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Alex M. Landolt and Nicoletta Lomax

levels. It is thought that no other therapeutic option can be offered that will not diminish fertility. Clinical Material and Methods Gamma knife radiosurgery was performed in 20 patients (five men and 15 women, ranging in age from 24–74 years) harboring prolactinomas in whom hyperprolactinemia persisted after surgery and/or treatment with dopaminergic drugs. All the patients but one experienced disturbances of sexual function: amenorrhea, infertility, and loss of potency. The exception was a 74-year-old woman who suffered from trigeminal neuralgia caused by an

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Masao Tago, Atsuro Terahara, Masahiro Shin, Keisuke Maruyama, Hiroki Kurita, Keiichi Nakagawa, and Kuni Ohtomo

–40)  median margin dose (range) 20 (18–20) Gamma knife surgery was performed using the Leksell gamma knife models (Elekta Instrument AB, Stockholm, Sweden). Treatment planning was performed using KULA or Leksell GammaPlan (Elekta Instruments AB) and stereotactic computerized tomography or MR images. The treatment protocol calls for the irradiation of the enhanced mass with a margin dose of 20 Gy. In cystic tumors only the mural nodule is targeted. In this series, all tumor margins were covered by the 50% isodose. Twenty-eight tumors received 20 Gy to the

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Wen-Yuh Chung, David Hung-Chi Pan, Cheng-Ying Shiau, Wan-Yuo Guo, and Ling-Wei Wang

in coronal T 1 -weighted MR images (A and B). Before GKS, hydrocephalus and poor consciousness was corrected by placement of a ventriculoperitoneal shunt, followed by stereotactic aspiration of the large cyst (arrow) and Ommaya reservoir implantation. C and D: Images revealing that the tumor volume has decreased to 6 cm 3 , which is suitable for GKS. E and F: Images revealing the tumor response to a 12-Gy margin dose. The tumor volume shrank to 0.7 cm 3 6 months after GKS. Gamma Knife Radiosurgery Gamma knife radiosurgery was used as the initial

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Gamma Knife surgery–induced meningioma

Report of two cases and review of the literature

Jason Sheehan, Chun PO Yen, and Ladislau Steiner

S ince April 1970, the Gamma Knife has become an increasingly important neurosurgical tool in the treatment of AVMs. 13 , 21 , 28 Because of its minimally invasive nature and its precision, radiosurgery is associated with a low morbidity rate and essentially a 0% mortality rate. Rare instances of a serious complication, however, do occur. An attempt to contact 2500 patients with AVMs that were treated with GKS by the senior author (L.S.) has thus far yielded follow-up data on 1333 patients. During a retrospective examination of cases in which there was

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Chun Po Yen, Jason Sheehan, Greg Patterson, and Ladislau Steiner

involved the third ventricle. Two patients developed a new lesion in a location different from that of the previously treated lesion 2.5 and 4 years following GKS, and they underwent a second GKS. On MR images, all tumors were isointense to gray matter of the brain. The enhancement was variable including eight with mild to moderate enhancement and one without enhancement. The tumor volume at the time of GKS ranged from 1.4 to 19.8 cm 3 (mean 6 cm 3 ). Gamma Knife Surgery Technique The procedure has been detailed elsewhere. 31 Briefly, a stereotactic frame was

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Neurosurgical Forum: Letters to the Editor To The Editor Dexter Y. L. Leung , M.R.C.S., F.C.Ophth(HK) Fiona O.J. Luk , M.R.C.S. Dennis S. C. Lam , F.R.C.S., F.R.C.Ophth The Chinese University of Hong Kong Hong Kong, People's Republic of China 192 193 Abstract Object The authors performed a study to characterize the effects of ciliary body gamma knife surgery (GKS) for advanced glaucoma. Methods In addition to a pilot project involving 14 patients, 88 other patients

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Yanhe Li, Desheng Xu, Zhiyuan Zhang, Yipei Zhang, Dong Liu, Xiaomin Liu, Guokai Wang, and Yiguang Lin

T he incidence of brain metastases is increasing as survival of patients with cancer becomes more prolonged due to advanced cancer therapy. Brain metastases are the most common intracranial tumor; however, brainstem metastases are relatively uncommon, and account for only 3% to 7% of all brain metastases. Open surgery for brainstem metastases is difficult because of the risk of neurological damage. Gamma Knife surgery has been reported to provide benefits to patients with brain metastases; however, few data are available to evaluate the effectiveness of

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Jason Sheehan, Chun Po Yen, Yasser Arkha, David Schlesinger, and Ladislau Steiner

During a 16-year period at the University of Virginia Lars Leksell Gamma Knife Center, 26 patients with trigeminal schwannomas underwent 27 GKS procedures. The patient who underwent two GKSs was initially treated for a lesion in the Meckel cave and had a favorable response in tumor reduction. A prepontine cistern portion of the tumor was discovered later and treated in a second procedure. The mean age of patients at the time of GKS was 50 years (range 19–76 years). There were nine men and 17 women. Eight patients had undergone at least one prior tumor resection and

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Masahiro Izawa, Motohiro Hayashi, Kohtarou Nakaya, Hiroyuki Satoh, Taku Ochiai, Tomokatsu Hori, and Kintomo Takakura

normalization of endocrinopathies. If patients are not able to undergo resection in a state of general anesthesia because of age or poor general medical condition, GKS may be recommended as a primary treatment alternative to surgical resection. Gamma knife radiosurgery for pituitary adenomas has been shown to be a safe and effective treatment. 9 This investigation was conducted to evaluate the clinical results of GKS and its efficacy and safety in the treatment of pituitary adenomas. Clinical Material and Methods Patient Population One hundred eight of the 1490

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Jay Jagannathan, Jason P. Sheehan, Nader Pouratian, Edward R. Laws, Ladislau Steiner, and Mary Lee Vance

, damage to other cranial nerves (that is, the third, fourth, and sixth cranial nerves), cerebrospinal fluid leakage, and the development of permanent diabetes insipidus and hypopituitarism. The success of stereotactic radiosurgery in treating a number of sellar and parasellar lesions 2 , 18 has led to investigation of the efficacy of both the Gamma Knife and linear accelerator–based radiosurgery as adjuvant treatments for Cushing's disease. 30 , 41 The Gamma Knife is well suited for treating Cushing's disease, because these pituitary tumors tend to be small