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Safety and outcomes of resection of butterfly glioblastoma

Fara Dayani, Jacob S. Young, Alexander Bonte, Edward F. Chang, Philip Theodosopoulos, Michael W. McDermott, Mitchel S. Berger, and Manish K. Aghi

B utterfly glioblastomas (bGBMs), which invade and cross the corpus callosum (CC) or interhemispheric commissure to involve the contralateral hemisphere, are thought to have extremely poor outcomes and are generally considered to be lesions for which the risks of resection outweigh the benefits. 8 This tenet stems from the belief that these tumors represent a more diffuse and aggressive phenotype of an already aggressive and incurable disease. 12 Moreover, in the past, patients who underwent resection have often suffered from significant morbidity such as

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Surgical resection of intrinsic insular tumors: complication avoidance

Frederick F. Lang, Nancy E. Olansen, Franco DeMonte, Ziya L. Gokaslan, Eric C. Holland, Christopher Kalhorn, and Raymond Sawaya

work, which drew the neurosurgical community's attention to resection of tumors in the insular region. He revitalized the idea, initially proposed in the mid-1900s, that most low-grade tumors of the insula spread within the confines of the anatomical limbic system and spared the deep mesial and neocortical structures. He demonstrated that insular tumors could be resected safely via the transsylvian approach. Since Yaşargil's seminal publications, interest in the resectability of these tumors has grown, and several recently published descriptions of the normal

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Multiple resections for patients with glioblastoma: prolonging survival

Clinical article

Kaisorn L. Chaichana, Patricia Zadnik, Jon D. Weingart, Alessandro Olivi, Gary L. Gallia, Jaishri Blakeley, Michael Lim, Henry Brem, and Alfredo Quiñones-Hinojosa

G lioblastoma is the most common malignant primary CNS tumors in adults. 11 , 17 Despite advances in medical and surgical therapy, the median survival for patients harboring these tumors remains approximately 1 year. 11 , 13 These tumors frequently invade and infiltrate surrounding normal parenchyma, making curative resection unlikely. In fact, Walter Dandy performed hemispherectomies for glioblastoma in the 1920s, 10 and the tumors still recurred on the contralateral side. Despite extensive resection, these tumors will also continue to recur despite

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Cerebral arterial vasospasm complicating supratentorial meningioma resection: illustrative cases

Andrew C Pickles, John T Tsiang, Alexandria A Pecoraro, Nathan C Pecoraro, Ronak H Jani, Brandon J Bond, Anand V Germanwala, Joseph C Serrone, and Vikram C Prabhu

Meningiomas are the most frequently diagnosed primary tumor of the central nervous system. 1 , 2 Resection of meningiomas is the first-line treatment, with the extent of removal being inversely related to the rate of recurrence. 3 Preservation of the arachnoid plane around a meningioma facilitates a more complete resection with avoidance of injury to the adjacent cortex. However, at times, pial or brain invasion may complicate identification of the tumor margin. 4 In addition, meningiomas parasitize pial and cortical vessels and can be densely adherent

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Counterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5-aminolevulinic acid glioma resection study

Clinical article

Walter Stummer, Jörg-Christian Tonn, Hubertus Maximilian Mehdorn, Ulf Nestler, Kea Franz, Claudia Goetz, Andrea Bink, and Uwe Pichlmeier

I t is generally thought that a more complete resection improves outcome in patients suffering malignant glioma, and a number of analyses have emerged with a high level of evidence in support of this concept. 7 , 9 , 11 Furthermore, it appears not only that cytoreduction influences survival, but that novel medical therapies also seem to rely on resections being as complete as possible for these therapies to be as efficacious as possible. In this context it was observed that concomitant radiochemotherapy followed by adjuvant chemotherapy was most efficacious

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Postoperative evaluation of microsurgical resection for cavernous malformations of the brainstem

Ken-ichiro Kikuta, Kazuhiko Nozaki, Jun A. Takahashi, Susumu Miyamoto, Haruhiko Kikuchi, and Nobuo Hashimoto

context of cavernous malformations in the brainstem causes focal neurological deterioration. 19 Although resection of these brainstem lesions remains difficult, the recent advances of MR imaging and neurophysiological monitoring (the mapping of cranial nerve functions) have increased the safety and accuracy of these surgeries. 1–8, 10–13 Analysis of recent data indicates that recurrent clinical hemorrhaging has occurred following incomplete resection of a lesion; 13, 14 however, it is often difficult to evaluate postoperatively whether complete resection has been

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Stereotactic radiosurgery and resection for treatment of multiple brain metastases: a systematic review and analysis

Uma V. Mahajan, Ansh Desai, Michael D. Shost, Yang Cai, Austin Anthony, Collin M. Labak, Eric Z. Herring, Olindi Wijesekera, Debraj Mukherjee, Andrew E. Sloan, and Tiffany R. Hodges

multiple metastases is even higher than the number of patients with a solitary lesion. 2 , 5 , 6 Reduction of metastatic burden to the brain has been strongly linked to improved neurocognitive function, neurological function, and overall survival (OS); thus, treatments aimed at reducing tumor volume have become mainstays in the management of intracerebral metastatic disease. 7 Treatment of brain metastases usually entails the use of multiple modalities. 4 , 7 Historically, resection was performed, given its ability to acutely alleviate the increased intracranial

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Outcomes following resection of intramedullary spinal cord cavernous malformations: a 25-year experience

Clinical article

Alim P. Mitha, Jay D. Turner, Adib A. Abla, A. Giancarlo Vishteh, and Robert F. Spetzler

C avernous malformations can be found throughout the CNS, but only rarely occur within the spinal cord. Intramedullary spinal cord CMs account for only 5% of all CMs of the CNS and for 5%–12% of all spinal cord vascular lesions. 8 They can manifest with the sudden onset of neurological deficit, with a gradually progressive decline in neurological function or, rarely, with the sudden onset of pain caused by subarachnoid hemorrhage. Resection is the only definitive treatment for symptomatic intramedullary spinal cord CMs, but surgery in this highly eloquent

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Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection

Clinical article

Ryan P. Morton, Paul D. Ackerman, Marc T. Pisansky, Monika Krezalek, John P. Leonetti, Michael J.M. Raffin, and Douglas E. Anderson

F acial nerve weakness following VS resection continues to pose a significant challenge to both operative prognostics and patient quality of life. Exacerbating this challenge is the recent observation that normal or near-normal postoperative facial function may deteriorate after VS resection, and that such a trend was underreported in the early 1990s. In fact, recent literature suggests that 25% of VS resections result in DFP, a sustained facial weakness occurring after postoperative Day 1. 1 , 11–13 Using a more conservative definition, DFP includes

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Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival

Clinical article

Daniel Orringer, Darryl Lau, Sameer Khatri, Grettel J. Zamora-Berridi, Kathy Zhang, Chris Wu, Neeraj Chaudhary, and Oren Sagher

W hile controversy has surrounded glioblastoma surgery since the early days of modern neurosurgery, a growing body of evidence suggests that EOR is a key prognostic factor. 11 , 18 Neurosurgeons, therefore, often play a central role in determining patient outcome by maximizing resection. Radiographically complete resection, defined as the absence of tumor on MRI, is the ideal surgical result because it is associated with the best possible outcome and prognosis. However, in cases in which radiographically complete resection carries a high risk of