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Rebecca M. Burke, Ching-Jen Chen, Dale Ding, Thomas J. Buell, Jennifer D. Sokolowski, Cheng-Chia Lee, Hideyuki Kano, Kathryn N. Kearns, Shih-Wei Tzeng, Huai-che Yang, Paul P. Huang, Douglas Kondziolka, Natasha Ironside, David Mathieu, Christian Iorio-Morin, Inga S. Grills, Caleb Feliciano, Gene H. Barnett, Robert M. Starke, L. Dade Lunsford and Jason P. Sheehan

high-grade (SM grades IV and V) AVMs commonly incorporates adjunctive or alternate interventions, such as endovascular embolization and stereotactic radiosurgery (SRS), to ameliorate the overall therapeutic risk. 3 , 4 Prior studies suggest that AVMs in children have distinct characteristics compared with those in adults. 5–8 Pediatric AVMs are more often located in deep brain regions, more likely to present with hemorrhage, and more likely to recur after obliteration. 5 , 7 , 9–13 The longer life expectancy of children subjects them to a greater cumulative

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Cheng-Chia Lee, Michael A. Reardon, Benjamin Z. Ball, Ching-Jen Chen, Chun-Po Yen, Zhiyuan Xu, Max Wintermark and Jason Sheehan

T he gold standard for diagnosing an arteriovenous malformation (AVM) nidus and evaluating the post–stereotactic radiosurgery (SRS) obliteration is cerebral angiography, which in current radiological terminology is called digital subtraction angiography (DSA). Over the past 3 decades, confirmation of AVM obliteration after SRS has been obtained by using DSA. However, patients often opt not to undergo angiography, especially when they experience no AVM-related symptoms. In addition to procedural complications, 3 , 7 , 8 , 12 , 13 patients usually

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Constantin Tuleasca, Iulia Peciu-Florianu, Henri-Arthur Leroy, Maximilien Vermandel, Mohamed Faouzi and Nicolas Reyns

wall and conjunctive tissue changes, with further coagulopathy and respective AVM obliteration. 17 In order to evaluate a radiobiological model as straightforwardly as possible, patients with previous hemorrhage (subject to different physiopathology and eventual radiobiology) 18 and previous treatment modalities (reputed to have different results) were excluded. 19 Methods Study Design The design of this study was retrospective and nonrandomized. All patients gave written informed consent. The ethics committee of Lille University Hospital (CHU Roger Salengro

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Satoshi Maesawa, John C. Flickinger, Douglas Kondziolka and L. Dade Lunsford

S tereotactic radiosurgery is an effective treatment for patients with suitable AVMs of the brain. 2, 3, 12, 13, 18, 19, 23 The goal of AVM radiosurgery is complete obliteration of the AVM nidus without any associated adverse radiation effect. Complete nidus obliteration demonstrated on angiography postradiosurgery appears to eliminate the risk of hemorrhage; we know of no report of hemorrhage following angiographic confirmation of nidus obliteration. Incomplete obliteration does not obviate the threat of future hemorrhage. 13, 20 Patients with a residual

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Neurosurgical Forum: Letters to the Editor To The Editor Masaaki Yamamoto , M.D. Tokyo Women's Medical College Dai-ni Hospital Tokyo, Japan 979 980 I read with great interest the article by Kihlström, et al. (Kihlström L, Guo WY, Karlsson B, et al: Magnetic resonance imaging of obliterated arteriovenous malformations up to 23 years after radiosurgery. J Neurosurg 86: 589–593, April, 1997). The authors reported that among 18 patients with arteriovenous malformations (AVMs) in whom postradiosurgical

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Joseph A. Epstein, Bernard S. Epstein, Leroy S. Lavine, Alan D. Rosenthal, Robert E. Decker and Robert Carras

, and clinical significance of arachnoiditis associated with various syndromes of spinal stenosis. Five patients are presented who had cauda equina and nerve root compression related to stenosis of the lumbar spinal canal, complicated by spondyloarthrosis, degenerative spondylolisthesis with an intact neural arch, spinal fusion, and massive discal herniation. Complete obliteration of the spinal subarachnoid space was found in each, confined only to the involved areas. Each patient improved significantly after decompressive laminectomy, foraminotomy, and discectomy

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Peter Varady, Jason Sheehan, Melita Steiner and Ladislau Steiner

Heading : Chun Po Yen

T he primary goal of GKS in treating cerebral AVMs is to achieve a complete obliteration of the nidus, thus eliminating the risk of cerebral hemorrhage. It is generally accepted that once the AVM is obliterated, the cure is permanent. 19 , 25 , 26 Occasionally rebleeding has been reported despite the fact that the posttreatment angiogram was assessed as normal. 15 , 21 , 29 However, usually either a small residual nidus was missed or, due to hemodynamic conditions at the time of the follow-up angiography, the nidus did not fill. Unsatisfactory quality of

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Cheng-Chia Lee, Ching-Jen Chen, Benjamin Ball, David Schlesinger, Zhiyuan Xu, Chun-Po Yen and Jason Sheehan

, 37 , 44 , 52 Following the introduction of radiosurgical technique in the early 1960s, Steiner et al. successfully treated a brain AVM with stereotactic radiosurgery (SRS) in 1970. 62 Since then, SRS has been established as an effective treatment alternative for intracranial AVMs, particularly for those with small-or medium-sized nidi located in eloquent or deep regions. In previously reported series, intracranial AVMs treated with 20–25 Gy have 3-year obliteration rates between 55% and 81% and complication rates ranging from 2.5% to 9.3%. 16 , 22 , 49 , 67 , 68

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Omar Tanweer, Rona Woldenberg, Sarah Zwany and Avi Setton

A neurysms or pseudoaneurysms of the spinal vasculature are a rare cause of SAH. Spinal SAH is primarily a result of high-flow vascular lesions such as arteriovenous malformations, 2 dural arteriovenous fistulas, and associated aneurysms. Isolated PSA aneurysms (that is, with no associated high-flow state) are rare, and to date only 8 cases have been reported. 1 , 3 , 6–11 We report a case of a ruptured isolated PSA pseudoaneurysm at the thoracic level presenting with SAH, which was subsequently treated with endovascular obliteration. We also discuss the

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Brandyn Castro, Brian P. Walcott, Navid Redjal, Jean-Valery Coumans and Brian V. Nahed

infection and CSF fistulas. It is also the responsibility of the treating surgeon to avoid unnecessary interventions when they have no proven benefit. The risk of morbidity related to any procedure to treat frontal sinus fractures must be weighed against the anticipated morbidity of declining or delaying intervention. Treatment options include observation, reconstruction, obliteration, cranialization, or a combination thereof. The optimal management of frontal sinus fractures is controversial and varies between providers and institutions. The need for complex surgical