The neurosurgical and endocrinologic treatment of prolactinomas has undergone significant advances in the past three decades. Because of medical progress, we are now confronted with two safe, effective approaches for treating prolactinomas. Transsphenoidal surgery for microprolactinomas carries a 90% cure rate while incurring minimal risks, and offers the only opportunity for endocrinologic and oncologic cure. Al-ternatively, treatment with bromocriptine and other dopaminergic agents also results in effective chemical control in greater than 90% of cases but requires lifelong treatment. Pharmacologic control of microprolactinomas remains the mainstay of treatment, but surgical indications include patients intolerant of medical treatment, failing medical therapy, and desiring pregnancy. Young patients wishing to avoid lifelong medical treatment may also be operative candidates. In these situations. surgery is a vital adjunct in the management of prolactinoma-secreting microadenomas.
{"title":"Is There a Role for Surgery for Microprolactinomas?","authors":"Michael Y. Wang, M. Weiss","doi":"10.1055/s-2001-33619","DOIUrl":"https://doi.org/10.1055/s-2001-33619","url":null,"abstract":"The neurosurgical and endocrinologic treatment of prolactinomas has undergone significant advances in the past three decades. Because of medical progress, we are now confronted with two safe, effective approaches for treating prolactinomas. Transsphenoidal surgery for microprolactinomas carries a 90% cure rate while incurring minimal risks, and offers the only opportunity for endocrinologic and oncologic cure. Al-ternatively, treatment with bromocriptine and other dopaminergic agents also results in effective chemical control in greater than 90% of cases but requires lifelong treatment. Pharmacologic control of microprolactinomas remains the mainstay of treatment, but surgical indications include patients intolerant of medical treatment, failing medical therapy, and desiring pregnancy. Young patients wishing to avoid lifelong medical treatment may also be operative candidates. In these situations. surgery is a vital adjunct in the management of prolactinoma-secreting microadenomas.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"638 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133102151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Kondziolka, A. Niranjan, J. Sheehan, J. Flickinger, Lunsford Ld
Pituitary tumors can be managed with medication, surgical resection, radiation therapy (XRT), and stereotactic radiosurgery. Radiation approaches are best suited for patients with residual tumors after prior resection, particularly when the tumor involves the cavernous sinus. Irradiation can also be useful for patients with persistent hormone-secreting tumors despite resection or in those for whom resection would be associated with excessive risk. In this report, we review the rationale behind the various radiation approaches and discuss the risks and benefits of radiosurgery and XRT.
{"title":"The Role of Radiation Therapy and Stereotactic Radiosurgery in the Treatment of Pituitary Adenomas","authors":"D. Kondziolka, A. Niranjan, J. Sheehan, J. Flickinger, Lunsford Ld","doi":"10.1055/s-2001-33625","DOIUrl":"https://doi.org/10.1055/s-2001-33625","url":null,"abstract":"Pituitary tumors can be managed with medication, surgical resection, radiation therapy (XRT), and stereotactic radiosurgery. Radiation approaches are best suited for patients with residual tumors after prior resection, particularly when the tumor involves the cavernous sinus. Irradiation can also be useful for patients with persistent hormone-secreting tumors despite resection or in those for whom resection would be associated with excessive risk. In this report, we review the rationale behind the various radiation approaches and discuss the risks and benefits of radiosurgery and XRT.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125551545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Disabling hypertonia—spasticity, dystonia, or a combination—is a major clinical problem in children and is most commonly seen in cerebral palsy. This article reviews current definitions of various types of hypertonia and the management of hypertonia in these children. The multidisciplinary nature of the management is stressed, and the various modalities of treatment are discussed, with an emphasis on the neurosurgical aspects of management. The two major neurosurgical treatments, namely, selective dorsal rhizotomy and intrathecal baclofen, are reviewed in detail, with the current knowledge about outcomes with these treatments presented according to a paradigm developed by the National Council for Medical Rehabilitation Research. Guidelines are provided for the selection of the most appropriate treatment modalities in any given situation.
