摘要:

OBJECTIVE:Pituitary tumors causing gigantism are rare in childhood and adolescence. In a review of 2367 patients with pituitary adenomas who were treated between 1970 and 1997, we found 15 cases (0.63%, 9 male and 6 female patients) of growth hormone-secreting pituitary adenomas in patients who were less than 20 years of age at the time of surgery, and we compared their characteristics with those of adenomas in an adult group.METHODS:Patients were grouped according to their ages at the first operation, with five patients (33.3%) in the prepubescent group (0–11 yr), eight (53.3%) in the pubescent group (12–17 yr), and two (13.3%) in the postpubescent group (18–19 yr). All 15 patients exhibited the typical symptoms of growth hormone oversecretion. The incidence of hyperprolactinemia among patients with prepubescent onset was 66.7%. Radiological examinations demonstrated microadenomas in 4 patients (26.7%) and macroadenomas in 11 patients (73.3%). The mean follow-up period was 73.5 months.RESULTS:Direct transnasal explorations were performed for all patients. Tumor invasion into the cavernous sinus was observed in six patients (40%). Radical tumor resection was performed for four patients (80%) in the prepubescent group, for five patients (62.5%) in the pubescent group, and for neither patient in the postpubescent group. Surgical morbidity was caused by permanent diabetes insipidus in three patients (20%). Rapid growth was postoperatively improved in 80% of the prepubescent age group. The recurrence rate was 13.3% (2 of 15 patients).CONCLUSION:Transnasal pituitary surgery was found to be as safe in pediatric patients with gigantism as in adults. Growth hormone-secreting pituitary adenomas in childhood and adolescence were more likely to be invasive or aggressive than were those in adulthood. The clinical biological characteristics for children were different from those for adults.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:Schwannomas that arise from the trigeminal nerve are rare and are usually managed by surgical resection. The role of radiosurgery in the care of patients with these basal tumors remains to be defined.METHODS:We reviewed the clinical presentation, management, and outcomes for 16 trigeminal schwannoma patients who underwent gamma knife stereotactic radiosurgery. Fifteen of the 16 patients presented with trigeminal sensory dysfunction. Nine patients had tumors in the region of the ganglion, six in the region of the trigeminal nerve root, and one in the region of the mandibular branch. Six patients had undergone one or more previous resections before radiosurgery. Ten underwent radiosurgery as the first procedure. The mean tumor volume was 5.3 cc (range, 1–17.8 cc). The mean tumor margin dose was 15.3 Gy (range, 12–20 Gy).RESULTS:During the average imaging follow-up of 44 months (range, 8–116 mo), the tumor control rate was 100% (regression in nine patients and no further tumor growth in seven patients). Five patients had improvement of clinical symptoms, and 11 remained unchanged. No new cranial nerve deficit developed in any patient.CONCLUSION:As a minimally invasive alternative to microsurgery, gamma knife radiosurgery proved to be an alternative primary or adjuvant strategy that controlled tumor growth, did not cause new deficits, and often improved presenting symptoms.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:To determine the risks and survival benefit associated with implantation of an absorbable, 1,3-bis(2-chloroethyl)-1-nitrosourea-impregnated polymer wafer, we prospectively studied patients with recurrent glioblastoma multiforme and compared them with a demographically matched cohort group.METHODS:Over a 29-month period, 62 patients underwent operations. All had tumor growth despite standard treatment, a Karnofsky performance score of ≥70, and histopathological confirmation of glioblastoma. Seventeen patients underwent gross total resection with placement of 1,3-bis(2-chloroethyl)-1-nitrosourea wafers (wafer group) at a median 44 weeks from diagnosis (6 women, 11 men; median age, 56 years). A cohort group of 45 patients undergoing surgery for recurrent glioblastoma during the same time period, but not receiving wafers, was identified. Surgery was performed at a median 47 weeks from diagnosis (14 women, 31 men; median age, 54 years).RESULTS:Within 6 weeks of surgery, 13 complications were identified in 8 patients in the wafer group. In the cohort group, 6 patients sustained 8 complications. We were unable to identify any survival advantage using Kaplan-Meier analysis. In the wafer group, median survival was 58 weeks from diagnosis and 14 weeks from wafer implantation. In the cohort group, median survival was 97 weeks from diagnosis and 50 weeks from operation.CONCLUSION:1,3-bis(2-chloroethyl)-1-Nitrosourea wafer implantation for recurrent glioblastoma was associated with a higher risk of postoperative complications, particularly those related to infection and wound healing. No clear survival benefit associated with wafer implantation was identified.