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György T. Szeifert, Nicolas Massager, Daniel DeVriendt, Philippe David, Françoise De Smedt, Sandrine Rorive, Isabelle Salmon, Jacques Brotchi and Marc Levivier

been GKS. Dose planning was based on MR imaging and computerized tomography scanning with additional metabolic data obtained using positron emission tomography in some cases. 8 The treated volume ranged from 6.5 to 15.6 cm 3 . The tumors received a prescription dose of 9 to 16 Gy delivered to the target margin in the 50% isodose. The maximum dose ranged between 18 and 32 Gy. The relevant lesions were removed during conventional craniotomy after discovery of progression of neurological deficit 3 to 12 months after radiosurgery. The surgical exploration required the

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György T. Szeifert, Isabelle Salmon, Sandrine Rorive, Nicolas Massager, Daniel Devriendt, Stephan Simon, Jacques Brotchi and Marc Levivier

better tumor control after radiosurgery, in that the interval from GKS to surgery was over 6 months. In the five patients in whom this applied, sharply demarcated areas of coagulation necrosis were surrounded by differing amounts of granulation tissue rich in collagen bundles together with small vessels (that is, arterioles, capillaries, and venules). The granulation tissue reaction was accompanied by a striking inflammatory cell infiltration, which varied across the volume of the GKS-induced lesions. The necrotic center of the lesions consisted of tissue debris mixed

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Benoît Pirotte, Serge Goldman, Olivier Dewitte, Nicolas Massager, David Wikler, Florence Lefranc, Nordeyn Oulad Ben Taib, Sandrine Rorive, Philippe David, Jacques Brotchi and Marc Levivier

T he increasing availability and routine application of image-guided neurosurgery, or neuronavigation, improves the accuracy and safety of neurosurgical interventions. It may help to optimize tumor resection by using contours representing tumor limits and brain structures defined on anatomical imaging such as CT scanning and MR imaging. Indeed, most gliomas will have a definitive volume based on either Gd-DTPA– or non–Gd-DTPA–enhanced scans. For example, LGGs will have a volume defined by imaging based on their T 2 -weighted or FLAIR MR imaging volume. A