From 1977 to 1988, 56 patients with a preoperative diagnosis of Cushing's disease were treated by transsphenoidal microsurgical exploration of the pituitary gland. In 42 patients, a discrete tumor was found and a selective adenomectomy was performed. Total hypophysectomy was performed in nine patients. In an attempt to preserve pituitary function, a technique of subtotal hypophysectomy was utilized in the remaining five patients. Regular and adequate follow-up results were obtained in 53 patients. A sustained remission was obtained in 45 of these 53 patients for a remission rate of 84.9%. Eight patients were classified as therapeutic failures. The causes for failure included: 1) invasive tumor; 2) hyperplasia mistaken for an adenoma; 3) a presumed ectopic source of adrenocorticotropic hormone; 4) misdiagnosis; 5) atypical tumor; and 6) recurrence of disease after remission. In cases of therapeutic failure, the original diagnosis of Cushing's disease must be reevaluated and treatment continued until sustained remission is achieved. Necessary measures to help avoid surgical failures and an approach for further diagnostic and therapeutic maneuvers in these cases are discussed.

Transcranial stab wounds are uncommon. Three such cases are presented. The severity of the wounds may vary from innocuous to devastating. Skull films are useful in delineating the depth of penetration. The presence of the knife blade in situ may make the computed tomographic scan impossible to perform or difficult to interpret. Cerebral angiography may be indicated if injury to a major cerebral vessel is suspected or if the patient suffers a delayed subarachnoid or intracerebral hemorrhage. Provided that the patient's clinical status indicates a positive prognosis, transcranial stab wounds should be explored surgically. The weapon should be removed in the operating room immediately before or at the time of operation.

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Central nervous System transplantation currently is being investigated in numerous Centers throughout the world. The concept of restoring lost neurological function by grafting neuronal or neuronal-like tissue into the CNS has the potential for revolutionizing the treatment of numerous neurological disorders. Parkinson''s disease is the subject of the majority of CNS transplantation studies although the first human studies were disappointing. However, further refinements of technique and patient selection, and animal research using a newly developed primate model of parkinsonism, led to promising results reported from several centers. Despite this, numerous fundamental issues have yet to be resolved: (1) age of patient? (2) degree of disability of patient? (3) use of fetal or adrenal tissue? (4) caudate or putamen placement? and (5) open or stereotactic surgery? This report reviews the clinically significant results of nonhuman primate research and clinical studies, and addresses these unresolved issues.

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