Cerebellar mass caused by Candida species

1984 ◽  
Vol 60 (2) ◽  
pp. 428-430 ◽  
Author(s):  
Edward B. Ilgren ◽  
Diana Westmorland ◽  
Christopher B. T. Adams ◽  
Robert G. Mitchell
Keyword(s):  
Amphotericin B ◽  
Candida Species ◽  
Favorable Outcome ◽  
Total Removal ◽  
Content Type ◽  
Systemic Disorder ◽  
Extracranial Disease ◽  
Cerebellar Mass ◽  
Fine Print

✓ The authors report a case of cerebellar pseudotumor caused by a Candida species without evidence of any underlying systemic disorder or extracranial disease. Total removal followed by treatment with amphotericin B resulted in a favorable outcome.

Total removal of large global meningiomas at the medial aspect of the sphenoid ridge

1971 ◽  
Vol 34 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Albert W. Cook
Keyword(s):  
Optic Nerve ◽  
Middle Cerebral Artery ◽  
Operative Technique ◽  
Middle Meningeal Artery ◽  
Medial Aspect ◽  
Total Removal ◽  
Content Type ◽  
Meningeal Artery ◽  
Sphenoid Ridge ◽  
Fine Print

✓ An operative technique for total removal of large global meningiomas at the medial aspect of the sphenoid ridge is described, and experience with 11 patients reported. The technique involves extradural liberation of the dural and tumor attachments to the underlying bone, and extradural occlusion of the blood supply through bone and middle meningeal artery. Subsequent procedures are carried out sequentially in the parasellar area to free the optic nerve and carotid, in the subtemporal tentorial region to release tumor from neighboring structures, and in the Sylvian fissure to isolate the middle cerebral artery.

Interhemispheric approach for the surgical removal of thalamocaudate arteriovenous malformations

1987 ◽  
Vol 66 (3) ◽  
pp. 345-351 ◽  
Author(s):  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Corpus Callosum ◽  
Arteriovenous Malformations ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Total Removal ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Parinaud’S Syndrome ◽  
Fine Print

✓ A series of 250 surgically treated cerebral arteriovenous malformations (AVM's) is presented, in which 22 lesions were located primarily in the thalamus and caudate nucleus. A standardized interhemispheric approach through the posterior corpus callosum and into the atrium of the lateral ventricle was utilized for the surgical removal of these AVM's. Total removal was confirmed by angiography in 18 patients; removal was subtotal in four cases. There were no deaths in this group of patients. Disturbances of recent memory pre- and postoperatively were seen in half of the patients, but most of these deficits were temporary. Other complications included: postoperative homonymous hemianopsia (six cases), transient hemiparesis (three cases), hemisensory loss (two cases), Parinaud's syndrome (one case), and recurrent hemorrhage 2 years after surgery (one case). All 22 patients returned to their previous occupations and are leading independent lives. The results of this experience indicate that thalamocaudate AVM's can be effectively treated by resection.

The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors

2005 ◽  
Vol 102 (5) ◽  
pp. 832-841 ◽  
Author(s):  
Joshua R. Dusick ◽  
Felice Esposito ◽  
Daniel F. Kelly ◽  
Pejman Cohan ◽  
Antonio DeSalles ◽  
...  
Keyword(s):  
Residual Tumor ◽  
Transsphenoidal Approach ◽  
Total Removal ◽  
Content Type ◽  
Patients Âgés ◽  
Extended Transsphenoidal Approach ◽  
Planum Sphenoidale ◽  
Dural Defects ◽  
Fine Print ◽  
Csf Leaks

