scholarly journals Peritumoral cysts associated with pituitary macroadenoma

2015 ◽  
Vol 123 (3) ◽  
pp. 789-793 ◽  
Author(s):  
Ryan F. Herde ◽  
Nguyen Hoang ◽  
Diem Kieu Tran ◽  
Genevieve Couldwell ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Tumor Resection ◽  
Pituitary Macroadenoma ◽  
Lateral Extension ◽  
Predictable Pattern ◽  
Mri Scans ◽  
Fluid Collections ◽  
Lost To Follow Up ◽  
Pituitary Macroadenomas

OBJECT Peritumoral cysts are benign nonneoplastic cysts that are found adjacent to extraaxial brain tumors such as meningiomas, schwannomas, craniopharyngiomas, and esthesioneuroblastomas. Peritumoral cysts associated with pituitary macroadenomas have not been previously described in the literature. The authors report 6 cases of giant macroadenoma-associated peritumoral cysts and delineate their imaging spectrum. METHODS The authors retrospectively reviewed the records of 179 patients diagnosed with pituitary macroadenomas who underwent tumor resection at their institution and had preoperative MRI scans available for review. The patients were evaluated for the presence of associated peritumoral cysts. Clinical presentation, histopathology, follow-up time, tumor and peritumoral cyst dimensions were recorded. Signal intensity on T1-weighted, T2-weighted, diffusion-weighted, and FLAIR sequences, as well as pre- and postcontrast appearance, were determined. RESULTS Six patients (3.4%) with associated peritumoral cysts were identified in our cohort of 179 patients with pituitary macroadenoma. Twelve patients in the cohort had giant macroadenomas (≥ 4.0 cm), and 50% of these tumors had associated peritumoral cysts with significant extrasellar extension of the macroadenoma. Only tumors with craniocaudal, transverse, and anteroposterior diameters of 3.6 × 3.4 × 4.2 cm to 7.0 × 7.4 × 6.8 cm (mean 5.3 × 5.1 × 5.6 cm), respectively, had associated peritumoral cysts. The growth pattern in all tumors was suprasellar, with predominant anterior and lateral extension. Cysts showed T1-weighted, T2-weighted, and FLAIR hyperintensity in 67%, 67%, and 60% of patients, respectively. There was no contrast enhancement of the cyst wall or fluid contents in any patient. Postoperatively, cysts had completely resolved (4 of 5) or significantly decreased in size (1 of 5). One patient was lost to follow-up. CONCLUSIONS Macroadenoma-associated peritumoral cysts are rare, benign, and likely nonneoplastic fluid collections that do not represent neoplasm. These cysts display a predictable pattern of hyperintensity on T1-weighted, T2-weighted, and FLAIR sequences and do not enhance. They most likely represent proteinaceous CSF in a sulcus or cistern that becomes trapped (encysted) by anterolateral extension of unusually large macroadenomas. Peritumoral cysts may facilitate resection of the associated macroadenoma by providing a cleavage plane.

scholarly journals Prognosis and treatment of 46 Chinese pediatric cystic fibrosis patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qionghua Chen ◽  
Yuelin Shen ◽  
Hui Xu ◽  
Xiaolei Tang ◽  
Haiming Yang ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Respiratory Tract Infections ◽  
Adverse Reactions ◽  
Clinical Presentation ◽  
Public Awareness ◽  
Sputum Production ◽  
Tract Infections ◽  
Lost To Follow Up

Abstract Background Since public awareness of cystic fibrosis (CF) has increased, more children have been diagnosed with CF in China. This study aimed to investigate medical and other challenges faced by pediatric CF patients in China. Method Treatments and treatment outcomes were retrospectively analyzed for 46 pediatric CF patients diagnosed from August 2009 to June 2019. Pre- and post-treatment results were compared using independent samples t-test. Results Of 46 pediatric CF study patients, four died and five were lost to follow-up. Thirty-seven patients were monitored for 0.03 to 9.21 years; patients exhibited fewer attacks of respiratory tract infections after diagnosis (4.49 ± 2.13 episodes/year before diagnosis vs 1.97 ± 1.87 times/year after 1-year treatment, p < 0.05), significantly reduced sputum production and experienced 1.62 ± 1.71 exacerbations/year. Patient mean body mass index was 16.87 ± 3.53 and pancreatic malfunction persisted in 15 patients. For 17 children, no significant differences in lung function were found at follow-up as compared to lung function at diagnosis (FEV1: 82.45% ± 16.56% vs 75.26% ± 22.34%, FVC: 87.18% ± 13.64% vs 86.99% ± 19.95%, FEF75%: 46.51% ± 28.78% vs 36.63% ± 24.30%, P = 0.27, 0.97, 0.20, respectively). Pseudomonas aeruginosa (17/27) and bronchiectasis (22/22) were found during follow-up evaluation. Twenty-four patients (64.8%) maintained good adherence to therapies. Overall, azithromycin and tobramycin treatments were administered for 0.5–62 months and 0.5–48 months, respectively, and triggered no obvious adverse reactions. Conclusion No obvious declines in clinical presentation or lung function were found in Chinese pediatric CF patients after receiving standard therapeutic and active treatments, although malnutrition and low compliance were persistent challenges.

