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  • 1
    Electronic Resource
    Electronic Resource
    Delayed Postoperative CSF Rhinorrhea of Intrasellar Arachnoid Cyst (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 165-169 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: CSF rhinorrhea; intrasellar arachnoid cyst; pituitary gland; MRI.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  CSF rhinorrhea due to a transsphenoidal approach usually follows accidental or intentional arachnoid opening. We report a patient with an intrasellar arachnoid cyst, who developed delayed onset of CSF rhinorrhea. A sixty-two-year-old man presented with bitemporal type visual field defect for the last 3 years. With the diagnosis of arachnoid cyst or Rathke's cleft cyst, based on MRI findings of intra-and supra-sellar cyst with CSF intensity, he successfully underwent transsphenoidal surgery without evidence of intra-operative CSF leakage. He developed CSF rhinorrhea one week later. This needed another operation for sellar floor repair. The pathomechanism of this delayed onset is explained as follows. Incomplete or one-way communication of subarachnoid space to cyst cavity, unrecognized during surgery, might cause delayed onset of CSF rhinorrhea. By using MRI, identification of the residual gland, which was compressed posteriorly, is useful for differentiating an arachnoid cyst from other cystic lesions. In highly suspect cases, even without evidence of intra-operative CSF leakage, peri-operative measures to prevent occurrence of postoperative CSF rhinorrhea are required.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050281
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  • 2
    Electronic Resource
    Electronic Resource
    Proliferation, Vascular Endothelial Growth Factor Expression and Cavernous Sinus Invasion in Growth Hormone Secreting Pituitary Adenomas (2000)
    Springer
    Acta neurochirurgica 142 (2000), S. 1345-1351 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Pituitary adenoma; vascular endothelial growth factor; Ki-67; cavernous sinus.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Surgical cure of growth hormone producing pituitary adenomas (GHomas) becomes difficult when they invade the cavernous sinus (CS). Tumour proliferative activity and angiogenesis are thought to be required for tumour growth and invasion, and vascular endothelial growth factor (VEGF) activates neovascularization around tumours. In this study, the mechanism and clinical significance of CS invasion is analysed. In 25 surgically treated GHomas, the extent of CS invasion was classified as high (Knosp's grade 3 and 4), and low (grade 0, 1 and 2) MR grades, and the MR grades were compared with tumour proliferative potential (Ki-67 expression), angiogenetic demand (VEGF expression), volume of adenomas and serum hormone levels.  The Ki-67 index of high MR grade adenomas (1.17±0.62%) was significantly higher than that of low MR grade adenomas (0.55±0.42%, p=0.027), whereas VEGF expression showed no significant correlation with MR grades (p〉0.999). Tumour volume also showed a significant correlation with MR grade (p=0.002). VEGF expression was not correlated with serum hormone level and volume, but was correlated with tumour proliferative potential. Proliferative potential and tumour volume were two independent factors related to CS invasion. Although VEGF expression was not a direct factor related to CS invasion, it may indirectly play a role in activation of tumour aggressiveness, which is required in CS invasion.  Our results show that high MR grade adenomas have higher proliferative ability. In order to improve the surgical outcome, pre-operative medical debulking is indicated, particularly, in such adenomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010070003
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  • 3
    Electronic Resource
    Electronic Resource
    Outcome of Traumatic Optic Neuropathy. Comparison Between Surgical and Nonsurgical Treatment (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 27-30 
    Details
    ISSN: 0942-0940
    Keywords:  Keywords: Traumatic optic neuropathy; visual improvement; surgical treatment; nonsurgical treatment.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  34 patients with indirect traumatic optic neuropathy were studied to identify factors affecting outcome and surgical indications. 12 cases (13 eyes = group A) underwent surgery and 24 patients (24 eyes = group B) were managed without surgery. Age, optic canal fracture, visual acuity before treatment (initial visual acuity) and days until surgery (only group A) were employed as variables. Visual acuity improved significantly more in patients with initial visual acuity, hand movement (HM) or better than in those with initial visual acuity for light perception (LP) only or worse. When initial visual acuity was HM or better, vision improved significantly more in patients with surgery than in those without surgery (p=0.0003) by Mann-Whitney U test). Days until surgery were correlated with visual improvement in patients with visual acuity HM or better. Age and optic canal fracture did not affect visual improvement or influence the decision for or against surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050262
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  • 4
    Electronic Resource
    Electronic Resource
