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Biomedical subjects

M Buchfelder

Publications and source records attributed to M Buchfelder.

At least 145 records · Page 8Linked to original sources
PubMed1989

The coexistence of pituitary adenomas and meningiomas: three case reports and a review of the literature.

A coexistence of pituitary adenomas and meningiomas is very rare. We have reported on three of our own cases and reviewed the 17 cases reported in the literature. One has to differenciate between the coexistence of a pituitary adenoma and a meningioma without previous irradiation, and the occurrence of a meningioma following the irradiation of a pituitary adenoma. In the cases without irradiation, the adenoma and the meningioma are diagnosed simultaneously. On the other hand meningiomas arising after irradiation of a pituitary tumour are usually diagnosed only after a long latent period. The coexistence of pituitary tumours and meningiomas resulting from hormone dependent growth as well as the induction of growth of meningiomas by irradiation are discussed.

Adenoma↗
PubMed1988

Transsphenoidal surgery of parasellar pituitary adenomas.

A series of 147 transsphenoidal operations for parasellar pituitary adenomas performed in a 4.5 year period is presented. The clinical and radiological features of the tumours are described and a new practical classification for the neurosurgeon is introduced. The results of surgery are analyzed with special attention to normalization rates in endocrinologically active adenomas and to the recovery rate of optomotoric nerve lesions in 10 of these cases. While in intra- and parasellar microadenomas the surgical normalization rates are comparable to those not extending beyond the confines of the sella, correction of hormonal oversecretion is only exceptionally observed in invasive parasellar macroadenomas. The prognosis for extraocular nerve palsies was found to be favourable, irrespective of the duration of the palsies before surgical intervention. It is to be stressed that even adenomas invading the cavernous sinus can be totally removed via the transsphenoidal approach.

Acromegaly↗
PubMed1987

Intrasphenoidal encephaloceles--a clinical entity.

In the current classification basal encephaloceles are grouped together with real transsphenoidal encephaloceles. But those encephaloceles extending only into but not through the sphenoid sinus seem to represent a specific clinical entity and therefore should be regarded as a rare subgroup of sphenoidal encephaloceles. One personal case and six cases from the literature are reviewed, the own case being associated with an empty sella turcica. The initial sign is rhinorrhea, almost invariably. The association with other intracranial anomalies is uncommon. The extradural transsphenoidal or transethmoidal midline approach accompanied by a shunting procedure today is the most suitable method of surgical treatment.

Adult↗
PubMed1987

Corticotropin-releasing hormone stimulation test before and after transsphenoidal selective microadenomectomy in 30 patients with Cushing's disease.

Thirty patients with ACTH-dependent Cushing's disease were tested with CRH before and 7-10 days and 3-6 months after selective transsphenoidal adenomectomy. In 28 of 30 patients an adenoma was found, and in 22 (79%) clinical and endocrinological remission occurred. Preoperatively, the majority of the patients had basal and CRH-stimulated plasma ACTH levels that were markedly increased compared to those in normal subjects. On the basis of the CRH stimulation test and low dose (2 mg) dexamethasone suppression test results 7-10 days after surgery, these 30 patients were divided into 4 groups. Groups I, II, and III were patients in remission, as defined by undetectable, subnormal, or normal basal plasma ACTH and cortisol levels in addition to sufficient suppression of cortisol (less than 2 micrograms/dL) during the low dose (2 mg) dexamethasone suppression test. Patients in group IV were not in remission. In group I (n = 6), CRH failed to raise undetectable basal ACTH levels in the early postoperative period; however, 3-6 months later plasma ACTH did increase in response to CRH. In group II (n = 11), undetectable or low basal ACTH levels increased after CRH, and the increase was similar to that in normal individuals. In group III (n = 5), basal ACTH levels were normal, and the response to CRH was exaggerated, but all patients responded normally to the dexamethasone suppression test. The CRH-induced ACTH increase in group III was significantly greater (P less than 0.003) than that in normal subjects, but was similar to that in patients not in remission in group IV (n = 6). Three to 6 months later, the ACTH response to CRH in group III was normal. In summary, the CRH test 7-10 days after surgery in patients with Cushing's disease indicated remission when there was no CRH-induced ACTH response or the response was normal (groups I and II). The test failed to predict remission in patients with an exaggerated CRH-induced ACTH response (groups III and IV). However, with regard to group II, the CRH-induced ACTH increase 1 week after selective adenomectomy indirectly supports the concept of CRH deficiency during hypercorticism and thus, in these patients as well as in group I, a pituitary origin of the disease.

Adenoma↗
PubMed1987

Short-term preoperative treatment of macroprolactinomas by dopamine agonists.

