Re-written by: Daniel Habashi Seminar by: Dr.

Intracranial hypertension Symptoms ▫General  Headache nausea, vomiting  papillar edema (stages)  EPI  Blindness (intermittent)  Nose touching ▫Vegetative  Bradycardia  BP rise  Breathing disturbances ▫Psychic  Consciousness (quantitative) disturbances  Fully conscious – coma depasse

Focal Symptoms 1. Deficits 2. Excitations ▫Epileptic seizures (small focal) ▫Paraesthesias

Radiology ▫Morphology and topography ▫Oedema Temporal horns in a normal CT are not visible. If they are visible then it means that they’re enlarged. – hydrocephalus or cerebral atrophy etc.

Management Scant space occupying Lesion Neurosurgery (planned admission) Intensive space occupying Lesion Urgent neurosurgery (urgent admission)

In-Hospital Management Complementary diagnostics: ▫Extra-imagery ▫Biopsy ▫General “suitability” ▫Specific tumor diagnostic

Surgical Maneuvers Biopsy Cytoreduction, subtotal Total Palliative (Rickham, Shunt, External Decompression) ▫Rickham – small tube that we put into the cyst (catheter?), used to diminish the quantity of the fluid in a cyst, just like a shunt I suppose.

Out-Patient Management Steroids: Diminishing protocol Anti-Epileptics: Tegretol 3 x 200mg ▫(blood level, EEG) General examination Karnofsky 1. I ° -II ° Kernohan: (not-malignant) ▫CT 6 months 2. III ° -IV ° Kernohan (malignant) ▫CT 2 months

Karnofsky Scale (modified) 100Normal: no complaints, no evidence of disease 90Able to carry on normal activity: minor symptoms 80Normal activity with effort: some symptoms 70Cares for self: unable to carry on normal activity 60Requires occasional assistance: cares for most of needs 50Requires considerable assistance and frequent care 40Disabled: requires special care and assistance 30Severely disabled: hospitalized, death not imminent 20Very sick: active supportive care needed 10Moribund: fatal processes are progressing rapidly 0DEAD

Neuronavigation Assisted Transphenoid Pituitary Surgery