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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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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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James K. Liu, Ilesha A. Sevak, Peter W. Carmel and Jean Anderson Eloy

. Because of their intimate involvement with critical structures, resection of these lesions can be associated with considerable risks of morbidity. Nevertheless, surgery remains the first line of therapy and offers the best chance of radical resection and oncological cure. 16–20 , 28 , 56 , 59 Advances in skull base approaches, modern microsurgical and endoscopic techniques, neuroimaging, and hormone replacement therapy, however, have allowed for safer gross- or near-total resection in the modern neurosurgical era with gross-total resection rates ranging from 72.7% to

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James K. Liu, Lana D. Christiano, Smruti K. Patel and Jean Anderson Eloy

removal is based on anatomical preservation of the pituitary stalk (the preservation of which does not always retain pituitary function), it is better to choose complete tumor removal at the cost of sacrificing the stalk and accepting hormone replacement therapy. Therefore, in cases of Type II transinfundibular craniopharyngiomas, we prefer to perform a low stalk section to achieve a more aggressive removal of the tumor. By using bimanual microsurgical dissection techniques, the tumor capsule in relation to the optic chiasm and ONs is identified. In retrochiasmatic

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Antonios Mammis, Jean Anderson Eloy and James K. Liu

den Brande. 43 The measurement of endocrine function would later be revolutionized by radioimmunoassays. The physiological mechanisms of the growth hormone and insulin-like growth factor system were eventually understood. Innovations in modern neuroimaging, pituitary surgery, radiotherapy, and medical therapy contributed to the advancements that set the stage for modern medical and surgical management of acromegaly and gigantism. Conclusions Although accounts have appeared in the lay literature for millennia, the recognition of acromegaly and gigantism as

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James K. Liu, Nicole A. Silva, Ilesha A. Sevak and Jean Anderson Eloy

craniotomy, and had the highest rate of optic nerve adherence (62.5%, p = 0.011). In our study, there was only 1 recurrence after EEA for a GTR of a recurrent OGM in the sinonasal cavity. This new recurrence occurred in the left orbit, resulting in proptosis. The patient underwent another EEA for medial orbital decompression and subtotal debulking, followed by radiation therapy. The proptosis improved and there has not been any further tumor progression. TABLE 2. Clinical outcomes after resection of OGMs Variable Transbasal (n = 15) EEA (n = 5) Combined (n = 8) p Value GTR

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Richard F. Schmidt, Frederick Yick, Zain Boghani, Jean Anderson Eloy and James K. Liu

approach compl yes NA 9 no AWOD present case 36 52 M no no lt V1, V2, V3 facial pain, diplopia surgery 2 staged—orbitozygomatic, endoscopic craniofacial & sublabial incompl yes 5940 6 no AWD * AWD = alive with disease; AWOD = alive without disease; chemo = chemotherapy; compl = complete; DWD = dead with disease; DWOD = dead without disease; EOR = extent of resection; FT = frontotemporal; FU = follow-up; GG = gasserian ganglion; incompl = incomplete; NA = not available; RT = radiation therapy; subtemp = subtemporal; Tx

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James K. Liu, Lana D. Christiano, Smruti K. Patel, R. Shane Tubbs and Jean Anderson Eloy

base: secondary changes or tumor invasion . Neurosurgery 44 : 742 – 747 , 1999 33 Pompili A , Derome PJ , Visot A , Guiot G : Hyperostosing meningiomas of the sphenoid ridge—clinical features, surgical therapy, and long-term observations: review of 49 cases . Surg Neurol 17 : 411 – 416 , 1982 34 Rubinstein AB , Arbit E : Intracranial meningiomas presenting with epistaxis—case report and literature review . J Otolaryngol 14 : 248 – 250 , 1985 35 Schaller C , Rohde V , Hassler W : Microsurgical removal of olfactory groove

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Ibrahim Hussain, Qasim Husain, Soly Baredes, Jean Anderson Eloy, Robert W. Jyung and James K. Liu

tumor cell survival. The mechanism by which BNIP3 shifts tumor cells towards autophagy occurs in an mTOR-dependent fashion, such that mTOR inhibitors enhance tumor cell death. 47 Furthermore, autophagy inhibitors, such as chloroquine, result in a reduction in BNIP3 expression and subsequently tumor growth. 47 In vivo demonstrations of these agents have already shown effectiveness in hypoxia-induced glioblastoma models, and therefore may provide a promising new therapy for paragangliomas. 47 Immunoreactivity of the CCND1 protein product, cyclin D1, has also