Epidermoid cysts associated with thoracic meningocele.

Intraspinal tumours of cutaneous origin associated with various spinal dysraphisms have been well documented in the literature. However, the metachronous development of intra- and extra-medullary tumours in conjunction with dorsal meningocele is rare. The authors report a patient with a thoracic dorsal meningocele and congenital intradural extramedullary epidermoid tumour. The patient developed an intramedullary epidermoid growth 12 years later. Subtotal resection of the tumour predisposed to a later recurrence. Meningocele is not always an isolated clinical entity but the concurrent occult lesions are usually veiled by the more conspicuous surface anomaly. Thorough magnetic resonance imaging of the whole neural axis helps to identify associated pathologies. Delicate intradural exploration by a microsurgical approach is necessary to achieve appropriate treatment.

Activation of BKCa channels via cyclic AMP- and cyclic GMP-dependent protein kinases by eugenosedin-A in rat basilar artery myocytes.

BACKGROUND AND PURPOSE: The study investigated whether eugenosedin-A, a 5-hydroxytryptamine and alpha/beta adrenoceptor antagonist, enhanced delayed-rectifier potassium (K(DR))- or large-conductance Ca(2+)-activated potassium (BK(Ca))-channel activity in basilar artery myocytes through cyclic AMP/GMP-dependent and -independent protein kinases. EXPERIMENTAL APPROACH: Cerebral smooth muscle cells (SMCs) were enzymatically dissociated from rat basilar arteries. Conventional whole cell, perforated and inside-out patch-clamp electrophysiology was used to monitor K(+)- and Ca(2+)-channel activities. KEY RESULTS: Eugenosedin-A (1 microM) did not affect the K(DR) current but dramatically augmented BK(Ca) channel activity in a concentration-dependent manner. Increased BK(Ca) current was abolished by charybdotoxin (ChTX, 0.1 microM) or iberiotoxin (IbTX, 0.1 microM), but not affected by a small-conductance K(Ca) blocker (apamin, 100 microM). BK(Ca) current activation by eugenosedin-A was significantly inhibited by an adenylate cyclase inhibitor (SQ 22536, 10 microM), a soluble guanylate cyclase inhibitor (ODQ, 10 microM), competitive antagonists of cAMP and cGMP (Rp-cAMP, 100 microM and Rp-cGMP, 100 microM), and cAMP- and cGMP-dependent protein kinase inhibitors (KT5720, 0.3 microM and KT5823, 0.3 microM). Eugenosedin-A reversed the inhibition of BK(Ca) current induced by the protein kinase C activator, phorbol myristyl acetate (PMA, 0.1 microM). Eugenosedin-A also prevented BK(Ca) current inhibition induced by adding PMA, KT5720 and KT5823. Moreover, eugenosedin-A reduced the amplitude of voltage-dependent L-type Ca(2+) current (I(Ca,L)), but without modifying the voltage-dependence of the current. CONCLUSIONS AND IMPLICATIONS: Eugenosedin-A enhanced BK(Ca) currents by stimulating the activity of cyclic nucleotide-dependent protein kinases. Physiologically, this activation would result in the closure of voltage-dependent calcium channels and thereby relax cerebral SMCs.

The effect of an adenosine A1 receptor agonist in the treatment of experimental subarachnoid hemorrhage-induced cerebrovasospasm.

