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Background. The incidence of medical failure for prolactin (PRL)-secreting pituitary tumours is not well known. Object. The purpose of this study is to report clinical, radiographic and laboratory findings of PRL-secreting tumours that predict failed medical management. Methods. An analysis of 92 consecutive patients was performed that met the inclusion criteria. Decision for surgery was made based on failure of dopamine agonists to either control clinical symptoms and normalise hormonal level or diminish mass effect on follow-up evaluation. Results. Of the 92 patients treated, 14 patients (15%) required trans-nasal, trans-sphenoidal pituitary surgery (TSS). One patient underwent surgery for repair of a skull defect and 13 patients (14%) required surgery after failed medical management. Higher initial PRL was statistically significant regarding the need for surgical intervention, but a persistently abnormal level after initiation of treatment was a more significant predictor (Fisher exact test, p = 0.005 vs. p < 0.001). Size was also a statistically significant factor (p = 0.014); macroadenomas had a relative risk of 9.27 (95% CI: 1.15-74.86) for needing surgery compared to microadenomas. In addition, macroadenomas with cavernous sinus (CS) extension and pre-operative visual field deficit demonstrated a strong tendency for surgical intervention. Conclusion. Medical management remains the most effective treatment option for prolactinomas. A partial hormonal response to medical management seems to be the most significant predictive factor but adenomas > 20 mm, visual field deficit and invasion of the CS may help predict the need for surgery. We suggest a minimum trial period (at least 8 weeks) of medical treatment prior to the consideration of surgery. [ABSTRACT FROM AUTHOR]

The article presents a calendar of events including "9th European Congress on Epileptology," to be held in Rhodes, Greece, from June 27, 2010, the "8th Asian and Oceanian Epilepsy Congress," to be held in Melbourne, Australia, from October 21, 2010, and "10th Eilat Conference on New Antiepileptic Drugs (Eilat X)" to be held in Eilat, Israel, from April 25, 2010.

Brain aging contributes to cognitive decline and risk of dementia. Degeneration of the basal forebrain cholinergic system parallels these changes in aging, Alzheimer's dementia, Parkinson's dementia, and Lewy body dementia, and thus is a common element linked to executive function across the lifespan and in disease states. Here, we tested the potential of one-hour daily intermittent basal forebrain stimulation to improve cognition in senescent monkeys, and its mechanisms of action. Stimulation in five animals improved working memory duration in 8-12 weeks across all animals, with peak improvements observed in the first four weeks. In an ensuing three month period without stimulation, improvements were retained. With additional stimulation, performance remained above baseline throughout the 15 months of the study. Studies with a cholinesterase inhibitor produced inconsistent improvements in behavior. One of five animals improved significantly. Manipulating the stimulation pattern demonstrated selectivity for both stimulation and recovery period duration. Brain stimulation led to acute increases in cerebrospinal levels of tissue plasminogen activator, which is an activating element for two brain neurotrophins, Nerve Growth Factor (NGF) and Brain-Derived Growth Factor (BDNF). Stimulation also led to improved glucose utilization in stimulated hemispheres relative to contralateral. Glucose utilization also consistently declines with aging and some dementias. Together, these findings suggest that intermittent stimulation of the nucleus basalis of Meynert improves executive function and reverses some aspects of brain aging., Highlights: The basal forebrain and its cholinergic projections are the sole source of acetylcholine for the cortical mantle in primates and humans.Forebrain function tracks cognitive loss throughout the adult lifespan.One hour per day intermittent stimulation of this region improves executive function behaviors and plausibly reverses some aspects of brain aging, a large risk factor in dementias.This stimulation exceeds impacts of standard pharmacotherapies, is enduring, recruits brain neurotrophic pathways and improves cortical glucose utilization.

Background: Premature discontinuation and nonpublication of clinical trials contribute to research waste and compromise our ability to improve patient outcomes. However, the extent to which these problems exist in neurooncological randomized clinical trials (RCTs) is not known. This study aimed to evaluate the prevalence of discontinuation and nonpublication of neurooncological RCTs, identify contributing factors, and assess trial characteristics associated with each., Methods: We performed a retrospective, cross-sectional study of neurooncological RCTs registered in Clinicaltrials.gov before March 7, 2023. Data were collected from Clinicaltrials.gov and associated publications were located. We attempted to contact authors for all trials without associated publications or an identified reason for discontinuation., Results: Of 139 included RCTs, 57 (41%) were discontinued. The most common reason for discontinuation identified was slow enrollment or accrual (23%), though 30 trials (53%) were discontinued for unknown reasons. Trials funded by sources other than industry or the National Institutes of Health were more likely to be discontinued (odds ratio 4.2, 95% confidence interval 1.3-13.8). In total, 67 of the 139 (48%) RCTs were unpublished, including 50 of the 57 (88%) discontinued studies and 17 of the 82 (21%) completed studies., Conclusions: In our study, discontinuation of neurooncological clinical trials was common and often occurred for unknown reasons. Trials were also frequently unpublished, particularly those that were discontinued. Addressing these findings may provide an opportunity to reduce research waste and improve outcomes for patients with neurological cancers., Competing Interests: All authors: None declared., (© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)

Epilepsy is considered a chronic neurological disorder and is accompanied by persistent and diverse disturbances in electrical brain activity. While antiepileptic pharmaceuticals are still the predominant treatment for epilepsy, the advent of numerous surgical interventions has further improved outcomes for patients. Despite these advancements, a subpopulation continues to experience intractable seizures which are resistant to current conventional and nonconventional therapeutic options. In this review, we begin with an introduction to the clinical presentation of epilepsy before discussing the clinically relevant laboratory models of epilepsy. Finally, we explore the implications of regenerative medicine - including cell therapy, neuroprotective agents, and electrical stimulation - for epilepsy, supplemented with our laboratory's data. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed. Some original points in this article come from the laboratory practice in our research center and the authors' experiences., Competing Interests: There are no conflicts of interest.

