Recurrent adult pilocytic astrocytoma presenting with intraventricular and leptomeningeal spread

Background: Infratentorial pilocytic astrocytomas are uncommon tumors in adulthood but are thought to be prognostically similar to their pediatric counterparts with excellent overall survival following gross total resection. However, given the relative rarity of these tumors, no management guidelines exist for recurrent adult pilocytic astrocytomas (APAs). This lack of consensus is especially problematic for inoperable recurrences or those with aggressive features concerning for malignant transformation. Case Description: In 2017, a 26-year-old female presented with headaches, nausea, vomiting, and blurry vision. A brain magnetic resonance imaging (MRI) demonstrated a large, well-circumscribed mass within the fourth ventricle causing obstructive hydrocephalus. She underwent near-total resection through a midline suboccipital transtonsillar approach. Pathology demonstrated a World Health Organization Grade 1 pilocytic astrocytoma. Despite initial improvement in her symptoms, she developed worsening headaches and lethargy 10 months after surgery and repeat MRI demonstrated recurrent tumor within the entire ventricular system and the subarachnoid spaces of the left cerebellopontine angle suggesting leptomeningeal spread. Due to the unresectable nature of the recurrence, the patient declined any further intervention and succumbed to her disease 6 months later. Conclusion: We present the first case of a recurrent APA presenting with intraventricular and leptomeningeal spread. Although thought to be a benign neoplasm, close interval follow-up with serial imaging is of essential, especially in those patients with known residual tumor, to prevent aggressive recurrences such as this.

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Recurrent Sphenocavernous Meningioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1725941 ◽

2021 ◽

Author(s):

Mizuho Inoue ◽

Mohamed Labib ◽

Alexander Yang ◽

A. Samy Youssef

Keyword(s):

Tumor Resection ◽

Intensity Modulated Radiotherapy ◽

Residual Tumor ◽

World Health ◽

Neurological Deficits ◽

Falciform Ligament ◽

Total Resection ◽

Anterior Clinoid Process ◽

Who Grade ◽

Health Organization

AbstractA case of a recurrent sphenocavernous meningioma is presented. The patient is a 42-year-old male who presented with an episode of transient right-sided numbness. A magnetic resonance imaging (MRI) revealed a large left sphenocavernous meningioma. The patient underwent a frontotemporal craniotomy for tumor resection. Near total resection was achieved with minimal residual in the left cavernous sinus (CS) and orbital apex. The pathology was consistent with meningioma, World Health Organization (WHO) grade I. A follow-up MRI was done 9 months after surgery and showed a growth of the residual tumor, which was treated with intensity modulated radiotherapy. Tumor growth was detected on serial imaging over a 4-year period. Surgical resection was offered. A left frontotemporal craniotomy with pretemporal transcavernous approach was performed. The bone flap was reopened and the dura was opened in a Y-shaped fashion. The roof of the optic canal was drilled off, and the falciform ligament was opened to decompress the optic nerve. The tumor was disconnected from the anterior clinoid region (the anterior clinoid process was eroded by the tumor) and reflected off the wall of the lateral CS. Tumor was adherent to the V2 fascicles (the lateral CS wall was resected in the first surgery) and was sharply dissected off. Gross total resection was achieved. The pathology was consistent with meningioma, WHO grade I. The patient had an unremarkable postoperative course without any new neurological deficits.The link to the video can be found at: https://youtu.be/KVBVw_86JqM.

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Stereotactic Volumetric Resection of Thalamic Pilocytic Astrocytomas

Neurosurgery ◽

10.1227/01.neu.0000279725.13521.a3 ◽

2007 ◽

Vol 61 (1) ◽

pp. 66-75 ◽

Cited By ~ 47

Author(s):

Yaron A. Moshel ◽

Michael J. Link ◽

Patrick J. Kelly

Keyword(s):

