Prolactin-secreting pituitary adenomas: neurosurgical management of 37 patients.

Transsphenoidal exploration was performed on 37 patients with hyperprolactinemia and a sellar polytomographic picture consistent with an adenoma. Twenty-two patients were found to have a microadenoma, and 14 were found to have macroadenomas. In one patient who had recently received bromocriptine, no tumor was found. Seventy-two percent of patients with microadenomas had complete resolution of all signs and symptoms; only 35% of the patients with macroadenoma were cured. There was no mortality and minimal morbidity. Seventy-five percent of those patients who desired pregnancy delivered normal children. Transsphenoidal resection is a safe and effective therapeutic modality. The present diagnostic tests and therapeutic management of these patients at our institution is the subject of this report.

Multiple secreting microadenomas as a possible cause of selective transsphenoidal adenomectomy failure. Case report.

Approximately 10% to 20% of patients who undergo selective transsphenoidal removal of secreting microadenomas fail to achieve a cure. One of the possible causes of these failures is multiple adenomas. A case history is presented of two microadenomas within the same gland, and the multiplicity of pituitary adenomas is discussed.

Use of metrizamide in computerized tomography to diagnose the Chiari I malformation.

To properly diagnose and treat the Chiari I malformation, it is necessary to know: 1) the position of the cerebellar tonsils; 2) the degree of compression of the upper cervical cord and medulla; 3) the status of the spinal cord, particularly whether a syringohydromyelic condition exists; 4) whether basal arachnoiditis is present; 5) the nature of the communication between the fourth ventricle and the subarachnoid space; and 6) the overall ventricular size. The use of computerized tomography (CT) alone is not sufficient to furnish all of this information. The addition of metrizamide to the CT study enables the exact delineation of the basic pathology of the Chiari I malformation and its associated complications. A total of seven patients with surgically proven Chiari I malformation were included in this study. In all of these cases, CT with metrizamide was the essential diagnostic procedure. Plain films appear to be necessary only to facilitate the diagnosis of an associated Klippel-Feil syndrome or scoliosis.

Delayed myelopathy secondary to retained intraspinal metallic fragment. Case report.

The authors present a case of delayed myelopathy arising 8 years after a stab wound to the thoracic spine, with intradural retention of the knife tip. Following removal of the knife tip, the patient had a good recovery. A review of the literature documents eight additional cases of delayed myelopathy secondary to retained fragments from spinal stab wounds.

Immunobiology of primary intracranial tumors. Part 3: Microcytotoxicity assays of specific immune responses of brain tumor patients.

Fifty-six in vitro microcytotoxicity assays were conducted on 30 patients with intracranial tumors at various times during the postoperative course. Significant specific cellular cytotoxic responses were found in nine of 56 assays, humoral cytotoxic responses in nine of 54 assays, and host effector cell-dependent, antibody-dependent cytotoxic responses in four of 28 assays. Variables that might influence the occurrence of cytotoxicity were studied, and the relationship of these findings to other immune parameters was discussed.

Magnetic resonance imaging in childhood intracranial masses.

Magnetic Resonance Imaging (MRI) was compared with computerized tomography (CT) in 40 pediatric and adolescent patients with intracranial mass lesions as part of an ongoing project to determine the potential of MRI as a primary and definitive imaging modality. Multiplanar, multisequence MRI surpassed CT in providing mass localization, extent of involvement, and delineating the relationship to adjacent vital structures. Further development of MRI is encouraged to overcome current inconsistencies in pathologic characterization in order for this new technology to be employed not only as a primary screening modality but also as a definitive diagnostic test.

Spinal subdural empyema: diagnosis by spinal computed tomography.

The authors describe the use of metrizamide spinal computed tomography scan to delineate the surgical extent of spinal subdural empyema in a 65-year-old diabetic female.

Scalp marking of intracranial lesions using computed tomography (CT) images. A technical note.

A technique for scalp marking using computed tomography (CT) images is described. A reference marker is placed on the scalp and a plain lateral skull film is obtained. Using the CT scan image and the CT scout film, the target is marked on the plain skull film. The distance and angle of the target from the reference point on the plain film are measured and marked on the scalp to indicate the location of the target.

Immunobiology of primary intracranial tumours. II. Analysis of lymphocyte subpopulations in patients with primary brain tumours.

Circulating peripheral blood lymphocyte subpopulations were analysed in patients with primary intracranial neoplasia. Patients with tumours of glial origin demonstrated a significant depletion of E-rosetting lymphocytes whereas the quantitative lymphocyte profiles of patients with non-glial brain tumours were normal. The number of immunoglobulin and Fe receptor-bearing cells was not significantly altered in any group of patients: however, the EAC-RFC subpopulation was increased in those with malignant gliomas. Two hypotheses are suggested to explain these observations: first, the presence of cross-reacting antibody between T cells and brain (glial) cells, and secondly, the proliferation of EAC-RFC in response to malignant degeneration.

Electromagnetic field focusing (EFF) probe in aneurysm thrombosis. Preliminary report.

Due to its capability of producing a well localized intense heat field of predictable dimensions, the electromagnetic field focusing probe was evaluated experimentally as a surgical tool in aneurysm thrombosis. Aneurysm models were created by anastomosing a segment of vein to the abdominal aorta. Seventy-five such aneurysms were created in seventy-five animals. The aneurysms were then placed under the solenoidal radiofrequency coil and the tip of the field focusing probe was inserted into them. Intense heat was delivered with well defined, effective and quick thrombosis and shrinkage of the aneurysm. Nineteen of the aneurysms were followed for up to one week. Histological studies were conducted showing complete thrombosis of the aneurysm with good preservation of the aorta. With further refinement of this technique, it is hoped that stereotaxic aneurysm thrombosis might be possible.

Hydronephrosis in the asymptomatic neonate with myelodysplasia.

Early diagnosis and intervention in the child with myelodysplasia can effectively improve and preserve renal function in those newborns presenting with abnormalities at birth or who are at risk for deterioration of renal function from infection, vesicoureteral reflux and/or obstruction. During a 1-year period 10 newborns with myelodysplasia were seen. Hydronephrosis was present in 6, reflux in 3 and urinary tract infection in 3. In each newborn adequate decompression of the bladder and complete resolution of the hydronephrosis were achieved. Uroradiographic evaluation was helpful in determining the best mode of therapy for each individual.

Closure of thoracic and lumbar dysgraphic defects using bilateral latissimus dorsi myocutaneous flap transfer with extended gluteal fasciocutaneous flaps.

The latissimus dorsi-gluteal myofasciocutaneous flap has been successfully employed in closure of 6 large thoracolumbar myelomeningoceles in newborn infants. Good wound healing was attained in all cases. The technique of flap mobilization and closure is outlined and possible pitfalls are explained.