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Jean Régis, Philippe Metellus, Henry Dufour, Pierre-Hughes Roche, Xavier Muracciole, William Pellet, Francois Grisoli and Jean-Claude Peragut

Object. This study was directed to evaluate the potential role of gamma knife surgery (GKS) in the treatment of secondary trigeminal neuralgia (TN). The authors have identified three anatomicoclinical types of secondary TN requiring different radiosurgical approaches.

Methods. Pain control was retrospectively analyzed in a population of patients harboring tumors of the middle or posterior fossa that involved the trigeminal nerve pathway. This series included 53 patients (39 women and 14 men) treated using GKS between July 1992 and June 1997. The median follow-up period was 55 months. Treatment strategies differed according to lesion type, topography, and size, as well as visibility of the fifth cranial nerve in the prepontine cistern. Three different treatment groups were established. When the primary goal was treatment of the lesion (Group IV, 46 patients) we obtained pain cessation in 79.5% of cases. In some patients in whom GKS was not indicated for treatment of the lesion, TN was treated by targeting the fifth nerve directly in the prepontine cistern if visible (Group II, three patients) or in the part of the lesion including this nerve if the nerve root could not be identified (Group III, four patients). No deaths and no radiosurgically induced adverse effects were observed, but in two cases there was slight hypesthesia (Group IV). The neuropathic component of the facial pain appeared to be poorly sensitive to radiosurgery. At the last follow-up examination, six patients (13.3%) exhibited recurrent pain, which was complete in four cases (8.8%) and partial in two (4.4%).

Conclusions. The results of GKS regarding facial pain control are very similar to those achieved by microsurgery according to series published in the literature. Nevertheless, the low rate of morbidity and the greater comfort afforded the patient render GKS safer and thus more attractive.

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Takeshi Hasegawa, Kiyotoshi Yamano, Tadao Miyamori and Yoshitaka Hamada

decompression surgery of the posterior fossa. We believe that the application of this method can be extended to other vital situations in various types of skull-base microsurgeries. Acknowledgments The authors thank Drs. Toshio Komai and Masahiro Kitabayashi, Department of Neurosurgery, Kohseiren Takaoka Hospital, Toyama, Japan, for their encouragement in the development of this device. We also thank Mr. Masami Yamaji for his helpful assistance with the photography. References 1. Flamm ES : Aneurysms of internal carotid and anterior

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Sudheesh Ramachandran and Rajiv Midha

F , Samii A , Gharabaghi A : Using an end-to-side interposed sural nerve graft for facial nerve reinforcement after vestibular schwannoma resection. Technical note . J Neurosurg 105 : 920 – 923 , 2006 10.3171/jns.2006.105.6.920 17405267 24 Sanna M , Khrais T , Mancini F , Russo A , Taibah A : The Facial Nerve in the Temporal Bone and Lateral Skull Base Microsurgery Stuttgart , Thieme , 2006 25 Sterkers O , Badr el Dine M , Bagot d'Arc M , Tedaldi R , Sterkers JM : Anastomosis of the facial nerve using fibrin glue

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Sampath Chandra Prasad, Karthikeyan Balasubramanian, Enrico Piccirillo, Abdelkader Taibah, Alessandra Russo, Jingchun He and Mario Sanna

, Mancini F , Romano G : Facial nerve grafting in the cerebellopontine angle . Laryngoscope 114 : 782 – 785 , 2004 15064643 10.1097/00005537-200404000-00038 44 Sanna M , Khrais T , Mancini F , Russo A , Taibah A , Facial nerve management in middle ear and external auditory canal carcinoma . Sanna M , Khrais T , Mancini F , : The Facial Nerve in the Temporal Bone and Lateral Skull Base Microsurgery Stuttgart , Thieme , 2006 . 259 – 277 45 Sanna M , Mazzoni A , Saleh E , Taibah A , Mancini F : The system of the

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Seong-Hyun Park, Hideyuki Kano, Ajay Niranjan, John C. Flickinger and L. Dade Lunsford

advances in skull base microsurgery, surgery for CPA meningioma remains challenging because potential injury of adjacent critical vascular structures, cranial nerves, or the brainstem may have a major deleterious effect on postoperative quality of life. 1 , 16 , 20 , 22 , 27 During the last 20 years, SRS has become an important alternative option for CPA meningiomas. 9 , 17 , 26 , 28 The twin goals of SRS are to maintain or improve function and achieve long-term tumor control. Tumor Control After SRS Pollock et al. 19 have reported that the PFS rate after

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Aurelia Kollová, Roman Liščák, Josef Novotný Jr., Vilibald Vladyka, Gabriela Šimonová and Ladislava Janoušková

the imaging modality and 3D planning. Since the very first meningioma was treated using stereotactic radiosurgery back in 1976, these lesions have become the most frequently treated in some centers. 31 , 35 An optimum treatment modality or a combination of modalities must be selected for every particular patient to achieve the best result. Gamma Knife surgery should be considered as the treatment of choice for small and medium meningiomas in the skull base. Microsurgery is warranted in cases of optic nerve sheath meningiomas to decompress the nerve or to debulk a

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Mark E. Linskey, Stephen A. Davis and Vaneerat Ratanatharathorn

involving the basal dura and dural sinuses. 47 Advances in skull base microsurgery techniques have improved our ability to resect safely this subset of meningiomas. 3, 11, 12, 25, 55 Histological demonstration of perineural and carotid artery adventitial invasion in some cases of cavernous sinus meningioma has called into question whether Grade 1 resection in this location is technically possible without en bloc resection of all contained structures, 32, 35, 58, 59, 68 and skull base meningiomas carry higher morbidity rates, particularly in regard to cranial nerve