BACKGROUND: Adenosine is a potent vasodilator and an important modulator of cardiovascular function. It has been postulated that nitric oxide (NO) is involved in adenosine-induced vasodilation. This study was designed to examine the effect of an adenosine A1 agonist, N6-cyclopentyladenosine (CPA), in the prevention of subarachnoid haemorrhage (SAH)-induced vasospasm. Method. Experimental SAH was induced in Sprague-Dawley rats by injecting 0.3 mL autogenous blood into the cisterna magna. Intraperitoneal injections of CPA (0.003 mg/kg), or vehicle were administered 5 min and 24 hours after induction of SAH. The degree of vasospasm was determined by averaging the cross sectional areas of the basilar artery 2 days after SAH. Expressions of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in basilar artery were evaluated. Findings. There were no significant differences among the control and treated groups in physiological parameters recorded before sacrifice. When compared with animals in the control group, cross-sectional area of basilar arteries areas in the SAH only, SAH plus vehicle and SAH plus CPA groups were reduced by 19% (p < 0.01), 22% (p < 0.01), and 9% (p = 0.133), respectively. The cross-sectional areas of the CPA-treated group differed significantly from those of the SAH only and SAH plus vehicle group (p < 0.05). Induction of iNOS-mRNA and protein in basilar artery by SAH was not significantly diminished by CPA. The SAH-induced suppression of eNOS-mRNA and protein were relieved by CPA treatment. Conclusions. This is the first evidence to show an adenosine A1 receptor agonist is effective in partially preventing SAH-induced vasospasm without significant cardiovascular complications. The mechanisms of adenosine A1 receptor agonists in attenuating SAH-induced vasospasm may be, in part, related to preserve the normal eNOS expression after SAH. Inability in reversing the increased iNOS expression after SAH may lead to the incomplete anti-spastic effect of CPA.

The expression of rac1 pseudogene in human tissues and in human brain tumors.

BACKGROUND: Recent studies have demonstrated that Rac is a regulator of cell morphology and growth. Rac1 gene appears to have involvement in tumorigenesis and metastatic potential. In our previous study of rac1 gene in 45 human brain tumors, rac1 pseudogene was found. The rac1 pseudogene is an intronless pseudogene and has a similarity of 86% with rac1 nucleotide sequence. The rac1 pseudogene contains 579 nucleotides and only 46 amino acids can be translated. Little is known about the expression of rac1 pseudogene in human tissues or tumors. MATERIALS AND METHODS: The expression of rac1 gene and rac1 pseudogene in different human tissues and brain tumors was investigated by the use of reverse transcriptase-polymerase chain reaction and Northern blotting. RESULTS: The rac1 gene is apparently expressed in these 8 human tissues. The rac1 pseudogene is also apparently expressed in human tissues except for brain tissue. The overexpression of rac1 gene in brain tumors was 8% (2/25) and the overexpression of rac1 pseudogene was 76.9% (20/26). Only two astrocytomas had overexpression of rac1 gene, compared with normal brain tissues. The overexpression of rac1 pseudogene was 6 of 9 in meningiomas, 7 of 9 in astrocytomas, and 7 of 8 in pituitary adenomas. CONCLUSIONS: High frequency of overexpression of rac1 pseudogene was detected in the human brain tumors when compared with that expressed in the normal brain tissues. Our study suggested that the rac1 pseudogene may play an important role of the tumorigenesis of brain.

Fracture of anterior cervical plate implant--report of two cases.

Anterior cervical plate is a convenient and popular implant employed after corpectomy and bone grafting for traumatic or degenerative cervical spine disease. Although short-segment anterior cervical surgery may adequately be managed with anterior plate fixation alone, multilevel anterior cervical constructs exhibit a relatively high complication rate warranting a simultaneous posterior fusion. We report two patients undergoing two-level anterior corpectomy/fusion with a fixed anterior plate alone and exhibiting plate fracture in conjunction with pseudoarthrosis. The instrument failure was mainly attributed to pseudoarthrosis. However, improper contouring of the plate causing microstructural damage might create a weak point and contributed to this unusual hardware failure.

Rac2 expression and mutation in human brain tumors.

BACKGROUND: Rac1 and Rac2 are interchangeable in NADPH oxidase activation. Rac1 plays an important role in regulating nuclear signalling and in the activation of transcriptional factors that regulate gene expression and cell growth. Our previous study observed mutation in effector region of Rac1 gene in brain tumors. Little is known about the expression and mutation of Rac2 in human brain tumors. METHOD: We examined the expression of Rac2 by using reverse transcriptase-polymerase chain reaction (RT-PCR) and northern blot analysis and the mutation of Rac2 gene by using DNA sequence analysis. FINDINGS: The decreased expression of Rac2 was found in 15 cases (57.7%) including 8 of 10 astrocytomas, 2 of 8 meningiomas, and 5 of 8 pituitary adenomas. Two of 13 cases with decreased expression of Rac2 had gene mutation. Only two of 26 cases had Rac2 overexpression in which no Rac2 gene mutation was found. Four of 8 cases with normal Rac2 expression had Rac2 gene mutation. The site of Rac2 gene mutation had no hot spots and was not concentrated in the effector region. CONCLUSIONS: Our results showed a low frequency of mutation and no hot spots of mutation in Rac2 gene in brain tumors, suggesting a decreased possibility of Rac2 in the brain tumorigenesis. The role of high frequency of decreased Rac2 expression in brain tumors, particularly in malignant astrocytomas, needs further investigations to be elucidated.

