Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study.

Objective: The aim of the present study was to compare the anatomy of the cavernous sinus via an endoscopic transnasal route with the anatomy of the same region explored by the transcranial route. The purpose was to identify and correlate the corresponding anatomic landmarks both through the endoscopic transnasal transsphenoidal and the microscopic transcranial views.

Methods: Five fresh injected heads (10 specimens) were dissected by the endoscopic transnasal and microsurgical transcranial approaches.

The legacy of Pompeii and its volcano.

On August 24, AD 79, a terrible eruption of Mount Vesuvius deranged life in beautiful Pompeii and killed thousands of men, women, and children. They were restored to us by the fact that Mount Vesuvius, with its rain of ashes, proved to be a skilled sculptor, preserving the shape and even the wrinkles in the clothes the Pompeians wore while trying to escape during the day of the tragedy. The detailed description of Plinius the Younger and modern static studies of the eruptive residues have made it possible to reconstruct with great accuracy the various phases of the eruption that took place 2000 years ago, including the hours and days during which the phenomena first became obvious.

Endoscopic endonasal transsphenoidal surgery.

The endoscopic endonasal transsphenoidal approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. The procedure is performed via an anterior sphenoidotomy. The two main characteristics of the endoscopic approach, when compared with the standard microsurgical operation, arise from the use of the endoscope as a unique optical device and from the absence of a transsphenoidal retractor.

The "schola medica salernitana": the forerunner of the modern university medical schools.

The schola medica salernitana is considered the oldest medical school of modern civilization. Salerno's long medical tradition began during the Greco-Roman period in a Greek colony named Elea, where Parmenides decided to found a medical school. The fame of the school became more and more important during the 10th century, and it was best known in the 11th century.

Sellar repair with fibrin sealant and collagen fleece after endoscopic endonasal transsphenoidal surgery.

Objective: To determine, in patients undergoing sellar repair after endoscopic endonasal transsphenoidal surgery, the clinical efficacy of a combination of fibrin sealant/collagen fleece compared to the use of fibrin sealant or collagen fleece alone, in preventing CSF-related (cerebrospinal fluid) postoperative complications.

Methods: From a retrospective analysis of our series of 242 consecutive endoscopic transsphenoidal procedures, in 56 out of the 90 cases in which the sella had been repaired, fibrin sealant and/or collagen fleece was employed, both in combination with one or multiple layers of other materials. The incidence of postoperative CSF leaks and the need for a postoperative lumbar drainage in the groups of fibrin sealant or collagen fleece treated patients were compared to the group of patients treated with the fibrin sealant/collagen fleece combination.

Endoscopic endonasal transsphenoidal surgery: procedure, endoscopic equipment and instrumentation.

Introduction: In the last 10 years the endoscopic endonasal transsphenoidal approach has been proposed as a minimally invasive procedure for the treatment of pathologies of the sellar region. This procedure introduces various advantages compared with the transsphenoidal microsurgical approach such as a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the treatment of possible recurrences, and reduced complications. Nevertheless, as for any new procedure, there is an initial learning curve that is somewhat steep, due to the necessity of acquiring the specific endoscopic skills.

Endoscopy and transsphenoidal surgery.

ENDOSCOPY OFFERS INTERNAL visualization of many different cavities of the human body, with its specific vision inside the anatomy, close to the target area. The view of the surgical field in transsphenoidal surgery had been obtained with the naked eye from its beginning in 1907 up to the introduction of the operating microscope by Jules Hardy in the 1960s, which represented a great advance in terms of magnification and illumination. In the past decade, modern rigid endoscopes, with their wider view near the relevant anatomy, have permitted minimally traumatic transsphenoidal procedures in and around the sellar area, thus representing a "new wave" in transsphenoidal history.

Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis.

The outcome of 24 months of cabergoline treatment on prolactin (PRL) normalization, tumor shrinkage, restoration of pituitary function, and semen alterations was prospectively investigated in 41 men with macro- (age 17-70 yr) and 10 with microprolactinoma (age 18-53 yr). Fifty-one age-matched men served as controls for semen analysis. At study entry, of the 41 patients with macroprolactinoma, 17 (41.

Dopamine receptor expression and function in clinically nonfunctioning pituitary tumors: comparison with the effectiveness of cabergoline treatment.

