Superficial siderosis and nonobstructive hydrocephalus due to subependymoma in the ventricle: An illustrative case report

Background: Intraventricular tumors can generally result in obstructive hydrocephalus as they grow. Rarely, however, some intraventricular tumors develop superficial siderosis (SS) and trigger hydrocephalus, even though the tumor has hardly grown. Here, we present an illustrative case of SS and nonocclusive hydrocephalus caused by subependymoma of the lateral ventricles. Case Description: A 78-year-old man with an intraventricular tumor diagnosed 7 years ago had been suffering from gait disturbance for 2 years. He also developed cognitive impairment. Intraventricular tumors showed little growth on annual magnetic resonance imaging (MRI). MRI T2-star weighted images (T2*WI) captured small intratumoral hemorrhages from the beginning of the follow-up. Three years before, at the same time as the onset of ventricular enlargement, T2*WI revealed low intensity in the whole tumor and cerebral surface. Subsequent follow-up revealed that this hemosiderin deposition had spread to the brain stem and cerebellar surface, and the ventricles had expanded further. Cerebrospinal fluid (CSF) examination revealed xanthochromia. The tumor was completely removed en bloc. Histopathological findings were consistent with those of subependymoma. Although CSF findings improved, SS and hydrocephalus did not improve. Therefore, the patient underwent a lumboperitoneal shunt for CSF diversion after tumor resection. Conclusion: Some intraventricular tumors cause SS and nonobstructive hydrocephalus due to microbleeding, even in the absence of tumor growth. T2*WI and, if necessary, timely CSF examination can allow identification of presymptomatic SS. This follow-up strategy may provide a favorable course by facilitating early intervention in patients with intraventricular lesions, not just subependymomas.

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Control of temporal lobe epilepsy following en bloc resection of low-grade tumors

Journal of Neurosurgery ◽

10.3171/jns.1993.78.1.0019 ◽

1993 ◽

Vol 78 (1) ◽

pp. 19-25 ◽

Cited By ~ 142

Author(s):

Peter J. Kirkpatrick ◽

Minal Honavar ◽

Ivan Janota ◽

Charles E. Polkey

Keyword(s):

Temporal Lobe ◽

Age At Onset ◽

Tumor Resection ◽

Temporal Lobectomy ◽

Dysembryoplastic Neuroepithelial Tumor ◽

Low Grade ◽

En Bloc ◽

Content Type ◽

Incomplete Removal

✓ Thirty-one patients with a mean age of 18.9 years (range 3 to 53 years) who underwent temporal lobe surgery for tumor-related epilepsy over a 14-year period are presented. All had suffered chronic drug-resistant temporal lobe seizures (mean age at onset 6.9 years, range 0 to 30 years; mean duration of condition 11.9 years, range 3 to 39 years). Preoperative interictal scalp electroencephalography tracings indicated unilateral localized epileptic foci in 90% of patients, and computerized tomography scans showed abnormalities within the temporal lobe in 87%. All patients underwent en bloc temporal lobectomy. No patient received adjuvant radiotherapy or chemotherapy. Review of the histological material showed dysembryoplastic neuroepithelial tumor in 27 (87%) of the specimens and microscopic evidence of incomplete removal of tumor in 22 (71%). At long-term follow-up evaluation (mean duration 5.8 years, range 1 to 14 years), 81% of patients were completely free of seizures (Engel grade I) and 10% were almost seizure free (Engel grade II) with no deaths reported in either early or late follow-up review. Only one patient in the series failed to benefit from the surgery. Four patients suffered permanent neurological deficit causing a mild disability. Psychological assessment showed no significant fall in verbal or performance intelligent quotient for the group, but a mild memory impairment was evident in 32%. Behavioral and social aspects improved in nearly all (94%) cases. Relief of seizures could not be predicted by intraoperative electrocorticography, and outcome was independent of the completeness of tumor resection. Postoperative electroencephalographic findings identified epileptiform potentials in 65% of patients, which were associated with a worse seizure-control outcome grade.

