Craniopharyngeoma

We have given a methodological description of gas dissection and gas cisternography used during transsphenoidal surgery. 200 consecutive patients with pituitary adenomas or craniopharyngeomas have been operated according to Cushing- Guiot -Hardy's procedure. 68 patients had suprasellar expansions in which gas dissection was used. The operative procedure with technical equipment and staff requirement is reported as well as the combined neurosurgical and neuroradiological techniques.

CT investigations of 783 cases of brain tumors, which were covered by histology, were checked with regard to frequency and configurations of calcifications. As expected the calcifications were detected more frequently by CT than by conventional radiology because of higher resolution. Most frequently calcifications were detected in craniopharyngeomas (72%) and in oligodendrogliomas (51%). The calcifications shown by CT can be changed by variation of technical parameters. Certain patterns of calcifications can be differentiated, if constant and best technical conditions are used...

The effect of the infusion of 2-hydroxyestrone (125 micrograms/h for 8 h) on plasma PRL levels was investigated before and 64 h after the administration of 1 mg estradiol benzoate in five patients with PRL-secreting pituitary adenomas. There was no effect on the circulating PRL levels measured hourly for 8 h during both episodes of 2-hydroxyestrone infusion, but plasma LH and FSH levels were suppressed. Infusion of 2-hydroxyestrone in two hyperprolactinemic patients with craniopharyngeomas also did not change the circulating PRL levels...

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The course of rehabilitation in 11 young patients with craniopharyngeoma was investigated. With intelligence well-preserved, neuropsychological diagnosis revealed impairments in rate and persistence in virtually all patients; behaviour disorders were present in 8 of the 11 patients, with efforts to distinguish psychoorganic from psychoreactive causality however not always successful. The neuropsychological deficits and behavioural deviations mentioned, rather than complications of a medical nature (1 of 11), resulted in only 2 patients having been able to maintain their premorbid educational/vocational status...

41 patients with various sellar and parasellar lesions (pituitary adenomas, meningiomas, optic gliomas, craniopharyngeomas and granulomas), who underwent surgery consecutively, were studied by MRI investigations. In 10 patients post-operative MRI controls were performed. The information obtained by the MRI were compared with the other radiological investigations (especially coronar and axial high resolution CT), and the intra-operative findings. The advantages of MRI in the diagnosis of sellar lesion are demonstrated by exemplary cases...

In 204 patients with sellar lesions and isolated hyperprolactinaemia we analysed and compared many different morphological, immunocytochemical, hormonal, and clinical data for a differentiation of primary (Prl produced by a tumour) and secondary (Prl elevation by PIF inhibition) hyperprolactinaemia. We found Prl-positive pituitary adenomas with primary hyperprolactinaemia in 62.7% and a secondary Prl elevation with different alterations in 37.3% (Prl-negative adenomas 28.9%, craniopharyngeomas 5%, and non-tumourous conditions 3...

Immunohistochemical analysis of subpopulations of inflammatory cells in 81 primary and secondary human brain tumors was done. Natural killer (NK) cells, representing non-major histocompatibility complex-restricted, spontaneous cytotoxicity and monocytic cells are virtually absent in infiltrates of gliomas and account only for a minor percentage of inflammatory cells in brain metastases of carcinoma and in craniopharyngeomas. Infiltrates in gliomas consist almost exclusively of T-cells of the suppressor/cytotoxic type whereas infiltrates in carcinoma metastases and craniopharyngeomas contain considerable numbers of T-helper/inducer cells and B-cells...

Eleven patients with constitutionally delayed development, seven patients with idiopathic growth hormone deficiency and ten patients with craniopharyngeoma received growth hormone releasing factor GRF 1-40 in a dose of 1 micrograms/kg body weight as a bolus injection. In the patients with constitutionally delayed development, a mean maximum HGH value of 86.7 microU/ml was measured 30 minutes after GRF injection. Considerably higher HGH stimulation values were thus obtained after GRF than with conventional stimulation methods...

20 patients suffering from cystic craniopharyngioma were treated with intracavitary irradiation on 25 occasions. The beta emitting radionuclide 90Y silicate colloid was instilled into the cyst or cystic part of the tumour. 17 patients on 22 occasions underwent follow-up CT and ophthalmological examinations 1 to 144 (average: 34) months after the intracavitary radioisotope therapy. An 23 occasions there was an average of 82 to 90% volume decrease of the craniopharyngioma cysts. On two occasions the volume has remained unchanged and the result of the 90Y therapy cannot be evaluated yet...

