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Gregory M. Enns and Stephen L. Huhn

S ignificant advances in approaches to the diagnosis and treatment of inborn errors of metabolism have occurred in recent years. Expanded newborn screening using tandem mass spectrometry has led to the ability to identify and treat neonates who have metabolic conditions before symptoms appear. 123 Further developments in nutritional support and medical treatment, such as alternative pathway therapy for urea cycle disorders, biopterin for phenylketonuria, or small-molecule therapies for LSDs, have also led to better outcomes. 7 , 36 , 78 , 116 Patients

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Meic H. Schmidt, Mitchel S. Berger, Kathleen R. Lamborn, Ken Aldape, Michael W. McDermott, Michael D. Prados and Susan M. Chang

, 16 In many of these studies, however, malignant transformation is not well documented. Deficiencies in histological data from repeated surgeries and substantial differences in tumor grading systems that define permissible anaplastic features for the diagnosis of an LGG may account for the wide range of transformation rates. In addition, many of these patients received radiation therapy and/or chemotherapy, which may have interfered with histological interpretation and confounded the natural progression of the LGG. The aim of this study was to determine the rate

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Neurosurgical Forum: Letters to the editor To The Editor Robert F. Spetzler , M.D. Warren R. Selman , M.D. Cleveland, Ohio 581 581 We would like to make the clinical neurosurgeon aware of the potential risks of barbiturate therapy for the management of intracranial pressure (ICP). We have encountered two patients in whom barbiturate administration resulted initially in only an insignificant reduction of ICP, followed within an hour by a sharp rise of ICP resulting in their death. We assumed this to be

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Maurizio Domenicucci, Alessandro Ramieri, Maurizio Salvati, Christian Brogna and Antonino Raco

event. To our knowledge, apart from our case, only five other cases have been reported in the last 35 years ( Table 1 ). Almost all of the other cases were anatomically located in the cervical spine, except for one in the thoracic spine. The only case of a spinal subdural hematoma with sub-arachnoid extravasation was reported by Dabbert et al. 2 in 1970, who emphasized the risks of SMT during anticoagulation therapy in a discussion of factors that could lead to bleeding. TABLE 1 Summary of published reports describing patients with spinal epidural hematoma

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Bernhard Olzowy, Cornelia S. Hundt, Susanne Stocker, Karl Bise, Hans Jürgen Reulen and Walter Stummer

T he median survival time in patients with malignant gliomas is limited to little more than 12 months 32 with tumor progression usually occurring at the margins of the former resection cavity. 1, 2 Taking recurrence patterns into account, patients might benefit from more aggressive local therapy. Photodynamic therapy, a form of photoirradiation therapy, is a cancer treatment based on the apparently selective accumulation of photosensitizing drugs in malignant tissue. When activated by light of an appropriate wavelength, the photosensitizer exerts tumor

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Krishna Kumar, Gary Hunter and Denny D. Demeria

C hronic pain in general, and back pain in particular, has generated interest in recent years because of its pervasive nature, the high cost of its treatment, the reduced productivity of people with such pain, and the sufferings of the individual. 10, 14 Intrathecal drug therapy administered in carefully selected patients has proven to be an effective means of controlling pain, improving QOL, increasing the rate of work rehabilitation, and minimizing long-term costs of health care. 6, 11, 13, 15 Initially, IDT was designed for the treatment of pain related

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Keri S. Kim, Justin F. Fraser, Stephen Grupke and Aaron M. Cook

E ndovascular techniques are increasingly becoming the standard for the treatment of intracranial aneurysms and other cerebrovascular pathology. Stent and flow diversion techniques are often used, requiring peri- and postprocedural medical therapy, in particular antiplatelet medications, to minimize complications. Adequately trained operators and appropriate facilities are still relatively limited across the US; thus, many of these procedures are primarily performed at regional referral centers. The intent of this review is to introduce clinicians to the role of

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Shinji Kawabata, Ryo Hiramatsu, Toshihiko Kuroiwa, Koji Ono and Shin-Ichi Miyatake

established. For several years now, we have been applying BNCT for recurrent and refractory high-grade meningioma cases shown to be refractory to any intensive treatments currently available. 23 , 32 Boron neutron capture therapy is a targeted radiation approach that significantly increases the therapeutic ratio compared with that of conventional radiotherapeutic modalities. Boron neutron capture therapy is a binary approach: a boron-10–labeled compound delivers high concentrations of boron-10 to the target tumor, relative to the surrounding normal tissues. This is

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J. Mark Braughler and Edward D. Hall

therapy at some point during their hospital course, the ability of the glucocorticoids to significantly modify neurological recovery has been seriously questioned. 6, 7, 11, 23 The terms “high-dose” or “megadose” steroid therapy, when applied to the clinical management of head and spinal cord injuries, actually encompass a rather broad range of dosages. Dexamethasone and methylprednisolone, the most commonly used glucocorticoids in the neurosurgical setting, are routinely administered in doses which, although referred to as “high,” actually range from 0.7 to 3.0 mg

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Yoji Tamura, Shin-Ichi Miyatake, Naosuke Nonoguchi, Shirou Miyata, Kunio Yokoyama, Atsushi Doi, Toshihiko Kuroiwa, Masahiro Asada, Hideki Tanabe and Koji Ono

median survival was reported to be 6.89 years, and the rate of mortality due to recurrence was reported to be 69% after an initial surgery. 23 Although some treatments for recurrent malignant meningioma have been reported, a standard therapy has not yet been developed. Therefore, we propose a novel modality for treating recurrent malignant meningioma. In the past 3 years we have treated 35 patients with malignant glioma by using BNCT, which utilizes two kinds of boron compounds, BSH and BPA, whose accumulation mechanisms differ. 14 , 18 In the case of malignant