World Neurosurg
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Case Reports
Prolactin-Secreting Pituitary Carcinoma with Dural Metastasis: Diagnosis, Treatment, and Future Directions.
Pituitary carcinoma is extremely rare, representing approximately 0.2% of all surgically resected pituitary neoplasms. It is thought to arise from World Health Organization grade II (atypical) pituitary adenomas. Pituitary carcinoma is defined by metastasis; it is otherwise indistinguishable from atypical pituitary adenomas, which can be considered carcinoma in situ. Pituitary carcinoma is difficult to diagnose and treat and is associated with poor long-term outcomes. ⋯ Long-term surveillance using serum prolactin as a tumor biomarker and correlation to imaging studies were critical for the diagnosis and interval screening for recurrence. This technique can be applied to all secretory atypical pituitary adenomas to improve early detection of potential metastasis. Further research, especially of genetic and epigenetic characteristics, could readily improve the diagnosis and treatment of pituitary carcinomas.
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Review Case Reports
Fulminant vasculitis associated with extracranial dissections and occlusion, ischemic strokes, and aneurysm rupture: Case report and review of the literature.
Central nervous system vasculitis has multiple presentations, including stroke, seizures, cranial nerve palsies, and encephalopathy. ⋯ Fulminant central nervous system vasculitis can occur with critical vascular anomalies that require emergent intervention and should be part of the differential diagnosis of patients presenting with these multiple vascular pathologies.
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Multicenter Study
Coma and stroke following surgical treatment of unruptured intracranial aneurysm: an ACS-NSQIP study.
A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. ⋯ Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates.
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Spontaneous intracranial hypotension (SIH) is a well-known, but under- or misdiagnosed, condition caused by cerebrospinal fluid leak resulting from idiopathic dural breach. Blind lumbar epidural blood patch is an effective treatment in most cases, but occasionally, even targeted epidural blood patch fails to lead to improvement. In these cases, the cerebrospinal fluid leak is usually repaired surgically, especially for large dural breaches (>5 mm), once the site has been identified by imaging techniques (magnetic resonance myelography/computed tomography [CT] myelography/isotopic transit). ⋯ We report 2 cases with good technical and clinical outcome after 1 and 8 years of follow-up (clinical evaluation and brain imaging control by CT). The technique we describe here is of high interest in refractory SIH or for the serious form of the disease, before considering surgical repair. Further prospective studies are required to provide general guidelines in treatment options for patients with SIH.
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Multicenter Study
A multicenter analysis of CT angiography alone versus digital subtraction angiography for surgical treatment of poor-grade aneurysmal subarachnoid hemorrhage.
Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with increased intracranial pressure, and these patients are unstable with a high risk of rebleeding. Computed tomography angiography (CTA) has been proposed as an examination tool for the rapid detection of ruptured aneurysms. We aimed to determine the safety and efficacy of CTA alone for surgical treatment of poor-grade aSAH compared with digital subtraction angiography (DSA). ⋯ Although CTA alone can be safely and effectively used in most patients requiring surgical treatment, additional DSA may be considered in patients with smaller ruptured aneurysms or in those with multiple aneurysms.