Intradural extraosseous chordoma in the foramen magnum region

1991 ◽  
Vol 75 (6) ◽  
pp. 976-979 ◽  
Author(s):  
Yoichi Katayama ◽  
Takashi Tsubokawa ◽  
Takehiko Hirasawa ◽  
Tetsuya Takahata ◽  
Norimichi Nemoto
Keyword(s):  
Growth Pattern ◽  
Surgical Excision ◽  
Foramen Magnum ◽  
Content Type ◽  
First Case ◽  
Complete Surgical Excision ◽  
Fine Print

✓ Chordomas that are entirely extraosseous and intradural are extremely rare. The tumors described in the literature were observed mostly in the prepontine region. This is the first case reported of an intradural extraosseous chordoma occurring in the foramen magnum region. The tumor was totally excised. The distinction between an intradural extraosseous chordoma and a classic chordoma is important from a clinical viewpoint because of the potential for complete surgical excision and a more benign growth pattern.

Gliomas of the optic nerve or chiasm

1988 ◽  
Vol 68 (1) ◽  
pp. 85-98 ◽  
Author(s):  
Ellsworth C. Alvord ◽  
Steven Lofton
Keyword(s):  
Optic Nerve ◽  
Growth Rates ◽  
Surgical Excision ◽  
Sufficient Information ◽  
Low Grade ◽  
Complete Excision ◽  
Content Type ◽  
Complete Surgical Excision ◽  
Table Analysis ◽  
Fine Print

✓ A review of the literature revealed 623 cases of optic gliomas with sufficient information to permit actuarial (life-table) analysis concerning the prognosis of this disease by the patients' age, tumor site, treatment, and presence of concomitant neurofibromatosis or extension into the hypothalamus or ventricle. All of these factors are important. The development of mathematical models led to the conclusion that these tumors, generally regarded histologically as low-grade astrocytomas, actually have a very wide but continuous range of growth rates. Some grow rapidly enough to be explained by simple exponential doubling at a constant rate, but most behave as though their growth decelerates. Decelerating growth rates make comparisons of various groups of patients difficult. No support is found for the classical hypothesis that some may be hamartomas. Inadequately treated gliomas of the optic nerve or chiasm bear about the same poor prognosis. However, tumors of the optic nerve (intracranial as well as intraorbital) have an excellent prognosis following complete surgical excision and only a slightly poorer prognosis following irradiation. About 5% of optic nerve gliomas recur in the chiasm following “complete” intraorbital excision. Patients with neurofibromatosis have about twice the recurrence rate following complete excision of an intraorbital glioma. Optic chiasmal gliomas appear to respond to irradiation with doses above 4500 rads. Patients with neurofibromatosis have about the same prognosis as patients without neurofibromatosis following irradiation of a chiasmal glioma.

The use of intraarterial papaverine in the management of vasospasm complicating arteriovenous malformation resection

1995 ◽  
Vol 82 (2) ◽  
pp. 296-299 ◽  
Author(s):  
Michael K. Morgan ◽  
Maurice J. Day ◽  
Nicholas Little ◽  
Verity Grinnell ◽  
William Sorby
Keyword(s):  
Arteriovenous Malformation ◽  
Perfusion Pressure ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Venous Occlusion ◽  
Neurological Deterioration ◽  
Unusual Complication ◽  
Content Type ◽  
First Case ◽  
Normal Perfusion Pressure Breakthrough ◽  
Fine Print

✓ The authors report two cases of treatment by intraarterial papaverine of cerebral vasospasm complicating the resection of an arteriovenous malformation (AVM). Both cases had successful reversal of vasospasm documented on angiography. In the first case sustained neurological improvement occurred, resulting in a normal outcome by the time of discharge. In the second case, neurological deterioration occurred with the development of cerebral edema. This complication was thought to be due to normal perfusion pressure breakthrough, on the basis of angiographic arterial vasodilation and increased cerebral blood flow. These two cases illustrate an unusual complication of surgery for AVMs and demonstrate that vasospasm (along with intracranial hemorrhage, venous occlusion, and normal perfusion pressure breakthrough) should be considered in the differential diagnosis of delayed neurological deterioration following resection of these lesions. Although intraarterial papaverine may be successful in dilating spastic arteries, it may also result in pathologically high flows following AVM resection. However, this complication has not been seen in our experience of treating aneurysmal subarachnoid hemorrhage by this technique.

Late results of radical excision of craniopharyngiomas in children

1975 ◽  
Vol 42 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Edward L. Katz
Keyword(s):  
High Mortality ◽  
Surgical Excision ◽  
Late Results ◽  
Radical Excision ◽  
Initial Operation ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Fine Print

✓ The results of radical surgical excision of craniopharyngiomas in children operated on by Dr. Donald Matson beginning in 1950 are presented. The patients are analyzed in regard to survival and quality of survival. While 22 of 34 children so treated at the initial operation are presently alive and tumor-free, high mortality and morbidity followed in cases where reoperation was performed. Properly treated endocrinological deficits need not be a serious problem, but persistent hyperosmolality carried a grave prognosis. No predictive criteria are yet available to determine which tumors are amenable to radical surgical excision.

