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Douglas Kondziolka and L. Dade Lunsford

had undergone bilateral VP shunting prior to colloid cyst surgery. Aspiration was attempted in these patients in order to decrease cyst size and relieve foraminal obstruction, thus preventing shunt dependence. One young patient had shunts placed as an emergency procedure after presentation in coma. There was no morbidity or mortality after stereotactic intervention. TABLE 1 Treatment results for colloid cyst management Surgical Approach Total Cases No Residual Cyst Small Residual Cyst ≥ 30% Cyst Volume Remaining Unsuccessful

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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

operated on nor the presence or absence of localized radiographic canal stenosis significantly affected outcome. Gregorius, et al. , 21 also were unable to significantly link outcome to any of these five factors. For many years, controversy has centered around the appropriate surgical approach in these cases. The results of cervical laminectomy with various modifications have been contrasted with the results of anterior fusion. 20, 22, 27, 35, 39 A variety of surgical techniques have been proposed for anterior spinal cord decompression. These include an anterior

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Bruce E. Pollock, L. Dade Lunsford, Douglas Kondziolka, David J. Bissonette and John C. Flickinger

whose employment is dependent on normal vision, stereotactic radiosurgery may be preferable to microsurgical resection of AVMs within the visual pathways. Future radiosurgery and microsurgery series should examine those AVM factors that better predict the risks in an individual patient including age, AVM volume, location, presence of venous outflow restriction or related aneurysms, and the expected morbidity related to the specific surgical approach. Acknowledgments The authors thank Lisa Svitek and Mary Ann Vincenzini for preparation of the manuscript and

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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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Georgios Zenonos, Douglas Kondziolka, John C. Flickinger, Paul Gardner and L. Dade Lunsford

cases of FMM have been documented in the literature. 1–8 , 10 , 13 , 16–20 , 24–32 , 35 The various surgical approaches have included the posterolateral, far lateral (either retro- or transcondylar), 4 , 5 , 17 , 25 , 28 anterolateral or extreme lateral, 3 , 30 , 32 transoral and transclival approach, 10 , 19 as well as the lateral and posterior suboccipital approaches. 5 , 19 , 31 Many authors have described variations in these approaches, such as the transposition of vertebral arteries, 2 , 3 , 17 , 26 , 28 , 30 , 32 resection of the jugular tubercle, 3 , 5

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concerning their natural history. For example, angioarchitectural features such as prenidal and intranidal aneurysms, venous restriction, or deep venous drainage, are now well-known risk factors for hemorrhage. 7, 8, 13, 15 Before surgery, volume reduction is as important as flow reduction in helping to remove large AVMs. 14 The role of embolization also includes the occlusion of deep perforating vessels or arteries that will be hidden during surgical approach, in performing amytal testing in potential eloquent territories, and in detecting arteries en passage. Before

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Hideyuki Kano, Ajay Niranjan, Douglas Kondziolka, John C. Flickinger and L. Dade Lunsford

, Arkha Y , Schlesinger D , Steiner L : Gamma knife surgery for trigeminal schwannoma . J Neurosurg 106 : 839 – 845 , 2007 20 Taha JM , Tew JM Jr , van Loveren HR , Keller JT , el-Kalliny M : Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas . J Neurosurg 82 : 719 – 725 , 1995 21 Yasui T , Hakuba A , Kim SH , Nishimura S : Trigeminal neurinomas: operative approach in eight cases . J Neurosurg 71 : 506 – 511 , 1989 22 Yoshida K , Kawase T : Trigeminal

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Douglas Kondziolka, Oscar Zorro, Javier Lobato-Polo, Hideyuki Kano, Thomas J. Flannery, John C. Flickinger and L. Dade Lunsford

W hen medical management fails to control the pain of trigeminal neuralgia, patients require surgical intervention. Effective surgical procedures include craniotomy and microvascular decompression or percutaneous ablative procedures. 19 All surgical procedures have variable but definite rates of risk and pain recurrence. Gamma Knife surgery is a minimally invasive surgical approach for managing trigeminal neuralgia. In 1951, Lars Leksell advocated radiosurgery using a prototype guiding device linked to a dental x-ray machine. 14 , 15 During the next 50

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Greg Bowden, Hideyuki Kano, Huai-che Yang, Ajay Niranjan, John Flickinger and L. Dade Lunsford

, Lunsford. Acquisition of data: Kano, Bowden, Yang. Analysis and interpretation of data: Bowden. Drafting the article: Kano, Bowden, Lunsford. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Kano. Statistical analysis: Bowden. Study supervision: Kano, Lunsford. References 1 Batjer H , Samson D : Surgical approaches to trigonal arteriovenous malformations . J Neurosurg 67 : 511 – 517 , 1987 2 da Costa L , Thines L , Dehdashti

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Satoshi Maesawa, Camille Salame, John C. Flickinger, Stephen Pirris, Douglas Kondziolka and L. Dade Lunsford

surgical approach for treating trigeminal neuralgia. Stereotactic irradiation of the trigeminal ganglion was first reported by Leksell. 18 More recently, several authors have reported their initial results with radiosurgery in which high-resolution image guidance is used. 14, 16, 17, 19, 24, 25, 30, 32 These data established the accuracy of radiosurgical targeting as well as the initial safety of the procedure, and provided dose—response information. Over the last 5 years, trigeminal nerve GKS has been performed at medical centers worldwide, with more than 2800