Authors analyzed retrospectively the incidence of pituitary apoplexy in a series of 799 pituitary adenomas with respect to the long term follow-up of the patients. Focal vascular abnormalities in histological specimens of tumours, regarded as morphological suggestion of past apoplexy (haemorrhage, ischaemic infarction or necrosis), were established in 113 out of 783 surgical cases (14.4%). Acute clinical onset, justifying the clinical diagnosis of pituitary apoplexy, occurred in 39 patients only (5% of the whole series), 19 of them were subjected to urgent surgical decompression due to severe neurological deficit. The haemorrhagic character of apoplexy was established in most cases requiring immediate surgery. The detailed clinical picture of this condition and its management are discussed with respect to the long term prognosis. On this basis the authors suggest the necessity of surgical treatment in every case of pituitary apoplexy, taking into account not only neurological recovery, but also endocrine and oncological aspects of the disease. The observation that pituitary apoplexy may be a "marker" of tumour invasiveness (even in small, "enclosed" adenomas) is highlighted.
A computer system, based on IBM PC, was designed for the cerebrospinal compensatory model identification. The intracranial pressure (ICP) signal, registered during the lumbo-lumbar infusion test is analyzed by means of the spectral analysis algorithm in order to measure precisely the pulse wave amplitude. The amplitude and the mean ICP level, calculated repetetively within the period of about 8 seconds, are stored on the disk and form the basis for further model identification. Three different methods of identification were applied. They enable one to estimate the fundamental model parameters, such as: resistance to the cerebrospinal fluid resorption, pressure-volume index, baseline pressure, rate of formation of the cerebrospinal fluid. Statistical evaluation of the results of the infusion test analysis obtained by means of the system described in two groups of hydrocephalic patients (children and adults) is presented.
67 cases of brain abscess were analyzed retrospectively. As 2 comatose patients died on admission before any treatment was started, the results are based on 65 treated patients. Different methods of treatment included: total removal in 36 patients, drainage in 14, aspiration in 6 and conservative treatment in 9. Management mortality was 18.5% and was almost not dependent on the method of treatment (except aspiration) being lowest in the drainage group. The mortality was significantly higher in patients with serious impairment of consciousness on admission. Follow-up examination after 1 to 11 years was performed in 47 out of 53 discharged patients and revealed in 25 of them (53%) full recovery. 10 additional cases (21%) are independent. The best early and long term results were obtained in patients by drainage and medical treatment. Chronic epilepsy developed in 34% of patients with supratentorial lesions. The risk of epilepsy was lowest in the group of patients treated by drainage. The authors present the opinion that removal of brain abscess is necessary only in exceptional cases.
This easy method of sellar reconstruction represents an effective and fast possibility to perform the final step of the endoscopic transsphenoidal procedure, which otherwise may cause maneuverability problems in the limited space of one nostril.
The study is based on follow-up data of 108 patients treated for brain abscess (mean follow-up period 11 years). The overall incidence of epilepsy was 34% (37% in supratentorial lesions). The author compared the incidence of several parameters between two groups of patients: those presenting, and those not presenting with epilepsy after brain abscess treatment. Parameters characterized by significantly different incidence in each group were taken into account as possible risk factors influencing the development of epilepsy. Sex, age of the patient, localisation and size of the abscess are discussed as presumptive risk factors modifying prediction to epilepsy. The author presents a new concept of epileptic focus formation to explain satisfactorily the results of the study on the basis of pathological mechanisms. A protocol, which may be useful to evaluate the prediction to epilepsy after brain abscess treatment is proposed.
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