New York ◽

Residual Tumor ◽

Gross Total Resection ◽

Neurological Deficits ◽

Surgical Approaches ◽

New York University ◽

Total Resection ◽

Pilocytic Astrocytomas

Abstract OBJECTIVE To describe the surgical approaches, the radiographic and clinical outcomes, and the long-term follow-up of patients harboring thalamic pilocytic astrocytomas after radical resection by means of a stereotactic volumetric technique. METHODS Seventy-two patients with thalamic pilocytic astrocytomas underwent stereotactic volumetric resection by the senior author (PJK) at the Mayo Clinic between 1984 and 1993 (44 patients) and at New York University Medical Center between 1993 and 2005 (28 patients). Patient demographics, presenting symptoms, surgical approaches, neurological outcomes, pathology, initial postoperative status, and long-term clinical and radiographic follow-up were retrospectively reviewed. RESULTS On preoperative neurological examinations, 54 of the 72 patients had neurological deficits; of these, 48 had hemiparesis. Postoperative imaging demonstrated gross total resection in 58 patients and minimal (<6 mm) residual tumor in 13 patients. Tumor resection was aborted in one patient. On immediate postoperative examination, 16 patients had significant improvements in hemiparesis. Six patients had worsening of a preexisting hemiparesis and one had a new transient postoperative hemiparesis. There was one postoperative death. After 13 to 20 years of follow-up in the Mayo group (mean, 15 ± 3 yr) and 1 to 13 years of follow-up in the New York University group (mean, 8 ± 3 yr), 67 patients were recurrence/progression-free, one had tumor recurrence, and three had progression of residual tumor. There were two shunt-related deaths. On long-term neurological follow-up, 27 patients had significant improvements in hemiparesis; one patient with a postoperative worsening of a preexisting hemiparesis remained unchanged. There were no patients with new long-term motor deficits after stereotactic resection. CONCLUSION Gross total removal of thalamic pilocytic astrocytomas with low morbidity and mortality can be achieved by computer-assisted stereotactic volumetric resection techniques. Gross total resection of these lesions confers a favorable long-term prognosis without adjuvant chemotherapy and/or radiation therapy and leads to the improvement of neurological deficits.

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Chemotherapy-induced changes in tumor consistency can allow gross total resection of previously unresectable brainstem pilocytic astrocytoma

Surgical Neurology International ◽

10.25259/sni_594_2020 ◽

2021 ◽

Vol 12 ◽

pp. 12

Author(s):

Douglas J. Chung ◽

Bilal Arif ◽

Yazmin Odia ◽

Vitaly Siomin

Keyword(s):

Surgical Resection ◽

Pilocytic Astrocytoma ◽

Progression Free Survival ◽

Primary Brain Tumor ◽

World Health ◽

Gross Total Resection ◽

Low Grade ◽

Total Resection ◽

Complete Surgical Resection ◽

Tumor Consistency

Background: Low-grade gliomas (LGG) are described by the World Health Organization as Grades I and II. Among LGGs, the most common primary brain tumor is pilocytic astrocytoma (PA) and carries an excellent prognosis when treated with complete surgical resection. Cases, in which this is not possible, are associated with less favorable outcomes and worse progression-free survival. Case Description: This report describes a case of a 22-year-old male, who presented with progression of a primary brainstem tumor previously treated with stereotactic radiosurgery and chemotherapy. Patient underwent surgical exploration and was diagnosed with juvenile PA, but debulking was limited by the very dense and fibrous tumor. Complete surgical resection was not possible at this time. Despite efforts to treat with chemotherapy, the patient presented a year later with clinical deterioration and severe neurologic deficits, prompting surgical re-exploration. During the second operation, the tumor was found to have undergone very significant softening in consistency, allowing for gross total resection (GTR) Conclusion: Aggressive treatment of brainstem LGG should be pursued whenever possible, given its generally favorable prognosis. Repeat microsurgical resection, even with a different approach, might be reasonable and safe. Finally, chemotherapy may be associated with changes in the tumor consistency that can render previously unresectable lesions amenable to successful aggressive resection.

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Three-Dimensional Pseudo-Continuous Arterial Spin Labeling Parameters Distinguish Pediatric Medulloblastoma and Pilocytic Astrocytoma

Frontiers in Pediatrics ◽

10.3389/fped.2020.598190 ◽

2021 ◽

Vol 8 ◽

Author(s):

Nguyen Minh Duc

Keyword(s):

