Epidermoid cysts of the posterior fossa

1985 ◽  
Vol 62 (2) ◽  
pp. 214-219 ◽  
Author(s):  
Mitchel S. Berger ◽  
Charles B. Wilson
Keyword(s):  
Posterior Fossa ◽  
Cranial Nerves ◽  
Neurological Deficits ◽  
Content Type ◽  
Epidermoid Cysts ◽  
Large Size ◽  
Fourth Decade ◽  
Vascular Structures ◽  
Long Course ◽  
The Brain

✓ Epidermoid cysts originating in the paramedian basal cisterns of the posterior fossa are congenital lesions that grow to a large size through slow accumulation of desquamated epithelium. These lesions grow between and ultimately displace cranial nerves, vascular structures, and the brain stem, causing a long course of progressive neurological deficits. The onset of symptoms usually occurs during the fourth decade of life. Epidermoid cysts are easily diagnosed with computerized tomography scans, which characteristically show a low-density extra-axial pattern. The primary surgical objective is to decompress the mass by evacuating the cyst contents and removing nonadherent portions of the tumor capsule; portions of the capsule adherent to vital structures should be left undisturbed. Aseptic meningitis is the most common cause of postoperative morbidity, and its incidence may be minimized by intraoperative irrigation with steroids followed by systemic therapy with dexamethasone. Symptomatic recurrences that occur many years after surgery should be managed with conservative reoperation.

Surgical treatment of epidermoid cysts of the cerebellopontine angle

1996 ◽  
Vol 84 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Madjid Samii ◽  
Marcos Tatagiba ◽  
Jose Piquer ◽  
Gustavo A. Carvalho
Keyword(s):  
Cerebellopontine Angle ◽  
Postoperative Mortality ◽  
Complete Resection ◽  
Neurological Deficits ◽  
Total Resection ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Epidermoid Cysts ◽  
Vascular Structures

✓ A total of 40 patients with epidermoid cysts of the cerebellopontine angle (CPA) underwent surgery between 1980 and 1993. Total resection was achieved in 30 cases (75%); in 10 cases (25%) parts of the cyst capsule were left because they adhered to the brainstem and vascular structures of the CPA. One patient with very large bilateral epidermoid cysts, who underwent complete bilateral resection in one stage, died of pulmonary aspiration and infection. As of their latest clinical and radiological follow-up examinations (mean 5.7 years), 93% of the patients are able to lead useful lives. Three cases of cyst regrowth have been observed thus far. Modern radiological tools and microsurgery techniques have considerably improved the completeness of cyst resection and reduced postoperative mortality and morbidity rates; however, there still are some cases in which complete resection is impossible without producing severe neurological deficits.

Late postirradiation occlusive vasculopathy in childhood medulloblastoma

1998 ◽  
Vol 89 (3) ◽  
pp. 460-464 ◽  
Author(s):  
Yannick Grenier ◽  
Tadanori Tomita ◽  
MaryAnne H. Marymont ◽  
Sharon Byrd ◽  
Delilah M. Burrowes
Keyword(s):  
Radiation Therapy ◽  
Posterior Fossa ◽  
Arterial Wall ◽  
Posterior Cerebral Artery ◽  
Neurological Deficits ◽  
Content Type ◽  
Psychomotor Delay ◽  
First Case ◽  
Multiagent Chemotherapy ◽  
The Brain

✓ The authors report two cases of ischemic stroke secondary to occlusive vasculopathy two decades after radiation therapy (RT) for medulloblastoma. Both patients underwent posterior fossa medulloblastoma partial resection, followed by craniospinal RT in which a cobalt 60 source was used; 40 Gy were given to the whole brain plus a 15-Gy boost to the posterior fossa. Both patients received multiagent chemotherapy, immediately following radiation therapy in the first case and after repeated craniotomy for recurrence 13 years after radiation in the second case. They experienced multiple sequelae from radiation and chemotherapy, including growth retardation and psychomotor delay. However, 20 years after treatment, they remained tumor free and able to work, until they presented with focal neurological deficits and seizures. Computerized tomography and magnetic resonance imaging of the brain in both cases showed no tumor recurrence, but did demonstrate ischemia in a posterior cerebral artery distribution. Cerebral angiography revealed multiple mid-sized arterial wall irregularities as well as focal stenoses consistent with a postirradiation vasculopathy. The pathophysiological mechanisms, radiological appearance, and incidence of this syndrome are reviewed from the literature.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Successful evacuation of a pontine hematoma secondary to rupture of a pathologically diagnosed “cryptic” vascular malformation

