Tumors of the cerebellopontine angle. Changing policy in treatment.

One hundred and twenty-six cases of cerebellopontine angle tumors with various histologies are presented. Results of 75 operated vestibular neurinomas, 22 meningiomas, and 16 tumors with other histologies are discussed. The method of irradiation and non-radical surgery may be an alternative for treatment.

[The transoral approach in neurosurgical practice]. / Transoral'nyi dostup v neirokhirurgicheskoi praktike.

Operations were performed on 25 patients by the transoral approach. All of the pathological processes were localized epidurally in the clival, craniocervical or upper cervical regions. These were tumors, developmental anomalies, inflammatory processes, and odontoid fracture with compression of the brain stem, cranial nerves, spinal cord or spinal radices. The advantages of the transoral operation are obvious in decompressing the neural structures from the direction of the exerted pressure. Surgery led to improvement in the 25 primarily operated patients and there was no operative mortality. Among 7 reoperations an emergency and tenable transoral reoperation (C2-4 twice recurrent chordoma) undertaken to relieve respiratory arrest, however, was only a transitory success.

[Surgical treatment of pituitary apoplexy]. / A hypophysis apoplexia sebészi kezeléséröl.

Hypophysis apoplexy is a clinical syndrome characterized by the sudden development of headache, visual disturbance, associated with nausea, vomiting, signs of meningeal irritation and ophthalmoplegia. The symptoms are caused by the hemorrhage of a hypophyseal adenoma. This leads to the swelling of the tumor and compression of the perisellar structures. The authors processed the clinical and pathological characteristics of 28 cases occurring among the patient material of the National Institute of Neurosurgery of the past 10 years. According to the experiences the most important factor of a successful treatment of hypophyseal apoplexy is an early diagnosis and quick admittance to an institute of neurosurgery of satisfactory conditions. Thereafter a steroid hormone therapy of large doses and decompression operation performed by transnasal-transsphenoidal approach leads in the majority of cases to recovery.

[Transsphenoidal approach in pituitary adenomas with suprasellar growth]. / Transsfenoidal'nyi dostup pri adenomakh gipofiza s supraselliarnym rostom.

Experience in surgery through a transsphenoidal approach in 154 patients with suprasellar adenomas of the hypophysis complicated by disorders of vision is discussed. Positive changes of vision after the operation occurred in most cases. At the Budapest Scientific Research Institute of Neurosurgery the transsphenoidal approach to adenomas of the hypophysis is used in most cases, and only 10% of patients are operated on transcranially when there are tumors with parasellar growth. The authors persist in their opinion that the transsphenoidal approach is simpler in techniques and causes less injury as a result of which it can be used even in elderly patients and in those whose general condition is grave.

Transoral surgery for craniocervical space-occupying processes.

Although the number of reports concerning the transoral approach to anteriorly placed lesions of the craniocervical junction are increasing, the development of this technique is still in its early stages. The indications and surgical methods vary widely, and there is much room for discussion of the technical details. Eight cases operated on via transoral surgery during the last 4 years are presented in support of the transoral approach to tumors in the craniocervical region.