This article reviews several recent advances in the management of pituitary adenomas. The development of dynamic contrast enhanced MRI scanning has enabled the detection of extremely small microadenomas. Wider recognition of the Hook effect has decreased the likelihood of misdiagnosing a prolactin secreting tumor. New therapeutic agents are available for the medical management of hormone secreting adenomas. Endoscopic endonasal pituitary surgery has increasingly been used to decrease the nasal discomfort associated with transseptal surgery. Endoscopic pituitary surgery is reviewed in this article. Finally, the role of radiosurgery in the treatment of pituitary adenomas is presented.
{"title":"Contemporary Management of Pituitary Adenomas","authors":"C. Heilman, J. Borden, R. Bhadelia","doi":"10.1055/s-2000-9367","DOIUrl":"https://doi.org/10.1055/s-2000-9367","url":null,"abstract":"This article reviews several recent advances in the management of pituitary adenomas. The development of dynamic contrast enhanced MRI scanning has enabled the detection of extremely small microadenomas. Wider recognition of the Hook effect has decreased the likelihood of misdiagnosing a prolactin secreting tumor. New therapeutic agents are available for the medical management of hormone secreting adenomas. Endoscopic endonasal pituitary surgery has increasingly been used to decrease the nasal discomfort associated with transseptal surgery. Endoscopic pituitary surgery is reviewed in this article. Finally, the role of radiosurgery in the treatment of pituitary adenomas is presented.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114159166","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":"Clinical Trials for Traumatic Brain Injury: The Road Traveled and Development of New Pathways","authors":"P. Matz","doi":"10.1055/s-2003-42769","DOIUrl":"https://doi.org/10.1055/s-2003-42769","url":null,"abstract":".","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124983483","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}
Traumatic brain injury (TBI) may be managed clinically in the university or community setting. Traditional reviews regarding clinical management of TBI are often presented from a university viewpoint with the role of neurosurgery and surgery residents and attending staff well defined in the setting of a large, regional hospital. In contrast, community trauma centers are usually smaller and lack neurosurgery and surgical resident staff. In the community, an emergency department physician and/or a trauma surgeon first assesses acute trauma injury. Neurosurgery, orthopedic surgery, and critical care physicians are all utilized on a consultation basis. The overall general guidelines for clinical management of TBI are similar to those used in a university setting. However, the pathways to the end result differ, and this article details these pathways.
{"title":"Management of Acute Traumatic Brain Injury in the Community Setting","authors":"E. Eichbaum","doi":"10.1055/s-2003-42764","DOIUrl":"https://doi.org/10.1055/s-2003-42764","url":null,"abstract":"Traumatic brain injury (TBI) may be managed clinically in the university or community setting. Traditional reviews regarding clinical management of TBI are often presented from a university viewpoint with the role of neurosurgery and surgery residents and attending staff well defined in the setting of a large, regional hospital. In contrast, community trauma centers are usually smaller and lack neurosurgery and surgical resident staff. In the community, an emergency department physician and/or a trauma surgeon first assesses acute trauma injury. Neurosurgery, orthopedic surgery, and critical care physicians are all utilized on a consultation basis. The overall general guidelines for clinical management of TBI are similar to those used in a university setting. However, the pathways to the end result differ, and this article details these pathways.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116676037","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}
Inflammatory conditions at the craniocervical junction (CCJ) consist mainly of rheumatic diseases and spondyloarthropathies, with rheumatoid arthritis (RA) representing the predominant example of the former condition. Secondary atlantoaxial subluxation (AAS) is noted in up to 70% of cases of RA, yet neurologic manifestations are not common. Atlantoaxial impaction (AAI) however, a less frequent entity, is associated with potentially grave deficits. All of the seronegative spondyloarthropathies may also have abnormalities at the CCJ. Erosive
{"title":"Inflammatory Conditions of the Craniocervical Junction","authors":"S. Tuli, Eric J. Woodard","doi":"10.1055/s-2002-35810","DOIUrl":"https://doi.org/10.1055/s-2002-35810","url":null,"abstract":"Inflammatory conditions at the craniocervical junction (CCJ) consist mainly of rheumatic diseases and spondyloarthropathies, with rheumatoid arthritis (RA) representing the predominant example of the former condition. Secondary atlantoaxial subluxation (AAS) is noted in up to 70% of cases of RA, yet neurologic manifestations are not common. Atlantoaxial impaction (AAI) however, a less frequent entity, is associated with potentially grave deficits. All of the seronegative spondyloarthropathies may also have abnormalities at the CCJ. Erosive","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132748338","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}
