Evolution of a primary intrasellar germinomatous teratoma into a choriocarcinoma

1975 ◽  
Vol 42 (5) ◽  
pp. 602-604 ◽  
Author(s):  
Renato Giuffrè ◽  
Nicola Di Lorenzo
Keyword(s):  
Precocious Puberty ◽  
Content Type ◽  
Intracranial Surgery ◽  
Urinary Levels ◽  
Renal Metastases ◽  
Anatomical Evidence ◽  
Very High ◽  
Fine Print

✓ A case of intrasellar teratoma with a germinal structure in a 10-year-old girl is described. A few months after intracranial surgery the tumor differentiated into a choriocarcinoma and finally spread to multiple cerebral, pulmonary, and renal metastases. In the course of choriocarcinomatous evolution, very high urinary levels of luteinizing gonadotropin (HCG) developed, but there was no clinical or anatomical evidence of precocious puberty.

Precocious puberty in a girl with an hCG-secreting suprasellar immature teratoma

1994 ◽  
Vol 81 (4) ◽  
pp. 601-604 ◽  
Author(s):  
Chifumi Kitanaka ◽  
Masao Matsutani ◽  
Shigeo Sora ◽  
Sachiko Kitanaka ◽  
Ayako Tanae ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Precocious Puberty ◽  
Germ Cell Tumors ◽  
Immature Teratoma ◽  
Content Type ◽  
Intracranial Germ Cell Tumors ◽  
Hcg Secretion ◽  
High Level ◽  
Very High ◽  
Fine Print

✓ Although precocious puberty is common in boys with human chorionic gonadotropin (hCG)-secreting brain tumors, it is extremely rare in girls. The authors describe a 6-year-old girl with an hCG-secreting suprasellar immature teratoma who presented with diabetes insipidus, increased intracranial pressure, and precocious puberty. On admission, breast budding was observed. The serum hCG level was 1230 mIU/ml. Both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) remained below detectable levels, even after gonadotropin-releasing hormone stimulation. Serum estrogen and androgen were moderately elevated. After chemotherapy, breast budding disappeared with normalization of serum hCG. It has been believed that hCG does not produce precocious puberty in girls in the absence of FSH, and this has been used as an explanation for the rarity of precocious puberty in girls with hCG-secreting brain tumors. However, it has also been reported that hCG has not only LH activity but also intrinsic, although weak, FSH-like activity. In the present case, this FSH-like activity was considered to have played a role in the development of precocious puberty. It is speculated that a very high level of serum hCG can produce precocious puberty in girls. The rarity of intracranial germ-cell tumors with a high potential of hCG secretion may be one of the reasons why hCG-induced precocious puberty is uncommon in girls.

Surgical treatment of cerebral metastases from lung cancer

1971 ◽  
Vol 35 (4) ◽  
pp. 416-420 ◽  
Author(s):  
Edwin E. MacGee
Keyword(s):  
Lung Cancer ◽  
Surgical Treatment ◽  
Operative Mortality ◽  
Cerebral Metastases ◽  
Cerebral Metastasis ◽  
Metastatic Lung Cancer ◽  
Content Type ◽  
Intracranial Surgery ◽  
Metastatic Lung ◽  
Fine Print

✓ Results in 27 cases of intracranial surgery for metastatic lung cancer are evaluated with regard to both the quality and duration of survival; 56% of the patients lived more than 1 year, with the longest survivor still living 32 months after operation. The operative mortality was 26%. These data suggest that intracranial surgery is worthwhile in patients with lung cancer when the cerebral metastasis is either solitary or single.

