Neurosurgery
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Sphenoid wing meningiomas (SWMs) can encase arteries of the circle of Willis, increasing their susceptibility to intraoperative vascular injury and severe ischemic complications. ⋯ Subtotal resection should be considered in SWM with significant vascular encasement of proximal arteries to limit postoperative ischemic complications.
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Seizure risk has not been fully characterized in pediatric patients with arteriovenous malformations (AVMs). ⋯ Risk of seizure persists after treatment in pediatric AVM patients. Seizure presentation, male gender, and nonconservative management are associated with increased risk of post-treatment seizure. Early identification of these risk factors provides important information for determining seizure management strategies.
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Although patients with brain metastasis are treated with primary stereotactic radiosurgery (SRS), the use of salvage therapies and their consequence remains understudied. ⋯ In selected patients, performing ≥3 SRS courses controls intracranial disease. Patients may need salvage SRS for distant intracranial relapse, but focal retreatments are associated with modest toxicity, do not appear to negatively affect a patient's performance status, and help preserve quality of life.
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The role of intervention in the management of unruptured brain arteriovenous malformations (AVM) is controversial. ⋯ Radiosurgery affords an acceptable risk to benefit profile for patients harboring unruptured AVMs. These findings justify further prospective studies comparing radiosurgical intervention to conservative management for unruptured AVMs.
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Superior cerebellar artery (SCA) aneurysms are usually grouped with aneurysms that arise from the upper basilar artery or more broadly, the posterior circulation. However, the SCA aneurysm has distinctive anatomy that facilitates safe surgical management, notably few associated perforating arteries, and excellent exposure in the carotid-oculomotor triangle. ⋯ SCA aneurysms are favorable for microsurgical clipping with low rates of permanent morbidity and mortality. Microsurgery should be considered alongside endovascular techniques as a treatment option in many patients.