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Biomedical subjects

Adam S Kanter

Publications and source records attributed to Adam S Kanter.

7 recordsLinked to original sources
PubMed2006

Extended transsphenoidal approach.

Transsphenoidal surgery is well established as an effective primary treatment for tumors of the sellar region. The technique of transsphenoidal surgery has evolved over the years with many prominent surgeons contributing to its present state of refinement. The transsphenoidal approach can be modified in various ways to permit resection of parasellar tumors that otherwise would require a transcranial or transbasal operation. Our experience with these 'extended' techniques has primarily involved the transtuberculum sella approach in which bone is removed from the tuberculum sellae and the posterior portion of the planum sphenoidale. Experience with this technique continues to burgeon, and offers an excellent alternative to transcranial surgery in dealing with a difficult constellation of tumors. Meticulous attention to detail, particularly with respect to reconstruction and closure of the sellar floor, is necessary for its effective application.

Humans↗
PubMed2006

Rathke's cleft cysts.

Rathke's cleft cysts are typically regarded as benign cystic lesions of the sella that may affect the pituitary gland and on occasion the visual apparatus. They are most commonly incidental and rarely of clinical significance. As medical neuroimaging and surgical technologies have rapidly advanced, so too has the discovery, experience, knowledge, and intrigue concerning this relatively rare disease entity. Nevertheless, numerous controversies still exist regarding its natural history, recurrence rate, predictive variables, and optimal surgical management. This chapter aims to review the pathogenesis, symptomatologic manifestations, radiographic, morphologic and histopathological characteristics, treatment strategies and outcomes in the cysts of Rathke's cleft.

Central Nervous System Cysts↗
PubMed2006

Anterior stabilization of three-column thoracolumbar spinal trauma.

OBJECT: The purpose of this study was to evaluate the results obtained in patients who underwent anterior stabilization for three-column thoracolumbar fractures. METHODS: The authors retrospectively reviewed available clinical and radiographic data (1997-2006) to classify three-column thoracolumbar fractures according to the Association for the Study of Internal Fixation (AO) system, neurological status, spinal canal compromise, pre- and postoperative segmental angulation, and arthrodesis rate. The mean computed tomography-measured preoperative spinal canal compromise was 48.3% (range 8-92%), and the mean vertebral body height loss was 39.4%. The mean preoperative kyphotic deformity of 14.9 degrees improved to 4.6 degrees at the final follow-up examination. Although this angulation had increased a mean of 1.8 degrees during the follow-up period, the extent of correction was still significant compared with the preoperative angulation (p < 0.01). There were no cases of vascular complication or neurological deterioration. CONCLUSIONS: Contemporary anterior spinal reconstruction techniques can allow certain types of unstable three-column thoracolumbar fractures to be treated via an anterior approach alone. Compared with traditional posterior approaches, the anterior route spares lumbar motion segments and obviates the need for harvesting of the iliac crest.

Adolescent↗
PubMed2005

The transsphenoidal approach. A historical perspective.

Over the last century, the transsphenoidal approach has evolved into the first-line method of treatment for sellar as well as select groups of parasellar and suprasellar lesions. The journey to its current popularity has been marked by controversy and near abandonment in the late 1920s, followed by its renaissance in the late 1960s. Despite the profound skepticism with which this procedure was viewed, several visionary neurosurgeons persevered through its nadir in popularity, preserving this surgical corridor to the skull base. Advances in medical and surgical techniques, paralleling an improved understanding of pituitary pathophysiology, contributed to its resurgence. The transsphenoidal procedures now performed stem from an array of modifications and refinements accumulated through nearly 100 years of medical and surgical evolution. This era's critical innovations and neurosurgical personalities are the topic of this historical overview.

Brain Neoplasms↗
PubMed2005

Single-center experience with pediatric Cushing's disease.

OBJECT: Despite ongoing advances in surgical and radiotherapeutic techniques, pediatric Cushing's disease remains a diagnostic and therapeutic challenge. The authors report on the results of a single-center retrospective review of 33 pediatric patients with Cushing's disease, providing details with respect to clinical presentation, diagnostic evaluation, therapeutic course, complications, and outcomes. METHODS: There were 17 female and 16 male patients whose mean age was 13 years (range 5-19 years) in whom a diagnosis of Cushing's disease was based on clinical and biochemical criteria. Typical symptoms included weight gain (91%), prepubertal growth delay (83%), round facies (61%), hirsutism (58%), headache (45%), abdominal striae (42%), acne (33%), amenorrhea (24%), and hypertension (24%). In 67% of the cases, preoperative magnetic resonance images revealed a pituitary lesion and in 82% of the cases the imaging studies effectively predicted lateralization. Inferior petrosal sinus sampling was performed in seven patients (21%), and in all of these cases lateralization was 100% reliable. Fifty-five percent underwent selective adenomectomies and 45% underwent subtotal hypophysectomies. Complications included one case of diabetes insipidus, one of persistent hypocortisolemia necessitating prolonged glucocorticoid replacement therapy, and one minor vascular injury that did not necessitate postoperative management modification or cause sequelae. There were no surgery-related deaths and no cases of postoperative cerebrospinal fluid leakage or meningitis. During a mean follow-up period of 44 months, clinical remission was ultimately achieved in 91% of patients: 76% after transsphenoidal surgery alone and an additional 15% after adjuvant radiosurgery and/or adrenalectomy following surgical failure. Three patients (12%) experienced disease recurrence and underwent a second surgical procedure at 18, 81, and 92 months, respectively; based on clinical and biochemical criteria a second remission was achieved in all. Three patients (9%) remain with persistent disease. CONCLUSIONS: Pediatric Cushing's disease is a rare condition, often requiring a multidisciplinary diagnostic and a multimodal therapeutic approach for successful long-term remission.

Adolescent↗
PubMed2004

Rathke cleft cysts.

Explore the source record for details and available documents.

Central Nervous System Cysts↗