Pneumoencephalographic studies following complete removal of supratentorial lesions.

Abstract

Pneumoencephalography, introduced by Dandy, is of paramount importance for the localization of intracerebral lesions. It also has its merits in the study of anatomical changes in vivo, as pointed out by Foerster. In the course of our work we have had the opportunity of studying the changes in the brain, particularly the ventricular system, occurring after the removal of well encapsulated supratentorial space-occupying lesions. In all the cases selected for this purpose the lesions were well delimited and were completely removed. The 10 cases upon which this study is based comprised 5 abscesses, 3 meningiomas, 1 ecchinococcus cyst, and 1 encapsulated tumor which seemed to be a meningioma but proved on histopathologic examination to be an oligodendroglioma. The purpose of the study is to direct attention to the changes in the ventricular system caused by supratentorial space-occupying lesions, and their reversibility as shown by preoperative and postoperative air studies. Case I: S. K., a boy of six and a half years, was admitted on Aug. 16, 1948, because of convulsive seizures of jacksonian type of ten days duration. The boy was known to have congenital heart disease. On examination a right pyramidal and sensory syndrome was found. Pneumoencephalography on Aug. 18 localized the lesion in the left parietal region (Fig. 1A and B). At operation, Aug. 20, a large abscess was completely removed. Recovery ensued. Postoperative pneumoencephalograms, Nov. 12, 1948, are reproduced in Figure 1C and D. Case II: J. G., a 32-year-old woman, was admitted on July 11, 1949, with a history of headache of nine years duration, mental disturbances for the past four years, and complete blindness which had developed in the last few months. On examination, secondary optic atrophy was evident and there were pyramidal tract signs on the left. X-ray examination of the skull revealed complete destruction of the sella turcica. The preoperative ventriculogram (Fig. 2A), obtained on July 26, disclosed a right parieto-occipital space-occupying lesion. At operation on the same day a parasagittal parieto-occipital meningioma weighing 220 gm. was removed. Except for blindness, the patient recovered. A second pneumcencephalographic study was performed on Sept. 16 (Fig. 2B). Case III: S. U., a 36-year-old male, was admitted on March 29, 1950, with severe left frontal headache of ten days duration. Positive neurologic findings were: right central facial weakness and an extensor toe sign on the right. Pneumoencephalography on March 30 showed a left frontal lesion. There were slight distortion of the left frontal horn, some compression of the body of the left ventricle, and depression of the left temporal horn. Air was absent in sulci over the left hemisphere but present over the right. The same day an abscess was evacuated through a left frontal burr hole. Penicillin was administered locally and systemically. On April 10 the capsule of the abscess was enucleated.