Composite Hemangioendothelioma (CHE) is a very rare, low-grade malignant vascular tumor. It is most commonly seen as one or more nodules on both sides of the fingers and toes. This tumor is rarely settled in the paraspinal muscles. The age of onset is usually between the ages of 21 and 72 (1), with average age of 39.5-41 years. The treatment is gross total removal of the lesion. The definitive diagnosis is made histopathologically. Our case was a 54-year-old male patient. He had a complaint of low back pain. A lumbar spine MRI revealed that it was settled in the right paravertebral muscle in the posterior vicinity of the transverse process between the right paraspinal muscle planes. The mass was removed grossly and totally. The diagnosis of CHE was made histopathologically. In this article, we presented a case of CHE a rare tumor settled in the paraspinal region a rare site.
AIM: To report and to discuss our experience of awake craniotomy for the treatment of supratentorial lesions.
MATERIAL and METHODS:We included patients who underwent awake craniotomy for supratentorial tumors between 2007 and 2018. A bipolar stimulation probe was used for patients with eloquent area lesions. The demographic features, presenting symptoms, comorbidities, localization, histopathology, pre-and postoperative Karnofsky performance status, mean operation length, mean length of hospital stay, and intraoperative and postoperative complications were recorded.
RESULTS:We included 250 patients (age, 53.5 ± 15.3 years; range, 15-90 years; 105 females and 145 males) mostly with metastasis (46%). The tumor resection rate was 90 ± 3.6%. Of 30 patients (12%) who experienced an increase in weakness, 26 experienced improvements within three days, and the remainder had permanent symptoms. Intraoperative and postoperative seizures occurred in three (1.2%) and seven (2.8%) patients, respectively, which were controlled by antiepileptic drugs. Dysphasia occurred intraoperatively in seven patients (2.8%) but improved in a month. The mean follow-up duration was 31.8 ± 11.9 months (range, 7-70 months). No mortality was seen during hospitalization.CONCLUSION: Awake procedures are a good option in supratentorial lesions to avoid the complications of general anesthesia for patients in poor medical condition. To obtain maximal tumor resection and to maintain better quality of life, neurosurgeons should opt for awake craniotomy when necessary.
Spinal epidural venous angiomas are extremely rare. We report the case of a 60-year-old man who presented with disc herniation symptoms, complaining of pain in his left leg and numbness, especially at the base of the knee. On physical examination, the Lasègue test was positive at 45 degrees on the left side and no neurological deficit was detected on the lower extremity. Contrast enhanced magnetic resonance imaging revealed a lesion in the left S1 neural foramen, which was initially evaluated as a schwannoma. However, after the lesion was totally excised, it was pathologically identified as a venous angioma. Here, the clinical presentation, management, and surgical, radiological, and pathological features are discussed.
Pituitary abscess is extremely rare and often misdiagnosed as pituitary tumor pre-operatively.We document a case of a 64-year-old lady presented to the outpatient department with complaints of headache and blurring vision of right eye for one month. Based on preliminary investigations, a clinical diagnosis of pituitary adenoma was made and the pituitary gland was surgically excised. Histopathological examination showed Actinomyces infection. This case has been documented due to the extremely rare involvement of the pituitary gland by actinomyces infection. Pituitary abscess is a rare pathology, but it must be considered during evaluating sellar masses, since its prognosis depends on surgical drainage and on the use of specific antibiotics. We report, to our knowledge, the fourth case of Actinomyces israelii infection of the pituitary region.
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