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Takanobu Kaido, Tohru Hoshida, Ryunosuke Uranishi, Nobuhisa Akita, Akihira Kotani, Noriyuki Nishi and Toshisuke Sakaki

R adiosurgery , or stereotactically focused irradiation, was initially used for intractable pain by Leksell 8 in 1968. In 1970, Steiner and associates 21 introduced the gamma knife for treatment of cerebral AVMs. Recently, radiosurgery has been widely used not only to treat AVMs, but also to treat brain tumors, intractable pain, neuralgia, Parkinson disease, and epilepsy. It is considered to be a relatively safe procedure, but there is still a risk of radiation necrosis as well as incomplete obliteration and bleeding before complete obliteration of the nidus

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Bruce E. Pollock, Yolanda I. Garces, Scott L. Stafford, Robert L. Foote, Paula J. Schomberg and Michael J. Link

symptomatic lesions. 3, 18, 21 Removal of the lesion provides relief of mass effect, reduction in seizure frequency, and immediate protection against future intracranial hemorrhage. The use of stereotactic radiosurgery for treating CMs is controversial. Kondziolka and colleagues 14 reported 47 cases of CMs managed with radiosurgery between 1987 and 1994. At a mean follow-up period of 3.6 years, these authors reported a significant reduction in bleeding risk that was most notable 2 or more years after the procedure. Twelve patients (26%) suffered a neurological decline

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Christer Lindquist, Wan-Yio Guo, Bengt Karlsson and Ladislau Steiner

collateral drainage. 6 Although the results in these lesions seem to be discouraging, surgery is still occasionally carried out. The rationale given is that complications such as hemorrhage or seizures can in some patients definitely be linked to the presence of a venous angioma. Conceptually, radiosurgery could offer an attractive alternative treatment technique for venous angiomas as irradiation causes obliteration of blood vessels over a prolonged period of time, thereby allowing ample time for the development of other paths of venous drainage from a normal part of the

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Bengt Karlsson, Lars Kihlström, Christer Lindquist, Kaj Ericson and Ladislau Steiner

G amma knife radiosurgery (GKRS) has been used for the treatment of arteriovenous malformations (AVMs) since 1970; 21 the favorable results 20 of this procedure prompted pilot series in which GKRS was used to treat venous angiomas 15 and cavernous malformations (CMs). 24 We first used GKRS to treat a patient with a CM in 1985. In the first half of the present series, we used radiation doses comparable to those used in the treatment of AVMs. This resulted in a high incidence of complications, and we changed the protocol to lower radiation doses for the

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Yoshihisa Kida, Masayuki Yoshimoto and Toshinori Hasegawa

cranial fossa. Facial palsy and hearing disturbances are the predominant presenting symptoms, but some patients can be totally asymptomatic. 8 , 10–12 Current treatment consists of resection via the translabyrinthine or transmastoid route. Facial palsy is often worse after surgery and always troublesome and can necessitate nerve grafting or anastomosis with the hypoglossal nerve. Given the success of radiosurgery for VSs, we attempted to treat facial schwannomas radiosurgically. Clinical Material and Methods Since 1991, 14 cases of facial schwannomas have been

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Elizabeth Tyler-Kabara, Douglas Kondziolka, John C. Flickinger and L. Dade Lunsford

tumors in critical locations that remain after resection or biopsy procedures, subsequent management options have included observation, radiation therapy, and now stereotactic radiosurgery. We report results in four patients who underwent radiosurgery for persistent neurocytomas. Case Reports Case 1 This 16-year-old young woman underwent two resections (one transfrontal and one transcallosal) for a large lateral and third ventricular tumor. The majority of the neurocytoma was removed during the first two surgeries. Residual tumor was seen in the left lateral

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Roberto Spiegelmann, William A. Friedman, Frank J. Bova, Daniel P. Theele and J. Parker Mickle

is poorly understood. The large number of uncontrollable variables in clinical radiosurgical series diminishes the value of these studies as a source of accurate data relating to these issues. Experimental studies on single-fraction radiation are scarce. Information based on the application of conventional irradiation techniques cannot easily be extrapolated to this clinical setting. The development of a reproducible animal model of radiosurgery is therefore crucial, and more so as the number of patients subjected to this treatment modality increases swiftly. The

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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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Douglas Kondziolka, L. Dade Lunsford, Jay S. Loeffler and William A. Friedman

Things are seldom what they seem; skim milk masquerades as cream.—W. S. Gilbert The incorporation of stereotactic radiosurgery into neurosurgery and recent improvements in the administration of fractionated radiation therapy represent fundamental paradigm shifts in modern medical care. Neurological surgery has focused on minimal access procedures, searching for the molecular responses of tissues so that they may be eradicated or inactivated, and relying on the multidisciplinary talents and backgrounds of practitioners in neurological surgery, radiation

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William A. Friedman, Patrick Bradshaw, Adam Myers and Frank J. Bova

anesthesia. Finally, the location of these tumors at the skull base in proximity to multiple critical neurological structures (that is, cranial nerves and brainstem) leads to appreciable surgical morbidity and infrequent death even in expert hands. These factors make the concept of an effective, less invasive, less morbid alternative treatment that can be performed in a single day under local anesthesia extremely attractive. In this paper we review our experience at the University of Florida with LINAC radiosurgery for VSs. Clinical Material and Methods Study