Abstract:
:Despite diagnostic advances, it remains difficult to identify intrasellar and ectopic parasellar adrenocorticotropic hormone (ACTH)-secreting microadenomas. The authors present the case of a 61-year-old woman with Cushing disease in whom a significant central-to-peripheral and lateralized right-sided ACTH gradient was demonstrated on inferior petrosal sinus sampling; no discernible abnormality was seen on magnetic resonance imaging. She underwent transnasal transsphenoidal surgery. No tumor was found on sellar exploration and a total hypophysectomy was performed, yet her hypercortisolemia persisted. The patient died of cardiac events 17 days postsurgery. Autopsy revealed an isolated, right-sided, intracavernous ACTH-secreting adenoma with no intrasellar communication. This case represents the first failed transsphenoidal surgery for Cushing disease in which there is postmortem confirmation of a suspected intracavernous sinus lesion. It supports the hypothesis that Cushing disease associated with nondiagnostic imaging studies, a strong ACTH gradient on venography, and negative findings on sellar exploration may be caused by an ectopic intracavernous ACTH-secreting adenoma. There are no premortem means of confirming the presence of such lesions, but these tumors could underlie similar cases of failed surgery. Radiation therapy targeting the sella turcica and both cavernous sinuses, possibly supplemented with medical treatment, is suggested for similar patients in whom transsphenoidal hypophysectomy has failed. Adrenalectomy may also be appropriate if a rapid reduction in ACTH is necessary.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Kim LJ,Klopfenstein JD,Cheng M,Nagul M,Coons S,Fredenberg C,Brachman DG,White WLdoi
10.3171/jns.2003.98.6.1312subject
Has Abstractpub_date
2003-06-01 00:00:00pages
1312-7issue
6eissn
0022-3085issn
1933-0693journal_volume
98pub_type
杂志文章abstract::Two unusual cases of neurocutaneous melanosis are presented. Both patients had congenital giant hairy nevi and both developed hydrocephalus, seizures, and myelopathy. The first patient displayed multicentric cerebral and spinal cord melanosis, as opposed to the more commonly described basilar leptomeningeal involvemen...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.61.4.0782
更新日期:1984-10-01 00:00:00
abstract::The authors determined the landmarks and coordinates for intraoperative ventricular puncture directly from the supraorbital craniotomy opening via an eyebrow incision. Fifty magnetic resonance (MR) imaging studies were obtained from patients with no pathological cerebral characteristics or ventricular distortion. The ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2006.105.3.485
更新日期:2006-09-01 00:00:00
abstract::OBJECT The authors' goal in this paper is to provide the first clinical, radiological, and genetic studies of panventriculomegaly (PaVM) defined by a wide foramen of Magendie and large cisterna magna. METHODS Clinical and brain imaging data from 28 PaVM patients (including 10 patients from 5 families) were retrospecti...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.6.JNS15162
更新日期:2016-06-01 00:00:00
abstract::Metrizamide computerized tomographic cisternography (MCTC) has proved 100% successful in documenting the precise anatomic location of the dural osseous defect in three patients with sphenoethmoidal rhinorrhea. In each patient, direct surgical approach to the site indicated by MCTC terminated the leakage in a single pr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.2.0222
更新日期:1980-08-01 00:00:00
abstract:OBJECT:Using a database that enabled longitudinal follow-up, the authors assessed the long-term outcomes of unruptured cerebral aneurysms repaired by clipping or coiling. METHODS:An observational analysis of the California Office of Statewide Health Planning and Development (OSHPD) database, which follows patients lon...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.3.JNS131159
更新日期:2014-06-01 00:00:00
abstract:OBJECT:Cerebrospinal fluid leaks may occur as a result of trauma or following surgery, and occasionally may also be spontaneous. Leakage of CSF from the lateral sphenoid recess is rare and challenging to treat. The authors present their experience with repairs of 10 CSF leaks that were confined to the lateral sphenoid ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.7.JNS09306
更新日期:2010-02-01 00:00:00
abstract:OBJECT:In this study the authors' goal was to identify the complication rate of subduroperitoneal (SDP) shunts for the treatment of subdural hematomas (SDHs) in infants and to determine the influences on and predictive factors for these complications. METHODS:The authors present a case series spanning the years 1994 t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.3.172
