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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From may 1986 to July 1988 ten patients have been treated by interstitial implantation of radioactive isotopes using Yttrium 90 colloidal solution (9 cases) and Aurum 198 grains (1 case). There were 7 cystic out of 8 craniopharyngiomas, one malignant pituitary adenoma and one hemispheric Astrocytoma grade III-IV. In all but one patient the tumors were recurrent after one or more reductive or palliative operations. To external radiation undervent preoperatively two cases (one craniopharyngioma and one pituitary adenoma). Target volume was established by CT data and X-ray studies after stereotaxic injection of contrast medium (one case). Doses for intracystic irradiation were calculated using the Backlund's formula. The lowest activity was calculated to be 3.84 mCi, and the highest 12.9 mCi (m 6.8 mCi or 252 MBq). The delivered activity was 100-200 Gy of Y90 (m 140 Gy). The activity of Au198 was determined using the producers dosimetric tables. The radionuclide implantation was performed by stereotaxic techniques with Leksell's system in 5 patients. In 5 patients the surgical procedures were open: 3 osteoplastic supratentorial and 2 craniectomies for direct instillation of Y90 into the craniopharyngiomatous cavities spread to posterior fossa. Early short lasting side effects of endocavitary irradiation were observed in 5 patients (headache and somnolence; adynamy, pseudobulbar symptoms and rigor; insomnia and agressiveness; lack of orientation and increased mental irritability). The longest follow up was 26 months. The clinical response to intracystic instillation of Y90 was very favorable in 8 cases: 7 craniopharyngiomas and one pituitary adenoma. A satisfactory anatomical result with diminution or retraction of cystic cavities was evident in all cases. The more pronounced achievement of intracystic irradiation therapy in our series were the effects on stabilization or recuperation of vision and on improvement of visual field finding. The recovery of endocrine insufficiency was also noted. Two patients died: the 3-year old child, one year after implantation of Au198 grains in a huge calcified craniopharyngioma, and a woman, 67 old, twelve days after Y90 instillation to a hemispheric glioma grade III-IV.
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PMID:[Implantation of radioactive isotopes in intracranial tumors]. 248 66

A case of malignant astrocytoma following radiotherapy for pituitary adenoma is presented in detail with a review of the literature. A 38 year-old housewife had developed a growth-hormone secreting pituitary adenoma, and received a total of 50 Gy at the pituitary region. Four years and six months later, she began suffering headache and vomiting. Computed tomography showed an extensive low density with ring enhancement in the right temporal region, corresponding to the previously irradiated field. A right frontotemporoparietal craniotomy was carried out, and a soft and reddish tumor was partially removed. The histological diagnosis was that of malignant astrocytoma. The patient was submitted to postoperative radiochemotherapy, receiving a total of 60 Gy, nimustine hydrochloride (ACNU), and tegafur (FT). Subsequently, after three months of clinical relief, she developed tumor regrowth, and died four months later. The present case fulfills the criteria for radiation-induced tumor established by Cahan et al.: A tumor location within irradiated area, no evidence of tumor prior to radiotherapy, a long latency period between radiation and tumor occurrence, and histological verification of the tumor. Thirty-nine cases of radiation-induced gliomas including the present case have been reported in the literature. It is noteworthy that the majority occur in the younger age bracket. Male preponderance is noted as it is in primary cerebral gliomas. The primary lesions for radiation frequently include leukemia and lymphoma. Craniopharyngioma, pituitary adenoma, and medulloblastoma etc are also included.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Malignant astrocytoma following radiotherapy in pituitary adenoma: case report]. 268 39

Brain tumors remain the second most common neoplasm of childhood, however, there is no adequate study of this disease in Thai children. From the year 1971 to 1987, 468 children under 15 years of age were admitted to the Department of Pediatrics, Ramathibodi hospital with the diagnosis of brain tumor. Four hundred and forty-four patients had primary intracranial tumors, of these, 17 were excluded due to inadequate information and the remaining 427 patients were studied. Male to female ratio was 1.3:1, the age ranged from one day old to 14 years old. The duration of illness before admission ranged from a few days to 4 years, with over 70 per cent within 3 months. Headache, vomiting and papilledema were the three most common symptoms and signs. Supratentorial and infratentoral tumors were seen in 209 and 216 patients respectively, craniopharyngioma was the most common supratentorial tumor (51/209) and medulloblastoma was the most common infratentorial tumor (95/216), however, malignant astrocytoma is the overall most common tumor type. Early diagnosis and treatment were needed for good outcome.
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PMID:Brain tumors in children at Ramathibodi Hospital. 273 28