Pilocytic Astrocytoma ◽

Arterial Spin Labeling ◽

Three Dimensional ◽

Treatment Strategies ◽

Brain Magnetic Resonance Imaging ◽

Spin Labeling ◽

Youden Index ◽

Roc Curve Analysis ◽

Pediatric Medulloblastoma ◽

Pilocytic Astrocytomas

Introduction: Arterial Spin Labeling (ASL), a perfusion assessment without using gadolinium-based contrast agents, is outstandingly advantageous for pediatric patients. The differentiation of medulloblastomas from pilocytic astrocytomas in children plays a significant role in determining treatment strategies and prognosis. This study aimed to assess the use of ASL parameters during the differentiation between pediatric medulloblastoma and pilocytic astrocytoma.Methods: The institutional review board of Children's Hospital 2 approved this prospective study. The brain magnetic resonance imaging (MRI) protocol, including axial three-dimensional (3D) pseudo-continuous ASL, was evaluated in 33 patients, who were divided into a medulloblastoma group (n = 25) and a pilocytic astrocytoma group (n = 8). The quantified region of interest (ROI) values for the tumors and the tumor to parenchyma ratios were collected and compared between the two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were utilized to identify the best cut-off, sensitivity, specificity, and area under the curve (AUC) values for significant ASL parameters.Results: The cerebral blood flow (CBF) and the ratio between the CBF of the tumor relative to that of the parenchyma (rCBF) values for medulloblastomas were significantly higher than those for pilocytic astrocytomas (p < 0.05). A cut-off value of 0.51 for rCBF was able to discriminate between medulloblastoma and pilocytic astrocytoma, generating a sensitivity of 88%, a specificity of 75%, and an AUC of 83.5%.Conclusion: The rCBF measurement, obtained during MRI with 3D pseudo-continuous ASL, plays a supplemental role in the differentiation of medulloblastoma from pilocytic astrocytoma.

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Pilocytic astrocytoma of a spinal nerve root

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.1.0110 ◽

2002 ◽

Vol 97 (1) ◽

pp. 110-112 ◽

Cited By ~ 1

Author(s):

Mark Robert Philipson ◽

Jake Timothy ◽

Aruna Chakrobarthy ◽

Gerry Towns

Keyword(s):

Mr Imaging ◽

Pilocytic Astrocytoma ◽

Nerve Root ◽

Residual Tumor ◽

Conus Medullaris ◽

Spinal Nerve ◽

Spinal Nerve Root ◽

Content Type ◽

First Case ◽

Fine Print

✓ A case of pilocytic astrocytoma involving a spinal nerve root is reported. A 39-year-old woman presented with a 1-year history of progressive pain and numbness, predominantly in the S-1 dermatome. Magnetic resonance (MR) imaging revealed an intradural lesion at the tip of the conus medullaris. The intradural tumor was excised as was the sacrificed nerve root. Histological examination showed a pilocytic astrocytoma in which there were unusual features of calcification and ossification. At 3-year follow-up review MR imaging demonstrated no residual tumor. To the best of the authors' knowledge, this is the first case of a primary pilocytic astrocytoma, a tumor typically of central nervous system origin, arising from a spinal nerve root.

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Pediatric Meningeal Tumors of the Sylvian Fissure Region without Dural Attachment: A Series of Three Patients and Review of the Literature

The Surgery Journal ◽

10.1055/s-0036-1584166 ◽

2016 ◽

Vol 02 (02) ◽

pp. e31-e36 ◽

Cited By ~ 2

Author(s):

Daniel Donovan ◽

Varoon Thavapalan

Keyword(s):

Medial Temporal Lobe ◽

World Literature ◽

Sylvian Fissure ◽

World Health ◽

Gross Total Resection ◽

Total Resection ◽

Who Grade ◽

First Case ◽

Dural Attachment ◽

Meningeal Tumors

Pediatric meningeal tumors are rare, but those in the region of the sylvian fissure without dural attachment are extremely rare, with only 24 previously reported cases in the world literature. In this series, we report two additional cases of sylvian fissure meningioma without dural attachment and one case of perisylvian meningioangiomatosis in the medial temporal lobe. All three patients presented with complex partial seizures, but the diagnosis was delayed in each case because the symptoms were misinterpreted to be behavioral rather than epileptic. The seizures were eventually confirmed with electroencephalogram, and subsequent imaging showed enhancing masses within the sylvian fissure region that were at least partially calcified in all three cases. Each patient underwent craniotomy. In the first case, gross total resection was achieved, and in the second case, a small residual portion of tumor was densely calcified and adherent to the middle cerebral artery branches. Both of these were World Health Organization (WHO) grade I meningiomas. The third patient underwent biopsy and limited resection of meningioangiomatosis. No dural attachments were noted in any of the tumors, but one of the meningiomas was intraparenchymal in location, surrounding the sylvian fissure in both the frontal and temporal lobes, which has been described in only a small number of these cases previously. The patients underwent pre- and postsurgical neuropsychiatric testing and did not experience any significant cognitive deficits. At 10-year follow-up, the patient who had gross total resection of the tumor has had no recurrence and is seizure-free without anticonvulsant medications. The incompletely resected intraparenchymal meningioma in the second patient recurred after 5 years, however, and at repeat surgery was found to have transformed to a WHO grade II tumor. Radiation therapy was delivered and the tumor has been stable for 2 years, but the patient continues to have occasional seizures despite medication. The patient with meningioangiomatosis has had no further growth and has excellent control of seizures but remains on medication. We review the clinical presentation of these rare tumors and discuss the treatment, outcomes, and possible relationship of meningiomas to meningioangiomatosis.

