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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraoperative radiotherapy (IORT) is a new concept in the treatment of recurrent and primary advanced colorectal tumors. Between October 1994 and December 1997 27 patients (primary tumor: 8, first recurrent tumor: 12, second recurrent tumor: 7) received IORT (32 applications). Chemotherapy and percutaneous radiotherapy had already been given to all patients with advanced and recurrent colorectal tumors. The intraoperative irradiation was performed through HDR iridium afterloading. A flexible flab--individually adapted to the "tumor bed"--was used as applicator. The contact dose ranged from 10 to 15 Gy. The mean operation time (rectum resection: 5, rectum amputation: 14, debulking: 8) increased by 30 min on average. Eight patients had postoperative complications: perianal wound infections (3), sacrovesical fistulas (3), leakage of anastomosis (1) and neural ureter dysfunction (1). To date--on average 17.1 months (range: 3-33) after operation--13 patients are free of tumor recurrence or show stable disease. Ten patients--all of them had macroscopic residual tumor--have local tumor progression combined with good quality of life. Only 4 patients died (acute kidney failure, stroke, marasmus, systemic progression). The afterloading flab technique represents a technically simple, minimally harmful procedure in the therapy of colorectal tumor. Even when IORT with electrons is not feasible or the patients have already been irradiated, a higher radiation dose is possible. Given the demonstrated rate of local tumor recurrence, the afterloading flab technique seems to be a valuable treatment alternative to extended, high-risk resections. Long-term follow-ups will be necessary.
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PMID:[In Process Citation] 1006 22

Cranial irradiation may lead to accelerated atherosclerotic changes to small or medium sized arteries, but stroke associated with pituitary irradiation is not frequent. A patient treated with Gamma Knife radio-surgery (GKRS) for a pituitary adenoma suffered a cerebral infarction with internal carotid artery occlusion 4 years after radiosurgery. The patient was a 35-year-old male presenting with a visual disturbance. Endocrinological tests were normal. MRI revealed a 4.3 by 4.3 cm diameter invasive macroadenoma of the pituitary, projecting toward the suprasellar region and with cavernous sinus involvement with encasement of both internal carotid arteries (ICAs). GKRS was performed for residual tumor after a transcranial resection. The maximum dose was 40 Gy and the dose to the right carotid artery was below 20 Gy. The delayed hemiparesis was accompanied by a right capsular lacunar infarct shown on MRI. The images also showed a marked reduction in tumor size. Total, right ICA occlusion was confirmed by Doppler ultrasound. The patient had no history or signs of heart disease or metabolic disorder which could predispose to cerebrovascular
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PMID:Cerebral infarction with ICA occlusion after Gamma Knife radiosurgery for pituitary adenoma: A case report. 1068 1

Although infrequent, recovery of pituitary function after necrosis of a pituitary adenoma is not an exceptional event. We report the case of a 32-year-old woman with previous surgery for an adrenal mass and signs of hypercortisolism which failed to revert postoperatively. She then developed pituitary apoplexy followed by hypopituitarism, as confirmed by hormonal measurements. Magnetic resonance imaging (MRI) showed evidence of a pituitary macroadenoma with signs of necrosis, impinging on the optic chiasm, which was excised by the trans-sphenoidal approach. Nine months later, hormone tests indicated a near total recovery of pituitary functions. The patient had a successful pregnancy three years later. After a 5-year follow-up, she remained clinically asymptomatic, with moderate reduction in cortisol and blunted growth hormone (GH) response to hypoglycemia and MRI failed to disclose any residual tumor, except for a partial arachnoidocele.
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PMID:[Pregnancy after spontaneous necrosis of a pituitary macroadenoma]. 1451 45