Object. The extended transsphenoidal approach, which requires a bone and dural opening through the tuberculum sellae and posterior planum sphenoidale, is increasingly used for the treatment of nonadenomatous suprasellar tumors. The authors present their experiences in using the direct endonasal approach in patients with nonadenomatous suprasellar tumors. Methods. Surgery was performed with the aid of an operating microscope and angled endoscopes were used to assess the completeness of resection. Bone and dural defects were repaired using abdominal fat, collagen sponge, titanium mesh, and, in most cases, lumbar drainage of cerebrospinal fluid (CSF). Twenty-six procedures for tumor removal were performed in 24 patients (ages 9–79 years), including two repeated operations for residual tumor. Gross-total removal could be accomplished in only 46% of patients, with near-gross-total removal or better in 74% of 23 patients (five of eight with craniopharyngiomas, six of seven with meningiomas, five of six with Rathke cleft cysts, and one of two with a dermoid or epidermoid cyst); a patient with a lymphoma only underwent biopsy. Of 13 patients with tumor-related visual loss, 85% improved postoperatively. The complications that occurred included five patients (21%) with postoperative CSF leaks, one patient (4%) with bacterial meningitis; five patients (21%) with new endocrinopathy; and two patients (8%) who needed to undergo repeated operations to downsize suprasellar fat grafts. The only permanent neurological deficit was anosmia in one patient; there were no intracranial vascular injuries. Conclusions. The direct endonasal skull-base approach provides an effective minimally invasive means for resecting or debulking nonadenomatous suprasellar tumors that have traditionally been approached through a sublabial or transcranial route. Procedures in the supraglandular space can be performed effectively with excellent visualization of the optic apparatus while preserving pituitary function in most cases. The major challenge remains developing consistently effective techniques to prevent postoperative CSF leaks.

Dural-cortical anastomosis in pial arteriovenous malformation

1979 ◽  
Vol 50 (4) ◽  
pp. 522-524 ◽  
Author(s):  
Shiro Waga ◽  
Atsunori Morikawa ◽  
Tadashi Kojima
Keyword(s):  
Arteriovenous Malformation ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Meningeal Artery ◽  
Review Of The Literature ◽  
Total Removal ◽  
Content Type ◽  
Posterior Parietal ◽  
Meningeal Artery ◽  
Fine Print

✓ A patient is reported with a purely pial arteriovenous malformation (AVM) supplied from the posterior parietal artery. The prominent middle meningeal artery contributed to opacification of the angular branches distal to the AVM, but did not contribute to the AVM. After total removal of the AVM, the angular branches became opacified from the middle cerebral artery. Review of the literature suggests that hypertrophied dural arteries which do not contribute to the AVM's but which do opacify the cortical branches distal to the AVM's are rare.

Cavernous angioma of the cauda equina producing subarachnoid hemorrhage

1987 ◽  
Vol 66 (1) ◽  
pp. 134-136 ◽  
Author(s):  
Shinsuke Ueda ◽  
Akihito Saito ◽  
Shigeo Inomori ◽  
Ilu Kim
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cauda Equina ◽  
Cavernous Angioma ◽  
Low Back ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Total Removal ◽  
Content Type ◽  
Similar Episode ◽  
Fine Print

✓ A case of a cavernous angioma of the cauda equina is presented. The patient was a 28-year-old man who experienced sudden low-back pain and headache without neurological symptoms. Lumbar puncture revealed subarachnoid hemorrhage. He had suffered a similar episode 3 years previously. Selective spinal angiography did not demonstrate any abnormal vascularity. Metrizamide myelography and magnetic resonance imaging were useful in demonstrating the presence of a tumor. Laminectomy at L1–3 and total removal of the tumor were performed without neurological deficit.

