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Michael L. Levy, Thomas C. Chen, and Martin H. Weiss

✓ A case report of monostotic fibrous dysplasia of the clivus in a postadolescent woman is described. Although fibrous dysplasia of craniofacial structures is well documented, involvement of the clivus has not been reported. Diagnosis by clinical, radiographic, and histopathological features is detailed. Implications for the role of surgery and management are discussed.

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Antibiotic neurotoxicity

Laboratory and clinical study

Martin H. Weiss, Theodore Kurze, and Frank E. Nulsen

✓ By ventriculocisternal perfusion, a series of newer antibiotics were circulated through the central nervous system to ascertain the potential toxicity of these drugs to the nervous parenchyma. Ampicillin, carbenicillin, gentamycin sulfate, and polymyxin B sulfate appear to be well tolerated whereas cephalexin monohydrate and penicillin G caused a repeated pattern of significant CSF pleocytosis, histological evidence of periventricular perivascular infiltrates, and evidence of clinical toxicity. A regime for treatment of central nervous system infections is presented, derived from the data presented above. Preliminary experience in a clinical series appears to support this program.

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Martin H. Weiss, Harold F. Young, and Dee E. McFarland

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William T. Couldwell, Parakrama T. Chandrasoma, and Martin H. Weiss

✓ A case of prostatic carcinoma metastasis to the pituitary gland is reported. The presentation and rarity of such a lesion is addressed. The literature review yielded only isolated case reports of symptomatic brain metastases unassociated with bone disease from adenocarcinoma of the prostate. The management options of such a lesion are discussed.

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Adrian L. Rabinowicz, Martin H. Weiss, and Christopher M. DeGiorgio

✓ The authors report the case of an individual who developed compulsive polydipsia following resection of a left sphenoidal ridge meningioma. The episodic, stereotyped nature of his symptoms, response to treatment, and electroencephalographic and magnetic resonance imaging findings are all highly consistent with temporal lobe-onset epilepsy. The pathophysiology of this underrecognized phenomenon is discussed.

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Felipe C. Albuquerque, David R. Hinton, and Martin H. Weiss

✓ The authors report the case of a 48-year-old woman who presented with a nonprolactin-secreting adenoma and a preoperative prolactin level of 662 ng/ml. The patient's neoplasm subsequently enlarged despite normalization of her prolactin level with dopamine agonist therapy. Hyperprolactinemia, with levels of prolactin as high as 150 ng/ml, is commonly associated with sellar tumors and is attributed to disruption of the normal delivery of dopamine to the adenohypophysis. The prolactin level found in this patient represents the highest level attributed to the stalk-section effect reported in the literature and underscores the need for repeated radiographic assessment of patients who are undergoing treatment with bromocriptine and have prolactin levels in the 25 to 1000 ng/ml range.

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William T. Couldwell, Peter Kan, and Martin H. Weiss

✓ The most common nonendocrine complication after transsphenoidal surgery is cerebrospinal fluid (CSF) leak. Many neurosurgeons have advocated the routine reconstruction of the floor of the sella turcica using autologous fat, muscle, fascia, and either cartilage or bone after transsphenoidal surgery to prevent postoperative CSF fistulas. However, the use of autologous grafting requires a second incision, prolongs operative time, and adds to the patient's postoperative discomfort. In addition, the presence of sellar packing may interfere with the interpretation of postoperative images. To avoid these disadvantages, the authors suggest that routine sellar reconstruction or closure after transsphenoidal surgery is unnecessary unless an intraoperative CSF leak is encountered. The incidence of postoperative CSF leakage in the patients reported on in this series is no higher than that reported by others, and no other complications such as pneu-matocele have been encountered in approximately 2700 patients in whom no intraoperative CSF leak was encountered. The authors conclude that routine closure of the floor of the sella turcica or sphenoid is unnecessary in the absence of intraoperative CSF leak.

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William T. Couldwell and Martin H. Weiss

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Jane C. S. Perrin, Martin H. Weiss, and David Yashon

✓ A family with craniofacial dysostosis affecting a father and his monozygotic twin sons is described. The father had no surgery until linear craniectomy when 3 years old; he is of normal intelligence but legally blind. Prophylactic coronal craniectomy and orbital decompression were done on the twins. One had an uncomplicated course and is developing normally. The other developed neonatal meningitis and ventriculitis with secondary hydrocephalus, plus poor vision and retarded development.