Abstract:
:The potential efficacy of early repeat transsphenoidal surgery for persistent Cushing's disease has not previously been examined. On 222 patients with no prior pituitary treatment and a preoperative diagnosis of Cushing's disease, 29 (13%) remained hypercortisolemic after an initial transsphenoidal pituitary exploration. Seventeen of these 29 patients underwent further surgery 7 to 46 days after the initial transsphenoidal approach in order to completely excise suspected residual tumor. Patients were followed for 4 to 84 months (mean +/- standard deviation, 34 +/- 25 months) to document sustained remission or recurrence of Cushing's disease (a urine free cortisol level > 90 micrograms/day was considered evidence of recurrence). Of the 17 patients with repeat surgery, 12 (71%) had resolution of hypercortisolism (morning plasma cortisol level < 5 micrograms/dl); however, in three of these 12, hypercortisolism recurred 5, 12, and 24 months later. In 14 patients a lesion that appeared to be a tumor was identified during the initial procedure or on histological examination. Of these, 12 had immediate resolution of hypercortisolism and nine are still in remission. Three patients, in whom no adenoma could be identified during the initial surgery or an examination of the partial hypophysectomy specimen from the initial surgery, had persistent Cushing's syndrome after the second operation. Seven (41%) of the 17 patients developed hypopituitarism requiring treatment with thyroid hormone, gonadal steroid, or vasopressin replacement. The low incidence of identification of an adenoma on computerized tomography or magnetic resonance images (three of 17 patients), the failure to find a corticotrophic adenoma during the initial surgery (10 of 17 patients), and the failure of these 17 patients to respond to the initial transsphenoidal surgery suggest that they may comprise a subset of patients who are more difficult to treat successfully with surgery than most patients with Cushing's disease. Despite that, early reoperation induced immediate remission of hypercortisolism in 71% of cases, but did so at the expense of a high risk of hypopituitarism. However, since the alternative treatments (such as radiation therapy, long-term drug therapy, or bilateral adrenalectomy) also have potential adverse effects, early reoperation deserves consideration for the management of persistent Cushing's disease, especially when an adrenocorticotrophic hormone-secreting adenoma was partially excised during the first surgery.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Ram Z,Nieman LK,Cutler GB Jr,Chrousos GP,Doppman JL,Oldfield EHdoi
10.3171/jns.1994.80.1.0037subject
Has Abstractpub_date
1994-01-01 00:00:00pages
37-45issue
1eissn
0022-3085issn
1933-0693journal_volume
80pub_type
杂志文章abstract:OBJECT:The use of intercostal nerves (ICNs) for the neurotization of the musculocutaneous nerve (MCN) in adult patients with traumatic brachial plexus palsy has been well described. However, its use for brachial plexus palsy in infants has rarely been reported. The authors surgically created 31 ICN-MCN communications f...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2001.94.3.0386
更新日期:2001-03-01 00:00:00
abstract::A micro-corrosion technique was used to demonstrate an extensive vasa vasorum network in extracranial vessels but did not reveal this system in intracranial vessels of comparable size in three species of animals. The absence of a vasa vasorum network in cerebral vessels may result in a higher level of susceptibility t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.61.1.0044
更新日期:1984-07-01 00:00:00
abstract::Cases of pigmented villonodular synovitis (PVNS) that affect the axial skeleton are rare and thus information regarding its natural history, treatment, and prognosis remains limited. To characterize this lesion more fully, the authors reviewed their experience with 12 cases of PVNS of the spine (one of which had been ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1996.84.4.0592
更新日期:1996-04-01 00:00:00
abstract::Active plasmin, available plasmin, and total plasminogen were measured by Enzo-diffusion fibirn plate techniques in 11 cases and level of tissue activator and tissue fibrinolytic activities in another 11 cases with chronic subdural hematoma. The values were too small to be measured in some instances. Anti-plasmin in t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.48.2.0197
更新日期:1978-02-01 00:00:00
abstract::Hematoporphyrin derivative (HPD) is a photosensitizing agent that has been used to locate and kill tumors. The distribution of tritiated (3H)-HPD was studied in a transplantable canine glioma model following intraperitoneal or direct intraneoplastic injection. Compared to intraperitoneal administration of 3H-HPD, dire...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1986.65.3.0364
更新日期:1986-09-01 00:00:00