Deep and brainstem cavernomas: a consecutive 8-year series

2003 ◽  
Vol 99 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Tiit Mathiesen ◽  
Göran Edner ◽  
Lars Kihlström
Keyword(s):  
Basal Ganglia ◽  
Neurological Deterioration ◽  
Radical Excision ◽  
Long Term Outcomes ◽  
Total Removal ◽  
Shunt Insertion ◽  
Content Type ◽  
Operative Notes ◽  
Fine Print

Object. The goal of this study was to provide epidemiological and clinical data on the management of cavernomas of the basal ganglia and brainstem from a long-term series at one institution. Methods. All 68 patients who were referred to the authors' department between 1992 and 2000 for deep cavernomas were evaluated by clinic examinations, review of neuroimaging examinations, and review of charts and operative notes. Twenty-nine patients underwent microsurgical procedures, which carried a 69% risk of transitory neurological deterioration. Radical excision was achieved in 25 of these patients, as determined by a review of neuroimages; the remaining four patients all experienced new hemorrhages that led to increased morbidity or even to mortality. Surgical results were better if surgery was performed early, within 1 month posthemorrhage, than if operations were postponed. In selected patients, deep lesions not reaching a pial surface could be safely removed from the thalamus, basal ganglia, or medulla oblongata. Of five patients who underwent gamma knife surgery, two experienced hemorrhages, one at 2 and the other at 5 years following treatment. Patients who did not undergo surgery had a yearly incidence of hemorrhage that was 2% in cases of incidental cavernomas and 7% in symptomatic ones. Conclusions. Over the long term, outcomes were worse following conservative treatment or shunt insertion surgery than after microsurgery of symptomatic cavernomas. Incidental cavernomas carried a low risk of neurological deterioration. Surgery should follow generally accepted indications, but only with the confidence that total removal can be safely achieved. Surgery that is performed within 10 to 30 days following ictus may be preferable to delayed surgery.

Preservation of facial and acoustic nerves in the total removal of large and small acoustic tumors

1981 ◽  
Vol 54 (2) ◽  
pp. 268-272 ◽  
Author(s):  
Wanxing Chai
Keyword(s):  
Relevant Literature ◽  
Operating Microscope ◽  
Total Removal ◽  
Content Type ◽  
Large Lesion ◽  
Acoustic Tumor ◽  
Fine Print

✓ Two cases are presented in which an acoustic tumor was totally removed without the aid of an operating microscope. In one of them, a large lesion was excised, with restoration of the patient's hearing postoperatively. The anatomical problems are analyzed, and the relevant literature is reviewed briefly.

Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control

2003 ◽  
Vol 98 (2) ◽  
pp. 342-349 ◽  
Author(s):  
Jason P. Sheehan ◽  
Ming-Hsi Sun ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Cell Cancer ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Content Type ◽  
Extracranial Disease ◽  
The Brain ◽  
Fine Print

Object. Renal cell carcinoma is a leading cause of death from cancer and its incidence is increasing. In many patients with renal cell cancer, metastasis to the brain develops at some time during the course of the disease. Corticosteroid therapy, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, the median survival in patients with renal cell carcinoma metastasis is approximately 3 to 6 months. In this study the authors examined the efficacy of gamma knife surgery in treating renal cell carcinoma metastases to the brain and evaluated factors affecting long-term survival. Methods. The authors conducted a retrospective review of 69 patients undergoing stereotactic radiosurgery for a total of 146 renal cell cancer metastases. Clinical and radiographic data encompassing a 14-year treatment interval were collected. Multivariate analyses were used to determine significant prognostic factors influencing survival. The overall median length of survival was 15 months (range 1–65 months) from the diagnosis of brain metastasis. After radiosurgery, the median survival was 13 months in patients without and 5 months in those with active extracranial disease. In a multivariate analysis, factors significantly affecting the rate of survival included the following: 1) younger patient age (p = 0.0076); 2) preoperative Karnofsky Performance Scale score (p = 0.0012); 3) time from initial cancer diagnosis to brain metastasis diagnosis (p = 0.0017); 4) treatment dose to the tumor margin (p = 0.0252); 5) maximal treatment dose (p = 0.0127); and 6) treatment isodose (p = 0.0354). Prior tumor resection, chemotherapy, immunotherapy, or whole-brain radiation therapy did not correlate with extended survival. Postradiosurgical imaging of the brain demonstrated that 63% of the metastases had decreased, 33% remained stable, and 4% eventually increased in size. Two patients (2.9%) later underwent a craniotomy and resection for a tumor refractory to radiosurgery or a new symptomatic metastasis. Eighty-three percent of patients died of progression of extracranial disease. Conclusions. Stereotactic radiosurgery for treatment of renal cell carcinoma metastases to the brain provides effective local tumor control in approximately 96% of patients and a median length of survival of 15 months. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can offer patients an extended survival.