Simultaneous multiple hypertensive intracerebral haemorrhages.

BACKGROUND: Simultaneous occurrence of multiple intracerebral haemorrhages (ICHs) in different arterial territories is a rare clinical event which has been reported to be associated with cerebral amyloid angiopathy, venous sinus thrombosis, coagulopathy, vasculitis, haemorrhagic transformation of cerebral infarcts and multiple intracranial pathologies such as vascular anomalies or tumours. Although hypertension is the most common etiological factor for the development of spontaneous single intracerebral bleeding, its role in simultaneous multiple ICHs is not clear. METHODS: The authors have reviewed all patients with non-traumatic ICH admitted to Kaohsiung Medical University Hospital from 1993 to 2002. Ten hypertensive patients with simultaneous multiple ICHs were found. For the purpose of comparison, another 600 cases with solitary hypertensive ICH were also reviewed as a control group. Computerized tomographic scans and medical records concerning patients' histories, clinical presentations, locations of haematomas, associated risk factors, and outcome were analyzed. FINDINGS: The mean age and sex distribution were similar in both patient groups. Bilateral putaminal or thalamic haemorrhages were the most common combinations of simultaneous bleedings. As for the individual location of haematoma, there was a strong preponderance for the supratentorial space with the thalamus being the most preferable site. The duration of hypertension was longer and the percentage of previous stroke was higher in patients with multiple ICHs. Other associated risk factors were similar in both groups except for higher incidence of hypercholesterolemia in multiple ICHs group. Patients with simultaneous multiple ICHs had a much worse outcome compared to those with solitary ICH. CONCLUSIONS: As with solitary ICH, hypertension is still the most important etiological factor for simultaneous multiple ICHs. The widespread and prolonged degeneration of intracerebral arterioles predispose patients to the development of multiple ICHs, which could be justified by the longer history of hypertension and higher incidence of former strokes. Only hypercholesterolemia was identified to be significantly associated with this unusual brain event in our study. The mechanism underlying the development of simultaneous multiple ICHs is not clear although structural and haemodynamic changes of first haemorrhage may be responsible for the second one. Poorer outcome in patients with multiple ICHs can be explained by the concomitant destruction of crossing and non-crossing fiber tracts and bilateral diaschisis phenomenon.

Massive intracerebral air embolism associated with meningitis and lumbar spondylitis: case report.

BACKGROUND: Massive intracerebral air embolism is a rare pathologic state and never in association with meningitis and lumbar spondylitis. To the best of our knowledge, our presented case is the first of a massive intracerebral air embolism associated with meningitis and lumbar spondylitis of Klebsiella pneumonia. CASE DESCRIPTION: A 55-year-old man presented with a high fever and low back pain. Blood culture showed Klebsiella pneumonia. Lumbar computed tomography (CT) revealed discitis at L1-2 and L2-3 levels and paraspinal abscess in which air was found. Despite management with antibiotics, patient's consciousness deteriorated, and brain CT revealed diffuse intravenous air embolism and severe brain swelling. Cerebrospinal fluid (CSF) examination demonstrated bacterial meningitis, and the CSF culture showed Klebsiella pneumonia. Later, septic shock occurred and patient expired. CONCLUSION: Intracerebral air embolism can occur in the Klebsiella pneumonia meningitis that resulted from lumbar spondylitis and sepsis.

Spinal chronic subdural hematoma in a patient with ventriculo-peritoneal shunting after a minor trauma.

