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Objectives: Pituitary adenoma represents the most frequent tumour encountered in the sellar region. We have proposed to review the principles of diagnosis and treatments and to analyze their standard protocol of approaching pituitary lesions. Material and method: We have retrospectively analyzed the cases of pituitary adenoma between Jan 2006 and Dec 2010, we studied presenting symptoms, hormonal status, local extension, surgical approach, tumor histology, type of resection, tumor volume, cavernous sinus invasion, surgical corridors, recurrence rate, intra operative and postoperative complications Results: 72 patients were included in the study, with no significant difference between sexes, the pathology was dominated by pituitary macro adenomas in 47 cases, regarding the hormonal status 51.3% were non secreting pituitary adenomas, the rate of operability in our series was 65.2%, the surgical indication has been given mainly by the hormonal status and involvement of the optic apparatus which in our series was 51%, the invasion of the cavernous sinus has been appreciated according the Knosp criteria (7) and grade 3 and 4 was present in 44% of the cases. The most used surgical approach was the pterional approach in 83% and the remaining 17% by the transsphenoidal approach. The most frequent surgical corridor was represented by the prechiasmatic route in 54%, gross total resection was achieved in 51%. The most frequent postoperative complication encountered in our series was represented from systemic complication the meningitis 13%, as for endocrine complication it was represented by transitory diabetes insipidus in 23.4% and SIADH in 4.2% (2 cases). The follow up at 3 months showed no cases of early recurrence, from the group of patient with STR 6 were sent to radiotherapy. The follow up at 1 year has comprised 3 deaths, 3 cases of hydrocephalus treated with ventriculoperitoneal derivation, 19 cases were with no imagistic or clinical symptoms of tumour and 22 presented with imagistic evidence of stable residual tumour with no clinical symptoms. Conclusions: The main surgical indication in pituitary adenomas is represented by the secreting hormonal status of the patient (excepting prolactin secreting tumours) and the impairment of the vision. The most frequent surgical approach was represented by the transcranial (pterional) approach due to the large dimensions and invasiveness of the tumours presented in our series but also the surgical team preference (in the absence of intracranial endoscopy at those times). more...

Authors describe a giant intradiploic epidermoid cyst of the cranial vault with massive intra- and extracranial extension and analyze the clinicopathological, imaging features and treatment of these lesions in the light of the most important published data. A 38-years old male patient with a history of chronic headache reported a painless subcutaneous swelling 4 months ago on the right frontoparietal scalp. CT and MRI evaluation revealed a large well-defined extracerebral mass in the frontoparietal scalp with destruction of both the inner and outer tables of the bone. The patient underwent a total microsurgical resection of the tumor and the cranial defect produced by the resection of the space-occupaying lesion was repaired with titanium wire mesh and methyl methacrylate cranioplasty. The histological examination has shown a cystic structure lined by squamous epithelium and containing laminated keratin material, aspects that are suggesting a epidermoid cyst. The patient post-operative course was uneventful, without any neurological deficit and was discharged after 48 hours of hospitalisation in a good medical condition. The review of the literature shows that the parietal bone location for intradiploic epidermoid tumors in rare. Complete surgical resection represent the gold standard of treatment, and no adjuvant therapy is needed. Recent advances in diagnostic imaging and treatment of these lesions are reviewed. more...

Background: Diffuse infiltrative low-grade gliomas (LGG) of the cerebral hemispheres in the adult are tumors with distinct clinical, histological and molecular characteristics. WHO (World Health Organization) classification recognizes grade II astrocytomas, oligodendrogliomas and oligoastrocytomas. Conventional MRI is used for differential diagnosis, guiding surgery, planning radiotherapy and monitoring treatment response. Advanced imaging techniques are increasing the diagnostic accuracy. Low-grade gliomas have been documented to undergo transformation into high-grade gliomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients diagnosed with low-grade gliomas. Methods: We have reviewed all adult patients operated on for hemispheric glioblastoma at N Oblu Hospital in Iasi between 2006 and 2009 and in particular those patients with secondary glioblastoma. Results: from the total 110 cases of glioblastoma, ten of them were secondary to malignant transformation of an previously operated low grade glioma. Of the 10 patients with secondary glioblastoma, the initial histology was: gr II astocytoma in 6 cases, oligoastocytoma in 2 cases and in oligodendroglioma in 2 cases. The mean patient age was 46.1± 0.9 years and the most frequent symptom was represented by seizures 70%, the mean time from the first symptom to diagnosis was 11,2 months. 40% of the cases had subtotal resection and 60% had total resection (defined by the surgeon at the time of operation). 5 patients received radiotherapy postoperatively, 2 received both radio and chemotherapy and 3 had no adjuvant treatment. In our series the median time to malignant transformation was 32,5 months. Conclusions: Younger age, normal neurological examination and oligodendroglial histology are favorable prognostic factors, total/near total resection can improve seizure control, progression-free and overall survival, mean while reducing the risk of malignant transformation. Early post-operative radiotherapy improves progression free but not overall survival. Chemotherapy can be useful both at recurrence after radiotherapy and as initial treatment after surgery to delay the risk of late neurotoxicity from large-field radiotherapy. more...