Epidermoid Cysts and Cholesterol Granulomas Centered on the Posterior Fossa: Twenty Years of Diagnosis and Management

Neurosurgery ◽  
1987 ◽  
Vol 21 (6) ◽  
pp. 798-805 ◽  
Author(s):  
Howard Ian Sabin ◽  
Lorenzo Tommaso Bordi ◽  
Lindsay Symon
Keyword(s):  
Posterior Fossa ◽  
Diagnostic Procedures ◽  
Jugular Foramen ◽  
Neurological Deficits ◽  
Petrous Apex ◽  
Epidermoid Cysts ◽  
Diagnosis And Management ◽  
Presenting Symptoms ◽  
Review Period ◽  
Contrast Ventriculography

Abstract The clinical features, diagnosis, and management of 23 posterior fossa epidermoid cysts and 9 petrous apex lesions presenting to one unit over a period of 20 years are summarized. Of the epidermoid cysts, 13 were entirely infratentorial, but the other 10 had an additional supratentorial component. Presenting symptoms and signs were usually long-standing and at onset had often been vague and nonspecific. With time, however, a variety of neurological deficits that depended on the site of the lesion developed. These were generally combinations of cerebellopontine (CP) angle and jugular foramen syndromes, deafness, facial palsy, and motor weakness. Diagnostic procedures have changed greatly over the review period. Computed tomography and magnetic resonance imaging have replaced air encephalography and contrast ventriculography. The better preoperative localization of these lesions allows rational planning of the surgical approach required for optimal tumor exposure, which is essential for any attempt at total excision, considering the large size of the majority of these tumors when diagnosed. We favor operation through a posterior fossa craniectomy for those tumors restricted to the CP angle or 4th ventricle, but routinely use a combined supra- and infratentorial approach if the lesion has a more rostral component. The infiltrating nature of epidermoid cysts within the cranium compromises the extent of excision if neurological deficit is not to be increased, but we attempt as complete an excision of tumor and capsule as possible in the hope that many years will pass before symptoms recur. Cholesterol granulomas seem to respond well to simple cavity drainage and have shown no tendency to recur.

Epidermoid cysts of the posterior fossa

1985 ◽  
Vol 62 (2) ◽  
pp. 214-219 ◽  
Author(s):  
Mitchel S. Berger ◽  
Charles B. Wilson
Keyword(s):  
Posterior Fossa ◽  
Cranial Nerves ◽  
Neurological Deficits ◽  
Content Type ◽  
Epidermoid Cysts ◽  
Large Size ◽  
Fourth Decade ◽  
Vascular Structures ◽  
Long Course ◽  
The Brain

✓ Epidermoid cysts originating in the paramedian basal cisterns of the posterior fossa are congenital lesions that grow to a large size through slow accumulation of desquamated epithelium. These lesions grow between and ultimately displace cranial nerves, vascular structures, and the brain stem, causing a long course of progressive neurological deficits. The onset of symptoms usually occurs during the fourth decade of life. Epidermoid cysts are easily diagnosed with computerized tomography scans, which characteristically show a low-density extra-axial pattern. The primary surgical objective is to decompress the mass by evacuating the cyst contents and removing nonadherent portions of the tumor capsule; portions of the capsule adherent to vital structures should be left undisturbed. Aseptic meningitis is the most common cause of postoperative morbidity, and its incidence may be minimized by intraoperative irrigation with steroids followed by systemic therapy with dexamethasone. Symptomatic recurrences that occur many years after surgery should be managed with conservative reoperation.

scholarly journals Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases

2016 ◽  
Vol 124 (6) ◽  
pp. 1752-1765 ◽  
Author(s):  
Terrence F. Holekamp ◽  
Matthew E. Mollman ◽  
Rory K. J. Murphy ◽  
Grant R. Kolar ◽  
Neha M. Kramer ◽  
...  
Keyword(s):  
Venous Drainage ◽  
Diagnostic Procedures ◽  
Endovascular Embolization ◽  
Venous Hypertension ◽  
Neurological Deficits ◽  
Progressive Dementia ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Dementia Syndrome ◽  
Increased Risk

Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.