STUDY DESIGN: Case report and review of literature. OBJECTIVES: Intracranial chronic subdural hematoma (SDH) is a well-recognized complication of ventriculoperitoneal (VP) shunt. Spinal chronic SDH is very rarely associated with VP shunt. SETTING: Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. CASE REPORT: We describe a spinal chronic SDH, developing after a minor trauma, in a patient who underwent a VP shunt surgery for hydrocephalus 6 months previously. A good outcome was achieved after decompressive surgery. CONCLUSION: Spinal chronic SDH should be considered in the diagnosis of progressive spinal compression, especially in the patients with VP shunt after minor trauma.

Factors influencing seizures in adult patients with supratentorial astrocytic tumors.

Seizures and epilepsy in adults are important and increasingly common clinical problems. Despite this, the investigation of seizures in adults with astrocytic tumors remains a grey area. The incidence and influencing factors of preoperative and postoperative seizures were evaluated in 101 patients of 45 years or older with supratentorial astrocytic tumors. Preoperative seizures occurred in 14 (14%) patients. Seizures at presentation were significantly correlated with pathological grades of astrocytic tumors (p = 0.0318). The risk of seizures at presentation was greatest in patients with well-differentiated astrocytomas as compared with anaplastic astrocytomas (Odds ratio = 4.364, p = 0.056) or glioblastomas multiforme (Odds ratio = 5.673, p = 0.007). There was no association of preoperative seizures with age, sex, location or site of the tumors. Postoperative seizures occurred in 18 (18%) patients, including 8 (8/14, 57%) recurrent seizures and 10 (10/87, 12%) late-onset seizures. Postoperative seizures were significantly correlated with the presence of preoperative seizures (p = 0.0003). The presence of preoperative seizures was potentially predictive of postoperative seizures when evaluated by logistic regression model (Odds ratio = 6.650). Thirteen (72%) of 18 patients with postoperative seizures were associated with tumor recurrence in 7 cases, hemorrhage in 3 cases and malignant progression in 3 cases. There was no association of postoperative seizures with age, sex, location or site of the tumors, grades of tumors, type of preoperative seizures, duration of preoperative seizures, serum level of anticonvulsant drug, extent of surgery, postoperative radiation or chemotherapy. The patients with preoperative seizures had a higher risk of postoperative seizures and should be carefully monitored. Imaging examination of brain to exclude the possibilities of tumor recurrence or hemorrhage is warrantable in supratentorial astrocytoma patients with postoperative seizures.

Rac1 gene mutations in human brain tumours.

AIMS: Rac1 is a member of the Ras superfamily of small GTPase and plays a fundamental role in cytoskeleton reorganization, regulation of gene expression and cell proliferation, and cellular transformation. Though recent studies point to an involvement of rac1 in tumorigenesis, little is known about the alteration of rac1 gene in human brain tumours. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR), TA cloning, and DNA sequencing were performed to detect rac1 gene mutations in the surgical specimens of 45 human brain tumours. RESULTS: Twelve of 45 cases had base changes in the rac1 gene. The frequency of rac1 alterations was seven of 18 meningiomas, three of 14 astrocytomas, one of seven pituitary adenomas, and one of four metastatic brain tumours. No mutation was detected in acoustic neurilemomas. The subtypes of seven meningiomas include three meningotheliomatous, two atypical, one transitional and one angioblastic meningioma. Three astrocytomas had rac1 gene mutation, including one grade II, one grade III, and one grade IV astrocytoma. All of single base changes were transitions, five of them being T to C transitions. Sites of rac1 mutation were found in codons 34, 41 (two cases), 42 (two cases), 43, 44, 46 and 58. These mutations are mainly localized in the putative effector-domain of rac1 gene and may enhance the activity of rac1, which increases the survival of brain tumours. CONCLUSION: Our results suggest that rac1 gene may play a role in some brain tumours of divergent histogenesis and that the alterations of rac1 gene may contribute to tumorigenesis and/or metastasis.

The conditional probabilities of survival in patients with anaplastic astrocytoma or glioblastoma multiforme.

