Rupture of intracranial dermoid cysts (RICDC) is a rare phenomenon. The mechanism of rupture, pathophysiology of fat in the ventricles and subarachnoid spaces, possible complications, and proper management of such conditions are proposed on the basis of a review of the literature and experience with two cases of ruptured intracranial dermoid cysts (One was in the pineal region, while another was in the fourth ventricle). It is concluded that rupture of intracranial dermoid cysts is usually spontaneous and non-fatal. Persistence of fat in the subarachnoid spaces postoperatively may last asymptomatically for years. Surgery is the only way to deal with these benign lesions. If the capsule is adherent to vital areas, incomplete removal is advised as recurrence and malignant transformation are unlikely to occur.
Despite the panoramic view provided by the telovelar approach, the pathological nature of the lesion and vital neural tissue infiltration are limiting factors for total tumour removal. Total removal of tumours focally attached to critical areas in the fourth ventricle should not be attempted at the expense of patient's morbidity and mortality. To achieve optimum outcome, near total excision is acceptable in cases where complete removal may endanger function or life.
The frontolateral approach has the advantages of both the pterional and conventional bifrontal approaches. The frontolateral approach allows quick and minimally invasive access to OGMs less than 4 cm in diameter, and also to tumors more than 4 cm in diameter without encasement of the anterior cerebral artery complex. Tumor size more than 4 cm in diameter and encasement of the anterior cerebral artery complex are limiting factors for the frontolateral approach if radical tumor removal is considered.
Surgical outcome of intramedullary spinal cord ependymoma was investigated in order to define the treatment strategy. We have operated on 18 cases of intramedullary spinal cord ependymoma based on the principle of radical resection. The follow-up periods ranged from 10 months to 249 months with an average of 86.2 months. Postoperative neurological status in the long follow-up periods was compared to the pre-operative status and was correlated with the histological grade of malignancy. Total removal of the tumour was achieved in 17 cases, and subtotal removal followed by radiation therapy was conducted in 1 case. There was neither surgical mortality nor radiological evidence of recurrence in the long-term follow-up periods. The final outcome of the neurological condition was improved in 1 case, unchanged in 15 cases (including a case of subtotal removal) and deteriorated in 2 cases. The deterioration was in the form of gait disturbance due to the worsening of proprioception in 2 cases and dysaethesia in 1 case. Histological examination showed no evidence of anaplasia in 6 cases, evidence of early anaplasia in 10 cases, and moderate evidence of anaplasia in 2 cases. No relationship between the histological malignancy and clinical course was found. Intramedullary spinal cord ependymoma should be removed radically as early as possible while taking great care to avoid posterior column injury. Histologically malignant ependymoma might be a clinical exception.
A 40-year-old man without stigmata of neurofibromatosis presented with proptosis and impairment of lateral gaze of the left eye. Neuro-imaging studies revealed an extra-axial lytic spheno-orbital mass. The mass was completely removed. Classic schwannoma was documented histopathologically. Schwannosis or hyperplasia of Schwann cells of perivascular nerve plexus may be attributed in the histogenesis of this unusually located schwannoma.
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