Background:The aim of this paper is to report on our surgical strategy and technique and to identify the best management for intracranial dermoids and epidermoids tumors (IDETs).Methods:We retrospectively reviewed 33 consecutive patients (14 males and 19 females; mean age at surgery, 37.9 years) with pathologically confirmed IDETs who underwent surgical resection, with mean follow-up of 7.2 years.Results:Gross total tumor removal was achieved in 24 cases (72.7%) with zero surgical mortality and a recurrence rate of 9%.Conclusions:The surgical strategies used in this group of patients enabled total removal of most tumors without surgical mortality and with low morbidity and recurrence rates, proving to be safe and effective.
Eventhough supratentorial glioblastoma multiforme (GBM) is the most frequent primary brain tumor in adults, its localization in the cerebellum is extremely rare 1 . It is very important for the neurosurgeon to make the differential diagnosis between the cerebellar GBM, and other diseases like metastasis, anaplasic astrocytomas, and cerebellar infarct because their treatment modalities, prognosis, and outcome are different 2 . Clinical manifestations of these diseases are very similar, so making an appropriate diagnosis is fundamental for the management of each of them 3 .We describe a case of cerebellar GBM managed at our institution reporting its clinical presentation, radiological and histological findings, and treatment instituted. CaSeA 65 year-old male patient was admitted with a clinical history of headache, mental confusion, left hemiparesis, gait and trunk ataxia, and dismetry. The symptoms had been worsening on the last five months. Past medical history was significant for previous cerebral ischemic event without persistent deficits, and an emergency laparotomy for a bleeding gastric ulcer was done one year before and aortic ectasy.An investigation with brain CT and MRI scan, showed an heterogenic contrast enhancing expanding process in the vermis and left cerebellar hemisphere. The MRI showed an intra-axial, infiltrative, heterogenic mass localized in the vermis with extension to left cerebellar hemisphere, left superior cerebellar peduncle and brainstem. The lesion was isointense in T1-weighted images, hyperintense in T2-weighted images, showing enhancement after paramagnetic contrast administration. Its dimensions were 4.8 cm × 3.6 cm × 2.6 cm. The lesion compressed the IV th ventricle, and caused hydrocephalus (Fig 1A).Abdominal ultrasound, thoracic imaging and investigation for metastasis were negative.The patient was submitted to microsurgical resection of the lesion through a cisternal craniectomy and transvermian approach. The surgery was uneventful but a subtotal resection was performed because the tumor infiltrated the superior cerebellar peduncle and brainstem (Fig 1B). Postoperatively, the hydrocephalus diminished, but an occipital pseudo-meningocele originated another surgery for its closure. Control MRI six moths after the first surgery shows residual tumor without signs of disease progression (Fig 1C).Histological examination showed a poor-differentiated glial neoplasm with intense pleomorphism, nuclear hyperchromasy, and necrosis (Fig 2). The histological diagnosis was GBM.The case was eligible for cranial radiotherapy starting for-
-The article describes a woman with 53 year-old that has presented diplopia when looking down and adopted a tilted head position in order to read for the last six months. The neuro-ophthalmic examination shows isolated right superior oblique muscle paresis. The magnetic resonance and the angioresonance show the dolicoectatic basilar artery compressing the right ventral lateral brainstem.KEY WORDS: trochlear nerve, dolichoectasy, basilar artery, ophtalmoplegy, compression. Paresia isolada do nervo patético por compressão da artéria basilar dolicoectásica: relato de casoRESUMO -O artigo descreve uma mulher de 53 anos que há seis meses apresenta diplopia ao olhar para baixo, além de adotar postura inclinada da cabeça para ler. O exame neuro-oftalmológico revelou paresia isolada do músculo oblíquo superior direito. Os exames de ressonância magnética e angioressonância evidenciaram dolicoectasia da artéria basilar, que comprimia a face ventral lateral direita do tronco cerebral.
The purpose of the present clinical case is to remind clinicians that craniopharyngiomas, which are benign neoplasms with a high incidence of local recurrences, may also present ectopic recurrences which may at first go unsuspected. These tumors most commonly arise in the suprasellar region and despite their benign histology, they may infiltrate the surrounding neurovascular structures making total removal challenging. Ectopic recurrences of craniopharyngiomas are very rare. We describe an adult patient with ectopic recurrence of craniopharyngioma, emphasizing unique features of the case presentation and its physiopathological aspects. A 49-year-old male presented with headache and visual field defect and was diagnosed with a suprasellar tumor. He was submitted to neurosurgery and histological examination revealed an adamantinomatous craniopharyngioma. Postoperative magnetic resonance imaging (MRI) showed complete tumor resection. The patient remained asymptomatic with no imaging signs of local recurrence during follow up. Five years after surgery, the patient noticed a rapidly growing lump at the surgical incision site. He reported a mild to moderate local trauma 4 months before. A MRI showed a subgaleal cystic tumor arising in the pathway of the craniotomy. Surgical resection of that cystic lesion was performed and histological examination revealed an adamantinomatous craniopharyngioma. One year later no recurrences have been detected. The case reported has two particular features: the local trauma as a potential trigger for tumor progression and the rapidly growing pattern of the ectopic recurrent tumor. We emphasize that although ectopic recurrences of craniopharyngiomas are rare, they may occur away from the primary tumor and quite late in the follow up of the patient.
Objective The aim of this paper is to describe our surgical strategy and technique and to identify the best management for posterior fossa dermoid and epidermoid tumors (PFDETs). Methods We retrospectively identified 21 consecutive patients (11 males and 10 females), with a mean age of 33.2 years, a mean follow-up of 6.1 years, and pathologically confirmed PFDETs. Total 17 patients were submitted to the extended retrosigmoid approach. This approach incorporates transverse sigmoid sinus exposure and a generous mastoidectomy. Results Gross total tumor removal was achieved in 16 (76.1%) cases, with no surgical mortality and a recurrence rate of 9.5%. Conclusions The surgical strategies used in this group of patients enabled the total removal of most tumors without surgical mortality and with minimal morbidity and recurrence rates. The extended retrosigmoid approach used is an alternative path regarding cranial base approaches. This approach is quick, simple and safe, and decreases the retraction of the cerebellum. ResumoObjetivos O objetivo deste estudo é descrever a técnica operatória para a melhor abordagem dos tumores dermoides e epidermoides da fossa posterior. Métodos Foram analisados retrospectivamente 21 pacientes (11 masculinos e 10 femininos), com idade média de 33,2 anos e acompanhamento de 6,1 anos, com diagnóstico histopatológico de tumor dermoide ou epidermoide de fossa posterior.
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