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Neurosurgical Diseases
AnEvidence-BasedApproachtoGuidePractice
LeonT.Lai,MBBS,PhD,FRACS
AssociateProfessorofNeurologicalSurgery
DepartmentofSurgery
MonashUniversity;
HeadofCerebrovascularSurgeryandSkullBaseNeurosurgeon
DepartmentofNeurosurgery
MonashHealth
Melbourne,Australia
CristianGragnaniello,MD,PhD
AssistantProfessorofNeurologicalSurgery
DepartmentofNeurologicalSurgery
UniversityofTexasHealthScienceCenteratSanAntonio
SanAntonio,Texas,USA
149illustrations
Thieme
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Thisbookisdedicatedtoourpatientsandtheirfamilies,whoareourgreatestclinicalteachers.
Theyimpartinusthehighsandlowsofneurosurgeryandtheimportanceofhumilityineveryday
practice.
Toourmentors,whohavepouredsomuchintousandmadeusseehope.
LeonT.Lai,MBBS,PhD,FRACS
CristianGragnaniello,MD,PhD
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Contents
Foreword ................................................................................. xv
Preface ................................................................................... xvi
Acknowledgments ....................................................................... xvii
Contributors ............................................................................. xviii
1. NaturalHistoryandManagementOptionsofRecurrentGlioblastoma..................... 1
BenjaminH.M.HunnandKatharineJ.Drummond
1.1 Introduction.............................. 1 1.5 TreatmentOptionsforRecurrent
Glioblastoma............................. 4
1.2 SelectedPapersontheNaturalHistoryof
RecurrentGlioblastoma ................... 1 1.5.1 RepeatSurgery............................ 5
1.5.2 FurtherRadiotherapy....................... 6
1.3 TheNaturalHistoryofRecurrent 1.5.3 FurtherChemotherapy ..................... 6
Glioblastoma ............................. 2
1.6 Authors’Recommendations............... 6
1.4 SelectedPapersontheTreatmentOutcomes
ofRecurrentGlioblastoma................. 4
2. NaturalHistoryandManagementOptionsofUnrupturedBrainArteriovenous
Malformation..................................................................................... 8
MichaelKerinMorgan
2.1 Introduction.............................. 8 2.4 TreatmentOptionsforUnrupturedBrain
AVM..................................... 12
2.2 SelectedPapersontheNaturalHistoryof
UnrupturedbAVM ........................ 8 2.4.1 Embolization.............................. 14
2.4.2 Radiosurgery.............................. 14
2.2.1 ComparingFutureRiskofICHforUnruptured 2.4.3 SurgerywithorwithoutPlannedPreoperative
bAVM..................................... 9 Embolization.............................. 15
2.2.2 FactorsthatImpactontheRiskofFirstICH..... 10 2.4.4 ResultsofSurgery.......................... 19
2.2.3 TheExpectedOutcomefrombAVMICH ....... 11 2.4.5 CombinedTreatment....................... 20
2.2.4 UnderstandingtheCauseforICHAssociated 2.4.6 ConclusionRegardingTreatment............. 20
withbAVM................................ 11
2.3 SelectedPapersontheTreatmentOptions
forUnrupturedBrainAVM................. 12
3. NaturalHistoryandSurgicalManagementofSpontaneousIntracerebralHemorrhage.. 25
JonathanRychenandDavidBervini
3.1 Introduction.............................. 25 3.4 NaturalHistoryofSpontaneous
SupratentorialICH........................ 28
3.2 SelectedPapersontheNaturalHistoryof
SpontaneousICHs......................... 25 3.5 NaturalHistoryofSpontaneous
InfratentorialICH......................... 29
3.3 NaturalHistoryofSpontaneous
ICHs...................................... 26 3.6 SelectedPapersonSurgicalManagementof
SpontaneousICHs ........................ 29
vii
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Contents
3.7 SurgicalManagementOptionsfor 3.11 MedicalManagementofSpontaneousICH.. 31
SpontaneousICHs ........................ 29
3.12 Authors’Recommendations................ 32
3.8 SurgicalManagementofSpontaneous
SupratentorialICH........................ 30 3.12.1 MedicalManagementofSpontaneous
ICH....................................... 32
3.9 SurgicalManagementofSpontaneous 3.12.2 ManagementofSupratentorialHemorrhage.... 32
InfratentorialICH......................... 31 3.12.3 ManagementofInfratentorialHemorrhage..... 32
3.12.4 ManagementofIntraventricularHemorrhage... 32
3.10 SurgicalManagementforSpontaneousICH
AssociatedwithIntraventricular
Hemorrhage ............................. 31
4. NaturalHistoryandManagementOptionsofPinealCyst .................................... 35
MichaelJ.MulcahyandBehzadEftekhar
4.1 Introduction.............................. 35 4.4 SelectedPapersontheTreatmentOptions
forPinealCyst ............................ 37
4.2 SelectedPapersontheNaturalHistoryof
PinealCyst............................... 36 4.5 TreatmentOptionsforPinealCysts......... 37
4.3 NaturalHistory........................... 36 4.6 Authors’Recommendations................ 37
5. NaturalHistoryandManagementOptionsofColloidCysts.................................. 40
AntheaH.O’Neill,CristianGragnaniello,andLeonT.Lai
5.1 Introduction.............................. 40 5.5 SelectedPapersontheTreatmentOutcomes
ofColloidCysts............................ 42
5.2 SelectedPapersontheNaturalHistoryof
ColloidCysts ............................. 40 5.6 TreatmentOptions........................ 42
5.3 NaturalHistoryofColloidCysts............ 40 5.7 Authors’Recommendations................ 43
5.4 PredictingtheRiskofSuddenDeath....... 42
6. NaturalHistoryandManagementOptionsofVestibularSchwannomas.................... 46
JordanJones,AndrewH.Kaye,andAndrewMorokoff
6.1 Introduction.............................. 46 6.5 Treatment ................................ 48
6.2 SelectedPapersonNaturalHistory ........ 46 6.5.1 Microsurgery .............................. 48
6.5.2 StereotacticRadiosurgery.................... 49
6.3 NaturalHistory........................... 47 6.5.3 MicrosurgeryandStereotacticRadiosurgery.... 50
6.5.4 NeurofibromatosisType2.................... 50
6.3.1 RateofGrowth ............................ 47
6.3.2 RiskFactorsforGrowth..................... 47 6.6 Authors’Recommendations................ 50
6.3.3 GrowthinNeurofibromatosisType2Vestibular
Schwannomas............................. 48
6.4 SelectedPapersonTreatment............. 48
7. NaturalHistoryandManagementOptionsofAcromegaly................................... 53
MendelCastle-KirszbaumandTonyGoldschlager
7.1 Introduction.............................. 53 7.2 Pathology ................................ 53
viii
