[A case of pituitary apoplexy with severe consciousness disturbance following mild head trauma].

A rare case of pituitary apoplexy following mild head trauma is reported. A 56-year-old woman was referred to our hospital for loss of consciousness following a traffic accident. Magnetic resonance (MR) imaging showed a large suprasellar tumor containing a low intensity area on the T 1-, T 2-weighted images and fluid-attenuated inversion recovery (FLAIR) image. These findings indicated fresh intratumoral hemorrhage. The tumor extended to the suprasellar region and put pressure on the hypothalamus and brain stem. The tumor, with marked intratumoral hemorrhage, was resected with an emergency right front-temporal craniotomy. And the patient was left severely disabled. The tumor histology was diffuse-type pituitary adenoma. In our case, we suggest that the cause of pituitary apoplexy following head trauma was shearing stress between the intra- and suprasellar part of the easy bleeding tumor, or direct injury by bone structure such as teberculum sellae, dorsum sellae, or anterior clinoid process.

[Gamma knife radiosurgery for malignant melanoma in the paranasal sinuses: case report].

A case of malignant melanoma in the paranasal sinuses, successfully treated with gamma knife stereotactic radiosurgery, is reported. A 90-year-old man with left periorbital swelling was referred to our hospital for gamma knife radiosurgery. He had a 4-month history of left periorbital swelling and ophthalmalgia, but he was treated conservatively due to his age. CT showed a large mass with bone destruction located in the nasal cavity, paranasal sinuses, and orbita. A 15 Gy peripheral dose was administered to the upper portion of the tumor with the gamma knife technique, at the 50% isodose line using a 18 mm collimator (21 shots). Seven months after radiosurgery, his left periorbital swelling was improved markedly, and CT showed a significant reduction in the volume of the tumor. Gamma knife radiosurgery is a feasible treatment for malignant melanoma in the paranasal sinuses. It provides excellent quality of life, less injury to the patient, and fewer side effects than other treatment strategies.