Pituitary apoplexy: endocrine, surgical and oncological emergency. Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas.

Authors analyzed retrospectively the incidence of pituitary apoplexy in a series of 799 pituitary adenomas with respect to the long term follow-up of the patients. Focal vascular abnormalities in histological specimens of tumours, regarded as morphological suggestion of past apoplexy (haemorrhage, ischaemic infarction or necrosis), were established in 113 out of 783 surgical cases (14.4%). Acute clinical onset, justifying the clinical diagnosis of pituitary apoplexy, occurred in 39 patients only (5% of the whole series), 19 of them were subjected to urgent surgical decompression due to severe neurological deficit. The haemorrhagic character of apoplexy was established in most cases requiring immediate surgery. The detailed clinical picture of this condition and its management are discussed with respect to the long term prognosis. On this basis the authors suggest the necessity of surgical treatment in every case of pituitary apoplexy, taking into account not only neurological recovery, but also endocrine and oncological aspects of the disease. The observation that pituitary apoplexy may be a "marker" of tumour invasiveness (even in small, "enclosed" adenomas) is highlighted.

[Teratoma of the posterior cranial fossa]. / Potworniaki w tylnej jamie czaszkowej.

Two cases of posterior cranial fossa teratomas are reported. The rarity of these lesions is stressed. In the material of surgically treated cases of brain tumours from a period of 12 years in only two patients teratomas of this location were found. In adults they are extremely rare. In both cases teratoma finding during the operation was a surprise for the neurosurgeons and this was confirmed by literature reports.

[Many-year survival after surgical treatment of glioblastoma multiforme. Report of 2 cases]. / Kilkunastoletnie przezycie po operacji glejaka wielopostaciowego mózu; opis dwóch przypadków.

Two female patients are described with survival over 13 years after operation for glioblastoma multiforme. The first patient was 42-year-old at the time of partial removal of the tumour situated in deep parts of the temporal lobe. After the operation she was not given any radiotherapy. CT done 13 years after the operation failed to show tumour presence. The patient is leading a self-dependent life (80 points in Karnofski scale). The other female patient was 28-year-old at the time of nearly complete removal (macroscopic) of right temporal lobe tumour. She received cobalt radiotherapy. CT 9 years after the operation showed no tumour. The present state of the patient was evaluated at 90 points Karnofsky scale. In no case cytostatics were given. These cases demonstrate an exceptionally long survival after operation for malignant glioma. The cause of this long survival is not known.

[Postoperative radiotherapy of glial tumors of the central nervous system]. / Pooperacyjna rentgenoterapia glejopochodnych guzów osrodkowego ukladu nerwowego.

The authors analysed the survival time of 372 patients subjected to radiotherapy after operations for central nervous system tumours of glial origin. Subtentorial gliomas with a better prognosis than supratentorial gliomas accounted for 82% of cases in this group of 67 children, and cerebellar medulloblastoma most sensitive to radiation accounted for 85%. In the group of 305 adults supratentorial tumours were found in 90.8% of cases, and the very malignant multiform glioblastoma was present in 50.8% of cases. In view of these differences the five-year survival rate was 31.3% in children than 40 years; no sex differences were found between the groups with different survival rates. Postoperative radiotherapy of malignant gliomas is of great value prolonging the life of the patients and improving its quality.

[Erdheim's tumors in adults--diagnosis, treatment and therapeutic results]. / Guzy Erdheima u doroslych--diagnostyka, leczenie i wyniki.

The authors present a group of 27 adult patients aged over 25 years treated in the Department of Neurosurgery, Medical Academy in Warsaw in the years 1960-1985 for Erdheim's tumours. In most cases the first signs were visual disturbances and signs of raised intracranial pressure, and in only 48% of cases endocrine disturbances were additionally found. The basic diagnostic method in these cases was computerized tomography which indicates precisely the location of the lesion, its consistency and width of ventricles. All patients were treated surgically, the operative surgery was 14.8%. The authors believe that surgical treatment followed by radiotherapy is the best method of management of such tumours in adults.

Cytostatics for acromegaly. Marked improvement in a patient with an invasive pituitary tumour.

A 21-year-old woman suffering from acromegaly was treated with transsphenoidal subtotal hypophysectomy (microscopy: acidophilic adenoma), followed by x-ray and bromocriptine therapy. Seven years later she was re-operated because of a partial bitemporal loss of vision, intracranial hypertension, and regrowth of the pituitary tumour seen on CT-scan. A large part of the invasive suprasellar tumour was then removed by transcranial approach. The neurosurgery was followed by cobalt radiotherapy and bromocriptine administration. Two years later, symptoms and signs of tumour growth reappeared. Administration of cytostatics, such as doxorubicin (Adriamycin) and lomustine (Belustine), resulted in distinct clinical improvement associated with a seven-fold decrease in the serum growth hormone concentration. The visual field became normal and the intracranial mass on a CT scan decreased markedly. As a result the patient was able to resume work.

[Neuropathologic analysis of 8 undiagnosed cases of cerebral cysticercosis]. / Analiza neuropatologiczna 8 nie rozpoznanych przyzyciowo przypadków wagrzycy mózgu.

