Non-tumoral Aqueductal Stenosis in Adults

Though non-tumoral stenosis of the aqueduct has long been described as a common cause of hydrocephalus in infants and young children, its occurrence in adults has been recorded infrequently. In adults, the general picture of the clinical features is of chronic hydrocephalus such as impaired memory, epilepsy, unsteady gait, headache and other features of increased intracranial tension and endocrine disorders and features indicative of hypothalamic involvement. Plain skull X-rays show the signs of increased intracranial tension. The diagnosis if confirmed by ventriculography with or without lumbar encephalography. Recently cerebral angiography is stressed in diagnosis of aqueductal stenosis. We have seen two cases of aqueductal stenosis which can be regarded as non-tumoral origin. They were females and 29 and 34 years old respectively. Their symptoms were similar. It was headache for several months' duration which were aggrevated as time progress and combined with convulsions. Bilateral papilledema was the only finding in neurological examination. In conray ventriculography, the third ventricles were markedly enlarged and involved the salla tursica, and conray was not filled the caudal part of the aqueduct in two cases. The first case, following Torkildsens ventriculocisternal shunt did well for several days, however, patient died in spite of massive antibiotic therapy and ventriculostomy after removal of shunt tube which was regarded as infective. Autopsy showed periaqueductal gliosis without neoplasmic infiltration. Second case was improved with anterior third ventriculostomy.

Non-tumoral Aqueductal Stenosis in Adults

Though non-tumoral stenosis of the aqueduct has long been described as a common cause of hydrocephalus in infants and young children, its occurrence in adults has been recorded infrequently. In adults, the general picture of the clinical features is of chronic hydrocephalus such as impaired memory, epilepsy, unsteady gait, headache and other features of increased intracranial tension and endocrine disorders and features indicative of hypothalamic involvement. Plain skull X-rays show the signs of increased intracranial tension. The diagnosis if confirmed by ventriculography with or without lumbar encephalography. Recently cerebral angiography is stressed in diagnosis of aqueductal stenosis. We have seen two cases of aqueductal stenosis which can be regarded as non-tumoral origin. They were females and 29 and 34 years old respectively. Their symptoms were similar. It was headache for several months' duration which were aggrevated as time progress and combined with convulsions. Bilateral papilledema was the only finding in neurological examination. In conray ventriculography, the third ventricles were markedly enlarged and involved the salla tursica, and conray was not filled the caudal part of the aqueduct in two cases. The first case, following Torkildsens ventriculocisternal shunt did well for several days, however, patient died in spite of massive antibiotic therapy and ventriculostomy after removal of shunt tube which was regarded as infective. Autopsy showed periaqueductal gliosis without neoplasmic infiltration. Second case was improved with anterior third ventriculostomy.

A Clinical Study of Sellar and Parasellar Lesions

A series of 58 verified various sellar and parasellar lesions exclusive of aneurysms and inflammatory lesions was reviewed as to history, development and progression of the neurological features, spontaneous and steroid induced remission, endocrine disturbances, other laboratory findings, reontgenograms, differential diagnosis, operative methods and findings, and pathologic findings of the lesion. The author has only emphasized some interesting points illustrated in our cases because other results do not differ greatly from previous authors' reports. 1. No direct correlation was found to exist between the amount of the sellar destruction and the occurrence of endocrine disturbances. However, it was likely that marked endocrine changes were due to cystic formation in pituitary adenomas. 2. On angiograms of sellar and parasellar lesions, opening of the siphon and lateral displacement of the supraclinoid portion of the internal carotid artery were important in the diagnosis, and the event of nonvisualization of the posterior communicating and posterior cerebral arteries was observed in the majority of pituitary tumors. 3. In pituitary cystic adenomas, intracapsular bleeding was very hard to control on occasions because of rupturing vascular network or trabeculae in the cyst. 4. Definition of the empty sella was always obscure in intracranial exploration under the diagnosis of pituitary tumor when no definite lesion was found. 5. In a hydrocephalic patient with raised intracranial pressure and a markedly enlarged third ventricle extending into the sella turcica, third ventriculostomy still seems to be the choice of treatment.

Trigeminal Neurinomas: Report of 2 Cases

No abstract available.

A Case of Trigeminal Neuralgia Treated with Percutaneous Radiofrequency Lesions

The radiofrequency has been used for percutaneous cordotomy in patient having intractable pain. Recently the use of this radiofrequency has been extended to include other neurosurgical procedures, which in the past were done with chemical agents or mechanical methods etc. We treated one case of trigeminal neuralgia with the radiofrequency. The gasserian ganglion was punctured through the foramen ovale using a modified Hartel technique and the radiofrequency lesion was made in the second and third branches of the right trigeminal nerve selectively. The postoperative result was satisfactory. We reviewed the literature and described the technical procedures and complications.