Mark McLaughlin1, Regis Haid2, Gerald Rodts2, Jay Miller2
The number of patients with degenerative disease of the lumbar spine being treated with interbody fusion has increased dramatically over that last decade. A posterior exposure has been the primary approach of choice for neurosurgeons in the past, but, with the introduction of minimally invasive surgery, anterior techniques have become more popular. Although there are risks associated with the anterior technique, the advantages of this method over posterior lumbar interbody fusion are considerable. This article reviews the “mini” open anterior lumbar interbody fusion and emphasizes important lessons we have learned through our experience with our last sixty cases
{"title":"CURRENT ROLE OF ANTERIOR LUMBAR INTERBODY FUSION IN LUMBAR SPINE DISORDERS","authors":"Mark McLaughlin1, Regis Haid2, Gerald Rodts2, Jay Miller2","doi":"10.1055/s-2000-13230","DOIUrl":"https://doi.org/10.1055/s-2000-13230","url":null,"abstract":"The number of patients with degenerative disease of the lumbar spine being treated with interbody fusion has increased dramatically over that last decade. A posterior exposure has been the primary approach of choice for neurosurgeons in the past, but, with the introduction of minimally invasive surgery, anterior techniques have become more popular. Although there are risks associated with the anterior technique, the advantages of this method over posterior lumbar interbody fusion are considerable. This article reviews the “mini” open anterior lumbar interbody fusion and emphasizes important lessons we have learned through our experience with our last sixty cases","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123716795","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}
Neurosurgeons outside pediatric centers are sometimes called upon to treat patients with spinal dysraphism. Children with spinal dysraphism are living longer. Upon entering adulthood they often become ineligible for care in pediatric facilities having a robust resource base focused on management of this complex multiorgan-system disease. Additionally, a percentage of patients will present in adulthood with spinal cord tethering of various etiologies. There is very limited data to recommend that adults should be followed in a multidisciplinary spina bifida clinic. There is even less data to suggest whether this care should be provided in the adult or the pediatric setting. We will discuss the pediatric model and its implications relevant to adults with spinal dysraphism. We feel that adults with complex spinal dysraphism should be followed in a multidisciplinary spina bifida clinic.
{"title":"Myelomeningocele and Tethered Cord: Caring for an Aging Population","authors":"L. Moores, Jonathan E. Martin","doi":"10.1055/s-2002-35248","DOIUrl":"https://doi.org/10.1055/s-2002-35248","url":null,"abstract":"Neurosurgeons outside pediatric centers are sometimes called upon to treat patients with spinal dysraphism. Children with spinal dysraphism are living longer. Upon entering adulthood they often become ineligible for care in pediatric facilities having a robust resource base focused on management of this complex multiorgan-system disease. Additionally, a percentage of patients will present in adulthood with spinal cord tethering of various etiologies. There is very limited data to recommend that adults should be followed in a multidisciplinary spina bifida clinic. There is even less data to suggest whether this care should be provided in the adult or the pediatric setting. We will discuss the pediatric model and its implications relevant to adults with spinal dysraphism. We feel that adults with complex spinal dysraphism should be followed in a multidisciplinary spina bifida clinic.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114066779","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 classification of pituitary tumors includes the large group of common pituitary adenomas, the rare pituitary carcinoma, craniopharyngiomas, and various other primary and secondary neoplasms that arise in the region of the sella turcica. In addition, there is a group of tumorlike lesions that can mimic pituitary tumors, including cysts, inflammatory conditions, and hyperplasias. The understanding of pituitary adenoma cyto-differentiation has been greatly enhanced by the identification of transcription factors that regulate cell differentiation in this gland; these factors provide novel tools for tumor classification and diagnosis. The pathologist plays an important role in identifying the morphologic features of pituitary lesions to ensure appropriate classification and clinico-pathological correlations that will determine patient management.
