Delayed Diagnosis of Enhancing Posterior Fossa Tumors Mimicking the Tela Choroidea of the Fourth Ventricle

2015 ◽  
Vol 84 (3) ◽  
pp. 865.e1-865.e5
Author(s):  
Brandon C. Gabel ◽  
Michael L. Levy ◽  
John R. Crawford
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Delayed Diagnosis ◽  
Posterior Fossa Tumors ◽  
Tela Choroidea

Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery

2014 ◽  
Vol 121 (2) ◽  
pp. 359-366 ◽  
Author(s):  
Maria Koutourousiou ◽  
Francisco Vaz Guimaraes Filho ◽  
Tina Costacou ◽  
Juan C. Fernandez-Miranda ◽  
Eric W. Wang ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Fat Graft ◽  
Control Group ◽  
Reconstruction Technique ◽  
Endoscopic Endonasal Surgery ◽  
Posterior Fossa Tumors ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Dural Opening

Object Transclival endoscopic endonasal surgery (EES) has recently been used for the treatment of posterior fossa tumors. The optimal method of reconstruction of large clival defects following EES has not been established. Methods A morphometric analysis of the posterior fossa was performed in patients who underwent transclival EES to compare those with observed postoperative anatomical changes (study group) to 50 normal individuals (anatomical control group) and 41 matched transclival cases with preserved posterior fossa anatomy (case-control group) using the same parameters. Given the absence of clival bone following transclival EES, the authors used the line between the anterior commissure and the basion as an equivalent to the clival plane to evaluate the location of the pons. Four parameters were studied and compared in the two populations: the pontine location/displacement, the maximum anteroposterior (AP) diameter of the pons, the maximum AP diameter of the fourth ventricle, and the cervicomedullary angle (CMA). All measurements were performed on midsagittal 3-month postoperative MR images in the study group. Results Among 103 posterior fossa tumors treated with transclival EES, 14 cases (13.6%) with postoperative posterior fossa anatomy changes were identified. The most significant change was anterior displacement of the pons (transclival pontine encephalocele) compared with the normal location in the anatomical control group (p < 0.0001). Other significant deformities were expansion of the AP diameter of the pons (p = 0.005), enlargement of the fourth ventricle (p = 0.001), and decrease in the CMA (p < 0.0001). All patients who developed these changes had undergone extensive resection of the clival bone (> 50% of the clivus) and dura. Nine (64.3%) of the 14 patients were overweight (body mass index [BMI] > 25 kg/m2). An association between BMI and the degree of pontine encephalocele was observed, but did not reach statistical significance. The use of a fat graft as part of the reconstruction technique following transclival EES with dural opening was the single significant factor that prevented pontine displacement (p = 0.02), associated with 91% lower odds of pontine encephalocele (OR = 0.09, 95% CI 0.01–0.77). The effect of fat graft reconstruction was more pronounced in overweight/obese individuals (p = 0.04) than in normal-weight patients (p = 0.52). Besides reconstruction technique, other noticeable findings were the tendency of younger adults to develop pontine encephalocele (p = 0.05) and the association of postoperative meningitis with the development of posterior fossa deformities (p = 0.05). One patient developed a transient, recurrent subjective diplopia; all others remained asymptomatic. Conclusions Significant changes in posterior fossa anatomy that have potential clinical implications have been observed following transclival transdural EES. These changes are more common in younger patients or those with meningitis and may be associated with BMI. The use of a fat graft combined with the vascularized nasoseptal flap appears to minimize the risk of pontine herniation following transclival EES with dural opening.

scholarly journals Fourth ventricle tumors in children: complications and influence of surgical approach

2021 ◽  
Vol 27 (1) ◽  
pp. 52-61 ◽  
Author(s):  
Sebastian M. Toescu ◽  
Gargi Samarth ◽  
Hugo Layard Horsfall ◽  
Richard Issitt ◽  
Ben Margetts ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Surgical Management ◽  
Surgical Approach ◽  
Fourth Ventricle ◽  
External Ventricular Drain ◽  
Preoperative Imaging ◽  
Posterior Fossa Tumors ◽  
Presenting Symptoms ◽  
Significant Difference ◽  
Telovelar Approach

