Dear Colleagues,

The supplemental issues of Surgical Neurology International bring cutting-edge articles that are not in the main stream of neurosurgery, or the medical practice at large. They bring novel approaches to diseases deemed without solution by the majority of the medical practitioners, and even specialists in the field of these diseases. We call attention to recent articles from SNI: Stereotactic highlighting this concept. If you would like to submit your own manuscript, please click here.

Tinnitus: Is there a place for brain stimulation?
By Gusta van Zwieten, Jasper V. Smit, Ali Jahanshahi, Yasin Temel, Robert J. Stokroos

The authors belonging to Departments of Ear Nose and Throat/Head and Neck Surgery and Neurosurgery at the Maastricht University Medical Center make a call for Neurosurgeons to help with this terrible afflictive problem for patients. The ENT doctors without means to help their patients, as this suicidal leading symptom for many, is out of the realm of their specialty, ask Functional Neurosurgeons to step in to find a solution for this central brain established disease. Several suggestions of targets for interventions are proposed, all of them in need of careful studies. The reader will find this article inspiring for research projects, as well as for the understanding of the human hearing physiology.

Camptocormia and deep brain stimulation: The interesting overlapping etiologies and the therapeutic role of subthalamic nucleus-deep brain stimulation in Parkinson disease with camptocormia
By Hakan Ekmekci, Hulagu Kaptan

Here, a Neurologist and a Neurosurgeon from Departments of Neurology and Neurosurgery, School of Medicine, Selçuk University, Konya, Turkey, helped a patient with this totally disabling disease, prone to generate spinal pathologies. They call attention to a widely and universally accepted functional neurosurgery procedure that can help patients with camptocormia. They review the literature and provide directions for Functional Neurosurgeons on how to manage and grade this disease. Although well known by Neurologists and Neurosurgeons, Orthopedic Surgeons and Family Medicine specialists -- who are largely seeing these patients -- need to learn that with proper referrals, their patients can have a life-changing medical intervention.

Treatment of epidermoid tumors with gamma knife radiosurgery: Case series
By Javier A. Jacobo Vasquez, Julio R. Fonnegra, Juan C. Diez, Andres Fonnegra

This important series from the Institute of Neuroscience at El Bosque University,
Department of Neurosurgery, Shaio Clinic, Bogota, Colombia, discloses in this timely article that recurrent epidermoid tumors can be controlled long-term with adjuvant radiosurgery. They show that the recurrence rate in these tumors operated on by experienced surgeons reaches the level of over 10% when extended follow-up is reported. Moreover, they also show that durable control of these indolent tumors can be achieved with relatively low-dose radiosurgery using the Gamma Knife. There is also durable improvement of cranial nerve dysfunction when using their approach. It is not widely known that stereotactic radiosurgery controls this rare tumor. The effect of radiosurgery in the epidermoid tissue is expected, as this histology responds well to radiation.

Radiotherapy-induced tumors of the spine, peripheral nerve, and spinal cord: Case report and literature review
By Asdrubal Falavigna, Pedro Guarise da Silva, William Teixeira

At an age when large fields of radiotherapy are less and less acceptable due to harmful secondary effects, and side effects on cognition for whole brain radiation (WBRT). Radiosurgery has successfully shown that WBRT is no longer routine because of the persistent goal of Stereotactic Surgeons to protect normal brain matter. The same is happening when radiating the spine; stereotactic radiosurgery of the spine (SRS-spine) mitigates the side effects on the esophagus, heart and intestines. Again, we are convincing the Radiation Oncologists to improve their radiation delivery. The Brazilian group from the Cell Therapy and Basic Models of Spinal Disorders Laboratory at the University of Caxias do Sul, RS, together with the Departments of Neurosurgery and AOSpine, Latin America, and Institute of Cancer of the State of São Paulo, SP, present a timely review of nerve sheath tumors induced by conventional techniques of radiation therapy. This is a stimulus for neurosurgeons to demand stereotactic techniques of radiation when adjuvant radiation is necessary for their patients.

Adaptive hypofractionated gamma knife radiosurgery for a large brainstem metastasis
By Georges Sinclair, Jiri Bartek Jr., Heather Martin, Pierre Barsoum, Ernest Dodoo

The authors from the Karolinska University, Sweden, where the Gamma Knife was conceived, and from Copenhagen University Hospital, Denmark, describe an ingenuous use of a technique to treat large lung metastasis in the brainstem, setting parameters for adaptive radiosurgery. The detailed account of the technique can be followed to help patients with this inoperable disease, unresponsive to conventional radiation therapy and other forms of radiosurgery. A landmark description of radiosurgery application.

Radiosurgery for symptomatic cavernous malformations: A multi-institutional retrospective study in Japan
Yoshihisa Kida, Toshinori Hasegawa, Yoshiyasu Iwai, Takashi Shuto, Manabu Satoh, Takeshi Kondoh, Motohiro Hayashi

This important contribution of the multicentric study organized by the Scientific Committee of the Japanese Gamma Knife Society settles once and for all the place of radiosurgery on the treatment of inoperable cavernous angiomas. They show unequivocally that the repetitive bleeding rate of these lesions decreases over time with radiosurgery. The moderate and precise dose delivery achieved with the Gamma Knife avoids complications and maximizes the beneficial effects when reaching exquisitely the micro-capillarity forming the angioma. The large number of cases presented by this multi-institutional effort permits convincible statistics that patients with inoperable cavernous angiomas should undergo Gamma Knife Surgery.

Antonio De Salles, M.D., Ph.D.
Editor - SNI: Stereotactic
Professor of Neurosurgery
Professor of Radiation Oncology
University of California, Los Angeles, CA
Head, HCor Neuroscience, Sao Paulo Brazil


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