Fully Endoscopic Resection of an Epidermoid Cyst of the Cerebellopontine Angle: Bilateral Resection via a Unilateral Approach

2020 ◽  
Author(s):  
Sricharan Gopakumar ◽  
Visish M Srinivasan ◽  
Himanshu Sharma ◽  
Jacob Cherian ◽  
Akash J Patel
Keyword(s):  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Clinical Presentation ◽  
Contralateral Side ◽  
Radiographic Imaging ◽  
Total Resection ◽  
Surgical Video ◽  
Unilateral Approach ◽  
Neurovascular Structures

ABSTRACT BACKGROUND AND IMPORTANCE Epidermoid cysts are rare, benign intracranial neoplasms that typically arise at the cerebellopontine angle (CPA) and can be extensive lesions that intricately involve many critical neurovascular structures. We describe the case of a patient who presents with the classic picture of CPA epidermoid cyst and describe the value of the 4K endoscope for resection, which is illustrated in our accompanying surgical video. CLINICAL PRESENTATION The patient presents with headache, nausea, and vomiting accompanied by dizziness and balance issues. Radiographic imaging demonstrated a large lesion highly consistent with epidermoid cyst which involved the left CPA, encircled the basilar artery, and extended to the opposite side. Surgery was planned with a small left-sided retrosigmoid craniotomy with use of a 2-dimensional 4K endoscope to aid in resection, particularly of the contralateral side. This approach was successful with gross total resection apparent at 14-mo follow-up. CONCLUSION We describe the use of a fully endoscopic technique from a unilateral approach for resection of a lesion that extended in the CPA bilaterally. Additionally, we highlight the relevant neuroanatomical and neurovascular structures in this highly critical intracranial region which is well-visualized through endoscopy in the associated surgical video.

Aggressive Intramedullary Melanotic Schwannoma: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. E1430-E1434 ◽  
Author(s):  
Carlo Santaguida ◽  
Abdulrahman J. Sabbagh ◽  
Marie-Christine Guiot ◽  
Rolando F. Del Maestro
Keyword(s):  
Clinical Presentation ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Total Resection ◽  
Neck Stiffness ◽  
Neck Extension ◽  
Melanotic Schwannoma ◽  
Pathological Characteristics ◽  
Intramedullary Lesion

Abstract OBJECTIVE AND IMPORTANCE: Intramedullary melanotic schwannomas are very rare lesions; only four cases have been reported previously. We describe a patient with an intramedullary melanotic schwannoma that had a more aggressive course than those reported in the literature, and we review the theories regarding the cause of these lesions. CLINICAL PRESENTATION: A 35-year-old man presented with neck stiffness and paraesthesia extending down his right arm upon neck extension. A magnetic resonance imaging scan revealed an intramedullary lesion extending from C4 to C5. INTERVENTION: Gross total resection of the mass was performed, and pathological characteristics were consistent with a melanotic schwannoma. Two years after resection the tumor recurred, and the patient was treated with radiation therapy. The tumor progressed 2 years after radiotherapy, and at repeat resection, multiple pigmented foci were present on the surface of the spinal cord and dura consistent with metastatic seeding. CONCLUSION: In a patient with intramedullary melanotic schwannoma with an unusually aggressive course, careful follow-up may be essential.

scholarly journals Meningiomas of pineal region in children

2007 ◽  
Vol 65 (4a) ◽  
pp. 1000-1006 ◽  
Author(s):  
Hamilton Matushita ◽  
Fernando Campos Pinto ◽  
José Píndaro Pereira Plese
Keyword(s):  
Clinical Presentation ◽  
Complete Removal ◽  
Pineal Region ◽  
Total Resection ◽  
Long Term Follow Up ◽  
One Year ◽  
Velum Interpositum ◽  
Transtentorial Approach

Meningiomas are uncommon tumors in children and either more rarely encountered in the pineal region. We report two cases of meningioma of the pineal region in children. One of these cases was a five years-old girl and the other a one year-old boy. No specific clinical presentation or tomographic examinations findings was identified before treatment, suggestive of a diagnosis of menigioma. The clinical and laboratory features were very similar to the most common tumors of the pineal region. Prior to the surgery, the histology of these tumors was not suspected. Both patients underwent direct surgery and complete removal was achieved by a suboccipital transtentorial approach. The tumors originated from velum interpositum in both cases. At the follow up, one case presented with recurrence six years later, and she underwent a reoperation with total resection without morbidity. Long-term follow up presented no other recurrences.

