Diagnostic challenges of an incidental finding: case report of definitely-congenital glioblastoma multiforme in a very preterm infant

Abstract Background Congenital brain tumors are extremely rare in the neonatal population, and often associated with a poor prognosis. The diagnostic suspicion is often aroused at antenatal scans or postnatally, if clinical signs and symptoms of increased intracranial pressure become evident. We present a case of definitely congenital glioblastoma multiforme incidentally diagnosed in a preterm infant, aiming to raise clinical awareness on this condition and to highlight the challenges of the related diagnostic work-up. Case presentation This female infant was born at 31 weeks’ gestation after an uneventful pregnancy. No abnormalities were detected at antenatal ultrasound scans and genetic tests. Head circumference at birth was on the 25th centile. A routine brain ultrasound scan performed on day 1 revealed a large, inhomogeneous lesion in the right cerebral hemisphere, with contralateral midline shift, which was confirmed by brain magnetic resonance imaging (MRI). Eye fundus and routine blood exams, including platelets count, coagulation screening and C-reactive protein, were normal. Given the high risk of complications, surgical biopsy of the lesion was temporarily hold and a daily sonographic follow-up was undertaken. Although head circumference growth was steady on the 25th centile, progressive changes of the lesion were detected by cranial ultrasound. The repeat MRI scans showed a significant enlargement of the mass, with contralateral midline shift and signs of intralesional and intraventricular bleeding. In view of this worsening, surgical resection was performed. The histological examination of the lesion biopsy documented a GFAP+ highly cellular neoplasm, with no mutation on SMARCB1 gene. At the molecular analysis, mutations on IDH and H3F3A genes were absent, whereas MGMT promoter was unmethylated. The diagnosis was grade IV glioblastoma IDH wild-type. Conclusions Congenital glioblastoma multiforme is an extremely rare but highly aggressive neoplasm. Since intralesional biopsy is not often feasible in affected neonates, knowledge of the associated clinical and neuroradiological features is particularly important, as they can also add useful information on the neoplasm behavior. Specimens from open surgical resection allow to perform a definite histological analysis and an extended molecular characterization, with relevant prognostic implications.

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Microsurgical resection of a glioblastoma multiforme of the medulla oblongata with intraoperative subcortical stimulation and mapping

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19405 ◽

2019 ◽

Vol 1 (2) ◽

pp. V1

Author(s):

Sima Sayyahmelli ◽

Jian Ruan ◽

Bryan Wheeler ◽

Mustafa K. Başkaya

Keyword(s):

Glioblastoma Multiforme ◽

Surgical Resection ◽

Medulla Oblongata ◽

Cranial Nerves ◽

The Body ◽

Fine Motor ◽

Surgical Video ◽

Inferior Aspect ◽

Hyperintense Signal ◽

Microsurgical Resection

Primary glioblastoma multiforme tumors of the medulla oblongata are rare, especially in the adult population. Perhaps due to this rarity, we are not aware of any previous reports addressing the resection of these tumors or their clinical outcomes.In this surgical video, we present a 43-year-old man with a 1-month history of left-sided paresthesia. The paresthesia initiated in the left hand, along with weakness and reduced fine motor control, and then spread to the entire left side of the body. He had recent weight loss, imbalance, difficulty in swallowing, and hoarseness in his voice. He also had a diminished gag reflex, and significant atrophy of the right side of the tongue with an accompanying deviation of the uvula and fasciculations of the tongue. MRI showed an infiltrative expansile mass within the medulla with peripheral enhancement and central necrosis. In T2/FLAIR sequences, a hyperintense signal extended superiorly into the left inferior aspect of the pons and left inferior cerebellar peduncle and inferiorly into the upper cervical cord.The decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of this infiltrative expansile intrinsic mass in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials and monitoring of lower cranial nerves IX, X, XI, and XII. A gross-total resection of the enhancing portion of the tumor was performed, along with a subtotal resection of the nonenhancing portion. The surgery and postoperative course were uneventful. Histopathology revealed a grade IV astrocytoma. The patient received radiation therapy.In this surgical video, we demonstrate important steps for the microsurgical resection of this challenging glioblastoma multiforme of the medulla oblongata.The video can be found here: https://youtu.be/QHbOVxdxbeU.

