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Query: UMLS:C0027651 (tumor)
 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report the case of a 49-year-old man with synchronous drop metastases from a multiply recurrent somatotroph pituitary adenoma. The metastatic lesions were found in the subarachnoid space of the cauda equina and foramen magnum 18 years after the initial diagnosis of the disease. Five transsphenoidal resections had previously failed to cure the sellar tumor. Two of these, performed 4 and 5 years before the patient's current presentation, had been complicated by cerebrospinal fluid rhinorrhea that necessitated lumbar drainage. Resections of the two subarachnoid lesions, separated by 14 months, removed pathologically aggressive pituitary adenomas. There were no signs of local recurrence or subarachnoid dissemination of disease during the postoperative follow-up periods, which lasted 18 and 4 months, respectively. Previous cases of subarachnoid spread of a pituitary adenoma have been associated with multiple intracranial metastases, multiple intraspinal metastases, or widely disseminated disease. This case demonstrates that subarachnoid metastasis of a pituitary adenoma, particularly when it follows multiple operations, is not invariably widely disseminated or associated with a very poor prognosis.
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PMID:Synchronous subarachnoid drop metastases from a pituitary adenoma with multiple recurrences. Case report. 1274 76

The technical approach for anterior skull base tumors has progressed considerably during the last decade. In the classical combined craniofacial resection (CFR) technique, anterior skull base lesions have been approached through bi-frontal craniotomy coupled with Weber-Ferguson and related modifications incisions. The purpose of this work is to present our experience with the subcranial approach for treatment of anterior skull base tumors. During the years 1994-2002, 64 patients underwent 72 procedures of anterior skull base tumor resection via the subcranial approach. The ages of the patients ranged from 2 to 81 years (mean 42 years). Twenty-nine cases involved malignant tumors (40%), and 43 cases involved benign tumors (60%). The most common benign pathology was meningioma (n = 12) and the most common malignant tumor was squamous cell carcinoma (n = 8). The principle skull base reconstruction procedure was performed using a multi-layered fascia: limited defects of the dura were reconstructed with the use of temporalis fascia, whereas reconstruction of large dural defects was performed using a multi-layered fascia lata sheath. Reconstruction of significant bony defects was achieved by utilizing a split calvarial bone graft, posterior sinus wall, or titanium mash covered with pericranial flap. Postoperative follow-up (26 months in average) revealed that 76% of the patients are without evidence of disease, 14% are alive with disease, 3% died of their diseases and 7% died of unrelated causes. Twenty-seven patients (44%) have suffered from anosmia following the operation. The rate of severe complications was 5.6%, and included meningitis (n = 2), cerebrospinal fluid rhinorrhea (n = 1) and tension pneumocephalus (n = 1). We conclude that the extirpation of anterior skull base tumors via the subcranial approach is simple, reproducible and reliable, and is associated with reasonable complication rates.
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PMID:[The subcranial approach for tumors involving the anterior skull base]. 1285 24

Cephalocele is a rare lesion mainly of congenital or traumatic origin. The lesion occurs as an extracranial hernia of dura mater that consists of cerebrospinal fluid only (meningocele) or cerebellar tissue (encephalocele). Some cephaloceles concern anterior cranial fossa and then are observed as hernias in nasal cavity or in paranasal sinuses. Three patients are presented. In 52 year woman, who was admitted due to idiopathic rhinorrhea (persisting 16 years) with periodical headache, the meningocele in right ethmoid sinus was diagnosed. The lesion was removed with the rhinosurgical approach and the defect in anterior cranial fossa was repaired with the free cartilaginous flap. 12 year boy was admitted due to the nasal tumor diagnosed by CT and MRI. The lesion was removed with the combined access: firstly the hernia sac was cut intracranially with the frontal craniotomy and then encephalocele was removed with lateral rhinotomy. Cranial fossa defect was repaired by the periosteum flap. In third case (8 year boy) encephalocele caused 5 incidences of purulent meningitis. CT and MRI showed the lesion in frontal sinus. Encephalocele was removed with rhinosurgical approach and the defect in posterior frontal wall was repaired with free cartilaginous and mucosal flaps. In all patients long term result of operations was good. Anatomic and pathologic conditions that influence on the choice of rhinosurgical or combined access to nasal and sinusal encephaloceles are presented and discussed.
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PMID:[Meningoencephalocele as rhinosurgical problem]. 1452 81