Anterior Petrosal Approach for Enlarging Previously Radiated Recurrent Trigeminal Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Vol 20 (5) ◽  
pp. E353-E353
Author(s):  
Lorenzo Rinaldo ◽  
Neil S Patel ◽  
Colin L W Driscoll ◽  
Michael J Link
Keyword(s):  
Surgical Resection ◽  
Posterior Fossa ◽  
Residual Tumor ◽  
Neurological Deficits ◽  
Petrous Apex ◽  
Meckel’S Cave ◽  
Trigeminal Neuropathy ◽  
Subtemporal Approach ◽  
Cranial Nerve Palsies ◽  
Meckel's Cave

Abstract Trigeminal nerve schwannomas (TNSs) are rare lesions that typically present with symptoms of trigeminal neuropathy or other cranial nerve palsies. These lesions classically have a dumbbell shape, with an anterior component within Meckel's cave and posterior component extending into the posterior fossa through the porus trigeminus. Surgical resection of TNSs can often be achieved via an extradural subtemporal approach to Meckel's cave without an anterior petrousectomy, even for tumors with a significant posterior fossa component, as the tumor often erodes a portion of the petrous apex.1 We present the case of a 53-yr-old female presenting to our institution with complete trigeminal neuropathy secondary to a right-sided, previously resected and radiated TNS. Serial imaging demonstrated an interval growth of significant residual tumor despite multiple adjuvant therapies, and, thus, the patient was recommended to undergo additional surgical resection. The lesion was approached through a right-sided subtemporal approach to Meckel's cave,2 with a plan to utilize an anterior petrousectomy only if difficulty resecting the posterior fossa component of the tumor was encountered. Intraoperatively, the posterior fossa component was found to be densely adherent to the adjacent brainstem, likely secondary to prior surgery and radiation therapy, and, thus, an anterior petrousectomy was performed. Postoperatively, the patient had stable trigeminal neuropathy without any new neurological deficits and a magnetic resonance imaging (MRI) confirmed a gross total resection. In the accompanying video, we hope to demonstrate the steps and nuances of both the subtemporal approach to accessing Meckel's cave and anterior petrousectomy when employed for the resection of TNSs. The patient in question provided formal consent for the making of this video.

Tumors of the Jugular Foramen—Diagnosis and Management

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Ricardo Ramina ◽  
Joao Jarney Maniglia ◽  
Yvens Barbosa Fernandes ◽  
Jorge Rizzato Paschoal ◽  
Maurício Coelho Neto
Keyword(s):  
Jugular Foramen ◽  
Diagnosis And Management

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.

The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology

2020 ◽  
Vol 130 (1) ◽  
pp. 38-46
Author(s):  
Geoffrey Casazza ◽  
Matthew L. Carlson ◽  
Clough Shelton ◽  
Richard K. Gurgel
Keyword(s):  
Skull Base ◽  
Tertiary Care ◽  
Case Series ◽  
Hearing Preservation ◽  
Csf Leak ◽  
Petrous Apex ◽  
Otic Capsule ◽  
Retrospective Case ◽  
Presenting Symptoms ◽  
Subtotal Petrosectomy

Objective: Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base. Study Design: Retrospective case series Setting: Two tertiary care academic centers. Patients: Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017. Interventions: Surgical management of medially-invasive cholesteatomas. Main Outcome Measures: The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed. Results: Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence. Conclusions: The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.

scholarly journals Medulloblastoma Presenting as Severe Headache during Pregnancy: A Case Report and Review of the Literature

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 127
Author(s):  
Francesca Gabriela Paslaru ◽  
Anca Maria Panaitescu ◽  
Elena Nestian ◽  
George Iancu ◽  
Alina Veduta ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Imaging Techniques ◽  
Diagnostic Procedures ◽  
Intracranial Tumor ◽  
Neurological Deficits ◽  
Physiological Changes ◽  
Intracranial Tumors ◽  
Review Of The Literature ◽  
Common Complaint ◽  
Persistent Headache

Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms—persistent headache followed by neurological deficit—in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.

scholarly journals No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial

2020 ◽  
Vol 6 (4) ◽  
pp. 00342-2020
Author(s):  
Hamid Akbarshahi ◽  
Zainab Ahmadi ◽  
David C. Currow ◽  
Jacob Sandberg ◽  
Zac Vandersman ◽  
...  
Keyword(s):  
Gender Bias ◽  
Diagnostic Procedures ◽  
Morbidity And Mortality ◽  
Case Scenario ◽  
Double Blind ◽  
Diagnosis And Management ◽  
Hypothetical Patient ◽  
Parallel Group ◽  
Randomised Controlled ◽  
Study Participants

IntroductionCOPD is a major cause of morbidity and mortality. The prevalence, morbidity and mortality of COPD among females have increased. Previous studies indicate a possible gender bias in the diagnosis and management of COPD. The present study aims to determine if there is gender bias in the management of COPD in Sweden.MethodsThis was a double-blind, randomised (1:1), controlled, parallel-group, web-based trial using the hypothetical case scenario of a former smoker (40 pack-years and quit smoking 3 years ago) who was male or female. The participants were blind to the randomisation and the purpose of the trial. The case progressively revealed more information with associated questions on how the physician would manage the patient. Study participants chose from a list of tests and treatments at each step of the case scenario.ResultsIn total, 134 physicians were randomised to a male (n=62) or a female (n=72) case. There was no difference in initial diagnosis (61 (98%) male cases and 70 (97%) female cases diagnosed with COPD) and planned diagnostic procedures between the male and female cases. Spirometry was chosen by all the physicians as one of the requested diagnostic tests. The management of the hypothetical COPD case did not differ by sex of the responding physician.ConclusionIn Sweden, diagnosis and management of a hypothetical patient with COPD did not differ by the gender of the patient or physician.

Approach to the Patient with a Breast Mass

2019 ◽  
Author(s):  
George Plitas ◽  
Monica Morrow ◽  
Brandon R Bruns
Keyword(s):  
Breast Cancer ◽  
Differential Diagnosis ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Breast Mass ◽  
Breast Lesions ◽  
Breast Clinic ◽  
Breast Masses ◽  
Diagnosis And Management ◽  
Benign Breast Lesions

A breast mass is the most common presenting symptom among patients in a breast clinic. The presence of a breast mass can cause a great deal of anxiety in women, as well as their physicians. The differential diagnosis of a palpable breast abnormality is broad, although the majority of breast masses are benign. The responsibility of the physician who is evaluating a breast mass is to exclude the presence of malignancy. Once cancer is ruled out, the physician should then attempt to provide an accurate diagnosis, appropriate treatment, and reassurance to the patient. This chapter discusses the assessment of normal breast physiology, identification of a breast mass, evaluation of the various classifications of breast mass (e.g., dominant mass with clinically benign features and dominant mass with suspicious features), differential diagnosis and management of common benign breast masses (e.g., cysts, fibroadenomas, phyllodes tumors, hamartomas, fat necrosis), and the risk of breast cancer associated with benign breast lesions. The chapter also discusses the diagnosis and management of a breast mass in male patients. Tables outline breast lesions that may present as a palpable abnormality, factors used for the assessment of breast cancer risk, physical characteristics of benign and malignant breast masses, the accuracy of fine-needle aspiration, and benign breast lesions by category. Figures illustrate diagnostic procedures, the anatomy of the human breast, visual inspection of the breasts, physical examination of the breasts, breast palpation technique, the evaluation and management of a new breast mass, and the identification of cysts. This review contains 10 figures, 14 tables, and 64 references. Keywords: breast mass, lobuloalveolar development, subareolar nodularity, parenchyma (glandular elements), stromal tissue, ovarian graafian follicles

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