OBJECTIVESThe goal of this study was to characterize the complications and morbidity related to the surgical management of pediatric fourth ventricle tumors.METHODSAll patients referred to the authors’ institution with posterior fossa tumors from 2002 to 2018 inclusive were screened to include only true fourth ventricle tumors. Preoperative imaging and clinical notes were reviewed to extract data on presenting symptoms; surgical episodes, techniques, and adjuncts; tumor histology; and postoperative complications.RESULTSThree hundred fifty-four children with posterior fossa tumors were treated during the study period; of these, 185 tumors were in the fourth ventricle, and 167 fourth ventricle tumors with full data sets were included in this analysis. One hundred patients were male (mean age ± SD, 5.98 ± 4.12 years). The most common presenting symptom was vomiting (63.5%). The most common tumor types, in order, were medulloblastoma (94 cases) > pilocytic astrocytoma (30 cases) > ependymoma (30 cases) > choroid plexus neoplasms (5 cases) > atypical teratoid/rhabdoid tumor (4 cases), with 4 miscellaneous lesions. Of the 67.1% of patients who presented with hydrocephalus, 45.5% had an external ventricular drain inserted (66.7% of these prior to tumor surgery, 56.9% frontal); these patients were more likely to undergo ventriculoperitoneal shunt (VPS) placement at a later date (p = 0.00673). Twenty-two had an endoscopic third ventriculostomy, of whom 8 later underwent VPS placement. Overall, 19.7% of patients had a VPS sited during treatment.Across the whole series, the transvermian approach was more frequent than the telovelar approach (64.1% vs 33.0%); however, the telovelar approach was significantly more common in the latter half of the series (p < 0.001). Gross-total resection was achieved in 70.7%. The most common postoperative deficit was cerebellar mutism syndrome (CMS; 28.7%), followed by new weakness (24.0%), cranial neuropathy (18.0%), and new gait abnormality/ataxia (12.6%). Use of intraoperative ultrasonography significantly reduced the incidence of CMS (p = 0.0365). There was no significant difference in the rate of CMS between telovelar or transvermian approaches (p = 0.745), and multivariate logistic regression modeling did not reveal any statistically significant relationships between CMS and surgical approach.CONCLUSIONSSurgical management of pediatric fourth ventricle tumors continues to evolve, and resection is increasingly performed through the telovelar route. CMS is enduringly the major postoperative complication in this patient population.

scholarly journals Posterior Fossa Arachnoid Cyst Masking a Delayed Diagnosis of Hyperparathyroidism in a Child

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
B. Dhamija ◽  
D. Kombogiorgas ◽  
I. Hussain ◽  
G. A. Solanki
Keyword(s):  
Differential Diagnosis ◽  
Primary Hyperparathyroidism ◽  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Hospital Admissions ◽  
Delayed Diagnosis ◽  
Visual Disturbance ◽  
Organ Damage ◽  
Presenting Symptoms ◽  
History Of

Background. Primary hyperparathyroidism in childhood is a very rare entity, often being diagnosed late after the onset of its presenting symptoms. It most commonly affects patients in their fourth decade of life and beyond. The inclusion of primary hyperparathyroidism in the differential diagnosis is necessary when evaluating patients presenting with nonspecific symptoms such as polyuria, fatigue, weight loss, abdominal pain, nausea, and vomiting.Methods. We report the case of an eleven-year-old girl presenting with three years history of headaches, visual disturbance, along with episodes of emotional lability. Neuroimaging confirmed a large posterior fossa arachnoid cyst. It was decided to manage this lesion conservatively with surveillance. Only after further hospital admissions with recurrent loss of consciousness, dizziness, and nausea to add to her already existing symptoms, a full biochemical and endocrine assessment was performed to look for more specific causes for her presentation. These pointed to a diagnosis of primary hyperparathyroidism.Conclusions. The inclusion of primary hyperparathyroidism in the differential diagnosis should be considered when evaluating paediatric patients presenting with nonspecific (neurological, gastrointestinal, and renal) symptoms in order to establish a prompt diagnosis of the disorder and to avoid severe complications of prolonged hypercalcaemia and end-organ damage.

Shunt Metastases in Posterior Fossa Tumors

1979 ◽  
Vol 10 (03) ◽  
pp. 296-300 ◽  
Author(s):  
Rainer Oberbauer ◽  
Hans Tritthart ◽  
Peter Ascher ◽  
Gerhard Walter ◽  
H. Becker
Keyword(s):  
Posterior Fossa ◽  
Posterior Fossa Tumors
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