Neurosurgery
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Review Case Reports
Cervical myelopathy caused by hypoplasia of the atlas: two case reports and review of the literature.
Congenital anomalies of the posterior arch of the atlas (C1) are uncommon. They range from partial clefts to total agenesis of the posterior arch. Developmental cervical canal stenosis is a congenital anomaly that may cause cervical myelopathy. Myelopathy caused by cervical stenosis at the level of the atlas has been reported in only three cases. We present two cases of nontraumatic cervical myelopathy caused by spinal stenosis at the level of the atlas associated with a hypoplastic but complete posterior arch of C1. ⋯ The anomaly presented in our two cases differs from the established classification of congenital abnormalities of the posterior arch of the atlas, suggesting a different embryological defect. The hypoplastic posterior C1 arch created a congenitally narrowed spinal canal in our patients, rendering the spinal cord more susceptible to compression related to degenerative changes of the spine. Surgical removal of the shortened posterior C1 arch and surrounding degenerative ligaments is an effective treatment for symptomatic patients with this condition.
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Review Comparative Study
Vestibular schwannoma management in the next century: a radiosurgical perspective.
To discuss how the evolution of vestibular schwannoma radiosurgery, changes in health care delivery, and patient accessibility to medical information will affect the management of vestibular schwannomas in the future. ⋯ Early data regarding vestibular schwannoma radiosurgery predicted an exponential growth curve. Although it is premature to assume that the current trend will continue, it is likely that an ever increasing percentage of patients will undergo radiosurgery as accessibility to this alternative increases, and more data are published regarding long-term tumor growth control rates. If the mathematical model proves to be accurate, then stereotactic radiosurgery will replace surgical resection as the preferred management strategy for the majority of patients with vestibular schwannomas.
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Clinical Trial
Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas.
This prospective clinical trial was undertaken to assess the rate of tumor recurrence in patients with endocrine-inactive pituitary macroadenomas who underwent gross total surgical resection of their tumors and did not receive adjuvant radiotherapy. ⋯ This study demonstrates a 6% 5-year recurrence rate in patients with endocrine-inactive pituitary macroadenomas treated using gross total surgical resection alone. Reserving radiation therapy for the infrequent patient with recurrence and sparing the majority of patients the associated risks inherent in its use seems reasonable.
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Biography Historical Article
The mystery of angiography and the "unawarded" Nobel Prize: Egas Moniz and Hans Christian Jacobaeus.
To investigate the circumstances surrounding why Egas Moniz was not awarded the Nobel Prize for his contribution of angiography, provide a synopsis of Moniz's political and medical careers, and present a biographical sketch of Hans Christian Jacobaeus, the neurologist who evaluated Moniz's Nobel Prize nominations, as well as to dispel long-standing misconceptions concerning Moniz's recognition and to acknowledge the contributions of other researchers. ⋯ The development of imaging techniques was not isolated to any one individual's contribution. Several persons, including Walter Dandy and Jacobaeus, were leading figures.
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Primary central nervous system lymphoma is a disease with increasing incidence. Atypical presentations are becoming more frequent. ⋯ All four cases included atypical presentations of lymphoma. These cases again illustrate that a correct diagnosis cannot be obtained based only on imaging and clinical findings.