Effect of long-term treatment with somatostatin analogue (SMS 201-995) on pituitary tumor shrinkage in acromegaly--report of two cases.

The effect of long-term somatostatin analogue (SMS 201-995) treatment in two acromegalic patients is reported. Continuous tumor shrinkage was observed even after 129 and 139 weeks of treatment with 600 micrograms of SMS 201-995 daily. A huge and firm adenoma underwent shrinkage during treatment with SMS 201-995. No serious side effect appeared during 160 weeks of treatment. SMS 201-995 has a longterm tumor shrinkage effect and improves endocrinopathies.

[Contribution of computerized tomography to the diagnosis and postoperative study of sellar tumors]. / Contribuição da tomografia computadorizada no diagnóstico e no estudo pós-operatório dos tumores selares.

The computerized tomography (C.T.) of 18 patients with sellar tumours were analysed. The C.T. made before surgery in 6 cases was positive in 3 and the type of tumour suggested by C.T. was confirmed in 3. Twelve patients had a C.T. investigation after surgery and the examination suggest recurrent tumour in 5. Two of these were re-operated. One patients with cholesteatoma had the recurrent tumour verified by surgery and the other, with a pituitary adenoma during re-operation was noted only cicatricial tissue at sellar region.

Classification of tumours in the sellar region using CT and encephalotomography.

Tumours in the sellar region may still present diagnostic problems. We therefore compared encephalotomographic and CT findings in sellar tumours and 91 patients were examined by both methods. For clinical purposes and operative treatment the degree of compression of the hypothalamus is of great importance. Encephalotomographic and CT findings are analysed and demonstrated. In cases of density differences between tumour and brain tissue shown by contrast enhancement, more information on the inner structure of a tumour (cystic or solid) can be obtained by computerized tomography. But if these are no density differences or/and contrast enhancement, tumour diagnosis is made easier by encephalotomography because of the great efficiency of this method.

[Encephalotomography and computer tomography for abnormalities of the sella (author's transl)]. / Enzephalotomographie und computertomographische Untersuchungen bei Sellaprozessen.

Seventy-four patients with tumors in the sellar region were examined by means of encephalotomography and axial computerised tomography. In nearly all cases, the localisation and expansion of tumors could be exactly determined by encephalotomography. In addition, a graduation according to the degree of hypothalamic compression was possible. In cases of density differences between tumor and brain tissue and contrast enhancement more information of the inner structure of a tumor (cystic or solid) could be obtained by computerised tomography. But in cases of missing density differences or/and contrast enhancement tumor diagnosis is easier by encephalotomography because of the high efficiency of encephalotomography. The indication for the form of operative treatment, transsphenoidal or transcranial, depends on the exact knowledge of tumor growth, especially of the degree of hypothalamic compression. Therefore, in all uncertain computerised diagnosis encephalotomography has to be undertained.

Computed tomography of intra- and juxtasellar lesions. A radiological study of 108 cases.

During the first two years with the 160 X 160 matrix EMI scanner at Rigshospitalet, Copenhagen 108 consecutive patients referred with the suspicion of intra- or juxtasellar tumor were subjected to 166 computed tomography (CT) examinations. The X-ray attenuation and contrast enhancement patterns of the various lesions were analyzed. In general, it was difficult to correlate these parameters with the histopathological features. Arachnoid cysts, however, had typical low preinjection attenuation and no contrast enhancement. Chromophobe and eosinophilic pituitary adenomas rarely contained calcium and only in minute amounts, hardly visible on the polaroid pictures. Craniopharyngiomas and low grade suprasellar gliomas frequently contained large calcifications. Grade I gliomas, when located in the optic nerves or hypothalamus, showed significantly higher contrast enhancement than elsewhere in the brain. Three purely intrasellar adenomas were demonstrated with CT only. The diagnostic accuracy of CT was compared to that of carotid angiography, PEG and plain skull films in the lesions verified by initial operation (n = 32). CT gave the highest accuracy of the four methods, but the accuracy of CT differed statistically only from that of carotid angiography.