BACKGROUND: By the use of conditional probabilities of survival, we studied the yearly survival rates for individual tumor survivors. METHODS: Conditional survival rate was estimated in 114 consecutive patients with anaplastic astrocytoma or glioblastoma multiforme. Conditional probabilities of surviving some years given survival to a specific period of time after craniotomy and 95% confidence intervals were calculated in the individual tumor survivors. RESULTS: The estimated median survival was 30 months for 45 patients with anaplastic astrocytoma and 12 months for 69 patients with glioblastoma multiforme. The conditional probabilities of surviving next one year given survival to 1 year, 2 years, 3 years, 4 years, or 5 years after craniotomy for anaplastic astrocytoma were 86.2%, 75.0%, 85.9%, 77.8%, or 85.7%, respectively; for glioblastoma multiforme 64.8%, 58.7%, 85.7%, 80.0%, or 75.0%, respectively. The conditional probability of surviving to 5 years given survival to 2 years after craniotomy for anaplastic astrocytoma, i.e., surviving an additional 3 years, was 50.1%, which was better than observed 5-year survival rate (28.6%); for glioblastoma multiforme it was 40.2%, which also was better than observed 5-year survival rate (12.4%). CONCLUSIONS: The conditional probability of survival was a good method to clinically predict yearly survival rate for individual tumor survivors. In addition, the method can estimate the probabilities of surviving next some years given survival to a specific period of time after craniotomy. It also showed a more encouraging result than observed survival rate in patients with supratentorial malignant astrocytomas.

Alteration of ischemic reperfusion injury in the rat neocortex by a potent antioxidant mexiletine.

The mechanisms by which mexiletine exerts its effects in increasing myocardial circulation, and smooth muscle perfusion and alleviating diabetic neuropathic pain have been widely discussed. The purpose of this study was to examine the protective effect of this compound in ischemia/reperfusion-induced cerebral injury following middle cerebral artery occlusion in Sprague-Dawley rats. Blood flow to the left cerebral hemisphere of the animals was interrupted by occluding the left cerebral artery and both carotid arteries simultaneously for 3 hrs. These animals were assigned to one of ten groups and divided into treatment group and pretreatment group; 1) control treatment group (n=8); 2) vehicle treatment group (n=8); 3) lower dose mexiletine (400 microg/kg) treatment group (n=8); 4) medium dose mexiletine (800 microg/kg) treatment group (n=8); 5) high dose mexiletine (2 mg/kg) treatment group (n=8); 6) control pretreatment group (n=8); 7) vehicle pretreatment group (n=8); 8) lower dose mexiletine (400 microg/kg) pretreatment group (n=8); 9) medium dose mexiletine (800 microg/kg) pretreatment group (n=8); and 10) high dose mexiletine (2 mg/kg) pretreatment group (n=8). The volume of cerebral infarction was measured in serial brain sections stained with triphenyltetrazolium chloride (TTC). Tissue infarction volume and tissue edema were estimated for each animal. The volume of cerebral infarction was significantly decreased in rats pretreated with mexiletine, and the ratio of tissue edema was also decreased as the dose of mexiletine increased. These results demonstrate that mexiletine, an anti-arrhythmic and use-dependent Na+ channel blocker, has protective effects in stroke at concentrations sufficient to confer significant protection, as measured by the volume of infarction and brain edema index in a model of focal, neocortical ischemia in Sprague-Dawley rats.

Preoperative and postoperative seizures in patients with astrocytic tumours: analysis of incidence and influencing factors.