The aim of this study was to correlate dopamine receptors and D(2) isoform expression with the cabergoline effect on alpha-subunit secretion in vitro and tumor mass in vivo in clinically nonfunctioning pituitary tumors. Eighteen patients were subjected to neurosurgery, and a tumor sample was used for dopamine receptor and D(2) isoform expression evaluation by RT-PCR and the in vitro functional studies. After neurosurgery, nine of 18 patients with persistent tumor were treated with cabergoline and tumor mass was evaluated before and after 1 yr treatment.

Single brain metastases of carcinoid tumors.

Carcinoid tumors are one among the most uncommon source of metastatic lesion to the brain. Four cases of single brain metastases from carcinoid tumors operated upon and verified by both histology and immunohistochemical staining are reported. The site of the primary carcinoid tumor was the lung in two cases, ileum in one and the left colon in another.

Surgical treatment of intracavernous trigeminal schwannomas via a fronto-temporal epidural approach.

The purpose of this study is to evaluate the efficacy of the fronto-temporal epidural approach in managing intracavernous trigeminal schwannomas. Five unselected patients harboring an intracavernous trigeminal schwannoma were operated on. Each of them was cured by a single craniotomy.

Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia.

Background: Whether the withdrawal of treatment in patients with nontumoral hyperprolactinemia, microprolactinomas, or macroprolactinomas is safe and effective has been unclear. We performed an observational, prospective study of cabergoline (a dopamine-receptor agonist) withdrawal in such patients.

Methods: The study population included 200 patients--25 patients with nontumoral hyperprolactinemia, 105 with microprolactinomas, and 70 with macroprolactinomas.

Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia.

Background: Gender differences in tumor size are supposed to exist in hyperprolactinemia since microadenomas are more commonly found in women and macroadenomas in men. Whether this reflects only a delay in diagnosis in men or a true gender difference in tumor pathogenesis is still unclear.

Objective: To prospectively analyze gender differences in the presentation and response to cabergoline treatment in 219 consecutive newly diagnosed patients with hyperprolactinemia.

Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases.

Objective: To describe techniques and materials used in sellar repair after an endoscopic endonasal transsphenoidal approach.

Methods: Different techniques of sellar closure and indications for each specific condition are reviewed in a series of 170 consecutive patients.

Results: Only 47 (27.

Lumbar diskectomy with preservation of the ligamentum flavum.

RE: Aydin Y, Ziyal IM, Duman H, Türkmen CS, Başak M, Sahin Y. Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique. Surg Neurol 2002;57:5-14.

Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions.

Objective: To demonstrate the flexibility of the endoscopic transsphenoidal approach, with respect to nasal and paranasal anatomic features and the extension of different sellar lesions, for customization of the procedure for specific conditions.

Methods: In 16 of 170 consecutive endoscopic transsphenoidal operations, some modifications of the standard approach were adopted to optimize surgical removal of different lesions. These modifications consisted of a hemisphenoidotomy, a partial ethmoidectomy, extended sellar floor opening toward the planum sphenoidale or the clivus, enlarged opening of the sphenoid ostium area with ipsilateral removal of the superior turbinate, and a bilateral approach.

Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas.

Object: To assess postoperative complications related to the surgical procedure, a retrospective analysis was conducted in a series of 146 consecutively treated patients who underwent an endoscopic endonasal transsphenoidal approach to the sellar region for resection of pituitary adenomas between January 1997 and July 2001.

Methods: Complications were divided into groups (nasofacial, sphenoid sinus, sella turcica, supra or parasellar, and endocrine complications) according to the anatomical structures and the systems involved. Overall, a decreased incidence of complications has been observed, compared with large historical series of the traditional microsurgical transsphenoidal approach, likely because of the overview inside the anatomy facilitated by the endoscope, and the decreased surgical trauma.

Endoscopic examination of the cerebellar pontine angle.

This anatomic study describes how to optimize the use of the endoscope in the cerebellar pontine angle (CPA) through a retrosigmoid approach. Unlike the microscope, that only permits visualization of structures directly ahead, the endoscope can see 'around the corner', also showing the structures down narrow. Nevertheless, to use the endoscope it is necessary to insert it into the CPA that is full of neurovascular structures which limit its movements.