The role and safety of the sitting position in instrumented cervical surgery.

Placing patients who are undergoing neurosurgical procedures to the cervical spine in the sitting position offers significant advantages. These must be counterbalanced against the risk of venous and paradoxical air embolism. This study addresses the role and safety of the sitting position for instrumented cervical surgery.

Technical aspects of decompressive craniectomy for malignant middle cerebral artery infarction.

Decompressive craniectomy is considered a life-saving procedure for malignant middle cerebral artery territory infarction in selected patients. However, the procedure is associated with a significant risk of morbidity and mortality, and there is no universal agreement as to how this operation should be combined with optimal medical management. In this review we consider the goals of this procedure and the technical aspects which may be employed to optimise results.

Decompressive craniectomy for malignant middle cerebral artery infarction: evidence and controversies.

Malignant middle cerebral artery (MCA) infarction (MMI) is associated with a mortality rate of 80%. Decompressive craniectomy is considered a life-saving procedure for patients with this devastating condition. Preclinical and clinical data suggest that this procedure should be undertaken as early as possible, prompting increasing demand for emergency surgery.

Primary diffuse leptomeningeal gliosarcomatosis with a sphenoid/sellar mass: confirmation of the ectopic glial tissue theory?

Gliosarcoma is a rare glioblastoma variant, classically arising in the cerebral hemispheres. We report a patient with primary diffuse leptomeningeal gliomatosis (PDLG) with a sphenoid sinus and sellar mass. An 84-year-old woman presented with progressive headache and right-sided visual failure, associated with ipsilateral oculomotor nerve palsy and left temporal field loss.

Forestier's disease presenting with dysphagia and dysphonia.

Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is a pathology of the vertebral bodies characterised by exuberant osteophyte formation. Symptoms range from negligible back discomfort to, less commonly, debilitating dysphagia and airway disturbances. Conservative management including analgesia, chiropractic and diet modification are common and effective treatments.

Role of transcranial approaches in the treatment of sellar and suprasellar lesions.

The principles in the surgical management of sellar and suprasellar tumors are to relieve mass effect, normalize pituitary hypersecretion, preserve or restore normal pituitary function, prevent tumor recurrence and to provide tissue for pathological and scientific study. Over the past century, the transsphenoidal approach has evolved as the approach of choice for pituitary surgeons. Despite the limitations of transcranial approaches in accessing the intrasellar component of pituitary adenomas and historically their increased morbidity and mortality, there are situations where transcranial procedures have considerable advantages over transsphenoidal approaches.

The history of the treatment of pituitary adenomas.

The immense history leading to our current understanding and treatment of pituitary pathology is inextricably linked to the evolution of the understanding of the numerous functions of the hypophysis cerebri as the "master gland" of the endocrine system. When the anatomists of old encountered this small organ sequestered "like a nugget in the innermost of Chinese boxes" at the base of the brain, they had no inkling of its importance in the control of multiple target organs in the human body. It would ultimately take two millennia and a vast amount of clinical and laboratory research for its role in the body to eventually become more completely appreciated.

Treatment of intracerebral hematomas caused by aneurysm rupture: coil placement followed by clot evacuation.

Object: The aim of this study was to evaluate the efficacy of a treatment combination of coil embolization and clot evacuation in patients presenting with an intracerebral hematoma (ICH) caused by the rupture of an aneurysm.

Methods: Twenty-seven patients were prospectively recruited in this study between 1996 and 2000. Endovascular treatment of the putative ruptured aneurysm was performed as soon as practical after diagnosis and before surgical evacuation of the ICH.

Evaluation of the use of BioGlue in neurosurgical procedures.

Objective: Post-operative cerebrospinal fluid (CSF) fistula following neurosurgery is associated with increased morbidity and mortality. This prospective study evaluates the efficacy of a new bioadhesive--BioGlue, as a dural sealant in preventing CSF fistula. The complications associated with its use are investigated and the literature regarding dural closure reviewed.

Anemia, testosterone, and pituitary adenoma in men.

Object: Older men with clinically nonfunctioning pituitary tumors have been noted to be anemic, to have hypopituitarism, and to have low serum levels of testosterone. The authors hypothesized that men with pituitary adenomas and hypogonadism have a physiologically related decrease in hematocrit.

Methods: A retrospective analysis was conducted of 216 patients older than 50 years of age who harbored pituitary adenomas.

Intrasellar schwannomas: report of two cases.

Objective And Importance: The complex regional anatomic features surrounding the sella turcica make the differential diagnosis of intrasellar and parasellar lesions complicated. Sellar and parasellar schwannomas are rare. With the exclusion of parasellar schwannomas arising from cranial nerves within the cavernous sinus and extending into the sella, there have been only two reported cases of true intrasellar schwannomas.

Reconstruction of the sellar floor using Bioglue following transsphenoidal procedures.

Objective: Cerebrospinal fluid rhinorrhea, pneumocephalus and meningitis are serious complications following transsphenoidal excision of sellar, suprasellar and parasellar lesions. This study evaluates the use of a new bioadhesive, Bioglue as an adjunct in reconstructing the sellar floor and preventing CSF fistula and investigates the possible complications associated with its use.

Methods: In thirty-two patients (31 pituitary adenomas and 1 meningioma) Bioglue was used to help reconstruct the sellar floor after endonasal transsphenoidal procedures between January 2001 and April 2002 at the Royal Melbourne Hospital.

Use of FloSeal hemostatic sealant in transsphenoidal pituitary surgery: technical note.

Objective: Bleeding during transsphenoidal pituitary surgery can lead to a variety of operative difficulties. When the endonasal transsphenoidal approach is used, even mild intraoperative hemorrhage can lessen visibility in the confined operative field of view. This technical note describes the use of a hemostatic agent we have found of benefit in obtaining prompt hemostasis during this operation.

Spontaneous intracranial hypotension due to thoracic disc herniation. Case report.

Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause.

Lawrence of Arabia, Sir Hugh Cairns, and the origin of motorcycle helmets.

When Colonel T.E. Lawrence ("Lawrence of Arabia") was fatally injured in a motorcycle accident in May 1935, one of the several doctors attending him was a young neurosurgeon, Hugh Cairns.