To evaluate the incidence and influencing factors related to preoperative and postoperative seizures, a retrospective analysis was performed in 190 patients with astrocytic tumours. Preoperative seizures occurred in 50 (26%) patients and 27 (54%) of the m had recurrent seizures. Late-onset seizures developed after craniotomy in 11 (8%) of 140 patients. Seizures at presentation were significantly correlated with age at diagnosis (P=0.0204) and pathological grade of tumour (P=0.0040). The patients aged less than 40 years had a high risk of seizures at presentation (odds ratio=3.076, P=0.0134). Postoperative seizures were significantly associated with the presence of preoperative seizures (P<0.0001), type or duration of preoperative seizures (P<0.0001, P<0.0001, respectively) and serum level of anticonvulsant drug (P=0.0068). However, only the presence of preoperative seizures had a potential for prediction of postoperative seizures when evaluated by logistic regression model (odds ratio=20.859, P=0.0001). Fifty-nine percent of patients with recurrent seizures and 64% of patients with late-onset seizures had seizures which occurred within 6 months after craniotomy. Despite therapeutic anticonvulsant levels, most postoperative seizures were associated with tumour recurrence or haemorrhage. Postoperative seizures commonly occurred relatively soon after craniotomy and prophylactic anticonvulsants should be given. In patients with postoperative seizures, particularly in the presence of therapeutic anticonvulsant level, brain computed tomography should be performed to exclude tumour recurrence or haemorrhage.

Prevention of cerebral vasospasm by a capsaicin derivative, glyceryl nonivamide, in an experimental model of subarachnoid hemorrhage.

BACKGROUND: Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) remains a major complication in patients suffering from SAH. In our previous study, we reported that stimulating vascular K(+) channel activity prevented the development of cerebral vasospasm. Recent evidence indicates that glyceryl nonivamide (GLNVA), a capsaicin derivative, has a vasorelaxant effect on the aortic vascular smooth muscle due to the release of coronary calcitonin gene-related peptide, which in turn stimulates K(+) channel opening. The purpose of the present study was to examine the preventive effects of GLNVA on vasospasm. METHODS: New Zealand white rabbits were subjected to experimental SAH by injecting autologous blood into the cisterna magna. GLNVA or vehicle was injected intrathecally immediately after the induction of SAH. All animals were killed by perfusion-fixation at 48 hours after SAH. The basilar arteries were removed and sectioned, and their cross-sectional areas were measured. RESULTS: The average cross-sectional areas of basilar arteries were reduced by 69% and 71% in the SAH only and SAH plus vehicle groups, respectively, when compared with the healthy controls. After treatment with 0.35, 1.75, and 3.5 mg/kg GLNVA in rabbits subjected to SAH the average cross-sectional area was decreased by 46%, 12% and 2%, respectively, when compared with the healthy controls. The protective effect of GLNVA achieved statistical significance at all dosages. Morphologically, corrugation of the internal elastic lamina of vessels was often observed in the vehicle-treated group, but was not prominent in the GLNVA-treated groups or healthy controls. CONCLUSION: The findings showed that GLNVA dose-dependently attenuated cerebral vasospasm after SAH in the rabbit. These results suggest that intrathecal administration of GLNVA could be an effective strategy for preventing cerebral vasospasm after SAH.

Trigeminal neuralgia caused by nasopharyngeal carcinoma with skull base invasion--a case report.

We report a case of nasopharyngeal carcinoma with skull invasion, whose chief complaint was left-sided facial pain, which mimicked trigeminal neuralgia, and in whom there was no palpable neck mass. The magnetic resonance imaging (MRI) revealed an infiltrated lesion with abnormal signal intensity in the left nasopharynx, involving the left retro- and parapharyngeal space. The lesion was pathology-proven through biopsy of the nasopharynx to be a non-keratinizing carcioma. The patient received 6000 rad radiotherapy combined with 5-Fluorouracil(5-FU) and Cisplatin, and has been well after 2 years' follow-up.

Traumatic lumbar spinal subdural hematoma--a case report.

A 74-year-old woman suffered from lower legs weakness after a motor vehicle accident. Magnetic resonance imaging (MRI) on the seventh posttraumatic day, revealed a lumbar spinal subdural hematoma at the level of L4-5. After surgical intervention to remove the subdural hematoma, the patient made a complete recovery.

Effects of endothelin-converting enzyme inhibitors on hemolysate-induced morphological changes and production of endothelin-1 in bovine cerebrovascular endothelial cells.