Optochiasmatic syndrome from adhesive arachnoiditis with coexisting hypophyseal adenoma: case report.

Adhesive arachnoiditis is an occasional finding during neurosurgical operations for pituitary adenoma, previously treated by radiation therapy. A case where an arachnoidal process was found in combination with an eosinophilic pituitary adenoma, which had never been treated by irradiation, is reported. A 44-year-old woman at the time of surgery with scarce endocrinologic symptoms had suffered visual loss from 2 episodes, 18 years apart. Analysis of her symptoms, neuro-ophthalmologic findings and neurodadiologic features suggest that her visual damage was due to an optochiasmatic arachnoiditis, rather than to the tumor itself.

[Chiasmatic syndromes-diagnostic possibilities with computerized tomography (CT)]. / Chiasmasyndrome-computertomographische Diagnostik

The normal suprasellar subarachnoid space (so-called "suprasellar hexagon") and its content are fairly well demonstrated by CT. Abnormal appearance (obstruction, stenosis, asymmetry) of this space is always suspect of a suprasellar space occupying lesion. Enhancing (intravenous application of iodine containing contrast medium) helps to delineate the exact tumor extension. The point of origin--important for deciding on the nature of a lesion--is often difficult to determine. The CT-pattern itself is not specific for a certain kind of tumor. We have observed a typical chiasmatic syndrome with all meningiomas of the tuberculum sellae, with 75% of the chromophobe adenomas and with 50% of the craniopharyngiomas. Absence of this syndrome was due to high position of the tumor (craniopharyngiomas) or to parasellar extension of the lesion (chromophobe adenomas). Diagnosis of recurrent tumor is difficult; it must be based on the post-operative CT-examination. Chiasmatic syndromes not due to the pressure effect of a space occupying lesion (i.e. chiasmatic syndromes of vascular, toxic or degenerative origin) can not be assessed directly by CT.

[Postoperative radiological control in space occupying lesions of the sellar region (author's transl)]. / Postoperative Röntgenkontrolle bei raumfordernden Prozessen der Sellaregion

Different methods of postoperative radiological examination of space occupying lesions of the sellar region are discussed with regard to early diagnosis of recurrences. The important role of regular controls by lateral radiographs of the skull is stressed in this follow up survey of 164 cases over a period of 23 years. Comparisons of radiographs over a period showed in 80% of our cases whether there was a tumour recurrence or not. Radiological changes in the area of the sella can be demonstrated more clearly by the use of magnified lateral radiographs and a centimetre rule. With regard to frequency and time of recurrence, 40% of first recurrences were found after 5 years, so periodic radiographic follow up X-ray examinations should be carried out six monthly intially, and later at twelve month intervals. Examples are demonstrated. Intraoperative marking of the diaphragm and dorsum sellae with gold foil for later control radiography is evaluated. Today, space occupying lesions, including intrasellar pituitary tumours, can be clearly demonstrated with the CT scan after i.v. injection of contrast medium to intensity the shadow of the tumour tissue.

[Microadenomas and hypersecreting pituitary adenomas]. / Microadenomas e adenomas hipersecretantes da hipofise

The early radiographic changes of the sella turcica in the cases of hypersecreting pituitary adenomas (Cushing disease, acromegaly, amenorrhea-galactorrhea) are reported and discussed. The finding of the double contour of the sellar floor and the small crescentic bulging of its antero-inferior wall, with the aid of the tomographic cuts of the sella, has permited the diagnosis of the microadenoma'a localization. With this it si possible the achievement of a selective excision of the lesion in the initial stage, when the tumor has not caused yet irreversible damage to the inside normal pituitary tissue. This surgery is performed in the precocious stage with the primary goal to preserve the normal gland, without hurt it to avoid postoperative hipopituitarism. A anatomo-radiologic classification of the alterations sella turcica in 4 grades is made, which is of great utility for the surgical prognostic, since we have observed clinical and biological cure over 90% in the grade 1, 75% in the grade 2, 50% in the grade 3 and up to 10% in the grade 4 in the first surgery.