Intraventricular cavernomas (IVCs) are extremely infrequent and only occur in 2.8 to 10% of patients with cerebral cavernomas. We describe three IVC cases and briefly review previously documented IVC cases in PubMed. Among 136 IVC cases, the mean age of the patients was 36.5 years; the male-to-female ratio was 0.8. The most frequent location was the lateral ventricle (52.6%), and most of the clinical symptoms (74%) were related to mass effects on adjacent brain tissues. Intraventricular hemorrhage occurred in 22.9% of cases. Most of the articles concluded that complete surgical resection is the treatment of choice.The microsurgical approach is currently considered the gold standard for IVC resection. Using the neuroendoscope and neuronavigational guidance and based on the biological characteristics of the IVC, proper lesion size, and dilated ventricles, we totally resected the lesion in all three cases. Neuroendoscopy can be considered as an alternative to microsurgery of IVCs. However, we believe a larger series of cases is necessary to demonstrate when microsurgery and when neuroendoscopy should be performed for IVC resection.
Endometriosis which affects 5-10 % of females at the reproductive age, is most often found in the pelvic cavity and this estrogen-dependent inflammatory disease is one of the prevalent causes of chronic pelvic pain [1].One rare presentation of endometriosis is sciatic involvement, which presents as catamenial sciatica or foot drop [2,3].A 37-year-old nulliparous woman was referred to our clinic with a history of pelvic pain and right lower extremity associated with gait difficulty and recurrent right ankle sprains since 2 years. The pain became worse during menses.On the first assessment, there was muscle wasting and decreased deep tendon reflexes in right lower extremity. She was unable to perform the toe and heel walk test properly. During the motor strength examination, the hip flexion, foot dorsiflexion and plantar flexion were 4/5, 3/5 and 4/5 respectively. The big toe dorsiflexion and plantar flexion test were completely impaired. Slight hypoesthesia was detected in the medial aspect of the thigh (L1 and L2) and the posterior portion of the leg (S1). There were no fasciculations.Brain and panspinal MRI with and without contrast were normal. On transvaginal ultrasound, multiple leiomyofibromas were seen in the uterus. In addition to the multiple fibroids, several right ovarian cysts and asymmetries in the right sciatic region with an enhancing soft tissue in the sacrosciatic notch with thickening of the sciatic nerve were reported on CT scan and MRI of the pelvis.EMG-NCV was suggestive of partial involvement in the lumbosacral plexus.CSF analysis was within normal range without any malignant cells.Serologic findings for sarcoidosis, brucellosis, rheumatologic disorders, HIV, HBV, HCV, EBV, and CMV were negative.Due to unsatisfactory findings, we referred the patient to an expert laparoscopist to explore her pelvic cavity. During the laparoscopic procedure, because of severe mass effects of multiple myomas on the rectum and bladder, a hysterectomy was performed. Also, one of the ovarian cysts was resected from the right ovary, but no other masses were detected by the surgeon.The pathologic study revealed evidence of endometriotic cysts in the right ovary.Postoperatively, the pain decreased to some extent for 2 months, but again the patient experienced severe intractable pain in her pelvis and right lower extremity during expected menses and her gait became more abnormal.Repeat examination at 6 months revealed complete foot drop on the right side and a new EMG-NCV study showed progression in the lumbosacral plexus; therefore, we repeated a pelvic MRI which was diagnostic and showed a 4-4.5 cm lobulated lesion in the right sciatic notch involving the Sciatic nerve.
Background & Aim: We described the presentation, management and subsequent treatment outcomes of children and adolescents diagnosed with a pituitary adenoma in a joint neuroendocrine setting followed up by a single service as well as assessing long-term outcomes in terms of endocrine status and neurology symptoms. Methods & Materials/Patients: A total of 21 participants with histologically verified pituitary adenoma between January 2011 and June 2014 were studied. Patients' data from clinical, radiological and pathological records were analyzed using SPSS (Version 16). Results: All these children and adolescents with pituitary adenomas were managed with microscopic transsphenoidal surgery. The most common symptom was Cushing (47.6%, n=10). The functional type (76.2%, n=16) was more than the non-functional. The post-operative control MRI of most of them was clear (90.5%, n=19). The lab control of most of them was normal (76.2%, n=16). Apoplexy was seen in 5 patients (33.8%). Gross-total resection (GTR; 100% tumor removal as judged by early post-operative imaging) was achieved in 19 cases. Only one of these patients showed evidence of radiologic recurrence. Conclusion: In our study, all patients underwent microscopic transsphenoidal surgery due to limitation of endoscopic approach in pediatric and avoided wide anatomical deficit. Doing a comparative study between these two approaches will bring about promising results.
The aim of the current study was to evaluate for the first time the hippocampal changes in patients with pure sleep and pure waking epilepsy. A total of 35 patients with pure partial onset sleep epilepsy and 35 patients with pure partial onset waking epilepsy matched for age and sex ratio were enrolled. MR images were analyzed to determine hippocampal body changes. Rounding ratio of hippocampal body was defined as short axis divided by long axis and hippocampal bodies with ratios ≥ 0.70 were considered rounded. Hippocampal sclerosis and atrophy were found in nine (25.7 %) and seven (20.0 %) patients with pure sleep epilepsy, and in 12 (34.3 %) and 11 (31.4 %) patients with pure waking epilepsy, respectively (P > 0.05 for the comparison between sleep and waking epilepsy). However, proportion of subjects with rounded hippocampal bodies (15, 42.9 % vs. 3, 8.6 % for patients with sleep and waking epilepsy, respectively) and rounding ratios of both left and right hippocampal bodies (0.66 ± 0.13 and 0.61 ± 0.12, respectively for left and right hippocampal bodies in sleep epileptic patients vs. 0.57 ± 0.11 and 0.55 ± 0.11, respectively for left and right hippocampal bodies in waking epileptic patients) were increased in patients with sleep epilepsy (P < 0.05). Further, in sleep epileptic patients with left sided hippocampal body rounding, epileptiform discharges were more readily lateralized to the left temporal lobe (P < 0.05). In conclusion, hippocampal sclerosis and atrophy are not different between pure partial onset sleep and waking epileptic patients. However, rounding ratio and frequency of hippocampal body rounding are increased in sleep epileptic patients.
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