abstract::The authors present the rare case of a myxoma, a benign soft-tissue tumor of mesenchymal origin noted for occurring in the left atrium of the heart, which was found in the lumbar paraspinal muscles of an 80-year-old woman. This patient experienced low-back pain for over 20 years and had noted its increasing severity w...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/spi.2001.95.2.0260
更新日期:2001-10-01 00:00:00
abstract:OBJECT:The aims of this study were to construct an animal model of deafferentation of the spinal cord by brachial plexus avulsion and to analyze the effects of subsequent dorsal root entry zone (DREZ) lesions in this model. To this end, the authors measured the clinical and electrophysiological effects of total deaffer...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.97.6.1402
更新日期:2002-12-01 00:00:00
abstract::Pituitary apoplexy has not been reported in the setting of lymphocytic hypophysitis. The authors present the case of a woman with sudden vision loss and headache. Magnetic resonance imaging revealed focal hemorrhages in a sellar lesion with suprasellar extension. The results of histopathological analysis were consiste...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.98.1.0183
更新日期:2003-01-01 00:00:00
abstract::Infestation of the central nervous system with sparganum, the larva of Spirometra mansoni, is rare. Only 27 cases have been reported in the literature; however, the true incidence might be underestimated. Two cases are reported that were definitively diagnosed by stereotactic biopsy techniques. Without a positive hist...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1993.78.1.0129
更新日期:1993-01-01 00:00:00
abstract::The authors report a rare case of spontaneous left vertebrovertebral fistula associated with neurofibromatosis Type 1 in a young woman. The patient had undergone previous failed surgical attempts to close the fistula and presented to the authors with recurrence of the fistula and neurological deterioration. Successful...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2008.12.JNS081209
更新日期:2009-07-01 00:00:00
abstract::This is a report of five cases in which a bullet penetrated the vertex of the skull and brain, apparently during its vertical descent after having been fired into the air. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1971.34.2part1.0222
更新日期:1971-02-01 00:00:00
abstract::OBJECTIVE Neurosurgical intervention may increase the risk of developing cerebral vein and dural sinus thrombosis (CVT). The clinical management of CVT in postoperative patients remains unclear. This retrospective study explores the disease occurrence, associated risk factors, and outcomes in patients with tumors who ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.11.JNS161871
更新日期:2018-02-01 00:00:00
abstract:OBJECT:The factors that contribute to periprocedural complications following cranioplasty, including patient-specific and surgery-specific factors, need to be thoroughly assessed. The aim of this study was to evaluate risk factors that predispose patients to an increased risk of cranioplasty complications and death. M...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.9.JNS14405
更新日期:2015-07-01 00:00:00
abstract:OBJECT:The goal of this study was to establish the therapeutic window during which delayed therapy with MgSO4 improves neurological motor outcome in rats that have suffered severe traumatic axonal brain injury. METHODS:Severe brain injury was induced in male Sprague-Dawley rats by using the impact-acceleration model o...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.90.3.0504
更新日期:1999-03-01 00:00:00
abstract::Tuberculosis continues to be a major public health concern, especially in developing countries. Many types of neurotuberculosis have been described, but there is only one previously reported case of subdural empyema caused by tuberculous bacilli. A 1-year-old boy who had been treated for pulmonary tuberculosis was ref...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.94.6.0988
更新日期:2001-06-01 00:00:00
abstract::The authors report the case of a 6-year-old boy with cerebral sparganosis due to infection with a plerocercoid tapeworm larva of Spirometra mansoni. Magnetic resonance imaging revealed an area of irregular long T2 signal in the right frontal lobe. When compared with images obtained 2 years earlier, the lesion appeared...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.105.6.470
更新日期:2006-12-01 00:00:00
abstract::Head trauma, intracerebral hematoma formation, and hemorrhagic cerebral infarction cause extravasation of the intravascular contents, red blood cell (RBC) hemolysis, hemosiderin deposition within the neuropil, and an increased incidence of epilepsy. Reports conflict regarding the efficacy of the administration of prop...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.60.3.0467
更新日期:1984-03-01 00:00:00