JUVENILE INTRADURAL CHORDOMA

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. E525-E527 ◽  
Author(s):  
Steven W. Chang ◽  
Pankaj A. Gore ◽  
Peter Nakaji ◽  
Harold L. Rekate
Keyword(s):  
Clinical Presentation ◽  
Radiation Treatment ◽  
Complete Resection ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Total Resection ◽  
Surgical Cure ◽  
Neurologically Intact ◽  
Resonance Imaging Scan

Abstract OBJECTIVE We report the youngest known case of a prepontine intradural chordoma. These tumors are exceedingly rare. Unlike their more common extradural counterparts, no recurrence of an intradural chordoma has been reported. CLINICAL PRESENTATION A 9-year-old boy underwent diagnostic imaging for evaluation of headaches. Although neurologically intact, a magnetic resonance imaging scan revealed a large prepontine mass with focal enhancement. INTERVENTION Endoscopic-assisted gross total resection was attained with staged bilateral retrosigmoid approaches. There were no additional adjuvant therapies. At the time of the 1-year follow-up evaluation, the patient had no recurrence. CONCLUSION By using an endoscopic-assisted procedure, we achieved complete resection of an intradural chordoma offering a potential for surgical cure. Resection is particularly advantageous because it spares the young child the need for radiation treatment. Close follow-up is warranted because we postulate that this tumor exists in a biological continuum between benign notochordal hamartomatous remnants and typical invasive chordomas.

Calcified Epidermoid Cyst at an Unusual Location in a 5-Year-Old Child with Intellectual Disability

2017 ◽  
Vol 16 (04) ◽  
pp. 232-235
Author(s):  
Pramod Giri ◽  
Kirti Jaiswal ◽  
Milind Bhatkule ◽  
Vaibhav Chavan
Keyword(s):  
Intellectual Disability ◽  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Clinical Presentation ◽  
Unusual Site ◽  
Suprasellar Region ◽  
Interhemispheric Fissure ◽  
Intracranial Neoplasm ◽  
The Right ◽  
Slow Growing

AbstractAn epidermoid cyst is a rare intracranial neoplasm. It is mostly found in cerebellopontine angle, suprasellar region, interhemispheric fissure, and is rarely found in other locations too. Epidermoid cyst at the parietooccipital area is rare, and calcification among epidermoids is very unusual and dystrophic in nature. The clinical presentation is usually in adults because of slow-growing nature of epidermoid cyst. Here, we present the case of a 5-year-old child with intellectual disability who presented with seizure and frequent crying episodes and was diagnosed with an intradural extra-axial calcified mass of size 8 × 5.5 × 5 cm in the right parietooccipital region which turned out to be a calcified epidermoid cyst and was excised successfully in toto. This is the youngest reported case of the calcified epidermoid cyst at an unusual site of our knowledge.

scholarly journals Spinal angiolipoma: a report of two cases and review of the literature

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095469
Author(s):  
RuiDeng Wang ◽  
Hai Tang
Keyword(s):  
Standard Treatment ◽  
Clinical Presentation ◽  
Cord Compression ◽  
Benign Tumors ◽  
Fatty Tissue ◽  
Resonance Imaging ◽  
Total Resection ◽  
Vascular Channels ◽  
Spinal Angiolipomas

Spinal angiolipomas (SALs) are extremely rare benign tumors composed of both mature fatty tissue and anomalous vascular channels. We present two cases of SALs and review the clinical presentation, radiological appearance, pathological aspects, and treatment of this distinct clinicopathological mass. The patients’ neurologic symptoms improved postoperatively and follow-up revealed no signs of tumor recurrence or neurological deficit. SAL should be considered as a differential diagnosis in patients with spinal cord compression. Magnetic resonance imaging is important for detecting and characterizing SALs. The gold standard treatment modality should be total resection.

