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Gamma Knife radiosurgery to the surgical cavity following resection of brain metastases

Clinical article

Jay Jagannathan, Chun-Po Yen, Dibyendu Kumar Ray, David Schlesinger, Rod J. Oskouian, Nader Pouratian, Mark E. Shaffrey, James Larner, and Jason P. Sheehan

original operative neurosurgeon) were excluded from the analysis, leaving 47 patients who underwent GKS to the surgical cavity of a gross-totally resected brain metastasis ( Fig. 1 ). F ig . 1. Summary of patients and treatments. Forty-seven patients received GKS to the resection cavity. Three patients received WBRT prior to radiosurgery, whereas 34 patients had concomitant radiosurgery for a synchronous metastasis. Thirteen patients showed no radiographically visible tumor at treatment. Three of these patients underwent upfront WBRT. All 10 of the remaining

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Gadolinium leakage into the surgical bed mimicking residual enhancement following spinal cord surgery

Case report

Matthew Walker, Saquib Khawar, Ali Shaibani, Sireen Reddy, Aruna Ganju, and Manu Gupta

this assessment is to distinguish blood products in the surgical bed from true enhancement. When high signal intensity is present on T 1 -weighted MR imaging, it is important to match the pre- and postoperative patterns of enhancement to detect any residual tumor. Gradient-echo imaging can also help by demonstrating blood products in the surgical bed. We report a case in which Gd filled the surgical cavity of a decompressed thoracic intramedullary cyst that had not enhanced on preoperative imaging. Immediate postoperative MR imaging revealed homogeneous enhancement

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Network-level prediction of set-shifting deterioration after lower-grade glioma resection

Sofiane Mrah, Maxime Descoteaux, Michel Wager, Arnaud Boré, François Rheault, Bertrand Thirion, and Emmanuel Mandonnet

, set at 0.05. Overlap of the Surgical Cavity With Cortical Parcels of Yeo’s Network The cortical areas composing each of the 17 networks of Yeo’s parcellation were split, leading to a total of 122 individual cortical parcels. For each parcel, its percentage of overlap with the surgical cavity was computed, resulting in 122 predictors. Tractotron of the Surgical Cavity We mapped the cavity from each patient onto tractography reconstructions of white matter pathways obtained from a group of healthy controls. 12 We quantified the severity of the

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5-Aminolevulinic acid–enhanced fluorescence-guided treatment of high-grade glioma using angled endoscopic blue light visualization: technical case series with preliminary follow-up

Ben A. Strickland, Michelle Wedemeyer, Jacob Ruzevick, Alexander Micko, Shane Shahrestani, Siamak Daneshmand, Mark S. Shiroishi, Darryl H. Hwang, Frank Attenello, Thomas Chen, and Gabriel Zada

possibilities of leveraging the advantages afforded by endoscopic tumor resection within an anatomical space (e.g., angled lenses, panoramic visualization, and delivery of illumination into the anatomical surgical cavity) to assess visualization and differentiation of fluorescent tumor tissue. Here we describe our prospective experience using blue light endoscopic 5-ALA–enhanced fluorescence-guided HGG surgery and discuss the ergonomics and workflow of exoscopic to endoscopic (E2E) channel-based and microscopic to endoscopic (M2E) resections. Methods Study Design

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Surgery for gliomas involving the left inferior parietal lobule: new insights into the functional anatomy provided by stimulation mapping in awake patients

Clinical article

Igor Lima Maldonado, Sylvie Moritz-Gasser, Nicolas Menjot de Champfleur, Luc Bertram, Gérard Moulinié, and Hugues Duffau

all cases, glioma removal was interrupted at this site, and the same procedure was performed again in the neighboring structures. When functional pathways were identified, they were followed progressively from or to the previously identified cortical eloquent sites without disrupting any zone of the surgical cavity already marked with a sterile tag. Therefore, while the resection progressed into the depth, it was crucial to alternate stimulation and tumor resection continuously. To perform optimal tumor resection, the procedure did not stop until eloquent pathways

