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Dale Ding, Robert M. Starke, Hideyuki Kano, David Mathieu, Paul P. Huang, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Douglas Kondziolka, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

characterized by a combination of catheter cerebral angiography and thin-slice (slice width ≤ 1 mm) MRI or CT (in patients for whom MRI was not feasible). Patient variables were sex, age, symptoms at the time of presentation, and time interval from clinical presentation to treatment with radiosurgery. AVM variables were prior hemorrhage status (dichotomized into unruptured vs ruptured), maximum nidus diameter, volume, eloquent location, deep venous drainage, and presence of AVM-associated intranidal or prenidal arterial aneurysms. Eloquent locations included sensorimotor

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Robert M. Starke, Dale Ding, Hideyuki Kano, David Mathieu, Paul P. Huang, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Douglas Kondziolka, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

Gamma Knife (Elekta AB). Baseline Data and Variables Baseline data comprised patient, AVM, and radiosurgery variables. Patient variables were sex, age, symptoms at the time of presentation, and time interval from clinical presentation to treatment with radiosurgery. AVM variables were prior hemorrhage status (dichotomized into unruptured vs ruptured), maximum nidus diameter, volume, eloquent location, deep venous drainage, and presence of AVM-associated intranidal or prenidal arterial aneurysms. Eloquent locations included sensorimotor, language, and visual

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Mohana Rao Patibandla, Dale Ding, Hideyuki Kano, Zhiyuan Xu, John Y. K. Lee, David Mathieu, Jamie Whitesell, John T. Pierce, Paul P. Huang, Douglas Kondziolka, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

T he Spetzler-Martin (SM) grading system is a 5-tier classification scheme that stratifies brain arteriovenous malformations (AVMs) into low-, intermediate-, and high-grade lesions (Grades I–II, Grade III, and Grades IV–V, respectively). 63 Although the SM grading system was originally devised to predict AVM surgical outcomes, it has also been shown to reliably correlate with outcomes after stereotactic radiosurgery (SRS) for smaller-volume AVMs. 18 , 24 , 25 , 36 , 39 SM Grade IV–V AVMs are difficult to successfully treat with any modality, 28 , 41 , 63 due

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Dale Ding, Robert M. Starke, Hideyuki Kano, John Y. K. Lee, David Mathieu, John Pierce, Paul P. Huang, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Douglas Kondziolka, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

inconsistencies in the data were addressed by the contributing institutions. The inclusion criteria for the study cohort were as follows: 1) SM Grade III AVMs; 59 2) sufficient baseline data to assess demographic information, AVM angioarchitecture, and SRS parameters; and 3) minimum 12 months of radiological and clinical follow-up. Data from AVM patients treated with volume-staged or dose-staged SRS were excluded. All AVMs were treated in a single session (i.e., one fraction) with a common SRS device, the Gamma Knife (Elekta AB). Baseline Data and Variables The

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Mohana Rao Patibandla, Dale Ding, Hideyuki Kano, Robert M. Starke, John Y. K. Lee, David Mathieu, Jamie Whitesell, John T. Pierce, Paul P. Huang, Douglas Kondziolka, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

Data and Variables The baseline data comprised patient, AVM, and SRS factors. The patient variables were age, sex, initial clinical presentation, and time interval from presentation to SRS. The AVM variables were prior interventions, prior hemorrhage, size (maximum diameter and volume), venous drainage pattern (exclusively superficial or deep component), location (eloquent or noneloquent), and presence of associated arterial aneurysms. The eloquent locations were previously defined by Spetzler and Martin as follows: “primary somatosensory, primary motor, language and

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Robert M. Starke, Hideyuki Kano, Dale Ding, John Y. K. Lee, David Mathieu, Jamie Whitesell, John T. Pierce, Paul P. Huang, Douglas Kondziolka, Chun-Po Yen, Caleb Feliciano, Rafael Rodgriguez-Mercado, Luis Almodovar, Daniel R. Pieper, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Gene H. Barnett, L. Dade Lunsford and Jason P. Sheehan

treatment were also included. Patients with volume-staged radiosurgery were excluded. Radiosurgical Technique The Gamma Knife models U, B, C, 4C, or Perfexion were used, depending on the technology available at the time of GKRS for each participating center. The radiosurgery procedure began with the application of the Leksell model G stereotactic frame (Elekta AB), using local anesthetic supplemented by additional sedation as needed. After stereotactic frame placement, high-resolution, stereotactic MRI was performed. In cases for which MRI was not feasible or when

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equipment and personnel are outlined. Patient response to the program is documented. Results: The analysis of our telemedicine program indicates that patient satisfaction, cost containment, and surgical case volume all benefit from the provision of neurosurgical tele-services. Conclusion: Utilization of telemedicine can expand the reach of neurosurgical expertise, locally, regionally, nationally and internationally. The experience of one program in metropolitan Washington, D. C. provides an example of how telemedicine in neurosurgery may be successful

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clinical signs of normal pressure hydrocephalus and the efficacy of high volume lumbar puncture in predicting successful outcomes Jonathan Pomeraniec , Aaron Bond , MD, PhD , M Beatriz Lopes , MD, PhD , and John Jane Sr , MD, PhD (Charlottesville, VA) 8 2015 123 2 History of Craniotomy, Cranioplasty, and Perioperative Care A480 A481 Copyright held by the American Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written permission from