Radiosurgical case presentations (Cases R-1 to R-11)
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Springer-Verlag Wien GmbH
Univ.-Prof. Dr. Hans-jakob Steiger Priv.-Doz. Dr. Robert Schmid-Elsaesser Dr. Alexander Muacevic Univ.-Prof. Dr. Hartmut BrOckmann Priv.-Doz. Dr. Berndt Wowra Ludwig-Maximilians-University, Klinikum Gro&hadem and Gamma Knife Center, Munich, Germany
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© 2002 Springer-Verlag Wien Originally published by Springer-Verlag Wien New York in 2002 Product Liability: The publisher can give no guarantee for aII the information contained in this book. This does also refer to information about drug dosage and application thereof. In every individual case the respective user must check its accuracy by consulting other pharmaceuticalliterature. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Typesetting: Asco Typesetters, Hong Kong Printed on acid-free and chlorine-free bleached paper SPIN: 10758859
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ISBN 978-3-7091-6163-0 (eBook) ISBN 978-3-7091-7276-6 DOI 10.1007/978-3-7091-6163-0
Preface Arteriovenous malformations (AVM) and arteriovenous fistulas (AVF) differ from all other pathology affecting the central nervous system by their highflow arteriovenous shunts. Permanent occlusion of these shunts is the essence and the challenge of therapy. Much progress has been made since the first neurosurgical efforts to deal with these problems. Endovascular therapy and radiosurgery became accepted alternatives or adjuncts to surgery. In many instances the choice of the primary therapeutic modality is not clear and arguments can be found for several options. However, microsurgery, endovascular therapy and radiosurgery differ very much with regard to invasiveness, length of stay at the hospital but also residual risk after therapy. These secondary factors are often decisive for the choice of treatment modality. The continuous interdisciplinary discussions motivated ongoing improvement of all therapeutic modalities. Each specialty tried to reduce its specific shortcomings, that is treatment morbidity for microsurgery and insufficient effect for radiosurgery and endovascular therapy. The resulting quality culture had the consequence that each specialty limited the indications to the spectrum of pathology that appeared safely amenable to the possibilities of the method. In addition, combination of the different methods enlarged the spectrum of curable malformations. The emerging treatment concepts are the object of this book. Description of the surgical method focuses therefore on lower Spetzler & Marti n grades and not on the very large and critically located lesions, which can only occasional
