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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

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Ian F. Parney, James S. Waldron and Andrew T. Parsa

M alignant gliomas are the most common primary tumors of the CNS. Despite significant advances in surgery, radiation therapy, and chemotherapy over the past 3 decades, the median patient survival remains < 1 year from lesion diagnosis. 26 , 27 , 31 This finding has prompted the investigation of novel therapeutic strategies, including immunotherapy. So far, glioma immunotherapy efforts largely have been focused on stimulating antitumor lymphocyte responses. For example, several types of glioma vaccines using various strategies have recently been developed

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

be representative of a subset of patients who maintain optic nerve structural integrity and can indeed benefit from delayed therapy. Clearly, the reversibility of a deficit relates to the duration of symptoms, and cases of reversibility following prolonged optic nerve compression are uncommon. Nonetheless, the very existence of such cases raises the question of whether the concept of delayed decompression has been prematurely abandoned based on earlier very small case series and anecdotal experiences. The optic nerve symptomatology in the patient in the present

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

radiotherapy between pediatric and adult patients. Among patients who underwent GTR and no radiation therapy, the recurrence rate was 65% (13 of 20 patients) among children and 7.6% (9 of 118 patients) among adults (p < 0.001, Fisher exact test). Conversely, in patients who underwent STR and radiation therapy, the recurrence rate was 16.7% (2 of 12 patients) among pediatric patients and 37.7% (20 of 53 patients) among adult patients (p = 0.20, Fisher exact test). The authors of 7 studies reported the age of the children at radiotherapy treatment, which ranged from 8 to 18

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Nader Sanai, Mei-Yin Polley, Michael W. McDermott, Andrew T. Parsa and Mitchel S. Berger

S tandard treatment for GBM, the most common primary malignant brain tumor, includes microsurgical resection followed by concomitant chemotherapy and radiation therapy. 9 Unfortunately, despite decades of refinement, this multimodal approach still leads to a mean survival time of 12–14 months, except for a select group of patients who have methylguanine methyltransferase promoter methylation and are treated with temozolomide (46% 2-year overall survival). 2 , 9 Beyond establishing the histological diagnosis and decompressing tumor mass effect, the value

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Seunggu J. Han, Isaac Yang, Tarik Tihan, Susan M. Chang and Andrew T. Parsa

currently treated in a similar fashion to GBMs, with modalities including tumor resection, postoperative radiation therapy, and chemotherapy. Most gliosarcomas are de novo, and are hence termed primary gliosarcomas, whereas those detected at subsequent surgery for previously resected and irradiated GBMs are termed secondary gliosarcoma ( Figs. 1 and 2 ). 25 F ig . 1. Neuroimages of secondary gliosarcoma in a patient with GBM previously treated with the Stupp protocol A: Axial Gd-enhanced T1-weighted image of right-sided frontal temporal lobe GBM. B: Axial Gd

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

: 131 – 135 , 2003 5 Bhandari M , Joensson A : Clinical Research for Surgeons New York , Thieme , 2009 6 Boarini DJ , Beck DW , VanGilder JC : Postoperative prophylactic anticonvulsant therapy in cerebral gliomas . Neurosurgery 16 : 290 – 292 , 1985 7 Calabresi P , Cupini LM , Centonze D , Pisani F , Bernardi G : Antiepileptic drugs as a possible neuroprotective strategy in brain ischemia . Ann Neurol 53 : 693 – 702 , 2003 8 Chalk JB , Ridgeway K , Brophy T , Yelland JD , Eadie MJ : Phenytoin impairs

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Michael E. Sughrue, Andrea H. Yeung, Martin J. Rutkowski, Steven W. Cheung and Andrew T. Parsa

cycle arrest, and increased apoptosis. These experiments highlight the importance of merlin-mediated control of schwannoma growth, suggesting promise for gene or protein therapy as a possible future treatment option. Merlin and Cell Cycle Regulation The pRb-CDK Pathway. The mammalian cell cycle is divided into 4 phases: G1, S (DNA replication), G2, and M (mitosis). Progression from phase G1 to S is tightly regulated by the pRb-CDK pathway. Several studies have revealed an interaction between the NF2 gene product and cell cycle regulation via the pRb-CDK pathway

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

.429–1.773)  cardiac arrest requiring CPR 65 (0.6) 49 (0.2) 114 (0.3) 3.701 (2.556–5.359) †  myocardial infarction 34 (0.3) 54 (0.2) 88 (0.2) 1.757 (1.145–2.697) †  bleeding requiring transfusion 540 (5.4) 1201 (4.3) 1741 (4.6) 1.255 (1.136–1.385) †  graft/prosthesis/flap failure 2 (0.0) 7 (0.0) 9 (0.0) 0.797 (0.166–3.837)  deep venous thrombosis requiring therapy 259 (2.6) 225 (0.8) 484 (1.3) 3.212 (2.690–3.834) †  sepsis 363 (3.6) 251 (0.9) 614 (1.6) 4.035 (3.441–4.732) †  septic shock 128 (1.3) 80 (0

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Matthew Z. Sun, Michael C. Oh, Michael Safaee, Gurvinder Kaur and Andrew T. Parsa

V estibular schwannoma is a benign CNS tumor arising from one or more constituent nerves of the eighth cranial nerve complex. 87 Management options include observation, radiation, radiosurgery, microsurgery, and a combination of these modalities. Overall, microsurgical resection remains the best cytoreductive therapy and has been shown to be most effective for treating large lesions that cause mass effect and obstructive hydrocephalus. However, microsurgery cannot achieve the facial and cochlear nerve outcomes of radiosurgery. 78 , 95 Because functional