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Corinna C. Zygourakis, Taemin Oh, Matthew Z. Sun, Igor Barani, James G. Kahn and Andrew T. Parsa

V estibular schwannomas (VSs; also known as acoustic neuromas) are benign tumors that represent approximately 10% of intracranial primary brain tumors. 12 Although they may be asymptomatic, they often present with unilateral hearing loss, tinnitus, imbalance, or vertigo. When they are discovered, VSs are managed in 3 ways: observation (the “wait and scan” approach); Gamma Knife surgery (GKS); or microsurgery. There is a significant body of literature (including many single- and multi-institution studies, as well as meta-analyses) regarding which

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Michael E. Sughrue, Martin J. Rutkowski, Gopal Shangari, H. Quinn Chang, Andrew T. Parsa, Mitchel S. Berger and Michael W. McDermott

years, many patients with lesions large enough to require surgical intervention are older and as a result have preexisting medical conditions. 5 , 6 The surgical and neurological risks for various meningioma surgeries have already been reported, 3 , 4 , 11 , 22 but much less effort has been expended in studying the rates of serious medical complications following meningioma surgery. In the absence of such data, 2 potential hypotheses could be formulated regarding the rigors of meningioma surgery in “medically at-risk” patients. On the one hand, it is well known

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Michael E. Sughrue, Martin J. Rutkowski, Derick Aranda, Igor J. Barani, Michael W. McDermott and Andrew T. Parsa

I t is generally accepted that the most effective treatment for meningiomas is aggressive resection of the tumor and its dural and bony attachments. 71 Surgery remains the ideal first-line therapy for large and symptomatic meningiomas. 2 , 8 , 28 , 71 , 74 Benign meningiomas are particularly amenable to complete resection, and this is the only current treatment thought to offer a potential “cure.” 2 , 8 , 28 , 71 , 74 Given these observations, early microsurgical philosophies emphasized aggressive tumor resection in all cranial regions where these

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Michael E. Sughrue, Isaac Yang, Derick Aranda, Martin J. Rutkowski, Shanna Fang, Steven W. Cheung and Andrew T. Parsa

O utcomes in patients surgically treated for VS have improved dramatically over the years. In the pre–microsurgical era, even in the best hands, operative death rates of 10–20% were realized only with subtotal removal. 23 , 24 , 65 Years later, House and others lowered the morbidity of VS surgery to < 10%, even with complete tumor removal. 46 , 47 , 115 Further refinement of and experience with multiple surgical approaches have lowered mortality rates for VS removal to between 0.8 and 5% for all approaches. 14 , 28 , 35 , 43 , 62 , 100 , 111 , 115 Within

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John D. Rolston, Seunggu J. Han, Catherine Y. Lau, Mitchel S. Berger and Andrew T. Parsa

audited using test cases, and their data are ignored if they fail these auditing checks. 19 With the NSQIP data set, it is possible to determine the most frequent complications in neurological surgery. Identifying these complications will allow us to better distribute resources to prevent and mitigate the most costly and common adverse events in our patients. Moreover, understanding the type and frequency of complications in neurosurgery will allow us to better coordinate care with stakeholders—insurers, governmental institutions, and patients. In this study, we used

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Ari J. Kane, Michael E. Sughrue, Martin J. Rutkowski, Derick Aranda, Steve A. Mills, Raphael Buencamino, Shanna Fang, Igor J. Barani and Andrew T. Parsa

physicians in prognostic counseling as well as directing patients toward the appropriate treatment regimen. 50 , 83 , 94 , 134 The lack of authoritative evidence has resulted in heterogeneous treatment selections including unimodal approaches composed of surgery, radiotherapy, or chemotherapy, as well as multimodal therapies. A meta-analysis published in 2001 attempted to review and determine appropriate treatment. 49 This analysis was unable to find a statistically significant difference between surgery alone and surgery with adjuvant radiotherapy. However, based on a

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William B. Feldman, Aaron J. Clark, Michael Safaee, Christopher P. Ames and Andrew T. Parsa

treated by GTR alone versus STR followed by radiotherapy. In contrast, Sonneland and colleagues 35 showed that GTR was associated with lower overall recurrence rates and improved overall survival than was STR alone. A second important area of controversy in the treatment of MPEs is the value of adjuvant radiotherapy. Bagley and colleagues 7 and Chao and colleagues 11 demonstrated no benefit in recurrence-free survival for patients treated with adjuvant radiotherapy after surgery. Akyurek and colleagues, 2 on the other hand, found that adjuvant radiotherapy was

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Eli T. Sayegh, Shayan Fakurnejad, Taemin Oh, Orin Bloch and Andrew T. Parsa

afflict 15%–50% of patients who undergo brain tumor surgery, 10 , 42 , 54 including a sizable proportion without a prior seizure history. 32 , 50 Postcraniotomy seizures are stratified by chronology: immediate (within 24 hours), early (within 1 week), and late (all subsequent events). 15 Two-thirds of seizures occur in the first month after craniotomy, 42 especially during the first 72 hours, 27 although the seizure risk persists for several months postoperatively. 50 In a systematic review of supratentorial craniotomies, the first postoperative seizure occurred

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Michael E. Sughrue, Michael W. McDermott and Andrew T. Parsa

clinic 1 week later with plans for endovascular embolization followed by bifrontal decompressive surgery. Given that her visual loss was not acute and her acuity had not recently changed according to her primary ophthalmologist, steroids were not administered at that time, and surgery was scheduled on an elective basis for ~ 3 weeks later. Results of visual field examinations performed 1 week prior to her clinic visit are shown in Fig. 2 upper . F ig . 1. Preoperative and postoperative axial Gd-enhanced T1-weighted MR images demonstrating a large anterior

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John D. Rolston, Seunggu J. Han, Orin Bloch and Andrew T. Parsa

vena cava ligation, or anticoagulation therapy. Pulmonary embolisms must occur within 30 days of an operation and must be confirmed with a highprobability ventilation-perfusion (VQ) scan, CT scan, or pulmonary arteriogram. Database files were acquired in delimited text format and parsed using both SPSS version 20 (IBM Corp.) and MATLAB R2012a (MathWorks Inc.). Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as “neurological surgery” and further classified as “spine” or “cranial” depending on the current procedural