Résumé
A 27-year-old man suffered a relatively minor trauma. He developed signs of raised intracranial pressure three days after injury. Investigations revealed superior sagittal sinus and torcular thrombosis.
Sujets)
Adulte , Anticoagulants/usage thérapeutique , Traumatismes cranioencéphaliques/complications , Héparine/usage thérapeutique , Humains , Thrombose intracrânienne/traitement médicamenteux , Angiographie par résonance magnétique , Mâle , Thrombose du sinus sagittal/traitement médicamenteux , Fractures du crâne/complications , TomodensitométrieRésumé
A clinicopathological study of 41 cases of pituitary apoplexy in a series of 324 surgically treated pituitary adenomas is presented. In 23 patients, the predominant operative finding was hemorrhage with or without necrosis. However, there were 15 (37.7%) cases where pale, necrotic tissue with no evidence of hemorrhage was found at surgery. Pale, necrotic material was particularly found when there was a long interval between the acute clinical event and surgery. It is concluded that the pale, necrotic debris represents one stage in the resorption process of blood after hemorrhagic necrosis of pituitary adenomas. This entity needs to be kept in mind especially since the material closely resemble the pultaceous material seen in craniopharyngiomas and epidermoid cysts.
Sujets)
Adénomes/complications , Adulte , Femelle , Hémorragie/étiologie , Humains , Imagerie par résonance magnétique , Mâle , Adulte d'âge moyen , Nécrose , Apoplexie hypophysaire/diagnostic , Tumeurs de l'hypophyse/complications , Études rétrospectives , TomodensitométrieRésumé
This study was done to determine the usefulness of the sagittal magnetic resonance image (MRI) in predicting the ease of resectability of pituitary adenomas operated through the transsphenoidal route. Tumors were graded according to Hardy's method and a new system proposed by us. In this system the amount of tumor above the line of vision (V-line) as seen on the sagittal MRI was estimated and correlated with the extent of excision assessed on the postoperative computed tomogram (CT). There were 7 Hardy's grade A (8.8%), 32 grade B (41.3%), 31 grade C (37.5%), 6 grade D (8.8%) and 2 grade E tumors (3.8%) among the 78 tumors studied. It was seen that most of the tumor volume was below the V-line in Hardy's grade A and B tumors. In grade C tumors 5 were < 25% above, 14 were 25-50% above and 12 were 50-75% above the V-line. A radical excision was possible in 15 of l9 grade C tumors in which < 50% of the tumor was above the V-line. However, only 5 of 12 with Hardy's grade C were radically excised when >50% of the tumor was above the V-line. In conclusion, Hardy's grade C tumors are not a homogenous group radiologically and using the V-line on MRI helps in predicting the case of respectability in a single stage.