Evaluation of the risks of anticoagulation therapy following experimental craniotomy in the rat

1985 ◽  
Vol 63 (6) ◽  
pp. 959-962 ◽  
Author(s):  
Keith L. Schaible ◽  
Lawrence J. Smith ◽  
Richard G. Fessler ◽  
Jacob R. Rachlin ◽  
Frederick D. Brown ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Anticoagulation Therapy ◽  
Early Postoperative Period ◽  
Activated Partial Thromboplastin Time ◽  
Content Type ◽  
Intracranial Surgery ◽  
Heparin Administration ◽  
Postoperative Interval ◽  
Potential Use ◽  
Fine Print

✓ The risk of hemorrhagic complications with anticoagulation therapy in patients following intracranial surgery has prevented investigation of the potential use of heparin in the early postoperative period. The authors have evaluated the safety of anticoagulation therapy following experimental craniotomy in male Holtzman rats. The dose and schedule of heparin administration, which elevated and maintained the activated partial thromboplastin time (APTT) within the therapeutic range of 15 to 3 × control APTT, was alternating doses of 400 and 500 IU/kg injected subcutaneously every 6 hours. This schedule was initiated 2, 4, 7, 10, and 14 days after craniotomy and was continued for 72 hours thereafter. The results demonstrated that the incidence of intracerebral hemorrhage declined as the postoperative interval prior to initiation of anticoagulation increased. If anticoagulation therapy was initiated during the first 7 postoperative days, the risk of intracerebral hemorrhage was high (mean 14.7%); however, if an additional 3 to 7 days elapsed prior to initiation of anticoagulation, the incidence of intracerebral hemorrhage dropped significantly (mean 0%) (p < 0.05). These results suggest that anticoagulation therapy can be safely initiated 10 to 14 days after craniotomy.

Cushing's disease with pituitary apoplexy leading to hypopituitarism, empty sella, and spontaneous fracture of the dorsum sellae

1979 ◽  
Vol 51 (6) ◽  
pp. 866-869 ◽  
Author(s):  
Philip H. Gutin ◽  
William G. Cushard ◽  
Charles B. Wilson
Keyword(s):  
Pituitary Adenoma ◽  
Cushing’S Disease ◽  
Plasma Cortisol ◽  
Pituitary Apoplexy ◽  
Empty Sella ◽  
Cushing's Disease ◽  
Content Type ◽  
Urinary Levels ◽  
Fine Print ◽  
Transsphenoidal Resection

✓ A patient with a pituitary adenoma secreting adrenocorticotropin hormone manifested panhypopituitarism after an episode of pituitary apoplexy. The previously elevated urinary levels of 17-ketogenic steroids dropped sharply, and plasma cortisol became undetectable. The apoplexy also resulted in a partially empty sella on which the dorsum sellae collapsed. Recurrent Cushing's disease developed and was cured by transsphenoidal resection of a microadenoma.

Gamma knife surgery for hypothalamic hamartomas accompanied by medically intractable epilepsy and precocious puberty: experience in Mexico

2005 ◽  
Vol 102 ◽  
pp. 53-55 ◽  
Author(s):  
Marco A. Barajas ◽  
Maria G. Ramírez-Guzmán ◽  
Carlos Rodríguez-Vázquez ◽  
Vinicio Toledo-Buenrostro ◽  
Abel Cuevas-Solórzano ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Precocious Puberty ◽  
Intractable Epilepsy ◽  
Gamma Knife Surgery ◽  
Sleep Cycle ◽  
Hypothalamic Hamartoma ◽  
High Morbidity ◽  
Content Type ◽  
Hypothalamic Hamartomas ◽  
Fine Print