1973 ◽  
Vol 39 (1) ◽  
pp. 104-108 ◽  
Author(s):  
Ben B. Scott ◽  
Joachim F. Seeger ◽  
Richard C. Schneider
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Vascular Malformation ◽  
Nerve Palsy ◽  
Neurological Deficits ◽  
Content Type ◽  
Brain Stem Lesion ◽  
Seventh Nerve ◽  
Fine Print

✓ A posterior fossa exploration was performed on a child thought initially to have an inoperable brain stem lesion. A pontine hematoma was discovered and evacuated. The pathological specimen was designated as a “cryptic” arteriovenous malformation. All preoperative neurological deficits disappeared except for a minimal left seventh nerve palsy.

Epidermoid Cysts and Cholesterol Granulomas Centered on the Posterior Fossa: Twenty Years of Diagnosis and Management

Neurosurgery ◽  
1987 ◽  
Vol 21 (6) ◽  
pp. 798-805 ◽  
Author(s):  
Howard Ian Sabin ◽  
Lorenzo Tommaso Bordi ◽  
Lindsay Symon
Keyword(s):  
Posterior Fossa ◽  
Diagnostic Procedures ◽  
Jugular Foramen ◽  
Neurological Deficits ◽  
Petrous Apex ◽  
Epidermoid Cysts ◽  
Diagnosis And Management ◽  
Presenting Symptoms ◽  
Review Period ◽  
Contrast Ventriculography

Abstract The clinical features, diagnosis, and management of 23 posterior fossa epidermoid cysts and 9 petrous apex lesions presenting to one unit over a period of 20 years are summarized. Of the epidermoid cysts, 13 were entirely infratentorial, but the other 10 had an additional supratentorial component. Presenting symptoms and signs were usually long-standing and at onset had often been vague and nonspecific. With time, however, a variety of neurological deficits that depended on the site of the lesion developed. These were generally combinations of cerebellopontine (CP) angle and jugular foramen syndromes, deafness, facial palsy, and motor weakness. Diagnostic procedures have changed greatly over the review period. Computed tomography and magnetic resonance imaging have replaced air encephalography and contrast ventriculography. The better preoperative localization of these lesions allows rational planning of the surgical approach required for optimal tumor exposure, which is essential for any attempt at total excision, considering the large size of the majority of these tumors when diagnosed. We favor operation through a posterior fossa craniectomy for those tumors restricted to the CP angle or 4th ventricle, but routinely use a combined supra- and infratentorial approach if the lesion has a more rostral component. The infiltrating nature of epidermoid cysts within the cranium compromises the extent of excision if neurological deficit is not to be increased, but we attempt as complete an excision of tumor and capsule as possible in the hope that many years will pass before symptoms recur. Cholesterol granulomas seem to respond well to simple cavity drainage and have shown no tendency to recur.

Progressive spasticity and scoliosis in children with myelomeningocele

1985 ◽  
Vol 62 (3) ◽  
pp. 367-375 ◽  
Author(s):  
T. S. Park ◽  
Wayne S. Cail ◽  
William M. Maggio ◽  
Diane C. Mitchell
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Clinical Presentation ◽  
Contrast Material ◽  
Posterior Fossa Decompression ◽  
Content Type ◽  
Motor Strength ◽  
Favorable Neurological Outcome ◽  
The Brain ◽  
Tomography Scanning

