Journal of neurosurgery
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Journal of neurosurgery · Feb 2002
The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery.
Pituitary adenomas are considered benign tumors; however, they may infiltrate surrounding tissues including the dura mater. In this paper the authors analyze the clinical significance of microscopically confirmed dural invasion by comparing a range of variables (age and sex of patients, adenoma type, adenoma size on magnetic resonance [MR] images, remission, residual pituitary disease, recurrence, survival, and disease-free interval after surgery) between patients with noninvasive adenomas and those with invasive ones. ⋯ The principal significance of dural invasion by pituitary adenoma is the persistence of tumor tissue after transsphenoidal surgery (incomplete adenomectomy; 20% in primary pituitary tumor resections). The increase in adenoma size with time and the concurrent development of dural invasion are the major factors that determine an incomplete adenomectomy. When the adenoma remains restricted to the sellar compartment or shows only moderate suprasellar extension, dural invasion may not yet have developed and conditions for complete selective adenomectomy are improved.
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Journal of neurosurgery · Feb 2002
Comparative StudyMeasurement of brain tissue oxygenation performed using positron emission tomography scanning to validate a novel monitoring method.
The benefits of measuring cerebral oxygenation in patients with brain injury are well accepted; however, jugular bulb oximetry, which is currently the most popular monitoring technique used has several shortcomings. The goal of this study was to validate the use of a new multiparameter sensor that measures brain tissue oxygenation and metabolism (Neurotrend) by comparing it with positron emission tomography (PET) scanning. ⋯ The lack of correlation between the absolute values of PbO2 and PvO2 indicates that PbO2 cannot be used as a substitute for PvO2. Nevertheless, the positive correlation between deltaPbO2 and deltaPvO2 when the sensor had been inserted into healthy brain suggests that tissue PO2 monitoring may provide a useful tool to assess the effect of therapeutic interventions in brain injury.
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Journal of neurosurgery · Feb 2002
Accuracy of transcranial color Doppler ultrasonography in the diagnosis of middle cerebral artery spasm determined by receiver operating characteristic analysis.
The value of transcranial Doppler ultrasonography for the detection of middle cerebral artery (MCA) spasm has been asserted. None of the published studies, however, has adequately scrutinized the overall diagnostic accuracy of this procedure. There are only sporadic reports concerning the utility of transcranial color Doppler (TCCD) ultrasonography, although this method has been proved to be more precise. In this study the authors attempted to estimate the performance of TCCD ultrasonography in detecting MCA narrowing by using receiver operating characteristic (ROC) curve analysis, based on TCCD studies obtained in a relatively large, randomly selected population of patients. ⋯ The performance of TCCD ultrasonography in the diagnosis of advanced MCA narrowing is very good, and is acceptable for all vasospasms. The best-performing parameter was peak systolic velocity.
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Journal of neurosurgery · Feb 2002
Case ReportsCerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery: a retrospective study.
Postoperative cerebellar hemorrhage as a complication of supratentorial surgery is an increasingly recognized clinical entity. So far, it has remained unclear whether this complication constitutes an intraoperative or postoperative event. The observation of such cases prompted the authors to analyze retrospectively their series of supratentorial craniotomies. The aim of this study was to determine the incidence of cerebellar hemorrhage and its temporal relationship to supratentorial surgery. ⋯ The authors have demonstrated that cerebellar hemorrhage as a complication of supratentorial surgery arises not as an intraoperative event, but as a postoperative event. Resective nontumorous temporal lobe procedures place patients at particular risk for this complication. Evidence suggests that the complication might be precipitated by postoperative suction drainage.
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Journal of neurosurgery · Feb 2002
Case ReportsFar-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle.
The goal of this study was to determine whether drilling out the occipital condyle facilitates surgery via the far-lateral approach by comparing data from 10 clinical cases with that from studies of eight cadaver heads. ⋯ On the basis of their findings the authors conclude that removal of the occipital condyle is not necessary for the safe and complete resection of anterior intradural foramen magnum tumors.