variable delays. These results contrast with inconsistent effects of yttrium hypophysectomy or cryoablation and postoperative panhypopituitarism after microsurgical resection. Ocular Results Three points will be discussed: the consequences of delayed radiobiological results, the response to Stereo-GIHF in progressing but not proliferative retinopathy, and the problem of neovascularization in proliferative retinopathy. For the discussion of ocular response, patients treated only by Stereo-GIHF without laser photocoagulation were selected. The preoperative and 6
Selective growth hormone blockade and ocular results
Claude Schaub, Gabor Szikla, Pierre Drouin, Marie-Thérèse Bluet-Pajot, Luc Mejean, Gerard Debry and Jean Talairach
Joseph F. Cusick, Joel Myklebust, Sanford J. Larson and Anthony Sances Jr.
✓ Summated responses evoked by peripheral nerve stimulation were recorded from electrodes located in the epidural and subdural spaces anterior and posterior to the monkey spinal cord. Segmental microsurgical resection of the dorsal columns both at the thoracic and cervical levels resulted in total obliteration of the response recorded rostral to these lesions. Isolated segmental dorsal column preservation did not significantly alter response latency or wave form recorded at the rostral electrodes. Bilateral cervical dorsolateral column resection also resulted in no discernible alterations of these responses. These data indicate that spinal evoked potentials recorded from levels rostral to their root entry zones arise almost exclusively from the dorsal columns.
Results in 100 women with the amenorrhea-galactorrhea syndrome
Miguel A. Faria Jr. and George T. Tindall
resection of pituitary tumors. Neurosurgery 3 : 142 – 145 , 1978 . McLanahan CS, Christy JH, Tindall GT: Anterior pituitary function before and after trans-sphenoidal microsurgical resection of pituitary tumors. Neurosurgery 3: 142–145, 1978. 31. Mroueh AM , Siler-Khodr TM : Bromocryptine therapy in cases of amenorrhea-galactorrhea. Am J Obstet Gynecol 127 : 291 – 298 , 1977 Mroueh AM, Siler-Khodr TM: Bromocryptine therapy in cases of amenorrhea-galactorrhea. Am J Obstet Gynecol 127: 291–298, 1977 32
Philip Cogen and Bennett M. Stein
, angiography was helpful in defining the intramedullary AVM component or patent venous aneurysms, but not the thrombosed portions. All six patients underwent microsurgical resection of the AVM. The follow-up periods ranged from immediate to 8 years. TABLE 1 Data from six patients with intramedullary spinal AVM's * Case No. Age (yrs), Sex Type of Onset Results of Examination Vertebral Level Radiographic Findings Follow-Up Results † Myelography Angiography 1 9, M SAH (multiple) normal T9–12 serpentine
Alfred T. Nelson Jr., H. St. George Tucker Jr. and Donald P. Becker
pituitary tumor by bromocriptine therapy. N Engl J Med 300: 291–293, 1979 9. McLanahan CS , Christy JH , Tindall GT : Anterior pituitary function before and after transsphenoidal microsurgical resection of pituitary tumors. Neurosurgery 3 : 142 – 145 , 1978 McLanahan CS, Christy JH, Tindall GT: Anterior pituitary function before and after transsphenoidal microsurgical resection of pituitary tumors. Neurosurgery 3: 142–145, 1978 10. Parkes D : Drug therapy. Bromocriptine. N Engl J Med 301
Results in 20 patients
Lindsay Symon and William Sprich
Methods Patient Population The 20 cases are not consecutive, but all were operated on by one of us (L.S.) between 1977 and 1981. The senior author has personally operated on over 60 tumors histologically verified as craniopharyngiomas, but radical microsurgical resection did not become the preferred treatment until 1977. Since then, over 90% of all procedures for craniopharyngiomas have been radical resections, the few exceptions being recurrent tumors operated on elsewhere, or massive cystic lesions extending into more than one cranial fossa and inaccessible by a
Effects of isobutyl 2-cyanoacrylate embolization
Peter M. Klara, Eugene D. George, Dennis E. McDonnell and Paul H. Pevsner
five embolizations, with the earliest resection occurring 3 weeks after embolization, and the latest 18 months after final embolization. Ten patients were treated with microsurgical resection alone and thus served as controls. TABLE 1 Summary of 10 AVM patients with and 10 without embolization * Location of AVM Age (yrs), Sex Embolization No. Interval (mos) Time (mos) to Surgery lt parieto-occipital 17, M 1 0 ¾ rt frontoparietal 37, M 1 0 2 lt parietal 30, F 1 0 2 rt
An assessment of benefits and risks in 158 patients
Edward R. Laws Jr., Nicolee C. Fode and Michael J. Redmond
, Christy JH , Tindall GT : Anterior pituitary function before and after transsphenoidal microsurgical resection of pituitary tumors. Neurosurgery 3 : 142 – 145 , 1978 McLanahan CS, Christy JH, Tindall GT: Anterior pituitary function before and after transsphenoidal microsurgical resection of pituitary tumors. Neurosurgery 3: 142–145, 1978 50. Nelson PB , Goodman M , Maroon JC , et al : Factors in predicting outcome from operation in patients with prolactin-secreting pituitary adenomas. Neurosurgery
Roberto C. Heros, Gerard M. Debrun, Robert G. Ojemann, Pierre L. Lasjaunias and Pierre J. Naessens
often multiple, arising directly from the anterior spinal arterial system. However, successful treatment by embolization, 6, 10, 16, 19 by feeder ligation, 5, 10, 19, 30 or by microsurgical resection 7, 21, 23, 26, 27, 30, 32, 41 has been reported. The third type of spinal AVM is the juvenile malformation. 8, 26, 30 Fortunately, these awesome lesions are uncommon. They occur most frequently in adolescents and young adults, are mostly intramedullary, and have multiple feeders involving sometimes several vertebral segments. Occasionally they have extramedullary
Report of 35 cases
Marc R. Mayberg and Lindsay Symon
✓ Between March, 1966, and June, 1985, 23 women and 12 men underwent partial or total resection of apical petrous or clivus meningiomas at The National Hospital for Nervous Diseases. Presenting symptoms were typically of long duration (mean 29 months) and consisted primarily of gait disturbance, headache, hearing loss, and facial pain. Cranial nerve deficits, especially affecting the fifth, seventh, and eighth nerves, were observed in nearly every patient. Tumor size, but not location, was generally associated with degree of preoperative disability. Plain skull films were usually unremarkable, but computerized tomography (CT) proved highly accurate in determining tumor location and size. A characteristic pattern of vascular displacement was seen on vertebral angiograms, although blood supply to the tumors was derived primarily from branches of the internal and external carotid arteries.
Subtotal or total resection was undertaken in all cases; nine patients required adjunctive cerebrospinal fluid shunting procedures. Although surgical techniques evolved during the course of the 20-year study, a combined supra- and infratentorial approach proved a relatively safe and effective means of surgical treatment. New or worsened postoperative deficits, especially cranial nerve palsies, and complications in the immediate postoperative period frequently resulted in temporary deterioration of the clinical status during this period; the total operative mortality rate was 9%. Follow-up periods ranged up to 9 years; 70% of patients resumed an independent existence, and none is known to have required subsequent tumor surgery. The size of the lesion was the only significant factor in determining outcome. These data suggest that meningiomas of the clivus and apical petrous bone can be accurately diagnosed by CT and three-vessel angiography, and effectively treated by microsurgical resection.