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Jonathan A. Friedman, Mark A. Pichelmann, David G. Piepgras, John L. D. Atkinson, Cormac O. Maher, Fredric B. Meyer and Kristine K. Hansen

aneurysm 7 (14) presentation  SAH from AChA aneurysm 24 (47)  SAH from other aneurysm 9 (18)  symptoms other than rupture 3 (6)  found incidentally preop 8 (16)  found incidentally at surgery 6 (12) Thirty-three patients (66%) presented with SAH; in 24 of these patients (with 47% of all AChA aneurysms), the AChA aneurysm had caused the hemorrhage ( Table 1 ). In the other nine patients (18% of all AChA aneurysms), the SAH was caused by rupture of another aneurysm. Two patients presented with a third cranial

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Fredric B. Meyer and Donald A. Muzzi

performed at least once daily prior to surgery. Postoperatively, these patients were examined a minimum of twice daily. A computerized tomography scan was obtained 24 to 36 hours following surgery to document any evolving infarct and to observe for possible hydrocephalus. Transcranial Doppler ultrasound studies were also performed on a daily basis. If there was significant clinical deterioration suggesting vasospasm, a transfemoral cerebral angiogram was obtained for evaluation of possible angioplasty. Mild alterations in clinical status associated with increased blood

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Editorial

Gamma Knife surgery and brain metastases

Fredric B. Meyer

control in ~ 94% of patients. The survival was predictably poor, with a median of ~ 7 months, and as with most brain cancers, the patient's Karnofsky Performance Scale (KPS) score was most important in predicting outcome. It should be noted that the tumors were not large, with a mean volume of 4.3 cm 3 . As in most series of this nature, the article is weakened by its retrospective design, heterogeneous group of patients in terms of interventions (see Tables 1 and 2), tumor number and type, treatment, and follow-up. For example, 10 patients had undergone prior surgery

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Fredric B. Meyer

we care? There are, of course, many answers to the first part of this rhetorical question. The Journal of Neurosurgery , like all other leading scientific journals, has a primary obligation to advance science relevant to that discipline, whether it be clinical or laboratory science. It is reasonable to suggest that future advances in clinical neurosurgery will most likely emerge from basic science research. As an example, has surgery really provided a paradigm shift in glioblastoma prognosis over the last quarter century? Yes, we may better understand the

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Fredric B. Meyer

distal protection device, there is a significantly higher risk of embolic events with the CASP procedure. As illustrated in the carotid artery plaque in Fig. 1 , this finding is not surprising given the morphological entity being treated. F ig . 1. Photograph of carotid artery plaque. The concern regarding temporary neuropsychological dysfunction following CEA has been attributed in part to perioperative embolic or hypoperfusion events. 1 , 2 The findings in the present study with respect to the appearance of new lesions on DW MR imaging after surgery

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Fredric B. Meyer and Wanda L. Windschitl

S urgery for recurrent carotid artery stenosis is becoming more common because of longer patient survival times and follow-up reviews conducted using noninvasive testing. From a technical perspective, repeated surgery is more challenging and has a significantly higher complication rate. 2, 7, 18, 20 Therefore, every effort during the initial surgery should be directed to decreasing the risk of recurrent stenosis. The problem of recurrent carotid artery stenosis has raised a controversy regarding primary compared with secondary closure of the initial

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Fredric B. Meyer

The article by Hasegawa et al. 1 in this month's Journal of Neurosurgery is a retrospective study in which the authors analyze the effects and durability of Gamma Knife surgery (GKS) for 125 superficial meningiomas in 112 patients. What makes this article interesting and worth discussing is that meningiomas in these locations are those for which surgeons would more often favor open resection due to ease of access. In this study the median tumor diameter was 2.5 cm and the mean follow-up was 6 years. In patients in whom GKS was the initial treatment (46

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Jonathan A. Friedman, Fredric B. Meyer, Nicholas M. Wetjen and Douglas A. Nichols

(AP) view, demonstrating profound vasospasm of the supraclinoid ICA with delayed filling of the middle cerebral artery (MCA) branches and no filling of the anterior cerebral artery (ACA). Right: Left ICA injection, AP view, after balloon angioplasty of the vasospastic segment revealing a significant increase in caliber of the supraclinoid ICA with normal filling of the MCA branches. The ACA now fills, but severe vasospasm is seen in the left A 1 segment. Ischemic neurological deficit due to vasospasm following transsphenoidal pituitary surgery has been

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Neurosurgical Forum: Letters to the Editor To The Editor Akio Morita , M.D. , Fredric B. Meyer , M.D. Mayo Clinic Rochester, Minnesota 1195 1196 We appreciated the recent article by Kodama, et al. (Kodama N, Matsumoto M, Sasaki T: Preservation of the arteries around an aneurysm: practical use of oxycellulose. Technical note. J Neurosurg 83: 748–749, October, 1995), describing their technique to avoid compromising perforators during aneurysm surgery using oxycellulose. Their report

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Jamie J. Van Gompel, W. Richard Marsh, Fredric B. Meyer and Gregory A. Worrell

( Fig. 1 ) designed to assess seizure type (based on semiology), outcome from epilepsy surgery (based on Engel classification and International League Against Epilepsy outcome scale score), and patient perceived satisfaction was used. 21 The survey was designed with the goal of creating a useful tool for outcome follow-up that would not represent a significant burden for patients to respond. The 2-page survey was sent by US mail to all patients. F ig . 1. Survey form used in the study. Analysis of Follow-Up Follow-up was determined by date of initial