John R. Jinkins

Primary Cranial and Intracranial Chondrosarcoma

SummaryFifty cases of intracranial and cranial chondrosarcoma were reviewed in the world literature including two of our own. These were analyzed relevant to their histological subgroup, site of origin, age and sex incidence, calcification and vascularity, recurrence, and metastases. The analysis was done in order to clarify points in the diagnosis, management, and prognosis of this rare tumour. The mesenchymal subtype is a more malignant form with a higher tendency for recurrence, metastasis, and increased vascularity.

Microsurgery for giant craniopharyngiomas in children.

The authors report 20 cases of giant craniopharyngioma in children operated on during the 6-year period from 1978 through 1984. The tumor size (maximal diameter) ranged from 5 to 11 cm. These patients presented with increased intracranial pressure, severe visual loss, and neurological and endocrinological deficits. Tumor growth had occurred in several directions, causing displacement of the circle of Willis, the optic apparatus, and the hypothalamus, as well as encroachment into the interpeduncular and prepontine cisterns and into the frontal, temporal, and posterior fossae. The surgical technique for total removal of these giant tumors in the last 10 cases is described. Emphasis is placed on the use of microsurgical technique during the first operation, close endocrinological follow-up, and early reevaluation by computed tomographic scanning.

Medulloblastomas: a review of modern management with a report on 75 cases

The authors summarize the 8-year experience of a tertiary medical center with 75 cases of medulloblastoma in Saudi Arabia. A discussion of the evolution of modern management of this difficult problem ensues. As 5-year survival statistics approach 80% in some institutions, attention is being focused on the long-term effects of modern therapy and the quality of life led by these children.

Ruptured middle cerebral aneurysm with accumulation of subarachnoid blood within convexity arachnoid cyst

A case of acute rupture of a right middle cerebral bifurcation aneurysm with extravasation of blood into a distant arachnoid cyst is reported.

Histiocytosis-X of the spinal cord: a case report

A rare case of histiocytosis-X of the spinal cord with evidence of intramedullary infiltration and epidural spinal cord compression is reported. The clinical, radiological, and histopathological features are discussed, and the pertinent literature is reviewed.

Extrasellar Prolactinomas: Successful Management of 24 Patients Using Bromocriptine

24 patients with an extrasellar prolactinoma (mean prolactin 4,722 ng/ml), 8 of whom had previously had surgery, received 5-40 mg bromocriptine daily for 13-252 weeks. The mean prolactin level had fallen 89% at 2 days, 95% at 6 weeks, and 15 patients achieved normal values. Tumor shrinkage occurred in all 9 patients rescanned within 2 weeks and later was documented in 23; in 18 the extrasellar tumour disappeared. 12 patients had visual abnormalities; 7, including 2 who had been completely blind, improved within 1 week. 2 patients had normal prolactin levels after withdrawal of bromocriptine, 1 following radiotherapy and the other during two uncomplicated pregnancies. Bromocriptine is safe and effective. We conclude that medical treatment should always precede surgery unless pituitary apoplexy causes sudden deterioration of vision. Most patients will subsequently require radiotherapy or surgery for permanent cure.

Current neuroradiological investigation of spontaneous hemorrhage into the craniospinal axis.

&NA; Increasing experience‐based statistical knowledge, expertise, and technical advancements in recent years have all contributed to the facility of investigations into the cause of spontaneous neuraxis hemorrhage. The sum of the neuroradiological evaluation has become increasingly more straightforward, simpler to execute, more informative, and safer to perform. Methods of investigation include the traditional forms of radiography such as skull roentgenography and conventional anteriography. However, the contribution of high resolution computed tomography, dynamic computed tomography, and venous and arterial digital subtraction angiography has been largely responsible for the progress in this complicated area of radiological diagnosis. The future advancement of radiological evaluation in patients with craniospinal hemorrhage will lie in the technical improvements of current imaging systems, as well as in the further development and refinement of new techniques such as magnetic resonance imaging. (Neurosurgery 18:664‐674, 1986)

Syrinx of the conus medullaris and filum terminale in association with multiple hemangioblastomas

A patient with multiple hemangioblastomas and syrinxes of the cerebellum and spinal cord is presented. An additional mass imaged at the L-3 vertebral level was identified by percutaneous syringography as a bilobular syrinx extending from the conus medullaris into the filum terminale. At surgery the syrinx was opened into the caudal cerebrospinal fluid space and the several hemangioblastomas excised. These spinal tumors all appeared to arise in juxtaposition to the posterolateral sulcus and dorsal sensory roots.

The aberrant jugular bulb

The aberrant jugular bulb has been found in 0.5-7.0% of autopsy cases. Its primary interest lies in the appreciation of its benignancy, its occasional symptomatic behavior and of the consequences of failing to glean its true nature of surgery. Therefore, the importance of proper preoperative diagnostic evaluation must be stressed so that operative interference with an anomalous but otherwise normal structure can be avoided.

Histiocytosis-X of the hypothalamus: Case report and literature review

Involvement of the central nervous system (CNS) in patients with histiocytosis-X manifesting secondary hormonal change is well known clinically. Proof of involvement of the most common CNS focus, the hypothalamus, is also seen in autopsy cases on occasion. However, premortem radiographic evidence of hypothalamic infiltration is unusual. Presented is a case report and a brief literature review of such cases.