Optic canal decompression with dural sheath release; a combined orbito-cranial approach to preserving sight from tumours invading the optic canal.

PURPOSE: The purpose of this case series is to describe an orbito-cranial surgical approach for the management of optic nerve compression secondary to tumours extending into the optic canal. METHOD: We present a retrospective, observational case series of 4 patients who underwent surgery aimed at improving or stabilising vision for tumours invading the optic canal. In all cases tumours were not amenable to complete resection due to their intrinsic relation to important structures including: the internal carotid artery, cavernous sinus, optic and oculomotor nerves. All patients underwent combined orbito-cranial surgery consisting of craniotomy, debulking of the tumour, transcaruncular orbital and optic canal decompression with release of the dural sheath overlying the optic nerve via the craniotomy approach. Visual acuity was the primary outcome measure. RESULTS: Four patients, aged 42, 44, 61 and 78 years, three with spheno-orbital meningioma and one with cerebral sino-nasal adenocarcinoma were included in the study. Mean postoperative follow-up time was 26, 19 and 15.6 months. The fourth patient died at 2.9 months post-surgery due to high grade aggressive cerebral adenocarcinoma. Postoperative visual acuity improved by greater than 4 lines of Snellen acuity in 2 patients at 26 and 19.1 months. Two patients decreased from counting fingers vision to perception of light at last follow-up. CONCLUSIONS: In cases of non-resectable meningioma extending into the optic canal with secondary optic nerve compression, a combined surgical approach with optic canal decompression and dural sheath release may help preserve and even improve vision in certain cases.

Prostatic adenocarcinoma presenting with metastatic frontal bone involvement and orbital invasion.

We present a rare case of prostatic adenocarcinoma presenting with metastatic frontal bone involvement with subsequent spread to the orbit. Although prostatic adenocarcinoma has a strong tendency to metastasize to bone, particularly axial skeletal bone, frontal bone involvement is rare and subsequent orbital involvement is even more so.

Neuropsychological profiling of ischemic deficit secondary to ruptured dermoid cyst: a case report.

This report presents a case of a 39-year-old male with a spontaneously ruptured frontotemporal dermoid cyst. Intraoperatively, during surgical resection of the cyst, significant fat spillage occurred associated with a profound anterior circulation vasospasm. The patient underwent serial neuropsychological evaluation over five months, revealing a profile of initial deterioration, followed by delayed recovery of cognitive function. A review of the literature reveals three other case reports describing ischemic deficit after dermoid rupture, but the cognitive impairment associated with this pathology has never been formally profiled before, and it may be possible to draw analogies to the well-established ischemic deficit post-subarachnoid hemorrhage found in the literature. Neuropsychological profiling additionally informs us about the nature and progression of this entity from a cognitive perspective and whether the etiology of deficit caused by dermoid rupture could be localized, or global, secondary to diffuse fatty dissemination in the CSF.

Transcranial surgery for pituitary tumors performed by Sir Victor Horsley.

OBJECTIVE: To describe the clinical details and the operative method used in pituitary tumors by Sir Victor Horsley (1857-1916), which represent the earliest attempts at pituitary surgery. METHODS: Horsley's case books and postmortem records, archived at the National Hospital, Queen Square, London, were studied for patients with a primary diagnosis of a pituitary tumor admitted during the period 1886 to 1916 who were treated surgically. Contemporary records of nonpituitary cases were also examined to study aspects of Horsley's operative method. RESULTS: Four patients (three men and one woman) underwent craniectomy for removal of a pituitary tumor via the subtemporal approach between 1904 and 1907. All four patients experienced significant impairments of visual fields or visual acuity; one patient had severe trigeminal neuralgia. Evidence of acutely raised intracranial pressure was present in one patient. All patients underwent craniectomy under chloroform anesthesia. One patient died on the day of surgery, and the postmortem findings are presented. In the other three patients, neurological morbidity was recorded in the postoperative period in the form of new cranial nerve deficits, monoparesis with dysphasia, and seizures. The patient with trigeminal neuralgia experienced partial relief and was readmitted later for reexploration and Gasserian ganglionectomy via the same route. Four contemporary nonoperative cases of pituitary tumor are also presented. CONCLUSION: These cases provide insight into the presentation and operative treatment of pituitary tumors during the pre-Halsted era.