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Lucia Schwyzer, Robert M. Starke, John A. Jane Jr. and Edward H. Oldfield

patients with acromegaly caused by GH-secreting tumors. We explored the possibility that if individual tumors have their own intrinsic level of GH production and if that level of GH production is homogeneous across the tumor, a comparison of GH levels before and after surgery would indicate the fraction of tumor that had been removed. Thus, a close correlation between tumor volume and hormone secretion in individual patients would permit calculation of the fraction of tumor removed by surgery, simply by measuring the postoperative GH levels. Methods We assessed

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Shayan Moosa, Ching-Jen Chen, Dale Ding, Cheng-Chia Lee, Srinivas Chivukula, Robert M. Starke, Chun-Po Yen, Zhiyuan Xu and Jason P. Sheehan

large AVMs involve the delivery of radiation doses in stages with dose- or volume-staged SRS. Dose staging is described in the literature as either hypofractionated stereotactic radiotherapy (HSRT) or repeat SRS. Hypofractionated stereotactic radiotherapy is typically performed by administering several small doses of radiation to the AVM over a period of a few weeks. Repeat radiosurgery uses a higher initial dose (yet still lower than traditional single-session SRS for small to moderate AVMs), and another dose is administered after several months or years if there is

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

defined as a 15% or greater change in tumor volume as compared with the volume at the time of GKS. 37 To make this determination of tumor size, the tumor was outlined on radiographic images, and serial volumetric calculations were performed using the ImageJ program (NIH; http://rsb.info.nih.gov/ij/ ) in all patient imaging studies. 37 Any patient with tumor progression of more than 15% was considered a treatment failure, even if this progression stabilized with further GKS or microsurgery. Statistical Analysis Data are presented as median or mean and range for

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

history of hemorrhage, and 67% had AVMs in eloquent locations. Lesion volume was less than 2 cm 3 in 198 patients (19.6%), between 2 and 4 cm 3 in 486 (48.0%), and greater than 4 cm 3 in 328 (32.4%). Pretreatment patient and AVM characteristics are listed in Table 1 . TABLE 1: Patient characteristics and univariate predictors of favorable outcome Pretreatment Characteristics No. (%) * Favorable Outcome Odds Ratio 95% CI p Value males 517 (51.1) 1.10 0.85–1.42 0.462 mean age ± SD (yrs) 33.9 ± 15.8 0.68 0

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Erin N. Kiehna, Robert M. Starke, Nader Pouratian and Aaron S. Dumont

better. Until there is endorsement of the CONSORT guidelines across all journals, this bias may be hard to eliminate. Despite the growing volume of RCTs in neurosurgery over the past century, the quality of reporting these trials remains suboptimal, especially in the neurosurgical journals. Although the neurooncology community has recognized the importance of standardizing reporting of clinical trials and has gone so far as to create their own guidelines for reporting Phase I and II trials, 15 the neurosurgical community as a whole has not held itself accountable to

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Robert M. Starke, Felipe C. Albuquerque and Michael T. Lawton

It is with great pleasure that we present this Neurosurgical Focus video supplement on supratentorial cerebral arteriovenous malformations (AVMs). We were privileged to view a remarkable number of outstanding videos demonstrating current state-of-the-art management of brain AVMs using endovascular and microsurgical modalities. Careful and critical review was required to narrow down the submitted videos to a workable volume for this supplement, which reflects the excellent work being done at multiple centers with these lesions.

This issue consists of videos that represent modern microsurgical and neuroendovascular techniques for the treatment of supratentorial cerebral AVMs. The videos demonstrate cutting-edge therapies as well as standard ones, which will be valuable to both novice and expert neurointerventionists and neurosurgeons. We are honored to be involved with this project and proud of its content and expert authors. We believe you will enjoy the video content of this supplement and hope that it will raise the collective expertise of our community of AVM surgeons.

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Douglas Kondziolka

identification of the AVM shunt, but the morbidity of SRS is a function of the radiation dose and the total volume targeted. Ding and colleagues provide additional evidence that embolization prior to radiosurgery is associated with reduced obliteration rates. 1 , 2 This may be due to difficulties in AVM nidus identification. Most of the data are from the pre-Onyx era, and more information is needed to see if this observation holds true today. We are now exploring the use of radiosurgery as the initial therapy followed by targeted embolization for any hemorrhagic risk

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Robert M. Starke, Justin M. Cappuzzo, Nicholas J. Erickson and Jonathan H. Sherman

, 1996 8733971 42 Sun B , Wang D , Tang Y , Fan L , Lin X , Yu T , : The pineal volume: a three-dimensional volumetric study in healthy young adults using 3.0 T MR data . Int J Dev Neurosci 27 : 655 – 660 , 2009 10.1016/j.ijdevneu.2009.08.002 43 Tajima Y , Minami N , Sudo K , Moriwaka F , Tashiro K : Hot water epilepsy with pineal cyst and cavum septi pellucidi . Jpn J Psychiatry Neurol 47 : 111 – 114 , 1993 8411782 44 Tamaki N , Shirataki K , Lin TK , Masumura M , Katayama S , Matsumoto S : Cysts of the

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

. Factors analyzed in these analyses included sex, age, preradiosurgery hemorrhage, preradiosurgery embolization, AVM volume, AVM location (superficial vs deep and noneloquent vs eloquent), location of draining veins (superficial vs deep), number of draining veins (single vs multiple), prescription dose, number of isocenters, radiological presence of RIC, SM grade, radiosurgery-based AVM scale (RBAS) score, and Virginia Radiosurgery AVM Scale (Virginia RAS) score. The patient, AVM, and treatment characteristics listed above were initially subjected to univariate

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

.6%), III in 163 (36.7%), IV in 30 (6.8%), and V in 3 (0.7%). We also calculated the modified Pittsburgh radiosurgery-based AVM score, which accounts for patient age, deep location, and AVM volume. 36 TABLE 1: Preradiosurgery patient and AVM characteristics in 444 cases Characteristic Value sex  male 222 (50.0%)  female 222 (50.0%) age (yrs)  mean 36.9  median 35.8  range 5–82 preradiosurgery embolization 122 (27.4%) preradiosurgery microsurgical resection 20 (4.5%) location