Pineal Region Meningioma in a Very Young Child

2021 ◽  
Vol 56 (1) ◽  
pp. 73-78
Author(s):  
Chandrashekhar Gendle ◽  
Madhivanan Karthigeyan ◽  
Pravin Salunke
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Young Child ◽  
Germ Cell Tumors ◽  
Pineal Region ◽  
Raised Intracranial Pressure ◽  
Total Resection ◽  
Case Presentation ◽  
Pineal Lesion ◽  
Dural Attachment

Introduction: Meningiomas in childhood are infrequently seen. Furthermore, they are extremely rare at a pineal location with few reported cases above 5-years of age. We present a very young child with a large pineal region meningioma which mimicked the usually occurring pathologies at this site. Case Presentation: A 2.5-year-old child presented with symptoms of raised intracranial pressure. MRI demonstrated a homogenously enhancing pineal lesion with small cystic areas. After an initial cerebrospinal fluid evaluation for germ cell tumors, the child underwent excision of the lesion by the Krause approach. The tumor showed no definitive dural attachment, had well-defined arachnoid interface, and was completely excised. The final histopathology was meningioma. Conclusion: Although unusual, we highlight the importance of considering meningiomas among the childhood pineal region lesions, given their good outcome with total resection. Also, pertinent brief literature of the pediatric pineal region meningiomas has been provided. An assessment of preoperative and intraoperative features (clear arachnoid plane) along with adjuncts such as frozen studies can help discern various entities of this region, and decide the extent of excision.

Increased Intracranial Pressure

1981 ◽  
Vol 2 (9) ◽  
pp. 269-276
Author(s):  
John F. Griffith ◽  
Jimmy C. Brasfield
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Subarachnoid Space ◽  
Buffering Capacity ◽  
Raised Intracranial Pressure ◽  
Cranial Cavity ◽  
Increased Intracranial Pressure ◽  
Underlying Process ◽  
Spinal Subarachnoid Space ◽  
Rate Of Absorption

The infant or child with increasing pressure within the cranial cavity must be identified early and treated promptly in order to prevent serious complications or death. When the pressure elevation is gradual it is frequently well tolerated, and the patient may seem deceptively well. There is a critical point, however, beyond which any further increase in pressure leads to a catastrophic deterioration in the patient's condition.1 When this occurs, the outlook for quality survival is poor despite the best therapy. Unfortunately, this can occur when the underlying process is benign and would have been reversible if recognized and treated promptly. For prompt recognition and treatment, the physician must be familiar with the pathophysiology of raised intracranial pressure. PATHOPHYSIOLOGY The intracranial compartment contains blood vessels, cerebrospinal fluid (CSF), brain, and leptomeninges which include the rigid dural membranes forming the falx and tentorium. Whenever there is an increase in the volume of any one of these intracranial components (brain, CSF, blood) there must be a corresponding reduction in the size of the others in order for the intracranial pressure to remain normal. This type of compensation or buffering capacity is particularly important in the early stages of intracranial disease. As the pressure mounts from any type of mass lesion, the CSF is displaced caudally into the spinal subarachnoid space and there is a corresponding increase in the rate of absorption of CSF.2

scholarly journals Blood to cerebrospinal fluid human chorionic gonadotropin-beta ratios in intracranial germ cell tumors

1998 ◽  
Vol 5 (1) ◽  
pp. E6 ◽  
Author(s):  
Paul B. Rogers ◽  
Eliot C. Sims ◽  
Nicholas Plowman
Keyword(s):  
Cerebrospinal Fluid ◽  
Germ Cell ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Germ Cell Tumors ◽  
Intrathecal Administration ◽  
Pineal Region ◽  
Elevated Blood ◽  
Intracranial Germ Cell Tumors ◽  
Human Chorionic Gonadotropin Beta