Background: Traditional anterior and posterior approaches to the thoracolumbar spine are associated with significant morbidity. In an effort to eliminate these drawbacks, minimally invasive retropleural approaches have been developed., Objective: To demonstrate the feasibility and clinical experience of a minimally invasive lateral retropleural approach to the thoracolumbar spine., Methods: Seven cadaveric dissections were performed in 7 fresh specimens to determine the feasibility of the technique. In each specimen, the lateral aspect of the vertebral body was accessed retropleurally, and a corpectomy was performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the extent of decompression. As an adjunct, 3 clinical cases of thoracic fractures and 1 neurofibroma were treated with this minimally invasive approach. Operative results, complications, and early outcomes were assessed., Results: In the cadaveric study, adequate exposure was obtained to perform a lateral corpectomy and to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases without conversion to conventional approaches. A pleural tear was noted in the first clinical case, and a chest tube was placed without any long-term sequelae., Conclusion: Our early experience suggests that the minimally invasive lateral retropleural approach allows adequate vertebrectomy and canal decompression without the tissue disruption associated with posterolateral approaches. This approach may improve the complication rates that accompany open or endoscopic approaches for thoracolumbar corpectomies.

Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom's criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara's index at 1 year. Group 1 had a mean age 46.2 years (range 35-60 years). Group 2 had a mean age 50.1 years (range 35-70 years).The operative time was significantly lower (P < 0.001) and blood loss significantly higher (P < 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P > 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P > 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.

Purpose: While an abnormal pre-operative high-resolution brain MRI portends a favorable outcome in patients undergoing resective epilepsy surgery for medically intractable localization-related epilepsy (LRE), a normal MRI is less favorable. Ascertaining desirable pre-operative predictors for successful anterior temporal lobectomy (ATL) in LRE patients with a normal brain MRI is essential to better anticipate surgical outcome., Methods: Patients with LRE and normal temporal structures on MRI underwent ATL at two epilepsy centers in the southeastern US (FL and NC). Outcome was separated into those patients that were seizure free (SF), and those that were not seizure free (NSF), and those NSF were stratified in accordance with the Engel classification system. Those with a pre-operative history of clinical risk factors, unilateral anterior temporal interictal epileptiform discharges (IEDs), well localized scalp ictal EEG with rhythmic temporal theta at onset, localized PET/ictal SPECT, and Wada asymmetry with >2.5/8, were evaluated for the purpose of predicting outcome. Where appropriate, data is presented as a median (mean +/- S.D.)., Results: Thirty-nine patients, median age 33 years, were followed up 2 years (3+/-1.2) after ATL. Overall, 22/39 (56.4%) patients were identified as SF, and 17/39 (43.6%) patients were NSF. Ictal EEG with rhythmic temporal theta at onset was the only predictive measure of seizure-free outcome (p=0.001, Fisher's exact test), and also favorably correlated with seizure reduction (p=0.0001, r(2)=0.34, multiple regression analysis). None of the other predictors examined added greater predictive value., Conclusions: ATL is a favorable option for patients with LRE even when high-resolution brain MRI reveals normal temporal structures. Normal brain MRI patients with localizing pre-operative scalp ictal EEG, have better outcomes following ATL.

Objective: To describe our technique for temporal lobe epilepsy surgery using a minimal-access approach., Methods: Our epilepsy surgery registry was reviewed, and all patients with at least 2 years follow-up were queried. Clinical data included age, sex, side of lesion, presence of mesial temporal sclerosis, surgical complications, and Engel class outcome. Our operation was performed through a 6- to 8-cm linear vertical incision extending upward from just anterior to the tragus. An oval trephine (2 x 3 cm) craniotomy was performed flush with the middle fossa floor. Resection of part of the inferior temporal gyrus provided a corridor to the mesial temporal lobe. Identification of the temporal horn of the lateral ventricle was followed by resection of the parahippocampal gyrus, the amygdala, and the uncus. Segregation of the hippocampus and its subsequent resection in subpial fashion preserved perimesencephalic vasculature. Use of a fine suture for skin closure produced a cosmetic result., Results: In our 8-year series of 201 patients with a minimum follow-up duration of 2 years, we have observed a low number (1.5%) of complications and a 78% rate of Engel Class I seizure-free outcome. Surgery times were short (average, 2-5 h; range, 2 h 20 min-4 h 10 min) and hospital stays brief (<3 d; range, 1-4 d)., Conclusion: Our results suggest that the trephine craniotomy with the inferior temporal gyrus approach has the advantage of minimal invasiveness, including brief operative times and postoperative stays, and also effectively reduces or eradicates medically intractable seizures.