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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

-six citations reflect an interest in 2 articles on metastatic tumors, a somewhat paradoxical citation because as many as 400,000 patients in North America will develop metastatic brain cancer each year. Virtually all of those patients are suitable candidates for treatment by radiosurgery. The vast majority of them will never need whole-brain radiation therapy, an older paradigm that is rapidly being replaced by radiosurgery because the latter significantly improves cognitive outcomes and is associated with enhanced tumor control in brain disease. Twenty-six citations reflect

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Constantinos G. Hadjipanayis, Douglas Kondziolka, Paul Gardner, Ajay Niranjan, Shekhar Dagam, John C. Flickinger and L. Dade Lunsford

P ilocytic astrocytomas represent a distinct histological subtype of glial neoplasms that is frequently diagnosed in children and young adults. Because these tumors often behave in a comparatively indolent fashion, pilocytic astrocytomas are thought to be clinically benign, potentially curable by surgery, and associated with long survival. Due to adverse locations, recurrence, or progression of the lesion despite surgery, however, some patients require multiple therapies after diagnosis. For such patients, a different spectrum of options must be evaluated

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L. Dade Lunsford

Object Endoscopic aqueductal stent therapy has evolved into an important technique in the treatment of a trapped fourth ventricle (TFV). The authors analyzed five cases of symptomatic TFV treated by endoscopic aqueductal stent therapy and, on the basis of intra-operative findings, discuss aspects of TFV formation. Methods Patients' ages ranged from 2 to 17 years (mean 9.2 years). Two patients underwent endoscopy via a coronal bur hole approach and three via a small suboccipital craniectomy. The mean follow-up period was 30 months (range 24–38 months

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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

latest follow-up examination 16 to 122 months after surgery, all patients are receiving anticonvulsant therapy and are asymptomatic. Seven patients had CT-guided stereotaxic aspiration of their colloid cysts. Six patients underwent intraoperative metrizamide ventriculography after aspiration which confirmed ventricular patency in five. A lack of communication between the third and fourth ventricles was seen in one patient who suffered persistent headaches; he underwent a transfrontal craniotomy with cyst resection. Subsequent CT scanning did not demonstrate

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Douglas Kondziolka, Salvador Somaza, Christopher Comey, L. Dade Lunsford, Diana Claassen, Sudha Pandalai, Ann Maitz and John C. Flickinger

T he increased use of stereotactic radiosurgery or stereotactic fractionated irradiation as an addition or alternative to conventional therapy for malignant brain tumors mandates investigation into the relative effects of these approaches. Use of the C6 rat glioma model is a valuable technique to evaluate the response of different radiation modalities on tumor biology, to study chemotherapeutic agents, and to analyze tumor growth patterns. We previously tested the effects of stereotactic radiosurgery alone using a frontal lobe C6 rat glioma model. 7 In that

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L. Dade Lunsford, Salvador Somaza, Douglas Kondziolka and John C. Flickinger

“benign” sobriquet is clearly erroneous. Although early diagnosis and treatment may enhance survival, with initial management options ranging from simple observation to radical surgical resection, no consensus on effectiveness of cytoreductive surgery or radiation therapy on survival has emerged. 23 In 1982 the senior author (L.D.L.) initiated a prospective Phase I–II investigation to evaluate the role of adjuvant fractionated radiation after stereotactic histological diagnosis. Our study reports the long-term outcome of this treatment strategy. Clinical Material

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Douglas Kondziolka, L. Dade Lunsford, Jay S. Loeffler and William A. Friedman

Things are seldom what they seem; skim milk masquerades as cream.—W. S. Gilbert The incorporation of stereotactic radiosurgery into neurosurgery and recent improvements in the administration of fractionated radiation therapy represent fundamental paradigm shifts in modern medical care. Neurological surgery has focused on minimal access procedures, searching for the molecular responses of tissues so that they may be eradicated or inactivated, and relying on the multidisciplinary talents and backgrounds of practitioners in neurological surgery, radiation

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Neurosurgical Forum: Letters to the Editor To The Editor Fraser C. Henderson , M.D. Georgetown University Hospital Washington, D.C. 586 588 Abstract Object. Radiosurgery and radiation therapy represent important but unique treatment paradigms for patients with certain neoplasms, vascular lesions, or functional disorders. The authors discuss their differences. Methods. Reviewing the authors' experiences shows how the roles of these approaches vary just as their techniques differ. The distinct differences

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

tumors remain a rare clinical entity. 41, 42 They account for 0.03% of all neoplasms and 0.6% of all head and neck tumors. 2 The mean patient age at presentation is 55 years. 6 Bilateral glomus jugulare tumors are found in 1% to 2% of cases; 7% to 10% present with both glomus jugulare and carotid body tumors. 25, 39, 52 Further complicating the treatment of these entities is the fact that 1% of the tumors secrete catecholamines. 46 Traditionally, the management of glomus tumors has involved radiation therapy or resection often preceded by preoperative