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Diagnosis, treatment and postsurgical complications in a dog with epileptic seizures and a naso-ethmoidal meningoencephalocele

Acta Veterinaria Scandinavica ◽

10.1186/s13028-021-00591-1 ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Abtin Mojarradi ◽

Sofie Van Meervenne ◽

Alejandro Suarez-Bonnet ◽

Steven De Decker

Keyword(s):

Surgical Resection ◽

Medical Management ◽

Surgical Intervention ◽

Clinical Signs ◽

Epileptic Seizures ◽

Nasal Discharge ◽

Dural Defect ◽

Drug Resistant ◽

Tension Pneumocephalus ◽

Postsurgical Complications

Abstract Background Naso-ethmoidal meningoencephalocele is usually a congenital anomaly consisting of a protrusion of cerebral tissue and meninges into the ethmoidal labyrinth. The condition is a rare cause of structural epilepsy in dogs. We report the clinical presentation, surgical intervention, postoperative complications and outcome in a dog with drug resistant epilepsy secondary to a meningoencephalocele. Case presentation A 3.3-year-old male neutered Tamaskan Dog was referred for assessment of epileptic seizures secondary to a previously diagnosed left-sided naso-ethmoidal meningoencephalocele. The dog was drug resistant to medical management with phenobarbital, potassium bromide and levetiracetam. Surgical intervention was performed by a transfrontal craniotomy with resection of the meningoencephalocele and closure of the dural defect. Twenty-four hours after surgery the dog demonstrated progressive cervical hyperaesthesia caused by tension pneumocephalus and pneumorrhachis. Replacement of the fascial graft resulted in immediate resolution of the dog’s neurological signs. Within 5 months after surgery the dog progressively developed sneezing and haemorrhagic nasal discharge, caused by sinonasal aspergillosis. Systemic medical management with oral itraconazole (7 mg/kg orally q12h) was well-tolerated and resulted in resolution of the clinical signs. The itraconazole was tapered with no relapsing upper airway signs. The dog’s frequency of epileptic seizures was not affected by surgical resection of the meningoencephalocele. No treatment adjustments of the anti-epileptic medication have been necessary during the follow-up period of 15 months. Conclusions Surgical resection of the meningoencephalocele did not affect the seizure frequency of the dog. Further research on prognostic factors associated with surgical treatment of meningoencephaloceles in dogs is necessary. Careful monitoring for postsurgical complications allows prompt initiation of appropriate treatment.

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A gastric outlet thickened mucosal fold associated with cytomegalovirus infection in an extremely preterm infant managed by surgical resection

Paediatrics and International Child Health ◽

10.1080/20469047.2021.1967626 ◽

2021 ◽

pp. 1-4

Author(s):

Susmitha Tangirala ◽

Prakash Amboiram ◽

Umamaheswari Balakrishnan ◽

Sandhya Sundaram ◽

Prakash Agarwal ◽

...

Keyword(s):

Preterm Infant ◽

Surgical Resection ◽

Cytomegalovirus Infection ◽

Extremely Preterm ◽

Mucosal Fold

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Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

BIRDEM Medical Journal ◽

10.3329/birdem.v7i3.33779 ◽

2017 ◽

Vol 7 (3) ◽

pp. 194-197

Author(s):

Tasnima Ahmed ◽

Abdul Baki ◽

Tahmina Begum ◽

Nazmun Nahar

Keyword(s):

Clinical Features ◽

Intraventricular Hemorrhage ◽

Tertiary Care ◽

Clinical Signs ◽

Sudden Onset ◽

Morbidity And Mortality ◽

Preterm Neonates ◽

Cranial Ultrasound ◽

Care Hospital ◽

One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

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P13.10 * SURGICAL TREATMENT FOR GLIOBLASTOMA MULTIFORME: OUTCOME AND ANALYSIS OF PROGNOSTIC FACTORS ESPECIALLY ORIENTED TO THE EXTENT OF SURGICAL RESECTION

Neuro-Oncology ◽

10.1093/neuonc/nou174.256 ◽

2014 ◽

Vol 16 (suppl 2) ◽

pp. ii67-ii68

Author(s):

L. Di Somma ◽

M. Iacoangeli ◽

L. Alvaro ◽

A. Di Rienzo ◽

V. Liverotti ◽

...

Keyword(s):

Prognostic Factors ◽

Surgical Treatment ◽

Glioblastoma Multiforme ◽

Surgical Resection ◽

Extent Of Surgical Resection

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Prevalence and Clinical Implications of Incidentally Detected Parotid Lesions as Blind Spot on Brain MRI: A Single-Center Experience

Medicina ◽

10.3390/medicina57080836 ◽

2021 ◽

Vol 57 (8) ◽

pp. 836

Author(s):

In-Chul Nam ◽

Hye-Jin Baek ◽

Kyeong-Hwa Ryu ◽

Jin-Il Moon ◽

Eun Cho ◽

...

