[Clinical-radiological-anatomopathological correlations in cases of inoperable tumors]

The analysis concerned 27 patients disqualified for radical surgical treatment and qualified for palliative procedures or conservative treatment in the Department of Neurosurgery, Medical Academy in Lódź in the years 1960-1976. The decisions of disqualification were based on the assessment of the clinical state, angiography of the cerebral vessels, pneumoencephalography or both these methods. Computer tomography was not available then, similarly as it is not available presently in most neurosurgical centres in Poland. The accuracy of the diagnosis of the nature of the pathological process and particularly its location based on these methods was compared with the results of postmortem examinations. The material was divided into two groups depending on the presence or absence of hydrocephalus. This division was based on the experiences showing that in cases with coexistent hydrocephalus paliative treatment is as a rule easier and more successful than similar treatment in cases without hydrocephalus. The analysis showed that two types of errors are possible when the possibilities of diagnostic investigations are at the level present in average neurosurgical centres in Poland. These errors may have a significant influence on the fates of the patients. The first type is due to erroneous estimation of the nature of the pathological process, with erroneous diagnosis of malignant process in cases without malignancy, and, conversely, diagnosis of non-malignant process in cases of malignant changes. Four such cases were found in this material. The second type of errors is due to false diagnosis of neoplasm location. Such errors lead to unsuccessful trials of radical treatment in cases with neoplasms situated in inaccessible sites or to unnecessary abandoning of surgical or palliative treatment in the presence of operable tumours. Both these types of errors are illustrated in the discussion.