Hamit Z. Gökalp

Meningiomas of the tuberculum sella.

A series of 88 consecutive patients operated on for tuberculum sellae meningioma at the Neurosurgery Department of the University of Ankara Medical School was reviewed. Visual impairment was the most common initial complaint. All but 9 patients had visual symptoms. All patients underwent craniotomy, with an operating microscope being used in 62 cases. Use of the operating microscope appeared to increase the total removal rate while lowering the mortality. In our series visual function improved in 53.5%, was unchanged in 27.5%, and worsened in 19% of the patients.

Colloid cyst of the third ventricle. Evaluation of 28 cases of colloid cyst of the third ventricle operated on by transcortical transventricular (25 cases) and transcallosal/transventricular (3 cases) approaches.

SummaryThe clinical and x-ray features of 28 cases of colloid cyst of the third ventricle are described. Colloid cyst is one of the most favourable space-occupying lesions of the brain for successful surgical removal, because an exact pre-operative diagnosis is possible. The surgical approach for colloid cyst of the third ventricle is discussed and the frequency of postoperative seizure is reviewed in 28 cases and compared with the literature.

Tumours of the lateral ventricle. A retrospective review of 112 cases operated upon 1970–1997

Between the years 1970 and 1997, 112 patients with tumors of the lateral ventricle were operated on at the University of Ankara, School of Medicine, Department of Neurosurgery. Seventy-one patients (63.4 %) were male and 41 patients (36.6 %) female. Headache (35.7 %), nausea and vomiting (22.3 %) were the most common presenting complaints. Papilloedema (42.9 %), motor and sensory loss (25 %) were the most common findings at neurological examination. Complete tumor removal was accomplished in 38.4 % of the patients. Histopathologically, the most commonly seen types of the tumor were ependymoma (25 %) and astrocytoma (21.4 %). Among the various approach, the anterior transcortical (53.6 %) and the posterior transcortical (16 %) were the most commonly used. Eleven patients were reoperated for tumor recurrence. After surgery, radiation therapy was also performed on fourty-two patients. The morbidity and mortality rates were considerably higher before 1976 when the use of microneurosurgical techniques was introduced. After this, our morbidity and mortality rates decreased dramatically. The overall surgical mortality rate was 7.1 % before 1976; during the last 10 years (n:46), it was 6.5 %. In this report, our choice of operative approaches and the results will be discussed.

Tentorial meningiomas. Commentaries

We report our experience with and long-term results of 37 patients with tentorial meningiomas who underwent surgery between 1972 and 1993. The average age was 43 years, and the mean duration of symptoms was 36 months. Headache (83.8%) and extremity or gait ataxia (35.1%) were the most common complaints. On neurological examination, signs of elevated intracranial pressure and cerebellar deficits (51.4%) were the most common findings, followed by third nerve involvement (35.1%). Computed tomography, angiography, and, in recent years, magnetic resonance imaging were used as diagnostic tools and for planning the surgical procedure. According to the primary site of attachment, the tentorial meningiomas were divided into three subgroups: medial, lateral, and falcotentorial

Evaluation of cerebral vasospasm in patients with subarachnoid hemorrhage using single photon emission computed tomography.

Cerebral vasospasm (CVS) occurs as a result of the breakdown in cerebral autoregulation mechanisms. Because cerebral vasospasm can occur after subrachnoid hemorrhage (SAH), it is important to evaluate borderline perfusion. Evaluation of borderline vascular insufficiency is important to reduce ischemic complications. In this study 25 patients with SAH were investigated by somatosensory evoked potentials (SEP), computed tomography (CT), digital subtraction angiography (DSA) and single photon emission computed tomography (SPECT) in order to predict borderline ischemic areas. Clinical grades were also correlated with these investigations. Thirteen patients had symptomatic vasospasm and 15 patients had angiographic vasospasm. SPECT showed hypoperfusion in 22 out of 25 patients. CT predicted CVS in 8 of these 22 patients. Our study shows that brain perfusion SPECT is a non-traumatic, non-invasive, non-allergic, inexpensive method for the prediction of cerebral vasospasm. We conclude that brain SPECT with Tc-99m HM-PAO is an accessible technique that can demonstrate varying degrees of regional tissue hypoperfusion in patients with delayed ischemic deficits due to CVS following SAH.

Craniopharyngioma of the Posterior Fossa

A case of craniopharyngioma originating in the very unusual location of the posterior fossa is presented. The patient, a 23-year-old man, was operated on at another hospital when he was 3 years old for craniopharyngioma in the suprasellar area. There was no complaint for several years after this initial operation. Three months before he was admitted to our hospital, he had complaints of headache, vomiting, nausea, and ataxia. A computed tomographic scan revealed a mass with a cyst and calcifications in the posterior fossa. The tumor was removed totally.

A giant meningioma of the fourth ventricle associated with Sturge-Weber disease

SummaryA case of meningioma without dural attachment within the fourth ventricle associated with Sturge-Weber disease is reported. Review of the literature revealed that meningiomas arising from the choroid plexus of the fourth ventricle and lying totally within the fourth ventricle are very rare. Coexistence of Sturge-Weber disease with meningioma of the fourth ventricle has never been reported, as far as we could find out.

Brain tumour associated with intracranial arterial aneurysm

SummaryFour cases of brain tumour associated with intracranial aneurysm are presented, and the available literature is reviewed. The association of brain tumours and arterial aneurysms is not well documented in neurosurgical literature. Reports of the association of giant aneurysms with brain tumours are rare. We could find only five such cases, and one of our cases is the sixth. The operative mortality of the patient with coexisting brain tumour and cerebral aneurysm is high. Two of our cases died postoperatively, one from pre-existing cardiac disease, and the other from hypothalamic vascular insufficiency related to surgery.

Pituitary abscesses. Report of three cases

Three cases of pituitary abscess are presented. In spite of improvements in radiological evaluation, preoperative diagnosis of pituitary abscess is quite difficult and definite preoperative diagnosis is rare in the literature. In our three cases, diagnosis was made postoperatively. Pituitary abscesses are associated with high mortality and morbidity. When first suspected, prompt antibiotic therapy should be considered. Early operative drainage seems to be an important factor in decreasing this high mottality and morbidity.

PSEUDOTUMOR CEREBRI WITH FAMILIAL MEDITERRANEAN FEVER

Pseudotumor cerebri (PC) is a condition that occurs predominantly in obese women, and long lists of putative causes and associations have been reported. We describe here the case of a woman in whom PC coexisted with familial Mediterranean fever (FMF). A review of the literature revealed no report of an association of these two conditions.