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Theodore H. Schwartz, Brian Ho, Charles J. Prestigiacomo, Jeffrey N. Bruce, Neil A. Feldstein and Robert R. Goodman

, 29 This technique has demonstrated that ICP may remain elevated immediately after third ventriculostomy and begins to decrease between 4 to 8 days postoperatively. In an earlier retrospective study, 30 we showed that careful measuring of ventricular diameter on standard CT scans will show a consistent decrease in both third and lateral ventricular size if performed later than 1 month after successful surgery (that is, in patients with clinical improvement). We hypothesized that, because volume changes in proportion to the cube of the radius, measurements of

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Theodore H. Schwartz

was a significantly lower volume of residual tissue in the iMRI group. Based on these data they recommend the use of iMRI for pituitary surgery when the technology is available. Although several prior studies have already shown that iMRI increases extent of resection, the control group has always consisted of the same patients whose surgeries were halted when the surgeon thought that all tumor was removed, and the experimental group consisted of the same patients after iMRI showed residual tumors. Such a study design leads to bias because the surgeons may have

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Evan D. Bander, Samuel H. Jones, Ilhami Kovanlikaya and Theodore H. Schwartz

T1-weighted images. Hyperintense areas in the vicinity of lesions on T1-weighted images was defined as blood. Using the advanced manipulation tools within the program, blood was subtracted from pre- and postoperative tumor burden for a final tumor volume. Gross-total resection (GTR) was defined as 100% tumor removal. Near-total resection (NTR) was defined as > 95%, and subtotal resection (STR) as < 95%. Brain edema and nonenhancing cellular infiltration around tumors was defined as hyperintensity on pre- and postoperative T2-weighted FLAIR images with the tumor

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Kunal S. Patel, Mingrui Zhao, Hongtao Ma and Theodore H. Schwartz

H emodynamic signals derived from perfusion and oximetry significantly correlate spatially with brain function. They are the fundamental basis of functional neuroimaging. In recent years, there has been great interest in using a variety of brain mapping techniques that measure those hemodynamic responses to assist in clinical diagnosis and management of neurological disorders. In particular, seizures have been shown to elicit a large increase in metabolism, utilization of oxygen, and increases in blood flow and blood volume in epileptic cortex. More

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Ankit Bansal and Sumit Sinha

purely endonasal endoscopic approach.” The study, however, has some inherent methodological shortcomings to which we would like to draw the authors' attention. The mean tumor volume was 19.6 cm 3 in the endonasal group, 33.5 cm 3 in the supraorbital group, and 37.8 cm 3 in the combined group. It is not methodologically appropriate to compare 2 techniques in patients with different tumor volumes. Moreover, the derived conclusions may be an overestimate, as the number of cases in each group is small: purely endonasal (6 cases), supraorbital eyebrow (microscopic with

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Osaama H. Khan, M.Sc., Vijay K. Anand and Theodore H. Schwartz

.7%). There were no endocrine abnormalities. In Group 1, 1 patient underwent a previous surgery 30 years ago. In Group 2, 4 patients had previously undergone a remote craniotomy for tumor removal. In Group 2, 1 patient had prior fractionated stereotactic radiosurgery and 1 had Gamma Knife surgery. Average tumor volume was 44.4 cm 3 (range 13.5–90.3 cm 3 ) in Group 1 and 28.8 cm 3 (range 1.95–130.1 cm 3 ) in Group 2 (p = 0.47). Brain edema was present in 4 patients (100%) in Group 1 and in 6 patients (54.6%) in Group 2 (p = 0.23, nonsignificant). Tumor was juxtaposed to

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Lessons learned in the evolution of endoscopic skull base surgery

JNSPG 75th Anniversary Invited Review Article

Theodore H. Schwartz, Peter F. Morgenstern and Vijay K. Anand

procedure being done. 3) The procedure can be offered to patients for a trial period before it is fully adopted. 4) The procedure is a simple modification of an existing procedure or can be easily learned by attending surgeons. 5) The volume of cases presenting to the hospital and the expected demand from patients justify surgeons learning the procedure. 6) The procedure will appeal to patients. Wilson provides historical examples such as chymopapain for lumbar disc herniation and superficial temporal–middle temporal artery bypass as examples of treatments quickly adopted

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Justin F. Fraser, Gurston G. Nyquist, Nicholas Moore, Vijay K. Anand and Theodore H. Schwartz

search was performed to identify reports of patients with skull base chordomas treated using endoscopic endonasal resection. Cases were included if the publication provided data on tumor resection volume, recurrence, clinical outcome, and complications. Publications that used case examples to describe surgical/technical nuances without follow-up data were not included. Data were summarized with the following specific target outcome variables: rate of GTR, recurrence after GTR, use of adjuvant treatment, clinical outcome, progression-free status, CSF leakage rate, and

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Konstantinos Margetis, Prajwal Rajappa, Apostolos John Tsiouris, Jeffrey P. Greenfield and Theodore H. Schwartz

has also been used within the CNS, administered intrathecally or intraventricularly, for CSF flow studies. 16 Hence, its safety has been studied. Our concept was to inject a small volume of dye to mark the deep tumor margins by using a stereotactically guided needle passed through a bur hole in the dura. After injection of the dye into as many locations as needed, the surgery could proceed in a standard fashion and the injected margin would always be labeled regardless of brain shift. In this study, we investigated the safety, feasibility, and preliminary efficacy

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Peter J. Wilson, Sacit B. Omay, Ashutosh Kacker, Vijay K. Anand and Theodore H. Schwartz

18.1/100,000 persons per year 20 and an overall prevalence of 16.7%. 7 The majority of pituitary tumors in the elderly are nonfunctional, 27 and most of the incidental microadenomas are adrenocorticotropic hormone (ACTH) cell adenomas, followed by prolactin cell adenomas. 22 Although the tumor volume doubling time is longer in older patients, 44 there is increased mortality in patients with pituitary disease. 42 If this pathology can be managed safely with surgical intervention, there is an argument that it should be offered to patients as an alternative to