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Constantinos G. Hadjipanayis, Douglas Kondziolka, Paul Gardner, Ajay Niranjan, Shekhar Dagam, John C. Flickinger and L. Dade Lunsford

patients harboring pilocytic astrocytomas compared with those harboring other low-grade tumors. In their series of 88 children with low-grade astrocytomas, the researchers performed biopsies to confirm that 32 were pilocytic astrocytomas located in the optic chiasm/hypothalamus (25 patients), thalamus (four patients), and medulla (three patients). The rate of recurrence of pilocytic astrocytomas was 62.5%, with a mortality rate of 28.1%. Radiation Therapy For those patients in whom total or subtotal resection cannot be safely performed, alternative management

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John Y. K. Lee, Ajay Niranjan, James McInerney, Douglas Kondziolka, John C. Flickinger and L. Dade Lunsford

base (Simpson Grade I) is the preferred treatment for many patients. 4, 23, 24, 27 Complete resection of meningiomas of the cavernous sinus, however, is not feasible without causing serious disease or death. Overall, the estimated likelihood of obtaining a complete resection of a cavernous sinus tumor ranges from 22.9 to 100%. 3, 6, 10, 11, 18, 29, 30, 34, 37 The mortality rate in modern microsurgical series ranges from 0 to 7%. 10, 29, 35 Permanent cranial nerve deficits were noted in a significant percentage of patients (8–26%). 10, 16, 29 In patients in our

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Keisuke Maruyama, Douglas Kondziolka, Ajay Niranjan, John C. Flickinger and L. Dade Lunsford

T he management of AVMs located in the brainstem remains controversial. The significant cumulative risk of hemorrhage and the high morbidity and mortality rates associated with a hemorrhage in this location warrant careful consideration of treatment in most patients with brainstem AVMs. 10, 19 When the AVM nidus resides within the brainstem parenchyma, microsurgical resection is associated with high morbidity rates and low rates of complete removal. 3, 12, 19 Although safe and successful resection of these lesions has been reported, it can be achieved in

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L. Dade Lunsford, Ajay Niranjan, John C. Flickinger, Ann Maitz and Douglas Kondziolka

progression. 1 Other centers have reported at least three cases of a secondary malignant neoplasm. 15, 34 The risk of oncogenesis over a 5- to 30-year period (fitting the description of a radiation-related cancer) is estimated to be approximately 1:1000. Such a case has not been confirmed in our total radiosurgical experience of more than 6200 procedures. The outcome of this potential problem related to single-fraction exposure of a small volume of radiation could be compared with the estimated surgical mortality rates at centers of excellence in patients undergoing

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Juan J. Martin, Ajay Niranjan, Douglas Kondziolka, John C. Flickinger, Karl A. Lozanne and L. Dade Lunsford

. Surgical and postoperative morbidity and mortality rates remain high even with current single or staged microsurgical procedures. 1 , 10 , 21 , 32 , 34 Recently, endoscopic skull base approaches have shown promising preliminary results. 15 , 17 , 18 Nevertheless, the recurrent and invasive nature of these lesions warrants multimodal management to improve long-term control rates and outcomes. 2 , 5 , 6 Various modalities of fractionated radiation therapy have been used to increase local control or halt disease progression. 8 , 13 , 25 , 29 Stereotactic radiosurgery

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Hideyuki Kano, Ajay Niranjan, Douglas Kondziolka, John C. Flickinger and L. Dade Lunsford

Trigeminal schwannomas are slow-growing, benign nerve sheath tumors that occur uncommonly compared with the incidence of vestibular schwannomas. 3 , 5 , 10 , 15 , 21 Trigeminal schwannomas account for 0.2–1% of all intracranial tumors and 0.8–8% of all intracranial schwannomas. 3 , 5 , 8 , 10 , 15 , 17 , 20 , 21 Although advanced cranial base surgical techniques have significantly reduced mortality rates in patients with these lesions, tumor adherence to adjacent critical neurovascular structures makes complete lesion removal difficult. 2 , 5 , 8 , 10

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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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Edward A. Monaco III, Aftab A. Khan, Ajay Niranjan, Hideyuki Kano, Ramesh Grandhi, Douglas Kondziolka, John C. Flickinger and L. Dade Lunsford

the CMs in this series reached the pial surface. Following surgery, 33% of patients had new cranial nerve deficits, 30% exhibited cerebellar findings, and 29% had new-onset weakness. The overall rate of temporary and/or permanent morbidity and mortality was 35%. Overall mortality rate was 8% and all-cause 30-day mortality rate was 3.5%. Twelve percent of patients had permanent or severe deficits. Eleven patients required additional surgery to either retreat the target lesion or address a complication. Mathiesen et al. 24 reported on a series of patients with deep

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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