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Tumor emboli due to a sarcoma are usually confirmed by an autopsy or operative findings. A sarcoma embolus in an acute stroke patient is rare. We herein report a 37-year-old man with acute stroke caused by internal carotid artery occlusion who underwent embolectomy. A histopathological analysis of an embolus obtained with a mechanical retriever device was diagnosed as undifferentiated sarcoma. This is the first case of extracardiac sarcoma extraction via mechanical retrieval performed during intervention for acute ischemic stroke. A histopathologic evaluation with embolectomy is important for diagnosing tumor emboli.

We describe a patient with subcutaneous hematoma associated with manual cervical massage during carotid artery stenting. A 73-year-old man with left cervical carotid artery stenosis presented with left amaurosis fugax. We performed carotid artery stenting using distal embolic protection with balloon occlusion. Dual antiplatelet therapy was maintained in the periprocedural period and an anticoagulant agent was administered during the procedure. Because the aspiration catheter became entrapped by the stent, it did not reach the distal side of the stenotic lesion, and manual compression of the cervical region was therefore performed. Immediately afterwards, a subcutaneous hemorrhage occurred in the cervical region. There was no postoperative dyspnea due to enlargement of the hematoma, which was absorbed spontaneously. Cervical subcutaneous hematoma can occur in the cervical region due to cervical massage in patients who are receiving adjuvant antiplatelet therapy and anticoagulation therapy.

Biodegradable scaffolds are of great value in tissue engineering. We have developed a method for fabricating patient-specific vascular scaffolds from a biocompatible and biodegradable polymer, poly( l -lactide-co-ɛ-caprolactone). This method's usefulness is due to flexibility in the choice of materials and vascular configurations. Here, we present a way to fabricate scaffolds of human carotid artery by combining processes of rapid prototyping, lost wax, dip coating, selective dissolution, and salt leaching. The result was the successful development of porous biodegradable scaffolds, with mechanical strength covering the range of human blood vessels (1–3 MPa). Human umbilical vein endothelial cells were also cultured on the scaffolds and their biocompatibility was confirmed by cell growth. The Young's modulus of scaffolds could be controlled by changing polymer concentration and porosity. The wall thickness of the tubular scaffold was also controllable by adjusting polymer concentration and pull-up velocity during dip coating. We believe that this fabrication technique can be applied to patient-specific regeneration of blood vessels.

Background To date, no quantitative analysis has been developed to evaluate catheter performance inside the vascular lumen. Methods An evaluation system for endovascular tools was built with a polyurethane elastomer vascular model inside a polariscope and a catheter driving system. This robotic system reproduced a catheter insertion trajectory inside the vascular model, using a surgical catheter and three catheter prototypes used for motion capture on endovascular surgery simulation. Birefringence is produced by photo-elastic characteristics of the polyurethane elastomer when the material is submitted external stress. The birefringence produced by the catheter on the vascular model wall was recorded and represented numerically by the correlation between consecutive frames of the registered video. Results Correlation values between frames showed that the performance of the prototypes was lower than that of the medical use catheter. The performance of prototypes was reduced by microcoils on their tips. Conclusions This methodology opens new options to evaluate medical catheters and physicians skills. Copyright © 2008 John Wiley & Sons, Ltd.

Background When resecting at falcine or parasagittal portion of paramedian meningiomas, intraoperative hemostasis often is difficult despite effective management of ipsilateral meningeal arteries. We attribute such difficulties to meningeal artery blood supply from the contralateral side. We retrospectively studied feeding arteries from both sides in case of paramedian meningioma in terms of patient and tumor characteristics. Methods Forty-three patients with paramedian meningiomas underwent selective internal and external carotid angiography. We investigated how contralateral meningeal arterial feeders related to patient profiles and imaging, histopathologic, and immunohistochemical findings. Results Contralateral meningeal supply existed for 14 of 25 falcine meningiomas and 6 of 18 parasagittal meningiomas. Patients with contralateral feeders were 8.5 years younger than the others ( P = .027) and were more likely to have larger tumors ( P = .028). These were histopathologically malignant ( P = .048), while showing more proliferation followed by monoclonal antibody against the Ki-67 antigen index ( P = .012) and angiogenetic potential associated with vascular endothelial growth factor expression ( P = .0085). Conclusions Contralateral meningeal supply may reflect strong angiogenetic recruitment from rapid tumor growth followed by high expression of vascular endothelial growth factor. This angiographical feature may predict the aggressive growth of paramedian meningiomas.

