Complete Microsurgical Resection of Large Retrochiasmatic Hypothalamic Craniopharyngioma by Transpetrosal Approach: 2-Dimensional Operative Video

Abstract This two-dimensional video shows the technical nuances of complete microsurgical resection of a hypothalamic craniopharyngioma located in the retrochiasmatic region by the transpetrosal approach. This 49-yr-old man presented with progressive fatigue, excessive sleepiness, and difficulty in vision in both eyes. He was found to have right CN 3 paralysis and bitemporal hemianopsia on neurological examination. Further workup revealed panhypopituitarism. Brain magnetic resonance imaging (MRI) demonstrated a large solid retrochiasmatic hypothalamic lesion with homogeneous contrast enhancement, measuring 2.1 × 2.6 × 2.4 cm. Optic chiasm was prefixed, and the tumor was just posterior to the pituitary stalk area. The preoperative differential diagnosis included hypothalamic astrocytoma, craniopharyngioma, germinoma, and histiocytosis. Because of the prefixed chiasm, a presigmoid, transpetrosal approach was performed. Our initial plan was a large biopsy, but based on frozen section histology, we decided to excise the tumor completely. The tumor had a pseudocapsule, which was firm and yellowish. It was debulked, dissected from the surrounding hypothalamus, and removed completely. The pituitary stalk was found at the anterior and inferior ends of the tumor and was preserved. Postoperatively, the patient developed diabetes insipidus and requires desmopressin replacement, which was gradually tapered. For panhypopituitarism, he is receiving thyroxine, hydrocortisone, and testosterone. Postoperatively, patient had an improvement in vision in his left eye and ptosis was improving in the right eye with mRs 1- at 10-wk follow-up. An informed consent was obtained from the patient prior to the surgery, which included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

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Overlapping anti-N-methyl-D-aspartate receptor (NMDAR) Encephalitis With Neuromyelitis Optica Spectrum Disorders: A Case Report

10.21203/rs.3.rs-907816/v1 ◽

2021 ◽

Author(s):

Jialin Pan ◽

Begench Ovlyakulov ◽

Lili zhou

Keyword(s):

Neuromyelitis Optica ◽

Brain Magnetic Resonance Imaging ◽

Chinese Patient ◽

Cerebellar Hemisphere ◽

Double Positive ◽

Blurred Vision ◽

Aspartate Receptor ◽

Nmdar Encephalitis ◽

Magnetic Resonance Imaging Mri ◽

The Right

Abstract BackgroundAnti-N-methyl-D-aspartate receptor (NMDAR) encephalitis can coexist with neuromyelitis optica spectrum disorder (NMOSD). Patients with overlapping anti-NMDAR encephalitis with positive NMDAR antibodies and aquaporin 4 immunoglobulin G (AQP4-IgG)-seropositive NMOSD are rare but should not be ignored.Case presentationThis report describes a unique case of anti-NMDAR encephalitis coexisting with NMOSD is presented. A 27-year-old male presented with blurred vision, cognitive impairment, psychosis, dysphagia, gait instability and urinary incontinence. Brain magnetic resonance imaging (MRI) showed abnormal signals in the right cerebellar hemisphere, temporal lobe, and corpus callosum. NMDAR antibodies were positive in the CSF. AQP4-IgG antibodies were positive in the serum. The patient's condition was stable following intravenous gamma globulin, corticosteroids, immunosuppressants and symptomatic treatments. ConclusionsThis case provides further evidence for the occurrence of anti-NMDAR encephalitis overlapping NMOSD with AQP4-IgG-seropositive in a Chinese patient. However, the mechanisms underlying the occurrence of double positive antibodies remain elusive.

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Paroxysmal kinesigenic dyskinesia–like phenotype in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458517702535 ◽

2017 ◽

Vol 23 (13) ◽

pp. 1795-1797 ◽

Cited By ~ 4

Author(s):

Roxana Pop ◽

Stefan Kipfer

Keyword(s):

Multiple Sclerosis ◽

Gene Mutations ◽

Brain Magnetic Resonance Imaging ◽

Acute Onset ◽

Intravenous Steroid ◽

Paroxysmal Kinesigenic Dyskinesia ◽

Hyperkinetic Movement Disorder ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Rapid Regression

In April 2015, a 20-year-old woman with multiple sclerosis (MS) presented with acute onset of repetitive abnormal postures and choreatic movements of the right arm, precipitated by voluntary movements (online video 1 and 2). Brain magnetic resonance imaging (MRI) showed a new active MS lesion involving the basal ganglia on the left side (Figure 1(a)). Intravenous steroid treatment resulted in rapid regression of this paroxysmal kinesigenic dyskinesia (PKD)-like hyperkinetic movement disorder. The patient became asymptomatic within 3 months. PKD is characterized by recurrent uni- or bilateral choreoathetosis and usually represents an autosomal dominant inherited disorder caused by PRRT2 gene mutations. As in the present case, a PKD-like phenotype may be associated with MS relapses in presumably genetic negative cases.