We report a Taiwanese boy who presented with apoplexy of a prolactinoma. A 12 9/12 year-old boy presented to our clinic with headache and visual deficit of bitemporal hemianopsia. Skull X-ray showed an enlarged sella. Magnetic resonance imaging (MRI) of the sella turcica showed a 4 x 2.5 x 2.5 cm mass, located at the sella turcica and extending upward to compress the optic chiasm. Preoperative laboratory data showed hyperprolactinemia, hypothyroidism and hypocortisonism. After a stress dose of i.v. hydrocortisone was given, he underwent transsphenoid surgery to remove the tumor. Immunohistochemical stains were positive for PRL in the tumor cells. After surgery, he suffered from neurogenic diabetes insipidus, hypopituitarism and hyperprolactinemia, with serum PRL level of 491 ng/ml. Visual field examination was normal 4 months later. In conclusion, pituitary apoplexy is rare in children but should be considered if a patient suffers from headache, vomiting, and visual deficit. Brain MRI is preferred for diagnosis. Dopaminergic agonists should be given if residual tumor or recurrence of prolactinoma is found after transsphenoidal surgery.
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PMID:Pituitary apoplexy due to prolactinoma in a Taiwanese boy: patient report and review of the literature. 1471 55

This is report on four cases of giant pituitary tumors that developed postoperative pituitary apoplexy after they had undergone a partial tumor resection. Three patients had undergone surgery by a transsphenoid route and one patient underwent surgery by transcranial route. Postoperative CT scan showed hemorrhagic expansion of residual tumor mass. All the four patients were re-explored transcranially and hemorrhagic swelling of the tumor was observed. In three cases, the tumor had swollen to a size greater than twice the original tumor. All the four patients had a fatal outcome.
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PMID:Post operative 'pituitary apoplexy' in giant pituitary adenomas: a series of cases. 1623 Aug 2

Pituitary tumor apoplexy is an uncommon syndrome resulting often spontaneously from hemorrhage or infarction of a pre-existing pituitary adenoma. As the primary event involves the adenoma, the syndrome should be referred to as pituitary tumor apoplexy and not as pituitary apoplexy. The sudden increase in sellar contents compresses surrounding structures and portal vessels, resulting in sudden, severe headache, visual disturbances, and impairment in pituitary function. Initial management of patients with pituitary tumor apoplexy includes supportive therapy (intravenous fluids and corticosteroids), following which many patients exhibit clinical improvement. Because those patients can be effectively managed with supportive measures, many who remain clinically and neurologically unstable might benefit from urgent surgical decompression by an experienced neurosurgeon. All patients presenting with this syndrome require long-term follow-up to treat any residual tumor and/or pituitary dysfunction. Close interaction between members of the management team is necessary for optimal patients' outcome.
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PMID:Pituitary tumor apoplexy: a review. 1837 48

Clinically nonfunctioning pituitary tumors are common in tertiary endocrine practice. Although it is widely accepted that patients with these adenomas require long-term surveillance after surgery-particularly those with macroadenomas, which grow much more frequently than microadenomas-a consensus on postoperative monitoring and treatment strategies is lacking. The indications for radiotherapy, which has seen a decline in use over the past decade, are not clear, although most experts would agree that residual tumor mass after surgery, as well as tumor expansion into the cavernous sinus, indicate the need to consider postoperative radiotherapy. In patients not treated with radiotherapy after surgical treatment of a nonfunctioning adenoma, MRI of the tumor should be performed annually for the first 6 years and every 2 years thereafter. In addition, silent adrenocorticotropic hormone-secreting tumors can behave more aggressively if they recur, and tumor regrowth can also occasionally be found in patients after classical pituitary apoplexy, which suggests that individuals with these conditions should also be monitored carefully after surgery. However, at which point this scanning routine can be ceased remains the subject of debate, as few data on late recurrence of nonfunctioning pituitary adenomas exist.
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PMID:The postoperative monitoring of nonfunctioning pituitary adenomas. 2146 69