Microsurgical Resection of Anaplastic Ependymoma of the Cerebellopontine Angle in an Adult: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E91-E91 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Mustafa K Baskaya
Keyword(s):  
Cerebellopontine Angle ◽  
Recurrent Disease ◽  
Anaplastic Ependymoma ◽  
Total Resection ◽  
3 Dimensional ◽  
History Of ◽  
Microsurgical Techniques ◽  
Microsurgical Resection ◽  
Grade Iii

Abstract Infratentorial ependymomas usually arise in the fourth ventricle and extend into the cerebellopontine angle (CPA) through the foramina of Luschka is well described. A primary CPA location of an ependymoma is distinctly uncommon.  In this 3-dimensional video, we present a 38-yr-old woman with a 1-mo history of vertigo and slow left sided gaze drift. She underwent microsurgical gross total resection of the CPA ependymoma via retrosigmoid approach. The histopathology was grade III anaplastic ependymoma. She tolerated the surgery well and her postoperative course was uneventful. She received radiation therapy and there was no recurrent disease in follow-up studies.  Important steps of the surgical approach and microsurgical techniques in resection of these challenging tumors are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her image.

scholarly journals Retrosigmoid Suprameatal Approach for Resection of Petrotentorial Cerebellopontine Angle Meningioma: Operative Video and Technical Nuances

2019 ◽  
Vol 80 (S 03) ◽  
pp. S290-S291
Author(s):  
James K. Liu ◽  
Vincent N. Dodson
Keyword(s):  
Cerebellopontine Angle ◽  
Fat Graft ◽  
Cerebrospinal Fluid Leakage ◽  
Total Resection ◽  
Nerve Preservation ◽  
Microsurgical Resection ◽  
Neurologically Intact ◽  
Neurovascular Structures ◽  
Gain Access ◽  
Base Technique

Meningiomas are the second most common tumor to arise in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a petrotentorial meningioma in the cerebellopontine angle via a retrosigmoid suprameatal approach. Drilling of the hyperostotic suprameatal tubercle was necessary to gain access to the dural origin and anterior petrosal extent of the tumor. The nuances of microsurgical and skull base technique are illustrated including microsurgical dissection of the tumor away from the brainstem and neurovascular structures, facial nerve preservation, and fat graft-assisted Medpor Titan reconstruction to prevent cerebrospinal fluid leakage. A gross total resection was achieved, and the patient was neurologically intact. In summary, the retrosigmoid suprameatal approach is an important strategy in the armamentarium for surgical management of petrotentorial meningiomas in the cerebellopontine angle.The link to the video can be found at: https://youtu.be/kwQP6BSYK7U.

Retrosigmoid craniotomy for cerebellopontine angle/petroclival epidermoid cyst

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1
Author(s):  
Shaan M. Raza ◽  
Franco DeMonte
Keyword(s):  
Soft Tissue ◽  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Total Resection ◽  
Vertebrobasilar System ◽  
System A ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Key Steps

This video describes the surgical management of an epidermoid cyst within the cerebellopontine angle and petroclival region with involvement of cranial nerves V through XI and the vertebrobasilar system. A retrosigmoid craniotomy was performed for gross total resection of the lesion. The key steps of the procedure are discussed, including: positioning, soft tissue dissection, craniotomy, microsurgical dissection/resection, closure. Additionally, surgical nuances with regards to the safe maximal resection of such lesions are detailed.The video can be found here: http://youtu.be/VEROVO5cYdU.

scholarly journals Solitary bone plasmacytoma as posterior fossa cranial neoplasia, presentation of two clinical cases

2022 ◽  
Vol 13 ◽  
pp. 7
Author(s):  
Luis David Molina Andaluz ◽  
Josué Alejandro Cervantes Gonzalez ◽  
Zita Elizabeth Salazar Ramírez ◽  
Nelly Ramírez ◽  
Luis Guillermo Castellanos ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Clinical Presentation ◽  
The Other ◽  
Occipital Region ◽  
Cerebellar Syndrome ◽  
Total Resection ◽  
Plasma Cell Neoplasm ◽  
Cell Neoplasm ◽  
Solitary Bone Plasmacytoma

Background: Solitary bone plasmacytoma is a plasmatic cell dyscrasia; its presentation in the posterior fossa is very rare. Case Description: We present two cases, a 59-year-old male and a 50-year-old female, both with heterogeneous clinical presentation. One had symptoms compatible with endocranial hypertension, and the other presented with a hemispheric cerebellar syndrome and ipsilateral trigeminal neuralgia. They were both related to an intraosseous tumor of the occipital region near the torcula with large extension to the posterior fossa. The diagnosis of a plasma cell neoplasm arising from the diploe of the squamous portion of the occipital bone was confirmed with immunohistochemistry. Conclusion: The treatment for a cranial tumor that is suspected to be a solitary bone plasmacytoma requires a multidisciplinary team to diagnose, plan a total resection, and after surgery continue with the follow-up of the patient. Solitary bone plasmacytoma should be considered as a differential diagnosis for a tumor that produces cancellous bone widening without sclerotic borders.

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