✓ A presumed developmental variant of the dorsum sellae was found in a patient undergoing evaluation for a suspected pituitary adenoma. An initial computerized tomography (CT) scan suggested a suprasellar mass; however, high-resolution CT with reformations clearly revealed the mass to be the pituitary gland, which was deformed and displaced upward by an osseous spine projecting from the dorsum sellae. The radiographic appearance and etiology of this anomaly are discussed. Neurosurgeons and neuroradiologists should be aware of this anomaly when evaluating a patient for pituitary adenoma.
David L. LaMasters, James E. Boggan and Charles B. Wilson
Neil A. Martin and Charles B. Wilson
✓ In a consecutive operative series of 115 intracranial arteriovenous malformations (AVM's), 16 occupied the medial occipital region. Typically, the patients with medial occipital AVM's presented with bleeding, often accompanied by homonymous visual field deficit, or with migrainous headache. The malformations were supplied principally by branches of the posterior cerebral artery. Through an occipital craniotomy, a surgical approach along the junction of the falx and tentorium provided access to the arteries feeding the AVM and facilitated excision of the malformation. There were no deaths in the series. The incidence of visual field deficit after the operation varied, but in only five cases was the visual field worsened postoperatively. All patients who had a history of intractable headache were cured or improved after surgery. These lesions are favorably situated for surgical treatment.
A review of 137 cases
David S. Baskin, James E. Boggan and Charles B. Wilson
✓ A series of 137 patients with growth hormone (GH)-secreting pituitary adenomas were treated by transsphenoidal surgery during a 10-year period. Group A comprised patients for whom this surgery was the first therapeutic intervention, and Group B included those who underwent the surgery after previous therapeutic intervention. The results were analyzed considering preoperative and postoperative endocrinological, neurological, ophthalmological, and neuroradiological data. Remission was defined as clinical response and a normal postoperative GH level, and partial remission as clinical response and postoperative reduction of the GH level by more than 50%. Any other result was considered failure. The mean follow-up period was 37.1 months; follow-up review was achieved in all the patients.
Among the 102 patients in Group A, remission was achieved in 80 (78%) patients with transsphenoidal surgery alone, and in an additional 16 (16%) after postoperative irradiation (combined response rate, 94%). All failures and patients with partial remission had preoperative GH levels of more than 50 ng/ml and suprasellar extension of the tumor. There were no deaths; 8% of patients had minor surgical morbidity; 5% had new hypopituitarism postoperatively. Of patients subsequently irradiated, 71% developed hypopituitarism.
Among the 35 patients in Group B, remission was achieved in 26 (74%), partial remission was obtained in two (6%), and seven (20%) were considered treatment failures. There were no deaths, and the morbidity rate was 14%; 66% of patients had hypopituitarism postoperatively. Of the eight patients who had received prior irradiation only, seven (88%) went into remission. All failures and partial responders had preoperative GH levels greater than 40 ng/ml; 56% had suprasellar extension. These results confirm the efficacy of the transsphenoidal approach for the treatment of GH-secreting pituitary adenomas.
Report of two cases
Jeannette J. Townsend, Uwamie Tomiyasu, Alexander MacKay and Charles B. Wilson
✓ Amyloidomas of the central nervous system are rare. Two cases involving middle-aged patients with neurological symptoms are presented. Massive focal accumulations of amyloid in the cerebral hemispheres were confirmed pathologically.
Report of four cases
Charles G. Maitland, Seisho Abiko, William F. Hoyt, Charles B. Wilson and Tomomi Okamura
✓ Four patients with chiasmal syndromes were found to have intrachiasmal hematomas. Computerized tomography scans showed high-density suprasellar masses in all cases. Cryptic vascular anomalies were presumed to be responsible for spontaneous bleeding into the chiasm in three of the cases. In the remaining case, hemorrhage was due to an occult optic glioma. Surgical evacuation of clotted blood resulted in improved visual function in three of the four cases.
David S. Baskin, Jeannette J. Townsend and Charles B. Wilson
✓ Diffuse lymphocytic infiltration of the adenohypophysis occurring in temporal relation to pregnancy was found in two patients, each of whom had an intasellar mass with suprasellar extension that caused compression of the optic chiasm. The pathology and etiology of this lesion is discussed. This entity should be considered when evaluating patients with a pituitary mass lesion that presents in temporal association to pregnancy, particularly if there is evidence of hypopituitarism rather than a hypersecreting, endocrineactive adenoma.
Isolated hypertrophic interstitial neuropathy of the trigeminal nerve associated with trigeminal neuralgia
Case report of an entity not previously described
David S. Baskin, Jeannette J. Townsend and Charles B. Wilson
✓ Hypertrophic interstitial neuropathy (HIN) of the trigeminal nerve was observed in a patient with trigeminal neuralgia who had no other neurological abnormalities. Pathological documentation confirmed focal HIN. No similar histologically documented case of isolated trigeminal nerve involvement by HIN has been reported previously.
Neil A. Martin, Martha Hales and Charles B. Wilson
✓ A 31-year-old woman developed a cerebellar metastasis from an invasive prolactin-secreting pituitary adenoma while undergoing treatment with bromocriptine. The metastatic tumor was totally excised. Metastatic spread of pituitary tumors within the central nervous system is reviewed briefly.
Stephen K. Powers and Charles B. Wilson
✓ The case of a patient with two separate prolactin-secreting pituitary adenomas is presented. The importance of thorough inspection of the pituitary gland at operation is emphasized.
Dorcas S. Fulton, Victor A. Levin, William M. Wara, Michael S. Edwards and Charles B. Wilson
✓ Forty-five children harboring brain-stem tumors were treated at the University of California, San Francisco, between 1969 and 1979. Pathological diagnoses were made in 19 patients. All patients received radiation therapy (RT). Thirteen patients received chemotherapy before, during, or immediately after RT. Twenty-four patients were treated with chemotherapy at the time of tumor progression, after initial treatment with RT alone. No statistically significant difference in time to tumor progression or survival was found for treatment with chemotherapy as an adjuvant to RT compared to treatment with RT alone followed by chemotherapy administered at the time of tumor progression. There were, however, more long-term survivors in the group that was first treated with chemotherapy at the time of tumor progression. There was no statistically significant correlation between survival and tumor pathology or location, although there were more long-term survivors among patients harboring low-grade gliomas and among patients with tumors confined to the midbrain. The authors documented the response of some brain-stem tumors to chemotherapy; however, cooperative controlled studies will be required to determine the optimum treatment for this disease.