USE OF TEMOZOLOMIDE IN AGGRESSIVE PITUITARY TUMORS

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. E773-E774 ◽  
Author(s):  
Safraz Mohammed ◽  
Kalman Kovacs ◽  
Warren Mason ◽  
Harley Smyth ◽  
Michael D. Cusimano
Keyword(s):  
Pituitary Adenomas ◽  
Clinical Presentation ◽  
Pituitary Tumors ◽  
Clinical State ◽  
Resonance Imaging ◽  
First Line ◽  
Cell Variant ◽  
Potential Use ◽  
Pituitary Macroadenomas

Abstract OBJECTIVE The management of aggressive pituitary macroadenomas represents a challenge to neurosurgeons. These tumors are very difficult to treat, owing mainly to their invasive nature, thus resulting in incomplete resections and propensity for recurrence. Multiple surgical procedures (transsphenoidal, transcranial, or a combination of both) are the first line management, followed by radiotherapy and chemotherapy. CLINICAL PRESENTATION Three cases of patients with pituitary adenomas who underwent temozolomide treatment are presented. The first 2 patients had corticotroph macroadenoma of the Crooke's cell variant. Deterioration occurred in both cases despite multiple surgeries and adjuvant therapy. The third patient had a glioblastoma multiforme with an incidental pituitary tumor. INTERVENTION All 3 patients had temozolomide administered orally on the first 5 days of a 28-day cycle for 12 cycles. Magnetic resonance imaging, endocrinological, and clinical follow-up were performed at monthly intervals. CONCLUSION The marked improvement in clinical state of the first 2 patients accompanied by radiological evidence of tumor shrinkage in all patients demonstrates the potential use of temozolomide in treating aggressive pituitary macroadenomas. The usefulness of temozolomide in aggressive pituitary adenomas should be studied in larger trials.

Myxopapillary Ependymoma of the Filum Terminale and Cauda Equina in Childhood: Report of Seven Cases and Review of the Literature

Neurosurgery ◽  
1984 ◽  
Vol 14 (2) ◽  
pp. 204-210 ◽  
Author(s):  
Helen S. L. Chan ◽  
Laurence E. Becker ◽  
Harold J. Hoffman ◽  
Robin P. Humphreys ◽  
Bruce E. Hendrick ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Tumor Resection ◽  
Cauda Equina ◽  
Good Prognosis ◽  
Myxopapillary Ependymoma ◽  
Filum Terminale ◽  
Spinal Ependymoma ◽  
Neuroectodermal Tumors ◽  
Lost To Follow Up

Abstract Seven of fourteen children with spinal cord ependymoma had myxopapillary tumors of the filum terminale. These tumors made up 15.9% of all primary spinal neuroectodermal tumors in children (44 cases) seen during a 62-year period (1919 to 1981). Their clinical presentation, radiological features, pathological findings, treatment, and outcome are reported. Six of the seven patients were known to be alive at the time of writing. The seventh patient was lost to follow-up after 3 years without tumor recurrence. Of 5 patients whose primary mode of treatment was operation alone, 3 had intraspinal or intracranial recurrences. Despite tumor recurrences, 2 patients were long term survivors after further operation and irradiation, whereas the third patient recently received craniospinal irradiation for intracranial tumor recurrence. The 2 patients who did not have tumor recurrence after operation alone had been followed for 3 and 7 years, respectively. Two children with subtotal tumor resection and spinal irradiation had no recurrences at 1 and 17 years, respectively. Our data suggest that this unusual subtype of spinal ependymoma is not uncommon during childhood and has a good prognosis. All patients with this tumor require prolonged follow-up for tumor recurrence after operation and irradiation.

Compliance with McDonald criteria and red flag recognition in a general neurology practice in Ireland

2010 ◽  
Vol 16 (6) ◽  
pp. 678-684 ◽  
Author(s):  
Christine Albertyn ◽  
Sean O'Dowd ◽  
John McHugh ◽  
Raymond Murphy
Keyword(s):  
Consensus Statement ◽  
Clinical Presentation ◽  
Red Flags ◽  
Clinical Notes ◽  
Important Principle ◽  
Mcdonald Criteria ◽  
Red Flag ◽  
Lost To Follow Up ◽  
Over Time