    Spontaneous Disappearance of Temporo-Frontal Arachnoid Cyst in a Child (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 537-540 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Temporal arachnoid cyst; surgical indication; spontaneous disappearance; volumetry.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  We report a child with a large temporo-frontal arachnoid cyst which resolved spontaneously. There was no history of a head injury. The patient was a boy aged 1.6 years. Though a large head was pointed out (+2SD), no therapeutic intervention was made because the relationship of the head circumference and the cyst was not established. No change in cyst size was visualized on the follow-up CTs at the age of 2.5 years and 6 years. At the age of 7 years, the arachnoid cyst had completely disappeared on CT. In order not to overlook a minute change in cyst size, the volumetry of the cyst and the intracranial cavity was performed, using the Photoshop, Macintosh. Both the cyst volume and the volume ratio of the cyst to the intracranial cavity slightly decreased and then increased. It is speculated that the cyst spontaneously ruptured by factors such as extreme breath holding and crying on the presence of the higher intracystic tension which might become a factor to accelerate spontaneous rupture of the cyst. Since a number of paediatric cases of symptomatic arachnoid cysts in need of surgical intervention has been larger than that of adult cases, we can speculate that a large arachnoid cyst might spontaneously resolve more frequently than we had expected. This case demonstrates that the surgical treatment of asymptomatic arachnoid cyst in the middle cranial fossa is not necessarily indicated in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050338
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  • 5
    Electronic Resource
    Electronic Resource
    MRI Prediction of Fibrous Pituitary Adenomas (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 779-786 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Collagen; magnetic resonance imaging; pituitary adenoma; transsphenoidal surgery.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  The transsphenoidal approach is a less invasive and safer procedure for removing pituitary adenomas. However, this procedure becomes extremely difficult when the tumour consistency is fibrous as encountered in about 10% of pituitary adenomas. In this study, we investigated predicting factors of tumour consistency in magnetic resonance images (MRIs).  MRIs of two groups, twenty-one soft and five firm (fibrous) adenomas, were retrospectively evaluated and compared in respect of tumour consistency. To compare the two groups objectively, tumour densities on MRI films and percentage of collagen content on operative specimens were expressed as numerical data using NIH-imageTM. The relationships between collagen content and T1-weighted images, T2-weighted images, grade of enhancement effect, and heterogeneity of enhancement were investigated.  Signal intensities on T1-weighted images were not correlated with tumour consistency, whereas those on T2-weighted images were significantly correlated with the percentage of collagen content. Adenomas, showing lower signal intensities on T2-weighted images, contained more collagen. On enhanced images, homogeneously enhanced adenomas tended to include more collagen, even though the grade of enhancement effect showed only weak correlation with the tumour hardness.  MRIs give us useful information on tumour consistency. Adenomas may be firm and fibrous if they show low signal intensities on T2-weighted images and homogeneous enhancement. To remove such tumours, a long sized and small-calibred ultrasonic aspirators applicable to transsphenoidal approach must be prepared and multi-staged operations may be more than likely needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050179
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  • 6
    Electronic Resource
    Electronic Resource
    MRI Findings and Clinical Manifestations in Rathke's Cleft Cyst (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 1055-1061 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: MRI; Rathke's cleft cyst; pituitary cyst; pituitary adenoma; incidentaloma.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  We retrospectively analysed patients with histologically proven Rathke's cleft cyst (RCC) in relation to the clinical manifestations and MRI findings, in particular, of cyst size and intensity in order to obtain an insight into their growing mechanisms, clinical presentations and their management.  Eleven patients with RCC were divided into two groups based on T1 weighted images(WI). The A group consisted of 4 patients with cyst of low intensity in T1 WI. The age averaged 64.5 years. Their initial complaints were visual field defects(VFD). Their complaints were rather insidious. The maximum cyst size averaged 27.8±2.4 mm. The B group consisted of 7 patients with cyst of iso- or high-intensity in T1 WI. Two patients in the B group showed mixture of low and high and iso- and high-intensity, suggesting the presence of bleeding at the onset of symptoms or growing mechanism of the cysts. In the B group the age averaged 39.9 years, being lower than that in the A group. (P=0.0140 with Mann-Whitney's U test) The 5 patients out of 7 showed headache of insidious type or acute onset and the 3 showed a fluctuation of the VFD. The average size was 21.7±3.5 mm and smaller than that of the A group. (P=0.0298 with Mann-Whitney's U test)  Our study has shown that the cyst with iso-to high intensity on T1 WI may cause clinical symptoms with a smaller size than cysts of the low intensity. In the former cyst pattern the onset and growing mechanism may be related to bleeding. The patients with this pattern are more likely to have acute and/or fluctuation of clinical presentations. Knowing these various clinical manifestations based on MRI pattern will be of help in following and managing patients with RCC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050482
