Orbital unifocal Langerhans cell histiocytosis [eosinophilic granuloma]

Langerhans cell histiocytosis [LCH] is a clinical entity characterized by abnormal proliferation of Langerhans cells that probably results from an immunoregulatory defect which can be triggered by several different factors. Orbital involvement by LCH most often represents unifocal disease [eosinophilic granuloma]. The condition is uncommon and descriptions of eosinophilic granuloma of the orbit generally have been limited to single case reports or small case series. A case of orbital eosinophilic granuloma is reported, followed by a discussion encompassing a literature review

Endo-nasal endoscopic pituitary surgery experience of a university hospital in Saudi Arabia

Trans- sphenoidal hypophysectomy is known for many years back. The microscopic approach is traditionally used. A minimally invasive technique using the endoscope is recently gaining popularity. Is to present experience of a minimally invasive technique for the management of pituitary sellar tumors, using an endoscopic endonasal trans-sphenoidal approach. Four patients with pituitary adenomas were treated using this technique. All the patients had undergone preoperative evaluations by CT scan and MRI for the pituitary gland and sphenoid sinuses. Visual fields assessment as well as endocrinological evaluations was done. The four cases were macro adenomas. Complete removal of the tumor was achieved in two cases while the other two with suprasellar and cavernous sinus extension only safe tumor debulking was possible. The histopathology revealed non-functioning adenomas in three cases and one with infarction. We documented that the endonasal endoscopic trans-sphenoidal approach for pituitary surgery is a minimally invasive procedure with low morbidity and short hospital stay and even further less invasive after our modification in the approach. To our knowledge and after computerized literature search this is the first reported experience from the Arabian Peninsula

Management of cerebral tuberculoma

Cerebral tuberculosis in developing countries is still a common disease, and there is an emergence of cerebral tuberculoma. Involvement of the brain by tuberculoma is a serious complication of cerebral tuberculosis and in rare cases an abscess or multiple tubercular abscesses may result. The management is controversial among the neurosurgical services which could be excision or stereotactic aspiration, or by conservative treatment with anti-tuberculous chemotherapy alone. Twenty-four patients with either histological confirmation of tuberculoma or classical radiological image appearance of the tuberculoma with complete structural disappearance of tuberculous lesion due to anti-tuberculous chemotherapy were reviewed retrospectively in the Neurosurgery Department, King Fahd Hospital of the University from June 1982 - June 1999. We tend to favour a surgical approach in cases with cystic lesion with marked cerebral compression or midline cerebral displacement either by stereotactic aspiration or excision alone. In addition, we also recommend conservative treatment when there is no evidence of clinical and/or radio-logical deterioration. The protocol for management of cerebral tuber-culoma is also discussed