{"title":"Neurosurgical Management of Hypertonia in Children","authors":"P. Steinbok","doi":"10.1055/s-2002-35247","DOIUrl":"https://doi.org/10.1055/s-2002-35247","url":null,"abstract":"Disabling hypertonia—spasticity, dystonia, or a combination—is a major clinical problem in children and is most commonly seen in cerebral palsy. This article reviews current definitions of various types of hypertonia and the management of hypertonia in these children. The multidisciplinary nature of the management is stressed, and the various modalities of treatment are discussed, with an emphasis on the neurosurgical aspects of management. The two major neurosurgical treatments, namely, selective dorsal rhizotomy and intrathecal baclofen, are reviewed in detail, with the current knowledge about outcomes with these treatments presented according to a paradigm developed by the National Council for Medical Rehabilitation Research. Guidelines are provided for the selection of the most appropriate treatment modalities in any given situation.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116499689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Children with medically refractory epilepsy may benefit from neurosurgical interventions. As in adults, temporal lobectomy in patients with temporal lobe seizure focus gives good rates of long-term seizure freedom. Neocortical foci are more common in children and often require invasive monitoring with different resective surgeries to treat. Hemi-spherectomy in patients with unilateral epilepsy and hemispheric deficits has a good outcome as well. Corpus callosotomy and vagus nerve stimulation are effective tools to reduce seizure severity and frequency in children who are not candidates for resective surgery.
{"title":"Surgical Treatment of Pediatric Epilepsy","authors":"J. Ojemann","doi":"10.1055/s-2002-35249","DOIUrl":"https://doi.org/10.1055/s-2002-35249","url":null,"abstract":"Children with medically refractory epilepsy may benefit from neurosurgical interventions. As in adults, temporal lobectomy in patients with temporal lobe seizure focus gives good rates of long-term seizure freedom. Neocortical foci are more common in children and often require invasive monitoring with different resective surgeries to treat. Hemi-spherectomy in patients with unilateral epilepsy and hemispheric deficits has a good outcome as well. Corpus callosotomy and vagus nerve stimulation are effective tools to reduce seizure severity and frequency in children who are not candidates for resective surgery.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122254430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 1991 Tsubokawa and colleagues first published their landmark results from a series in which epidural motor cortex stimulation (MCS) was used in the treatment of eight patients with central and neuropathic pain. In ensuing studies authors have elaborated on the indications, technique, hypotheical mechanisms, and beneficial results of this treatment. Epidural MCS is effective for trigeminal neuropathy, lateral medullary and thalamic infarction, anesthesia dolorosa, postherpetic neuralgia, spinal cord injury, and limb stump pain. Postoperative outcomes are better when patients present with only mild or absent motor weakness in the region of pain and when there is pain in the trigeminal region. It is hypothesized that MCS is effective because it increases regional cerebral blood flow in the ipsilateral ventrolateral thalamus in which corticothalamic connections from the motor and premotor areas predominate. The extent of pain alleviation also correlates with the increase of blood flow in the cingulate gyrus. This suggests that stimulation reduces the suffering experienced by a patient with chronic pain. Procedure-related morbidity has included epidural hematoma, subdural effusion, gradual diminution of benefit, and painful stimulation. Although of concern, treatment-induced chronic seizure disorders have not occurred as a complication or in animal models of chronic cortical stimulation. Stimulation-induced pain relief occurs within minutes. There are no associated paresthesias or muscle contractions that confirm function. Pain relief may last for hours after electrical stimulation is discontinued. Motor cortex stimulation is an established therapy for the treatment of complex central and neuropathic pain syndromes that have proved refractory to medical treatment.
