Search NEL Online

Journal Article 2016; 37(3): 233-238 PubMed PMID: 27618608 Citation  Keywords:  Adolescent, Adult, Aged, Child, Endoscopy, Female, Follow-Up Studies, Humans, Hydrocortisone:blood, Male, Middle Aged, Monitoring, Physiologic, Neurosurgical Procedures:methods, Pituitary ACTH Hypersecretion:blood, Pituitary Gland:surgery, Postoperative C.   

INTRODUCTION: To increase radicality and avoid surgical complications new treatment options are under investigation. One of the promising possibilities is to assess early morning cortisol levels on the first and second postoperative day.

MATERIAL AND METHODS: We enrolled 34 patients (9 males, 25 females) diagnosed with Cushing's disease. Blood samples to determine cortisol level were taken always at 06:00 and sent to the lab. The samples were taken on the first and second postoperative day. For all patients, standard four-handed, a bi-nostril endoscopic endonasal technique was used. Endocrinological follow-up (6-34 months) was performed using morning cortisol sampling.

RESULTS: In total, 36 patients (88%) were disease-free post-surgery. In the group with early postoperative levels of morning cortisol of less than 463 nmol/L, only 2 of 29 patients (7%) exceeded the final morning level of cortisol at follow-up. In patients with early postoperative cortisol levels between 17 nmol/l and 234 nmol/l all subjects showed normal postoperative cortisol levels.

DISCUSSION: In 30 of 34 patients (88%), the level of cortisol was within normal limits. The prediction importance of early measurement of cortisol is 93% for patients with early postoperative cortisol levels of less than 463 nmol/L. The prediction importance of early measurement of cortisol is 100% for patients with early postoperative cortisol levels from 17 to 234 nmol/L.

CONCLUSION: The monitoring of early morning cortisol levels seems to be an important tool in the management of central Cushing's disease....

Read abstract  Full text PDF

Case Reports 2015; 36(5): 407-409 PubMed PMID: 26707037 Citation  Keywords:  Cervical Vertebrae:surgery, Humans, Male, Middle Aged, Neurosurgical Procedures:adverse effects, Pancreatitis:etiology, Spinal Cord Injuries:etiology, Spondylosis:surgery,.   

: Acute pancreatitis (AP) is a frequent and potentially life-threatening disease with high morbidity and mortality. The overall mortality of AP is approximately 5%. Alcohol consumption and gallstones are the main etiology of AP. Hypertriglyceridemia, idiosyncratic reactions to drugs, anatomic alterations and ascaris lumbricoides can also give rise to AP. Although spinal cord injury (SCI) can cause AP, however, the case of induced by cervical spine surgery has not been reported. A 61-year-old man with quadriplegic and respiratory distress received cervical spine surgery for spinal cervical spondylosis and multi-stage longitudinal ligament. He was admitted to intensive care unit (ICU) after tracheotomy for progressive dyspnea, one day after the cervical spine surgery. The patient was diagnosed with AP, in the absence of any identifiable causes of pancreatitis. He was treated with intravenous fluids, no oral feeding, enteral and parenteral nutrition, antibiotic and mechanical ventilation. The patient's condition gradually improved after the treatment. This case describes a case of postoperative cervical spondylosis that led to AP. In this report, we highlight the importance of early diagnosis and subsequent appropriate treatment. We conclude that the outcome can be favorable, if the treatment is appropriate....

Read abstract  Full text PDF

Case Reports 2014; 35(4): 257-261 PubMed PMID: 25038593 Citation  Keywords:  Cysts:etiology, Growth Hormone:blood, Growth Hormone-Secreting Pituitary Adenoma:complications, Humans, Kidney:pathology, Liver:pathology, Male, Middle Aged, Neurosurgical Procedures, Sphenoid Bone:surgery, Treatment Outcome,.   