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Policy Review: Dubai Health Authority’s COVID-19 Rapid Response

Medical & Clinical Research ◽

10.33140/mcr.05.001 ◽

2020 ◽

Vol 5 (Special) ◽

Keyword(s):

United Arab Emirates ◽

Well Being ◽

Healthcare Services ◽

Rapid Response ◽

Policy Implications ◽

World Health ◽

Healthcare Sector ◽

Services Delivery ◽

First Case ◽

The World

Dubai Health Authority (DHA) is the entity regulating the healthcare sector in the Emirate of Dubai, ensuring high quality and safe healthcare services delivery to the population. The World Health Organization (WHO) declared COVID-19 a pandemic on the 11th of March 2020, indicating to the world that further infection spread is very likely, and alerting countries that they should be ready for possible widespread community transmission. The first case of COVID-19 in the United Arab Emirates was confirmed on 29th of January 2020; since then, the number of cases has continued to grow exponentially. As of 8th of July 2020 (end of the day), 53,045 cases of coronavirus have been confirmed with a death toll of 327 cases. The UAE has conducted over 3,720,000 COVID-19 tests among UAE citizens and residents over the past four months, in line with the government’s plans to strengthen virus screening to contain the spread of COVID-19. There were vital UAE policies, laws, regulations, and decrees that have been announced for immediate implementation to limit the spread of COVID- 19, to prevent panic and to ensure the overall food, nutrition, and well-being are provided. The UAE is amongst the World’s Top 10 for COVID-19 Treatment Efficiency and in the World’s Top 20 for the implementation of COVID-19 Safety measures. The UAE’s mission is to work towards resuming life after COVID-19 and enter into the recovery phases. This policy research paper will discuss the Dubai Health Authority’s rapid response initiatives towards combating the control and spread of COVID-19 and future policy implications and recommendations. The underlying factors and policy options will be discussed in terms of governance, finance, and delivery.

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Novel Coronavirus Disease (COVID-19): A Narrative Review Based on Current Status

Anti-Infective Agents ◽

10.2174/2211352518999201020202540 ◽

2020 ◽

Vol 18 ◽

Author(s):

Rina Das ◽

Dinesh Kumar Mehta ◽

Meenakshi Dhanawat

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Clinical Symptoms ◽

Virus Disease ◽

Relevant Literature ◽

World Health ◽

Current Status ◽

Future Research ◽

Treatment And Prevention ◽

First Case ◽

Novel Coronavirus

Abstract:: A novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appeared and expanded globally by the end of year in 2019 from Wuhan, China, causing severe acute respiratory syndrome. During its initial stage, the disease was called the novel coronavirus (2019-nCoV). It was named COVID-19 by the World Health Organization (WHO) on 11 February 2020. The WHO declared worldwide the SARS-CoV-2 virus a pandemic on March 2020. On 30 January 2020 the first case of Corona Virus Disease 2019 (COVID-19) was reported in India. Now in current situation the virus is floating in almost every part of the province and rest of the globe. -: On the basis of novel published evidences, we efficiently summarized the reported work with reference to COVID-19 epidemiology, pathogen, clinical symptoms, treatment and prevention. Using several worldwide electronic scientific databases such as Pubmed, Medline, Embase, Science direct, Scopus, etc were utilized for extensive investigation of relevant literature. -: This review is written in the hope of encouraging the people successfully with the key learning points from the underway efforts to perceive and manage SARS-CoV-2, suggesting sailent points for expanding future research.

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Impact of hydroxychloroquin/azithromycin protocol on COVID-19 case-fatality rate reduction in Algeria. (Preprint)

10.2196/preprints.20886 ◽

2020 ◽

Author(s):

Ahmed Youssef Kada

Keyword(s):

