Neurosurgery
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Gamma Knife radiosurgery (GKRS) allows for the treatment of intracranial tumors with a high degree of dose conformality and precision. There are, however, certain situations wherein the dose conformality of GKRS is desired, but single session treatment is contraindicated. In these situations, a traditional pin-based GKRS head frame cannot be used, as it precludes fractionated treatment. ⋯ Fractionated GKRS was well-tolerated in the treatment of large meningiomas, perioptic tumors, vestibular schwannomas with intent of hearing preservation, and in reirradiation of previously treated tumors.
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Overlapping surgery is a common practice to improve surgical efficiency, but there are limited data on its safety. ⋯ When planned appropriately, overlapping surgery can be performed safely within the infrastructure at our academic institution.
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The treatment of large arteriovenous malformations (AVMs) remains challenging. Recently, staged-volume radiosurgery (SVRS) has become an option. ⋯ Obliteration and hemorrhage rates of large AVMs treated by SVRS are similar to historical SSRS. However, SVRS offers a lower rate of AREs.
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Whether additional indirect bypasses effectively contribute to revascularization in combined procedures remains unclear in patients with moyamoya disease. ⋯ Simultaneous direct and indirect bypass development was most frequently observed, regardless of patient age and hemodynamic status. Applying indirect bypass as an adjunct to direct bypass could maximize revascularization in adults and children.
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Historical Article
Ayub Khan Ommaya (1930-2008): Legacy and Contributions to Neurosurgery.
Ayub Khan Ommaya (1930-2008) was a pioneering neurosurgeon of Pakistani origin who is widely known for inventing the Ommaya reservoir, a ventricular catheter with a mushroom-shaped dome for administration of intraventricular therapies. As a Rhodes Scholar at Oxford, Ommaya developed an early interest in studying traumatic brain injury. ⋯ His work on traumatic brain injury led to the creation of the National Center for Injury Prevention and Control, a center for injury prevention research at the Center for Disease Control. This historical paper visits Ommaya's life story and recounts his key contributions to neurosurgery.