The effects of CGS 26303, a dual inhibitor of endothelin-converting enzyme (ECE) and neutral endopeptidase 24.11, and its prodrug, CGS 26393, on bovine cerebrovascular endothelial cells stimulated with hemolysate were investigated. Upon incubation with hemolysate for 48 h, cell density was significantly decreased, with concomitant increases in endothelin-1 (ET-1) (42 vs 11 pg/ml) and big ET-1 (79 vs 27 pg/ml) levels in culture medium when compared with controls. Simultaneous addition of CGS 26303 (10 and 100 microM) and hemolysate protected against cell loss and decreased cellular vacuolization caused by hemolysate. The levels of ET-1 and big ET-1 in the culture medium were decreased dose-dependently. More drastically, pretreatment with 100 microM CGS 26303 for 30 min decreased the production of ET-1 and big ET-1 by 94% and 87%, respectively, when compared with the untreated control. However, treatment with CGS 26393 was much less effective. These results suggest that suppression of ET-1 production by ECE inhibitors may prove to be efficacious for the treatment of hemolysate-induced cytotoxicity on cerebral endothelial cells.

Follow-up of invasive pituitary macroadenoma in 56 patients within a duration of 5 years.

From June 1986 to September 1996, 56(30%) patients with invasive pituitary macroadenoma were studied retrospectively. We compared the clinical and endocrinological characteristics, neuroimaging findings, and surgical outcome of these patients in a period of follow up of 5 years. Twenty-one patients (38%) were found to have a prolactinoma, 8 patients (14%) had a GH-producing adenoma, and 27 patients (48%) had non-functional tumors. Pituitary apoplexy was found in 16 cases (29%). Their age ranged from 15 to 72 years and no sex difference (F:M = 27:29) was found. According to Hardy's classification, all the 56 tumors were invasive pituitary macroadenoma, of a tumor size more than 10 mm with sellar floor erosion partially or diffusely or paracarvenous sinus invasion. Those tumors were divided into grade III (tumor causing localized perforation of the sellar floor), and IV (tumor destroying entire sellar floor diffusely); the tumors were further subdivided into stage C (3rd ventricle grossly displaced), D (intracranial intradural extension) and E (tumors invading the cavernous sinus through the lateral dural envelope of the sellar). Eight out of 56 tumors belonged to grade III stage C, 18 tumors were grade III stage D, 8 tumors were grade IV stage D, and the other 22 were grade IV stage E. Fifty-one patients received transsphenoidal craniectomy for tumor removal, one patient took subfrontal craniotomy only and 4 cases received both. Most patients improved significantly in visual field and general quality of life after surgery. In this study, it was concluded that: 1) surgical intervention as quick as possible was proven advantageous, especially in patients with an invasive macroadenoma; 2) in cases with invasive pituitary macroadenomas, the patients, with grade III and IV tumors, had a longer symptom-free interval than those who refused surgical intervention and radiotherapy with the same grade tumor; 3) to achieve satisfactory late results, multidisciplinary treatment was necessary: post-operative radiotherapy ranging from 4500 to 6500 rads was done in 50 patients, endocrine therapy in 52 patients and adjunct bromocriptine treatment was done in 13 patients with prolactinomas; 4) symptomatic recurrence or elevated postoperative hormone levels occurred in 20(35%) cases. There was a high incidence of recurrence in 6(6/20) GH-secreting tumors, and in 8(8/20) prolactinomas with preoperative prolactin levels more than 200 eta g/dl.

The change of relative incidences of intracranial tumors after the use of computed tomography in Taiwan.

The improved diagnostic capacity of computed tomography (CT) may have resulted in improved detection of intracranial tumors. We were interested to know whether the frequency of intracranial tumors has changed after the introduction of CT in Taiwan. The relative incidences of intracranial tumors in Taiwan were analyzed from the hospital based data. Our data showed that meningiomas were the most encountered intracranial tumors. Neuroepithelial tumors in our series (in the post-CT era) (23.9%) were apparently lower than those found in the pre-CT era (36.0%). However, the relative incidences of meningiomas and pituitary adenomas after the use of CT (24.2%, 21.1%, respectively) were much higher than those found before the use of CT (14.5%, 7.7%, respectively). Our data suggest that the increased incidence for benign tumors and the decreased incidence for malignant tumors may have resulted from the improved diagnostic capacity of CT, which reduces the number of undetected tumor cases.