Case Fatality Rate ◽

Doubling Time ◽

Case Fatality ◽

World Health ◽

Fatality Rate ◽

Therapeutic Protocol ◽

First Case ◽

The World ◽

The Impact ◽

At Home

BACKGROUND Covid-19 is an emerging infectious disease like viral zoonosis caused by new coronavirus SARS CoV 2. On December 31, 2019, Wuhan Municipal Health Commission in Hubei province (China) reported cases of pneumonia, the origin of which is a new coronavirus. Rapidly extendable around the world, the World Health Organization (WHO) declares it pandemic on March 11, 2020. This pandemic reaches Algeria on February 25, 2020, date on which the Algerian minister of health, announced the first case of Covid-19, a foreign citizen. From March 1, a cluster is formed in Blida and becomes the epicentre of the coronavirus epidemic in Algeria, its total quarantine is established on March 24, 2020, it will be smoothly alleviated on April 24. A therapeutic protocol based on hydroxychloroquine and azithromycin was put in place on March 23, for complicated cases, it was extended to all the cases confirmed on April 06. OBJECTIVE This study aimed to demonstrate the effectiveness of hydroxychloroquin/azithromycin protocol in Algeria, in particular after its extension to all patients diagnosed COVID-19 positive on RT-PCR test. We were able to illustrate this fact graphically, but not to prove it statistically because the design of our study, indeed in the 7 days which followed generalization of therapeutic protocol, case fatality rate decrease and doubling time increase, thus confirming the impact of wide and early prescription of hydroxychloroquin/azithromycin protocol. METHODS We have analyzed the data collected from press releases and follow-ups published daily by the Ministry of Health, we have studied the possible correlations of these data with certain events or decisions having a possible impact on their development, such as confinement at home and its reduction, the prescription of hydroxychloroquine/azithromycin combination for serious patients and its extension to all positive COVID subjects. Results are presented in graphics, the data collection was closed on 31/05/2020. RESULTS Covid-19 pandemic spreads from February 25, 2020, when a foreign citizen is tested positive, on March 1 a cluster is formed in the city of Blida where sixteen members of the same family are infected during a wedding party. Wilaya of Blida becomes the epicentre of coronavirus epidemic in Algeria and lockdown measures taken, while the number of national cases diagnosed begins to increases In any event, the association of early containment measures combined with a generalized initial treatment for all positive cases, whatever their degree of severity, will have contributed to a reduction in the fatality rate of COVID 19 and a slowing down of its doubling time. CONCLUSIONS In Algeria, the rapid combination of rigorous containment measure at home and early generalized treatment with hydroxychloroquin have demonstrated their effectiveness in terms of morbidity and mortality, the classic measures of social distancing and hygiene will make it possible to perpetuate these results by reducing viral transmission, the only unknown, the reopening procedure which can only be started after being surrounded by precautions aimed at ensuring the understanding of the population. CLINICALTRIAL Algeria, Covid-19, pandemic, hydroxychloroquin, azithromycin, case fatality rate

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LGG-23. EXCELLENT CLINICAL / RADIOLOGICAL RESPONSE TO BRAF INHIBITION IN A YOUNG CHILD WITH IN-OPERABLE SUPRA-SELLAR PILOCYTIC ASTROCYTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.405 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii370-iii371

Author(s):

Stacy Chapman ◽

Demitre Serletis ◽

Colin Kazina ◽

Mubeen Rafay ◽

Sherry Krawitz ◽

...

Keyword(s):

Targeted Therapy ◽

Pilocytic Astrocytoma ◽

Clinical Symptoms ◽

Obstructive Hydrocephalus ◽

Braf V600e Mutation ◽

Braf V600e ◽

Low Grade ◽

Dramatic Improvement ◽

Chemotherapeutic Regimen ◽

Response To Chemotherapy

Abstract In-operable low grade gliomas (LGG) in the pediatric population continue to present a treatment dilemma. Due to the low-grade nature of these tumors, and variable response to chemotherapy / radiation, the choice of adjuvant treatment is difficult. Overall survival is directly related to the degree of surgical resection, adding complexity to these inoperable tumors. Current chemotherapeutic regimen for these inoperable tumors includes vincristine (VCR) and carboplatin (Carbo). With advancements in the molecular characterization of gliomas, the role of targeted therapy has come into question. We present a 2-year-old female with biopsy proven Pilocytic Astrocytoma (positive BRAF-V600E mutation) involving the hypothalamic/optic chiasm region. She presented with ataxic gait, bi-temporal hemianopia, obstructive hydrocephalus and central hypothyroidism, which progressed to altered consciousness, and right hemiparesis due to location/mass effect of the tumor. She was initially treated with chemotherapy (VCR/Carbo) but her tumor progressed at 6 weeks of treatment. As her tumor was positive for BRAF-V600E mutation, she was started on Dabrafenib monotherapy, resulting in dramatic improvement in her clinical symptoms (able to stand, improved vision), and a 60% reduction in tumor size at 3-months. At 6-months, follow up MRI showed slight increase in the solid portion of the tumor, with no clinical symptoms. We plan to add MEK inhibitor (Trametinib) and continue with Dabrafenib. Our experience and literature review suggests that LGG with BRAF-V600E mutations may benefit from upfront targeted therapy. Prospective clinical trials comparing the efficacy of BRAF inhibitors versus standard chemotherapy in LGG with BRAF mutations are urgently needed.

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