更新日期:2007-03-01 00:00:00
abstract::The authors report a unique case of subarachnoid hemorrhage caused by a traumatic pseudoaneurysm of the ophthalmic artery, which was successfully treated with coil embolization. Clinical and imaging features, as well as the relevant literature, are described. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS-07/11/1043
更新日期:2007-11-01 00:00:00
abstract:OBJECT:Sphenopalatine ganglion stimulation activates perivascular vasodilatory nerves in the ipsilateral anterior circle of Willis. This experiment tested whether stimulation of the ganglion could reverse vasospasm and improve cerebral perfusion after subarachnoid hemorrhage (SAH) in monkeys. METHODS:Thirteen cynomolg...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.6.JNS091525
更新日期:2011-04-01 00:00:00
abstract:OBJECT:Peripheral nerve injury in a limb usually causes intrahemispheric functional reorganization of the contralateral motor cortex. Recently, evidence has been emerging for significant interhemispheric cortical plasticity in humans, mostly from studies of direct cortical damage. However, in this study, a long-range i...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.1.JNS09448
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:Tumor proximity to the ventricle and ventricular entry (VE) during surgery have both been associated with worse prognoses; however, the interaction between these two factors is poorly understood. Given the benefit of maximal tumor resection, it is imperative for surgical planning and technique to know if VE h...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2020.7.JNS201362
更新日期:2021-01-08 00:00:00
abstract:OBJECT:The authors reviewed their experience with endoscopic approaches to determine their safety and efficacy in the treatment of pediatric patients who harbor skull base lesions. Although they were interested in ascertaining outcomes after surgery as well as validating and defining indications and limitations of thes...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.2.75
更新日期:2007-02-01 00:00:00
abstract::Blood flow velocity was recorded from the middle or anterior cerebral and extracranial internal carotid arteries using transcranial Doppler sonography (TCD) in 121 unselected consecutive patients with acute aneurysmal subarachnoid hemorrhage (SAH). Recordings were made daily or every 2nd day after SAH for a 14-day per...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1993.78.2.0183
更新日期:1993-02-01 00:00:00
abstract:OBJECT:The trigeminal nerve conducts both sensory and motor impulses. Separate superior and inferior motor roots typically emerge from the pons just anterosuperomedial to the entry point of the sensory root, but to date these two motor roots have not been adequately displayed on magnetic resonance (MR) images. The spec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.101.3.0427
更新日期:2004-09-01 00:00:00
abstract::Methyl-2-cyanoacrylate was used to mechanically immobilize the coronal suture unilaterally in a series of New Zealand white rabbits at varying ages. The animals were separated into groups; some were sacrificed at 30 day and some at 60 days postoperatively. Amalgam markers were placed in the parietal and frontal bones ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.6.0794
更新日期:1980-12-01 00:00:00
abstract::Tophaceous pseudogout is one of the rarest forms of crystal deposition disease, typically presenting as a destructive and invasive mass involving the temporomandibular joint or the infratemporal fossa region in the absence of any other articular manifestations. Previous cases have been assumed to be caused by calcium ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.90.1.0148
更新日期:1999-01-01 00:00:00
abstract::Myelomeningoceles are routinely diagnosed prenatally by using ultrasonography. Because the level of the neural defect has been shown to correlate with functional and cognitive outcome in infants with myelomeningocele, it is of prognostic importance to identify the level prenatally. The authors report on a case in whic...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.2005.102.2.0248
更新日期:2005-03-01 00:00:00
abstract::Intrathecal ossification causing progressive myelopathy or radiculopathy does not occur frequently. The majority of the reported lesions have been in the thoracic spine and seldom in the sacral canal. This report presents the occurrence of disabling low backache and sciatica from intradural periradicular ossification ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.49.1.0132
更新日期:1978-07-01 00:00:00