abstract::Melanocytomas are rare tumors of the central nervous system that are believed to arise from leptomeningeal melanocytes. A young girl presented with a contrast-enhancing cystic mass in the temporal horn of the left lateral ventricle. Microsurgical resection of a black-colored vascular tumor supplied by the anterior cho...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/109/9/0480
更新日期:2008-09-01 00:00:00
abstract::A series of 87 patients with severe brain injury were studied. Intracranial pressure (ICP) monitoring and external ventricular drainage were used to control ICP at high and low levels. Clearance of ytterbium-169-labeled diethylenetriaminepentaacetic acid (169Yb-DTPA), Evans blue dye, and ventricular cerebrospinal flui...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.61.4.0707
更新日期:1984-10-01 00:00:00
abstract:OBJECT:There is no description of the change in the posterior cerebral artery (PCA) in the diagnostic criteria of moyamoya disease (MMD). However, PCAs are often involved in the clinical setting, and an understanding of the significance of PCA lesions is therefore of great importance when evaluating the disease progres...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.6.JNS122099
更新日期:2013-10-01 00:00:00
abstract:OBJECT:Complete avulsion traumatic brachial plexus injuries (BPIs) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how patients make decisions rega...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.2.JNS132686
更新日期:2015-06-01 00:00:00
abstract:OBJECT:Neuronal injury remains a leading cause of morbidity in both neonates and adults with injuries induced by intracranial hemorrhage, ischemia-reperfusion, and excitotoxicity. To date, a number of neuroprotective strategies have been evaluated, but they have shown little benefit. Poloxamer 188 (P-188), a membrane-a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.1.36
更新日期:2007-01-01 00:00:00
abstract::OBJECTIVEThe aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs).METHODSThe MEDLINE and Embase databases were searched without publication date restrict...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/2018.5.JNS18599
更新日期:2018-11-01 00:00:00
abstract:OBJECT:High-frequency stimulation (HFS) delivered through implanted electrodes in the subthalamic nucleus (STN) has become an established treatment for Parkinson disease (PD). The precise mechanism of action of deep brain stimulation (DBS) in the STN is unknown, however. In the present study, the authors tested the hyp...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.101.3.0511
更新日期:2004-09-01 00:00:00
abstract::OBJECT This study explored whether there were differences between the autoimmune disease prevalence rates in unilateral and bilateral moyamoya disease (MMD). METHODS The authors performed a retrospective review of data obtained from the medical records of their hospital, analyzing and comparing the clinical characteri...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.4.JNS142936
更新日期:2016-05-01 00:00:00
abstract:OBJECT:The goal of this study was to investigate the protective effects of long-term (3-14 days) mild hypothermia therapy (33-35 degrees C) on outcome in 87 patients with severe traumatic brain injury (TBI) (Glasgow Coma Scale score < or = 8). METHODS:In 43 patients assigned to a mild hypothermia group, body temperatu...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.93.4.0546
更新日期:2000-10-01 00:00:00
abstract::The authors report an unusual case of a dural arteriovenous fistula (DAVF) in the cervical spine after a C1-2 fracture. The patient presented with a delayed epidural hematoma and quadriparesis. The DAVF was successfully treated by coil embolization and the patient made a full recovery. The possibility of a DAVF as a l...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2004.100.4.0382
更新日期:2004-04-01 00:00:00
abstract::In this paper, the authors present a physical model developed to teach surgeons the requisite drilling techniques when using an endoscopic endonasal approach (EEA) to the skull base. EEA is increasingly used for treating pathologies of the ventral and ventrolateral cranial base. Endonasal drilling is a unique skill in...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.3.JNS1552
更新日期:2016-03-01 00:00:00
abstract::The author presents a follow-up review of 61 patients with subarachnoid hemorrhage (SAH) and at least two intracranial artery aneurysms in whom only the ruptured aneurysm had been clipped. During a 10-year follow-up period, seven patients bled from a previously unruptured aneurysm; four of the hemorrhages were fatal. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1981.55.4.0524
更新日期:1981-10-01 00:00:00
abstract::The present study describes the usefulness of blood vessel allografts to repair gaps in rat peripheral nerve after immunosuppression with cyclosporine. Isogeneic strains of rats with known histoincompatibility were used for this study. A 10-mm gap was created in the peroneal nerve of host Fischer rats. The gap was bri...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.1.0115
更新日期:1989-01-01 00:00:00