Lester A. Mount

The value of radiation therapy in the management of glioma of the optic nerves and chiasm.

The most common primary tumors of the optic nerves and chiasm are those which arise from the glial stroma of the visual pathways. Growth of the neoplasms is slow but the natural course is an extension of the process with the production of blindness and often death. Since optic nerve gliomas are encountered infrequently, the effect of various forms of treatment is difficult to assess. It is the purpose of this paper to report, in summary, the case histories of 34 patients with primary glioma of the optic nerves and chiasm and to evaluate the use of radiation therapy and surgery in their management. Incidence and Pathology Optic nerve gliomas are tumors of young people. They are not, however, closely related to the highly malignant retinoblastoma, which also is a disease of early life. Optic gliomas are relatively uncommon, constituting only 1 to 2 per cent of all glial new growths (Martin and Cushing, 11; Lundberg, 10). The 34 cases to be reported here occurred during a period when approximately 2,000 surg...

Papillomas of the Choroid Plexus

p APILLOMAS of the choroid plexus are solitary reddish grey tumors attached to the choroid plexus. The irregular surface is covered by a thin transparent capsule, and the firm tumor occasionally is partly calcified. Microscopically, papillomas resemble normal choroid plexus, being composed of columnar or cuboidal epithelium supported by highly vascularized connective tissue. They are usually benign but may undergo malignant transformation. 7,n,~,24 They are occasionally multiple and may metastasize by way of the cerebrospinal fluid regardless of their ventricular location.3,1~,2~,2a In order of frequency papillomas are located in the fourth ventricle, atrium of the lateral ventricle, and the third ventricle. In infants and the younger age groups they are most often found in the lateral ventricle; in adults, in the fourth ventricle. 4,7,~~ Although they occur in any age group, even in the newborn, 7 they show a predilection for the younger age group with the greatest incidence in the first decade of life. 7,~6,1s They are slightly more common in males 22 and have been found in a brother and sister? ~ Papillomas of the choroid plexus account for 0.4 to 0.6% of all brain tumors.6,9,1~ ~a The clinical picture of a papilloma of the fourth ventricle is one of increased intracranial pressure without localizing features except for ataxia, nystagmus, and cranial nerve palsies. ~,~,2~ In infants, the symptoms are those of progressive hydrocephalus with enlargement of the head, apathy, irritability, and a failure to thrive. In adults, the hydrocephalus is caused by obstruction to the circulation of cerebrospinal fluid, while in infants it frequently is due to the increased secretory surface created by the tumor which causes a concomitant increase in the production of cerebrospinal fluid.~, 9, ~ 6, ~7 Subarach-

Neurosurgery 1977: problems and attainments. The 1977 AANS presidential address.

The President of the American Association of Neurological Surgeons (AANS) discusses the many elements that appear to restrict the professional activities of neurosurgeons and other physicians. He stresses the importance of the active role required of the AANS, the American Medical Association, and the American College of Surgeons in finding solutions to problems related to neurosurgery.