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Transnasal endoscopic resection of nasal chondromesenchymal hamartoma in infancy: an analysis of 5 cases

BMC Pediatrics ◽

10.1186/s12887-021-03082-4 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Zheng Jie Zhu ◽

Qi Huang ◽

Lan Cheng ◽

Jun Yang

Keyword(s):

Endoscopic Resection ◽

Tumor Resection ◽

Diagnostic Techniques ◽

Endoscopic Approach ◽

Benign Tumors ◽

Radiographic Findings ◽

Transnasal Endoscopic Approach ◽

Magnetic Resonance Imaging Mri ◽

Midfacial Degloving

Abstract Background Nasal chondromesenchymal hamartomas (NCMHs) are extremely rare benign tumors that most commonly affect children in the first year of life. The purpose of this study was to investigate and summarize the characteristics of NCMH cases and the efficacy of transnasal endoscopic resection of NCMHs. Methods This is a retrospective study including 5 cases of infant diagnosed as NCMH between April 2016 and April 2020. Diagnostic techniques include nasoendoscopy, computerized tomography (CT) scan, magnetic resonance imaging (MRI) with contrast and microscopic and immunohistologic studies. Data collected included patient demographics, patient symptoms, radiographic findings, characteristics of tumor growth, follow-up time, recurrence, and postoperative complications. Results In 5 cases, 3 were males and 2 were females who aged 1, 2, 3, 6 months and 1 year, respectively. The size of the mass measured 1.6 cm*1.9 cm*1.8 cm at its smallest and largest was 4.0 cm*3.5 cm*3.0 cm. All five patients underwent tumor resection via transnasal endoscopic approach. Four tumors were completely removed, and one underwent partial resection, which was completely resected by midfacial degloving operation 13 months after the first surgery. There was no postoperative complication. The current postoperative follow-up period was 1 to 4 years, and no recurrence has been observed. Conclusions Complete surgical resection of NCHM is necessary to resolve the symptoms and prevent recurrence. Transnasal endoscopic approach is a safe and effective choice for pediatric NCMH patients.

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Continuous Minor Bleeding from Tumor Surface in Patients with Craniopharyngiomas: Case Series of Nonobstructive Hydrocephalus

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1646957 ◽

2018 ◽

Vol 79 (05) ◽

pp. 436-441

Author(s):

Takuhiro Shoji ◽

Yoshikazu Ogawa ◽

Mika Watanabe ◽

Miki Fujimura ◽

Teiji Tominaga ◽

...

Keyword(s):

Obstructive Hydrocephalus ◽

Case Series ◽

Imaging Study ◽

Preoperative Imaging ◽

Superficial Siderosis ◽

Minor Bleeding ◽

Daily Living Activity ◽

Preoperative Imaging Study ◽

Csf Diversion ◽

Csf Examination

Nonobstructive hydrocephalus in patients with craniopharyngiomas is uncommon. We describe our surgical series of 25 consecutive patients with craniopharyngioma who presented with hydrocephalus. Obstructive hydrocephalus was evident in most cases, and nonobstructive hydrocephalus was revealed in three cases. Even after improvement of cerebrospinal fluid (CSF) pathway obstruction by tumor removal, 10 patients (40%) required CSF diversion. Preoperative imaging study revealed thin intraventricular hemorrhage or superficial siderosis in five cases, and CSF examination revealed hemosiderin-laden phagocytes in one case. These findings indicate continuous bleeding into the CSF that might be associated with CSF malabsorption. We also describe a representative case of craniopharyngioma associated with nonobstructive hydrocephalus due to continuous minor bleeding from the tumor surface in a 62-year-old man with a complaint of disorientation and a decline in daily living activity.Our study demonstrated that minor bleeding into the CSF is a possible mechanism of the development of nonobstructive hydrocephalus in patients with craniopharyngiomas.

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Resection of a Lumbar Intradural Extramedullary Schwannoma: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy238 ◽

2018 ◽

Vol 16 (5) ◽

pp. 640-640 ◽

Cited By ~ 1

Author(s):

Simone E Dekker ◽

Chad A Glenn ◽

Thomas A Ostergard ◽

Mickey L Smith ◽

Brian D Rothstein ◽

...

