Pedunculated gliomas in the lateral ventricle.
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Biomedical subjects
Publications and source records attributed to A Kunicki.
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Two cases of giant pituitary adenomas spreading extensively beyound the sella are described. In the 1st case death occurred 18 hours after the operation, in the 2nd case a good result was obtained by operation from subtemporal approach followed by 60Co radiotherapy. Control scintigraphic and angiographic examinations 11 months after treatment failed to demonstrate the signs which indicated extrasellar spread of adenoma before treatment.
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The authors describe a system for rapid digital automatic recording of cerebrospinal fluid pressure. The results are recorded in numerical form by a recorder. Owing to this quantitative expression of results the subjective evaluation of analog curves is avoided. The system may be used also to measure other slowly changing physiological processes.
In the reported group of 114 cases the overall operative mortality was 3,5% and when two incurable cases are escluded this mortality falls to 1,7%. An essential change in the management of this disease was abandoning of postoperative radiotherapy and increasing of the extent of tumour removal. This decision was based on the view that despite weak antigenicity of the neoplasm immune mechanisms mobilized after radical operation are sufficient to inhibit or even destroy the remaining tumour tissue. In the light of eight years of experience with this method it seems that it will pass the test of time.
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In 39 patients with intracranial lesions the resorption resistance was measured using an own computerized infusion test. A high usefulness of this test was demonstrated in the diagnosis of hydrocephalus and for establishing indications to ventriculocardiac valve implantation. In patients after craniocerebral injuries a rise was observed of the resorption resistance immediately after trauma in cases with subarachnoid haemorrhage. Later on, this resistance decreased gradually reaching a stable value after 1-2 years. Data obtained in the infusion test make possible establishing of optimal intracranial pressure and choice of an appropriate valve. The determination can be performed intraoperatively.
Three patients are described, who were treated because of tumors of the medulla oblongata, growing towards the lumen of the IV ventricle and into the subarachnoid space. In two cases clinical cure was achieved after partial removal of the tumor and radiotherapy. One of these patients 32 years after the operation is working as a librarian, the other one treated 25 years ago is also professionally active and has a 5-year old son. In the third case only fragments of the tumor were taken for histological examination but radiotherapy was not given in view of serious condition of the patient. The patient however improved and after 23 years he died suddenly from myocardial infarction. On the base of these cases and a survey of the world literature it may by supposed that there are two kinds of brain stem tumors differing in their clinical course and direction of growth. Type A develops in the transverse plane of the brain stem and along its longitudinal axis producing paralysis of cranial nerves, signs of damage to the long ascending and descending pathways and disturbances of equilibrium. Symptoms of intracranial hypertension appear late or not at all. Type B grows into the lumen of the fourth ventricle and subarachnoid space as well, without infiltrating the deep structures of the brain stem. Partial removal of the tumor followed by radiotherapy may give useful survival for many years and may be even permanent cure.