Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Apr 2012
ReviewThe use of motor mapping to aid resection of eloquent gliomas.
Surgery remains one of the oldest and still most important forms of treatment for patients with glioma. The advantages of surgical resection for glioma must be balanced with the potential of operative morbidity to surrounding eloquent brain. To that end, advances in functional brain mapping allow for safer operations with more aggressive surgical resections. A brief history of motor mapping as well as its present day use in aiding resection of eloquent gliomas is discussed.
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The insula is a functionally and anatomically complex cortical structure that can be affected by both low-grade and high-grade gliomas. This complexity often prevents many neurosurgeons from attempting to surgically manage insular gliomas. This article reviews the anatomic and functional uniqueness of the insula and the surgical outcomes and lessons learned from previously reported surgical series. Successful management of insular gliomas, defined as maximal resection of the tumor without postoperative neurologic morbidity, can be achieved through a sophisticated understanding of the neurovascular structure of the insular region and an intraoperative functional mapping using cortico-subcortical electrical stimulation.
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Neurosurg. Clin. N. Am. · Apr 2012
ReviewRadiology: criteria for determining response to treatment and recurrence of high-grade gliomas.
The development of radiologic criteria for the assessment of response to treatment in high-grade gliomas (HGGs) has evolved considerably over the past few decades since the original response criteria based on computed tomography imaging. Accuracy and objectivity in the assessment of response to treatment of HGGs is necessary for altering treatment regimens, establishing accurate provider communication, and improving the quality of clinical trials. Future studies assessing emerging advanced neuroimaging techniques will facilitate the development of even more accurate evidence-based radiologic response criteria.
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewSurgical treatment of cranial arteriovenous malformations and dural arteriovenous fistulas.
Microsurgical resection remains the treatment of choice for more than half of all patients with arteriovenous malformations (AVMs). It reduces the treatment window to a span of a few weeks and is curative. ⋯ When performed, however, microsurgical obliteration of DAVFs is associated with excellent outcomes as well. This article reviews the current state of microsurgical treatment of AVMs and DAVFs.
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewStereotactic radiosurgery of cranial arteriovenous malformations and dural arteriovenous fistulas.
Cranial arteriovenous malformations (AVM) and cranial dural arteriovenous fistulas (AVF) carry a significant risk of morbidity and mortality when they hemorrhage. Current treatment options include surgery, embolization, radiosurgery, or a combination of these treatments. ⋯ Success in treating AVMs is variable depending on the volume of the lesion, the radiation dose, and the pattern of vascular supply and drainage. This article discusses the considerations for selecting radiosurgery as a treatment modality in patients who present with AVMs and AVFs.