This study investigated the angiographic changes in embolised arteriovenous malformations (AVMs) pre- and post-embolisation and preradiosurgery to clarify the usefulness of embolisation as a pretreatment for radiosurgery and the strategy of embolisation for the radiosurgical success. A total of 37 patients with cerebral AVMs treated over a period of 4 years was investigated. All the AVMs were embolised with N-butyl cyanoacrylate and 2 months later they were treated by radiosurgery. The size of AVM nidus reduced just following the embolisation (mean 21.9 ml to 3.9 ml). The angiogram taken in preparation for radiosurgery showed a further size reduction in the nidus of 16 AVMs, no change in 10 and regrowth in 11. In all the cases where size was reduced, the nidus was densely packed, while all the regrown AVMs were of the diffuse type. Five AVMs disappeared following radiosurgery, all of which were size-reduction or no-change cases. In conclusion, to achieve success in subsequent radiosurgery, nidus embolisation and the occlusion of fistulous and meningeal feeders are mandatory. Imprudent proximal feeder occlusion and the use of embolic materials with a risk of recanalisation should be avoided to prevent regrowth of the nidus, which may lead to errors in planning the radiosurgery to follow.

Near-infrared spectroscopy was used to measure the relative concentration changes of oxygenated hemoglobin (HbO(2)), deoxygenated hemoglobin (HbR), and total hemoglobin (t-Hb) before, during, and after hyperventilation in eight patients with childhood moyamoya disease who underwent surgery. The patients were divided into the following two groups: those with and those without re-build-up phenomenon on electroencephalography. All patients except one exhibited decreased concentrations of HbO(2) and t-Hb during hyperventilation and decreased concentrations of HbO(2) and increased concentrations of HbR after hyperventilation. The difference between the hemoglobin concentration during and after hyperventilation was significantly greater in the group with the re-build-up phenomenon than the group without it (P0.03, Mann-Whitney U test). The patients with the re-build-up phenomenon had lower HbO(2) and higher HbR concentrations after hyperventilation. The concentrations of HbO(2) and HbR reflect an alteration in the oxygenated blood supply and/or oxygen use. Thus, it is strongly suggested that regional cerebral hypoxia and metabolic oxygen disturbances play an important role in the occurrence of the re-build-up phenomenon. Near-infrared spectroscopy is a useful noninvasive method to evaluate the efficacy of surgical treatment in childhood moyamoya disease.

In the wake of the SAPPHIRE trial1 and subsequent approval of carotid stenting (CAS) devices by the Food and Drug Administration (FDA) in the United States, CAS is poised to explode in the frequency of its application in North America. Although the results of the Carotid Revascularization Stenting versus Endarterectomy Trial (CREST), the largest randomized controlled trial comparing carotid endarterectomy to CAS, are years away, many practitioners in multiple disciplines have already entered the competition for patients and remuneration. Despite the absence of evidence to support CAS over carotid endarterectomy2,3 and the need to continue recruiting patients to CREST,4 cardiologists, vascular surgeons, neurologists, neurosurgeons, general interventional and neurointerventional radiologists are all vying to treat carotid stenoses, many of which are

There are several complications associated with Stent-assisted Coil Embolization (SACE) in cerebral aneurysm treatments, due to damaging operations by surgeons and undesirable mechanical properties of stents. Therefore, it is necessary to develop an in vitro simulator that provides both training and research for evaluating the mechanical properties of stents.A new in vitro simulator for three-dimensional digital subtraction angiography was constructed, followed by aneurysm models fabricated with new materials. Next, this platform was used to provide training and to conduct photoelastic stress analysis to evaluate the SACE technique.The average interaction stress increasingly varied for the two different stents. Improvements for the Maximum-Likelihood Expectation-Maximization method were developed to reconstruct cross-sections with both thickness and stress information.The technique presented can improve a surgeon's skills and quantify the performance of stents to improve mechanical design and classification. This method can contribute to three-dimensional stress and volume variation evaluation and assess a surgeon's skills.

The development of new diagnostic technologies for cerebrovascular diseases requires an understanding of the mechanism behind the growth and rupture of cerebral aneurysms. To provide a comprehensive diagnosis and prognosis of this disease, it is desirable to evaluate wall shear stress, pressure, deformation and strain in the aneurysm region, based on information provided by medical imaging technologies.In this research, we propose a new cyber-physical system composed of in vitro dynamic strain experimental measurements and computational fluid dynamics (CFD) simulation for the diagnosis of cerebral aneurysms. A CFD simulation and a scaled-up membranous silicone model of a cerebral aneurysm were completed, based on patient-specific data recorded in August 2008. In vitro blood flow simulation was realized with the use of a specialized pump. A vision system was also developed to measure the strain at different regions on the model by way of pulsating blood flow circulating inside the model.Experimental results show that distance and area strain maxima were larger near the aneurysm neck (0.042 and 0.052), followed by the aneurysm dome (0.023 and 0.04) and finally the main blood vessel section (0.01 and 0.014). These results were complemented by a CFD simulation for the addition of wall shear stress, oscillatory shear index and aneurysm formation index. Diagnosis results using imaging obtained in August 2008 are consistent with the monitored aneurysm growth in 2011.The presented study demonstrates a new experimental platform for measuring dynamic strain within cerebral aneurysms. This platform is also complemented by a CFD simulation for advanced diagnosis and prediction of the growth tendency of an aneurysm in endovascular surgery.

Quantification of medical skills is a challenge, particularly simulator-based training. In the case of endovascular intervention, it is desirable that a simulator accurately recreates the morphology and mechanical characteristics of the vasculature while enabling scoring.For this purpose, we propose a cyber-physical system composed of optical sensors for a catheter's body motion encoding, a magnetic tracker for motion capture of an operator's hands, and opto-mechatronic sensors for measuring the interaction of the catheter tip with the vasculature model wall. Two pilot studies were conducted for measuring technical skills, one for distinguishing novices from experts and the other for measuring unnecessary motion.The proficiency levels were measurable between expert and novice and also between individual novice users. The results enabled scoring of the user's proficiency level, using sensitivity, reaction time, time to complete a task and respect for tissue integrity as evaluation criteria. Additionally, unnecessary motion was also measurable.The development of cyber-physical simulators for other domains of medicine depend on the study of photoelastic materials for human tissue modelling, and enables quantitative evaluation of skills using surgical instruments and a realistic representation of human tissue.

In the domain of endovascular neurosurgery, the measurement of tissue integrity is needed for simulator-based training and for the development of new intravascular instruments and treatment techniques. In vitro evaluation of tissue manipulation can be achieved using photoelastic stress analysis and vasculature modeling with photoelastic materials. In this research we constructed two types of vasculature models of saccular aneurysms for differentiation of embolization techniques according to the respect for tissue integrity measurements based on the stress within the blood vessel model wall. In an aneurysm model with 5 mm dome diameter, embolization using MicroPlex 10 (Complex 1D, with 4 mm diameter loops), a maximum area of 3.97 mm2 with stress above 1 kPa was measured. This area increased to 5.50 mm2 when the dome was touched deliberately with the release mechanism of the coil, and to 4.87 mm2 for an embolization using Micrusphere, (Spherical 18 Platinum Coil). In a similar way trans-cell stent-assisted coil embolization was also compared to human blood pressure simulation using a model of a wide-necked saccular aneurysm with 7 mm diameter. The area with stress above 1kPa was below 1 mm2 for the pressure simulation and maximized at 3.79 mm2 during the trans-cell insertion of the micro-catheter and at 8.92 mm2 during the embolization. The presented results show that this measurement system is useful for identifying techniques compromising tissue integrity, comparing and studying coils and embolization techniques for a specific vasculature morphology and comparing their natural stress variations such as that produced by blood pressure.

Biodegradable scaffolds with controlled pore layout and porosity have great significance in tissue engineering for cell penetration, tissue ingrowth, vascularization, and nutrient delivery. Porogen leaching has been commonly used to control pore size, pore structure and porosity in the scaffold. In this paper we focus on the use/development of two magnetically guided porogen assembly methods using magnetic sugar particles (MSPs) for scaffold fabrication. First, a patterning device is utilized to align MSPs following designed templates. Then a magnetic sheet film is fabricated by mixing poly(vinyl alcohol, PVA) and NdFeB powder for steering the MSPs. After poly( l -lactide-co-ɛ-caprolactone) (PLCL) casting and removal of the sugar template, a scaffold with spherical pores is obtained. The surface and the inner structure of the scaffolds are evaluated using light and electron micrographs showing their interconnection of pores, pore wall morphology and porosity. Single layer scaffolds with the size of 8 mm in width and 10 mm in length were constructed with controllable pore diameters in the ranges of 105–150 μm, 250–300 μm and 425–500 μm.

We report five patients with dural carotid cavernous sinus fistula presenting with isolated oculomotor nerve palsy. All patients were older women with a fistula derived from the internal carotid artery, who had early filling of the supero-posterior cavernous sinus, followed by drainage posteriorly into the inferior petrosal sinus, with low shunt flow. The hypothesized pathogenesis was nerve compression by an expanding sinus, or ischemic neuropathy secondary to venous congestion or arterial steal. Dural carotid cavernous sinus fistula must be considered in patients presenting with isolated oculomotor nerve palsy.

The authors report a case of cranial plasmacytoma with multiple myelomas and palsy of the lower cranial nerves. The osteolytic lesion adjacent to the jugular foramen was demonstrated by an angiogram to be exceedingly hypervascular, with arteriovenous shunting resembling that seen in paragangliomas. Forty-five cases of cranial and intracranial plasmacytoma from the literature were reviewed. The findings indicate that a cranial plasmacytoma commonly appears to be a hypervascular tumor, whereas most dural tumors or intraparenchymal tumors have poor vascularity.

An extracranial vertebral artery aneurysm in a patient with neurofibromatosis is described. The aneurysm was treated by endovascular balloon occlusion of the proximal vertebral artery. The details of the therapeutic management are discussed, and the vascular manifestations of neurofibromatosis are reviewed.

Background: Our objective was to set up a management-oriented classification for paraclinoid aneurysms, and then design and apply a simplified management scheme according to each group defined by this classification. Methods: Paraclinoid aneurysms were classified as group I (supraophthalmic artery), group II (ophthalmic artery) and group III (infraophthalmic artery) aneurysms intradurally. Between January 2005 and December 2006, 86 cases with 89 paraclinoid aneurysms were treated. There were 35 (40.2%) aneurysms in group I (20 in group Ia, 15 in group Ib), 32 (36.8%) in group II and 20 (23%) in group III. Results: In group I aneurysms, 20 (57.1%) were treated by clipping or/and wrapping, while 15 (42.9%) were managed by coiling. In group II aneurysms, 20 (62.5%) were treated by clipping and 12 (37.5%) by coiling. The contralateral approach was performed for 4 (6%) aneurysms in groups I and II. All 20 group III aneurysms were treated by coiling. The overall rate of permanent complications was 4.6%. The rate of complete occlusion was 92.5% in surgical cases and 55.6% in endovascular ones. The overall outcomes in the treatment of paraclinoid aneurysms were excellent (GOS = 5, 95.4%). Conclusion: Based on our modified classification of paraclinoid aneurysms, a simplified management scheme was designed and applied. For group I (supraophthalmic artery) and group II (ophthalmic artery) aneurysms, surgical clipping or/and wrapping should be the first choice of treatment, while for group III (infraophthalmic artery) aneurysms, endovascular coiling should be the best modality. Additionally, individualizing the treatment planning might contribute to better results.

Background: A limited series of patients with aneurysm were reviewed retrospectively to analyze strategies for integrating microsurgical and endovascular techniques in the management of complex, surgically intractable aneurysms. Methods: Four patients were managed in Fujita Health University with a multimodality approach: intentional reconstruction of the aneurysm neck followed by endovascular coiling. Results: A total of 5 aneurysms were treated, of which 3 were large or giant in size, and 3 were fusiform or multilobulated. Complete angiographic obliteration was confirmed in 4 aneurysms (80%). All patients had a good outcome (Glasgow Outcome Scale score 5; mean follow-up, 64 months). Conclusion: As for complex, surgically intractable aneurysms, the intentional reconstruction of the aneurysm neck followed by endovascular coiling should be considered more often.

Summary: Electrocardiographically (ECG) gated multisection helical CT images were obtained in 23 patients with ruptured intracranial aneurysms. 4D-CTA (3D CT angiography plus phase data) images were generated by ECG-gated reconstruction. Four patients showed pulsation of an aneurysmal bleb. Clipping was performed in two of these patients, and the rupture site matched the pulsatile bleb seen in 4D-CTA.

The year 2004 in interventional neuroradiology has been distinguished by the steady accumulation of evidence to validate the efficacy of therapeutic procedures, such as carotid angioplasty and stenting (CAS) for cerebrovascular atherosclerosis. There is increasing momentum to design trials that will validate the role of endovascular therapy in the treatment of acute stroke and other cerebrovascular disorders. Practice patterns continue to evolve as evidence-based principles are applied to interventional therapy. In September 2004, the US Food and Drug Administration approved the use of stents for the treatment of atherosclerotic disease of the carotid bifurcation. This approval was based on data from the industry-supported Acculink for Revascularization of Carotids in High Risk patients (ARCHeR)1 registry and the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial.2 ARCHeR showed a 10% complication rate for CAS in 581 high-risk patients compared with a 15% complication rate derived from the carotid endarterectomy (CEA) literature. SAPPHIRE was a randomized control trial (RCT) comparing CAS to CEA in 334 high-risk patients. Primary end points were the cumulative incidence of death, stroke, or myocardial infarction within 30 days and death or ipsilateral stroke between 31 days and 1 year. The overall rate of primary end points was 39% lower in the CAS group, and CAS resulted in complication rates for all adverse events ≤CEA in both symptomatic and asymptomatic patients. The authors believe they have proven their hypothesis that CAS with distal protection is not inferior to CEA in high-risk patients. Criticisms of the study include the large proportion of asymptomatic patients, bias favoring CAS due to unequal randomization, the inclusion of many patients with recurrent stenoses after prior CEA, small sample size, and controversial end points, such as myocardial infarction and cranial nerve palsy.3 The evidence is also …

BACKGROUND AND PURPOSE: Reported treatments and outcomes in aneurysmal carotid-cavernous fistulas (CCFs) have been admixed with those of cases considered to be symptomatic of intracavernous aneurysm. However, aneurysmal CCFs have clinical features distinct from those of dural arteriovenous fistulas, and treatment strategies similar to those of traumatic CCF are required. We evaluated our experience in placing detachable balloons in the management of spontaneous CCFs due to rupture of an intracavernous aneurysm. METHODS: Six patients (one man, five women; mean age, 64.7 years) were treated for spontaneous direct CCF at our institution between 1995 and 2001. All patients presented with sudden ocular symptoms including exophthalmos, conjunctival injection, chemosis, and ocular motor palsies. Detachable latex balloons were used as the embolic material in five patients, and in one patient the cavernous sinus was packed transarterially with coils. RESULTS: All six patients were successfully treated by means of transarterial embolization, and symptoms improved within a week. CONCLUSION: Although other techniques using a transvenous approach and/or detachable coils may also be useful, embolization with detachable balloons should be a safe and effective method to immediately occlude the fistula.

Arterial dissection is now recognized as an important cause of stroke. Most reported dissections involve the extracranial portion of the internal carotid artery (ICA) and vertebral arteries. Spontaneous dissecting aneurysms of the intracranial ICA are uncommon. Endovascular treatment for cerebral aneurysms has become widespread; however, the dissecting aneurysm is still difficult to treat if the parent artery has to be preserved. More recently, stenting has been advocated for use with endosaccular coiling, with the coils held in place by the stent. We herein report a spontaneous intracranial ICA dissecting aneurysm in a 51-year-old woman who was treated using a new technique of combined stent and coils.

A 53-year-old female was admitted with apathy, left sensory and motor disturbance, left homonymous hemianopsia, and dressing apraxia. Computed tomography and magnetic resonance imaging showed a huge mass markedly enhanced in and around the right trigone. Cerebral angiography revealed rich vascularity of the tumor mainly fed by the right anterior choroidal artery. The feeding vessel was embolized with microfibrillar collagen after superselective catheterization. Seven days later, the tumor was totally removed with low blood loss. The histological diagnosis was fibroblastic meningioma. She was discharged without neurological deficit, except for left homonymous hemianopsia.

✓ The pressure in 47 arteries feeding 21 arteriovenous malformations (AVM's) was investigated during transarterial embolization using a Tracker-18 microcatheter. On average, systolic pressure increased by 22 mm Hg. In AVM's with single or few feeders, embolization was usually achieved well; in contrast, giant AVM's with multiple feeders and a large arteriovenous shunt were poorly embolized. However, large AVM's with well-demarcated components may be reduced by embolization to an appropriate size for surgery or stereotactic radiation therapy. It was found that the feeding artery pressure increased significantly more in well-embolized than in poorly embolized cases. Measurement of the feeding artery pressure clarified the hemodynamics of AVM's and facilitated more successful embolization.

We studied 52 patients with cerebral arteriovenous malformations (AVMs) by selective angiography and found that half received supply from meningeal branches of the external carotid artery. The frequency of meningeal arterial contribution was significantly higher in superficial AVMs, especially in the temporal, parietal and occipital regions. Larger lesions and higher shunt with steal phenomena on angiography were other factors favouring a meningeal arterial contribution. Diffuse AVMs with pial arterial networks around the nidus commonly received meningeal blood supply. In the past, meningeal feeders have been thought to be congenital, but this study suggests that they may develop during growth of the AVM.

Selective external carotid angiography using Seldinger's technique was employed in 20 cases (9 tumors, 9 spontaneous carotid-cavernous fistulas [CCF], 2 others), and its clinical applications are discussed. Diagrams of normal external carotid angiogram were drawn on the basis of analysis of the films obtained from these 20 cases. Various clinical situations were then investigated as follows: 1) A case with a right temporal bone tumor, where the ophthalmic artery originated solely from the middle meningeal artery of the same side and fed the tumor. 2) Nine cases of spontaneous CCF. One case was an internal CCF, and eight were dural CCF. A case of dural CCF with feeders arising from the accessory meningeal artery, the artery of the foramen rotundum, vidian artery of the external carotid artery, as well as the C4 part of the internal carotid artery, is presented. 3) A case of left sphenoid ridge meningioma with extracranial extension via the base of the cranium. The proximal part of the external carotid artery was ligated. By vertebral and deep cervical angiographies, the external carotid artery was opacificated via the enlarged anastomoses between the occipital, vertebral, and deep cervical arteries. 4) A case of giant neurinoma in the right middle fossa with a feeder arising from the middle meningeal artery of the same side. Other lesions in the cranium, the face, and the scalp are also presented. Selective external carotid angiography proved valuable in the diagnosis of the extra and intracranial lesions.

Plain and contrast-enhanced computed tomography (CE-CT) was evaluated in 48 patients with 55 angiographically confirmed cerebral aneurysms by a method simulating the prospective study to show the real value. The detection rate by CE-CT was 44%. The CE-CT was a helpful diagnostic method, when there was no localizing sign in plain CT. Seven aneurysms out of fifteen (47%) without subarachnoid hemorrhage or other lacalizing signs in plain CT were detected by CE-CT. The CE-CT gave a more specific diagnosis and may be useful, when angiography is deferred. Though other less invasive techniques, like intravenous digital subtraction angiography, provides an alternative method at present, the detection rate of this study would represent one of the standards of less invasive tech niques for the diagnosis of intracranial aneurysms.

Metrizamide CT cisternography in a young woman with a chronic sixth nerve palsy demonstrated a cavernous sinus subarachnoid diverticulum originating from the cerebellopontine cistern. The possible etiologic role of this diverticulum in her palsy is discussed.

The authors describe the case of a 67-year-old man with acquired obstruction of the common carotid artery and a large, direct occipital-vertebral artery anastomosis bridging the vertebral and carotid artery systems. They discuss the hemodynamics within this type of anastomosis in the context of cerebrovascular occlusive disease and outline their classification of the hemodynamic patterns that have been observed. Surgical procedures for occlusive disease in the presence of such anastomoses are also addressed.

One hundred patients with Cushing's disease were operated on in Nagoya University Hospital between January 1977 and January 1984. Pituitary adenomas were found and resected in 93 cases and complete clinical remissions were observed in 89 treated by operation alone and in two additional cases by operation followed with radiotherapy. The clinical features, pre-operative endocrine data, radiological findings including high resolution CT with coronal and sagittal reconstructions, data of selective venous sampling, operative findings, tumour pathology, postoperative clinical course, postoperative endocrine results and follow-up findings are presented and discussed.