Object.Hypothalamic hamartoma is a nonneoplastic malformative mass of neurons and glia in the region of the hypothalamus. Because of its location, open surgery is associated with high morbidity and mortality rates. Gamma knife surgery (GKS) may be an efficient and safe treatment approach, which produces little morbidity. The authors describe the results of GKS in three patients with hypothalamic hamartomas.Methods.All patients were male, aged 3, 12, and 15 years. The lesions were classified according to the Valdueza scale: one was Type IIb and two were Type IIa. The patients presented with gelastic seizures (15–20 per day), generalized epilepsy, behavioral abnormalities, and alterations of the sleep cycle. Precocious puberty was present in one patient. The Type IIb tumor had a volume of 1.8 cm3, and the Type IIa tumors were 597 mm3and 530.1 mm3. The lesions received 12.5 Gy, 14 Gy, and 15 Gy, respectively, to the 50% isodose line. The patients were followed for 30 to 50 months. After 3 months, all patients showed improvement of their sleep, behavior, and epilepsy. At the present time, these patients are receiving low-dose antiepileptic agents and have achieved adequate social development and school integration.Conclusions.Gamma knife surgery appears to be a good, safe, and effective option for the treatment of selected hypothalamic hamartomas. No morbidity or mortality was associated with these three cases.

Hemostasis and intracranial surgery

1983 ◽  
Vol 58 (5) ◽  
pp. 693-698 ◽  
Author(s):  
J. Jaap van der Sande ◽  
Jan J. Veltkamp ◽  
Marijke L. Bouwhuis-Hoogerwerf
Keyword(s):  
Head Injury ◽  
Surgical Procedures ◽  
Degradation Product ◽  
Product Concentration ◽  
Fibrinogen Degradation Product ◽  
Content Type ◽  
Intracranial Surgery ◽  
Coagulation Abnormalities ◽  
Fine Print

✓ Preoperative and postoperative coagulation studies were performed in 25 patients undergoing various intracranial surgical procedures. Coagulation abnormalities, mostly consisting of an increase of fibrin/fibrinogen degradation product concentration, either appeared or increased postoperatively in 18 patients. This incidence of postoperative appearance or increase of coagulation abnormalities is higher than that reported in a comparable study of patients after general surgical procedures, and also higher than that of coagulation abnormalities in a previous study of patients after blunt head injury. Although the coagulation abnormalities after intracranial surgery were usually small, they tended to be larger in patients with more extensive intracranial procedures.

The relationship between magnetic resonance imaging findings and clinical manifestations of hypothalamic hamartoma

1999 ◽  
Vol 91 (2) ◽  
pp. 212-220 ◽  
Author(s):  
Kazunori Arita ◽  
Fusao Ikawa ◽  
Kaoru Kurisu ◽  
Masayuki Sumida ◽  
Kunyu Harada ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Magnetic Resonance ◽  
Precocious Puberty ◽  
Third Ventricle ◽  
Clinical Manifestations ◽  
Hypothalamic Hamartoma ◽  
Content Type ◽  
The Third ◽  
The Relationship ◽  
Fine Print

Object. Hypothalamic hamartoma is generally diagnosed based on its magnetic resonance (MR) imaging characteristics and the patient's clinical symptoms, but the relationship between the neuroradiological findings and clinical presentation has never been fully investigated. In this retrospective study the authors sought to determine this relationship.Methods. The authors classified 11 cases of hypothalamic hamartoma into two categories based on the MR findings. Seven cases were the “parahypothalamic type,” in which the hamartoma is only attached to the floor of the third ventricle or suspended from the floor by a peduncle. Four cases were the “intrahypothalamic type,” in which the hamartoma involved or was enveloped by the hypothalamus and the tumor distorted the third ventricle.Six patients with the parahypothalamic type exhibited precocious puberty, which was controlled by a luteinizing hormone—releasing hormone analog, and one patient was asymptomatic. No seizures or mental retardation were observed in this group. All patients with the intrahypothalamic type had medically intractable seizures, and precocious puberty was seen in one. Severe mental retardation and behavioral disorders including aggressiveness were seen in two patients. The seizures were controlled in only one patient, in whom stereotactically targeted irradiation of the lesion was performed.This topology/symptom relationship was reconfirmed in a review of 61 reported cases of hamartoma, in which the MR findings were clearly described. The parahypothalamic type is generally associated with precocious puberty but is unaccompanied by seizures or developmental delay, whereas the intrahypothalamic type is generally associated with seizures. Two thirds of patients with the latter experience developmental delays, and half also exhibit precocious puberty.Conclusions. Classification of hypothalamic hamartomas into these two categories based on MR findings resulted in a clear correlation between symptoms and the subsequent clinical course.

