[Current diagnosis and treatment of idiopathic intracranial hypertension]. / Az idiopathiás intracranialis hipertenzió korszeru diagnózisa és kezelése.

BACKGROUND AND PURPOSE: Idiopathic intracranial hypertension is cha-racterized by raised intracranial pressure of unknown origin, leading to persisting visual loss if left untreated. Purpose - We assessed timing of surgery, and the efficacy and safety of ventriculo-peritoneal shunt. METHODS: Retrospective analysis of 65 patients treated at our Neuro-ophthalmology Clinic between 2009 and 2017. Patients - We treated 15 children and 50 adults, 42 patients conservatively, and 23 surgically. The median age at presentation was 27 years for adults, 88% were obese, and 86% female. The age of children was 5-17 years, 40% were obese, and 53% girl. The commonest presentation symptom was headache in both groups (64%), followed by obscuration (33%), and double vision (22-31%). Subjective visual loss was only experienced in the surgical group (50%). The time until diagnosis was 2 weeks in both groups. However, the conservative group presented to our institute significantly earlier (3 weeks), than the surgical group (8 weeks). The follow-up time was 25 months. RESULTS: In the conservative group papilla edema was 2D, visual acuity ≥0.7, and visual field loss was only mild. Time to cure was 3 months. In the surgical group both preoperative papilla edema (3D), and visual function were significantly worse. Indications for surgery were papilla edema, deteriorating visual function or relapse resistant to conservative treatment. Papilla edema disappeared 3 months after surgery, and visual field deficit improved significantly. We detected significant improvement in all aspects of visual function even at first neuro-ophthalmic control 4 days after surgery. However, visual acuity only improved in cases of preoperative acuity ≥0.3. Shunt revision occurred in 17%, and shunt infection in 8.5%. One patient suffered from persistent visual deterioration after surgery, and asymptomatic complication (epidural hematoma) was found in another patient. There was no surgical mortality. CONCLUSION: This is a curable condition with early diagnosis and adequate treatment, and persistent visual loss can be prevented. Surgery is effective and safe, close neuro-ophthalmic monitoring is mandatory for its optimal timing. Visual function of all patients can be preserved when operated on in time, whereas severe visual loss appears to be irreversible despite surgery.

[Clinical presentation, differential diagnosis and treatment of lacrimal gland tumours]. / A könnymirigydaganatok klinikai tünetei, diagnosztikája és kezelése.

PURPOSE: We describe the tumours occurring in the lacrimal gland fossa region, the important symptoms and the principles of the therapy. METHODS: We surveyed the patients observed and operated at the National Institute of Neurosurgery, Budapest, Hungary. RESULTS: Space-occupying lesions of lacrimal gland fossa are: 1. Epithelial lacrimal gland tumours, which may be benign or malignant (benign pleomorphic adenoma, malignant pleomorphic adenocarcinoma, adenoid cystic carcinoma, other carcinomas). 2. Lymphoproliferative tumours (lymphoma, leukaemia, Hodgkin's disease, lymphosarcoma, plasmocytoma). 3. Pseudotumours (chronic inflammation, granuloma, sarcoidosis, reactive lymphoid hyperplasia). 4. Other tumours (dermoid cyst, haemangioma, neurinoma, haemangiopericytoma, metastatic tumour). In our Institute, 42% of the tumours of the lacrimal fossa was epithelial, 50% was lymphoid or pseudotumour, and 8% other tumours. Of the 59 primary epithelial tumours 62.7% was benign and 37.3% was malignant. The differential diagnosis and management are based on the clinical presentations, imaging studies and histological examination. CONCLUSIONS: Pleomorphic adenomas of the lacrimal gland should be diagnosed on radiological and clinical evidence, and biopsy avoided to prevent the recurrences and malignant transformation. The prognosis of pleomorphic adenomas depends on the early diagnosis and radical surgical excision of the lesion. In cases of suspected malignant epithelial tumours, lymphomas and pseudotumours, biopsy is indicated for the choice of appropriate treatment.