Keyword(s):

Back Pain ◽

Treatment Options ◽

Tumor Resection ◽

Sensory Nerve ◽

En Bloc ◽

3 Dimensional ◽

Postoperative Mri ◽

Intradural Extramedullary ◽

Magnetic Resonance Imaging Mri ◽

Dural Opening

Abstract This 3-dimensional operative video illustrates resection of a lumbar schwannoma in a 57-yr-old female who presented with right lower extremity numbness, paresthesias, as well as a long history of lower back pain with rest. On magnetic resonance imaging (MRI), there was evidence of an intradural extramedullary enhancing lesion at L5, nearly completely encompassing the spinal canal. This video demonstrates the natural history, treatment options, surgical procedure, risks, and complications of treatment of these types of tumors. The patient underwent a posterior lumbar laminectomy with a midline dural opening for tumor resection. The tumor was encountered intradurally and electromyography recording confirmed that the tumor arose from a lumbar sensory nerve root. The sensory root was then divided and the tumor was then removed. The mass was removed en bloc and histopathologic analysis was consistent with a schwannoma. Postoperative MRI demonstrated gross total resection of the patient's neoplasm with excellent decompression of the spinal cord. The patient had an uneventful postoperative course with full recovery and complete resolution of her back pain and leg paresthesias.

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Posterior Cervical Laminoplasty for Resection Intradural Extramedullary Spinal Meningioma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy204 ◽

2018 ◽

Vol 16 (3) ◽

pp. 392-392 ◽

Cited By ~ 2

Author(s):

Simone E Dekker ◽

Thomas A Ostergard ◽

Chad A Glenn ◽

Efrem Cox ◽

Nicholas C Bambakidis

Keyword(s):

High Speed ◽

Treatment Options ◽

Tumor Resection ◽

Cervical Laminoplasty ◽

En Bloc ◽

Who Grade ◽

Left Hand ◽

Postoperative Mri ◽

Intradural Extramedullary ◽

Magnetic Resonance Imaging Mri

Abstract This operative video demonstrates a posterior cervical laminoplasty for the resection of a cervical intradural extramedullary meningioma. In addition, the natural history, treatment options, and potential complications are discussed. The patient is a 68-yr-old male who presented with left-hand grip weakness and paresthesias. Magnetic resonance imaging (MRI) demonstrated an enhancing mass that displacing the spinal cord anteriorly and causing severe flattening of the cord at C4 and C5. The patient underwent a posterior cervical laminoplasty for tumor resection. Removal of the dorsal elements with a high-speed drill was performed at C3, C4, and C5. A midline durotomy was performed and a large extra-axial intradural tumor was encountered. The tumor was resected en bloc and specimens were sent for permanent pathological analysis. The dura was closed in a watertight fashion using 6-0 Prolene sutures. The laminoplasty was performed by using titanium miniplates and screws to reconstruct the dorsal bony elements, and the wound was closed in layers using sutures. There were no complications. Final pathology was consistent with a WHO grade I meningioma. Postoperative MRI demonstrated gross total resection. The patient's perioperative course was uncomplicated and his preoperative weakness completely resolved by time of discharge.

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Clival meningocele causing bilateral hearing loss in a child due to superficial siderosis of the central nervous system: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.11.peds17302 ◽

2018 ◽

Vol 21 (5) ◽

pp. 498-503 ◽

Cited By ~ 2

Author(s):

Stephen J. Johans ◽

Kevin N. Swong ◽

Daniel J. Burkett ◽

Michael P. Wemhoff ◽

Sean M. Lew ◽

...