Postoperative mutism in neurosurgery

1994 ◽  
Vol 81 (1) ◽  
pp. 115-121 ◽  
Author(s):  
J. Stuart Crutchfield ◽  
Raymond Sawaya ◽  
Christina A. Meyers ◽  
Bartlett D. Moore
Keyword(s):  
Motor Cortex ◽  
Thalamic Nucleus ◽  
Transient Condition ◽  
Brain Surgery ◽  
Content Type ◽  
First Case ◽  
Ventrolateral Nucleus ◽  
Supplementary Motor Cortex ◽  
Parasagittal Meningioma ◽  
Fine Print

✓ Mutism is defined as a state in which a patient is conscious but unwilling or unable to speak. It has been reported to occur in association with a multitude of conditions, including trauma, epilepsy, tumors, stroke, psychoses, and brain surgery. The cases of two patients who became mute in the immediate postoperative period are presented. The first patient developed mutism following removal of a parasagittal meningioma, and the second following removal of a posterior fossa medulloblastoma. It is believed that transient injury may have occurred to the supplementary motor cortex in the first case and to the dentate nuclei in the second case. It is interesting that these two areas are connected via pathways involving the ventrolateral nucleus of the thalamus, and that lesions of this thalamic nucleus can also lead to mutism. It therefore appears plausible that interruption of these pathways may be involved in the pathogenesis of mutism. Although mutism is an infrequent complication of brain surgery, neurosurgeons should be aware that it may occur following removal of lesions in these areas and that it is generally a transient condition.

Spontaneous spinal subdural hematoma associated with low-molecular-weight heparin

2005 ◽  
Vol 2 (5) ◽  
pp. 612-613 ◽  
Author(s):  
Yoon-Hee Cha ◽  
John H. Chi ◽  
Nicholas M. Barbaro
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Spinal Instrumentation ◽  
Cord Compression ◽  
Low Molecular Weight ◽  
Content Type ◽  
First Case ◽  
Spinal Subdural Hematoma ◽  
History Of ◽  
Fine Print

✓ Spinal subdural hematomas (SDHs) are a rare cause of cord compression and typically occur in the setting of spinal instrumentation or coagulopathy. The authors report the first case of a spontaneous spinal SDH occurring in conjunction with low-molecular-weight heparin use in a patient with a history of spinal radiotherapy.

Papillomas and carcinomas of the choroid plexus in children

1998 ◽  
Vol 88 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Philippe Pencalet ◽  
Christian Sainte-Rose ◽  
Arielle Lellouch-Tubiana ◽  
Chantal Kalifa ◽  
Francis Brunelle ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Surgical Excision ◽  
Preoperative Embolization ◽  
Older Children ◽  
Complete Excision ◽  
Choroid Plexus Tumors ◽  
Content Type ◽  
Intraventricular Tumors ◽  
Fluid Collections ◽  
Fine Print

Object. Choroid plexus tumors are rare intraventricular tumors (1% of all intracranial tumors) that occur mainly in children. The pathophysiological characteristics of associated hydrocephalus, surgical management, and oncological issues related to these tumors remain a matter of debate. To understand more about these tumors, the authors have reviewed their experience with the management of 38 children with choroid plexus tumors. Methods. There were 25 cases of papilloma and 13 of carcinoma. The mean age of the patients at presentation was 22.5 months, and one-half of the patients were younger than 2 years of age. Hydrocephalus was present in 33 patients and poorly correlated with the size, site, and pathological characteristics of the tumor. In nine children, a ventriculoperitoneal shunt was required after tumor excision, calling into question the notion that cerebrospinal fluid oversecretion is the only cause of hydrocephalus. Complete excision was achieved in 96% of the cases of papilloma and 61.5% of the cases of carcinoma. These surgical procedures were complicated by the risks of intraoperative hemorrhage, which proved to be fatal in two cases, and postoperative brain collapse, which led to subdural fluid collections requiring subdural shunt placement in six patients. Preoperative embolization was partially successful in four cases and significantly assisted surgery. Preoperative controlled drainage of excessively dilated ventricles and intraoperative gluing of the cortical incision have been used to address the problem of postoperative brain collapse. Patients with carcinomas were treated postoperatively by chemotherapy alone (seven cases), radiotherapy (one case), or chemotherapy plus radiotherapy (one case). The overall 5-year survival rate was 100% for patients with papillomas and 40% for those with carcinomas. Conclusions. Total surgical excision is curative in cases of papillomas. For carcinomas, the most effective treatment remains total surgical excision; however, adjuvant treatment in the form of chemotherapy in patients younger than age 3 years, supplemented by radiation therapy in older children, can moderately reduce the risk of recurrence.

