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Samer Ghostine, Michelle S. Ghostine, and Walter D. Johnson

cavernous sinus regions. 20 Radiosurgery is commonly used in cases of tumor recurrence, 40 or may be used prophylactically after resection if there is evidence of residual tumor on postoperative neuroimaging. Long-term control of pituitary adenomas after transsphenoidal resection varies from 50 to 80%. 4 , 9 , 19–21 , 28 Leksell first described SRS in 1951 as a tool to perform “closed skull destruction of an intracranial target using ionizing radiation.” 22 In 1968, Leksell first used the Gamma Knife in the treatment of a patient with a pituitary adenoma

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Menno Iprenburg, Ralf Wagner, Alexander Godschalx, and Albert E. Telfeian

discectomies, interbody fusions, and screw placement), endoscopic spine surgery depends heavily on the use of fluoroscopy for targeting and instrument placement. Here we describe our experience treating patients with herniated lumbar discs, who presented with persistent lumbar radiculopathy despite conservative nonoperative treatment, using transforaminal endoscopic discectomy. A prospective study of radiation exposure is presented for 2 groups of patients: those treated with lumbar disc herniations at L4–5 and above, and those treated with L5–S1 disc herniations. The

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Toshihiro Yasui, Hisatoshi Yagura, Masaki Komiyama, Yoshihiko Fu, Yasunori Nagata, Katsuhiko Tamura, Virender Kumar Khosla, and Akira Hakuba

A lthough several reports on radiation myelopathy have appeared since its first description by Ahlbom, 1 the exact mechanisms involved in its production are not known and there is no effective treatment available. Difficulties in diagnosis have led to inappropriate treatment, causing further insult to the already damaged spinal cord and other unwarranted consequences. 15, 16 A case of cervical radiation myelopathy, confirmed histologically, is presented along with the magnetic resonance (MR) imaging findings. Case Report This 28-year-old woman

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Judith M. Wong, Allen L. Ho, Ning Lin, Georgios A. Zenonos, Christopher B. Martel, Kai Frerichs, Rose Du, and William B. Gormley

uncertain nature. Among these latter effects is neurocognitive deterioration extending from memory and speech dysfunction to dementia. 5 , 7 , 15 , 18 , 38 Additionally, strong associations exist between chronic exposure to radiation and the development of head and neck cancers, such as thyroid malignancies, squamous and basal cell lesions, and benign and malignant intracranial tumors. 25 , 31 , 35 , 36 Patients with SAH are often critically ill. Population-based mortality is as high as 45%, with survivors experiencing significant morbidity. 3 Given the long

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David S. Hersh, Kenneth Moore, Vincent Nguyen, Lucas Elijovich, Asim F. Choudhri, Jorge A. Lee-Diaz, Raja B. Khan, Brandy Vaughn, and Paul Klimo Jr.

R adiation-induced cerebral vasculopathy, or radiation-induced moyamoya, was reported as early as the 1970s. 25 , 28 Given its rarity, the literature is limited to numerous case reports, small case series, and review articles. 1 , 2 , 10 , 16 , 24 , 33 At-risk patients are those who received radiation at a young age for parasellar tumors, with optic pathway gliomas and craniopharyngiomas being the most common. The total radiation dose may also be a significant risk factor. To date, most cases in the literature have occurred following photon-based radiation

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Chris J. Neal and Leon E. Moores

The purpose of this review is to present a concise overview of the types of radiation, methods of dispersal, injury patterns, and treatment considerations in a scenario involving radiation-based weapons of mass destruction. Radiation-related casualties, although uncommon, are a potential threat because more nations and organizations are developing the technology for producing radioactive substances capable of being used as weapons.

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Ryan P. Morton, Renee M. Reynolds, Rohan Ramakrishna, Michael R. Levitt, Richard A. Hopper, Amy Lee, and Samuel R. Browd

patient to ionizing radiation, increasing the statistical risk of developing cancer later in life. This risk is particularly increased in children due to longer remaining life expectancy and thinner, less dense skulls that offer less shielding than the adult calvaria. A recent study has evaluated the cancer risk of leukemia and brain tumors in patients receiving head CT scans. Pearce et al. 9 concluded that the risk of leukemia and brain tumors is almost 3 times greater in those patients who received a cumulative dose of 50–60 mGy (approximately 2–3 head CT scans at

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John Mealey Jr., Tsu T. Chen, and Robert Shupe

T he average life expectancy after a definitive operative diagnosis of glioblastoma multiforme is 3 to 6 months, with less than 20% of the cases remaining alive at 1 year and less than 10% at 2 years. 18, 20, 28 It is generally believed that radiation therapy increases the average postoperative lifespan of patients with this disease 18, 28, 40, 48 but after 12 to 18 months there is little difference in the survival rate between the irradiated and nonirradiated groups. 18, 20 The most favorable results have been reported after substantial tumor resections

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Terry C. Burns, Ahmed J. Awad, Matthew D. Li, and Gerald A. Grant

A lthough brain radiation therapy is critical to the management of primary and metastatic brain tumors, cognitive impairments caused by chemotherapy and radiation are increasingly recognized. In adults, impairments occur in up to 50%–90% of patients within 3–6 months after fractionated whole-brain radiation therapy (WBRT). 8 , 24 Long-term survivors of childhood brain radiotherapy are most severely affected, experiencing double-digit declines in IQ, vocational restriction, and an elevated incidence of psychiatric impairments. 45 , 52 , 53 Neurooncology

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Jeremy K. Cutsforth-Gregory, Giuseppe Lanzino, Michael J. Link, Robert D. Brown Jr., and Kelly D. Flemming

C avernous malformations (CMs) are well-circumscribed, multilobulated, angiographically occult vascular malformations that may be sporadic or associated with genetic mutations in CCM1 , CCM2 , or CCM3 . In patients with a genetic predisposition, it is hypothesized that a “second hit” is required to develop CM. The nature of the second hit has been debated, with hypothesized mechanisms including infection, inflammation, additional genetic mutations, or radiation. 15 In the sporadic or acquired form, the etiology of CM is not clear, but CMs have been