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Microsurgical Resection of Recurrent Cavernous Sinus Hemangioma by Superior and Lateral Approach: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz313 ◽

2019 ◽

Vol 19 (2) ◽

pp. E165-E166

Author(s):

Qazi Zeeshan ◽

Juan P Carrasco Hernandez ◽

Michael K Moore ◽

Laligam N Sekhar

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Cavernous Sinus ◽

Tumor Resection ◽

Cranial Nerves ◽

Brain Magnetic Resonance Imaging ◽

Mass Effect ◽

Lateral Approach ◽

Microsurgical Resection ◽

The Right

Abstract This video shows the technical nuances of microsurgical resection of recurrent cavernous sinus (CS) hemangioma by superior and lateral approach. A 77-yr-old woman presented with headache and difficulty in vision in right eye for 6 mo. She had previously undergone attempted resection of a right CS tumor in another hospital with partial removal, and the tumor had grown significantly. Neurological examination revealed proptosis, cranial nerve 3 palsy, and loss of vision in right eye (20/200). Left side visual acuity was 20/20. Brain magnetic resonance imaging (MRI) demonstrated a large CS mass with homogeneous enhancement, measuring 3.3 × 3.3 × 2.6 cm, extending into the suprasellar cistern with mass effect on the right optic nerve. It extended anteriorly to the region of the right orbital apex and abuted the basilar artery posteriorly. She underwent right frontotemporal craniotomy, posterolateral orbitotomy and anterior clinoidectomy as well as optic nerve decompression, and the CS tumor was removed by superior and lateral approach. An incision was made into the superior wall of the CS medial to the third nerve. On lateral aspect the tumor had extended outside the CS through the Parkinson's triangle. Posteriorly it extended through the clival dura. Anteriorly tumor encased the carotid artery and it was gradually dissected away. At the end of the operation, all of the cranial nerves were intact. Postoperative MRI showed near complete tumor resection with preservation of the internal carotid artery. At 6 mo follow-up her modified Rankin Scale was 1 and vision in left eye was normal. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

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A Conjunctival Vascular Malformation as a Rare Presenting Sign of Wyburn–Mason Syndrome

Journal of Pediatric Neurology ◽

10.1055/s-0037-1607996 ◽

2017 ◽

Vol 16 (04) ◽

pp. 239-242

Author(s):

Gunnar Buyse ◽

Lieven Lagae ◽

Philippe Demaerel ◽

Frank Kesteloot ◽

Ingele Casteels ◽

...

Keyword(s):

Vascular Malformation ◽

Arteriovenous Malformations ◽

Brain Magnetic Resonance Imaging ◽

Rare Condition ◽

Vascular Lesion ◽

Facial Skin ◽

Sudden Appearance ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

The Brain

AbstractWyburn–Mason syndrome is a rare condition that is characterized by ipsilateral arteriovenous malformations affecting the eye, brain, and facial skin. A conjunctival vascular dilation can be a rare ocular presenting sign. We report a 6-year-old boy who attended the hospital because of the sudden appearance of a conjunctival vascular lesion in his right eye. Inspection of his facial skin showed a subtle discoloration along the right trigeminal nerve and a vascular structure of the conjunctiva. Fundoscopy showed dilated and tortuous retinal vessels. Brain magnetic resonance imaging (MRI) revealed a large arteriovenous malformation involving the thalamus and perimesencephalic area. Ophthalmologic and neuroradiologic findings were consistent with the diagnosis of Wyburn–Mason syndrome. The sudden emergence of a vascular malformation in the conjunctiva should alert the clinician to perform an ophthalmoscopy, and in our patient, this finding was the clue to diagnosis of Wyburn–Mason syndrome. Because of the association between retinal and intracranial arteriovenous malformations, an MRI of the brain is strongly recommended in all patients with ocular arteriovenous malformations.

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Ganglioglioma of optic chiasma: A case report and review of literature

Surgical Neurology International ◽

10.25259/sni_496_2020 ◽

2020 ◽

Vol 11 ◽

pp. 392

Author(s):

Bashar Abuzayed ◽

Khaled Alawneh ◽

Majdi Al-Qawasmeh ◽

Sohaib Al-Khatib ◽

Marwa Barukba ◽

...