A rare case of craniopharyngioma wholly located within the third ventricle is reported. A 55-year-old female was admitted to our hospital with the complaints of headache and fever of unknown origin. Neurological findings were normal. Computed tomography (CT) scan showed homogeneously enhanced mass lesion within the third ventricle. Axial and coronal CT scans disclosed an intact suprasellar cistern. The tumor was completely removed using an interhemispheric trans-lamina terminalis approach. Histological diagnosis was squamous cell type of craniopharyngioma. Post-operative diabetes insipidus was well controlled, and irradiation of 50 Gy was performed. Craniopharyngioma located entirely in the third ventricle was reviewed, and etiology, clinical feature and treatment were discussed.
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PMID:[Craniopharyngioma in the third ventricle]. 322 91

The authors report a rare case of a 10-year-old girl with craniopharyngioma which showed malignant change after the first operation and irradiation. In June 1981, the patient complained of headache, nausea and vomiting. CT revealed obstructive hydrocephalus due to the calcified mass lesion which extended to the third ventricle. In order to alleviate the high intracranial pressure, the right ventriculo-peritoneal shunt was first settled and after that, partial removal of the tumor was performed. The pathological diagnosis of the specimen was typical adamantinomatous type of craniopharyngioma without any findings of malignancy. After this operation irradiation was performed. The tumor almost disappeared and the patient was discharged from the hospital and went to school, showing some signs of panhypopituitarism. In May 1984, she complained of decreased left visual acuity, right temporal anopsia, headache, nausea and vomiting. CT revealed recurrence of the tumor which obstract the foramen of Monro bilaterally. As an emergency measure, the left ventriculo-peritoneal shunt was added and the state of the patient became recovered. In order to improve decreased visual acuity, the tumor located around the optic nerves and over the frontal base was removed in June 1984, resulting in partial improvement of visual acuity bilaterally. The pathological examination of the second specimen showed, in addition to the part of adamantinomatous type of craniopharyngioma which was the same as before, the existence of thick layer of stratified large atypical cells which partially covered the cyst wall and partially invaded into the surrounding tissues. The pathological diagnosis was poorly differentiated squamous cell carcinoma with craniopharyngioma of 'adamantinoma' type.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Malignant changes in a craniopharyngioma]. 343 51

Twenty-nine adults operated on for craniopharyngioma between 1970 and 1981 are described. Headache and/or endocrine symptoms often preceded the diagnosis by several years. There were 3 surgical deaths. One patient died accidentally 4 years after surgery. The 5-year survival was 5/5 after total removal, 10/11 after partial removal, 0/3 after palliative surgery; 1/1 after total removal and radiotherapy, 0/2 after partial removal and radiotherapy and 3/3 after palliative surgery and radiotherapy. Visual acuity improved in 9 of 23 patients and deteriorated in 1 patient. Visual fields improved in 8 of 21 patients and deteriorated in 7. Surgery increased the degree of hypopituitarism. Relative body weight increased greater than or equal to 10% by 3 months after surgery in 8 of 15 patients. The prognosis would probably be improved by earlier diagnosis.
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PMID:Craniopharyngioma in adults. 344