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Chemokine detection in the cerebral tissue of patients with posttraumatic brain contusions

Roberto Stefini, Emanuela Catenacci, Simone Piva, Silvano Sozzani, Alessandra Valerio, Riccardo Bergomi, Marco Cenzato, Pietro Mortini, and Nicola Latronico

cerebral tissue by using a surgical pincer, a sample of white matter (20–40 mg) was removed from the surgical cavity corresponding to the edematous pericontusional area. The sample was washed with physiological saline solution, dried with sterile gauze, placed in a sterile tube, and rapidly frozen in a dedicated freezer. The 2 control patients had undergone elective surgery for clip ligation of an unruptured aneurysm in the anterior communicating artery region. Following pterional craniotomy, opening of the dura mater and basal cisterns was performed, and a small part

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Analysis of 5-aminolevulinic acid–induced fluorescence in 55 different spinal tumors

Matthias Millesi, Barbara Kiesel, Adelheid Woehrer, Johannes A. Hainfellner, Klaus Novak, Mauricio Martínez-Moreno, Stefan Wolfsberger, Engelbert Knosp, and Georg Widhalm

–induced PpIX fluorescence is a clinically reliable method. The application of 5-ALA is useful especially in certain spinal tumor entities such as ependymomas, meningiomas, hemangiopericytomas, and drop metastases of primary CNS tumors. In contrast, in other histopathological tumor entities such as neurinomas and carcinoma metastases, the application of 5-ALA is of limited value according to our experience. In cases of fluorescing intramedullary tumors, final inspection of the surgical cavity with violet-blue excitation light is a powerful technique for detecting potential

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Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage

Technical note

Roberto Gazzeri, Marcelo Galarza, Massimiliano Neroni, Alex Alfieri, and Stefano Esposito

The authors describe a minimally invasive technical note for the surgical treatment of primary intracerebral hematoma. Thirty-one patients with supratentorial intracerebral hematomas and no underlying vascular anomalies or bleeding disorders underwent treatment with a single linear skin incision followed by a 3-cm craniotomy. After evacuation of the hematoma, a matrix hemostatic sealant (FloSeal) was injected into the surgical cavity, and immediate hemostasis was achieved in all cases. A second operation was necessary in only 1 case. In this preliminary experience, a small craniotomy combined with FloSeal helped to control operative bleeding, reducing brain exposure and damage to the surrounding tissue while reducing the length of the surgery.

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Staged radiosurgery alone versus postoperative cavity radiosurgery for patients with midsize-to-large brain metastases: a propensity score matching analysis

Shoji Yomo, Takehiro Yako, Kazuo Kitazawa, and Kazuhiro Oguchi

, postoperative stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (SRT) targeting the entire surgical cavity were introduced as novel treatments in the 2nd decade of the 21st century. 6 , 7 However, postoperative stereotactic irradiation carries the potential risk of leptomeningeal disease (LMD) development due to spillage of viable tumor cells during resection procedures. 8 , 9 To overcome this danger, neoadjuvant SRS prior to resection has recently been advocated, and this strategy has several advantages including a sterilization effect, less

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Minimally invasive lumbar intradural extramedullary tumor resection

Brian Lee and Patrick C. Hsieh

Intradural, extramedullary schwannomas have long been treated with open midline incision, laminectomy, and dural opening to expose and resect the lesion. While this technique is well established, today new surgical techniques can be utilized to perform the same procedure while minimizing pain, size of incision, and trauma to adjacent tissues. In cases of intradural surgery, minimally invasive surgery limits the degree of soft tissue disruption. As a result, there is significant decreased dead space within the surgical cavity that may decrease the rate of CSF leak complications. Minimally invasive techniques have continuously improved over the years and have reached a point where they can be used for intradural surgeries. In this case presentation, we demonstrate a minimally invasive approach to the lumbar spine with resection of an intradural schwannoma. Surgical techniques and the nuances of the minimally invasive approach to intradural tumors compared to the standard open procedure will be discussed.

The video can be found here: .