Tratamento cirúrgico dos tumores da regiäo pineal: (85 casos operados por via occipital supra-transtentorial) / Surgical treatment of tumors of pineal region: (85 cases operated with occipital supra-transtentorial approach)

Foram analisados 85 pacientes operados de Tumores da Regiäo Pineal, entre 1970 e 1984. A abordagem utilizada em todos estes pacientes foi a via Occipital Supra-Transtentorial, segundo a técnica de Poppen, com algumas modificaçöes pessoais. Enfocamos neste estudo as vantagens desta via de acesso o complexo problema das derivaçöes do LCR, as indicaçöes de Radioterapia, os fatores de prognóstico e a qualidade de vida destes pacientes operados. Entre os 85 pacientes operados durante estes 15 anos, 27 faleceram e os outros 58 continuam vivos. Entre os sobreviventes; 2 possuem uma vida vegetativa, 3 estäo com severas deficiências, 15 possuem deficiências outras, mesmo que menores mas que lhes impedem de seguir normalmente suas ocupaçöes anteriores, entretanto estes pacientes näo necessitam de nenhum cuidado especial

Indication and contraindication for surgery of spontaneous intracerebral hematomas. Therapy and results.

The indication for surgery in spontaneous intracerebral hematoma is given when, in spite of the administration of dexamethasone in high dosage, an improvement of the initial neurological symptoms could not be observed, or if a worsening is seen. With the help of CT the size of the hematoma could be controlled so that if in comparison to initial findings an increase in mass displacement or herniation is observed, surgery should be performed immediately. In cases of deep coma with vegetative unstable states, as well as in cases of bleeding into the basal ganglia, surgery is contraindicated.

[The indication to neuro-surgical intervention in higher age (author's transl)]. / Die Indikation zum neurochirurgischen Eingriff im höheren Lebensalter.

Higher life expectancy has entailed the necessity of treating syndromes in the age group over 60 more frequently. Therapy also includes surgical intervention in general and neurosurgery in particular. References in literature and cases from our own hospital showed that the necessity of performing surgery was extended to include persons of advanced age. Growing life expectancy during the last few decades was accompanied by an improvement in surgical techniques, in the substitution therapy of age-dependent dysfunctions, and the development of careful up-to-date anaesthesia. Good interdisciplinary cooperation resulted in a decisive reduction of the intra- and post-operative mortality rate, even if patients of higher age groups who underwent the selected major neuro-surgical interventions yet have twice the mortality rate (24 per cent) of patients under 60 (11.4 per cent). Early diagnosis is the weakest link in this chain. Cerebral and spinal symptoms in older people are often attributed to age-dependent factors of the vascular system. The space--occupying process is often recognized too late. Once the function of the CNS has failed, even risky interventions cannot bring about a favourable change in the disease.

Loss and recovery of vision with suprasellar meningiomas.

Central visual acuity losses were documented in a group of 23 patients with surgically and histologically verified suprasellar meningiomas. The pattern demonstrated was that of acute, gradual or fluctuating loss in one eye, followed by later loss of central acuity in the other eye. Both optic nerves and chiasm were invariably involved either by stretching or compression. Neither preoperative field abnormalities nor central acuity deficits could be correlated with the anatomical location of the tumor, nor could postoperative changes in vision be correlated with tumor size. Lengthy duration of acuity loss and severe visual deficit did not preclude postoperative recovery of vision. Improvement in sight most frequently occurred within the first several weeks after operation, and further return of vision was not noted after 1 year.