A group of 30 consecutive patients (26 men and 4 women, mean age 51 years), with clinically and radiologically verified cervical spondylosis causing radiculopathy and/or myelopathy, were questioned about voiding symptoms, examined urodynamically and subjected to tests of tibial somatosensory evoked potentials (SEP). Seventeen patients (61%) complained of irritative bladder symptoms and detrusor hyperactivity was demonstrated urodynamically in 13 (46%). Three (11%) experienced difficulty in emptying the bladder, and all of these had a hypotonic detrusor. The bladder was insensitive to cold in 36%, this and SEP abnormalities being more common in the patients with clinically severe myelopathy, whereas detrusor hyperactivity was found equally in all patients. Urodynamic investigation seems to provide additional information on the severity of the disease and is therefore recommended for wider use in these patients.
Somatosensory evoked potentials (SEPs) were recorded by stimulating the median nerve at the wrist from the skin and epidural space of the 7th cervical spine in patients suffering from cervical radiculopathy or radiculomyelopathy. The patients were divided into four subgroups according to the severity of the disease. Skin and epidural SEPs were calculated and compared with each other and with control values. Usually only one negative potential N13 was identified in the skin recording, but two potentials N11 and N13 occurred in the epidural recording. Lower amplitudes were obtained from the skin than from the epidural space. In the skin SEPs the mean of the central latency of N13 was significantly prolonged in the severe radiculomyelopathy groups, while the mean of the amplitude N13 showed only a tendency to decrease. In contrast, in the epidural SEPs a significant decrease in the mean of the N11 and N13 amplitudes together with a significant prolongation in the mean of the central latency of N13 could be found. In the epidural recording the amplitude changes in particular increased with the severity of the disease, but the highest number of abnormalities (61%) could be seen in the central latency of N13.
Conventional thin-section CT is considered a usable alternative for the evaluation of suspected cervical disc herniations in selected patients. Stocky patients with wide shoulders and a short neck are not suitable candidates, even when new generation equipment is available.
The present series consists of 18 consecutive patients with pituitary adenomas operated on between 1977 and 1979 using the transfrontal route. Ten adenomas were 10, 20 or 30 times the normal maximum size of the pituitary measured according to Di Chiro and Nelson's (2) index (Table 2). Tumours without obvious suprasellar growth were operated on using the trans-sphenoidal route and thus are not included in the present series. Large and giant pituitary adenomas are preferably removed by the transfrontal route and using microsurgical techniques. Really poor vision associated with very large tumours seem to improve but not to normal level. A blind eye stays blind. Less poor vision returns to normal (Table 4). Prolactin values associated with giant prolactinomas are extremely high and may remain raised even after apparently radical extirpation. Isolated tumour-containing sellar crypts associated with these large tumours may be responsible for this observation. Postoperative radiotherapy and bromocriptine administration therefore seem advisable. Further operations may be necessary on patients with extensive posterior or lateral growths. Redundant partially intraosseous tumour fragments may be more easily removed later, possibly owing to the beneficial effects of radiation therapy. It is hoped that large and giant adenomas in the future will pass into history, even in the peripheral parts of the world. The trans-sphenoidal approach is always a better solution than the transfrontal approach whenever it can be carried out, but it requires earlier diagnosis.
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