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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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Shireen Parsai, Aditya Juloori, Lilyana Angelov, Jacob G. Scott, Ajit A. Krishnaney, Inyang Udo-Inyang, Tingliang Zhuang, Peng Qi, Matthew Kolar, Peter Anderson, Stacey Zahler, Samuel T. Chao, John H. Suh and Erin S. Murphy

historically been regarded as a relatively radioresistant histology. Thus, the Children’s Oncology Group seeks to explore the feasibility and local failure rates of using radiosurgery to treat osseous metastases using the AEWS1221 protocol (NCT02306161). Similarly, the Mayo Clinic, the St. Jude Children’s Research Hospital, and Johns Hopkins are leading a prospective multiinstitutional study on the efficacy of radiosurgery in patients with metastatic pediatric sarcoma, including Ewing sarcoma and osteosarcoma (NCT01763970). Stereotactic radiosurgery (SRS) has been commonly

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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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Diana A. Julie, Stefanie P. Lazow, Daniel B. Vanderbilt, Shoshana Taube, Menachem Z. Yondorf, Albert Sabbas, Susan Pannullo, Theodore H. Schwartz and A. Gabriella Wernicke

R esection of brain metastases (BM) results in local recurrence (LR) in nearly half of patients, underscoring the need for additional therapy. 1 When administered adjuvantly, whole-brain radiation therapy (WBRT) reduces death from neurological causes, as well as LR, from 46% to 10%. 1–4 However, WBRT is associated with neurocognitive deficits and reduced quality of life, establishing the need for more localized radiation therapy (RT). 5–7 Two potential localized RT techniques are stereotactic radiosurgery (SRS) and intracavitary brachytherapy. SRS achieves

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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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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