Bromocriptine therapy as pre-operative adjunct of non-functional pituitary macroadenomas.

Although bromocriptine administration produces reduction in size of prolactinomas, its effect upon non-functional pituitary adenomas is still uncertain. Nine patients with macroadenomas, 2 of them with prolactinomas and 7 with non-functional tumours, received bromocriptine prior to transsphenoidal surgery. Size reduction of tumour mass was assessed by computerized tomography and by visual field examination before and following bromocriptine treatment. There were no signs of size diminution or pathological changes in the non-functional adenomas treated pharmacologically during 15 to 360 days. Both patients with prolactinomas had radiological evidence of size reduction and morphological changes on microscopic examination. These 2 patients had tumours with prolactin granules (immunocytochemistry) and adenoma cells showed reduced cytoplasmatic, nuclear and nucleolar areas. Neither vascular damage, cell necrosis, nor infarction was observed by electron microscopy. Patients with non-functional tumours as determined by immunocytochemistry and hormone production did not benefit from bromocriptine. The suggestion that bromocriptine can be used as primary treatment for non-functional pituitary tumours is not supported by the present study. Conversely, in cases of macroprolactinoma, bromocriptine is a useful pre-operative adjunct when surgery is planned and for those patients in whom a surgical cure is considered difficult owing to the tumour size.

Combined supra-infrasellar approach for large pituitary tumors.

A combined supra- infrasellar approach for the resection of very large pituitary tumors is described. We think that it is superior to either the transsphenoidal or the intracranial approaches to these difficult tumors.

Complications associated with intra-arterial BCNU administered in combination with vincristine and procarbazine for the treatment of malignant brain tumors.

We have used intra-arterial (i.a.) 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) either alone or as part of adjuvant chemotherapy in patients with malignant brain tumors over a 3 year period (1979-1982). The i.a. BCNU technique was used 111 times to infuse 134 arteries in 37 patients. These patients, 28 cases with glial tumor and 9 cases with brain metastasis, received i.a. BCNU in combination with Vincristine and Procarbazine every 6 weeks. Complications encountered were transient and included: periorbital erythralgia or occipital-nuchal pain in 23 (62%), mild confusion and disorientation in 14 (38%), and ipsilateral conjunctival edema in 10 (27%). Reversible myelosuppression was not found. Our findings suggest that BCNU (100 mg/M2) may be given by i.a. infusion in combination chemotherapy without persistent severe untoward effects with a cumulative dose of 700 mg/M2.

Mechanisms of hydrocephalus in cerebral cysticercosis: implications for therapy.

Patients with hydrocephalus secondary to cerebral cysticercosis are a highly heterogeneous group. The mechanisms of hydrocephalus in these patients are multiple. Intraventricular cysts may be found in the 3rd and 4th ventricles, the sylvian aqueduct, and the foramen of Monro. Intraventricular cysts can be suspected when the 3rd and 4th ventricles or aqueduct remain enlarged despite shunting. Intraventricular contrast medium demonstrates the presence of the parasites. The intraventricular cysts should be removed surgically. Hydrocephalus due to cisternal cysticercosis can be diagnosed by isotope cisternography. These patients should receive shunts, but the long term prognosis is probably poor. Guidelines for the management of hydrocephalus due to cysticercosis are suggested.

Fourth ventricular cysticercosis.

This is a review of the clinical presentation and results of surgical treatment of 25 cases of cysticercosis of the 4th ventricle. All of the patients presented with hydrocephalus and, after shunting, dilatation of the 4th ventricle persisted while the supratentorial ventricular system returned to its normal size. We propose that, after a shunt procedure is performed, early direct surgical excision of the parasite should be done. Good or excellent results were achieved in 81.4% of the patients. Associated arachnoiditis and vasculitis were the major causes of poor outcomes.

Microsurgical anatomy of the pineal region.

The microsurgical anatomy of the pineal region was studied in 30 cadaver brains after the injection of a colored barium/gelatin mixture into the basilar artery and the straight sinus. The relationships of the pineal gland, vein of Galen, precentral cerebellar vein, internal cerebral veins, basal veins of Rosenthal, medial posterior choroidal arteries, quadrigeminal plate, pulvinar, splenium of the corpus callosum, and posterior 3rd ventricle were examined with the operating microscope and are described.

Lateral approach to the upper cervical spine.

A procedure for access to the ventral portion of the spinal canal from the foramen magnum to the superior portion of C-3 is described. This is useful for lesions that are primarily ventral or ventrolateral to the spinal cord, such as meningiomas or neurofibromas. The exposure involves no more bone removal than does a posterior laminectomy, but the angle of approach reduces markedly the amount of spinal cord manipulation necessary to deal with ventrally situated lesions.

Development of cerebellar malignant astrocytoma at site of a medulloblastoma treated 11 years earlier. Case report.

A child treated for a desmoplastic medulloblastoma of the left cerebellar hemisphere at the age of 10 months developed a malignant astrocytoma in the same site 11 years later. Theories of origin of the second tumor, particularly in relation to concepts of the genesis of medulloblastoma in general, are discussed.