✓ Seventeen myelodysplastic patients with progressive extremity spasticity and scoliosis underwent radiological evaluation and surgical treatment. All but one were under 18 years of age at the time of surgical treatment. Duration of the clinical presentation ranged from 1½ to 7 years. Metrizamide was instilled into the subarachnoid space in 12 patients, the lateral ventricle in two, and the hydromyelic cavity in three. Sequential computerized tomography scanning after intrathecal instillation of the contrast material clearly demonstrated hydromyelia in nine patients and compression of the brain stem in five. Posterior fossa decompression with plugging of the obex was performed in 12 patients, posterior fossa decompression alone in three, and ventriculoperitoneal (VP) shunting procedures in two. Of the 12 patients who underwent the obex plugging procedures, eight have shown partial or complete resolution of spasticity and an increase in motor strength with no significant postoperative complications. In contrast, posterior fossa decompression or VP shunting procedures alone have not led to a favorable neurological outcome. Hydromyelia may occur more commonly among myelodysplastic patients than previously recognized and may be treated most effectively by the obex plugging procedure.

General and local hypothermia of the brain in the treatment of intractable epilepsy

1970 ◽  
Vol 33 (3) ◽  
pp. 253-259 ◽  
Author(s):  
K. Šourek ◽  
V. Trávníček
Keyword(s):  
Intractable Epilepsy ◽  
Clinical Results ◽  
Emotional Stability ◽  
Local Temperature ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Changes ◽  
Local Hypothermia ◽  
The Brain ◽  
Fine Print

✓ Twenty-five cases of intractable epilepsy were treated by combined deep general and local extravascular brain hypothermia plus single doses of pentothal (Thiopental) or diazepam. The final local temperature of the brain in 21 patients was below 24°C, the rectal temperatures being 27° to 30°C. There was one death 6 weeks after surgery, and in two patients slight neurological deficits were found at 3 and 6 months postoperatively. In 15 patients in whom at least 1 year had elapsed since surgery, the frequency and intensity of the seizures were reduced by 50% in two, reduced to a single seizure in five, eliminated in four, and unaltered in four. The fair and excellent results included 60% of the group. In three patients improvement in behavior and emotional stability were observed postoperatively; this change was independent of the reduction of the frequency of seizures. Postoperative changes in the electroencephalogram were less frequent than changes in the frequency of seizures and also were completely independent of the clinical results.

Stereotactic radiosurgery for arteriovenous malformations of the brain

1991 ◽  
Vol 75 (4) ◽  
pp. 512-524 ◽  
Author(s):  
L. Dade Lunsford ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
David J. Bissonette ◽  
Charles A. Jungreis ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Content Type ◽  
Complete Obliteration ◽  
Latency Interval ◽  
Subtotal Removal ◽  
The Brain ◽  
Fine Print

✓ Stereotactic radiosurgery successfully obliterates carefully selected arteriovenous malformations (AVM's) of the brain. In an initial 3-year experience using the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 227 patients with AVM's were treated. Symptoms at presentation included prior hemorrhage in 143 patients (63%), headache in 104 (46%), and seizures in 70 (31%). Neurological deficits were present in 102 patients (45%). Prior surgical resection (resulting in subtotal removal) had been performed in 36 patients (16%). In 47 selected patients (21%), embolization procedures were performed in an attempt to reduce the AVM size prior to radiosurgery. The lesions were classified according to the Spetzler grading system: 64 (28%) were Grade VI (inoperable), 22 (10%) were Grade IV, 90 (40%) were Grade III, 43 (19%) were Grade II, and eight (4%) were Grade I. With the aid of computer imaging-integrated isodose plans for single-treatment irradiation, total coverage of the AVM nidus was possible in 216 patients (95%). The location and volume of the AVM were the most important factors for the selection of radiation dose. Magnetic resonance (MR) imaging was performed at 6-month intervals in 161 patients. Seventeen patients who had MR evidence of complete obliteration underwent angiography within 3 months of imaging: in 14 (82%) complete obliteration was confirmed. Complete angiographic obliteration was confirmed in 37 (80%) of 46 patients at 2 years, the earliest confirmation being 4 months (mean 17 months) after radiosurgery. The 2-year obliteration rates according to volume were: all eight (100%) AVM's less than 1 cu cm; 22 (85%) of 26 AVM's of 1 to 4 cu cm; and seven (58%) of 12 AVM's greater than 4 cu cm. Magnetic resonance imaging revealed postirradiation changes in 38 (24%) of 161 patients at a mean interval of 10.2 months after radiosurgery; only 10 (26%) of those 38 patients were symptomatic. In the entire series, two patients developed permanent new neurological deficits believed to be treatment-related. Two patients died of repeat hemorrhage at 6 and 23 months after treatment during the latency interval prior to obliteration. Stereotactic radiosurgery is an important method to obliterate AVM's, especially those previously considered inoperable. Success and complication risks are related to the AVM location and the volume treated.

