Unilateral autoregulation failure was seen in patients who developed DCI (worse ipsilateral to the ischemic hemisphere). Bilateral autoregulation failure was seen more frequently in patients with unfavorable outcome. Analysis of the temporal profile showed unilateral dysautoregulation as the primary event predisposing to DCI, which in selected cases led to bilateral failure and unfavorable outcomes.

Molecular biological insights have led to a fundamental understanding of the underlying genomic mechanisms of nervous system disease. These findings have resulted in the identification of therapeutic genes that can be packaged in viral capsids for the treatment of a variety of neurological conditions, including neurodegenerative, metabolic, and enzyme deficiency disorders. Recent data have demonstrated that gene-carrying viral vectors (most often adeno-associated viruses) can be effectively distributed by convection-enhanced delivery (CED) in a safe, reliable, targeted, and homogeneous manner across the blood-brain barrier. Critically, these vectors can be monitored using real-time MRI of a co-infused surrogate tracer to accurately predict vector distribution and transgene expression at the perfused site. The unique properties of CED of adeno-associated virus vectors allow for cell-specific transgene manipulation of the infused anatomical site and/or widespread interconnected sites via antero- and/or retrograde transport. The authors review the convective properties of viral vectors, associated technology, and clinical applications.

Objective According to the literature, gamma knife surgery (GKS) is a promising method for intracanalicular vestibular schwannoma (IVS) management, providing excellent tumor growth control rates (91%‐100%) and good hearing preservation rates (41%‐76%), but this evidence originates primarily from a small series of patients. The aim of this study was to present the outcomes of GKS in the largest group of patients with IVS studied to date, with particular emphasis on the long‐term outcomes of treatment. Methods The study included 136 consecutive patients with unilateral IVS, who underwent GKS in 2011‐2015. Mean age of the patients was 54 ± 12.6 years. All patients were operated on with a 192‐source cobalt‐60 gamma knife unit. All patients had complete follow‐up documentation and the mean duration of the follow‐up was 52 ± 13.8 months (6‐83 months). Neurological status (facial and trigeminal nerve), hearing and instability/dizziness presence were determined prior to GKS, immediately after the procedure, and during the follow‐up visits. Results Tumor growth control was obtained in 124/136 (~91.2%) patients. Hearing improvement was observed in 32/136 (23.5%) patients, and there was a distinct cluster of 9 patients (6.6%) regaining serviceable hearing after GKS, whereas in 36 patients (26.5%) was stable. Four patients developed facial nerve dysfunction, including 3 periodic hemifacial spasm and 1 partial paresis, which resolved spontaneously within 12 months of GKS. None of the operated patients showed new, debilitating neurological deficits, including trigeminal sensory disturbances or hydrocephalus. Conclusions GKS is a highly effective treatment for IVS, associated with low morbidity and good tumor growth control.

Aim of the studyOne of the alternative methods of surgical treatment of vestibular schwannoma is Gamma Knife radiosurgery. The purpose of this metaanalysis was to analyze the progress in treatment of vestibular schwannoma using Gamma Knife radiosurgery based on data in the literature of the last five years.Material and methodsIn the collected English-language literature from the years 2007–2011, contained in 20 scientific journals, clinical articles of many years study at a single center were extracted and also review papers and case reports. The main criteria of our own analysis were: patient age, tumor size, the dose in Gy, the time from surgery to follow-up, the degree of tumor growth inhibition, and hearing preservation. For statistical calculations comparing series of studies we used nonparametric analysis of variance and tests at the significance level of p > 0.05.ResultsThe 46 evaluated clinical articles show the results of studies over many years. A comparison of the results of the analysis made on the basis of papers published in the period 1998-2007 with the results of the current series from the period 2007–2011 allowed us to establish that the average dose applied to the periphery of the tumor was lower (12.4 Gy) than in the earlier series of 1998–2007 (14.2 Gy), and hearing preservation was higher (66.45% vs. 51.0%).ConclusionsClinical findings widely documented in the literature over the past five years indicate the progress in treatment of vestibular schwannoma using Gamma Knife radiosurgery.