Six cases of symptomatic parasellar granular cell tumor (pituicytoma, myoblastoma, choristoma) are reported. The clinical presentations included visual loss, dementia, and adenohypophyseal insufficiency. Lack of calcification and a suprasellar blush on angiography often help to differentiate these lesions from craniopharyngioma, pituitary adenoma, and optic glioma. These are the first cases studied by computed tomographic scan, which shows a high density, sharply demarcated lesion in the suprasellar region with dense, frequently homogeneous contrast enhancement. At operation these are characteristically tough, nonsuckable, vascular tumors. All previously reported patients with long survival (seven cases) have been contacted recently. The data do not support a role for postoperative radiation therapy. The surgical goal should be limited to decompression of the suprasellar if total excision seems too hazardous.
A case of saccular aneurysm associated with a fenestrated proximal basilar artery is presented. The aneurysm projected anteriorly, superiorly, and slightly to the left. Via a right suboccipital approach, the aneurysm was clipped with preservation of all vessels. The only postoperative deficit is a resolving dysphonia.
Meningiomas have been reported to have associated areas of surrounding low density on computerized tomography (CT). These low-density areas may represent edema, widened subarachnoid spaces, loculated cerebrospinal fluid, demyelination, or adjacent tumor. Two cases are presented in which this adjacent area of low density represented a tumor cyst. Recognition is important as the CT appearance of these lesions may simulate a metastatic tumor.
A case of intracranial saccular aneurysm occurring in early childhood and presenting with sudden dysphasia and hemiplegia is reported. A review of the literature emphasizes the rarity of this lesion. Despite a significant preoperative neurological deficit, the patient tolerated aneurysm clipping and recovered well. The majority of reported cases involve males under 2 years old. Aneurysms in infants have a distribution different from that seen in adults. Microscopic examination of these lesions fails to show any evidence of inflammation or atherosclerosis. The data suggest that the pathogenesis of these rare childhool lesions differs from that of adult saccular aneurysms.
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