Background: The revised McDonald criteria aim to simplify and speed the diagnosis of multiple sclerosis (MS). An important principle of the criteria holds there should be no better explanation for the clinical presentation. In Miller et al.’s consensus statement on the differential diagnosis of MS, red flags are identified that may suggest a non-MS diagnosis. Objective: All new patients with a practice diagnosis of MS were assessed for compliance with McDonald criteria. The group of patients not fulfilling criteria was followed up to assess compliance over time. At the end of the follow-up period, red flags were sought in the group of patients who remained McDonald criteria negative. Methods: Clinical notes and paraclinical tests were examined retrospectively for compliance with McDonald criteria and for the presence of red flags. Results: Sixty-two patients were identified, with two lost to follow-up. Twenty-six (42%) patients fulfilled criteria at diagnosis. After 53 months follow-up, 47 (78%) patients fulfilled criteria. In the 13 (22%) patients who remain McDonald criteria negative, a total of 20 red flags were identified, ranging from one to six per patient. Alternative diagnoses were considered and further investigations performed in 10 patients with no significantly abnormal results. Conclusion: Twenty-two percent of patients still do not fulfill McDonald criteria after 53 months. Dissemination in time was not proven in the majority of patients and the lack of follow-up neuroimaging was an important factor in this. Red flags may be useful in identifying alternative diagnoses, but the yield was low in our cohort.

scholarly journals HGG-14. TREATMENT AND PROGNOSTIC FACTORS FOR PEDIATRIC GLIOBLASTOMAS--THE 10 YEARS EXPERIENCE FROM ONE SINGLE CENTER

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii346-iii346
Author(s):  
Juan Li ◽  
Mingyao Lai ◽  
Qingjun Hu ◽  
Cheng Zhou ◽  
Zhaoming Zhou ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Tumor Resection ◽  
Resection Rate ◽  
The Past ◽  
Pediatric Glioblastoma ◽  
Lost To Follow Up

Abstract OBJECTIVE We retrospectively analyzed the clinical features of pediatric glioblastoma patients in our center in the past 10 years. METHODS From November 2009 to December 2018, patients with glioblastoma under 18 years were admitted to Guangdong Sanjiu Brain Hospital. Clinical and pathological features were summarized, and the curative effect was evaluated. RESULTS A total of 31 pediatric patients were enrolled. The median age is 13.8 years (range 0.8–18), including 19 males and 12 females. To Sep, 2019, the median follow-up time was 18 months(Range 4–80 months). Among them,2 were lost to follow-up,13 died, 16 still survived, and the longest survivor survived for 80 months. The median survival time was 16.4 months, the 2-year survival rate was 38%. In the prognostic factor analysis, the median survival time of patients with surgical resection ≥90% was 18 months (95% CI 15.9–20 months), and for children with resection 90% was 11 months (95% CI 9.9–12 months), P=0.027, with significantly statistically difference. Multivariate analysis showed that tumor resection rate was an independent prognostic factor for survival. CONCLUSION The prognosis of pediatric glioblastoma is still dismal. This study demonstrates that prognosis of such patients with GTR or near GTR is better.

scholarly journals Long-term serological follow-up after primary Coxiella burnetii infection in patients with vascular risk factors for chronic Q fever

2021 ◽  
Author(s):  
Sheila B. Buijs ◽  
Sanne K. Stuart ◽  
Jan Jelrik Oosterheert ◽  
Steffi Karhof ◽  
Andy I. M. Hoepelman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Q Fever ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Serological Testing ◽  
Chronic Q Fever ◽  
Lost To Follow Up

AbstractWe evaluated the long-term serological follow-up of patients with vascular risk factors for chronic Q fever that were previously Coxiellaburnetii seropositive. C. burnetii phase I IgG titers were reevaluated in patients that gave informed consent or retrospectively collected in patients already deceased or lost to follow-up. Of 107 patients, 25 (23.4%) became seronegative, 77 (72.0%) retained a profile of past resolved Q fever infection, and five (4.7%) developed chronic Q fever. We urge clinicians to stay vigilant for chronic Q fever beyond two years after primary infection and perform serological testing based on clinical presentation.

scholarly journals Relationship between postoperative volume of macroadenomas and clinical outcome after endoscopic trans-sphenoidal resection

2018 ◽  
Vol 31 (6) ◽  
pp. 565-571
Author(s):  
Valeria Onofrj ◽  
Carina Vallejo ◽  
Paulo Puac ◽  
Carlos Zamora ◽  
Mauricio Castillo
Keyword(s):  
Tumor Volume ◽  
Tumor Resection ◽  
Symptom Improvement ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Clinical Records ◽  
Resection Volume ◽  
Pituitary Macroadenomas

