Neurosurgery
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Pituitary tumors and associated neuroendocrine disorders pose significant challenges in diagnostic and therapeutic management. Optimal care of the "pituitary patient" is best provided in a multidisciplinary collaborative environment that includes not only experienced pituitary practitioners in neurosurgery and endocrinology, but also in otorhinolaryngological surgery, radiation oncology, medical oncology, neuro-ophthalmology, diagnostic and interventional neuroradiology, and neuropathology. ⋯ We propose that pituitary centers of excellence should fulfill 3 key missions: (1) provide comprehensive care and support to patients with pituitary disorders; (2) provide residency training, fellowship training, and/or continuing medical education in the management of pituitary and neuroendocrine disease; and (3) contribute to research in pituitary disorders. As this is a preliminary proposal, we recognize several issues that warrant further consideration including center and surgeon practice volume as well as oversight of the verification process.
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Multicenter Study
Meningiomas in pregnancy: a clinicopathologic study of 17 cases.
Dramatic growth of meningiomas is occasionally encountered during pregnancy. While cell proliferation is often assumed, hemodynamic changes have also been touted as a cause. ⋯ Our series suggests that pregnancy-associated meningiomas located in the skull base are likely to require surgical intervention for visual complaints and cranial nerve palsies. The rapid tumor growth is more often due to potentially reversible hemodynamic changes rather than hormone-induced cellular proliferation.
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Atlas occipitalization and congenital C2-3 fusion often result in atlantoaxial dislocation (AAD) and superior odontoid migration that requires occipitocervical fixation. The widely used technique is posterior occiput-C2 fixation with pedicle screws. However, congenital C2-3 fusion cases tend to have thinner C2 pedicles that are inadequate for normal-sized pedicle screw fixation. With the presence of AAD, the strength of the fixation is further compromised as the C2 pedicle screws (C2PS) sustain considerable cephalic shearing force during the reduction procedure. Therefore, a novel technique has been developed to augment the C2 pedicle screw fixation with a strengthening cable. ⋯ This technique is a promising option for the treatment of AAD with congenital C2-3 fusion and occipitalization. Biomechanically, this technique can reduce the occipital-axial motion significantly compared with occiput-C2 fixation.