Results of surgical treatment for growth hormone-secreting pituitary adenomas

1993 ◽  
Vol 79 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Dudley H. Davis ◽  
Edward R. Laws ◽  
Duane M. Ilstrup ◽  
James K. Speed ◽  
Michela Caruso ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Radiation Therapy ◽  
Hormone Level ◽  
Growth Hormone Level ◽  
Surgical Excision ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Prior Surgery ◽  
Fine Print

✓ The results of surgical therapy for acromegaly were reviewed in a series of 175 patients treated between 1972 and 1983. Patients with prior surgery or radiation therapy were excluded from the study. Postoperative radiation therapy was given to 54 patients. The criterion of achieving a postoperative basal or glucose-suppressed growth hormone level of 2 ng/ml or less was used to indicate remission. Utilizing the most recently available growth hormone determinations, 90 (51.7%) of 174 patients were in remission. The actuarial probability of remission at 1 and 5 years after surgery was 48.8% and 62.7%, respectively. Tumor size and the preoperative basal growth hormone level were correlated with outcome. Surgical excision of a pituitary adenoma is the most effective therapy currently available for acromegaly.

Intracerebral hemorrhage complicating cervical “hourglass” schwannoma removal

2001 ◽  
Vol 94 (1) ◽  
pp. 150-153 ◽  
Author(s):  
Xavier Morandi ◽  
Laurent Riffaud ◽  
Beatrice Carsin-Nicol ◽  
Yvon Guegan
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Procedure ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Neurosurgical Procedure ◽  
Content Type ◽  
Postoperative Course ◽  
First Case ◽  
Fine Print

✓ The authors report a case of infra- and supratentorial intracerebral hemorrhage complicating the postoperative course of a patient who had undergone surgical removal of a cervical schwannoma with an hourglass configuration. To their knowledge, this is the first case in which this neurosurgical procedure was followed by such a complication. Possible mechanisms are discussed; however, pathological events leading to this complication are unclear. The development of new neurological deficits not attributable to the surgical procedure should suggest this possibility.

Treatment of cerebral arteriovenous malformations

1980 ◽  
Vol 52 (5) ◽  
pp. 705-708 ◽  
Author(s):  
Laurence D. Cromwell ◽  
A. Basil Harris
Keyword(s):  
Arteriovenous Malformations ◽  
Direct Injection ◽  
Surgical Excision ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Significant Damage ◽  
Fine Print ◽  
Adjacent Brain

✓ It is believed that surgical excision of arteriovenous malformations is the best treatment when technically feasible without causing significant damage to adjacent brain. The introduction of polymers or particulate emboli by catheter has been used either alone or as an adjunct in attempts to reduce the size of these lesions prior to surgery; however, it is seldom possible to embolize the entire malformation. The authors have used direct injection of a 50% mixture of bucrylate and iophendylate into the feeding arteries supplying the area at craniotomy, with success in three cases. The cases are described to illustrate the method.

Tonsillar herniation: the rule rather than the exception after lumboperitoneal shunting in the pediatric population

1993 ◽  
Vol 78 (4) ◽  
pp. 568-573 ◽  
Author(s):  
Paul D. Chumas ◽  
Derek C. Armstrong ◽  
James M. Drake ◽  
Abhaya V. Kulkarni ◽  
Harold J. Hoffman ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Pediatric Population ◽  
Pseudotumor Cerebri ◽  
Foramen Magnum ◽  
Tonsillar Herniation ◽  
Content Type ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Sick Children ◽  
Fine Print

✓ Although the development of tonsillar herniation (acquired Chiari malformation) in association with lumboperitoneal (LP) shunting is well recognized, it has previously been considered rare. In order to ascertain the incidence of this complication after LP shunting, the authors undertook a retrospective study of all patients in whom this form of shunt had been inserted between 1974 and 1991 at The Hospital for Sick Children, Toronto. In the 143 patients, the mean age at insertion was 3.3 years and the indications for shunt placement were hydrocephalus (81%), pseudotumor cerebri (7%), cerebrospinal fluid fistula (6%), and posterior fossa pseudomeningocele (6%). The mean follow-up period was 5.7 years, during which time there was one shunt-related death due to unsuspected tonsillar herniation. Five other patients developed symptomatic tonsillar herniation treated by suboccipital decompression. Review of all computerized tomography (CT) scans not degraded by artifact showed evidence of excess soft tissue at the level of the foramen magnum in 38 (70%) of 54 patients so studied. In order to confirm that this CT finding represented hindbrain herniation, sagittal and axial magnetic resonance (MR) images were obtained for 17 asymptomatic patients and revealed tonsillar herniation (range 2 to 21 mm) in 12 (70.6%). In addition, some of these asymptomatic patients had evidence of uncal herniation and mesencephalic distortion. Similarities and distinctions are drawn between the morphological changes occurring after LP shunting and those seen in association with the Chiari I and II malformations. Although less than 5% of this study population required treatment for tonsillar herniation, the incidence of this complication was high in asymptomatic patients; MR imaging surveillance for patients with LP shunts is therefore recommended.

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