: Growth-hormone staining pituitary adenoma is a popular disease of the central nervous system. We noticed some patients have accompanying cystic disorders. Several cases of concomitant growth-hormone (GH)-staining pituitary adenoma and other cystic changes have been reported but with no further investigation. We report a case of adult growth-hormone staining pituitary adenoma with accompanying polycystic changes of multiple systems, as well as hypertension and nephrolithiasis. Preoperative clinical assessment revealed intrasellar tumor, multinodular thyroid disorder, renal cysts, and hepatic cysts, with increased serum growth-hormone level and normal thyroid hormone level. The total tumor resection was performed via endoscopic transsphenoidal approach. The pathologic analysis reported growth-hormone staining pituitary adenoma. The postoperative course was uneventful. The endocrine testing was normal soon after the operation and the patient remained well for a follow-up period of eight months. This is the fifth report about simultaneous growth-hormone staining pituitary adenoma and polycystic changes of the kidneys and the liver. With review of the literature we speculate that the abnormal growth hormone secretion of the pituitary adenoma may arouse sequential cystic changes of multiple systems through some IGF-I involved pathways....

Read abstract  Full text PDF

Case Reports 2013; 34(2): 111-117 PubMed PMID: 23645307 Citation  Keywords:  Brain Edema:diagnosis, Female, Humans, Magnetic Resonance Imaging:methods, Meningeal Neoplasms:diagnosis, Meningioma:diagnosis, Middle Aged, Neurosurgical Procedures:methods, Skull Base Neoplasms:complications, Treatment Outcome,.   

: Meningiomas are very common neurosurgical problem. Their histological appearance, different size and localization, adherence to vital neural and vascular structures or extensive peritumoral brain edema (PTBE), especially in deep seated tumors, may lead to severe, life-threatening complications. We report a case of tuberculum sellae meningioma (TSM). A 48-year old female presented with 7-month history of blurred vision and progressive visual impairment. Intracranial tumor was confirmed by magnetic resonance imaging (MRI). After ophtalmological and endocrinological evaluation, the patient underwent surgical removal of the tumor. She immediately recovered from her visual disturbances and no tumor recurrences were seen during follow-up. Pathological diagnosis showed a meningioma of the secretory subtype (MS). We discuss the role of immunohistochemical staining in the diagnosis and the role of different factors in the PTBE formation. Selection of surgical route to the TSM is discussed, as well. Review of the literature is presented....

Read abstract  Full text PDF

Case Reports 2012; 33(8): 765-768 PubMed PMID: 23391974 Citation  Keywords:  Adenoma:surgery, Adult, Angiography, Digital Subtraction, Female, Humans, Male, Middle Aged, Neuronavigation:methods, Neurosurgical Procedures:methods, Oculomotor Nerve Diseases:surgery, Pituitary Neoplasms:surgery, Sella Turcica:diagnostic imaging, Sphen.   

: A concha non-pneumatized sphenoid is considered to be a contraindication for the transsphenoidal resection of a pituitary adenoma. Specifically, this anatomical variation makes it difficult to approach the sella turcica. However, in this report, an intra-operative navigational system was used as a guide to access the sella through the sphenoid sinus. This procedure was found to be both reasonable and safe....

Read abstract  Full text PDF

Case Reports 2012; 33(6): 590-596 PubMed PMID: 23160226 Citation  Keywords:  Aged, Brain Neoplasms:diagnosis, Fatal Outcome, Female, Humans, Hydrocephalus:diagnosis, Hypothalamic Diseases:diagnosis, Hypothalamus:surgery, Male, Middle Aged, Neurosurgical Procedures:adverse effects, Postoperative Complications:diagnosis, Subdural Ef.   

BACKGROUND: Opening of the lamina terminalis is often used in surgery of the optico-chiasmatic region. Consequently, alteration of cerebral-spinal fluid (CSF) dynamics can occur after this manoeuvre, thus potentially translating into clinical complications. Herein, we describe 2 cases in which clinically relevant hypothalamic dysfunctions developed after few days opening of the lamina terminalis both patients showed mild to moderate preoperative hydrocephalus which improved postoperatively.

