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  • Author or Editor: Johannes Schramm x
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Intravascular papillary endothelial hyperplasia of the sellar region

Report of three cases and review of the literature

Rudolf A. Kristof, Dirk Van Roost, Helmut K. Wolf and Johannes Schramm

✓ Intravascular papillary endothelial hyperplasia (IPEH) is considered a reactive proliferation of endothelium associated with thrombosis. The occurrence of IPEH in the cranial cavity is exceedingly rare. In this article, the authors report three cases of IPEH that originated from the cavernous sinus and extended into the sellar contents. The lesions were resected incompletely in two cases and completely in one case. The IPEH in one of the patients was incompletely resected and exhibited further growth on magnetic resonance imaging 3 months postoperatively; local radiation therapy was instituted. This led to shrinkage of the lesion over an additional follow-up period of 3.5 years. In a review of the literature, the authors located seven other cases of intracranial IPEH. The authors conclude that clinically symptomatic intracranial IPEH should be completely resected whenever possible, because it can cause considerable morbidity and mortality and because it is prone to progression or recurrence.

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Rudolf A. Kristof, Ales F. Aliashkevich, Michael Schuster, Bernhard Meyer, Horst Urbach and Johannes Schramm

Object. The authors conducted a study to determine the results of decompressive surgery without fusion in selected patients who presented with radicular compression syndromes caused by degenerative lumbar spondylolisthesis and in whom there was no evidence of hypermobility on flexion—extension radiographs.

Methods. The medical records and radiographs obtained in 49 patients were reviewed retrospectively. Clinical status was quantified by summing self-assessed Prolo Scale scores. All 49 patients (55% female, mean age 68.7 years) presented with leg pain accompanied by lumbalgia in 85.7% of the cases. Preoperatively the median sum of Prolo Scale scores was 4. The mean preoperative degree of forward vertebral displacement was 13.5% and was located at L-4 in 67% of the cases. Osseous decompression alone was performed in 53%, and an additional discectomy at the level of displacement was undertaken in the remaining patients because of herniated discs. Major complications (deep wound infection) occurred in 2%. During a mean follow-up period of 3.73 years, 10.2% of the patients underwent instrumentation-assisted lumbar fusion when decompression alone failed to resolve symptoms. At last follow up the median overall Prolo Scale score was 8. Excellent and good results were demonstrated in 73.5% of the patients. Prolonged back pain (r = 0.381) as well as the preoperative degree of displacement (r = 0.81) and disc space height (r = 0.424) influenced outcome (p ≤ 0.05); additional discectomy for simultaneous disc herniation at the displaced level did not influence outcome (p > 0.05).

Conclusions. These results appear to support a less invasive approach in this subgroup of elderly patients with degenerative lumbar spondylolisthesis—induced radicular compression syndromes and without radiographically documented hypermobility. Additional discectomy for simultaneous disc herniation of the spondylolisthetic level did not adversely influence the outcome. Complication rates are minimized and fusion can eventually be performed should decompression alone fail. A prospective controlled study is required to confirm these results.

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Rudolf A. Kristof, Georg Neuloh, Lioba Redel, Dietrich Klingmüller and Johannes Schramm

Object. The suppression of growth hormone (GH) to less than 1 µg/L during the oral glucose tolerance test (OGTT) is generally considered to be the standard for the assessment of biochemical remission of GH excess following surgery for GH-secreting pituitary adenomas. In this study the authors examine the reliability of the results of the early postoperative OGTT (epOGTT) in indicating remission or persistence of active acromegaly.

Methods. Data from the case files of 67 consecutive patients who underwent surgery for the first time for GH-secreting pituitary adenomas were reviewed retrospectively. Definitive remission of acromegaly was considered to be present if, without adjuvant therapy and at the most recent follow-up examination, GH was suppressed to less than 1 µg/L during the OGTT, the level of insulin-like growth factor—I (IGF-I) was within normal limits, and there was no clinical or magnetic resonance imaging evidence of persisting disease. The results of the epOGTT (obtained during the 2nd postoperative week) and the 3-month-postoperative OGTT (3mpOGTT) were compared with the patient's outcome at the most recent follow-up examination. A highly sensitive (≤ 0.3 µg/L) immunoradiometric assay for GH and a highly sensitive (≤ 32 µg/L) radioimmunoassay for IGF-I were used.

Correct epOGTT findings were noted in 83.6% of the patients: correct normal results (definitive remission of acromegaly) in 55.2% and correct pathological results (persisting acromegaly) in 28.3% of the patients. The rate of false findings was 16.4%: false normal results in 1.5% and false pathological results in 14.9% of the patients. The rate of correct 3mpOGTT findings increased to 98.5%: correct normal results in 68.6% and correct pathological ones in 29.8% of the patients. A false (false pathological) 3pmOGTT result occurred in only one patient (1.5%). At the most recent follow-up examinations (median 3.6 years) all OGTT findings were correct: correct normal results in 70.1% and correct pathological results in 29.9% of the patients. An intact adenopituitary function was associated (p = 0.04) with the occurrence of false epOGTT findings.

Conclusions. The high rate of false results, 16.4% for the epOGTT, declined significantly to 1.5% 3 months postoperatively and to 0% at the most recent follow-up examination. The OGTT appears to be more reliable at 3 months postoperatively. Unless there is obvious evidence of persisting disease following surgery for GH-secreting pituitary adenomas, adjuvant therapy should be delayed for 3 months postoperatively to avoid subjecting the patient to superfluous treatment.