✓ Five patients with pituitary tumors associated with unusually high serum prolactin levels are presented. Tumor size and the presence of suprasellar extension were variable, but the finding common to all five cases was invasion of the cavernous sinus. It is proposed that very high serum prolactin levels suggest an invasive tumor, perhaps, specifically, invasion into a cavernous sinus. The surgical significance of this proposition is discussed.
William A. Shucart and Ivor Jackson
✓ The authors present a brief review of the problem of diabetes insipidus in neurosurgical patients, with particular emphasis on the differential diagnosis of postoperative and posttraumatic polyuria and the management of diabetes insipidus in these periods. A listing of drugs currently used in its treatment is given.
Report of four cases
William A. Shucart and Eddy Garrido
✓ Four cases are presented in which intermittent ischemic symptomatology was referable to a cerebral hemisphere. Arteriography in each case showed complete occlusion of the ipsilateral internal carotid artery in the neck with collateral filling of the ipsilateral intracranial carotid artery into the cavernous portion. Endarterectomy was performed successfully in each case from 1 to 5 weeks after the demonstrated complete occlusion. The collateral circulation to the intracranial portion of the internal carotid artery and the probable reasons for the technical success of these operations are discussed.
William A. Shucart and Samuel A. Wolpert
✓ A 6-month-old child presenting with diabetes insipidus was found to have irregularities of some of the intracranial arteries as well as a large aneurysm at the bifurcation of the left internal carotid artery. The case is described and discussed.
Jonathan A. Borden, Julian K. Wu and William A. Shucart
✓ A classification is proposed that unifies and organizes spinal and cranial dural arteriovenous fistulous malformations (AVFMs) into three types based upon their anatomical similarities. Type I dural AVFMs drain directly into dural venous sinuses or meningeal veins. Type II malformations drain into dural sinuses or meningeal veins but also have retrograde drainage into subarachnoid veins. Type III malformations drain into subarachnoid veins and do not have dural sinus or meningeal venous drainage. The arterial supply in each of these three types is derived from meningeal arteries.
The anatomical basis of the proposed classification is presented with several cases that illustrate the three types of dural AVFMs. A rationale for the treatment of spinal and cranial dural AVFMs according to their anatomical characteristics is discussed.