Gamma knife surgery for hypothalamic hamartomas accompanied by medically intractable epilepsy and precocious puberty: experience in Mexico

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 53-55 ◽  
Author(s):  
Marco A. Barajas ◽  
Maria G. Ramírez-Guzmán ◽  
Carlos Rodríguez-Vázquez ◽  
Vinicio Toledo-Buenrostro ◽  
Abel Cuevas-Solórzano ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Precocious Puberty ◽  
Intractable Epilepsy ◽  
Gamma Knife Surgery ◽  
Sleep Cycle ◽  
Hypothalamic Hamartoma ◽  
High Morbidity ◽  
Content Type ◽  
Hypothalamic Hamartomas ◽  
Fine Print

Object. Hypothalamic hamartoma is a nonneoplastic malformative mass of neurons and glia in the region of the hypothalamus. Because of its location, open surgery is associated with high morbidity and mortality rates. Gamma knife surgery (GKS) may be an efficient and safe treatment approach, which produces little morbidity. The authors describe the results of GKS in three patients with hypothalamic hamartomas. Methods. All patients were male, aged 3, 12, and 15 years. The lesions were classified according to the Valdueza scale: one was Type IIb and two were Type IIa. The patients presented with gelastic seizures (15–20 per day), generalized epilepsy, behavioral abnormalities, and alterations of the sleep cycle. Precocious puberty was present in one patient. The Type IIb tumor had a volume of 1.8 cm3, and the Type IIa tumors were 597 mm3 and 530.1 mm3. The lesions received 12.5 Gy, 14 Gy, and 15 Gy, respectively, to the 50% isodose line. The patients were followed for 30 to 50 months. After 3 months, all patients showed improvement of their sleep, behavior, and epilepsy. At the present time, these patients are receiving low-dose antiepileptic agents and have achieved adequate social development and school integration. Conclusions. Gamma knife surgery appears to be a good, safe, and effective option for the treatment of selected hypothalamic hamartomas. No morbidity or mortality was associated with these three cases.

Postoperative angiography and the “slipped” clip

1973 ◽  
Vol 39 (6) ◽  
pp. 683-689 ◽  
Author(s):  
Charles G. Drake ◽  
John M. Allcock
Keyword(s):  
Significant Part ◽  
Parent Artery ◽  
Arterial Spasm ◽  
Content Type ◽  
Intracranial Surgery ◽  
Fine Print

✓ After intracranial surgery for an aneurysm, postoperative angiography should be routine. This may demonstrate lesions such as arterial spasm and hematoma, and may also show, sometimes quite unexpectedly, that the sac has not been completely obliterated. A clip or ligature may be merely misplaced, not be closed tightly enough, slip, or include the parent artery. In our series of 329 patients who underwent postoperative angiography, contrast filling of a significant part of the sac still occurred in 43 (13%); at least 12 of these rebled. Further intracranial surgery was carried out in 18, with satisfactory obliteration of the sac in 16. An incompletely obliterated aneurysm should be reoperated on as soon as possible. The risk involved at this time is minimal and far less than the possibility of another catastrophic hemorrhage.

A nerve stimulator for the cerebellopontine angle

1977 ◽  
Vol 46 (5) ◽  
pp. 688-689
Author(s):  
Charles W. Morgan ◽  
Peter J. Jannetta
Keyword(s):  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Nerve Stimulator ◽  
Content Type ◽  
Intracranial Surgery ◽  
Fine Print

✓ A fine-tipped bipolar nerve-stimulator probe has been developed and has proved especially useful in intracranial surgery of the cranial nerves.

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