Two hundred consecutive stereotactic procedures were performed. These were 153 biopsies and 43 therapeutic procedures. The latter included aspiration of craniopharyngiomata, arachnoid cysts, deep-seated abscesses, and the destruction of colloid cysts. Cryogenesis was used to treat an arteriovenious malformation (AVM) in one case. In four cases, the system was used to locate lesions during open surgery. Leksell stereotactic systems were used throughout. The ages of the patients ranged between 12 months and 83 years. Overall, in 35% of biopsies the preoperative diagnosis was not confirmed. When the provisional diagnosis was glioma 70% were confirmed; 21% of them were benign, with 9% some other form of malignancy. Biopsy provided tissue on which a histological diagnosis could be made in 140 procedures. In eight cases the biopsy was repeated and in seven cases a positive diagnosis was subsequently made. Mortality was 1%; there was transient deterioration postoperatively in 5% and prolonged deterioration in 1%. These observations suggest that stereotactic surgery is far superior to freehand burr hole biopsy in the management of these lesions. No radiation treatment should be considered without histological confirmation.
Patient: Male, 56Final Diagnosis: Spindle cell oncocytoma of the adenohypophysisSymptoms: Disturbed conscious level • visual disturbancesMedication: —Clinical Procedure: Urgent craniotomySpecialty: NeurosurgeryObjective:Rare diseaseBackground:Spindle cell oncocytoma (SCO) is a rare nonfunctioning neoplasm of the adenohypophysis, and was first described in 2002. SCO has been categorized as a separate entity by the 2007 World Health Organization (WHO) and is classified as a Grade 1 tumor of the central nervous system (CNS). Review of the literature has shown that 33 cases of SCO have been reported to date, and most of them presented with a mass effect or with panhypopituitarism. However, all reported cases have described the tendency of SCO to be hypervascular on imaging and histology. We detail the first reported case of SCO to present with acute symptoms (pituitary apoplexy) and intraventricular hemorrhage, and review the literature on SCO.Case Report:We report the case of 56-year-old man who presented suddenly with a severe headache and an altered level of consciousness. Brain magnetic resonance imaging (MRI) showed a suprasellar mass with hemorrhagic areas within the tumor and bleeding into the lateral ventricle with chiasmal and hypothalamic compression. The patient underwent urgent craniotomy, tumor resection and placement of an external ventricular drain (EVD). Histology and immunohistochemistry supported a diagnosis of SCO.Conclusions:SCO of the adenohypophysis should be considered in patients who present suddenly with symptoms of pituitary apoplexy and intraventricular hemorrhage which may worsen the prognosis.
A 31-year-old male presented with a 1 year history of left leg weakness and right leg sensory changes. Myelography revealed a probable intramedullary lesion at T4 and CT confirmed its intramedullary nature. At operation an almost black, firm mass was found projecting from the dorsal aspect of the cord and was totally excised. Histological examination revealed it to be a cavernous angioma.
Intralesional infiltration of methylprednisolone acetate as a primary therapy for localized Langerhans cell histiocytosis leads to rapid relief of pain, restoration of bone morphology and reduction of associated soft tissue tumors. Performed with appropriate skill under sterile condition with the reported high percentage of effectiveness and low recurrence rate, this low invasive method is the treatment of choice, resulting in a lower morbidity and lower costs.
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