Neurochirurgia最新文献

Olfactory neuroblastoma and malignant melanoma of the nasal cavities as second primary tumors after resection of pituitary adenomas in two patients are described. These cases, which seem to be the first documented in the literature, demonstrate the problems in diagnosis and treatment. Because of its rare occurrence, a second primary tumor may not be suspected when symptoms develop in the region of a previous hypophysectomy. A close follow-up after hypophysectomy for pituitary adenoma is recommended for the early detection of a second primary tumor. Pathogenetic considerations are discussed.

163 cases of supratentorial astrocytomas and glioblastomas were evaluated retrospectively after close-meshed observation and treatment. We attached the greatest importance to the reevaluation of already known prognostic parameters and to the temporal analysis of the course of gliomas. We could confirm the influence of the histologic grade on the survival time. Histologic grading by means of immunohistochemistry proved to be more precise than grading only by means of HE staining. Furthermore, the patient's age was one of the most important prognostic variables for survival time after operation. Other factors were the first preoperative Karnofsky rating, the preoperative diameter of the tumour, the duration of preoperative symptoms and the interval between operation and diagnosis of tumour recurrence as well as between tumour recurrence and reoperation. Epileptic seizures as preoperative symptoms were found to be far less prognostic for survival time. Localisation of the tumour, other preoperative symptoms, Karnofsky rating before reoperation and the extent of tumour resection proved to be of no importance for survival time.

Primary malignant mesenchymal tumours were seen in 2.4 per cent of all autopsy cases with primary CNS-tumours. Primary leptomeningeal sarcomatosis is rare in this group of tumours. We discuss the rare disease on the basis of the case history of a 26-year-old patient.

Intracranial subependymomas are rare, benign tumours (WHO grade I) occupying a special position compared to the other ependymal neoplasms. They often remain asymptomatic and, in consequence, are found incidentally at autopsy. In the present study clinico-pathological data of 84 symptomatic (8 own cases) and 58 asymptomatic tumours (10 own cases) are summarised. Subependymomas are more frequently situated in the fourth (58.4%) than in the lateral ventricle (38.0%). They occur predominantly in middle-aged and elderly males. Tumours in the lateral ventricles manifest themselves more often than those in the fourth ventricle. In general, asymptomatic subependymomas do not exceed a diameter of 1.2 cm. The nature of symptoms, with a median symptomatic period of 12 months, is usually associated with hydrocephalus, which is present in more than 80% of the symptom-producing subependymomas. Growth within the ventricular lumen and sharp demarcation from the surrounding brain tissue allow a complete removal in half of the cases. Radical extirpation can be achieved more often in patients with subependymomas located in the lateral ventricles than in those with tumours arising from the floor of the fourth ventricle. The high operative mortality, at a rate of 28.8% so far, mainly refers to the period before microsurgical technique was established. Recurrences are very rare, spinal seeding has not been found to date. For the assessment of long-term results further detailed compilation and documentation of individual follow-ups is necessary.

The relative postnatal growth of the bony floor parts was calculated from previous measurements and planimetrically determined on 21 adults and 13 skulls of children. As expected 1) the percentage rise in length and breadth values was lower than that of the area values. 2) The greatest postnatal area rise (63%) was determined in the hypophyseal region. 3) The growth of the individual skull areas terminates at a variable period after birth, e.g. a) between the foramen caecum and the tuberculum sellae in the 8th year of life; the planum sphenoidale, however, grows after the 9th year of life by approx. 27%! b) In children of 8 years of age, the lateral length of the middle cranial fossa is about 98% of the adult value. c) Between the 6th year of life and adult age a length increase of 18.5% takes place (tuberculum sellae--dorsum sellae). d) In 5-year old children the lateral length of the posterior cranial fossa is 97.5%, in 8-year-olds 99.9% of the adult value. e) After the 8th year of life the breadth increase is e.g. 6.4% in the region of the anterior cranial fossa, 3.5% in the middle fossa, and 10% in the pituitary region.

Two rare cases of extracranial meningiomas associated with intracranial masses are reported. From the roentgenological findings both of the tumors were regarded as being partly connected. The tumors were surgically treated 21 and 19 years, respectively, after the first removal of the intracranial masses. They appeared as nasal-oral and orbicular masses, respectively, and were histologically diagnosed as meningotheliomatous meningioma. In one case a partial removal of a naso-oral tumor, including a subtotal removal of the tumor in the lateral orbital cavity, was performed by Weber-Kocher's incision plus Krönlein's incision. In the other case a tumor was removed via a transoral route by a lateral retraction of one half of the mandible after cutting it into halves. Our operative approaches and origins of the tumor are discussed.

In the University Cantonal Hospital in Basel, 34 intraventricular hemorrhages were diagnosed by computer tomography from 1981 to 1990. The most frequent cause of bleeding into the ventricular system (35.3%) was rupture of an aneurysm, followed by hypertensive hemorrhages (23.5%). The cause of bleeding into the ventricular system could not be found in 20.6% of the cases investigated. The hemorrhage was present in all ventricles in 13 cases. A ruptured aneurysm was responsible for this in five patients. The hemorrhage was found in two and three ventricles in 11 cases. Only one ventricle was filled with blood in 10 cases; this was due to hypertensive hemorrhage in four patients. Besides open and enclosed ventricular drainage, aneurysm clipping was carried out in six cases, osteoplastic craniotomy in 12 cases and bore hole trepanation in four cases, depending on the underlying disease responsible for bleeding into the ventricular system. We were able to observe restitution of complete functional integrity at the follow-up examination one year later in eight cases (23.53% of all patients). Neurological deficits were shown at follow-up in 10 cases (= 29.41%). In our patients, the mortality was 47.1% (= 16 patients).

The extreme lateral approach to the thoracic disc spaces produces minimum disruption of the normal spinal anatomy, avoids retraction of the spinal cord, and preserves the intercostal neurovascular bundle. It is achieved by removal of about 5 cm of the rib which has its insertion at the disc level, if necessary associated with partial removal of the transverse process, followed by partial pediculotomy and a limited lateral rachitomy (vertebral body resection), which permits the opening of the spinal canal exclusively ventral to the intervertebral foramen. The initial results of 6 patients, operated in up to four discs at the same occasion, are promising.