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Paritosh Pandey, Michael P. Marks, Ciara D. Harraher, Erick M. Westbroek, Steven D. Chang, Huy M. Do, Richard P. Levy, Robert L. Dodd and Gary K. Steinberg

institutional preference. 3 , 4 , 13 , 14 , 17 , 24 Embolization can be curative in approximately 10%–15% of these AVMs and is sometimes used as a presurgical adjunct for the rest of the AVMs. 12 , 21 , 26 The management of high-grade AVMs (Grades IV and V) is more controversial, with some groups advocating conservative management and others proposing multimodality treatment. 2 , 7 , 10 , 15 , 16 Grade III AVMs are a unique group encompassing 4 different types of AVMs according to their size, location in eloquent cortex, and venous drainage, with potentially different

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Dale Ding, Chun-Po Yen, Robert M. Starke, Zhiyuan Xu, Xingwen Sun and Jason P. Sheehan

S petzler -M artin Grade III arteriovenous malformations (AVMs) are the most heterogeneous class of AVMs by nature of the grading system, which accounts for AVM size, location eloquence, and venous drainage pattern. 22 The natural history of AVMs is not benign, with an annual hemorrhage rate of 2%–4% and combined annual morbidity and mortality risk of 2.7%. 2 , 7 , 17 Grade III AVMs straddle the line dividing low-grade AVMs (Grades I and II), the majority of which are treated aggressively, and high-grade AVMs (Grades IV and V), for which conservative

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Hideyuki Kano, John C. Flickinger, Huai-che Yang, Thomas J. Flannery, Daniel Tonetti, Ajay Niranjan and L. Dade Lunsford

T he Spetzler-Martin (SM) grading system is a simple, widely accepted, practical tool for assessing the outcomes associated with microsurgical management of brain arteriovenous malformations (AVMs). At experienced vascular centers, the grading system has demonstrated that microsurgery is an effective and relatively safe option for patients with SM Grade I or II AVMs. 3 , 4 , 6 , 7 , 10 , 11 , 13 , 16 In contrast, Grade IV and V AVMs are associated with higher risks and less success regardless of the option selected. 13 The SM Grade III AVMs are a

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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

commonly used system for stratifying AVMs, and its grade is derived from the nidus size, anatomical brain location, and venous drainage pattern of the AVM. 59 The SM grading system has been found to correlate with postoperative neurological morbidity and mortality rates after surgery at AVM centers with experienced personnel, and it is also correlated with outcomes after radiosurgery. 24–26 , 34 , 39 , 42 Spetzler-Martin Grade III AVMs represent the border zone between SM Grades I and II AVMs, which are typically managed with an early intervention, and SM Grades IV

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Leif G. Salford, Arne Brun and Sigrid Nirfalk

A strocytomas grade III and IV (according to the grading of Kernohan, et al. 7 ) are incurable in spite of extensive treatment with surgery, radiotherapy, and chemotherapy. Within 2 years after diagnosis, 90% of the patients are dead, 6 and very few survive for 5 years or more. Several neurosurgeons have experienced a unique case in which the patient has survived for 10 years or more. 1–5 Dr. Paul Bucy (personal communication, 1986) has described one of his patients who is in perfect health 30 years after surgery for a malignant glioma. Sweden has a

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Lyndon Kim, Fred H. Hochberg, Allan F. Thornton, Griffith R. Harsh IV, Heena Patel, Dianne Finkelstein and David N. Louis

O ligodendrogliomas and oligodendroglioma—astrocytomas (oligoastrocytomas) are thought to be uncommon, comprising 5% of primary brain neoplasms. 17, 20 Low-grade homogeneous oligodendroglial tumors are slow growing and often are diagnosed years after the onset of symptoms. Less certain is the natural history of the Grade III or Grade IV tumor that contains varying mixtures of oligodendroglioma and astrocytoma components. These two cell types may emerge from a bipotential precursor. 3, 19 Recent molecular evidence suggests that oligodendrogliomas and

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Michael E. Sughrue, Nader Sanai, Gopal Shangari, Andrew T. Parsa, Mitchel S. Berger and Michael W. McDermott

clinical behavior of de novo malignant meningiomas, we excluded all patients with potentially confounding neurosurgical histories. For example, we excluded from further analysis patients with additional or prior intracranial tumors other than Grade III meningiomas as well as all patients who had undergone intracranial radiation for reasons other than their malignant meningioma. This study was approved by the UCSF Committee on Human Research under the approval number H7828–29842–03. Microsurgical Technique and Perioperative Management Preoperative evaluation of all

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Kuo-Chuan Wang, Sung-Chun Tang, Jing-Er Lee, Dar-Ming Lai, Sheng-Jean Huang, Sung-Tsang Hsieh, Jiann-Shing Jeng and Yong-Kwang Tu

However, most studies measured only one or two parameters simultaneously, and some results have been contradictory. 19 , 25 In this study, we measured a series of intrathecal CSF parameters, including HO-1, oxyhemoglobin, ferritin, and bilirubin, on the 7th day post-SAH and investigated their associations with the 3-month functional outcome in patients with Fisher Grade III aneurysmal SAH. Methods Patients This study was approved by the National Taiwan University Hospital Committee of Human Research and conducted in accordance with human ethics regulations

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Lingyang Hua, Hongda Zhu, Jingrun Li, Hailiang Tang, Dapeng Kuang, Yin Wang, Feng Tang, Xiancheng Chen, Liangfu Zhou, Qing Xie and Ye Gong

M eningioma is one of the most common primary neoplasms in the CNS, constituting for approximately 36.4% of all intracranial tumors. 27 Although most of them are benign and associated with a satisfying outcome, a small subset of meningiomas have more aggressive biological behaviors and are more likely to relapse. These malignant meningiomas were classified as Grade III in the WHO classification of CNS tumors. 21 Three subtypes (anaplastic, rhabdoid, and papillary meningioma) account for 1%–3% of all meningioma grades. 27 , 35 WHO Grade III meningiomas have a

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Crister P. Ceberg, Anders Persson, Arne Brun, René Huiskamp, Ann-Sofie Fyhr, Bertil R. R. Persson and Leif G. Salford

tumor where the barrier is more permeable. Therefore, it seems that patients with gliomas are good candidates for BNCT. Patients with highly malignant gliomas, those with Grade III and IV astrocytomas according to the scale of Kernohan, et al. , 25 and equivalent to glioblastoma multiforme according to the Ringertz—Burger classification, 6 have a median survival time of at most 12 months after diagnosis. This survival time is in spite of treatment with extensive surgery and conventional radio- and chemotherapy. 32 Fewer than three patients per thousand survive