Craniopharyngeoma growing suprasellary attacks the medio-basal region of hypothalamus, that leads to the stopping of the production of gonadotropin releasing hormone. In connection with the case of a 15-year-old girl who had partial extirpation of craniopharyngeoma the authors write about the favourable endocrine effect of pulsatile gonadotropin releasing hormone treatment. Through giving gonadotropin releasing hormone every 90 minutes in 20 micrograms doses menstruation cycle and ovulation was performed. Beside surgical treatment hormonal substitution plays an important role in the treatment of additional endocrine symptoms...

The term "midline tumour" is defined partly from the topographic and from the pathogenetic point of view. Problems of modern imagegenerating procedures in establishing the diagnosis of cerebral midline lesions are described. The role of stereotactic diagnostic and therapeutic interventions is emphasized. Stereotactic brain tumour biopsy, installation of shunts and reservoirs under visual control are performed. Interstitial radiotherapy is carried out for low-grade gliomas. As an important innovation, stereotactic procedures are combined with endoscopic techniques...

Between 1975 and 1989, 58 patients, 32 females and 26 males, mean age 50 years, with intracranial giant aneurysms with a diameter more than 2.5 cm were treated at our clinic. 48% of the patients presented with subarachnoidal hemorrhage. The most of the other 30 patients presented with cranial nerve dysfunctions. The most common site of the aneurysm was the internal carotid artery (25 cases, 43%), followed by the anterior cerebral artery (14%), and the vertebro-basilar region (11 cases, 19%). In 14 patients direct surgery was not performed because of the poor general condition of the patient, the high risks, or non-consent...

The expression of the CD15 epitope was investigated by immunohistochemistry, western blotting and immuno-thin-layer chromatography on a large series of human nervous system tumours and ethylnitrosourea-induced rat gliomas. Our results show that CD15 is expressed as a glycoprotein- or glycolipid-associated epitope in normal human and rat brain. In contrast, immunoreactivity for CD15 was absent in tumour cells of experimental rat gliomas. In human tumours we found a more complex expression pattern. While intra- and perivascular granulocytes as well as macrophages in necrotic areas of anaplastic tumours were always strongly CD15-positive, immunoreactive tumour cells were detectable only in a fraction of low-grade gliomas...

One case is documented to verify that cystic hypophyseal tumours do not only stem from adenomas, craniopharyngeomas or as primary craniopharyngeal cysts from epithelial structures of the hypophyseal duct but may also originate from Rathke's cysts or Rathke's cavity.

The axial computed tomography of the skull has become an important part of the neuroradiologic diagnostics. The intracranial CT diagnosis is completed by the coronal sections which is used in particular in case of processes in the posterior cranial fossa and its differentiation of the supra- and infratentorial dimensions and in order to localize tumors in the sella region. The accurate determination of the tumor volume and the para-, supra-, and retrosellar dimensions makes possible an exact operation and irradiation planning...

This paper decribes the results of the CT teams of the University Clinics Berlin, Mainz and Munich. 1658 patients with cerebral tumors have been examined so far (EMI Scanner Mark I, Matrix 160/160) revealing a diagnostic accuracy of 98.4%. The findings of various kinds of tumors (306 glioblastomas, 255 astrocytomas and oligodendrogliomas, 248 meningiomas, 212 metastases, 200 pituitary adenomas and craniopharyngeomas) are discussed and illustrated by typical images. Differential diagnostic problems and the importance of additional neuroradiological procedures are discussed...

The LH-RH test was performed in 62 mainly prepuberal children. A dose of 25 mug/20 kg was given intravenously between 10 and 12a.m. Prepuberal healthy boys between 1 11/12 and 9 7/12 years of age reacted with a fourhold increase of LH. Prepuberal boys with an unilaterally undescended testicle showed no difference in LH response from normal. Even a low increase in LH may be followed by spontaneous puberty in children with pituitary dwarfism. The LH response in children with craniopharyngeoma was heterogeneous and appeared to depend on location of tumor and extent of operation...

The report at issue discusses the relationship between laryngeal papillomatosis and the endocrine system. It is referred to the clinical course of a 19-years-old patient suffering infantil laryngeal papillomatosis and antuitary insufficiency since childhood. The cause of hormonal insufficiency was the destruction of the hypophysis by a craniopharyngeoma. As a result of this insufficiency the total metabolic process of the patient was reduced to a "vita-minima"-function for years. Despite this metabolic depression the laryngeal papillomas have grown excessively...