Journal of neurosurgery
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Journal of neurosurgery · Dec 2012
Interfraction and intrafraction performance of the Gamma Knife Extend system for patient positioning and immobilization.
The Extend system for the Gamma Knife Perfexion makes possible multifractional Gamma Knife treatments. The Extend system consists of a vacuum-monitored immobilization frame and a positioning measurement system used to determine the location of the patient's head within the frame at the time of simulation imaging and before each treatment fraction. The measurement system consists of a repositioning check tool (RCT), which attaches to the Extend frame, and associated digital measuring gauges. The purpose of this study is to evaluate the performance of the Extend system for patient repositioning before each treatment session (fraction) and patient immobilization between (interfraction) and during (intrafraction) each session in the first 10 patients (36 fractional treatments) treated at the University of Virginia. ⋯ The Extend system can be used to reposition and immobilize patients in a radiosurgical setting. However, care should be taken to acquire measurements that can implicitly account for rotations of the patient's head. Further work is required to determine the sensitivity of the vacuum interlock to detect patient motion.
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Journal of neurosurgery · Dec 2012
Shunting with gravitational valves--can adjustments end the era of revisions for overdrainage-related events?: clinical article.
Overdrainage of CSF remains an unsolved problem in shunt therapy. The aim of the present study was to evaluate treatment options on overdrainage-related events enabled by the new generation of adjustable gravity-assisted valves. ⋯ Modern adjustable and gravity-assisted valves enable surgeons to set the opening pressure relatively low to avoid underdrainage without significantly raising the incidence of overdrainage and to treat overdrainage-related clinical and radiological complications without surgical intervention.
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Journal of neurosurgery · Dec 2012
Long-term follow-up studies of Gamma Knife surgery with a low margin dose for vestibular schwannoma.
The aim of this study was to assess long-term clinical outcomes in patients who underwent Gamma Knife surgery (GKS) with a low margin dose-14 Gy or less-to treat vestibular schwannoma (VS) unrelated to neurofibromatosis Type II. ⋯ With a low prescribed margin dose of 14 Gy or less, GKS was confirmed to provide long-term tumor control for small to medium-sized VSs and largely to prevent cranial nerves from iatrogenic injury. Based on the findings of this study, GKS is also a reasonable option for the treatment of large, heterogeneously enhancing tumors without symptomatic brainstem compression. Gamma Knife surgery can preserve a high quality of life for most patients with VS who do not have symptomatic brainstem compression. Long-term follow-up is required because of the risk of delayed recurrence of VS.
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The theme of the 80th Annual Meeting of the American Association of Neurological Surgeons and the title of this presidential address, "We are neurosurgery," is a simple 3-word affirmation of who neurosurgeons are, what they have achieved, and how much there is yet to accomplish. Recent advances in neurobiology and the clinical neurosciences have brought an unprecedented understanding of the human nervous system in both health and disease. ⋯ In this address, the author examines the contemporary meaning of the annual meeting's theme as it relates to the science, practice, specialty, and profession of neurosurgery, as well as the neurosurgeon. In doing so, the author reveals his interpretation of "We are neurosurgery," which he hopes will have an effect on others.
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Journal of neurosurgery · Dec 2012
High-precision volume-staged Gamma Knife surgery and equivalent hypofractionation dose schedules for treating large arteriovenous malformations.
The goal of this study was to develop a technique for performing submillimeter high-precision volume-staged Gamma Knife surgery and investigate its potential benefits in comparison with hypofractionated stereotactic radiotherapy (SRT) for treating large arteriovenous malformations (AVMs). ⋯ Volume staging remains advantageous over hypofractionation in delivering a higher dose to the target and for better sparing of normal brain tissue in the treatment of large AVMs. More clinical data are needed, however, to justify the clinical superiority of this increased dose when compared with a hypofractionated treatment regimen.