Effect of transsphenoidal surgery on decreased visual acuity caused by pituitary apoplexy.

We treated 12 patients with pituitary apoplexy out of 103 patients with pituitary tumors from August 1994 to March 2008 in the Nishi-Kobe Medical Center. The male to female ratio was 1:2 and the average age was 43 years old, ranging from 19 to 73. The symptoms on presentation were a decrease of visual acuity in nine, headache in seven, endocrinological disturbance in six, visual field defect in seven, a febrile state in six, vomiting in four, oculomotor disturbance in two, abducens palsy in one, and transient altered consciousness in one. All patients underwent transsphenoidal surgery and, in four of these, surgery was conducted within 7 days after onset. All nine patients with a decrease in the visual acuity recovered (100%) and, in addition, complete or near-complete vision recovery was noted in six out of eight patients (75%), excluding one patient whom we were unable to examine accurately. Emergent surgery was performed for only two patients with an acute deterioration of the visual acuity, with one finally developing complete blindness. Based on this study, we conclude that decompressive surgery is very useful for decreased visual acuity caused by pituitary apoplexy, but it is not necessary to perform emergent surgery for pituitary apoplexy in the absence of severe visual deterioration.

[Spinal subdural abscess in the cervical region: a case report].

The authors present a patient with a spinal subdural abscess (SSA) in the cervical region and review the relevant literature. A 48-year-old man suffering from intractable high fever and back pain was admitted to our hospital with a diagnosis of meningitis. Despite antibiotic therapy, his condition deteriorated and he developed neurological deficits including left hemiparesis, sensory disturbance and bladder dysfunction. MR images of the cervical spine with gadolinium contrast revealed a circumferentially enhancing lesion anterior to the spinal cord that extended from the C4 to C6 level and compressed the spinal cord. After an urgent laminectomy extending from C4 to C6, the subdural abscess that consisted of purulent material and a thick capsule was irrigated and drained. Staphylococcus aureus was cultured from the abscess and he received antibiotic therapy postoperatively for 14 weeks. The high fever and the back pain subsided immediately and his neurologic condition gradually recovered. The majority of SSA cases involve the thoracic or lumbar region and are rarely found in the cervical region. Because they are associated with a high morbidity, early diagnosis with MRI and urgent surgical interventions including decompressive laminectomy, copious irrigation and drainage followed by appropriate antibiotic therapy are vital.

Cranial fasciitis presenting with intracranial mass: a case report.

We describe a very rare case of cranial fasciitis presenting with intracranial mass in a 3-year-old girl. There was no palpable scalp mass. CT scan and MRI demonstrated an epidural mass adherent to the dura with destruction of the inner table of the skull. The tumor was extirpated completely and the resected specimens were diagnosed as cranial fasciitis. When neurosurgeons, pediatricians and radiologists encounter an epidural tumor in a pediatric patient, cranial fasciitis should be kept in mind.

Germinoma of the basal ganglia. An 8-year asymptomatic history after detection of abnormality on CT.

We describe a case of germinoma of the left basal ganglia. An 11-year-old boy, who demonstrated calcification of the left basal ganglia on CT scan following a head injury at the age of 3 years, presented with a weakness of the right upper extremity for 2 months. MRI demonstrated high intensity in the left basal ganglia on a T1-weighted image without enhancement as well as high intensity on a T2-weighted image. Ipsilateral hemiatrophy of the hemisphere and midbrain was also noted. In addition, high intensity in the left internal capsule and cerebral peduncle was demonstrated on T2-weighted image. Surgical specimens obtained by stereotactic biopsy showed germinoma with a two-cell pattern. The patient had remained asymptomatic for 8 years after abnormal calcification was initially detected on CT scan. Ipsilateral hemiatrophy of the hemisphere and midbrain was demonstrated before the onset of weakness.