Osteotomy design and execution.

Craniofacial osteotomies are an integral part of contemporary neurosurgery because of their ability to provide substantially more exposure to deepseated lesions with reduced brain retraction. A systematic approach to the performance of these osteotomies coupled with meticulous bone work capitalizes on their advantages without producing any significant cosmetic defects. As their indications are progressively more clearly defined and familiarity and facility are gained by the surgeons performing them, operative time and morbidity should decrease. Lowering operative time and morbidity with excellent esthetic results is likely to be increasingly important when considering operative versus nonoperative management, particularly as nonsurgical modalities continue to develop.

Cosmetic considerations in cranial base surgery.

Recent advances in the surgical techniques for the resection of cranial base tumors have allowed for improved degrees of tumor resection, functional outcomes, and esthetic results. If the resection and functional results are not compromised by procedures providing excellent cosmetic outcomes, there is no reason to ignore or compromise the esthetic aspect with regard to technical execution and planning. A thorough assessment of the patient's preoperative deficits and tumor anatomy and a working knowledge of the available cranial base approaches and their combinations permit the surgeon to design an approach that allows for optimal tumor resection with the best possible cosmetic result. In a time when alternative treatment options like radiosurgery exist for cranial base tumors, esthetic outcome is a significant quality-of-life issue that patients consider in their decision to choose surgery versus an alternative treatment.

Atypical pituitary adenoma with neurocytic transformation.

Here, we report an example of an atypical prolactin-producing pituitary adenoma showing clear morphologic and immunohistochemical evidence of neurocytic transformation. Its features support the concept that neoplastic neuroendocrine cells, in this case adenohypophyseal cells, are capable of neuronal differentiation and broaden the morphologic spectrum of such rare tumors. Our findings have implications with respect to the nosology of neuronal tumors of the adenohypophysis.