Surgical treatment of clival chordomas: the transsphenoidal approach revisited

1996 ◽  
Vol 85 (5) ◽  
pp. 784-792 ◽  
Author(s):  
Giulio Maira ◽  
Roberto Pallini ◽  
Carmelo Anile ◽  
Eduardo Fernandez ◽  
Fabrizio Salvinelli ◽  
...  
Keyword(s):  
Spinal Metastasis ◽  
Postoperative Radiotherapy ◽  
Primary Treatment ◽  
Transsphenoidal Approach ◽  
Total Removal ◽  
Partial Removal ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Lower Clivus ◽  
Fine Print

✓ This is a report of 12 cases of clival chordomas that were surgically treated at the Catholic University Medical School, Rome, Italy, over a 7-year period. The study emphasizes the role of the transsphenoidal approach. The study group included seven men and five women whose ages ranged from 26 to 80 years (mean 49.8 years). Diplopia was the most common presenting symptom (eight cases). The tumor involved the upper and middle clivus in five cases, the middle clivus in five, and the lower clivus in two cases. One patient developed spinal metastasis. On histological examination, eight cases proved to be typical chordomas, three cases had a chondroid component, and one case of chordoma had atypical features. Immunohistological staining for vimentin and epithelial membrane antigen was positive in all cases. Follow-up periods ranged from 14 to 86 months (mean 40.2 months). The primary treatment consisted of surgery. Ten patients with chordomas of the upper and middle clivus underwent a total of 13 transsphenoidal procedures. Total tumor removal was achieved in seven cases, subtotal removal in two, and partial removal in one case. In the two cases of lower clival chordomas, total removal was accomplished in one and partial removal in the other. After total removal, no recurrence was noted at 14 to 86 months (mean 37.5 months). In the cases undergoing operation via a transsphenoidal approach, there was zero morbidity and one cerebrospinal fluid fistula that resolved without surgery. The tumor recurred in two patients after subtotal and partial removal, respectively. The authors opted to reoperate in cases of recurrence. Postoperative radiotherapy was administered in only two cases in which further surgery was not indicated because of medical reasons or because such a procedure was contrary to the patient's wishes. When mortality and morbidity rates of this group are compared to those of chordoma patients who were treated with extensive skull-base surgery, the results prompt a reappraisal of the transsphenoidal approach in the treatment of clival chordomas.

Carcinoma of the choroid plexus

1982 ◽  
Vol 56 (5) ◽  
pp. 722-727 ◽  
Author(s):  
Duncan B. Carpenter ◽  
W. Jost Michelsen ◽  
Arthur P. Hays
Keyword(s):  
Radiation Therapy ◽  
Rare Disease ◽  
Choroid Plexus ◽  
Young Woman ◽  
Lateral Ventricle ◽  
Total Excision ◽  
Total Removal ◽  
Content Type ◽  
Left Lateral Ventricle ◽  
Fine Print

✓ Carcinoma of the choroid plexus is an extremely rare disease with a particularly virulent course. A case is reported in the left lateral ventricle of a young woman who is well 1 year after total excision of the tumor. The four previously reported patients with this disease who did well (two males and two females) were all children. Three of the four were treated with surgery followed by radiotherapy, and one with surgery alone. Although it appears possible that gross total removal may be curative, radiation therapy is suggested because of the distinct possibility that even the least aggressive-appearing lesions may degenerate and become rapidly fatal. Chemotherapy, although not used in any of the cases reported, is suggested as a possible adjunct in the treatment of this disease.

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