Comparison of traditional 2-dimensional endoscopic pituitary surgery with new 3-dimensional endoscopic technology: intraoperative and early postoperative factors.

BACKGROUND: Traditionally, endoscopic transsphenoidal pituitary surgery is performed using 2-dimensional (2D) endoscopes, which lack depth of field and contribute to image distortion. Recently, a new generation of 3D endoscopes has been introduced for improved endoscopic depth perception. Little data exist comparing surgical outcomes with 2D vs 3D endoscopic systems. This study examines perioperative and postoperative factors in patients undergoing pituitary surgery using 2D vs 3D endoscopes. The objective of this work was to determine the differences in perioperative and postoperative factors in patients undergoing pituitary surgery using 2D vs 3D endoscopy. METHODS: Retrospective chart review at a tertiary academic referral center. Statistical comparison was undertaken for perioperative (estimated blood loss, operative time) and postoperative factors (length of stay, complications, and readmission rate). RESULTS: A total of 58 patients underwent endoscopic pituitary surgery during the 24-month study period (22 functional, 36 nonfunctional lesions). The 2D endoscopic system was used for pituitary tumor resection in 32 patients (55%), and the 3D endoscopic system in 26 patients (45%). No significant difference existed between 2D and 3D endoscopic systems for operative time (p = 0.275) or estimated blood loss (p = 0.312). Additionally, no difference was found between groups for cerebrospinal fluid (CSF) leak rate (p = 0.581), postoperative endocrine complications (p = 0.081), length of hospital stay (p = 0.934), or hospital readmission rate (p = 1.0). CONCLUSION: 3D endoscopy affords the surgeon improved depth of field and stereoscopic vision. Our data demonstrate that 3D endoscopy does not result in significantly different perioperative or postoperative outcomes vs 2D endoscopic surgery.

Management of traumatic cervical spondyloptosis in a neurologically intact patient: case report.

STUDY DESIGN: Case report. OBJECTIVE: To review the management of a neurologically intact patient with complete cervical spondyloptosis with particular attention to the role and timing of closed preoperative cervical traction and subsequent stabilization. SUMMARY OF BACKGROUND DATA: Traumatic cervical spondyloptosis is typically associated with complete and irreversible spinal cord injury. In these patients, cervical traction can be implemented to restore anatomic alignment in preparation for stabilization with minimal consequence. When a patient presents neurologically intact, the management becomes more complicated. Preservation of function and restoration of anatomic alignment collectively represent the goals of therapy. The current literature does not clearly define the role of cervical traction in such cases. METHODS: A patient with traumatic cervical spondyloptosis at the C7-T1 level presented to our institution and was found to be neurologically intact. Computed tomography demonstrated complete spondyloptosis with multiple fractures through the posterior elements. RESULTS: The spondyloptosis was reduced with closed cervical traction and underwent anterior and posterior instrumented stabilization. No new deficit occurred in the patient after reduction. CONCLUSION: Fractures of the posterior elements functionally decompress the spinal canal and thereby allow for cervical traction to be safely implemented in patients with spondyloptosis. Safe restoration of anatomic alignment in the neurologically intact spondyloptotic patient is crucial to minimize the extent of surgical stabilization and create a long-term stable construct of the fracture dislocation.

NARG2 encodes a novel nuclear protein with (S/T)PXX motifs that is expressed during development.

We previously identified a partial expressed sequence tag clone corresponding to NARG2 in a screen for genes that are expressed in developing neurons and misexpressed in transgenic mice that lack functional N-methyl-d-aspartate receptors. Here we report the first characterization of the mouse and human NARG2 genes, cDNAs and the proteins that they encode. Mouse and human NARG2 consist of 988 and 982 amino acids, respectively, and share 74% identity. NARG2 does not display significant homology to other known genes, and lower organisms such as Saccharomyces cerevisiae, Drosophila melanogaster and Fugu rubripes appear to lack NARG2 orthologs. In vitro translation of the mouse cDNA yields a 150 kDa protein. NARG2 localizes to the nucleus in transfected cells, and deletion of a canonical basic nuclear localization signal suggests that this and other sequences in the protein cooperate for nuclear targeting. NARG2 consists of 16 exons in both mice and humans, 11 of which are identical in length, and alternative splicing is evident in both species. Exon 10 is the largest, and exhibits a much higher rate of nonsynonymous nucleotide substitution than the others. In addition, NARG2 contains (S/T)PXX motifs (11 in mouse NARG2, six in human NARG2). Northern blot analysis and RNase protection demonstrated that NARG2 is expressed at relatively high levels in dividing and immature cells, and that it is down-regulated upon terminal differentiation. The results indicate that NARG2 encodes a novel (S/T)PXX motif-containing nuclear protein, and suggest that NARG2 may play an important role in the early development of a number of different cell types.