flickinger JC, Lunsford LD, Coffey RJ, et al: Radiosurgery of acoustic neurinomas. Cancer 67: 345–353, 1991 2. House WF : Partial tumor removal and recurrence in acoustic tumor surgery. Arch Otolaryngol Head Neck Surg 88 : 644 – 654 , 1968 House WF: Partial tumor removal and recurrence in acoustic tumor surgery. Arch Otolaryngol Head Neck Surg 88: 644–654, 1968 3. Linskey

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L. Dade Lunsford, A. Julio Martinez and Richard E. Latchaw

S tereotaxic techniques assisted by computerized tomography (CT) have sparked a resurgent interest in the application of guiding devices to intracranial surgery. 4, 5 Magnetic resonance (MR) imaging has recently been integrated with modified stereotaxic systems to define stereotaxic targets and lesions. 2 In order to define the merits of this latter combination, we operated on three patients with brain lesions identified by both stereotaxic CT and MR imaging. This permitted us to directly compare the imaging attributes of CT and MR, as well as the results of

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

records, phone interviews, direct neurological examination, and subjective reports from the patients themselves. The patient population consisted of four men and four women. Their average age was 55.5 years (range 32–88 years) and details are provided in Table 1 . Three patients had undergone craniotomy and subtotal resection, and one had undergone embolization. Gamma knife surgery was the initial treatment modality in the remaining four patients. Histological confirmation of the tumor was obtained at surgery in three patients and in five patients a clinical

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Changing concepts in the treatment of colloid cysts

An 11-year experience in the CT era

Walter A. Hall and L. Dade Lunsford

colloid cysts because of the low morbidity and mortality rates associated with this procedure. This report summarizes our treatment of colloid cysts during the past 11 years in the CT era and compares our experience with microsurgical and stereotaxic surgical techniques. Clinical Material and Methods During the 10-year period from January 1, 1976, to December 31, 1985, 17 patients underwent surgery for colloid cysts of the third ventricle at the Hospitals of the University Health Center of Pittsburgh. There were 10 men and seven women, ranging in age from 19 to 63

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Douglas Kondziolka and L. Dade Lunsford

of patients. 6, 11, 20, 21, 25 This report summarizes our 9-year experience in the management of 22 consecutive patients with colloid cysts, all of whose cysts were initially treated by stereotactic techniques. We retrospectively identified two factors, both by preoperative CT, that help to determine the success of stereotactic aspiration: viscosity of the intracystic contents and colloid cyst size. Clinical Material and Methods Twenty-two consecutive patients underwent CT-guided stereotactic surgery for colloid cysts of the third ventricle between February