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January 1991

Is Radiosurgery All That It Appears to Be?-Reply

Author Affiliations

Department of Neurological Surgery University of Pittsburgh School of Medicine Presbyterian University Hospital Room 9402 230 Lothrup St Pittsburgh, PA 15213

Arch Neurol. 1991;48(1):20. doi:10.1001/archneur.1991.00530130027012

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In Reply.  —The response to our publication that appeared in the February 1990 issue of the Archives is most interesting. The goal of surgical treatment of vascular malformations, whether by microsurgery or by radiosurgery, is the same: total obliteration of an arteriovenous malformation (AVM) with preservation of neurological function, ultimately leading to the elimination of the risk of bleeding. The relative recent availability of radiosurgical techniques in the United States has led to a widespread evaluation of single-fraction, highly focused photon irradiation of AVM that is deemed unsuitable for conventional microsurgical removal. The great risk in radiosurgery (as opposed to microsurgery) is that during the treatment the patient feels nothing and the doctor sees nothing. No physician team involved in radiosurgery should be beguiled by this feature, as the benefits of radiosurgery and the risks do not accrue until later.Dr Stein indicates that in the past 10 years, he

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