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Neurosurgical endoscopy using the side-viewing telescope

Technical note

Michael L. J. Apuzzo, Milton D. Heifetz, Martin H. Weiss, and Theodore Kurze

✓ The authors report their application of the Hopkins telescope to various neurosurgical procedures, and describe the technique and advantages of its employment.

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Collagen sponge for surface brain protection

Technical note

Theodore Kurze, Michael L. J. Apuzzo, Martin H. Weiss, and James S. Heiden

✓ The authors discuss the properties, use, and advantages of collagen sponge as a microneurosurgical adjunct. Experience with the material in over 300 operative cases has demonstrated its value for protecting the surface of the brain during exposure and retraction in neurosurgical procedures.

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The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Christopher J. Stapleton, Charles Y. Liu, and Martin H. Weiss

Growth hormone (GH)–secreting pituitary adenomas represent a common source of GH excess in patients with acromegaly. Whereas surgical extirpation of the culprit lesion is considered first-line treatment, as many as 19% of patients develop recurrent symptoms due to regrowth of previously resected adenomatous tissue or to continued growth of the surgically inaccessible tumor. Although medical therapies that suppress GH production can be effective in the management of primary and recurrent acromegaly, these therapies are not curative, and lifelong treatment is required for hormonal control. Stereotactic radiosurgery has emerged as an effective adjunctive treatment modality, and is an appealing alternative to conventional fractionated radiation therapy. The authors reviewed the growing body of literature concerning the role of radiosurgical procedures in the treatment armamentarium of acromegaly, and identified more than 1350 patients across 45 case series. In this review, the authors report that radiosurgery offers true hormonal normalization in 17% to 82% of patients and tumor growth control in 37% to 100% of cases across all series, while minimizing adverse complications. As a result, stereotactic radiosurgery represents a safe and effective treatment option in the multimodal management of primary or recurrent acromegaly secondary to GH-secreting pituitary adenomas.

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Surgical treatment of craniofacial dysostosis in monozygotic twins

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.

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Simple closure following transsphenoidal surgery

Technical note

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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Excessively high prolactin level in a patient with a nonprolactin-secreting adenoma

Case report

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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Compulsive polydipsia following meningioma resection: an epileptic phenomenon?

Case report

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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Monostotic fibrous dysplasia of the clivus

Case report

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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Rathke Cleft Cysts

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Effects of prolonged cerebrospinal fluid shunting on the skull and brain

Benjamin Kaufman, Martin H. Weiss, Harold F. Young, and Frank E. Nulsen

✓ A review of postoperative radiographs in hydrocephalic patients treated with ventriculojugular shunts reveals a marked decrease in the CSF fluid spaces, both subarachnoid and intraventricular, reflected in compensatory skull changes and alterations in ventricular configuration. Most of the changes appear to be reversible when shunt malfunction develops, with the exception of acquired synostosis. Exceptions to the generalized changes that can be expected in all cases include absence of changes in the sella turcica in the presence of an intact diaphragma sellae, persistence of the “right angle” sella turcica and concave basi-occiput in patients with an Arnold-Chiari Type II malformation, and shifts of the lateral ventricle when the septum pellucidum is intact. Experimental evidence in shunted hydrocephalic dogs suggests that differential damping of ventricular pulse pressure by the shunt is a factor.