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Sung Mo Ryu, Sun-Ho Lee, Kyung Min Lee, Whan Eoh, and Eun-Sang Kim

schwannomas, we retrospectively analyzed a series of 90 cases of surgically treated cervical schwannomas with an emphasis on tumor characteristics, extent of resection (EOR), and growth of a residual tumor. Methods Patients We reviewed the records of 123 patients with cervical schwannomas who were surgically treated at our institute from January 1995 to December 2017. Among them, 13 patients did not undergo a postoperative MRI follow-up, 2 patients with subtotal resection (STR) did not undergo a minimum of two follow-up MRI studies, 2 patients had no identifiable

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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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Mazda K. Turel, Georgios Tsermoulas, Lior Gonen, George Klironomos, Joao Paulo Almeida, Gelareh Zadeh, and Fred Gentili

established guidelines for the optimal timing of repeat surgery versus radiation therapy (RT). Likewise, there is no clear consensus on the optimal management of any residual tumor. In addition, because this tumor is more common in the pediatric population, there is limited adult literature on the management of recurrent tumors. While several factors such as incomplete resection, adherence to critical neurovascular structures, and lack of adjuvant RT have been purported to be risk factors for recurrence, there is a paucity of data in the literature on the optimal management

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Kuniaki Nakahara, Masaru Yamada, Satoru Shimizu, and Kiyotaka Fujii

S olitary fibrous tumors are relatively rare neoplasms that arise most frequently in association with the pleurae. On histological examination they exhibit spindle cells, which renders their differentiation from more common tumors difficult. Immunohistochemically, these lesions are diffusely and strongly positive for CD34, a characteristic that facilitates their differential diagnosis. 4 In the patient in the featured case, we chose SRS as adjuvant therapy to address the regrowth, after subtotal removal, of a residual tumor at the transverse sinus

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Roxanna M. Garcia, Taemin Oh, Tyler S. Cole, Benjamin K. Hendricks, and Michael T. Lawton

separation plane. This interplay between tissue sensitivity and extreme eloquence makes it difficult, if not impossible, to avoid leaving a remnant on occasion. The largest institutional surgical case series by a single neurosurgeon reported a rate of residual or recurrent BSCM of 11% (29 of 260 patients). 4 The natural history and management of residual or recurrent BSCMs are poorly described in the literature. 4 , 8–10 Current findings suggest that completely resected BSCMs do not recur de novo in the same location, which implies that some residual BSCM or remnants are

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Hazem M. Negm, Rafid Al-Mahfoudh, Manish Pai, Harminder Singh, Salomon Cohen, Sivashanmugam Dhandapani, Vijay K. Anand, and Theodore H. Schwartz

scarring and anatomy that has been distorted by the previous dissection. Harvesting a nasoseptal flap is more challenging and the rate of invasive adenomas in the cavernous sinus and other parasellar areas is higher, since these factors led to incomplete resection in the first place. For these reasons, reoperative pituitary surgery has been reported to result in an overall lower cure rate and higher morbidity rate. 7 , 32 , 41 Residual or recurrent tumors are often treated with nonsurgical therapies such as observation, medical therapy, radiotherapy, radiosurgery, all

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Bryce K. A. Weir and Charles G. Drake

T he presentation of an aneurysm during pregnancy is fortunately rare. The surgical management of an aneurysm rest is controversial even without the added complication of pregnancy. We report the case of a woman whose aneurysm was clipped during pregnancy and who showed rapid postoperative growth of the residual aneurysmal neck. This case demonstrates the necessity for vigilant follow-up monitoring of partially clipped aneurysms during pregnancy. Case Report This 34-year-old woman in the 20th week of pregnancy experienced the sudden onset of dizziness

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Ronald J. Benveniste, Wesley A. King, Jane Walsh, Jacob S. Lee, Bradley N. Delman, and Kalmon D. Post

T ranssphenoidal resection of a pituitary adenoma is one of the most commonly performed surgeries for intracranial tumors. 7 Outcomes following an initial TSA are generally excellent, with high rates of clinical improvement and endocrinological remission, and minimal rates of morbidity and mortality. Unfortunately, a significant proportion of both nonfunctioning and hormone-secreting pituitary adenomas recur following a successful TSA; in addition, a residual tumor is often left behind following this procedure. Residual or recurrent tumors can be treated with

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Teresa Lin, Allan J. Fox, and Charles G. Drake

F or many years it has been the approach at our institution to reoperate on aneurysm cases in which a large portion of the aneurysm neck or sac remains after application of a clip or ligature. It is recognized that grossly incomplete treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences. 2, 6, 8 However, 1- to 2-mm residual aneurysm necks have been thought to pose little risk. Several cases of aneurysms recurring from small necks left after clipping have been reported from our center, 7, 8 but only one other case has

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Luigi M. Cavallo, Daniel M. Prevedello, Domenico Solari, Paul A. Gardner, Felice Esposito, Carl H. Snyderman, Ricardo L. Carrau, Amin B. Kassam, and Paolo Cappabianca

posterior portion of the planum sphenoidale have been removed to show the areas that can be accessed via the EEE route. We report on our experience with this expanded approach in the treatment of recurrent and symptomatic residual craniopharyngiomas. Our aim was to describe the feasibility of and evaluate the advantages to this technique in the management of this difficult lesion type. Methods Data were collected at 2 separate institutions. All patients underwent full preoperative endocrinological evaluations, which were repeated 1 month postoperatively and then