A 66-year-old man presented with a maxillary carcinoma manifesting as unrelenting spontaneous cerebrospinal fluid (CSF) rhinorrhea. Anterior craniofacial resection of the tumor was performed with multilayered repair of the dura mater. Maxillary carcinoma usually manifests as nasal blockage, epistaxis, or a mass lesion. This case highlights the necessity for a high index of suspicion for malignant tumor and the need for meticulous repair of the dura mater to seal off the CSF leakage.
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PMID:Spontaneous cerebrospinal fluid rhinorrhea as the primary manifestation of maxillary carcinoma--case report. 1509 68

A 69-year-old woman presented with a transethmoidal meningoencephalocele manifesting as gradually developing anosmia. Examinations revealed a mass in the nasal cavity associated with multiple angiomas in her lip and orbit. Neuroimaging showed meningoencephalocele extending via the ethmoid sinus to the nasal cavity. She had no history of craniofacial trauma and intranasal or intracranial operation, and no skull base tumor was detected. Frontal base reconstruction was performed with a two-layer vascularized flap to prevent cerebrospinal fluid leakage. The dural defect was repaired with the pericranial flap, and the bony defect of the cribriform plate was reconstructed using the reversed U-shaped split temporalis musculofascial flap. Transethmoidal meningoencephalocele is a rare congenital malformation and almost half of the cases are identified in the first year of life. We should be aware of this clinical pathology and avoid unexpected rhinorrhea in elderly patients. The most important aspect of the operation is watertight closure of the patent passage to the intracranial compartment. The reversed U-shaped split temporalis musculofascial flap is useful to reconstruct the midline frontal base defect.
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PMID:Transethmoidal meningoencephalocele in an elderly woman. Case report. 1597 68

We prospectively analyzed presentations and long-term therapeutic responses to bromocriptine (BRC) in 29 newly diagnosed men with macroprolactinomas including 14 patients with 'giant prolactinoma'. Clinical symptoms, prolactin (PRL) levels and tumor size on MRI were measured before BRC and sequentially thereafter. The duration of follow-up were 6 to 96 (30.7 +/- 14.4) months. Pretreatment PRL ranged between 124 and 29200 ng/mL (1698 +/- 857.1) and tumor volume was between 2.81 and 132 cm(3) (21.1 +/- 24.3). Baseline PRL levels did not correlated with tumor volume (r = 0.45, P > 0.05). Significant decrease (P = 0.0003) in PRL, at least 96% of the pretreatment value from 1698 +/- 857.1 ng/mL to 42.4 +/- 30.6 ng/mL occurred in 26 patients. Persistent normalization of PRL levels (< 16 ng/mL) for at least 6 months was achieved in 12 patients (40.8%). Twenty-two patients (74.8%) achieved significant tumor shrinkage (P = 0.005) at study completion. An improvement in visual field defects (VFD) and restoration of libido and potency was observed in 40% and 33.3%, respectively. Trans-sphenoidal / trans-frontal pituitary surgery was performed in 9 patients (31%) for various reasons: pituitary apoplexy in 1, CSF rhinorrhea in 2, increasing prolactin in spite of BRC therapy in 3, and intolerant /resistant to BRC in 3 patients. These data suggest that, in male macro- and giant prolactinomas, dopamine agonists represent the first-line therapy effective in reducing PRL, restoration of libido and potency, improvement of VFD and determining tumor shrinkage.
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PMID:Long-term efficacy of bromocriptine in macroprolactinomas and giant prolactinomas in men. 1637 32

