Biomedical subjects
Publications and source records attributed to I Goodrich.
The occurrence of a symptomatic Rathke's cleft cyst without extension into the sella turcica is rare. The purpose of this report is to present such a case, with its clinical manifestation, diagnostic imaging characteristics, operative approach, pathology and review of the literature.
It is difficult to predict the adequacy of the collateral blood flow in patients who undergo internal carotid artery occlusion. In order to address this difficulty, the authors have created a computer model of the cerebral circulation. This model features individualized simulations of the Circle of Willis and its afferent and efferent branches which can predict changes in flow that will occur during internal carotid artery occlusion. Analysis of the flow predictions suggests that in patients with a symmetric Circle of Willis the anterior communicating artery is the major conduit of collateral blood supply. In patients with a small anterior communicating artery, the posterior communicating arteries become more important as sources of collateral flow, but they cannot supply as much flow as in the case of a normal anterior communicating artery. Sensitivity studies show that changes in the dimensions of each artery affect the flow throughout the system, such that the arteries in the cerebral circulation must be analyzed as a network rather than as isolated elements. This computer model of the cerebral circulation may help clinicians predict the adequacy of collateral blood supply in patients who undergo internal carotid artery occlusion.
Intracranial saccular aneurysms frequently cause devastating neurologic injury when they rupture. With recent improvements in diagnostic imaging, however, an increasing number of aneurysms are now diagnosed in the unruptured state. Controversy exists regarding the appropriate management of these lesions. We have retrospectively examined a group of 86 patients from Connecticut with 104 intracranial aneurysms to determine whether small (less than 10 mm in greatest diameter) aneurysms have potential for rupture, and whether there is a role for prophylactic surgical therapy for these unruptured aneurysms. The majority of ruptured and unruptured aneurysms in the series measured less than 10 mm in greatest diameter. Out of a total of 82 patients who underwent surgical therapy, 44 had surgery for unruptured aneurysms. The major surgical morbidity in this group was 2%. We conclude that surgical therapy for small unruptured intracranial aneurysms may be beneficial since these lesions likely have substantial potential for rupture and because surgical treatment carries an acceptable risk.
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Advances in CT scanning and digital subtraction angiography have improved the accuracy of preoperative diagnosis of pituitary disease. Modern radioimmunoassay techniques are able to evaluate "subdivisions" and "relatives" of the classic pituitary hormones, including monomeric and oligomeric growth hormones, somatomedin C, beta-lipotropin, and beta-endorphin, as well as the alpha subunit of follicle-stimulating hormone. Pituitary pathologic states can now be identified immunologically in patients in whom results of radiologic studies are normal. Bromocriptine, a centrally active dopamine antagonist and ergot derivative, is effective in the treatment of prolactinomas, but it is not effective in the treatment of acromegaly. Transsphenoidal surgery remains the treatment of choice in adults with pituitary-dependent Cushing's disease. The surgical advantages of the sublabial, transseptal, transsphenoidal approach include wide-field pituitary accessibility via a midline exposure.
A thorough knowledge of the surgical anatomy of the sellar region is prerequisite to understanding the symptoms and the pathophysiology of diseases in this area. The differential diagnoses of sellar and parasellar lesions includes pituitary tumor, craniopharyngioma, carotid aneurysm, empty sellar syndrome, metastatic tumor, optic or hypothalamus glioma, meningioma, chordoma, mucocele, and bony tumor of the sphenoid sinus. The preoperative evaluation should encompass the consultations of an endocrinologist, an ophthalmologist, and a neurosurgeon.
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Two cases of the spontaneous occurrence of spinal epidural hematomas of the high thoracic area are reported. Both acute and subacute presentations of paraplegia are represented. Neither patient had experienced any significant antecedent trauma. No predisposing medical conditions were present. Both patients recovered to independent ambulation following timely operative intervention. The pertinent literature on spinal epidural hematomas is reviewed, and the differential diagnosis of this entity is discussed. The need for prompt diagnosis and surgical treatment to achieve the best neurological outcome is emphasized.
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