Transsphenoidal hypophysectomy for disseminated carcinoma of the prostate gland

1979 ◽  
Vol 50 (3) ◽  
pp. 275-282 ◽  
Author(s):  
George T. Tindall ◽  
Nettleton S. Payne ◽  
Daniel W. Nixon
Keyword(s):  
Pain Relief ◽  
Operative Procedure ◽  
Prostate Gland ◽  
Stage Iv ◽  
Early Postoperative Period ◽  
Significant Feature ◽  
Content Type ◽  
Carcinoma Of The Prostate ◽  
Microsurgical Approach ◽  
Fine Print

✓ Transsphenoidal microsurgical hypophysectomy was performed in 53 men with disseminated carcinoma (Stage IV) of the prostate gland. The mean age was 64.8 years. Forty-three of the 53 men had severe pain due to their disease. Significant pain relief was obtained following hypophysectomy, usually within 24 hours, in 39 (91%) of these 43 patients. Objective remission occurred in 16 (36%) of 45 patients in whom the follow-up review was adequate to make this decision. Although dramatic, pain relief was not permanent in every patient. Four patients died in the early postoperative period, and in one, death was directly related to the operative procedure. Significant complications included partial diabetes insipidus in 40 cases (75.5%), and cerebrospinal fluid leaks in six (11.3%). The authors conclude that hypophysectomy is an appropriate operation in patients with disseminated carcinoma of the prostate gland, particularly when pain is a significant feature of the illness. Further, the transsphenoidal microsurgical approach appears to be the operative procedure of choice for performing hypophysectomy.

Pain relief in metastatic cancer other than breast and prostate gland following transsphenoidal hypophysectomy

1977 ◽  
Vol 47 (5) ◽  
pp. 659-662 ◽  
Author(s):  
George T. Tindall ◽  
Daniel W. Nixon ◽  
James H. Christy ◽  
Jimmy D. Neill
Keyword(s):  
Pain Relief ◽  
Metastatic Cancer ◽  
Prostate Gland ◽  
Critical Evaluation ◽  
Pituitary Hormones ◽  
Content Type ◽  
Advanced Carcinoma ◽  
Brain Peptides ◽  
Progression Of Disease ◽  
Fine Print

✓ Hypophysectomy was performed in six patients with advanced carcinoma other than from breast and prostate gland to alleviate pain. Two patients received significant and lasting relief of pain; one achieved relief but died from progression of disease 5 weeks after surgery; one patient, initially relieved, had recurrence of pain 3 months later; one had about 50% relief; and one received no benefit. Possible mechanisms for pain relief include changes in pituitary hormones, prostaglandins, and the newly isolated brain peptides, alpha and beta endorphin. These preliminary observations will require further critical evaluation in a larger series to determine the effectiveness of hypophysectomy in relieving pain in cancer other than from the breast and prostate. The results, nevertheless, do imply that a different approach to pain, namely endocrine manipulation, may be beneficial in certain cancer patients.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine

1990 ◽  
Vol 72 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Joseph C. Maroon ◽  
Thomas A. Kopitnik ◽  
Larry A. Schulhof ◽  
Adnan Abla ◽  
James E. Wilberger
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Spinal Nerve ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Enhanced Ct ◽  
Disc Herniations ◽  
Microsurgical Approach ◽  
Far Lateral ◽  
Fine Print

✓ Lumbar-disc herniations that occur beneath or far lateral to the intervertebral facet joint are increasingly recognized as a cause of spinal nerve root compression syndromes at the upper lumbar levels. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the incorrect interspace. If these herniations are diagnosed, they often cannot be adequately exposed through the typical midline hemilaminectomy approach. Many authors have advocated a partial or complete unilateral facetectomy to expose these herniations, which can lead to vertebral instability or contribute to continued postoperative back pain. The authors present a series of 25 patients who were diagnosed as having far lateral lumbar disc herniations and underwent paramedian microsurgical lumbar-disc excision. Twelve of these were at the L4–5 level, six at the L5–S1 level, and seven at the L3–4 level. In these cases, myelography is uniformly normal and high-quality magnetic resonance images may not be helpful. High-resolution computerized tomography (CT) appears to be the best study, but even this may be negative unless enhanced by performing CT-discography. Discography with enhanced CT is ideally suited to precisely diagnose and localize these far-lateral herniations. The paramedian muscle splitting microsurgical approach was found to be the most direct and favorable anatomical route to herniations lateral to the neural foramen. With this approach, there is no facet destruction and postoperative pain is minimal. Patients were typically discharged on the 3rd or 4th postoperative day. The clinical and radiographic characteristics of far-lateral lumbar-disc herniations are reviewed and the paramedian microsurgical approach is discussed.

Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures

2002 ◽  
Vol 96 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Kyung Sik Ryu ◽  
Chun Kun Park ◽  
Moon Chan Kim ◽  
Joon Ki Kang
Keyword(s):  
Pain Relief ◽  
Epidural Space ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Content Type ◽  
Compression Fractures ◽  
Dose Dependent ◽  
Pmma Cement ◽  
Fine Print

Object. The use of polymethylmethacrylate (PMMA) cement by percutaneous injection in cases requiring vertebroplasty provides pain relief in the treatment of osteoporotic vertebral compression fractures. A retrospective study was performed to assess what caused PMMA cement to leak into the epidural space and to determine if this leakage caused any changes in its therapeutic benefits. Methods. Polymethylmethacrylate was injected into 347 vertebral compression fractures in 159 patients. The cement leaked into the epidural space in 92 (26.5%) of 347 treated vertebrae in 64 (40.3%) of the 159 patients, as demonstrated on postoperative computerized tomography scanning. Epidural leakage of PMMA cement occurred more often when injected above the level of T-7 (p = 0.001) than below. The larger the volume of PMMA injected the higher the incidence of epidural leakage (p = 0.03). Using an injector also increased epidural leakage (p = 0.045). The position of the needle tip within the vertebral body and the pattern of venous drainage did not affect epidural leakage of the cement. Leakage of PMMA into the epidural space reduced the pain relief expected after vertebroplasty. The immediate postoperative visual analog scale scores were higher (and therefore reflective of less pain relief) in patients in whom epidural PMMA leakage occurred (p = 0.009). Three months postoperatively, the authors found the highest number of patients presenting with pain relief, including those in the group with epidural leakage, and at this follow-up stage there were no significant differences between the two groups. Conclusions. The authors found that epidural leakage of PMMA after percutaneous vertebroplasty was dose dependent. The larger amount of injected PMMA, the higher the incidence of leakage. Injecting vertebral levels above T-7 also increased the incidence of epidural leakage. Epidural leakage of PMMA may attenuate only the immediate therapeutic effects of vertebroplasty.

Fetal nondopaminergic neural implants in parkinsonian primates

1991 ◽  
Vol 74 (1) ◽  
pp. 97-104 ◽  
Author(s):  
Krzysztof S. Bankiewicz ◽  
Robert J. Plunkett ◽  
David M. Jacobowitz ◽  
Irwin J. Kopin ◽  
Edward H. Oldfield
Keyword(s):  
Dopaminergic Neurons ◽  
Neural Implants ◽  
Behavioral Recovery ◽  
Foramen Of Monro ◽  
Caudate Nuclei ◽  
Content Type ◽  
Primate Brain ◽  
Brain Implants ◽  
Microsurgical Approach ◽  
Fine Print

✓ Implantation of fetal dopamine-containing tissue into preformed cavities in the caudate nucleus of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonian monkeys leads to behavioral recovery. Recovery may be related to two sources of dopamine: the grafted cells and/or the sprouted fibers from host dopaminergic neurons. The authors undertook this study to determine whether behavioral recovery requires release of dopamine by the implanted tissue, and to establish if nondopaminergic fetal central nervous system implants can induce sprouting of dopamine fibers in the primate brain and cause behavioral recovery. Rhesus monkeys with MPTP-induced hemiparkinsonism or full parkinsonism and a stable neurological deficit were used for this study. Cavities were created in the caudate nuclei anterior to the foramen of Monro via an open microsurgical approach. Fetal cerebellum or spinal cord was implanted into the preformed cavities of three monkeys. Control parkinsonian monkeys showed no recovery. However, implant-induced improvement was stable for up to 6 months after implantation. Sprouted dopaminergic fibers oriented from the ventral striatum and nucleus accumbens were found in the area of the tissue implant in the animals that received fetal grafts but were not present in the control monkeys. It is concluded that brain implants do not need to contain dopamine to induce functional recovery in MPTP-induced parkinsonian primates. Implant-induced and trophic factor-mediated dopaminergic sprouting by the host brain plays a role in the behavioral recovery and may well be responsible for the clinical improvement seen in parkinsonian patients after brain implants.

Activation of the anterior cingulate cortex by thalamic stimulation in patients with chronic pain: a positron emission tomography study

2000 ◽  
Vol 92 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Karen D. Davis ◽  
Ethan Taub ◽  
Frank Duffner ◽  
Andres M. Lozano ◽  
Ronald R. Tasker ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Chronic Pain ◽  
Pain Relief ◽  
Anterior Cingulate Cortex ◽  
Analgesic Effect ◽  
Anterior Cingulate ◽  
Emission Tomography ◽  
Content Type ◽  
Positron Emission ◽  
Fine Print

Object. Deep brain stimulation (DBS) of the sensory thalamus has been used to treat chronic, intractable pain. The goal of this study was to investigate the thalamocortical pathways activated during thalamic DBS.Methods. The authors compared positron emission tomography (PET) images obtained before, during, and after DBS in five patients with chronic pain. Two of the five patients reported significant DBS-induced pain relief during PET scanning, and the remaining three patients did not report any analgesic effect of DBS during scanning. The most robust effect associated with DBS was activation of the anterior cingulate cortex (ACC). An anterior ACC activation was sustained throughout the 40 minutes of DBS, whereas a more posteriorly located ACC activation occurred at a delay after onset of DBS, although these activations were not dependent on the degree of pain relief reported during DBS. However, implications specific to the analgesic effect of DBS require further study of a larger, more homogeneous patient population. Additional effects of thalamic DBS were detected in motor-related regions (the globus pallidus, cortical area 4, and the cerebellum) and visual and association cortical areas.Conclusions. The authors demonstrate that the ACC is activated during thalamic DBS in patients with chronic pain.

Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia

2004 ◽  
Vol 100 (5) ◽  
pp. 848-854 ◽  
Author(s):  
Ronald Brisman
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Recurrent Pain ◽  
Content Type ◽  
Kaplan Meier ◽  
Uniform Manner ◽  
Second Procedure ◽  
Fine Print

Object. The author presents a large series of patients with idiopathic trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS), at a maximum dose of 75 to 76.8 Gy, and followed up in a nearly uniform manner for up to 4.6 years. Methods. Two hundred ninety-three patients were treated and followed up for at least 6 months (range 0.4–4.6 years, median 1.9 years). At the final follow-up review, there was complete (100%) pain relief without medicines in 64 patients (21.8%), 90% or greater relief with or without small doses of medicines in 86 (29.4%), between 75 and 89% relief in 31 (10.6%), between 50 and 74% relief in 19 (6.5%), and less than 50% relief in 23 patients (7.8%). Recurrent pain requiring a second procedure occurred in 70 patients (23.9%). Kaplan—Meier analysis showed that 100%, 90% or greater, and 50% or greater pain relief was obtained and maintained for 3.5 to 4.1 years in 5.6 , 23.7, and 50.4% patients, respectively. Of 31 patients who described pain relief ranging from 75 to 89%, 80% of patients described it as good and 10% as excellent; of 17 patients who reported between 50 and 74% pain relief, 53% described it as good and none as excellent (p = 0.014). Dysesthesia scores greater than 5 (scale of 0–10, in which a score of 10 represents excruciating pain) occurred in four (3.2%) of 126 patients who had not undergone prior surgery; all these patients obtained either good or excellent relief from TN pain. There were 36 patients in whom the TN had atypical features; these patients were less likely to attain at least 50% or at least 90% pain relief compared with those without atypical TN features (p = 0.001). Conclusions. Gamma knife surgery is a safe and effective way to relieve TN. Patients who attain between 75 and 89% pain relief are much more likely to describe this outcome as good or excellent than those who attain between 50 and 74% pain relief.

Evaluation of the risks of anticoagulation therapy following experimental craniotomy in the rat

1985 ◽  
Vol 63 (6) ◽  
pp. 959-962 ◽  
Author(s):  
Keith L. Schaible ◽  
Lawrence J. Smith ◽  
Richard G. Fessler ◽  
Jacob R. Rachlin ◽  
Frederick D. Brown ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Anticoagulation Therapy ◽  
Early Postoperative Period ◽  
Activated Partial Thromboplastin Time ◽  
Content Type ◽  
Intracranial Surgery ◽  
Heparin Administration ◽  
Postoperative Interval ◽  
Potential Use ◽  
Fine Print

✓ The risk of hemorrhagic complications with anticoagulation therapy in patients following intracranial surgery has prevented investigation of the potential use of heparin in the early postoperative period. The authors have evaluated the safety of anticoagulation therapy following experimental craniotomy in male Holtzman rats. The dose and schedule of heparin administration, which elevated and maintained the activated partial thromboplastin time (APTT) within the therapeutic range of 15 to 3 × control APTT, was alternating doses of 400 and 500 IU/kg injected subcutaneously every 6 hours. This schedule was initiated 2, 4, 7, 10, and 14 days after craniotomy and was continued for 72 hours thereafter. The results demonstrated that the incidence of intracerebral hemorrhage declined as the postoperative interval prior to initiation of anticoagulation increased. If anticoagulation therapy was initiated during the first 7 postoperative days, the risk of intracerebral hemorrhage was high (mean 14.7%); however, if an additional 3 to 7 days elapsed prior to initiation of anticoagulation, the incidence of intracerebral hemorrhage dropped significantly (mean 0%) (p < 0.05). These results suggest that anticoagulation therapy can be safely initiated 10 to 14 days after craniotomy.

Lateral microsurgical approach to intraorbital tumors

1976 ◽  
Vol 44 (5) ◽  
pp. 556-561 ◽  
Author(s):  
Joseph C. Maroon ◽  
John S. Kennerdell
Keyword(s):  
Optic Nerve ◽  
Skin Incision ◽  
Team Approach ◽  
Tumor Localization ◽  
Axial Tomography ◽  
Content Type ◽  
Ultrasonic Scanning ◽  
Microsurgical Approach ◽  
Computerized Axial Tomography ◽  
Fine Print

✓ The authors describe their microsurgical lateral orbital approach to intraorbital tumors. In seven patients ultrasonic scanning, computerized axial tomography, polytomography, orbital venography, and arteriography have allowed precise intraorbital tumor localization relative to the optic nerve. The authors believe that circumscribed tumors superior, lateral, or inferior to the optic nerve can be safely and completely removed through a 30–35-mm lateral skin incision with microsurgical dissecting techniques. A combined neurosurgical-ophthalmological team approach is emphasized.

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