[Spatial localization of sources of slow EEG activity by the equivalent dipole method]

Coordinates and moments of equivalent sources of various kinds of slow activity--local, generalized and synchronous (delta- or theta-ranges) -- were estimated on a computer on the basis of a model of single equivalent dipole, by the method of the coordinates descent. Investigation of local delta-activity caused by a volume process in the brain shows that its localization coincides with the peripheral zone of the tumour. Localization of the delta-focus enables to indicate its position not only on the surface, but in the depth of the brain as well. The dipole localization method helps to specify the concept of "secondary" slow waves and to differentiate slow activity of total brain-, brain-stem and local nature.

Indications and methods for performance of osteoplastic-obliterative frontal sinusotomy with a description of a new method and some remarks upon the present state of the are of external frontal sinus surgery

The Goodale-Montgomery osteoplastic obliterative frontal sinusotomy has been the ultimate resource in America for the most difficult and intractable cases of frontal sinusitis. This operation respects the integrity of the frontal floor and is based upon a concept with which the author disagrees: that the frontal sinus may be treated as an entity quite separate form the ethmoid. Macbeth, who does not obliterate, avails himself of the excellent transfrontal approach to the ethmosphenoids, but breaches the frontal floor in so doing. American surgeons have not followed his lead. The pros and cons of obliteration are discussed, reviewing relevant clinical and experimental data. The author believes that Macbeth's operation is more rational and effective than Goodale's. In an effort to utilize it and have the benefits of an obliterative technique, he employs a composite fat-fascia lata graft which prevents prolapse of fat down into nose and ethmoid. Three cases are briefly reported.

Meningitis complicating transsphenoidal hypophysectomy

The case records of 98 patients who underwent a transsphenoidal hypophysectomy between 1969 and 1979 were examined to establish the frequency of postoperative cerebrospinal rhinorrhea and meningitis. There were seven cases of rhinorrhea and six of meningitis following the procedure. Five of the six patients with meningitis had diabetes mellitus and three of the seven with rhinorrhea had meningitis; thus, both diabetes and rhinorrhea were established as significant risk factors (P less than 0.001) in the development of meningitis after this operation. There were two proven cases of meningitis due to anaerobic organisms and a further two suspected cases. The prophylactic use of antibiotics did not prevent the development of meningitis in this series of patients.

[Orbital phlebography craniobasal meningiomas spreading into the orbit]

Analysis of the results of orbital phlebography performed in 39 patients with cranio-orbital meningiomas testifies to the important diagnostic value of this methods of examination in determining the spread of craniobasal meningiomas to the orbit. By means of orbital phlebography it is possible not only to precisely define the topography of the new growth in the orbital cavity, but to reveal disorders of venous drainage from the orbit and collateral tracts which provide the draining function of the superior ophthalmic vein.

Transsphenoidal hypophysectomy in disseminated breast cancer

Sixty patients with metastatic breast cancer had transsphenoidal hypophysectomy at Emory University Hospital. Median survival for the entire group was ten months. Survival was increased (longer than 14 months) in good responders as compared to nonresponders (three months). Pain was significantly relieved in the majority of those patients who had severe pain. Operative complications were minimal. The technic of transsphenoidal hypophysectomy offers a substantial chance of objective and subjective palliation with minimal morbidity in advanced breast cancer.

Invading meningiomas of the sphenoid ridge

The authors report a series of 34 meningiomas of the sphenoid ridge. Eight tumors were totally removed uneventfully: two from the middle sphenoid ridge and six from the pterion or Sylvian point. Five tumors were not operated on because of their extensions or the patient's age. Twenty-one tumors raised serious surgical problems, resulting in a classification into three groups: deep or clinoidal, invading beyond the sphenoid wings, and a combination of both. Histological study of the hyperostotic bone showed meningiomatous cells in the bone in 12 of 13 cases so examined. Surgical limitations included invasion of the cavernous sinus (15 cases), of the dura mater of the sella turcica (seven cases), of the lateral part of the sphenoid body at the insertion point of the ala magna (seven cases), and of the common tendinous annulus of Zinn in the orbit (five cases), and basilar extracranial extension, particularly in the pterygomaxillary fossa (three cases). Following extensive removal, there were no early recurrences and three late recurrences (9 years and more). In 13 cases with a follow-up period of 1 to 8 years, there were no clinical recurrences. In only two cases was the meningioma totally removed. There were three postoperative deaths, two cases of hemiparesis with aphasia and epilepsy, one case with a frontal lobe syndrome, and nine with slight oculomotor, visual, or esthetic sequelae.

[Immediate and remote results of surgical treatment of meningioma in the area of the small wing of the sphenoid bone]

Symptoms and therapeutic results are reported in 21 cases of the sphenoidal ridge meningiomas. These meningiomas are usually not recognized in an early stage of typical of intracranial tumours. Headaches as an early symptoms were the complaint in only 10 cases. In the stage of clinical manifestations 9 patients had no visual disturbances, in 4 cases the eye fundus was not changed, in 13 there were no visual field defects. Unilateral exophthalmos was present in 5 cases, radiological changes in 13. The first five patients operated upon under local anaesthesia were lost, but out of the remaining 16 patients operated upon under general anaesthesia only 1 died of septicaemia three weeks after the operation. A considerable facilitation of the operation was the sitting position of the patients which make possible a good insight into the operation field (Fig. 1). At the time of collecting data about the fates of the patients 10 lived without help, six of them returned to their previous occupations, and 4 other ones were partly disabled because of poor visual acuity. Two patients required continuous care because of frequent epileptic seizures. One patient had recurrence after 3 years and was treated surgically again with success.

Prolactin-secreting pituitary adenomas in males: transsphenoidal microsurgical treatment

Fifteen male patients with prolactin-secreting pituitary adenomas were studied before and after transsphenoidal microsurgical treatment. Loss of libido and sexual impotence were the most frequent symptoms, being present in 12. Visual defects were present in seven patients, gynecomastia was observed in four and galactorrhea was noted in three. Most of the tumours were large; only one was a microadenoma. Four patients were cured by the operation. In all the other patients the plasma levels of prolactin were significantly lowered and the visual defects corrected or lessened, but sexual impotence was not modified. No important deficiency of the pituitary gland was induced by the operation. The results indicate that in males loss of libido and sexual impotence are frequent and early manifestations of prolactinomas, and that transsphenoidal resection is a safe therapeutic approach.

[Functional results of transsphenoidal selective adenomectomy in acromegaly (40 cases)]

Forty acromegalic patients were investigated before, during and after transsphenoidal selective adenomectomy. Pre- and post-operative studies were based on HGH basal levels, OGTT, TRH and LRH stimulation tests, while HGH plasma variations were measured during operation. Selective adenomectomy normalized HGH levels in 70% of all cases (89.5% in grades I-II and 52.4% in grades III-IV); moreover in these cases, OGTT documented normal control of GH secretion. Per-operative GH levels evolution proved to be of pronostic value. Stimulation tests demonstrated normal regulation of other pituitary functions.

Sphenooccipital chordoma presenting as a nasopharyngeal mass. A case report

While the nasopharynx is most commonly regarded by the otolaryngologist as a primary site of neoplastic involvement, it is also an avenue of spread of base-of-the-skull tumors presenting as bulging nasopharyngeal masses. The temporal sequence of clinical signs and symptoms may reliably predict the origin of a ventrally extending sphenooccipital chordoma seen on a nasopharyngeal examination. This tumor may cause extensive bony erosion of the petrous apex, sphenoid sinus, and clivus and may suggest a more rapidly growing and aggressive tumor type. The extent of the tumor may be accurately determined by conventional tomography, computerized axial tomography, and arteriography. Severl surgical approaches including the infratemporal fossa approach, transoral transpalatal approach and rhinoseptal transphenoidal approach may be appropriately utilized singly or in combination to remove this tumor in whole or part; however, the rhinoseptal transphenoidal approach is emphasized and regarded as the most rational treatment plan for subtotal resection, recognizing the usual futility of an en bloc resection with its associated high morbidity.

Computed tomography of sphenoid wing meningiomas: tumor location related to distal edema

A review of the computed tomography and clinical characteristics of a series of sphenoid wing meningiomas revealed a high incidence of edema involving the ipsilateral cerebral hemisphere. This edema frequently accounted for the clinical presentation indicating the non-localizing insidious nature of these tumors. The etiology of the edema appears to be related in parts to the location of tumor in the middle cranial fossa and its proximity to the major venous pathways of this area.

[Computer tomography in unilateral exophthalmos caused by an osteomas of the orbital wall (author's transl)]

A 67-year-old woman patient presented with protrusion of the right globe of unknown origin. Computer tomography revealed a probably benign space-occupying lesion (osteoma) originating in the orbital wing portion of the sphenoidal bone and extending to the orbital roof of the frontal bone.

