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
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.
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Journal of neurosurgery · Feb 2002
Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products.
The mechanisms involved in brain edema formation following intracerebral hemorrhage (ICH) have not been fully elucidated. The authors have found that red blood cell lysis plays an important role in edema development after ICH. In the present study, they sought to determine whether degradation products of hemoglobin cause brain edema. ⋯ Hemoglobin causes brain edema, at least in part, through its degradation products. Limiting hemoglobin degradation coupled with the use of iron chelators may be a novel therapeutic approach to limit brain edema after ICH.
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Journal of neurosurgery · Feb 2002
Evaluation of the healing process after dural reconstruction achieved using a free fascial graft.
This study was undertaken to investigate the healing process and to delineate factors important for the survival of free fascial grafts used for dural repair. ⋯ Fascial grafts tolerated extraordinary intracranial pressures at 1 week postoperatively. Free fascial grafts can heal with durable fibrous tissue without the presence of a blood supply from an overlying vascularized flap.
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Journal of neurosurgery · Jan 2002
Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm?
The authors assessed the efficacy and outcomes of lumbar microdiscectomy performed on an outpatient basis by administering six questionnaires before and at five time points after surgery. The results were compared with those reported in literature in which the success rates vary between 70% and 80% and in excess of 90%. The authors use the methodology and data derived from their study to evaluate critically the relevance of these two categories of success rates. ⋯ The findings of this study support the evidence that lumbar microdiscectomy performed on an outpatient basis is a very safe and effective means of treating sciatic pain due to disc herniation. The authors believe that their outcome success rates of 75 to 80% are more realistic than those of 90% or more found in some reports.