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Thomas J. Flannery, Hideyuki Kano, L. Dade Lunsford, Sait Sirin, Matthew Tormenti, Ajay Niranjan, John C. Flickinger and Douglas Kondziolka

median follow-up of 85 months, radiologically demonstrated tumor growth was observed in 76% of cases. Furthermore, 63% of patients with growing tumors had evidence of functional deterioration. These observations suggest that in the majority of cases, with the possible exception of those involving an advanced age and significant medical comorbidity, petroclival meningiomas should be treated. Refinements in the microsurgical approaches to petroclival meningiomas have significantly reduced perioperative morbidity and mortality rates and improved GTR rates. 2 , 3 , 22

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Hideyuki Kano, L. Dade Lunsford, John C. Flickinger, Huai-che Yang, Thomas J. Flannery, Nasir R. Awan, Ajay Niranjan, Josef Novotny Jr. and Douglas Kondziolka

, respectively. When the margin dose was 20 Gy or less (106 patients), the total obliteration rates were 35%, 67%, and 70% at 3, 4, and 5 years, respectively. A margin dose greater than 20 Gy was significantly associated with a higher rate of total obliteration on angiography (p = 0.022, log-rank test) ( Fig. 2 ). Hemorrhage After Radiosurgery Thirteen patients (6%) developed a single AVM hemorrhage after SRS, and 6 patients died (2.8% mortality rate). No patient suffered a hemorrhage after AVM obliteration was documented using either MR imaging or angiography. In 559

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Hideyuki Kano, Douglas Kondziolka, John C. Flickinger, Huai-che Yang, Thomas J. Flannery, Nasir R. Awan, Ajay Niranjan, Josef Novotny Jr. and L. Dade Lunsford

A rteriovenous malformations are the most frequent cause of intracranial hemorrhage in children. 15 , 25 Those AVMs occurring in pediatric patients more frequently present after hemorrhage than those in adults. 2 , 5 , 11 Children also have a higher risk of additional hemorrhages than adults, as well as higher morbidity and mortality rates after the initial intracranial hemorrhage. 2 , 5 The management options for pediatric AVMs include craniotomy and resection, radiosurgery, endovascular embolization, or a combination of these techniques. Resection of

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Hideyuki Kano, Douglas Kondziolka, John C. Flickinger, Huai-che Yang, Thomas J. Flannery, Ajay Niranjan, Josef Novotny Jr. and L. Dade Lunsford

A rteriovenous malformations of the basal ganglia and thalamus represent challenging vascular anomalies that present major lifetime risks to patients. Left untreated, they are associated with high morbidity and mortality rates after hemorrhage because of their critical location. 1 , 2 , 5 , 14 , 27 , 29 , 37 Surgical removal is feasible in only a small subgroup of patients. 7 , 9 , 13 , 15 , 20 , 35 Endovascular management is rarely curative and is typically performed as a preoperative adjunctive therapy before resection or radiosurgery. 28 Stereotactic

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Hideyuki Kano, Douglas Kondziolka, John C. Flickinger, Huai-che Yang, Thomas J. Flannery, Ajay Niranjan, Josef Novotny Jr. and L. Dade Lunsford

A rteriovenous malformations of the brainstem (midbrain, pons, and medulla) represent 2%–6% of all cerebral AVMs. 3 , 5 , 12 , 19 Although the best options for management of a brainstem AVM remain controversial, the natural history of such untreated vascular anomalies indicates a high risk of major morbidity or mortality rates from hemorrhage. 1 , 2 , 4 , 8 , 21 , 22 , 29 Surgical approaches for carefully selected patients have been reported for these challenging vascular malformations. 3 , 5 , 9 , 13 , 20 , 28 , 31 , 35 Endovascular treatment is rarely