The present studies were conducted to test whether the outcome of severe head injury is improved by early administration of the synthetic corticosteroid triamcinolone. In a prospective, double-blind, multicenter clinical trial, 396 patients with severe head injury were randomized to a steroid group (n = 187) receiving 200 mg triamcinolone acetonide (Volon A soluble) i.v. within 4 h after trauma, followed by 3 x 40 mg/day i.v. for 4 days, and 3 x 20 mg/day i.v. for a further 4 days, and a placebo group (n = 209) receiving injections which did not contain any active drug. The placebo group was subjected to the same standard treatment procedures. Clinical features were not different between the groups upon admission to hospital. Subdural hematoma, epidural hematoma, and focal supratentorial contusion were among the most frequent diagnoses. The result of treatment with triamcinolone was assessed at discharge from the hospital and at 1 year after trauma, using the Glasgow Outcome Scale. Differences in favor of steroid treatment could be detected with regard to the patients' condition at discharge (P = 0.0634). More patients with steroids had a good recovery (49.2% vs 40.7%), and fewer died (16.0% vs 21.5%). Differences in outcome were even more pronounced (P < 0.0145) in patients with a focal lesion and a Glasgow Coma Score on admission of < 8 (n = 93). In this group, 34.8% of the patients made a good recovery, as against 21.3% of the placebo group; mortality was also lower in the verum group (19.6% vs 38.3%). The results indicate that a major subgroup of patients with severe head injury benefits from early administration of triamcinolone. Efficacy of the treatment can be expected, in particular, in patients with a focal cerebral lesion and a Glasgow Coma Score of < 8 on admission. Administration of steroids beginning at the scene of an accident would therefore be beneficial in these cases.

Cavernous hemangiomas are the most frequently found primary tumors in the orbital region. They normally appear in adults. Diagnostic features in the majority of cases include protrusio bulbi and orbital enlargement. B-Scan and computed tomography/MRI are the prime diagnostic aids. We recommend surgical removal of these tumors, at least in cases with marked orbital protrusion or significant optic nerve compression. The prognosis is usually good.

Pyogenic infections of the brain are divided according to the anatomic structures they involve. Brain abscess and subdural empyema are the main phenomena. This retrospective study analyses case records of the Neurosurgical University Teaching Hospital at Münster from a bacteriological standpoint and compares them with other reports in the literature. Various kinds of bacteria depending on etiology and pathogenesis are described. It is found that with improved bacteriological techniques the number of anaerobic infections increases and, at the same time, the number of sterile empyema decreases. A significantly higher mortality of patients with sterile suppuration is also found. It must be assumed that insufficient bacteriological evaluation leads to faulty diagnoses and ineffective antibiotic therapy and that genuine sterile empyema is rare.

In 1987 the UICC presented a proposal for TNM classification of brain tumors. This proposal is assessed in a retrospective study on 316 glioma and medulloblastoma patients treated in the Neurosurgical Clinic of the University Münster. It is evident that the T categories do not produce the correct sequence of prognostic differentiation required. The features of tumor spread used for classification are not of equal significance for the various types of tumors. In our opinion it is not possible to adequately describe the greatly varying development characteristics of all brain tumors using one system of classification.

Hypophysenmetastasen sind selten. Angaben über die Inzidenz in Autopsieserien schwanken zwischen 1,8 und 12% der metastasieren-den Tumoren. Die meisten finden sich beim Mammakarzinom, gefolgt von Karzinomen des Magen-Darm-Traktes. Klinisch werden nur 20% manifest in Form eines Diabetes insipidus – entsprechend dem bevorzugten Befall des Hypophysenhinterlappens. Es werden die Besonderheiten eines Falles von Prostatakarzinom mit Hypophysenmetastase diskutiert, bei dem eine Funktionsstörung der parasellär verlaufenden Hirnnerven zur Diagnose führte. Die Behandlung mit Flutamid erbrachte eine Remission. Die Überlebenszeit war mit 18 Monaten lang.