Keyword(s):

Spinal Cord ◽

Hearing Loss ◽

Case Report ◽

Subarachnoid Space ◽

Case Reports ◽

Hearing Threshold ◽

Superficial Siderosis ◽

Dural Defect ◽

Hemosiderin Deposition

Superficial siderosis (SS) of the CNS is a rare and often unrecognized condition. Caused by hemosiderin deposition from chronic, repetitive hemorrhage in the subarachnoid space, it results in parenchymal damage in the subpial layers of the brain and spinal cord. T2-weighted MRI shows the characteristic hypointensity of hemosiderin deposition, classically occurring around the cerebellum, brainstem, and spinal cord. Patients present with progressive gait ataxia and sensorineural hearing impairment. Although there have been several studies, case reports, and review articles over the years, the clear pathophysiology of subarachnoid space hemorrhage remains to be elucidated. The proposed causes include prior intradural surgery, prior trauma, tumors, vascular abnormalities, nerve root avulsion, and dural abnormalities.Surgical repair of a dural defect associated with SS has been shown to be efficacious at preventing symptomatic progression. There have been several reports of dural defects within the spinal canal treated with surgery. Here, the authors present the first known case of a dural defect of the ventral skull base, namely a clival meningocele, presumed to be causing SS. In this case report, a 10-year-old girl with a history of head trauma at the age of 3 years was found to have a clival meningocele 3 years after her original trauma. On follow-up imaging, the patient was found to have radiographic growth of the meningocele along with evidence of SS of the CNS. The patient was treated conservatively until she began to have progressive hearing loss. It was presumed that the growing meningocele was the source of her SS. An endoscopic endonasal transclival approach with a multilayer dural reconstruction was performed to fix the dural defect and repair the meningocele in hopes of mitigating the progression of her symptoms. At her 12-month postoperative follow-up, she was doing well, with audiometry showing a slightly decreased hearing threshold in the left ear but improved speech discrimination bilaterally. Postoperative MRI showed a stable level of hemosiderin deposition and meningocele repair. Long-term follow-up will be necessary to evaluate for continued clinical stabilization or possible improvement.

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Pancreatic Leiomyosarcoma With Schistosomiasis Hematobia: A Case Report and Literature Review

Frontiers in Oncology ◽

10.3389/fonc.2021.638905 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qiang Li ◽

Daniel Staiculescu ◽

Yurong Zhou ◽

Jiang Chen

Keyword(s):

Case Report ◽

Tumor Resection ◽

Clinical Manifestations ◽

Malignant Neoplasm ◽

The Body ◽

Imaging Characteristics ◽

Magnetic Resonance Imaging Mri ◽

The Relationship ◽

Ct And Mri

Pancreatic leiomyosarcoma (PL) is a very rare, malignant neoplasm with a very poor prognosis. Here, we examine a novel case of PL with schistosomiasis hematobia. The patient had been initially misdiagnosed by the first magnetic resonance imaging (MRI). The second imaging examination demonstrated an enlarged heterogeneous tumor mass in the body-tail of pancreas. Following image analysis, the patient underwent a pancreatectomy, splenectomy and lymph node dissections. Sixteen months after the tumor resection, follow-up computed tomography (CT) and MRI revealed tumor metastasis in the liver and lung. PL has non-specific clinical manifestations and imaging characteristics, making early diagnosis very challenging. When it is difficult to distinguish between benign and malignant pancreatic lesions, short-term imaging follow-up is preferred. In this case report, we discuss the relationship between PL and schistosomiasis hematobia.

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Acute disseminated encephalomyelitis following endonasal resection of a craniopharyngioma: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21293 ◽

2021 ◽

Vol 2 (16) ◽

Author(s):

Konrad Gag ◽

Jonas Müller ◽

Marie Süße ◽

Robert Fleischmann ◽

Henry W. S. Schroeder

Keyword(s):