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:Endothelial nitric oxide synthase (eNOS) may play an important role in the regulation of tumor blood flow and vascular permeability. However, there have been no reports describing alterations of eNOS expression in relation to malignant progression in human astrocytic tumors. We immunohistochemically studied the relationship between eNOS expression in tumor vasculature and malignancy in supratentorial astrocytic tumors.METHODS:Tissue samples were obtained from 12 patients with low-grade astrocytomas, 10 with anaplastic astrocytomas, and 17 with glioblastomas. Normal brain tissue samples were obtained from four patients with other brain diseases. Immunohistochemical staining was performed using the avidin-biotin complex method, with polyclonal anti-eNOS antibody, and the levels of eNOS expression in endothelial cells were evaluated as slight, moderate, or intense on the basis of eNOS immunoreactivity. The proliferative potential was assessed as the MIB-1 staining index for tumor cells.RESULTS:The expression of eNOS was slight in all specimens of normal brain tissue, slight in 7 and moderate in 5 specimens of low-grade astrocytoma, slight in 2, moderate in 6, and intense in 2 specimens of anaplastic astrocytoma, and moderate in 5 and intense in 12 specimens of glioblastoma. The MIB-1 staining index (mean ± standard deviation) was 0.2 ± 0.2% for normal specimens, 1.8 ± 0.6% for low-grade astrocytomas, 9.6 ± 6.9% for anaplastic astrocytomas, and 18.5 ± 7.7% for glioblastomas. The MIB-1 staining indices for slight, moderate, and intense eNOS expression were 2.0 ± 2.3%, 10.8 ± 9.8%, and 16.9 ± 7.7%, respectively.CONCLUSION:Expression of eNOS in tumor vessels was significantly correlated with histological grade and proliferative potential. These findings suggest that astrocytic tumor vessels possess higher activity for nitric oxide production than do normal vessels.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:To determine the prevalence of multiple neuraxis cavernous malformations in patients who initially presented with intramedullary spinal cord (IMSC) cavernous malformations without knowledge of cavernous malformations elsewhere in the neuraxis.METHODS:Hospital records and radiographic files were analyzed for 17 patients who subsequently underwent surgical resection of an IMSC cavernous malformation (histologically proven) and also underwent brain magnetic resonance imaging studies. These 17 patients represented a subset of 32 patients who underwent surgical resection of an IMSC cavernous malformation during the same period.RESULTS:Of 17 patients, 8 (47%) harbored multiple cavernous malformations. This group was composed of five women and three men (mean age, 35.9 yr). There were four Caucasian and four Hispanic patients.CONCLUSION:The prevalence of multiple cavernous malformations in the neuraxis seems to be increased in patients who harbor IMSC cavernous malformations. This finding has important implications for the evaluation and management of these patients and, in some cases, their family members.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:We examined the hypothesis that a plasma protease-antiprotease imbalance contributes to the formation of saccular cerebral aneurysms and the suggestion that the assay of these enzymes might be a screening tool for people at higher risk for aneurysm formation.METHODS:From June 1997 through May 1998, the plasma leukocyte elastase, which is an important proteolytic enzyme, and &agr;1-antitrypsin and &agr;2-macroglobulin, which are important antiproteolytic enzyme plasma proteins, were examined in 18 patients with ruptured aneurysms, 9 patients with unruptured aneurysms, and 22 controls.RESULTS:The elastase:&agr;1-antitrypsin ratio and the elastase:&agr;2-macroglobulin ratios were significantly higher in patients with ruptured aneurysms within 24 hours after subarachnoid hemorrhage (SAH) than in the controls. The protease-antiprotease imbalance depended on the elevation of the elastase level, which might be correlated with leukocytosis after SAH. The elastase level decreased to the control level 3 months after the onset of SAH. No significant difference in the elastase:&agr;1-antitrypsin and elastase:&agr;2-macroglobulin ratios was observed between the patients with unruptured aneurysms and the controls.CONCLUSION:These results do not support the hypothesis that a plasma protease-antiprotease imbalance is a potential marker to predict the formation of saccular cerebral aneurysms. The increase in plasma elastase levels in patients with ruptured aneurysms might be attributable to leukocytosis after SAH.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID