Intracranial Pressure, Neurological Condition and Operative Management in Relation to the Outcome of Patients with Supratentorial Midline Tumors

Summary

In 199 children, juveniles and adults operated on for supratentorial midline tumors, the clinical neurological factors important for the determination of the disease course were analysed. In 68 patients the importance of the intracranial pressure was examined.

When ranking clinical indicators for the disease course and for the outcome of patients, pre- and postoperative disturbances of consciousness, respiratory function and cranial nerve function are listed first.

Pathological increases of intracranial pressure correlate well with simultaneously persisting disturbances of consciousness in determining the disease course.

In 5 cases, anisocoria or mydriasis associated with coma after surgery of a tumor in the hypothalamic area, especially craniopharyngiomas, was not a sign of irreversible mesencephalic or brainstem herniation, but a reversible symptom related to functional alterations of nervous structures near the hypothalamus. Intracranial pressure monitoring in these cases facilitates the interpretation of this finding.

The extent of tumor resection was decisive for the postoperative ventricular fluid pressure. In all cases with subtotal resection of a midline tumor, acute rises of the intracranial pressure because of predictable CSF circulation disturbances, should be prevented by implanting an internal shunt. Implantation of a ventricular-peritoneal shunt is most appropriate for this purpose.