abstract::Primary leptomeningeal gliomatosis is rare, and the diffuse form is even rarer with only three cases reported in the literature. A fourth case is described in this report. Computerized tomography (CT) findings showed hydrocephalus with enhancement of the cerebral cisterns, and analysis of cerebrospinal fluid obtained ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.63.2.0283
更新日期:1985-08-01 00:00:00
abstract:OBJECT:The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs). METHODS:Retrospective review of data at Millard Fillmore Gates Hospital identified 43 patients with 44 CADs (intracranial and/or extracranial) treated with carotid artery (CA) stent placement between Ja...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.1.JNS091806
更新日期:2011-07-01 00:00:00
abstract:OBJECT:Due to the complex and variable nature of brachial plexus injury, outcome analysis can be cumbersome and imprecise. Many scales have been devised, but no single scale is used uniformly. Moreover, despite several studies in which the authors have reported brachial plexus surgical data, no highly predictive clinic...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.4.276
更新日期:2007-04-01 00:00:00
abstract::OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grad...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.3.JNS162383
更新日期:2018-07-01 00:00:00
abstract::This paper reports the third described case of infection-related atlantoaxial subluxation in an adult. Like most of the similar cases seen in the pediatric literature, this case was associated with a parapharyngeal beta-hemolytic streptococcal abscess. Based upon this experience, the authors advocate intravenous antib...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1988.69.3.0455
更新日期:1988-09-01 00:00:00
abstract::The author, while a research illustrator at the Smithsonian Institution National Museum of Natural History, studied two ancient skulls from the Incan period in Peru, both with trephination. Her conclusions and illustrations of the skulls are included in this paper. ...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/jns.1992.76.3.0550
更新日期:1992-03-01 00:00:00
abstract:OBJECT:Continuous intracranial pressure (ICP) monitoring using an epidural sensor is a common technique used in selected neurosurgical patients. The aim of this study was to assess the safety and accuracy of the Neurodur-P epidural sensor in the clinical setting. METHODS:The zero drift, as well as the medical and tech...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/108/5/0934
更新日期:2008-05-01 00:00:00
abstract:OBJECT:The authors studied the microsurgical anatomy of the ophthalmic artery (OphA), paying particular attention to its possibly dangerous anastomoses with the middle meningeal artery (MMA). METHODS:The microsurgical anatomy of the OphA and its anastomoses with the MMA were studied in 14 vessels from seven adult cada...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2007.106.1.142
更新日期:2007-01-01 00:00:00
abstract::Thirty-eight patients underwent transsphenoidal microsurgical treatment of non-neoplastic intrasellar cysts: 36 had cyst drainage and biopsy of the cyst wall, and in two the cyst was totally removed. Surgical morbidity was 8%. The mean follow-up time was 46.3 months; 100% patient follow-up evaluation was achieved. Six...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.60.1.0008
更新日期:1984-01-01 00:00:00
abstract::The authors report an unusual case of a widely metastatic glioblastoma. DNA copy number microarray profile of the resected specimen revealed complex rearrangements found throughout chromosome 6, a phenomenon known as chromothripsis. Such chromothripsis pattern was not observed in 50 nonmetastatic glioblastoma specimen...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.4.JNS153052
更新日期:2017-05-01 00:00:00
abstract::Two patients with large vascular carotid body tumors underwent preoperative intravascular embolization of the major arterial feeders. The tumor vascularity was reduced markedly, and complete surgical extirpation was accomplished without difficulty. The literature on carotid body tumors is briefly reviewed. The role of...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.59.5.0867
更新日期:1983-11-01 00:00:00
abstract::There are few reports of anterior communicating artery aneurysms causing visual symptoms, and penetration of the optic chiasm by such aneurysms has not been reported. A 40-year-old man presented with the abrupt onset of left homonymous hemianopsia, right visual acuity disturbance (finger counting), and slight headache...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1997.87.2.0324
更新日期:1997-08-01 00:00:00