Surgical Approach

Symptomatic hydrocephalus must be controlled and this may require a biventricular shunt if the tumor blocks both foramina of Monro.

When choosing a surgical approach (Table 11.4), there are several factors to consider: firstly the size, secondly whether or not it is cystic, and thirdly, the relationship to surrounding structures, namely the hypothalamus, third ventricle, optic pathways, pituitary and stalk, vessels, brainstem, dura and CSF pathways. In cranial approaches, the position of the chiasm, which is often pre-fixed, and the shape and laterality of the tumor must also be taken into consideration.

If the lesion is confined to the sella, or has moderate suprasellar extension but remains mainly midline, then a transsphenoidal approach may be attempted, particularly if cystic. Equally a subfrontal or pterional approach may be used (with or without orbitozygomatic extension), particularly if there is lateral extension.

In a cooperative study involving 415 patients [19], subfrontal routes were used in 46%, pterional in 27%, transsphenoidal in 8%,

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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