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Katsushige Watanabe, Takashi Watanabe, Akio Takahashi, Nobuhito Saito, Masafumi Hirato and Tomio Sasaki

cervical spine (four). The tumor types were glioblastoma (11 cases), meningioma (eight), astrocytoma (eight), schwannoma (three), oligodendroglioma (three), cavernous angioma (four), germinoma (one), pineocytoma (one), teratoma (one), and ependymoma (two cases). All patients were considered to be at relatively high risk for postoperative neurological deterioration. The neurophysiological monitoring methods were approved by our institutional review board. All patients gave informed consent to the procedure (or assent together with parental consent in the case of children

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Nobutaka Kawahara, Tomio Sasaki, Takahiro Asakage, Kazunari Nakao, Masashi Sugasawa, Hirotaka Asato, Isao Koshima and Nobuhito Saito

: The orbitozygomatic infratemporal fossa approach: a quantitative anatomical study . Acta Neurochir (Wien) 138 : 255 – 264 , 1996 15 Kawahara N , Sasaki T , Nibu K , Sugasawa M , Ichimura K , Nakatsuka T , : Dumbbell type jugular foramen meningioma extending both into the posterior cranial fossa and into the para-pharyngeal space: report of 2 cases with vascular reconstruction . Acta Neurochir (Wien) 140 : 323 – 330 , 1998 16 Kinney SE , Wood BG : Malignancies of the external ear canal and temporal bone: surgical techniques and

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Keisuke Maruyama, Tomoyuki Koga, Kyousuke Kamada, Takahiro Ota, Daisuke Itoh, Kenji Ino, Hiroshi Igaki, Shigeki Aoki, Yoshitaka Masutani, Masahiro Shin and Nobuhito Saito

LD : Stereotactic radiosurgery for brainstem arterio-venous malformations: factors affecting outcome . J Neurosurg 100 : 407 – 413 , 2004 18 Maruyama K , Shin M , Kurita H , Kawahara N , Morita A , Kirino T : Proposed treatment strategy for cavernous sinus meningiomas: a prospective study . Neurosurgery 55 : 1068 – 1075 , 2004 19 Masutani Y , Aoki S , Abe O , Hayashi N , Otomo K : MR diffusion tensor imaging: recent advance and new techniques for diffusion tensor visualization . Eur J Radiol 46 : 53 – 66 , 2003 20

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Kyousuke Kamada, Tomoki Todo, Takahiro Ota, Kenji Ino, Yoshitaka Masutani, Shigeki Aoki, Fumiya Takeuchi, Kensuke Kawai and Nobuhito Saito

(G-II) 16 64, M rt thalamus confusion metastatic tumor 17 57, M rt frontotemporal headache astrocytoma (G-II) 18 57, M rt parietal lt agnosia metastatic tumor 19 34, F rt frontotemporal lt hemiparesis GBM 20 29, F rt frontal headache astrocytoma (G-II) 21 33, F lt lat ventricle headache meningioma 22 44, M lt frontal headache astrocytoma (G-II) 23 64, F rt frontal dysarthria GBM 24 75, M rt frontal dementia GBM 25 60, M rt parietal headache GBM

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Takahiro Ota, Kensuke Kawai, Kyousuke Kamada, Taichi Kin and Nobuhito Saito

meningiomas; and 1 each had metastatic tumor, malignant meningioma with radiation necrosis, focal cortical dysplasia, AVM, radiation necrosis, metastatic carcinosarcoma, ganglioglioma, and cryptococcal granuloma. Three patients underwent surgical treatment for nonlesional epileptic foci. Written informed consent for surgery, intraoperative monitoring, and general clinical research was obtained in all patients. The patients in Cases 2 and 12 were described in our previous technical report, which validated the efficacy of tractography registered on the navigation system by

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Roberto C. Heros

The paper by Oya and colleagues 2 in the Journal of Neurosurgery is timely and important. These authors from the University of Tokyo have retrospectively, but very carefully, analyzed a series of 240 patients with 248 benign (WHO Grade I) intracranial meningiomas that were resected at the University of Tokyo Hospital between January 1995 and August 2010. The authors included only patients who had undergone radiological follow-up for at least 6 months, and they calculated the 5-year recurrence-free survival (RFS) by Kaplan-Meir analysis and correlated

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Soichi Oya, Kensuke Kawai, Hirofumi Nakatomi and Nobuhito Saito

M ost meningiomas are slow-growing lesions and are usually benign in nature. It has been a widespread belief that extensive resection is beneficial for minimizing the risk of tumor recurrence. In 1957, Simpson 33 classified the extent of resection of meningiomas into 5 subdivisions and demonstrated that the postoperative recurrence rates of these tumors were correlated with the extent of resection. In his report, the risks of eventual recurrence after Simpson Grade I, II, III, and IV resections were 9%, 16%, 29%, and 39%, respectively, when the patients

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Roberto C. Heros

This issue of the Journal of Neurosurgery includes a very nice paper by Fukushima and colleagues from the University of Tokyo, analyzing the influence on recurrence of detaching the residual tumor from its dural origin in meningiomas that cannot be completely removed surgically. 1 The authors were very careful to analyze a very specific group of patients. They retrospectively studied all cases of Simpson Grade IV resection for WHO Grade I meningiomas operated on at their institution from 1995 to 2010. From this group they excluded patients who were lost

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Yuta Fukushima, Soichi Oya, Hirofumi Nakatomi, Junji Shibahara, Shunya Hanakita, Shota Tanaka, Masahiro Shin, Kensuke Kawai, Masashi Fukayama and Nobuhito Saito

M eningioma usually occurs as a slow-growing benign intracranial tumor, 22 and the risk of recurrence is reduced by gross-total removal. 11 , 14 , 15 , 21 , 29 However, radical resection of meningioma can carry significant risks of postoperative neurological deterioration, 2 , 4 , 10 especially if the meningioma arises in the skull base or adheres to the surrounding neurovascular structures. Increasing the extent of resection for better tumor control frequently contradicts the requirement for minimization of postoperative neurological deterioration

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Shunya Hanakita, Tomoyuki Koga, Hiroshi Igaki, Naoya Murakami, Soichi Oya, Masahiro Shin and Nobuhito Saito

D uring the last 2 decades, stereotactic radiosurgery (SRS) has been widely accepted as an effective treatment option for benign intracranial meningiomas. 13 Especially in patients with tumors associated with a relatively high risk of recurrence when resected, SRS plays an important role as an adjuvant treatment modality after tumor resection or as the first choice of treatment, which can achieve a tumor control rate of more than 90% for 10 years with minimum neurological complications. 8 , 13 , 17 , 20 Despite its reputation in the treatment of