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  • 7
    Electronic Resource
    Electronic Resource
    Unusual MRI findings in lymphocytic hypophysitis with central diabetes insipidus (1999)
    Springer
    Neuroradiology 41 (1999), S. 899-900 
    Details
    ISSN: 1432-1920
    Keywords: Key words Hypophysitis lymphocytic ; Pituitary tumour ; Diabetes insipidus ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report an unusual case of lymphocytic hypophysitis, which proved to be cystic at surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050863
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  • 8
    Electronic Resource
    Electronic Resource
    MRI of growth hormone-secreting pituitary adenomas: factors determining pretreatment hormone levels (1999)
    Springer
    Neuroradiology 41 (1999), S. 765-771 
    Details
    ISSN: 1432-1920
    Keywords: Key words Pituitary ; adenoma ; Growth hormone-secreting ; Acromegaly ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Preoperative serum growth hormone (GH) level is one of the most important determinants of outcome. Our aim was to assess MRI findings which may correlate with pretreatment GH levels in GH-secreting adenomas. We retrospectively studied 29 patients with acromegaly caused by a pituitary adenoma. Tumor size (height, width, thickness and volume), suprasellar extension, sphenoid or cavernous sinus invasion, signal intensity and contrast enhancement were studied. Linear regression analysis or Fisher's exact probability test was used for statistical analysis. Factors related to high GH levels were the maximum dimension of the tumour (r = 0.496, P 〈 0.01), its volume (r = 0.439, P 〈 0.05), spenoid sinus invasion (P 〈 0.01) and intracavernous carotid artery (encasement (P 〈 0.01). The other items were not related to serum GH levels. Since we believe surgery is the first choice of treatment and the cavernous sinus is difficult of access with a conventional surgical approach, preoperative assessment of invasion into the cavernous sinus is critical for predicting the surgical outcome. Low GH levels (5–50 ng/ml) were found with tumours medial to the intercarotid line and high levels (more than 101 ng/ml) with invasive tumours with carotid artery encasement. Variable GH levels were noted with tumours extending beyond the intercarotid line. Because functioning adenomas invading the cavernous sinus tend to have markedly high hormone levels, and only patients with carotid artery encasement showed markedly elevated GH levels, we believe carotid artery encasement a reliable MRI indicator of cavernous sinus invasion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050839
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  • 9
    Electronic Resource
    Electronic Resource
    Neuroradiological characteristics of pineocytoma and pineoblastoma (2000)
    Springer
    Neuroradiology 42 (2000), S. 509-514 
    Details
    ISSN: 1432-1920
    Keywords: Key words Pineal ; tumours ; Pineocytoma ; Pineoblastoma ; Computed tomography ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We reviewed neuroradiological images in two histologically proven cases of pineocytoma and three of pineoblastoma to delineate the characteristic features of these rare tumours. CT revealed isodense or slightly hyperdense masses with central or peripheral calcification; enhancement with contrast medium tended to be homogeneous in pineocytomas and heterogeneous in pineoblastomas. In the pineocytomas, T1-weighted images revealed rounded, sometimes or slightly lobulated low-signal masses with strong, homogeneous contrast enhancement. Their margin was clear, without invasion of adjacent structures. In the pineoblastomas, however, T1-weighted images revealed multilobulated tumours with heterogeneous contrast enhancement. All three pineoblastomas had poorly defined margins with adjacent structures such as the posterior thalamus or corpus callosum, suggesting a more invasive nature. T2-weighted images revealed nonspecific high signal lesions in all five case.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002349900243
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  • 10
    Electronic Resource
    Electronic Resource
    Post-traumatic intention tremor - clinical features and CT findings (1989)
    Springer
    Neurosurgical review 12 (1989), S. 500-507 
    Details
    ISSN: 1437-2320
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eight patients with post-traumatic intention tremor were reported. Intention tremor developed in the young as a late complication of severe head injury (Glasgow Coma Scale was below 8 in all cases) and impaired their functional outcome. This state was treatable with medication or by stereotactic thalamotomy. Neurologically, all the patients lapsed into coma immediately after the injury and many patients manifested clinical signs of a midbrain lesion in the chronic stage. The characteristic CT (computed tomography) findings in the acute stage were a high density area in the midbrain, accompanied by diffuse cerebral swelling or intraventricular hemorrhage, and in the chronic stage, brain atrophy or ventricular enlargement were the most prominent CT findings. These characteristics, indicating diffuse brain damage in addition to midbrain injury, may suggest the presence of shearing injury. The midbrain damage is consistent with the classical hypothesis that the damage to the Dentate-Rubro-thalamic system accounts for the occurrence of intention tremor. Furthermore, the presence of diffuse brain damage suggests that a more widespread brain injury may participate in its development.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01790695
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