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Robert M. Starke, James H. Nguyen, Jessica Rainey, Brian J. Williams, Jonathan H. Sherman, Jesse Savage, Chun Po Yen and Jason P. Sheehan

M eningiomas of the posterior cranial fossa encompass approximately 7%–12% of intracranial meningiomas. 15 , 21 , 88 For symptomatic or progressive lesions, complete resection is the optimal primary treatment when possible. 79 Depending on the location of these tumors, a complete resection can be difficult because they are often in close proximity to critical vascular and neural structures. Reported gross-total resection rates of these tumors vary significantly in the literature (from 40% to 96%), and resection is often associated with significant

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Brian J. Williams, Chun Po Yen, Robert M. Starke, Bhuvaneswara Basina, James Nguyen, Jessica Rainey, Jonathan H. Sherman, David Schlesinger and Jason P. Sheehan

M eningiomas are common intracranial tumors. Despite the benign behavior associated with WHO Grade I meningiomas, they can be challenging to treat particularly depending on location. Over the past century, complete resection including the dural base has been the ideal treatment. Nevertheless, gross-total resection of parasellar meningiomas can be a challenge despite improvements in microsurgical techniques and more sophisticated image guidance. In fact, the risk of neurological morbidity and death following the resection of skull base meningiomas is not

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Ricardo J. Komotar, Daniel M. S. Raper, Robert M. Starke, J. Bryan Iorgulescu and Philip H. Gutin

performed a systematic meta-analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions. Methods Study Selection We performed a literature search using the PubMed gateway of the MEDLINE database and searching studies published between the years of 1979 and 2010. The following key words were queried singly and/or in combination: meningioma, supratentorial, epilep*, seiz*, convul*, antiepilep*, anticonvul

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Robert M. Starke, Brian J. Williams, Claire Hiles, James H. Nguyen, Mohamed Y. Elsharkawy and Jason P. Sheehan

S kull base meningiomas are typically in close proximity to critical vascular and neural structures, thereby hindering complete microsurgical resection. Although microsurgery has historically been the primary treatment for progressive, symptomatic skull base meningiomas, microsurgical resection has been associated with variable rates of complete resection and procedure-associated morbidity and mortality. 4 , 6 , 26 , 37 , 48 , 50 , 54 , 61 , 70 Moreover, resection has been associated with delayed recurrence. 26 , 30 , 45 , 51 , 56 , 61 , 66 With early

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Robert M. Starke, Brian J. Williams, John A. Jane Jr. and Jason P. Sheehan

Neurosurg 97 : 5 Suppl 415 – 421 , 2002 6 Feigl GC , Pistracher K , Berghold A , Mokry M : Pituitary insufficiency as a side effect after radiosurgery for pituitary adenomas: the role of the hypothalamus. Clinical article . J Neurosurg 113 : Suppl 153 – 159 , 2010 7 Flickinger JC , Kondziolka D , Maitz AH , Lunsford LD : Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma . Int J Radiat Oncol Biol Phys 56 : 801 – 806 , 2003 8 Gopalan R , Schlesinger D , Vance ML , Laws E , Sheehan J : Long

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Jason P. Sheehan, Robert M. Starke, David Mathieu, Byron Young, Penny K. Sneed, Veronica L. Chiang, John Y. K. Lee, Hideyuki Kano, Kyung-Jae Park, Ajay Niranjan, Douglas Kondziolka, Gene H. Barnett, Stephen Rush, John G. Golfinos and L. Dade Lunsford

after GKS for benign sellar and parasellar tumors. Similarly, in a group of patients with meningiomas of the cavernous sinus, improvements were noted in 29% of affected trigeminal nerves, 22% of CN III, and 13% of CNs IV and VI. 51 In the current study, CNs appeared to demonstrate a differential rate of impairment after GKS. Cranial nerve impairment in order of increasing frequency was as follows: CNs VII and IV; CN VI; CN V; CN III; and CN II ( Table 3 ). The risk of new or worsened optic neuropathy either from tumor growth or radiation injury was 6.6%. Although

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Kunal S. Patel, Ricardo J. Komotar, Oszkar Szentirmai, Nelson Moussazadeh, Daniel M. Raper, Robert M. Starke, Vijay K. Anand and Theodore H. Schwartz

which instance they are closed with Gelfoam for hemostasis, followed by DuraSeal. If a low-flow leak is encountered, we use autologous fat to plug the hole and Gelfoam as an overlay, followed by DuraSeal to hold the fat in place and establish a watertight seal. Patients are kept in bed for 24 hours with the head of the bed at 30°. Intradural Nonsellar Lesions These cases include suprasellar meningiomas and craniopharyngiomas or Rathke cleft cysts, intradural esthesioneuroblastomas and chordomas, epidermoids, enterogenous cysts, gliomas, and intradural

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Robert M. Starke, Chun-Po Yen, Dale Ding and Jason P. Sheehan

24 : 106 – 109 , 1997 27 Sheehan J , Yen CP , Steiner L : Gamma knife surgery-induced meningioma. Report of two cases and review of the literature . J Neurosurg 105 : 325 – 329 , 2006 28 Shin M , Kawamoto S , Kurita H , Tago M , Sasaki T , Morita A , : Retrospective analysis of a 10-year experience of stereotactic radio surgery for arteriovenous malformations in children and adolescents . J Neurosurg 97 : 779 – 784 , 2002 29 Shin M , Maruyama K , Kurita H , Kawamoto S , Tago M , Terahara A , : Analysis

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Dale Ding, Robert M. Starke, John Hantzmon, Chun-Po Yen, Brian J. Williams and Jason P. Sheehan

M eningiomas are the second most common primary brain tumor and the most common extraaxial intracranial neoplasm. 21 , 34 The World Health Organization (WHO) grading scheme classifies tumors based on histology, and it is the most powerful predictor of tumor recurrence following treatment and of overall survival. 26 The vast majority of meningiomas are benign, or WHO Grade I. Following the WHO's 2007 update of the diagnostic criteria for meningioma grading, the proportion of intracranial meningiomas histologically defined as atypical, or WHO Grade II

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Jason P. Sheehan, Robert M. Starke, Hideyuki Kano, Anthony M. Kaufmann, David Mathieu, Fred A. Zeiler, Michael West, Samuel T. Chao, Gandhi Varma, Veronica L. S. Chiang, James B. Yu, Heyoung L. McBride, Peter Nakaji, Emad Youssef, Norissa Honea, Stephen Rush, Douglas Kondziolka, John Y. K. Lee, Robert L. Bailey, Sandeep Kunwar, Paula Petti and L. Dade Lunsford

P arasellar and sellar meningiomas are clinically challenging for neurosurgeons to manage. The difficulty posed by these tumors relates to the potential morbidity associated with tumor exposure and dissection, their frequently firm consistency and vascularity, and their proximity to critical neuroendocrine, vascular, and cranial nerve (CN) structures. Such features usually hinder complete resection, whether by endoscopic or transcranial skull base approaches. 5 , 10 , 41 Open surgical approaches have been accompanied by widely varying rates of complete