Preoperative shunts in suprasellar tumours.
A series of 22 cases of large suprasellar tumours was studied retrospectively. These patients had undergone a preoperative shunt to facilitate surgical exposure of the tumour and to reduce intracranial pressure in critically ill patients. Our observations on the clinical progress of these patients following the shunt is analysed. Nine patients worsened to a varying degree following insertion of the shunt. Seven patients became drowsy, one developed worsening of vision and a hemiparesis, and one became an akinetic mute. The worsening was probably related to alteration of intracranial pressure dynamics and resultant compression in the hypothalamic region by subtle superior migration of the tumour. Operative difficulties were encountered during the dissection of the tumour from the neural structures in these cases. We conclude that with the availability of modern decongestive measures and basal surgical exposures, preoperative shunting is rarely indicated and can be occasionally dangerous. In the absence of actual proof, it is postulated that the secondary ventricular enlargement appears to be a protective mechanism of the brain helping to reduce tumour pressure on the basal forebrain structures.
Goel
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Department of Neurosurgery, K.E.M. Hospital, Parel, Bombay, India.
D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000601:surgery*; D007031:Hypothalamus / Q000473:pathology / Q000601:surgery; D007427:Intracranial Pressure; D008297:Male; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery; D015173:Supratentorial Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects; D014786:Vision Disorders / Q000209:etiology