Pituitary apoplexy in patients with adrenocorticotropic hormone (ACTH) producing tumors is a rare occurrence. We report four patients with Cushing's disease harboring ACTH-secreting macroadenomas who presented with pituitary apoplexy. We report the endocrinologic and visual outcomes of these patients after emergent transsphenoidal surgery. A retrospective chart review was performed in 4 patients who presented with pituitary apoplexy from hemorrhage into an ACTH-secreting pituitary adenoma. The patient charts were reviewed for clinical presentation, neuroimaging findings, intraoperative surgical findings, pathologic findings, and postoperative endocrinologic and visual outcomes. All patients presented with acute headaches, nausea, vomiting, and visual loss from optic compression. MR imaging demonstrated a hemorrhagic macroadenoma that was confirmed at surgery. All patients underwent emergent transsphenoidal decompression (within 24 h of presentation). One of these underwent an additional craniotomy to resect residual tumor. Postoperatively, all patients showed significant improvement in visual acuity and visual fields with biochemical remission confirmed on laboratory testing. Significant weight loss as well as resolution of diabetes and hypertension was noted in all cases. All four patients remained in biochemical remission at their most recent follow-up visit (mean 40 months, range: 24-72 months). Excellent endocrine and visual outcomes can be achieved after emergent transsphenoidal surgery in patients with Cushing's disease presenting with pituitary apoplexy. Although the cure rates of non-apoplectic ACTH macroadenomas are generally poor, higher rates of remission can be achieved in cases of pituitary apoplexy. This may be partly due to the effects of tumor infarction.
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PMID:Pituitary tumor apoplexy in patients with Cushing's disease: endocrinologic and visual outcomes after transsphenoidal surgery. 2192 87

Postoperative pituitary apoplexy is rare and usually occurs in the immediate postoperative period (within 12 hours) after subtotal resection of giant pituitary macroadenomas with fatal outcomes. We describe a unique patient with pituitary apoplexy occurring in a delayed fashion on the third postoperative day. Early detection and emergent endoscopic transsphenoidal exploration resulted in gross total removal of the residual tumor, decompression of the optic chiasm, and a favorable neurologic outcome.
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PMID:Delayed postoperative pituitary apoplexy after endoscopic transsphenoidal resection of a giant pituitary macroadenoma. 2272 88

Magnetic resonance imaging (MRI) or computerized tomography (CT) is routinely performed after resection of brain metastases (BrM), regardless of whether there are specific clinical concerns about residual tumor or potential complications. Routine imaging studies contribute a significant amount to the cost of medical care, and their yield and utility are unknown. An IRB-approved retrospective chart review study was performed to analyze all craniotomies for BrM performed at our institution from 2005 to 2012. Descriptive statistics were used to quantify the yield of postoperative imaging. 218 consecutive patients underwent 226 craniotomies for BrM. In 21 cases, new or worsened neurologic deficits occurred after surgery (9.0%), and 19 of the 21 underwent postoperative imaging. 9 of the 19 patients (47%) had significant findings on postoperative imaging, and 2 patients required reoperation. 201 patients had no new neurologic deficits (91%), and 23 of these patients had no postoperative imaging. Of the 178 remaining patients, 160 underwent postoperative MRI and 18 underwent postoperative CT. 9 patients (5.1%) had unexpected adverse imaging findings; 6 had small stroke, 1 had a subdural hemorrhage and 2 had possible or definite venous sinus occlusion. None of the imaging findings led to changes in management. 182 patients underwent imaging appropriate to detect residual tumor (177 gadolinium enhanced MRI and 5 contrast enhanced CT). Of these patients, 16 were known to have small residual tumors based on intraoperative findings. Of the remaining 166 patients felt to have had gross total tumor resection, 9 (5.4%) were found to have a small amount of residual tumor on postoperative imaging; no patient had a change in treatment plan as a result. Routine postoperative imaging in patients undergoing craniotomy for BrM has a very low yield and may not be appropriate in the absence of new neurologic deficits, or specific clinical concerns about large amounts of residual tumor or intraoperative complications.
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PMID:Yield and utility of routine postoperative imaging after resection of brain metastases. 2473 30


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