Ahead of Print: Evolution of Transoral Surgery

Background: Transoral surgery may be used to approachpathologies at the craniocervical junction.However, the requirement for this approach has decreased over the past few decades.

Objective: To assess the outcome and complications of transoral surgery and extended transoral approaches at a single UK center between 1980 and 2011.

Methods: Retrospective review of 495 ventral midline operations (between 1980-2004) and prospective review of 38 operations (2004-2011) in a total of 479 patients. Trends in surgery and factors associated with good or bad outcome were assessed over this 30-year period.

Ahead of Print: Spinal Pial (Type IV) Arteriovenous Fistulae

Background: Demographics, hemorrhage risk, and results of surgical and endovascular treatment of spinal pial (Type IV) arteriovenous fistulae (AVF) across a large patient group have not been previously reported.

Objective: To report demographics, hemorrhage rates, and treatment results for these AVF.

Methods: We performed a pooled analysis via the PubMed and Embase databases through November 2012. Individualized patient data were extracted and analyzed using Cox proportional hazards regression to obtain hazard ratios for hemorrhage risk factors and pooled for baseline demographics and treatment results.

Ahead of Print: Residual Fluorescence Value in Glioblastomas

Background: There is evidence in the literature that supports fluorescent tissue signal in fluorescence guided surgery (FGS) extends farther than tissue highlighted in T1Gd MRI, which is the standard to quantify the extent of resection (EOR).

Objective: To study whether the presence of residual fluorescent tissue after surgery carries a different prognosis for glioblastoma (GBM) cases with complete resection confirmed by MRI.

Methods: A retrospective review in our center found 118 consecutive patients with high-grade gliomas operated using 5-aminolevulinic acid (5-ALA) FGS. Within that series, the 52 patients with newly diagnosed GBM and complete resection of enhancing tumor (CRET) in early MRI were selected for analysis. We studied the influence of residual fluorescence in the surgical field on overall survival and neurological complication rate. Multivariate analysis included potential relevant factors: age, Karnofsky Performance Scale (KPS), MGMT methylation promoter status, tumor eloquent location, preoperative tumor volume, and adjuvant therapy.

Free Article: Radiosurgery to the Tumor Bed After Resection of Brain Metastases

Background: Optimal postoperative management paradigm for brain metastases remains controversial.

Objective: To conduct a systematic review of the literature to understand the role of postoperative stereotactic radiosurgery after resection of brain metastases.

Methods: We performed a MEDLINE search of the literature to identify series of patients with brain metastases treated with stereotactic radiosurgery after surgical resection. Outcomes including overall survival, local control, distant intracranial failure, and salvage therapy use were recorded. Patient, tumor, and treatment factors were correlated with outcomes through the use of the Pearson correlation and 2-way Student t test as appropriate.

Ahead of Print: Long-term Outcomes and Management Strategies for Central Neurocytoma

Background: A thorough investigation of the long-term outcomes of central neurocytoma (CN) after different treatments is required to establish optimal management strategies.

Objective: We retrospectively reviewed the long-term clinical outcomes of patients with CN according to various treatments, and suggest treatment strategies based on 30 years of experience in a single institution.

Methods: Fifty-eight consecutive patients with CN were treated at our institution between 1982 and 2008. Patient demographics, overall survival, local control rates according to multimodal treatments, and functional outcomes were evaluated. The mean clinical and radiological follow-up periods were 119 months (range, 18-304 months) and 98 months (range, 13-245 months), respectively.