Keyword(s):

Histopathological Examination ◽

Brain Magnetic Resonance Imaging ◽

Optic Chiasm ◽

Subtotal Resection ◽

Low Grade ◽

Who Grade ◽

Optic Chiasma ◽

Radiologic Findings ◽

Pilocytic Astrocytomas ◽

The Right

Background: Gangliogliomas are neoplasms containing both astrocytic and neuronal components. We present a case of gangliogliomas of the optic chiasm, which are extremely rare pathologies. Case Description: A 16-year-old female patient referred to our clinic with gradual deterioration of vision for the age of 1 year mostly in the right eye. Ophthalmic examination confirmed reduced visual acuity with only perception of light in the left eye. Brain magnetic resonance imaging showed a solid mass lesion involving the hypothalamus and the optic chiasm, which was hypointense on T1-weighted images, hyperintense on T2-WI, and marked homogenous contrast enhancement. The patient was operated and bulging of the optic chiasm and the site of lamina terminalis was seen. Subtotal resection of the tumor was achieved. Histopathological examination revealed ganglioglioma (WHO Grade I). Follow-up of the patient was for 3 years and 8 months with stable neurologic and radiologic findings. Conclusion: To the best of our knowledge, 20 cases, including ours, have been reported in the literature and a presurgical diagnosis of ganglioglioma is very infrequent with confused radiologically with low-grade pilocytic astrocytomas.

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Surgical Resection of a Cavernous Malformation of the Anterior Perforated Substance: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy354 ◽

2018 ◽

Vol 17 (2) ◽

pp. E64-E64

Author(s):

Alejandro Enriquez-Marulanda ◽

Abdulrahman Y Alturki ◽

Luis C Ascanio ◽

Ajith J Thomas ◽

Christopher S Ogilvy

Keyword(s):

Optic Tract ◽

Brain Magnetic Resonance Imaging ◽

Mass Effect ◽

Brain Structures ◽

Acute Onset ◽

Elective Resection ◽

Cavernous Malformations ◽

Patient Consent ◽

Magnetic Resonance Imaging Mri ◽

The Right

Abstract Cavernous malformations (CMs) are intracranial vascular anomalies of the brain blood vessels which are usually asymptomatic but sometimes may cause headache, seizures, or focal neurologic symptoms.1 The latter may be attributed to either hemorrhage of the lesion or due to associated mass effect.2 Here, we describe the case of a 27-yr-old woman who had an acute onset of headache and occasional left sided peripheral visual disturbances. A brain computed tomography scan revealed intraparenchymal hemorrhage near the right hypothalamus and a brain magnetic resonance imaging (MRI) was consistent with an anterior perforated substance CM. Medical management was pursued but severe headache persisted for several weeks to the point of interfering with normal daily function. Given the evidence of past hemorrhage and the persistence of symptoms, a microsurgical resection was indicated. She was scheduled for an elective resection through a right frontotemporal craniotomy. The lesion was found in the right anterior perforated substance, just above the optic tract and was resected without complications. The patient was neurologically stable at discharge. At 4-mo follow-up, the patient had a significantly decreased intensity of headache and an adequate resection cavity on MRI. Otherwise, she was neurologically intact. Cavernous malformations of deep brain structures, such as the anterior perforated substance can be surgically treated but carry a challenging procedure with a risk of visual deficits. In the following video illustration, we narrate this operative case and highlight the nuances of this approach. Patient consent was obtained for the submission of the video to this journal.

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Primary multiple cerebral hydatid disease in a young patient with surgically-treated intracerebral haemorrhage

Romanian Neurosurgery ◽

10.33962/roneuro-2021-011 ◽

2021 ◽

pp. 71-74

Author(s):

Anwar N. Hafedh ◽

Awfa A. Aktham ◽

Zahraa F. Al-Sharshahi ◽

Ahmed Ibrahim Al-Jorani ◽

Sama Albairamani ◽

...

Keyword(s):

Hydatid Disease ◽

Intracerebral Haemorrhage ◽

Right Hemisphere ◽

Brain Magnetic Resonance Imaging ◽

Future Research ◽

New Findings ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri ◽

One Year ◽

The Right

Introduction: Cerebral hydatid disease (CHD) is rare and the multiple-cystic variety is even rarer. In this paper, we report a case of multiple CHD and explore a possible link with a preceding spontaneous intracerebral haemorrhage (ICH). Case presentation: A 27-year old gentleman with a history of surgically-evacuated, spontaneous ICH presented with severe headache, left-sided weakness - Medical Research Council (MRC) grade II - and recurrent tonic-clonic seizures, while on a full dose of anti-epileptic medication. Brain magnetic resonance imaging (MRI) scans showed multiple intra-axial cystic lesions in the right hemisphere. The cysts were removed intact using Dowling’s technique through a large temporoparietal craniotomy. The surgery went uneventful and the patient recovered as expected. Post-operatively, a prophylactic course of albendazole (200 mg) was prescribed. On his one-year follow-up visit, the patient was symptom-free and his weakness had improved (left upper limb: MRC grade IV and full power of the left lower limb). The computed tomography (CT) scan showed no new findings. Conclusion: Primary cerebral hydatid disease is rare and the multiple-cyst variety is even rare. In this case, a peculiar association with a surgically-treated ICH was explored with possible theories to suggest future research directions.

