No abstract
ALTHOUGH the manifestations of destruction of various regions of the hypothalamus have been extensively studied in experimental animals, the opportunity for careful study of such lesions in humans is rare.The following is a case of a child with a suprasellar craniopharyngioma in whom the total removal of the tumor was accomplished without directly injuring the pituitary gland but with considerable damage to the hypothalamus. She was subsequently followed for a period of six years, and her eventual death permitted confirmation of the type and extent of the lesion. Report of a CaseA 5-year-old white girl was initially admitted to UCLA Hospital in October 1958. Her growth and development had been normal, and she was in excellent health until six weeks prior to admission when she began to complain of occasional headaches. During the ten days immediiately prior to admission the headaches became progressively more severe, and she became more and more listless and began to vomit. At physical examination she was a normal sized and normally proportioned child who was fully responsive but listless. She had bilateral hemorrhagic papilledema. Visual acuity was only slightly diminished and visual field testing revealed an enlarged blind spot but no field defects. Roentgenograms of the skull showed widened sutures and a suprasellar calcification. A ventriculogram verified the presence of a large suprasellar mass (Fig 1). A craniotomy was performed on Oct 21, 1958 and a large cyst was encountered lying above and behind the optic chiasm. This cyst was aspirated of 15 ml of fluid, and, as it was emptied, the inferior wall of the cyst was observed to retract back¬ wards toward the hypothalamus. Following this procedure, the patient was asymptomatic for 15 months.Fifteen months after her initial operation she again began to suffer headaches intermittently, and three months later the headaches became persistent and progressive visual loss followed. She was admitted to the hospital on May 4, 1960, 18 months after her initial operation. She was lethargic but responsive. She had bilateral¬ ly decreased visual acuity and a left homonymous hemianopsia. A craniotomy was per¬ formed the day of admission, and a cystic craniopharyngioma was totally removed. This removal was accomplished by approaching the tumor retrochiasmally, staying in the midline and carefully separating the tumor capsule from the inferior surface of the optic chiasm, the optic tracts, and the portion of the third ventricle that had been stretched and distorted by the mass as it pressed upward from below and behind the chiasm. Her immediate postop¬ erative course was stormy. She was semicoma¬ tose for four weeks and, at times, had the appearance of an akinetic mute. She manifest¬ ed early diabetes insipidus, and maintenance of
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