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We have reported an unusual case of pituitary adenoma with extensive calcification from the base of the skull to the right middle fossa. The patient was 28 years old male who was admitted to our department of neurosurgery on September 6, 1976 with the chief complaint of generalized convulsion. Neurological examination on admission revealed irregular bitemporal hemianopsia. There was no sparseness of body hair. Plain skull films showed extensive suprasellar calcification extending into the right middle fossa. The sella turcica and the sphenoid sinus was completely destroyed and was replaced with a huge calcified mass. Hormonal study revealed a slight hypopituitarism. On September 30, right frontotemporal craniotomy was performed. Grayish calcified tumor was found originating from the temporal base. It was covered with a thin capsule, easy to bleed and contained many small calcium freckles. Frozen section was reported as squamous cell carcinoma, and extensive tumor removal was abandoned. Postoperatively Cobalt therapy was given. However, paraffin sections showed no malignancy and pituitary adenoma or meningioma was suspected. After a course of irradiation, the second operation was carried out on December 2nd and this calcified tumor was subtotally removed. Postoperative hormonal studies disclosed prominently high level of the serum prolactin. Light microscopic finding of the specimen taken at the second operation was regarded as chromophobe adenoma, with predominant tendency to degeneration and calcification. Electron microscopically, tumor cells had dilated rough endoplasmic reticulum and sparse secreting granules compatible with prolactin-secreting adenoma cells.

The authors studied 22 cases of traumatic IVH encountered during a recent 5-year period, with particular emphasis on factors related to outcome. There were 21 males and one female ranging in age from 3 to 76 years. These 22 cases constituted 7.2% of all severe head injuries (Types III and IV, according to Araki's classification) seen in the authors' institution during the study period. They were classified into four types on the basis of the CT findings: Type I, IVH with no other intracranial abnormality; Type II, IVH with other intracranial abnormalities; Type III, delayed IVH (after decompressive surgery) ; and Type IV, IVH due to penetration of an intracerebral hematoma. The incidence of Types II and IV IVH was high. The average Glasgow Coma Scale (GCS) score on admission was 7.0, with Type I patients having the lowest mean score (4.3). The direction of impact was most often anteroposterior in Type I and lateral in Type II. Associated intracranial lesions were observed in 95% of the patients. These were mostly brainstem injury in Type I and brain contusion or subdural hematoma in Types II and III. The overall mortality rate was 54.5%. It was 67% in Type I, 50% in Type II, 33% in Type III, and 63% in Type IV. The outcome appeared to have been determined largely by the severity of associated brain injury and the GCS score, which suggests that the severity of impact or brain injury causing the IVH is the most important factor in terms of prognosis.