During a period of 3 years, 25 patients with intra- and extrasellar macroprolactinomas were pretreated with dopamine agonists for a period of 2 to 6 1/2 weeks prior to transsphenoidal microsurgical tumor resection. Dopamine agonists were administered orally to 17 patients, intramuscularly to three patients, and both orally and intramuscularly to five patients. Repeated computerized tomography (CT) examinations revealed that all neoplasms except one cystic tumor were reduced in size during the course of dopamine-agonist administration. No complications attributable to medical pretreatment were observed. Tumor shrinkage increased the efficacy of surgery, especially in cases with considerable extrasellar extension of the adenomas. Within 3 months following adenomectomy, prolactin levels were adjusted to normal levels in 19 patients by additional low-dose treatment with dopamine agonists. Thin-collimation CT assessments performed at least 3 months after surgery showed no evidence of residual tumor tissue in 23 patients. It is concluded that administration of dopamine agonists for some weeks prior to surgery is a useful adjunct to transsphenoidal microsurgery for macroprolactinomas. The new injectable form of bromocriptine is particularly valuable for this purpose.

Adenoma↗
PubMed1987

CRH test after pituitary microsurgery suggests tertiary adrenocortical insufficiency in successful operated patients with Cushing's disease.

In this study 30 patients with ACTH-dependent Cushing's disease underwent CRH-stimulation test before, 7-10 days and 3-6 months later after transphenoidal selective microadenomectomy. In 22 of 30 patients clinical and endocrinological remission (2 mg dexamethasone suppression test below 2 micrograms/dl cortisol) occurred. Fourteen of the 22 patients in remission showed a statistically significant increase of ACTH after CRH, 1 week after the operation. This CRH-induced ACTH increase in the early post-operative period gives indirect evidence for endogenous CRH deficiency and suggests tertiary adrenocortical insufficiency in successfully operated patients.

Adenoma↗
PubMed1986

Transsphenoidal surgery for Cushing's disease.

A series of 101 patients with Cushing's disease underwent transsphenoidal surgery. Diagnosis was fundamentally based on dynamic testing, mainly on the dosage-dependent suppression of cortisol after dexamethasone. The effect of surgery was monitored by intraoperative ACTH measurements. In 96 out of 101 patients a microadenoma of the pituitary was identified and removed selectively. In 74% of patients there was a clinical and endocrinological remission of Cushing's disease. Four 'operative failures' after selective adenomectomy underwent hypophysectomy in a second operation and each remitted. Thus the overall remission rate was 77%. In general, bilateral adrenalectomy was performed in patients who had failed to remit after selective adenomectomy. Although there is a considerable mortality and morbidity in patients with Cushing's syndrome, complications attributed to surgery were low. Two patients died postoperatively. In general, an improvement of disturbed pituitary function was noted after selective adenomectomy.

Adenoma↗
PubMed1986

CT appearances of craniopharyngiomas before and after therapy.

Different means of therapy are available for the treatment of craniopharyngiomas (surgery, radiation therapy, radioactive implants) but their respective impact is still a matter of controversy. Computed tomographic examinations of 26 patients before and after various forms of therapy were used to monitor the efficacy of treatment. 118 scans were retrospectively studied for characteristic features. 16 patients were treated by surgery and additional radiotherapy, 10 had surgery alone. The total size of the tumour was found to be decreased in 69% of patients treated by incomplete surgery and irradiation up to 9 years after treatment, while tumor progression occurred in three patients. Where the surgeon considered that there had been excision of the lesion, evidence of residual tumour was seen in 4/8 (50%) of cases, but no regrowth occurred in these whose postoperative scans had indicate complete resection. The increase or development of calcification after radiotherapy is compatible with a silent tumour.

Adolescent↗
PubMed1985

Neurosurgical treatment of Cushing's disease in children and adolescents.

The authors report on 15 unselected consecutive children and adolescents treated for hypothalamo-pituitary Cushing's disease by transsphenoidal sella exploration and microadenomectomy. The diagnosis was established by dynamic endocrine testing. Peri- and post-operative measurements of ACTH levels were used to monitor the effectivity of the surgical procedure. In one patient no microadenoma was found. Hypercortisolism was corrected in 13 of the 15 patients. Although transient secondary adrenocortical insufficiency occurred in all of the successfully operated patients, no permanent damage of the anterior or posterior pituitary was found by postoperative endocrinological follow-up testing. One patient died of pneumonia as a direct consequence of surgery.

Adenoma↗
PubMed1985

Present status of neurosurgery in the treatment of prolactinomas.

Our experience with prolactinomas started in 1972 and is based on about 370 patients. Of these 247 were treated surgically, about 110 underwent medical therapy and a small number of patients were observed only. In microprolactinomas prolactin-levels could be normalized in up to 80% of the patients after selective adenomectomy. However, true recurrences were observed in 16% of the patients during long-term follow-up. The operative risk is rather low. There was no mortality in this series. The rate of complications is about 1%. Medical treatment with dopamine-agonists is successful especially in women who desire pregnancy, but should only be used in small microadenomas, in order to avoid complications. In larger macroprolactinomas h extra-sellar extension in whom primary surgical removal leads to a normalization of prolactin-levels in a minority of cases only primary therapy with dopamine-agonists leads to shrinkage of the tumour mass in about two-thirds of the patients. Since the tumour mass does not disappear completely after short-term medical treatment, we favour additional surgical tumour removal instead of long-lasting administration of dopamine-agonistic drugs in higher dosages.

Adrenergic alpha-Agonists↗