CASES DESCRIPTION: In a patient with ruptured aneurysm of the basilar bifurcation, opening of the lamina terminalis was performed prior to acute-stage clipping. On postoperative day 7th, the patient developed significant subdural hygroma, mild disturbances of consciousness and increase of ADH concentration. These clinical features resolved only following subdural hygroma drainage and ventricular-peritoneal shunting. One previously operated patient in whom the lamina terminalis had been opened to remove a sizeable parasellar tumour showed a similar post-operative course. In this patient, sole subdural hygroma drainage was not an effective treatment, and the patient died subsequently for complications related to long-standing, though mild, hypothalamic dysfunction.

CONCLUSIONS: Our experience may suggest that hypothalamic dysfunctions should be reminded as a possible, although rare, complication following the opening of the lamina terminalis. This clinical condition, if not properly managed, may contribute to trigger severe life-threatening complications....

Read abstract  Full text PDF

Case Reports 2012; 33(5): 483-488 PubMed PMID: 23090264 Citation  Keywords:  Adult, Critical Illness, Dopamine Agonists:therapeutic use, Female, Humans, Neurosurgical Procedures:methods, Pituitary Apoplexy:drug therapy, Pituitary Neoplasms:drug therapy, Pregnancy, Pregnancy Complications:drug therapy, Prolactinoma:drug therapy, Sp.   

: Prolactinoma is the most common secreting pituitary adenoma. It is typically diagnosed in women of reproductive age and is common cause of infertility. Currently the treatment of choice is pharmacotherapy with dopamine agonists, whereas surgical treatment is reserved for a selected group of patients. Pituitary-tumor apoplexy is a rare, life-threatening condition associated with significant morbidity and mortality. The authors present the case of a 25-year-old woman with prolactinoma treated with dopamine agonist. In course of such a treatment the patient became pregnant. The bromocriptine was gradually withdrawn. In the 14th week of pregnancy she was admitted for symptoms suggesting pituitary tumor apoplexy. The treatment with bromocriptine was reinitiated. In the 20th week of pregnancy further deterioration of the patient's neurological condition and visual-field abnormalities were observed. The patient was qualified for surgical treatment - selective transsphenoidal adenomectomy. The successful surgery led to improvement of neurological condition. The early postoperative PRL level decreased significantly and hormonal function of the pituitary was preserved. The pregnancy ended in 38th week with a caesarean section. Endocrinological evaluation conducted after the uneventful delivery confirmed normal function of the pituitary. Magnetic resonance imaging (MRI) did not reveal tumor re-growth. The patient is kept under constant medical care. In this case study the authors discussed therapeutic management and reviewed literature regarding gestational pituitary-tumor apoplexy with particular emphasis on surgical treatment....

Read abstract  Full text PDF

Case Reports 2010; 31(5): 597-601 PubMed PMID: 21173743 Citation  Keywords:  Adult, Anti-Bacterial Agents:therapeutic use, Biopsy, Brain Abscess:drug therapy, Diagnosis, Differential, Female, Headache:etiology, Humans, Magnetic Resonance Imaging, Neurosurgical Procedures, Pituitary Diseases:complications, Sphenoid Bone:surgery, Tr.   

OBJECTIVES: Pituitary abscess is rare disease and the correct diagnosis is difficult because there are non-specific symptoms and it is often radiologically indistinguishable from other pituitary lesions.

CASE PRESENTATION: We present one case of pituitary abscess that constitute 0.15% of all pituitary adenomas operated in our department in the 20 years. A 49-year-old woman presented with a history of 10 months bifrontal headache. The MRI showed cystic intra and suprasellar mass with ring enhancement after contrast injection. During transsphenoidal surgery, copious yellowish pus was found. Antibiotic therapy was performed. Histological study of the cyst wall confirmed the diagnosis of pituitary abscess.

CONCLUSION: Pituitary abscess should be considered in the differential diagnosis of all other cyst mass in patients with diabetes insipidus....

Read abstract  Full text PDF