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  • Author or Editor: C. B. T. Adams x
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C. B. T. Adams

✓ The concept of microvascular compression (MVC) is discussed critically. The root entry or exit zone is defined: it is much shorter than generally realized. The anatomy of the intracranial vessels is considered, as well as known facts concerning trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia relating to MVC. The results of microvascular decompression (MVD) are analyzed; one-third of patients do not obtain an optimum result.

The evidence used to support the hypothesis of MVC, including neurophysiology, is discussed and it is believed to be insufficient and unconvincing. The basis of MVD could be trauma of the nerve during operative dissection and “decompression.” The concept of MVC might be more convincing if MVD can be shown to cure a condition such as spasmodic torticollis, which cannot be remedied by damage to or section of the same cranial nerve or nerves.

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Harvey J. Sagar, Edward B. Ilgren and Christopher B. T. Adams

✓ A case is reported of a patient in whom an intracranial extracerebral melanoma developed in association with a life-long nevus of Ota. Melanotic pigmentation of the skull, periosteum, and meninges beneath the nevus was found at operation.

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Christopher B. T. Adams, Michael R. Fearnside and Sean A. O'Laoire

✓ Serial postoperative angiograms were performed in 28 patients with intracranial aneurysms, 26 of whom had presented with a subarachnoid hemorrhage. The clinical state and intracranial pressure (ICP) were also measured. Angiograms were performed in the ward using a cannula, which was passed into the proximal external carotid artery via the superficial temporal artery. Measurements of the vessel diameters were made, with the preoperative angiogram as a baseline. Patients could be placed into one of five groups depending on the presence or absence of significant arterial spasm, the clinical state of the patient, and the normality or otherwise of the ICP. No patient's condition deteriorated without an elevated ICP and/or significant arterial spasm. The study shows that this spasm is usually associated with a poor clinical state if it reaches a maximum 8 to 12 hours after the operation, although the clinical deterioration is not apparent for a further 6 to 12 hours. Knowledge of the natural history of postoperative arterial spasm may allow earlier treatment of the spasm, which may be more successful than delaying treatment until clinical deterioration has occurred. The worth of the varied drugs proposed for the treatment of spasm may be assessed using this type of protocol.

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George T. Tindall, Carl J. Herring, Richard V. Clark, David A. Adams and Nelson B. Watts

✓ From 1977 to 1988, 56 patients with a preoperative diagnosis of Cushingαs disease were treated by transsphenoidal microsurgical exploration of the pituitary gland. In 42 patients, a discrete tumor was found and a selective adenomectomy was performed. Total hypophysectomy was performed in nine patients. In an attempt to preserve pituitary function, a technique of subtotal hypophysectomy was utilized in the remaining five patients. Regular and adequate follow-up results were obtained in 53 patients. A sustained remission was obtained in 45 of these 53 patients for a remission rate of 84.9%. Eight patients were classified as therapeutic failures. The causes for failure included: 1) invasive tumor; 2) hyperplasia mistaken for an adenoma; 3) a presumed ectopic source of adrenocorticotropic hormone; 4) misdiagnosis; 5) atypical tumor; and 6) recurrence of disease after remission. In cases of therapeutic failure, the original diagnosis of Cushing's disease must be reevaluated and treatment continued until sustained remission is achieved. Necessary measures to help avoid surgical failures and an approach for further diagnostic and therapeutic maneuvers in these cases are discussed.

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Edward B. Ilgren, Diana Westmorland, Christopher B. T. Adams and Robert G. Mitchell

✓ The authors report a case of cerebellar pseudotumor caused by a Candida species without evidence of any underlying systemic disorder or extracranial disease. Total removal followed by treatment with amphotericin B resulted in a favorable outcome.

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Marco L. Rossi, John S. Bevan, Margaret M. Esiri, John T. Hughes and Christopher B. T. Adams

✓ Tumors of the posterior pituitary are rare and the previous nomenclature has been confusing. A 40-year-old man presented with visual failure and disconnection hyperprolactinemia (830 mU/liter) due to a large invasive pituitary tumor shown to be a pituicytoma (pilocytic astrocytoma). Its astrocytic nature was confirmed by positive immunostaining for glial fibrillary acidic protein and the finding of cytoplasmic filaments on electron microscopy. This case report contains the pathological description of a pituicytoma and illustrates that a non-adenomatous pituitary lesion may masquerade as a pituitary adenoma. Large pituitary lesions associated with serum prolactin concentrations of less than 3000 mU/liter require early surgical biopsy.