{"title":"Motor Cortex Stimulation","authors":"J. Brown1","doi":"10.1055/s-2004-835706","DOIUrl":"https://doi.org/10.1055/s-2004-835706","url":null,"abstract":"In 1991 Tsubokawa and colleagues first published their landmark results from a series in which epidural motor cortex stimulation (MCS) was used in the treatment of eight patients with central and neuropathic pain. In ensuing studies authors have elaborated on the indications, technique, hypotheical mechanisms, and beneficial results of this treatment. Epidural MCS is effective for trigeminal neuropathy, lateral medullary and thalamic infarction, anesthesia dolorosa, postherpetic neuralgia, spinal cord injury, and limb stump pain. Postoperative outcomes are better when patients present with only mild or absent motor weakness in the region of pain and when there is pain in the trigeminal region. It is hypothesized that MCS is effective because it increases regional cerebral blood flow in the ipsilateral ventrolateral thalamus in which corticothalamic connections from the motor and premotor areas predominate. The extent of pain alleviation also correlates with the increase of blood flow in the cingulate gyrus. This suggests that stimulation reduces the suffering experienced by a patient with chronic pain. Procedure-related morbidity has included epidural hematoma, subdural effusion, gradual diminution of benefit, and painful stimulation. Although of concern, treatment-induced chronic seizure disorders have not occurred as a complication or in animal models of chronic cortical stimulation. Stimulation-induced pain relief occurs within minutes. There are no associated paresthesias or muscle contractions that confirm function. Pain relief may last for hours after electrical stimulation is discontinued. Motor cortex stimulation is an established therapy for the treatment of complex central and neuropathic pain syndromes that have proved refractory to medical treatment.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"168 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122325302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The diagnosis and treatment of low back pain has always been a challenging un-dertaking. The etiology of the pain has been postulated to arise from a degenerated, disrupted intervertebral disc. The provocation discogram has become the standard diagnostic method for this entity. The provocation discogram is an imperfect test because of a potentially high false-positive rate and poor positive predictive value. Lumbar arthrodesis has become an accepted means of treating the “painful disc.” Surgical series with independent observers have reported favorable outcomes approaching only 50%. Improved methods of diagnosis along with more rigorous evaluation of surgical outcomes are needed if we are to consider lumbar arthrodesis a reasonable treatment alternative for low back pain.
{"title":"ARGUMENT AGAINST LUMBAR FUSION FOR LOW BACK PAIN","authors":"Henry Pallatroni, III, P. Ball","doi":"10.1055/s-2000-13224","DOIUrl":"https://doi.org/10.1055/s-2000-13224","url":null,"abstract":"The diagnosis and treatment of low back pain has always been a challenging un-dertaking. The etiology of the pain has been postulated to arise from a degenerated, disrupted intervertebral disc. The provocation discogram has become the standard diagnostic method for this entity. The provocation discogram is an imperfect test because of a potentially high false-positive rate and poor positive predictive value. Lumbar arthrodesis has become an accepted means of treating the “painful disc.” Surgical series with independent observers have reported favorable outcomes approaching only 50%. Improved methods of diagnosis along with more rigorous evaluation of surgical outcomes are needed if we are to consider lumbar arthrodesis a reasonable treatment alternative for low back pain.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"264 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115595596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"PROTECTION FROM REBLEEDING BEFORE EARLY ANEURYSM SURGERY","authors":"T. Leipzig, T. Horner, T. Payner, K. Redelman","doi":"10.1055/S-2000-11553","DOIUrl":"https://doi.org/10.1055/S-2000-11553","url":null,"abstract":"","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132318124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"TREATMENT OF CEREBRAL VASOSPASM WITH INTRATHECAL NITRIC OXIDE DONORS","authors":"Jeffrey E. Thomas","doi":"10.1055/S-2000-11554","DOIUrl":"https://doi.org/10.1055/S-2000-11554","url":null,"abstract":"","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132745127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The development of pedicle screw instrumentation systems has revolutionized spine surgery. From a biomechanical perspective, pedicle screws provide the greatest degree of spinal stabilization among all spinal implants. Pedicle screws, attached to rods linked by crossmembers, provide rigid control of vertebral body motion in all three spatial dimensions. This characteristic provides substantial advantages to the spinal surgeon for treatment of numerous disorders. Pedicle screws offer distinct advantages in the treatment of tumors, trauma, and deformity of the lumbar spine. They can be applied in nearly any situation involving instability of the lumbar spine
{"title":"CURRENT ROLE OF PEDICLE SCREWS IN THE LUMBAR SPINE","authors":"N. Baldwin, D. Malone","doi":"10.1055/s-2000-13225","DOIUrl":"https://doi.org/10.1055/s-2000-13225","url":null,"abstract":"The development of pedicle screw instrumentation systems has revolutionized spine surgery. From a biomechanical perspective, pedicle screws provide the greatest degree of spinal stabilization among all spinal implants. Pedicle screws, attached to rods linked by crossmembers, provide rigid control of vertebral body motion in all three spatial dimensions. This characteristic provides substantial advantages to the spinal surgeon for treatment of numerous disorders. Pedicle screws offer distinct advantages in the treatment of tumors, trauma, and deformity of the lumbar spine. They can be applied in nearly any situation involving instability of the lumbar spine","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"86 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116263478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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