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Marvin Posner and Gilbert Horrax

5 have pointed out, subtemporal decompression followed by radiation therapy offers a comparatively safe method of treatment which has proved highly satisfactory in several cases. For this reason it is highly important to obtain all available evidence bearing upon the diagnosis of a growth in the pineal region. The oculomotor and pupillary disturbances furnish considerable information along these lines. Before taking up in detail the various ocular disorders that may occur with pineal tumors, it may be well to note briefly certain general features shown by

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Franc D. Ingraham and Orville T. Bailey

small area of calcification in the pineal region slightly to the right of the midline. Under avertin-ether anesthesia exploration was attempted but there was a marked fall in blood pressure before the scalp incision had been completed. He was very soon in a state of severe shock, operation was interrupted and the blood pressure was restored to normal levels only after the most heroic measures including the intravenous administration of large amounts of eschatin. At a later date he was given eschatin preoperatively as well as throughout the procedure and it was

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Gilbert Horrax and J. P. Wyatt

O ur interest in the so-called ectopic pinealomas was stimulated some ten years ago by the autopsy findings in Case 1 of the present report. This patient was a young boy twelve years of age, whose outstanding symptoms were polydipsia and polyuria. X-rays of his skull, however, showed a large calcification in the pineal region associated with a pineal tumor. Death followed an exploration of the pineal region, and the pathologic examination carried out by Dr. Louise Eisenhardt disclosed the cause of the boy's diabetes insipidus. It was due to an extension of the

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Arthur Ward and R. Glen Spurling

of radical surgical removal and the excellent results obtained by this type of conservative treatment in the group of radiosensitive lesions. Because of his 100 per cent case mortality in cases of pineal tumor, Cushing 2 in 1929 began treating such cases in this same conservative way. He said: It has been our custom, when a tumour of the pineal region was suspected or has been demonstrated by ventriculography, to make a generous sub temporal decompression, should loss of vision be feared, in the hope of temporarily relieving the tension while the tumour is

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Arne Torkildsen

T umors in the pineal region as well as neoplasms in or near the 3rd ventricle are characterized by signs of intracranial hypertension at an early stage of the disease due to the obstruction of the circulation of the cerebrospinal fluid. Neurological signs due to the local pressure of the tumor in many cases occur late or not at all. Most of the symptoms are of hydrodynamic genesis. Until recently our knowledge concerning tumors in the pineal region and neoplasms in or near the 3rd ventricle has been based predominantly on autopsy findings. The development

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Charles E. Troland and Carroll A. Brown

P recocious puberty of intracranial origin has been the subject of exhaustive inquiry and numerous theories as to its causative mechanism have been advanced. The pineal region has been most frequently indicted in consideration of the production of this syndrome. Interest in this subject in the present instance was stimulated by a case of undoubted somatic and sexual precocity in which the lesion surgically exposed was an ectopic pineal tumor of the chiasmal region. The pertinent literature on ectopic pineal tumors and also that concerning precocity of

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Metastatic Pineal Tumors

A Clinicopathologic Report of Two Cases

Victor N. Tompkins, Webb Haymaker and Eldridge H. Campbell

Metastasis to the lung from pineal tumor is known to be exceedingly rare. However, among 13 fatal cases of pineal tumor which reached the Army Institute of Pathology during World War II there were 2 in which metastasis to the lung had occurred. Only 1 such case has been previously reported—that of Stowell, Sachs and Russell. 25 Their patient, a boy of 15, had been ill for 3 weeks before entering hospital. At operation a large tumor, diagnosed as a primary intracranial chorionepithelioma, was removed from the pineal region. Death occurred approximately 3 months

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Lennart Herlin

yrs. Diplopia, headaches, dizziness, unsteady gait, disorientation, nystagmus. Poor condition. Vision not tested. Choked discs: R & L 4–5D. Central & subfrontal lesion. June 1948: Bilateral VC. Fever, disorientation, stiff neck. Died after 13 days. No passage between lat. vents. but dye to lumbar sac. − Glioma. 18. P.E.A. M, 15 3 mos. Headaches, vomiting, diplopia, dizziness, failing vision. Poor condition. Vision not tested. Choked discs: R 7, L 11–12D. Lesion in pineal region. July 1948: VC. High intracran. press. Died after

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L. H. Arnstein, Edwin Boldrey and Howard C. Naffziger

region Rapid + head size. 8. Gross 10 2 mos. Pinealoblastoma Pineal region Sudden + head size. Choroid plexicotomy. 9. Russell and Ellis 18 Birth Atypical polar spongioblastoma Lt. cerebral hemisphere Hydrocephalic. Stillbirth. 10. Cushing 8 2 mos. Teratoma Between lat. hemispheres Rapid + head size. Calc. in x-ray. 11. Baxter 3 Birth Teratoma Undetermined Caused dystocia. Head opened to permit birth. 12. Canavan and Hemsath 6 Birth Ependymoma 4th ventricle Incidental finding. 13. Alpers 2

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Robert W. Rand and Lloyd J. Lemmen

fibers concerned with upward conjugate deviation of the eyes terminate in the rostromedial portion of the superior colliculus and those mediating downward conjugate deviation terminate in its caudolateral portion. Tumors in the pineal region may cause loss of automatic upward deviation of the eyes (Parinaud's syndrome), by pressure upon or invasion of the rostral portions of the superior colliculi or interruption of fibers of the internal corticotectal tracts which terminate in the same region ( Fig. 1 ). Pressure upon or invasion of the caudolateral portion of the