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

topography and vasculature of the insula have greatly added to our knowledge of the surgical anatomy. 20, 21, 23, 26 Nevertheless, literature on the resection of insular tumors remains sparse, and only a few surgeons have reported their experiences. 2, 3, 5–7, 15, 22, 26, 27 Although these works have provided valuable insight into complications and resection techniques, a systematic evaluation of the anatomical bases of postoperative neurological dysfunction and potential avenues of avoidance has not been published. During the past 10 years, we have surgically treated

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John A. Anson and Robert F. Spetzler

. All patients underwent surgical resection of their lesions. Although complete resection was thought to have been achieved in all cases, one patient developed a recurrent cavernous malformation 21 months later. The recurrent lesion was removed and has not subsequently recurred during 4 years of follow-up monitoring. All patients had an excellent outcome after surgery; the symptoms completely resolved in two patients and were markedly reduced in four. The two most recent cases and the case with recurrence are described below. Illustrative Cases Case 1 This

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Dominique M. Higgins, Jamie J. Van Gompel, Todd B. Nippoldt, and Fredric B. Meyer

surrounding anatomy. 6 , 7 , 18 As a result, surgical intervention is recommended in symptomatic and at-risk patients, most commonly via a transsphenoidal approach. 1 , 3 , 4 , 10 , 15 The extent of resection that produces maximum benefit is still somewhat controversial. 1 , 4 , 9 , 16 Theoretically, a more aggressive resection such as a gross-total resection (GTR) would lead to a lower rate of recurrence than a subtotal resection (STR) or fenestration. However, this benefit has not been proven, and GTR conceivably leads to more complications. 1 , 2 , 8 , 15 Furthermore

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Christian A. Bowers, Tamer Altay, and William T. Couldwell

T uberculum sellae meningiomas constitute 5%–10% of all intracranial meningiomas. 5 Visual loss and headaches are the most common presenting symptoms. 14 These tumors occupy a unique space in that they take a subchiasmal position by pushing the optic chiasm superiorly and laterally. 5 Resection of a TSM is surgically challenging because of the proximity of vital neurovascular structures including the carotid artery and optic nerves/chiasm. 10 Resection is further complicated by the fact that TSMs usually have a firm, rubbery consistency and often

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James K. Liu and Vincent N. Dodson

Transcript 0:20–0:38 Title This is Dr. James Liu, and I’ll be demonstrating an operative video of microsurgical resection of a brainstem cervicomedullary ganglioglioma, and the technique for creating a surgical pseudoplane for near-total resection when there is no clear interface between the tumor and normal neural tissue. 0:38–0:58 Patient history The patient is a 22-year-old female who was involved in a motor vehicle accident and was evaluated for posttraumatic headaches and concussion. She reported worsening headaches, numbness, and tingling of the occipital

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Tomohiro Kawaguchi, Toshihiro Kumabe, Ryuta Saito, Masayuki Kanamori, Masaki Iwasaki, Yoji Yamashita, Yukihiko Sonoda, and Teiji Tominaga

S urgical treatment of insulo-opercular gliomas carries a high risk for postoperative deficits caused by damage to the functional cortical regions, subcortical motor/language fibers, and vascular structures. Improving the extent of resection and reducing the risk for neurological complications could be achieved by better understanding of the surgical anatomy, application of adjunctive methods (e.g., motor tract mapping by intermittent electrical cortical–subcortical stimulations or continuous motor evoked potential monitoring), and use of awake surgery. 4

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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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Jamie J. Van Gompel, Jesus Rubio, Gregory D. Cascino, Gregory A. Worrell, and Fredric B. Meyer

presented with epilepsy before undergoing a resection. All patients were screened for neuropathological confirmation of a cavernous hemangioma and a history of seizures intractable to medical therapy. Six-month neurological and surgical follow-up data at least were available for all patients. Demographic Evaluation Collected data included patient sex, age at operation, duration of preoperative epilepsy, lesion location, preoperative electroencephalographic recordings, lesion size, use of intraoperative ECoG, resection performed, and seizure outcome. A neurologist

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Daniel M. Sciubba, Rafael De la Garza Ramos, C. Rory Goodwin, Nancy Abu-Bonsrah, Ali Bydon, Timothy F. Witham, Chetan Bettegowda, Ziya L. Gokaslan, and Jean-Paul Wolinsky

different biological behavior, most spinal sarcomas are best treated with resection. The combination of chemotherapy and radiotherapy is often used as a neoadjuvant or adjuvant modality. 10 The Enneking classification system was developed as a surgical staging tool for primary nonspinal musculoskeletal tumors, 9 but studies have proven its validity in primary spinal neoplasms. 12 Based on tumor histological findings, anatomical extent, and the presence of metastases, the Enneking system recommends resection with negative margins for malignant tumors such as sarcoma. 9

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Jonathan A. Forbes, Edgar G. Ordóñez-Rubiano, Hilarie C. Tomasiewicz, Matei A. Banu, Iyan Younus, Georgiana A. Dobri, C. Douglas Phillips, Ashutosh Kacker, Babacar Cisse, Vijay K. Anand, and Theodore H. Schwartz

, 4 , 7 , 8 , 13 , 14 , 17 , 19 , 22 In their original report, Kassam et al. recommended against endonasal approaches for resection of type IV (intrinsic third ventricular) CPAs. 13 Despite considerable evolution in surgical technology and operative techniques over the past decade, the perception that intrinsic third ventricular craniopharyngiomas (IVCs) are not amenable to endonasal resection remains widely prevalent today. 6 , 13 , 25 , 28 , 31 IVCs have been reported by some authors to “pose the greatest surgical challenge” of all CPAs, especially when an