ABSTRACT
Craniopharyngiomas are rare, mainly sellar/parasellar, epithelial tumors diagnosed during childhood or adult life. Histologically, two primary subtypes have been recognized (adamantinomatous and papillary) with an as yet, unclarified pathogenesis. They may present with a variety of manifestations (neurological, visual, and hypothalamo-pituitary). Despite their benign histological appearance, they often show an unpredictable growth pattern, which, combined with the lack of randomized studies, poses significant difficulties in the establishment of an optimal therapeutic protocol. This should focus on the prevention of recurrence(s), improvement of survival, reduction of the significant disease and treatment-related morbidity (endocrine, visual, hypothalamic, neurobehavioral, and cognitive), and preservation of the quality of life. Currently, surgical excision followed by external beam irradiation, in cases of residual tumor, is the main treatment option. Intracystic irradiation or bleomycin, stereotactic radiosurgery, or radiotherapy and systemic chemotherapy are alternative approaches; their place in the management plan remains to be assessed in adequately powered long-term trials. Apart from the type of treatment, the identification of clinical and imaging parameters that will predict patients with a better prognosis is difficult. The central registration of patients with these challenging tumors may provide correlates between treatments and outcomes and establish prognostic factors at the pathological or molecular level that may further guide us in the future.
Subject(s)
Craniopharyngioma/therapy , Pituitary Neoplasms/therapy , Antibiotics, Antineoplastic/therapeutic use , Bleomycin/adverse effects , Bleomycin/therapeutic use , Cognition Disorders/etiology , Craniopharyngioma/complications , Craniopharyngioma/diagnosis , Humans , Hypothalamic Diseases/etiology , Neoplasm Recurrence, Local/etiology , Pituitary Neoplasms/complications , Pituitary Neoplasms/diagnosis , Radiotherapy/adverse effects , Radiotherapy/methodsABSTRACT
When Colonel T.E. Lawrence ("Lawrence of Arabia") was fatally injured in a motorcycle accident in May 1935, one of the several doctors attending him was a young neurosurgeon, Hugh Cairns. He was moved by the tragedy in a way that was to have far-reaching consequences. At the beginning of the Second World War, he highlighted the unnecessary loss of life among army motorcycle dispatch riders as a result of head injuries. His research concluded that the adoption of crash helmets as standard by both military and civilian motorcyclists would result in considerable saving of life. It was 32 years later, however, that motorcycle crash helmets were made compulsory in the United Kingdom. As a consequence of treating T.E. Lawrence and through his research at Oxford, Sir Hugh Cairns' work largely pioneered legislation for protective headgear by motorcyclists and subsequently in the workplace and for many sports worldwide. Over subsequent decades, this has saved countless lives.
Subject(s)
Famous Persons , Head Protective Devices/history , Motorcycles/history , Skull Fractures/history , History, 19th Century , History, 20th Century , Humans , Male , Neurosurgery/history , Saudi Arabia , United KingdomABSTRACT
De uma maneira sumária, utilizando termos que possam ser entendidos pelo grande público, e sobretudo pelos pacientes, uma série de conceitos säo emitidos e uma padronizaçäo dos exercícios é estabelecida. Essa série de condutas representa a rotina no departamento de cirurgia neurológica em Oxford e que é usada na recuperaçäo de pacientes com lombalgia
