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Zachary A. Seymour, Penny K. Sneed, Nalin Gupta, Michael T. Lawton, Annette M. Molinaro, William Young, Christopher F. Dowd, Van V. Halbach, Randall T. Higashida and Michael W. McDermott

S urgery , embolization, and stereotactic radiosurgery (SRS) are the primary modalities used in the treatment of brain arteriovenous malformations (AVMs). Most AVMs can be treated effectively with acceptable morbidity by using one or all of these modalities. Surgical removal is arguably the best option for small- to medium-sized lesions, defined as Spetzler-Martin (SM) Grades I– III, occurring in noneloquent and superficial regions of the brain, particularly those with a history of hemorrhage. 11 , 21 Complete resection is curative and eliminates the risk

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Timothy R. Smith, Rohan R. Lall, Rishi R. Lall, Isaac Josh Abecassis, Omar M. Arnaout, MaryAnne H. Marymont, Kristin R. Swanson and James P. Chandler

population; 25%–50% of patients treated with surgery and adjuvant WBRT will eventually succumb to intracranial progression. 3 , 6 , 12 , 28 Additionally, WBRT has been associated with significant short- and long-term neurological sequelae: radiation-induced edema, leukoencephalopathy, brain atrophy, neurocognitive deterioration, dementia, neuroendocrine dysfunction, and hydrocephalus. 11 , 24 , 29 , 41 , 43 Recently, interest in stereotactic radiosurgery (SRS) has arisen as both a primary and adjuvant treatment modality for intracranial metastasis. Many clinicians favor

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Shireen Parsai, Jacob A. Miller, Aditya Juloori, Samuel T. Chao, Rupesh Kotecha, Alireza M. Mohammadi, Manmeet S. Ahluwalia, Erin S. Murphy, Gene H. Barnett, Michael A. Vogelbaum, Lilyana Angelov, David M. Peereboom and John H. Suh

improved extracranial disease control and overall survival in patients who have previously received trastuzumab, the brain is increasingly recognized as the first site of disease relapse. 13 , 24 Initial treatment options for intracranial metastasis include whole-brain radiation therapy (WBRT), resection, or stereotactic radiosurgery (SRS). However, half of these patients will have intracranial disease progression following initial standard therapy. 5 Therefore, attention has been turned toward techniques to optimize intracranial disease control, specifically with

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Daniel A. Tonetti, Bradley A. Gross, Brian T. Jankowitz, Hideyuki Kano, Edward A. Monaco III, Ajay Niranjan, John C. Flickinger and L. Dade Lunsford

D ural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) are considered high risk because of the attendant risk of venous hypertension associated with both nonhemorrhagic neurological deficits (NHNDs) and frank intracranial hemorrhage. 1 Embolization is often the first-line treatment for these lesions, with surgery often serving as second-line therapy when the fistula site cannot be occluded or reached with embolisate. 3 , 9 , 11 , 13 , 17 A considerable body of evidence illustrates the feasibility and success of stereotactic radiosurgery (SRS

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Owoicho Adogwa, Isaac O. Karikari, Aladine A. Elsamadicy, Amanda R. Sergesketter, Diego Galan and Keith H. Bridwell

compared to baseline. 11 , 16 Combinations of questionnaires, such as the Scoliosis Research Society (SRS)-22r and Oswestry Disability Index (ODI), are among the most popular assessment tools used to measure PROs in spinal deformity patients. 13 Both the SRS-22r and the ODI have demonstrated effectiveness in accurately reflecting different aspects of patients’ perceptions of health, as well as the extent of their perceived improvement after surgery. 8 , 9 , 17 The SRS-22r questionnaire measures 5 domains—pain, activity, appearance, mental health, and satisfaction 24

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Zengpanpan Ye, Xiaolin Ai and Chao You

TO THE EDITOR: It was a great pleasure to read the article by Ilyas et al., 3 which pooled the data to compare the effects of volume-staged (VS) and dose-staged (DS) stereotactic radiosurgery (SRS) in patients with large brain arteriovenous malformations (AVMs) ( Ilyas A, Chen CJ, Ding D, et al: Volume-staged versus dose-staged stereotactic radiosurgery outcomes for large brain arteriovenous malformations: a systematic review. J Neurosurg 128:154–164, January 2018 ). The meta-analysis suggested that VS-SRS afford a higher obliteration rate and a less favorable

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Daniel A. Tonetti, Bradley A. Gross, Kyle M. Atcheson, Brian T. Jankowitz, Hideyuki Kano, Edward A. Monaco III, Ajay Niranjan, John C. Flickinger and L. Dade Lunsford

literature has been fairly consistent with a recent meta-analysis reporting an overall annual rupture risk of 2.2% for unruptured AVMs. 4 This represents a single element of the natural history of AVMs that must be compounded with the prospective risk of headache development, seizures, psychological burden, and ischemic events that may occur once a patient is diagnosed with an intracerebral AVM. Since stereotactic radiosurgery (SRS) requires a latency period to take effect, the benefit of this treatment modality cannot be realized for unruptured AVMs unless the patient is

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Mohana Rao Patibandla, Cheng-chia Lee, Athreya Tata, Gokul Chowdary Addagada and Jason P. Sheehan

progressive lesions. 62 However, a drawback of resection even via microsurgical techniques is the neurological impairment frequently associated with the surgical treatment of these challenging skull base lesions, and meningioma recurrence has been described even after complete resection. 1 , 2 , 4–10 , 12 , 14 , 18 , 24 , 27–29 , 32 , 35 , 39 , 51 , 54 , 55 , 57–59 , 64 Stereotactic radiosurgery (SRS) is increasingly used for both primary and adjuvant treatment of meningiomas. While this procedure has become widely applied in the treatment of skull base lesions, there have

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Nicholas J. Brandmeir and Michael D. Sather

TO THE EDITOR: We read with interest the article by Burrows et al. 2 (Burrows AM, Marsh WR, Worrell G, et al: Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas. Neurosurg Focus 41[4]: E8, October 2016). We previously reported achieving a seizure-free outcome utilizing laser interstitial thermal therapy (LITT) in an adult patient with a hypothalamic hamartoma (HH) after failure of stereotactic radiosurgery (SRS). This article by Burrows and colleagues adds to the collective experience. We agree

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Diogo Cordeiro, Zhiyuan Xu, Chelsea E. Li, Christian Iorio-Morin, David Mathieu, Nathaniel D. Sisterson, Hideyuki Kano, Luca Attuati, Piero Picozzi, Kimball A. Sheehan, Cheng-chia Lee, Roman Liscak, Jana Jezkova, L. Dade Lunsford and Jason Sheehan

C ushing ’s disease (CD) has high morbidity and mortality if left untreated. 35 Transsphenoidal resection (TSR) of the pituitary adenoma secreting adrenocorticotrophic hormone (ACTH) is typically the first-line treatment, 3 , 35 but remission rates are around 65%–90% for microadenomas and less than 65% for macroadenomas, with recurrence rates up to 45%. 7 , 9 , 25 For CD patients, conventional radiation therapy (RT) and stereotactic radiosurgery (SRS) have been employed to treat recurrence or failure after TSR, with control rates of hypercortisolism of around