Planum sphenoidale meningioma. Attachment and blood supply

By reviewing clinical and radiological data and surgical findings of 35 so-called "olfactory groove meningioma" cases, the authors conclude that this is not a homogenous group. According to the attachment and blood supply they differentiate two varieties, the planum sphenoidale meningioma (PM) and the olfactory meningioma (OM). It seems possible to distinguish both groups clinically and with regard to the localization of hyperostosis and pneumencephalographic and angiographic findings.

Growth of condylar, epiphyseal and spheno-occipital synchrondrosal cartilages cultured on medium BGJ

The purpose of this experiment was to examine the growth of condylar, epiphyseal, and spheno-occipital synchrondrosal cartilages cultured on medium BGJ. Materials from 12 neonatal rabbits were cultured for 7 days on this medium with the addition of 0, 10, or 20% fetal calf serum. Epiphyseal cartilages cultured with the addition of 20% fetal calf serum showed slightly better maintenance of in situ state, though little morphological changes were observed during 7 days. Spheno-occipital synchondrosal cartilages cultured with the addition of 10% or 20% fetal calf serum were histologically relatively similar to in situ state than those cultured without fetal calf serum, but no growth in length and width of these cartilages was observed. On the other hand, cultured condylar cartilages showed the least maintenance of histological and histochemical features. It was assumed that medium BGJ was not a recommendable medium for the organ culture of condylar cartilage.

False aneurysm of the cavernous carotid artery and progressive external ophthalmoplegia after transsphenoidal hypophysectomy. Case report

A case is reported in which a large false aneurysm and small associated fistula formed in the cavernous carotid artery as the result of laceration at the time of transsphenoidal surgery. The clinical syndrome associated with the enlarging mass and the surgical management of the lesion itself are described. The value of the midline approach to the sella is stressed, along with anatomical variants of the carotid artery.

Sphenopalatine (nasal) ganglion: remote effects including "psychosomatic" symptoms, rage reaction, pain, and spasm

Many articles implicate the nasal ganglion in the production of remote symptoms and discuss treatment. Symptoms are primarily spastic, involving both visceral and voluntary muscles including muscle spasm in the neck, shoulder, and low back; asthma, hypertension, intestinal spasm; diarrhea, angina pectoris, uterine spasm; intractable hiccup, and many others. All these symptoms appear to have 2 common denominators. They are mediated by the autonomic nervous system and at least in some instances can be "psychosomatic." The sphenopalatine ganglion (SPG) is a major autonomic ganglion located superficially in the pterygopalatine fossa, with major afferent distribution to the entire nasopharynx and important connections with the trigeminal nerve, facial nerve, internal carotid artery plexus of the sympathetic nervous system and, as shown in the rat, direct connection with the anterior pituitary gland. This paper presents arguments supporting the following hypotheses: 1. The SPG probably has a crucial role in lower animals in declenching the reflex responses known collectively as the rage reaction. 2. The SPG is a major point of entry to the autonomic system exposed to pathologic influences and readily accessible for therapeutic influences and readily accessible for therapeutic intervention. 3. A wide variety of symptoms are produced or maintained by alteration in autonomic system tonus and some of these may be affected by intervention on the SPG. 4. The possible relationship of some symptoms and "psychosomatic" conditions to the autonomic nervous system and the rage reaction must be considered.20

Selective transsphenoidal adenomectomy in women with galactorrhea-amenorrhea

Thirty women with prolactin (PRL)-secreting adenomas underwent selective adenomectomy via a transsphenoidal route. All had abnormal sella polytomes or visual fields, amenorrhea with low basal serum gonadotropin levels despite decreased serum estradiol concentrations, and elevated basal serum PRL levels with blunted PRL response to neuroendocrine stimulation tests )thyrotropin-releasing hormone, levodopa, chlorpromazine, and hypoglycemia). Of 17 patients with microadenomas, 14 (82.4%) were cured and three (17.6%) improved. None were unchanged or worse. Three (60%) of five patients with larger, but still intrasellar tumors, had normalization of PRL levels, return of menses, and resolution of galactorrhea. The patients with tumors extending out of the sella did not fare as well. Overall, 21 (70%) were cured, six (20%) improved, two (6.7%) were unchanged, and the condition of one (3.3%) became worse. All preoperative neurologic deficits resolved. Postoperative complications were minimal with no neurologic morbidity. When tumors are small, surgical results are excellent with minimal risk.