Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Between January 2004 and June 2007 we conducted a retrospective analysis to assess post-operative complications related to endoscopic pituitary surgery in a series of 150 patients. Patients were treated with an endoscopic endonasal transsphenoidal approach to the sellar region for removal of pathological sellar and suprasellar lesions. We analysed the complications in groups according to the anatomical structures of the approach and the functional systems of the pituitary gland (anterior and posterior endocrine systems), and compared them to a large historical series using the traditional microsurgical transsphenoidal approach. ⋯ We believe that the reduction of the complication rate observed in this study was mainly due to the wide structural overview offered by the endoscope as well as the anatomically direct, and therefore minimally invasive, character of the procedure. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Furthermore, close cooperation between a multidisciplinary team consisting of endocrinologists, neurosurgeons, ear, nose and throat surgeons, radiologists, and radiation oncologists is of utmost importance.
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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for patients with medically refractory Parkinson's disease (PD). The degree to which the anatomic location of the DBS electrode tip determines the improvement of contralateral limb movement function has not been defined. This retrospective study was performed to address this issue. ⋯ Two-tailed t-tests revealed no significant difference in electrode tip location between the two groups in three-dimensional distance (p=0.759), lateral-medial (x) axis (p=0.983), anterior-posterior (y) axis (p=0.949) or superior-inferior (z) axis (p=0.894) from the intended anatomical target. The range of difference in tip location and limb scores was extensive. Our results suggest that anatomic targeting alone may provide the same clinical efficacy as is achieved by "fine-tuning" DBS placement with microelectrode recording to a specific target.
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Temozolomide (TMZ) is an alkylating agent used in the management of gliomas. Although TMZ is generally safe and acute toxicity is well documented, there are limited data on long-term toxicities. ⋯ So far they have had no serious side effects. We discuss these patients while raising the question of prolonged TMZ use.
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Case Reports
Immediate postoperative death due to hypothalamic injury following surgery for craniopharyngioma.
Autonomic disturbances due to hypothalamic injury that result in postoperative death are rare complications following surgery for craniopharyngioma. We discuss the case of a child who died due to hypothalamic injury following radical excision of a multi-compartmental craniopharyngioma. Mechanisms and clinical manifestations of hypothalamic injury and ways to avoid this fatal complication are discussed.
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Spinal cord injury (SCI) continues to result in high morbidity and mortality throughout the world. An effective neuroprotective agent is still not available to counteract secondary damage caused by traumatic injury. Thrombospondin-1 (TSP-1) and transforming growth factor-beta (TGF-beta) have a role in angiogenesis, scar deposition, inflammation and may affect astrocyte phenotype and mobility. ⋯ Elevations in TSP-1 and TGF-beta concentrations persisted for 24 h after injury. These results show that elevated expression of TSP-1 and TGF-beta can be detected in the injured segment of the spinal cord 12 and 24 h after injury. Thus, TSP-1 and TGF-beta may have a role in SCI.