Asymptomatic chromophobe adenoma in an eight-year-old child biopsied by stereotaxic technique and treated with cobalt-60. Case report

Modifications of transnasal and transoral stereotactic procedures--technical notes

Stereotactic transnasal and transoral procedures have been reported by different authors in the past. In this paper, several modifications of these methods are described. The modifications are: transnasal approach to the frontal skull base and suprasellar regions; and transoral approaches to the clivus, the petroclival junction, medial part of the cerebellopontine angle and the lateral mass of C-1. Eleven patients were operated on using these modifications. The procedures were for biopsy and brachytherapy. No complications resulted from the procedures.

Pituitary adenomas with onset during puberty. Features and treatment

From a series of 207 patients with pituitary adenoma operated on by microsurgical technique from 1973 to February, 1982, the cases of nine young people whose symptoms had appeared between the ages of 11 and 15 years are presented. The most important data are that all the children were pubertal and that in seven the tumor was, or later became, invasive. By contrast, the tumor was enclosed in eight of nine other patients whose symptoms manifested between the ages of 16 and 20 years, and in 152 of the remaining 189 patients whose symptoms appeared after the age of 20 years. Considering the gravity of the disease treated, the results in this series may be termed encouraging. The treatment was multidisciplinary: starting with surgery, followed by radiotherapy, endocrine replacement therapy, and, in adenomas secreting prolactin and/or growth hormone, medical therapy with bromocriptine. The divergence between authors on the subject of childhood adenomas, especially as to whether they are more often invasive or enclosed, could be overcome, at least in part, if the term "pediatric age" were unequivocally defined and if there were an agreed distinction between puberty and childhood on the one hand and puberty and adolescence on the other.

Stereotactic biopsy of intracranial space occupying lesions

The results of stereotactic biopsies of intracranial expanding lesions with narrow instruments both prior to and during the CT era are evaluated in 345 patients. Eighty-four cystic lesions were needled and roughly classified. Small, cystic, or solid tumours in anatomically well-defined areas such as the sellar, the third ventricle, and the pineal regions were as easily punctured and classified without as with CT scanning. When larger tumours in different compartments were punctured the biopsy verification rate increased from 55% towards 91% if an enhanced CT investigation was included. A stereotactic biopsy is a fairly safe procedure, yielding in this series a mortality less than 1% and a morbidity of 2.3%.

The value of computed tomography in the radiotherapeutic management of juxtasellar tumors

Computerized tomography has proven to be extremely useful for accurate tumor localization and precise assessment of tumor extent in the juxtasellar region. A reconstruction and display system with ACTA scanner provides three-dimensional images from the serial two-dimensional sections. With this method, one can determine the volume and actual contour of the tumor. Using the ACTA scanner, both transaxial and coronal sections of the tumor can be precisely portrayed with accurate dimensions. With the aid of CT treatment planning, we have been successfully treating such radiocurable tumors as pituitary adenomas, germinomas, craniopharyngiomas and optic gliomas.

Pituitary adenomas of adolescents

A review of four cases of chromophobe adenomas in adolescents suggests that extracapsular extension with invasion of parasellar structures is more common in this age group than in adults. A syndrome of adolescent obesity, oculomotor palsies, and plain x-ray changes of the sella characterizes this group.

Stereotaxic diagnosis and treatment of intracranial tumors including an initial experience with cryosurgery for pinealomas

✓ With use of the Todd-Wells stereotaxic unit and appropriate biopsy needles, confirmation was obtained of the preoperative diagnosis in 25 of 31 deep-seated intracranial tumors. Selective criteria, preoperative evaluation, and the method of biopsy are described, and the advantages of stereotaxic biopsy discussed. The successful addition of stereotaxic cryosurgical treatment of two pinealomas following biopsy is briefly reported.