Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2013
ReviewStereotactic radiosurgery of intracranial cavernous malformations.
Despite increasing worldwide experience, the role of stereotactic radiosurgery (SRS) in the management of cerebral cavernous malformations (CMs) remains controversial. Microsurgical excision of easily accessible CMs is typically safe; therefore, removal remains the gold standard for most of the symptomatic hemispheric lesions. ⋯ Waiting for the cumulative morbidity of the natural history to justify intervention does not serve the patient's interest, therefore, we argue for early radiosurgical intervention. Carefully designed randomized controlled trials might resolve controversies concerning the role of SRS in treating cerebral CMs.
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Neurosurg. Clin. N. Am. · Oct 2013
ReviewStereotactic radiosurgery of intracranial arteriovenous malformations.
Stereotactic radiosurgery for intracranial arteriovenous malformations (AVMs) has been performed since the 1970s. When an AVM is treated with radiosurgery, radiation injury to the vascular endothelium induces the proliferation of smooth muscle cells and the elaboration of extracellular collagen, which leads to progressive stenosis and obliteration of the AVM nidus. Obliteration after AVM radiosurgery ranges from 60% to 80%, and relates to the size of the AVM and the prescribed radiation dose. The major drawback of radiosurgical AVM treatment is the risk of bleeding during the latent period (typically 2 years) between treatment and AVM thrombosis.
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The goal of pituitary adenoma radiosurgery is to halt tumor growth, normalize hormonal hypersecretion if present, maintain normal pituitary function, and preserve important structures around the sella. The radiation dose necessary to stop tumor growth is lower than the dose necessary to achieve normalization of hormonal hypersecretion. The minimum distance required between the irradiated target and the optic pathway should be 2 mm for secreting adenomas, but in cases of nonsecreting adenomas this distance is even lower. The current role of radiosurgery in most cases is as an adjuvant treatment of residual or recurrent adenomas after previous microsurgery.
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Neurosurg. Clin. N. Am. · Oct 2013
ReviewStereotactic radiosurgery for epilepsy and functional disorders.
Stereotactic radiosurgery is used for many indications. In functional neurosurgery, it is used to modulate the function of axons, neurons, and related brain circuits. In this article, indications, current techniques, and outcomes are discussed.
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Neurosurg. Clin. N. Am. · Oct 2013
ReviewStereotactic radiosurgery of intracranial chordomas, chondrosarcomas, and glomus tumors.
Chordomas and chondrosarcomas are rare, slow-glowing, locally aggressive tumors with high recurrence rates. Stereotactic radiosurgery (SRS) is an important management option for patients with recurrent or residual chordomas and chondrosarcomas. ⋯ Because of their highly vascular nature and surgically formidable anatomic location, curative resection often proves challenging. SRS can be used as an up-front treatment or as an additional treatment for patients with recurrent or residual glomus jugulare tumor after surgical resection.