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Microsurgical Resection of Medulla Oblongata Hemangioblastoma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy074 ◽

2018 ◽

Vol 15 (5) ◽

pp. E64-E65 ◽

Cited By ~ 3

Author(s):

Mirza Pojskić ◽

Kenan I Arnautović

Keyword(s):

Medulla Oblongata ◽

Posterior Arch ◽

Tumor Nodule ◽

Posterior Aspect ◽

Von Hippel Lindau ◽

Postoperative Mri ◽

Suboccipital Craniectomy ◽

Microsurgical Resection ◽

Magnetic Resonance Imaging Mri ◽

The Right

Abstract This video demonstrates the microsurgical resection of brainstem hemangioblastoma. The patient is a 32-yr-old woman with Von Hippel Lindau syndrome who presented with quadriparesis and inability to swallow. Magnetic resonance imaging (MRI) of the neuroaxis revealed a brainstem cystic lesion with contrast-enhancing tumor nodule right along the posterior aspect of the lower part of medulla oblongata. The surgery was performed in the prone position with suboccipital craniectomy and partial C1 posterior arch removal. The aim of the surgery was to remove the tumor nodule.1-12 The tumor was separated from the right dorsal nerve roots, and then progressively dissected with coagulation of arterial feeders and draining vein and division of the pia circumferentially. Postoperative MRI revealed complete resection. The patient completely recovered from her quadriparesis and difficulty swallowing.

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Cluster-like headache secondary to maxillary sinusitis by Aspergillus

Cephalalgia Reports ◽

10.1177/2515816318814226 ◽

2018 ◽

Vol 1 ◽

pp. 251581631881422

Author(s):

Laura Martinez Rodriguez ◽

Angel Ignacio Perez Alvarez ◽

Jose Maria Sanchez Alvarez

Keyword(s):

Maxillary Sinus ◽

Maxillary Sinusitis ◽

International Headache Society ◽

Brain Magnetic Resonance Imaging ◽

Imaging Study ◽

Resonance Imaging ◽

Symptomatic Cluster Headache ◽

Magnetic Resonance Imaging Mri ◽

Atypical Feature ◽

The Right

A symptomatic cluster headache (CH), caused by fungal maxillary sinus infection fulfilling the criteria of International Headache Society (ICDH-3) for CH is presented. A 35-year-old man without previous headaches reported episodes of pain in the right fronto-orbitary region, with severe eyelid oedema, photophobia, frontal sweating, lacrimation, conjunctival injection and rhinorrhoea, which lasted for 2–3 h. A brain magnetic resonance imaging (MRI) showed occupation of the right maxillary sinus, a mycetoma due to Aspergillus fumigatus. Although rare, secondary causes must be discarded before the diagnosis of a primary CH is made. Imaging study should always be performed, even though no atypical feature was present and ICDH-3 were fulfilled.

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Acute Intravenous Calcium Antagonist for Suspected Hemiplegic Migraine – A Case Story

Case Reports in Neurology ◽

10.1159/000474934 ◽

2017 ◽

Vol 9 (1) ◽

pp. 98-105 ◽

Cited By ~ 3

Author(s):

Charlotte Lützhøft Rath ◽

Jun He ◽

Mette Maria Nordling ◽

Troels Wienecke

Keyword(s):

Symptom Onset ◽

Right Hemisphere ◽

Young Patients ◽

Brain Magnetic Resonance Imaging ◽

Recombinant Tissue Plasminogen Activator ◽

Hemiplegic Migraine ◽

Brain Ct ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right

Stroke mimics, like attacks of hemiplegic migraine, are challenging in acute stroke evaluation. We present a 28-year-old woman with a suspected hemiplegic migraine attack with left-sided hemiparalysis. Brain CT with perfusion imaging 1 h 54 min after symptom onset revealed hypoperfusion in the right hemisphere. The patient was treated with intravenous recombinant tissue plasminogen activator (rtPA) with no effect. After a subsequent intravenous verapamil infusion, the patient gained full motor function within 10 min. Brain magnetic resonance imaging (MRI) performed 5 h 46 min after symptom onset revealed diffusion restriction in the same area as the hypoperfusion on CT. There were no notable changes on T2 images. The patient stayed clinically in remission, except for reduced sensation for all modalities on the extremities on the left side. Although brain CT 24 h after symptom onset revealed an edema in the same area, an MRI performed 17 days later showed no new infarctions. Young patients with a history of migraine with aura admitted with symptoms of acute ischemic stroke are at risk of insufficient treatment. Calcium antagonists might be considered if there is no effect of first-line treatment with rtPA.

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