{"title":"The Classification of Pituitary Tumors: An Update","authors":"Sylvia Asa1,3,5, Shereen Ezzat2,4,5","doi":"10.1055/s-2001-33618","DOIUrl":"https://doi.org/10.1055/s-2001-33618","url":null,"abstract":"The classification of pituitary tumors includes the large group of common pituitary adenomas, the rare pituitary carcinoma, craniopharyngiomas, and various other primary and secondary neoplasms that arise in the region of the sella turcica. In addition, there is a group of tumorlike lesions that can mimic pituitary tumors, including cysts, inflammatory conditions, and hyperplasias. The understanding of pituitary adenoma cyto-differentiation has been greatly enhanced by the identification of transcription factors that regulate cell differentiation in this gland; these factors provide novel tools for tumor classification and diagnosis. The pathologist plays an important role in identifying the morphologic features of pituitary lesions to ensure appropriate classification and clinico-pathological correlations that will determine patient management.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123885684","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}
Traumatic fractures of the axis account for 17 to 25% of cervical fractures. A comprehensive review of contemporary literature was undertaken with emphasis on traumatic C2 fracture categorization, causative biomechanical mechanisms, and current treat-ment options. Initial clinical and radiographic algorithms are discussed with reference to recently available guidelines. Anomalous anatomy is discussed as well as the special considerations given to both pediatric and elderly patients with C2 injuries.
{"title":"C2 Trauma","authors":"R. Austin, J. Alexander","doi":"10.1055/s-2002-35814","DOIUrl":"https://doi.org/10.1055/s-2002-35814","url":null,"abstract":"Traumatic fractures of the axis account for 17 to 25% of cervical fractures. A comprehensive review of contemporary literature was undertaken with emphasis on traumatic C2 fracture categorization, causative biomechanical mechanisms, and current treat-ment options. Initial clinical and radiographic algorithms are discussed with reference to recently available guidelines. Anomalous anatomy is discussed as well as the special considerations given to both pediatric and elderly patients with C2 injuries.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125382814","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":"Principles of Nerve Regeneration and Surgical Repair","authors":"R. Midha, M. Mackay","doi":"10.1055/S-2001-13001","DOIUrl":"https://doi.org/10.1055/S-2001-13001","url":null,"abstract":"","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115952155","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}
Carotid artery dissection (CD) is an unusual pathological entity capable of producing devastating neurological deficits in affected patients. Symptoms include one or more of the clinical triad of headaches, oculosympathetic dysfunction, and retinal or cerebral ischemia. Cerebral angiography remains the gold standard for the diagnosis of carotid dissection. However, magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) are emerging as both sensitive and specific modalities for the diagnosis of carotid artery disease. Management of CD remains controversial; the efficacy of anticoagulation, the current standard of care for initial management of CD, has not been demonstrated in a clinical trial. The authors review management options to include anticoagulation, antiplatelet agents, endovascular stenting, and surgical management of carotid dissection.
{"title":"Carotid Dissection: A Clinical Review","authors":"Jonathan Martin, R. Armonda","doi":"10.1055/s-2002-39820","DOIUrl":"https://doi.org/10.1055/s-2002-39820","url":null,"abstract":"Carotid artery dissection (CD) is an unusual pathological entity capable of producing devastating neurological deficits in affected patients. Symptoms include one or more of the clinical triad of headaches, oculosympathetic dysfunction, and retinal or cerebral ischemia. Cerebral angiography remains the gold standard for the diagnosis of carotid dissection. However, magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) are emerging as both sensitive and specific modalities for the diagnosis of carotid artery disease. Management of CD remains controversial; the efficacy of anticoagulation, the current standard of care for initial management of CD, has not been demonstrated in a clinical trial. The authors review management options to include anticoagulation, antiplatelet agents, endovascular stenting, and surgical management of carotid dissection.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122825158","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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