Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM) operated by the endoscopic endonasal approach (EEA). Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

-Cerebellar glioblastoma multiforme (GBM) is a rare tumor. This is the third case published in Brazilian literature and, the last one has been described more than 15 years ago. The aggressive behavior of GBM prompts for fast treatment, which can be hampered by the fact that the diagnosis of GBM re q u i re s a high degree of suspicion. We describe a case of GBM in a 46 years old man. In conjunction, we pre s e n t a literature review including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options and the behavior of such malignant tumor.KEY WORDS: high grade astrocytoma, cerebellar glioblastoma multiforme, posterior fossa glioma.Glioblastoma multiforme cerebelar primário em um adulto RESUMO -Glioblastoma multiforme (GBM) c e rebelar é um tumor raro. Apresentamos o terc e i ro caso re v i s ado em literatura neurológica brasileira, sendo o último descrito há mais de 15 anos. Devido a sua agre ssividade, o tratamento deve ser instituído rapidamente, porém certa indefinição quanto à conduta pode o c o rre r, pois o diagnóstico de GBM pode não ser lembrado. Apresentamos um caso de GBM c e rebelar em um homem de 46 anos. Também fazemos uma revisão a respeito de seu comportamento, quadro clínico e avanços quanto à investigação por imagem, aspectos histopatológicos, formas de tratamento e suas características peculiares.PA L AV R A S -C H AVE:a s t rocitoma de alto grau, glioblastoma multiforme cere b e l a r, glioma de fossa posterior.Glioblastoma multiforme (GBM) is the most common primary central nervous system (CNS) tumor in adults comprising approximately 50% of all primary intracranial tumors. Primary cerebellar GBM is a rare tumor in adults 1 -7 and accounts for 1% of all GBM 4 . The reason for its rarity is not completely understood 1 -3 , 5 . D i ff e rential diagnosis of GBM from other CNS lesions is an outstanding issue, especially in re g a rd to its diff e rentiation from other primary CNS tumors such as the anaplasic astrocytoma and from metastases 5 , 7 , 8 since the prognosis and outcome is diff e rent. For this reason, neuroimaging and ultimately the immunostainning assessment are important tools for planning the therapeutic course.We re p o rta case of an adult man with a cere b e llar GBM and a literature review concerning the clinical data, diagnosis including radiological and pathological aspects, treatment and its particular behavior is done. CASEA 46 years old man was admitted due to history of headache beginning 4 months before. Ve n t r i c l e -p e r i t o n e a l shunt was perf o rmed in another hospital due to acute h y d rocephalus 1 month after the initial symptoms. The patient developed progressive cerebellar signs with gait disturbance, nystagmus and clumsiness of the extremities, more intense on the left side, and vomiting. He was unable to walk and showed mild degree of confusional state at examination. A magnetic resonance imaging (MRI) revealed an infiltrative mass situated in the left hemisphere and para-

Twenty one patients were submitted to decompressive craniectomy for massive cerebral infarct. Ten patients (47.6%) presented a good outcome at the 6 months evaluation, eight had a poor outcome (38%) and three died (14.2%). There was no outcome statistical difference between surgery before and after 24 hours of ictus, dominant and non-dominant stroke groups. Patients older than 60 years and those who had a Glasgow Coma Scale (GCS)<8 in the pre-surgical exam presented worst outcome at six months (p<0.05). Decompressive craniectomy for space-occupying large hemispheric infarction increases the probability of survival. Age lower than 60 years, GCS ≥8 at pre-surgical exam and decompressive craniectomy before signs of brain herniation represent the main factors related to a better outcome. Dominant hemispheric infarction does not represent exclusion criteria. Key words: cerebral infarction, decompressive hemicraniectomy, surgical decompression.Craniectomia descompressiva no infarto cerebral extenso RESUMO Vinte e um pacientes foram submetidos a craniectomia descompressiva para o tratamento de infarto cerebral extenso. Dez pacientes (47,6%) apresentaram boa evolução em avaliação após 6 meses, 8 apresentaram evolução desfavorável (38%) e 3 faleceram (14,2%). Durante o seguimento, não se evidenciou diferença estatística na evolução entre pacientes operados antes e após 24 horas do ictus, nem entre lesões envolvendo o hemisfério dominante versus não dominante. Pacientes com mais de 60 anos e aqueles com Escala de Coma de Glasgow (ECG)<8 na avaliação pré-operatória apresentaram pior evolução após 6 meses (p<0,05). A craniectomia descompressiva para infartos hemisféricos extensos aumentam a probabilidade de sobrevivência. Idade abaixo de 60 anos e ECG ≥8 no exame pré-operatório e craniectomia descompressiva antes de sinais de herniação cerebral representam os principais fatores relacionados a uma melhor evolução clínica. Infarto hemisférico envolvendo o hemisfério dominante não representa um critério de exclusão. Palavras-chave: infarto cerebral, hemicraniectomia descompressiva, descompressão cirúrgica.

The frequency of intrasphenoid septations in the ICAp found is considerable. It is higher among patients with more pneumatised sinuses. This finding justifies an appropriate pre-operative study, and careful attention must be paid during transsphenoidal surgery.