A 40-year-old woman presented with a right petroclival meningioma compressing the brainstem and manifesting as a 6-month history of headache and gait difficulty. The patient underwent subtotal removal of the tumor via an anterior transpetrosal approach. The postoperative course was complicated by cerebrospinal fluid rhinorrhea, bacterial meningitis, and acute hemorrhagic rectal ulcer. The patient was discharged home in good condition after prolonged medical treatment. Four months after the surgery, the patient noted recurrence of gait difficulty. Magnetic resonance (MR) imaging of the brain showed enlargement of the ventricles and no residual brainstem compression. A ventriculoperitoneal shunt was placed, but the symptoms were unchanged. The shunt was removed 2 months later because of infection. The patient's gait gradually deteriorated, although repeat brain MR imaging showed no significant increase in ventricular size. Ten months after the initial surgery she became paraplegic. MR imaging of the thoracic spine revealed a large arachnoid cyst extending from C-6 to T-6. The patient underwent T2-4 laminectomy, partial removal of the cyst wall, and duraplasty, but no clinical improvement was observed. Preexisting long-tract signs and coincidental hydrocephalus confused the neurological findings and delayed detection of the spinal lesion in this case. Neurosurgeons should be alert to the possibilities of insidious spinal lesion if the patient has progressive neurological disorder which does not match the known cranial lesion.
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PMID:Spinal arachnoid cyst causing paraplegia following skull base surgery. 1679 54

For twelve years, the subject of this report, a 38-year-old man, presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome. He presented a stabbing and intense daily pain located in the left pre-auricular and temporal regions. Each of these intense pain attacks lasted around one minute and presented a frequency of two to eight times per day. The pain was associated with ipsilateral lacrimation, conjunctival injection and rhinorrhea. MRI revealed a pituitary tumor with little suprasellar extent. The subjects serial assays of prolactin, GH, TSH and ACTH were within normal levels. Following transsphenoidal hypophysectomy, with complete removal of the tumor, the subject no more presented pain. The pathological diagnosis was non-secreting adenoma. Fourteen months after the surgery, he remains symptom-free.
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PMID:SUNCT syndrome associated with pituitary tumor: case report. 1691 28

A consecutive series of 15 patients with trigeminal schwannomas treated surgically at the Centre Medico-Chirurgical Foch between 1979 and 1985 is reported. This report is limited to sphenocavernous (nine cases) and infratemporal (six cases) tumors. Initial clinical symptoms of these cases are detailed, including trigeminal and abducens nerve signs. Preoperative selective angiography and embolization are important adjuncts to surgical management. The surgical approach depends on the anatomic location of the tumor. Sphenocavernous neurinomas were removed through a pterionosubtemporal approach. Occasionally, infratemporal neurinomas were approached in two stages because of the need to reconstruct the skull base and prevent postoperative cerebrospinal fluid rhinorrhea. There were no operative deaths in the series and complete extirpation was achieved in all but one case.
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PMID:Sphenocavernous and infratemporal trigeminal neurinomas: surgical series of 15 cases. 1717 Aug 57

Although complications of transseptosphenoidal (TSS) pituitary surgery have been discussed in the literature, there has not been an analysis of complication rates related to clinical features and the nature of the tumor. A retrospective review of 366 TSS procedures (354 patients) for excision of pituitary adenomas evaluated the incidence and management of perioperative complications. The mortality rate was 0.82%. The most frequently encountered complications were transient diabetes insipidus (8.74%) and cerebrospinal fluid (CSF) rhinorrhea (4.10%). Other complications included exacerbation of visual acuity and visual field defects, hemorrhage, hydrocephalus, and meningitis. The factors evaluated were gender, age, tumor size, hormone secretory status, and any history of prior pituitary surgery.There was a significantly higher incidence of transient diabetes insipidus in patients with hormone-secreting tumors. Minor and total complication rates were significantly increased in microadenomas, hormone-secreting tumors, in female patients, and in patients less than 60 years of age reflecting the increased incidence of transient diabetes insipidus in young female patients with hormone-secreting tumors. Observed intraoperative CSF leaks predisposed to postoperative CSF rhinorrhea. There were no identifiable risk factors for major complications.
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PMID:Perioperative complications of transseptosphenoidal excision for pituitary adenomas. 1717 Oct 14


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