Stereotactic craniotomy in the resection of small arteriovenous malformations

1991 ◽  
Vol 75 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Michael B. Sisti ◽  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
Complete Removal ◽  
Neurological Deficits ◽  
Content Type ◽  
Neurological Improvement ◽  
Stereotactic Frame ◽  
Microsurgical Resection ◽  
The Brain ◽  
Radiological Studies ◽  
Fine Print

✓ Surgical resection of 10 obscure arteriovenous malformations (AVM's) was accomplished with craniotomy guided by computerized tomography (CT) or angiography and the use of the Brown-Roberts-Wells stereotactic frame. Stereotactic craniotomy was invaluable for resection of the following types of AVM's: 1) AVM's with a nidus less than 2 cm in diameter, 2) AVM's located in an eloquent area of the brain, and 3) AVM's located deep in the brain. Stereotactic localization of these AVM's on preoperative radiological studies provides a precise route to the nidus, often avoiding important areas of the brain. This series included six male and four female patients with a mean age of 32 years. All patients presented with an intracerebral hemorrhage, from which eight made a complete neurological recovery prior to surgery. Two AVM's were located on the cortex, three were found subcortically, and five were situated near the ventricles or in the deep white matter. As a guide, angiography was used in six cases and CT in four cases. In each instance, the study providing the best image of the AVM nidus was employed. Postoperatively, no neurological deficits were found in eight patients and, in the two patients with preoperative deficits, neurological improvement was observed after recovery from surgery. Postoperative studies revealed complete removal of the AVM in all patients, and all lesions were confirmed histologically. The authors conclude that stereotactic craniotomy provides the optimum operative approach for the localization and microsurgical resection of AVM's that are either obscure or located deep in the brain.

Biphasic occurrence of delayed ischemia after early aneurysm surgery

1983 ◽  
Vol 58 (3) ◽  
pp. 440-442 ◽  
Author(s):  
Mamoru Taneda ◽  
Akatsuki Wakayama ◽  
Koji Ozaki ◽  
Kazuo Kataoka ◽  
Toru Hayakawa ◽  
...  
Keyword(s):  
Time Course ◽  
Unusual Case ◽  
Internal Carotid ◽  
Complete Recovery ◽  
Neurological Deficits ◽  
Left Internal Carotid Artery ◽  
Content Type ◽  
The Right ◽  
Subarachnoid Blood ◽  
The Brain

✓ An unusual case of delayed ischemia following rupture of an aneurysm of the left internal carotid artery is reported. Symptoms occurred twice after clipping the aneurysm and removing most of the subarachnoid blood on the left side the day after subarachnoid hemorrhage (SAH). Initial ischemia due to vasospasm occurred on the left side of the brain on the 8th day after SAH and responded favorably to induced hypervolemia. After complete recovery, a second episode due to vasospasm occurred on the 16th day after SAH on the right side of the brain from which the subarachnoid blood had not been removed. This caused a massive lesion and permanent severe neurological deficits. This case suggests that removal of subarachnoid blood may affect the severity and time course of vasospasm, and emphasizes the necessity of extensive removal of subarachnoid blood for prevention of severe delayed ischemic symptoms.

Sign in / Sign up

Export Citation Format

Share Document