White Matter ◽

White Matter Lesions ◽

Acute Disseminated Encephalomyelitis ◽

Intravenous Immunoglobulins ◽

Neurological Deficits ◽

Illustrative Case ◽

Sensorimotor Deficits ◽

Fluid Analysis ◽

Magnetic Resonance Imaging Mri

BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a rare, acquired demyelination syndrome that causes cognitive impairment and focal neurological deficits and may be fatal. The potentially reversible disease mainly affects children, often after vaccination or viral infection, but may be seen rarely in adults. OBSERVATIONS A 50-year-old woman presented with loss of visual acuity of the left eye. Magnetic resonance imaging (MRI) revealed an intra- and suprasellar mass, which was removed successfully. On postoperative day 1, MRI showed gross total resection of the lesion and no surgery-related complications. On postoperative day 2, the patient presented with a progressive left-sided hemiparesis, hemineglect, and decline of cognitive performance. MRI showed white matter edema in both hemispheres. Cerebrospinal fluid analysis revealed mixed pleocytosis (355/µL) without further evidence of infection. In synopsis of the findings, ADEM was diagnosed and treated with intravenous immunoglobulins. Shortly thereafter, the patient recovered, and no sensorimotor deficits were detected in the follow-up examination. LESSONS Pituitary gland pathologies are commonly treated by transsphenoidal surgery, with only minor risks for complications. A case of ADEM after craniopharyngioma resection has not been published before and should be considered in case of progressive neurological deterioration with multiple white matter lesions.

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Adrenal Hemangioma: A Case of Retroperitoneal Tumor

Case Reports in Medicine ◽

10.1155/2018/8796327 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Genta Iwamoto ◽

Kota Shimokihara ◽

Takashi Kawahara ◽

Daiji Takamoto ◽

Masahiro Yao ◽

...

Keyword(s):

Tumor Resection ◽

Retroperitoneal Tumor ◽

Histopathological Analysis ◽

Small Vessels ◽

Positron Emission ◽

Pet Ct ◽

Slight Elevation ◽

Magnetic Resonance Imaging Mri ◽

Almost All

Introduction. Adrenal hemangioma is a rare disease, with only some 60 cases reported previously. Due to the difficulty of the preoperative diagnosis of adrenal hemangioma, almost all of the cases were diagnosed by a histopathological analysis of surgical specimens. Case Presentation. A 52-year-old man was referred to our department for further examination of his left retroperitoneal tumor. He had received hemodialysis due to chronic renal failure resulting from membranous nephropathy. Computed tomography revealed a mass around his left hilum. Magnetic resonance imaging (MRI) and positron-emission tomography (PET)-CT were unable to confirm or deny malignancy, and tumor markers, including CEA and CA19-9, showed slight elevation. His tumor grew from 38 mm to 54 mm in diameter in 7 months of follow-up. We therefore planned retroperitoneal tumor resection with left nephrectomy. Histopathologically, hyperplastic small vessels with hemorrhaging and denaturation were seen. The endothelial cells showed no variants or division of the nucleus. Based on this diagnosis, no further therapy was performed. He has had no recurrence in the eight months since the surgery. Conclusion. We herein report a rare case of adrenal hemangioma.

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Schistosomal Cervical Myelopathy

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1661356 ◽

2018 ◽

Vol 37 (02) ◽

pp. 151-153

Author(s):

Ronald Farias ◽

Kléver Oliveira ◽

George Mendes ◽

Ussânio Meira

Keyword(s):

Spinal Cord ◽

Inflammatory Diseases ◽

Histopathological Examination ◽

Cervical Spinal Cord ◽

Cervical Cord ◽

Illustrative Case ◽

Mild Reduction ◽

History Of ◽

Magnetic Resonance Imaging Mri

AbstractSchistosomiasis is an infectious disease caused by trematode platyhelminths of the genus Schistosoma. The involvement of the cervical spinal cord is rare, with few cases reported in the literature. The management of such patients is particularly challenging, since clinical and radiological findings may be confounded with other inflammatory diseases and/ or spinal cord tumors. We describe a 20-year old male with a history of swimming outdoors. He first presented pain in the back of the neck extending to shoulders and upper limbs paresis associated with four limbs hyperreflexia. The magnetic resonance imaging (MRI) showed a hypointense T1-weighted lesion in the cervical spinal cord, which was hyperintense on T2 images. The serologic testing was negative for schistosomiasis. A cervical cord biopsy at the C5-C6 level showed Schistosoma eggs in the histopathological examination. The treatment was performed using a single dose of praziquantel 50 mg/kg, with prednisone 40 mg/day for 3 weeks. On the follow-up, 1 year later, the patient presented mild reduction of the vibratory sensitivity in the distal third of both legs. Our illustrative case strengthens that, in endemic regions, Schistosoma mansoni infestation should be included in the differential diagnosis of intramedullary expansive lesions.

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