Neurosurgery
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Review Case Reports
Pituitary tumors and aneurysms: case report and review of the literature.
A case of acromegaly from a growth hormone-secreting pituitary adenoma associated with dilatation of all major intracranial arteries and bilateral giant, cavernous aneurysms is presented. Although saccular aneurysms are randomly associated with all types of pituitary tumors, the frequency of this happening with growth hormone-secreting or "chromophobe adenomas" is greater than would be expected by chance alone. Intrasellar saccular aneurysms contiguous with tumors have been reported. ⋯ Anomalous large arteries, such as the trigeminal or transsellar-carotid variants, may run through the sella, and there is a case reported in which the former was associated with a pituitary tumor. A knowledge of these aneurysmal types and vascular anomalies is essential for the pituitary surgeon. Magnetic resonance imaging is now the radiological procedure of choice in the preoperative assessment of patients suspected of having pituitary tumors or recurrences, because, in addition to depicting the tumor, it defines the arterial anatomy and excludes all but very small coexistent aneurysms.
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Spinal cord astrocytomas are rare lesions, usually of low grade, with a long natural history. Because of this, it is difficult to define the optimum approach to therapy based on available data. To provide more data, a retrospective review was performed. ⋯ Of the 15 irradiated patients, 7 experienced recurrence of the tumor, which occurred within the irradiated portion of the spinal cord in all 7. Gross total resections were rarely achieved and, also, the extent of resection did not influence the risk for recurrence. In summary, we observed a long natural history for this disease, and although additional local therapy appears needed, it is unclear that either higher doses of radiation or more extensive surgery will decrease the risk of recurrence.
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Between January 1, 1970, and December 31, 1988, 179 children (birth to age 16) were treated for spinal cord and/or vertebral column injury by the Neurosurgical Service at the University of Iowa Hospitals and Clinics. Pediatric injuries accounted for 9% of all spinal trauma seen during this period. The mean age was 10.2 years. ⋯ Most injuries can be successfully managed with nonoperative therapy. Prognosis is primarily correlated with the severity of the initial neurological insult. Finally, children with severe spinal cord injury must have close, long-term follow-up to monitor the development of posttraumatic spinal deformity.
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Review Case Reports
Meningeal hemangiopericytoma of the posterior fossa and thoracic spinal epidural space: case report.
The rare combination of spinal and intracranial meningeal hemangiopericytomas in the same patient is reported. The coexistence of cerebral and spinal meningiomas of all histological subtypes is distinctly uncommon with only nine cases found in the literature.
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Randomized Controlled Trial Clinical Trial
Therapeutic trial of cerebral vasospasm with the serine protease inhibitor, FUT-175, administered in the acute stage after subarachnoid hemorrhage.
The therapeutic effect of the synthetic serine protease inhibitor, FUT-175, on cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated. Twenty-three patients with severe SAH who were admitted between February and July 1990 and who underwent surgery within 48 hours of the initial aneurysmal rupture were treated with an intravenous administration of FUT-175 soon after the operation. The patients were divided randomly into three groups, each receiving a different dose of FUT-175 (Group A, 20 mg every 12 hours for 4 days; Group B, 20 mg every 6 hours for 4 days, Group C, 40 mg every 6 hours for 4 days). ⋯ The incidence of a delayed ischemic neurological deficit significantly decreased from 55% in the control group to 13% in all patients treated with FUT-175 and to 7% in the patients treated with higher doses (P less than 0.05). The incidence of cerebral infarction resulting from vasospasm significantly decreased from 43% in the control group to 9% in patients treated with FUT-175. In the patients treated with higher doses of FUT-175 (Groups B and C), none developed cerebral infarction.(ABSTRACT TRUNCATED AT 250 WORDS)