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Ibrahim Hussain, Jean Anderson Eloy, Peter W. Carmel and James K. Liu

hypothalamus, pituitary gland, and optic chiasm. There have only been rare reports of de novo malignancy or malignant transformation, often as a sequela of radiation therapy. 6 , 12 , 30 , 40 , 50 , 89 Individuals commonly present with headaches, visual field deficits, and endocrine abnormalities, 44 , 61 and therefore surgical removal with the goal of gross-total resection is the mainstay of therapy. Adjuvant radiation therapy for residual tumor improves both survivorship and the relapse-free interval. However, in many children, radiation therapy is associated with severe

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James K. Liu and William T. Couldwell

features, tumor type, visual and cranial nerve outcome, and endocrinological outcome. All patients underwent an endocrinological workup at the time of admission and were started on a regimen of intravenous corticosteroid drugs. Patients with prolactin-secreting adenomas were considered for dopamine agonist therapy. Each MR image was evaluated for the presence of thickening and enhancement of sphenoid sinus mucosa. The thickness of the sphenoid sinus mucosa adjacent to the sellar floor was measured on T 1 - or T 2 -weighted MR images obtained after addition of Gd. The

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Christina M. Sayama, James K. Liu and William T. Couldwell

✓Cerebral vasospasm remains a major source of morbidity and death in patients with aneurysmal subarachnoid hemorrhage (SAH). When vasospasm becomes refractory to maximal medical management consisting of induced hypertension and hypervolemia and administration of calcium channel antagonists, endovascular therapies should be considered. The primary goal of endovascular treatment is to increase cerebral blood flow to prevent cerebral infarction. Two of the more frequently studied endovascular treatments are transluminal balloon angioplasty and intraarterial papaverine infusion. These two have been used either alone or in combination for the treatment of vasospasm. Other pharmacological vasodilating agents currently being investigated are intraarterial nimodipine, nicardipine, verapamil, and milrinone. Newer intraarterial agents, such as fasudil and colforsin daropate, have also been investigated. In this article the authors review the current options in terms of endovascular therapies for treatment of cerebral vasospasm. The mechanism of action, technique of administration, clinical effect and outcomes, and complications of each modality are discussed.

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James K. Liu and William T. Couldwell

Prolactin-secreting pituitary adenomas—prolactinomas—are the most common type of functional pituitary tumor. Treatment of hyperprolactinemia is indicated because of the consequences of infertility, gonadal dysfunction, and osteoporosis. Making the correct diagnosis is important because the first line of therapy is medical management with dopamine agonists. Medical therapy is effective in normalizing prolactin levels in more than 90% of patients, but long-term treatment may be required in some patients. Transsphenoidal surgery is usually indicated in those patients in whom medical therapy fails or cannot be tolerated, or in patients who harbor microprolactinomas. In experienced hands, a hormonal and oncological cure can be achieved in more than 90% of patients after transsphenoidal removal of microprolactinomas with minimal risks. Thus, surgery may be an option for microprolactinomas in a young patient who desires restoration of fertility and avoidance of long-term medical therapy. The authors review the diagnosis and management of prolactinomas, including medical therapy, surgical therapy, and stereotactic radiosurgery.

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Christopher S. Eddleman and James K. Liu

but untreated, the lesions almost always result in progressive visual deterioration. Therefore, treatment of ONSM has, as a rule, been considered except in cases in which the progression of visual loss is negligible or other medical issues prevent the recommended therapy. Observation Without Treatment Historically, management of ONSMs has involved either observation without treatment, mostly in cases of high functional vision or negligible visual decline, or resection, especially in cases of threatening intracranial extension or disfiguring proptosis

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James K. Liu and Marion L. Walker

C hildren with cerebral palsy often suffer from severe spasticity and dystonia, which results in discomfort and deformity, impedes their ability to perform functional skills, and increases the burden of care for their caregivers. Intrathecal baclofen pumps for the management of severe spasticity are being used more often in children with cerebral palsy. Several studies have demonstrated substantial reduction in muscle tone as well as improvement of function and ease of care with intrathecal baclofen therapy. 1–5, 7, 10 The intrathecal catheter is

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Jimmy Patel, Jean Anderson Eloy and James K. Liu

surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. 13 , 38 , 47 Bilateral adrenalectomy represents a safe and effective definitive procedure for patients who need immediate treatment for hypercortisolemia or who have been unresponsive to multiple therapies for refractory Cushing's disease. 45 , 47 In 1958, Dr. Don Nelson et al. reported a case in which a 33-year-old woman, who had undergone bilateral adrenalectomy for Cushing's disease 3 years earlier, experienced skin hyperpigmentation, high plasma levels of adrenocorticotropic hormone (ACTH

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Anni Wong, Jean Anderson Eloy and James K. Liu

recognition of the pituitary gland as the primary source of the problem, the treatment strategy shifted to a more targeted therapy toward the aberrant pituitary source. Currently, the first-line treatment of CD is transsphenoidal resection of the pituitary adenoma. 16 , 20 , 22 , 24 , 27 Transsphenoidal surgery for the treatment of CD has served as an effective treatment option, with remission rates ranging from 70% to 90% when performed by experienced surgeons. 9 , 13 , 24 , 32 , 33 , 35 , 36 , 38–41 However, persistent and recurrent disease does occur in 11.5% to 25

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William T. Couldwell, Peter Kan, James K. Liu and Ronald I. Apfelbaum

involvement) whose lesions were categorized as Hirsch 8 Grade 2 or 3 (tumor encasing the CA with or without arterial narrowing) ( Table 1 ). In three patients, significant ophthalmoparesis existed before surgery. All patients underwent stereotactic radiosurgery or stereo-tactic IMRT 2 to 6 months after surgery. TABLE 1 Characteristics in 11 patients with CS meningiomas * CaseNo. Age (yrs) at Diagnosis Prior Treatment Presenting Symptoms Follow Up (mos) Subsequent Therapy 1 34 none headaches 15 SRS 2 † 58 Gamma

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James K. Liu, Oren N. Gottfried and Douglas L. Brockmeyer

veins in patients with postural headaches associated with SIH; 2 , 9 , 13 , 15 , 17 , 21 , 26 , 27 , 31 , 34 however, cervical my-elopathy was not present in these cases, and radiculopathy was present in only one case. 2 With only two previously reported cases, myelopathy resulting from engorged epidural veins after long-term shunt therapy is extremely rare. 19 , 33 We report the case of a patient who presented with progressive cervical myelopathy resulting from engorged cervical epidural veins related to longstanding CSF shunt overdrainage via a distal slit