摘要:

Primary hypophysitis is a rare but significant cause of sellar space-occupying lesions. Three forms have been described: granulomatous, lymphocytic, and xanthomatous hypophysitis. Current methods cannot diagnose or distinguish these entities before surgery with sufficient certainty. The disease most commonly presents with sellar space-occupying symptoms as a result of pituitary enlargement and hormonal abnormalities such as potentially lethal pituitary insufficiency or hyperprolactinemia. Pituitary insufficiency almost always ensues, with progressive inflammatory destruction of the pituitary tissue. All three disorders clinically and radiologically mimic pituitary adenomas, and the diagnosis is usually made after surgery. Idiopathic giant cell granulomatous hypophysitis is a cryptogenic inflammatory lesion. The diagnosis rests on eliminating secondary causes. Lymphocytic hypophysitis is a chronic autoimmune disorder of the anterior and, rarely, posterior pituitary. Although it is most commonly seen in peripartum women, it may be encountered in either sex and may be associated with other autoimmune diseases. Surgical removal, biopsy, and medical therapy are the three options of therapy. Response to medical therapy is unpredictable, but remissions are reported with steroids. A consensus regarding drug choice timing, duration, and dosage of therapy is lacking, but in preoperatively suspected cases, a therapeutic trial is justified. Surgery results in cure at the expense of potentially viable pituitary tissue. The natural course of these rare disorders is currently unknown, the prognosis is unpredictable, and the choice of effective therapy is yet to be established.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This article reviews a number of intracranial lesions that cause nontraumatic hemorrhages in the pediatric population. Most of these lesions include vascular malformations such as arteriovenous malformations, intracranial aneurysms, and cavernous malformations. Even though other lesions such as vein of Galen malformations, moyamoya disease, and intracranial bleeds associated with tumors are less common, they must be considered in children presenting with nontraumatic hemorrhages. We discuss the differences in presentation and evaluation of these lesions and advocate multidisciplinary management involving neurosurgery, radiosurgery, and interventional neuroradiology.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Hypothermia for aneurysm surgery was first used more than 40 years ago and was shortly followed by deep hypothermic circulatory arrest (DHCA). Some giant, complex intracranial aneurysms have limited therapeutic alternatives, because the results of endovascular obliteration and indirect surgical approaches can be disappointing. In these cases, DHCA allows aneurysm surgery traditionally considered to be neither feasible nor advisable. Two cases of giant intracranial aneurysms successfully operated on with DHCA and a review of the literature on the subject are presented.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The outcome of patients harboring intracranial abscesses has improved in the last decade as a result of improvement in imaging technologies, the introduction of potent antibiotics that penetrate the blood–brain barrier more readily, and minimally invasive surgical techniques with the possibility of image and real-time guidance. These therapeutic advances have, however, been counterbalanced by the increase in immunocompromised patients with pathogens that are more aggressive and difficult to eradicate. This review highlights the current approach to the diagnosis and treatment of intracranial abscesses, emphasizes pitfalls in management, and discusses dilemmas in treatment strategies.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The treatment of patients with high-grade gliomas remains a challenge for modern therapy. Clear treatment guidelines derived from randomized prospective studies in the literature do not exist, and there is some controversy regarding the best treatment for malignant brain tumors. An aggressive surgical philosophy for the treatment of malignant gliomas necessitates a strict avoidance of unanticipated complications. This can be accomplished by careful preoperative planning and patient selection with multidisciplinary input; the application of the latest imaging technology, such as functional MRI (fMRI), magnetoencephalography (MEG), magnetic resonance spectroscopy (MRS), and frameless stereotaxy; meticulous surgical technique; and the use of brain mapping for tumors located in eloquent regions. This article focuses on intraoperative techniques and strategies designed to mitigate potential complications, with special consideration for dominant hemisphere lesions.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID