Neurosurgery SHOULD ENDOLYMPHATIC SAG TUMORS BE CON- SIDERED PART OF THE VON HIPPEL-LINDAU COM- PLEX? Robert E. Tibbs, Jr, MD, and Alfred P. Bowles, J, MD. Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Hippet-Lindau (vHL) disease is an inherited disor deer characterized by numerous cystic and solid neoplasms. Because of the recent identification of the vHL gene, other investigators have shown genetic mutations in this several of the neoplasms associated with the dis- ease, We describe a patient with an endolymphatic suc (ELS) tumor and vHL disease, The purpose of this study was (o identify a similar genetic mutation with the vEL gene of the ELS tumor. Using the patient’s archival pathologic slides, neoplastic cells were microdissected to yield a purely neoplastic cell population. The deoxyribonucleic acid of these cells was then extracted and amplified via polymerase chain rea tion, After sufficient amplification, the specimen was an lyzed on a singlestrand conformation polymorphism gel system to detect putative changes in the base sequence. Singlestrand conformation polymorphism gel system analysis yielded uo bands representing the two single strands of deoxyribonucleic acid! that were amplified. The upper band of the specimen was shifted down (compared. with controls), representing a conformational change as a result of genetic mutation. Endolymphatic sac uimors are uncommon, and we believe only seven eases associated with vHL disease have been reported in the literature. Although this association has been previously mentioned, no definitive studies have linked the two together. We report the eighth case of ELS tumor and VHL disease. We have shown through molec lar biological techniques that in our patient's tumor a genetic mutation occurred and that this mutation is simi- lar to mutations previously reported in other cases. ENDOSCOPIC TRANSSPHENOIDAL APPROACH TO PEDIATRIC PITUITARY TUMORS. Charles Teo, MD, Charles Bower, MD, Ronald L. Young, MD, and Frederick A. Boop, MD. Division of Pediatric Neurosurgery, Arkansas Children’s Hospital, Little Rock, Endoscopy is rapidly becoming an essential part of every nenrostrgeon's armamentarium, 1s application to Sinus surgery has been exemplified by our ENTE colleges Progression of endoscopic techaiques from the sins the skull base was natural step, We presenta series of 1 pediatric cases in which an endoscopie trasyphienoidal Rpproach was taken to biopsy and resect tumors in the Dtuitary fos, sphenotd sinvs, and upper eval region. Many pathologie processes were encountered, including Fanga infection, primary bone lesions, pituitary adenor has, and mucocele. No complications spertfe to this tech- c occurred positive bropsies were obiained in al and total timor resection achieved sen this was i AKnough the learning curve is steep, the endo- seopie technique offers beter Humination and wider fl Ot vsti Its less invasive than train micros I techniques ane! does not have the aisociated ENT complications such as nasal fistulas and gum anesthesi We will present our series of pediatric cases and show video illustrating the surgical technique. SURGICAL MANAGEMENT OF SACRAL TUMORS. Dennis E. McDonnell, MD. Section of Neurosurgery, 1 College of Georgia, Augusta, sil uumors are uncommon with varying pathology. Generally, they tend to be slow growing, The symptoms are ofien initially ignored. These tumors can, therefore, be Targe at the time of initial diagnosis, Malignant lesions tend! to expanel with local invasion and to recur afer surgi- 1 removal if the tumor margin is violated. Treatment strategy depends on the histology and biologic behavior of the lesion. Some tumors can be cured with en bloc removal. Fifteen patients are presented with sacral tumors consisting of chordomas (6), metastatic carcinomas (2), dermoid cysts (2), neurofibrosarcoma (1), lymphoma (1), giant cell tumor (1), ganglioneuroma (1), and menin- xgioma (1). A strategy for surgical weatment, illustrated Aseription of sncrectomy, and the Tongterm results Tor this series will be presented, INTRAOPERATIVE MAGNETIC RESONANCE IMAG- ING: OUR INITIAL EXPERIENCE. Kevin R. Killough, MD, Alfred P. Bowles, jr, MD, John A. Lancon, MD, Adam I. Lewis, MD, George T. Mandybur, MD, Andrew D. Parent, Mb, and Gurmeet Dhillon, MD.’ Deparuments of Neurosurgery and Racliology, University of Mississippi Medical Genter, Jackson. Interventional magnetic resonance imaging (IMRI), currently undergoing investigations worldwide, is an ‘emerging tool for modern neurosurgeons. The develop- ‘ment, installation, and equipping of an [MRI suite isa con siderable, though attainable, feat in itself. This report deiails our experience in the developmer lish- ment of the suite, as well as the clini intwaoperative at the University of Mississippi Medical Center. The clinical application of our IMRI over a 6 month period consists of intracranial biopsies, cr iotomies for tumor resection and cyst drainage, dynamic functional spine imaging in patients ranging in age from 10 to 57 years, with a total of 45 cases. Intraoperative images obtained in a strategic pattern pro- vide extremely accurate lesion localiza ‘anatomic compensation during surgical procedures, verifi- cation of biopsy/resection of the lesion, and prevention /early detection of certain complications (ic, hemorrhage). To date, there have been no intraoperative or postoperative complications. IMRI parallels the effort toward minimally invasive surgery and thereby shortens the postoperative hospital stay. We suggest that IMI is a valuable surgical tool, allowing the neurosurgeon another view of the anatomy of the patient before, during, and after the neurosurgical procedure, thus providing obvious advantages now and carrying enormous potential for aug: ‘menting neurosurgery in the future, $55