A series of 74 patients with craniopharyngiomas were treated during a 15-year period. Of the 74 patients, 40 were males and 34 were females, with a mean age of 27 years (range 3 to 65 years). Twenty-eight patients (38%) were less than 18 years of age. Remission was defined as clinical improvement with stable ophthalmological and neurological status, radiological evidence of a decrease in tumor size, and either a continued decrease or a stable tumor size on follow-up radiological evaluations. A fair result was considered remission with new neurological deficits related to surgical intervention. All other results were considered a failure. The mean follow-up period in this study was 4 years, with 100% of the patients monitored. In children, the most common presentation was that of growth failure (93%). In adults, sexual dysfunction was the most common presentation, with 88% of males presenting with impotence or marked decrease in sexual drive, and 82% of females presenting with primary or secondary amenorrhea, often associated with galactorrhea. Considering the pediatric and adult populations together, the most common presenting symptom was visual dysfunction, with 71% of patients presenting in this manner. Fifty percent of patients presented with severe headache. The most frequent preoperative finding was a visual field defect, with 72% of patients so affected; 42% of patients had preoperative hypothyroidism and 24% had hypoadrenalism. Diabetes insipidus was present preoperatively in 23%. Hydrocephalus was uncommon, being present in only 15%. A subfrontal craniotomy was used in 47% of patients, a transsphenoidal approach in 39%, a subtemporal approach in 11%, a transcallosal approach in 5%, and a suboccipital craniectomy in 2%. Multiple procedures were required in 15% of patients in order to provide significant relief of compressive symptomatology. The results of therapy indicate that total tumor removal was deemed to have been achieved in only seven patients, six of whom have had no recurrence. However, 91% of patients are in remission, one had a fair result, and two died as a direct result of surgical intervention. One patient died from uncontrolled disease, and three patients died from unrelated causes. The results of this study indicate that radical subtotal removal followed by radiotherapy is an acceptable treatment for craniopharyngioma.
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PMID:Surgical management of craniopharyngiomas. A review of 74 cases. 371 25

Two cases of pituitary abscesses are reported. The first case was a 22-year-old female who was admitted with 14 months history of intermittent fever and headache followed by amenorrhea and polyuria. Plain craniograms showed no remarkable changes on the sella turcica. Direct coronal CT demonstrated a cystic lesion with a ring-like enhanced capsule in the pituitary complex with the apparent bulging of the pituitary top surface. On dynamic CT, the cystic lesion showed no remarkable increase in density. Transsphenoidal surgery was performed and a purulent materials was drained by cutting the underlying fibrous pituitary tissue. Pathological specimen revealed a marked inflammatory reaction around the degenerative pituitary gland. The second case was a 27-year-old female who underwent transsphenoidal excision of craniopharyngioma on May 12, 1983. Postoperatively she did well with the hormonal replacement therapy until 9 months after surgery when a follow up direct coronal CT revealed a cystic lesion with ring-like enhancement in the pituitary fossa. Purulent material was found at transsphenoidal surgery. Pathological specimen from the hard capsule was a chronic inflammatory fibrous tissue without tumorous component. Over seventy cases of pituitary abscesses have been reported previously, but the majority of them were secondary infections associated with systemic sepsis, chronic sphenoid sinusitis or pituitary tumors. Primary pituitary abscesses were rare and would be difficult to be diagnosed preoperatively without an aid of recent CT technology. Thirty cases in the literature since 1970 are reviewed and its clinical pictures and radiological findings are discussed.
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PMID:[Pituitary abscess: report of two cases and a review]. 380

This physician had a craniopharyngioma which was treated by radiation therapy in 1938, with relief of headaches and return to professional activity. Later, penetration of the tumor through the sphenoid sinus into the nasopharynx resulted in the intermittent drainage over 30 years of cystic parts of the tumor into the nasopharynx and from there to the oropharynx without any meningeal rupture. Radiation therapy was the initial mode of treatment, later combined with steroid and thyroid replacement therapy. A professional career was possible in spite of the patient's health problems.
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PMID:Craniopharyngioma with erosion and drainage into the nasopharynx. An autobiographical case report. 396 44

A 10-year-old boy had a 4-month history of blurred vision and severe occipital headaches. Visual acuity was diminished bilaterally, but ophthalmoscopy was normal, and the correct diagnosis was delayed until inferior bitemporal defects were found. Cranial CT scans and vertebral angiograms demonstrated a giant aneurysm at the bifurcation of the basilar artery. Bitemporal hemianopsia occurring in children is usually due to craniopharyngioma or chiasmal glioma. To the best of our knowledge, this is the first report of a patient whose chiasmal syndrome was due to a basilar artery aneurysm and whose visual deficit improved after occlusion of the aneurysm.
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PMID:Bitemporal hemianopsia in basilar artery aneurysm. 621 52


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