Purpose Although symptoms are expected to improve after the resection of pituitary macroadenomas, tumor resection volume does not always correlate with the patient’s symptoms. Our objectives were to assess the pre and postoperative volumes of pituitary macroadenomas before, immediately after surgery and at follow-up, and to explore possible associations and correlations among these changes and symptoms. Materials and methods We retrospectively reviewed the clinical records and the preoperative and postoperative magnetic resonance imaging studies at 24 hours and at 3, 6 and 9 months follow-up of 146 patients who underwent surgery for pituitary macroadenomas. We measured tumor volumes before and after surgery and compared changes with symptom improvement. Results The mean preoperative tumor volume was 24.66 cm3 (standard deviation 65.18 cm3, 95% confidence interval (CI) 14–35.32). The most common symptoms were visual/cranial nerve abnormalities (65%) and headaches (56%). Immediately after surgery, symptoms persisted without significant changes in all patients. A progressive tumor volume decrease was noted during follow-up, and symptoms improved in 78% of patients. Despite no imaging evidence of chiasm or cavernous sinus compression, 32 patients showed no symptom improvement. Patients with symptoms for more than 1 year (mean duration of symptoms 26 months, SD 24.3, 95% CI 22.03–29.97 months) had a higher risk of the persistence of symptoms compared to patients with a mean duration of symptoms of less than 1 year (odds ratio 2.5, 95% CI 2.4–3, P < 0.005). Conclusions The duration of symptoms prior of surgery is a more important factor than tumor resection volume alone when considering the long-term outcome of symptoms. Furthermore, lack of symptom improvement in the immediate postoperative period does not necessarily represent an inadequate resection.

scholarly journals THE STATUS OF THE UNAFFECTED EYE IS A PREDICTOR OF SHORT-TERM RECOVERY IN A CROATIAN COHORT OF PATIENTS WITH MONOCULAR OPTIC NEURITIS

2021 ◽  
Vol 65 (2) ◽  
Author(s):  
Marija Jelić Vuković ◽  
◽  
Suzana Matić ◽  
Josip Barać ◽  
Dubravka Biuk ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Clinical Presentation ◽  
Demographic Data ◽  
Short Term ◽  
Severe Attack ◽  
Fellow Eye ◽  
Male Ratio ◽  
The Status ◽  
Lost To Follow Up

Aim: To define the clinical profile of patients with unilateral optic neuritis (ON) presented to our clinic and to identify baseline clinical features and demographic data associated with one-month visual acuity (VA) outcome. Methods: Patients with suspected ON referred to our clinic were consecutively assessed for inclusion between February 2017 and November 2019. VA was measured using Snellen charts. Clinical and demographic, baseline and after one-month follow-up data were analyzed in a multivariate model. Results: Overall, 71 patients were included, of which six were considered lost to follow-up. The median age was 50 years old (interquartile range 37-57 years old) and the female to male ratio was 3:1. 14.1 % had a severe attack and 83.1 % recovered completely one month after the diagnosis. Multivariate analysis of data from 65 patients showed that baseline VA of the affected eye (P=0.011) and fellow eye (P=0.015) were factors associated with VA of the affected eye at follow up. Conclusion: Our cohort was older, had a higher female to male ratio and on average, a less severe ON clinical presentation compared to reports from other countries. Baseline VA of both the affected and fellow eye are predictors of one-month VA recovery

scholarly journals Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review

2022 ◽  
Vol 11 ◽  
Author(s):  
Xin Zhang ◽  
Wei Hua ◽  
Kai Quan ◽  
Guo Yu ◽  
Zunguo Du ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Case Series ◽  
Oculomotor Nerve Palsy ◽  
Cerebrospinal Fluid Leakage ◽  
Lateral Extension ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Pathological Conditions ◽  
Surgical Methods

Intraorbital tumor could be approached by numerous surgical methods. The neuroendoscopic endonasal approach could provide a feasible corridor for indicated tumors. Herein we present a series of 6 consecutive intraorbital tumors from April 2018 to October 2020, which received endonasal endoscopic resection. Cadaveric dissection was performed for the intraconal approach, and the literature was also reviewed. Five tumors were located intraconally, while one extraconally. The pathology revealed 1 angioleiomyoma, 1 cavernous hemangioma, 1 pilocytic astrocytoma, 1 meningioma, and 2 schwannomas. Five of the six achieved gross total resection, including 3 tumors with lateral extension beyond the optic nerve. Preoperative visual deterioration was observed in 4 of the 6 patients, and all got improvement postoperatively. Transient oculomotor nerve palsy was presented in one patient postoperatively. No cerebrospinal fluid leakage, enophthalmos, or strabismus was observed. The median follow-up time is 27 months (11~41 months). At the 6-month follow-up, the visual acuity remained unchanged compared with that at discharge. Proptosis was resolved in 2 of the 3 patients; diplopia was improved in one patient. In conclusion, endoscopic endonasal intraconal approach could be suitable for selected pathological conditions, and for both medial or beyond medial extraconal and intraconal orbital tumors.

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