The presented material comprised 17 cases observed in four Warsaw hospitals in a period of 20 years. Nine patients with the pseudotumour syndrome were diagnosed correctly and referred to neurosurgical services. The remaining eight cases died in neurological hospital departments with the following clinical diagnoses: cerebral stroke 3, subarachnoid haemorrhage 1, comatose state preceded by dementia 1, chronic meningoencephalitis 1, status epilepticus 2 cases postmortem investigations demonstrated cerebral cysticercosis in all cases. In four patients with predominant symptoms of cerebrovascular disease lesions were found of the type of residual vasculitis cysticercosa, the sequelae of which might have caused secondary complications independent of concomitant arteriosclerosis. Dementia appeared in a patient with huge hydrocephalus consequent to numerous cysticerci. The patient with the diagnosis of meningoencephalitis had an inflammatory reaction of the ependyma and meninges caused by a cysticercus floating in the IV ventricle. Of the patients dying in status epilepticus attention is called to a 6-year-old girl with a solitary cysticercus localised subcortically in the motor area. The authors suggest that the possibility of cysticercosis should be kept in mind, despite its rarity, in cases with a not completely clear clinical manifestations of cerebrovascular disease, chronic meningoencephalitis and epilepsy or dementia.

[Effect of the method of treatment on mean survival time of patients with glial brain tumors]. / Wplyw sposobu leczenia na sredni czas przezycia chorych z glejopochodnymi guzami mózgu.

In the years 1976-1981 54 patients were treated for malignant glial tumours confirmed by histological examination. The purpose of the reported analysis was a comparison of the mean survival time and the mean time of survival without evidence of recurrence in 3 groups of patients. In group I of 13 patients not treated surgically but receiving only conservative management the mean survival time was 7.4 weeks. In group II treated surgically but without other therapy this time was 29.2 weeks. In group III in which the patients were operated on and treated with chemotherapy and radiotherapy this time was 58.9 weeks. The differences between the groups were statistically significant. Similarly, the mean survival time without recurrence was significantly longer in the group receiving comprehensive treatment than in the group treated only surgically (46.5 vs 18.0 weeks).

Results of neurosurgical treatment by a transsphenoidal approach in 10 patients with Nelson's syndrome.

Ten patients with Nelson's syndrome, nine women and one man, aged 22 to 61 years, were treated neurosurgically by a transsphenoidal approach. In four patients, microadenomas were found, ranging in diameter from 4 to 10 mm. Microscopically, mixed adenoma was diagnosed in six cases, basophilic adenoma in three patients, and chromophobe adenoma in one patient. The presence of argyrophilic nerve fibers in the adenoma tissue was noted in one case. The time of observation after transsphenoidal surgery ranged from 6 months to 10 years. Clinical remission was achieved in eight patients; in two of them, radiation therapy was used to complement surgical treatment. In two patients, recurrence of the pituitary neoplasm was observed; anaplasia was revealed at the second operation in one of them. Radiation therapy might be a useful adjunct to neurosurgery in Nelson's syndrome, especially in patients with anaplastic adenoma.

[A case of tumor of the pineal body treated with gamma rays of Co-60]. / Przypadek guza szyszynki leczonego promieniami gamma kobaltu Co60.

A 21-year-old patients was admitted to hospital with symptoms suggesting a tumour in the area of the epiphysis. Computer tomography confirmed the initial diagnosis. Since signs were present of increased intracranial pressure a Pudenz valve was implanted and in the second stage of treatment radiotherapy with radioactive cobalt was applied. A very good result was obtained with control CT failing to demonstrate presence of the tumour and hydrocephalus.

[Late recurrent subarachnoid hemorrhage after strengthening the aneurysm wall with aneuroplastic]. / Odlegle nawrotowe krwawienia podpajeczynówkowe po wzmocnieniu sciany tetniaka aneuroplastykiem.

Two patients are presented in whom repeated subarachnoideal haemorrhages developed 4 and 13 years after operations for intracranial aneurysms including strengthening of aneurysm wall with aneuroplastic. The patients were reoperated on by microsurgery. In both cases it was possible to clip the aneurysm after removing aneuroplastic.

[Internal carotid artery aneurysm in the sella turcica area simulating pituitary tumor]. / Tetniak tetnicy szyjnej wewnetrznej w obrebie siodla tureckiego imitujacy guz przysadki.

A giant aneurysm of the internal artery is described which was situated in the sella and simulated hormonally inactive hypophyseal adenoma. Axial computer tomography demonstrated a hypophyseal tumour. During operation from intranasal approach through sphenoid sinus massive haemorrhage developed but was controlled with fibrin sponge. Postoperative angiography demonstrated a giant aneurysm of the internal artery situated in the sella. Although this location of aneurysm is exceptionally rare, each case of inactive hormonally pituitary adenoma should be subjected before the operation to cerebral angiography.

Nelson's syndrome: incidence and prognosis.

Fifty patients bilaterally adrenalectomized for Cushing's disease were followed for 1 to 22 (mean, 12) years. In 14 of them (28%) Nelson's syndrome appeared within 1.5 to 12 (mean, 4.8) years after adrenalectomy. All the patients were deeply pigmented, 12 had a radiologically demonstrable tumour and six had visual defects. Plasma ACTH levels ranged from 450 to 8000 ng/l. However in every case at least one estimation during circadian studies equalled 2000 ng/l. One patient with an anaplastic pituitary tumour died 3 years after the discovery of the tumour. Anaplasia was also diagnosed in another patient with recurrence of pituitary tumour after a transsphenoidal operation. Symptoms of tumour infarction occurred in two patients, followed by clinical remission of Nelson's syndrome. In the majority of cases the course was benign. We conclude that all cases, however, should be followed indefinitely because Nelson's tumours are not infrequently aggressive.