Keyword(s):

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Blind Spot ◽

Clinical Implications ◽

Single Center Experience ◽

Superficial Lobe ◽

Mean Size ◽

Magnetic Resonance Imaging Mri ◽

Clinical Awareness ◽

Low Prevalence

Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the brain MRI reports of 84 patients that contained the words “parotid gland” or “PG”. Of these, we finally included 49 lesions involving 45 patients following histopathological confirmation. Results: Based on the laboratory, radiological or histopathological findings, the prevalence of incidental parotid lesions was low (1.2%). Among the 45 study patients, 41 (91.1%) had unilateral lesions, and the majority of the lesions were located in the superficial lobe (40/49, 81.6%). The mean size of the parotid lesions was 1.3 cm ± 0.4 cm (range, 0.5 cm–2.8 cm). Of these, 46 parotid lesions (93.9%) were benign, whereas the remaining three lesions were malignant (6.1%). Conclusions: Despite the low prevalence and incidence of malignancy associated with incidental parotid lesions detected on brain MRI, the clinical implications are potentially significant. Therefore, clinical awareness and appropriate imaging work-up of these lesions are important for accurate diagnosis and timely management.

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Prediction of neurodevelopmental outcome in the preterm infant: short latency cortical somatosensory evoked potentials compared with cranial ultrasound.

Archives of Disease in Childhood ◽

10.1136/adc.67.10_spec_no.1177 ◽

1992 ◽

Vol 67 (10 Spec No) ◽

pp. 1177-1181 ◽

Cited By ~ 32

Author(s):

L S de Vries ◽

P Eken ◽

V Pierrat ◽

H Daniels ◽

P Casaer

Keyword(s):

Evoked Potentials ◽

Preterm Infant ◽

Somatosensory Evoked Potentials ◽

Neurodevelopmental Outcome ◽

Short Latency ◽

Cranial Ultrasound

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Complete Temporal Lobectomy for Surgical Resuscitation of Patients with Transtentorial Herniation Secondary to Unilateral Hemispheric Swelling

Neurosurgery ◽

10.1227/00006123-199107000-00010 ◽

1991 ◽

Vol 29 (1) ◽

pp. 62-66 ◽

Cited By ~ 22

Author(s):

Eric S. Nussbaum ◽

Aizik L. Wolf ◽

Leslie Sebring ◽

Stuart Mirvis

Keyword(s):

Daily Living ◽

Clinical Evidence ◽

Head Injuries ◽

Clinical Signs ◽

Temporal Lobectomy ◽

Midline Shift ◽

Single Patient ◽

Transtentorial Herniation ◽

Computed Tomographic ◽

Scale Scores

Abstract Transtentorial herniation is an ominous finding in the patient with head injuries. We report our experience with 10 patients suffering from acute transtentorial herniation secondary to posttraumatic unilateral hemispheric swelling who were treated aggressively with temporal lobectomy. Eight patients were men and 2 were women. Their ages ranged from 22 to 61 years, with a mean of 37 years. Their preoperative Glasgow Coma Scale scores ranged from 3 to 6, with a mean of 4. All patients had both computed tomographic and clinical evidence of unilateral hemispheric shift and acute herniation without a significant subdural or epidural hematoma. Seven patients had unilateral nonreactive pupils and 3 had bilateral nonreactive pupils. All were taken to the operating room within 2 hours of clinical signs of herniation. Complete unilateral temporal lobectomies including the mesial structures, amygdala, and uncus were performed. In this series, the mortality rate was 30%, including a single patient who was neurologically stable but died from nonneurological injuries. Of the 7 survivors, 4 were functionally independent and 3 required minimal assistance with the activities of daily living. Aggressive, early decompression via complete temporal lobectomy may thus significantly improve the outcome in patients with transtentorial herniation accompanying posttraumatic hemispheric swelling and midline shift. (Neurosurgery 29:62-66, 1991)

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Left Atrial Appendage Aneurysm Characterized by Multimodal Imaging

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118769327 ◽

2018 ◽

Vol 11 (4) ◽

pp. NP161-NP163

Author(s):

David J. Brenneman ◽

Andrew D. Pitkin ◽

Dipankar Gupta ◽

Mark S. Bleiweis ◽

Karl M. Reyes ◽

...

Keyword(s):

Surgical Resection ◽

Left Atrial ◽

Multimodal Imaging ◽

Left Atrial Appendage ◽

Incidental Finding ◽

Rare Condition ◽

Atrial Appendage ◽

Left Atrial Appendage Aneurysm

We present a four-year-old female with an incidental finding of a congenital left atrial appendage aneurysm who underwent surgical resection with excellent results. This case highlights the importance of multimodal imaging in the diagnosis and characterization of this rare condition.

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