Levels of human chorionic gonadotropin-beta (HCG-beta) are elevated in up to 43% of patients with intracranial germ cell tumors (GCTs) and are useful in the diagnosis of these tumors and the follow up of such patients. The ratio of blood HCG-beta to lumbar cerebrospinal fluid (CSF) HCG-beta in these patients at presentation has not been defined. Twenty-two patients with intracranial GCTs have been treated at St. Bartholomew's Hospital over the past 15 years. Two (17%) of 12 germinomas and seven (70%) of 10 nongerminomatous GCTs had elevated blood HCG-beta at presentation. Four cases of pineal region GCTs (one of 12 germinomas and three of 10 nongerminomatous GCTs) had paired, elevated, blood and lumbar CSF HCG-beta levels. The mean blood to CSF ratio was 1:10 (range 1.7-18.4), which is substantially lower than the ratio of 286:1 reported in systemic GCTs. The authors confirm the finding of a previous single report showing that ventricular CSF HCG-beta sampling via an accessible ventriculoperitoneal shunt reservoir may give a spuriously negative result, and they discuss the pathophysiology of the blood-brain barrier in the pineal region and the implications of the intrathecal administration of chemotherapy.

Pineal Tumors

2018 ◽  
Author(s):  
Daniel R. Felbaum ◽  
Jonathan H. Sherman ◽  
Walter C. Jean
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Germ Cell ◽  
Management Strategies ◽  
Germ Cell Tumors ◽  
Pineal Region ◽  
Surgical Approaches ◽  
Glial Tumor ◽  
Pineal Tumors ◽  
Pineal Region Tumors

Pineal region tumors can include a variety of histologies including pineal parenchymal tumor, germ cell tumor, glial tumor, metastasis and meningioma. The workup for pineal region tumors includes standard magnetic resonance imaging for anatomic imaging, as well as cerebrospinal fluid markers to assess for certain germ cell tumors. Cerebrospinal fluid diversion may be necessary if patients present with hydrocephalus. If surgical resection is indicated based on the suspected diagnosis, magnetic resonance venogram is an important study that influences the surgical trajectory. This chapter reviews common pineal region tumors in the setting of a case presentation. Management strategies and surgical approaches are also discussed in this chapter. Pearls for how to select the surgical approach and complication avoidance are also presented.

Cerebrospinal Fluid Drainage from a Subarachnoid Screw

Neurosurgery ◽  
1982 ◽  
Vol 10 (1) ◽  
pp. 91-92 ◽  
Author(s):  
Allan H. Ropper
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Cerebrospinal Fluid Drainage ◽  
Raised Intracranial Pressure ◽  
Aggressive Therapy ◽  
Fluid Removal

Abstract Reduction of intracranial pressure by the removal of cerebrospinal fluid from a subarachnoid screw device was accomplished in several patients. Attempts at fluid removal by this technique may obviate more aggressive therapy for raised intracranial pressure.

scholarly journals Pathophysiology and Management of Raised Intracranial Pressure

1981 ◽  
Vol 9 (4) ◽  
pp. 336-351 ◽  
Author(s):  
R. F. C. Jones ◽  
N. W. C. Dorsch ◽  
G. D. Silverberg ◽  
T. A. Torda
Keyword(s):  
Blood Flow ◽  
Cerebrospinal Fluid ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Blood Brain Barrier ◽  
Cerebral Oedema ◽  
Brain Barrier ◽  
Raised Intracranial Pressure ◽  
Pressure Monitoring ◽  
Different Types

The mechanism of cerebral homeostasis is reviewed, paying particular attention to the way blood-brain barrier, cerebrospinal fluid and cerebral blood flow contribute to the maintenance of normal intracranial pressure. The pathophysiology of raised intracranial pressure is outlined delineating the different types of cerebral oedema. Guidelines for the management of patients with raised intracranial pressure are presented as well as the techniques of intracranial pressure monitoring.

scholarly journals A case of racemose and intraventricular neurocysticercosis in an unusual location

2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Priya Singh ◽  
Surya P. Singh
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Intracranial Pressure ◽  
Lateral Ventricle ◽  
Fourth Ventricle ◽  
The Body ◽  
Raised Intracranial Pressure ◽  
Resonance Imaging ◽  
Left Lateral Ventricle

Racemose and intraventricular neurocysticercosis are uncommon types of neurocysticercosis, resulting in a multiloculated, grape-like cluster appearance in the cerebrospinal fluid (CSF) spaces. A male patient presented with symptoms of raised intracranial pressure and demonstrated racemose neurocysticercosis at an atypical location involving the region of the crus of the fornix at the level of the body of lateral ventricles on magnetic resonance imaging. Associated intraventricular neurocysticercosis was seen in the atrium of the left lateral ventricle and fourth ventricle.

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