Endoscopic removal of cysticercal cysts within the fourth ventricle

1999 ◽  
Vol 91 (2) ◽  
pp. 340-345 ◽  
Author(s):  
Marvin Bergsneider
Keyword(s):  
Fourth Ventricle ◽  
Treatment Options ◽  
Primary Treatment ◽  
Surgical Removal ◽  
Endoscopic Removal ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
The Mean ◽  
Optimum Management ◽  
Fine Print

✓ There is no consensus as to the optimum management of patients who harbor cysticercal cysts within the fourth ventricle. Compared with the alternative treatment options of anthelmintic medication and/or cerebrospinal fluid shunt placement, the surgical removal of the cyst has the advantage of eliminating the inflammatory nidus and potentially obviating the need for a complication-prone shunt. Here, an endoscopic surgical approach is described and proposed as an alternative to the standard suboccipital craniectomy for removal of cysticercal cysts within the fourth ventricle.A retrospective analysis of five consecutive endoscopic cases was performed. Endoscopic removal of all cysts within the fourth ventricle was successful in each case. The mean length of operative time was short and blood loss was insignificant. The endoscopic procedure was safe and associated with minimal postoperative discomfort in most patients.In properly selected patients, the endoscopic removal of cysticercal cysts located within the fourth ventricle should be considered as the primary treatment for this condition.

scholarly journals Endoscopic removal of cysticercal cysts within the fourth ventricle: technique and results

1999 ◽  
Vol 6 (4) ◽  
pp. E10 ◽  
Author(s):  
Marvin Bergsneider
Keyword(s):  
Blood Loss ◽  
Fourth Ventricle ◽  
Treatment Options ◽  
Primary Treatment ◽  
Endoscopic Procedure ◽  
Surgical Removal ◽  
Endoscopic Removal ◽  
Suboccipital Craniotomy ◽  
Cerebrospinal Fluid Shunting ◽  
Postoperative Discomfort

There is no consensus as to the optimum management of patients who harbor cysticercal cysts within the fourth ventricle. Compared with the alternative treatment options of anthelmintic medication and/or cerebrospinal fluid shunting, the surgical removal of the cyst has the advantage of eliminating the inflammatory nidus and potentially obviating the need for a complication-prone shunt. Here, an endoscopic surgical approach is described and proposed as a superior alternative to the suboccipital craniotomy for removal of a fourth ventricle cyst. A retrospective analysis was conducted to compare five consecutive endoscopic cases with eight previous consecutive cases in which a suboccipital craniotomy was performed to remove fourth ventricle cysticercal cysts. Comparisons are made with regards to success in removing the cyst, length of operation, surgical blood loss, postoperative discomfort, and complications. A detailed description of the endoscopic technique is given. Endoscopic removal of all cysts within the fourth ventricle was successful in each case. The mean length of operative times was shorter and the blood loss was reduced with the endoscopic procedure compared with the suboccipital craniotomy (2.5 ± 0.8 hours and 5.3 ± 2.2 hours [p = 0.02], 19 ± 4ml and 269 ± 203 ml [p = 0.02], respectively). The endoscopic procedure was safe and associated with less postoperative discomfort in most patients. In properly selected patients, the endoscopic removal of cysticercal cysts located within the fourth ventricle is superior to the suboccipital craniotomy and should be considered as the primary treatment for this condition.

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

Teratoma of the fourth ventricle

1973 ◽  
Vol 38 (3) ◽  
pp. 355-357 ◽  
Author(s):  
Robert J. Morelli
Keyword(s):  
Fourth Ventricle ◽  
Rare Case ◽  
Surgical Removal ◽  
Malignant Teratoma ◽  
Content Type ◽  
Fine Print

✓ The author reports a rare case in which a primary malignant teratoma presented as an obstructing mass in the fourth ventricle. The tumor was not cystic but well encapsulated, and a gross total surgical removal was accomplished. A fatal recurrence occurred within 3 months.

Efficacy of multiple intraarterial papaverine infusions for improvement in cerebral circulation time in patients with recurrent cerebral vasospasm

2004 ◽  
Vol 100 (3) ◽  
pp. 414-421 ◽  
Author(s):  
James K. Liu ◽  
Michael S. Tenner ◽  
Oren N. Gottfried ◽  
Edwin A. Stevens ◽  
Joshua M. Rosenow ◽  
...  
Keyword(s):  
Cerebral Vasospasm ◽  
Cerebral Circulation ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Primary Treatment ◽  
Circulation Time ◽  
Control Group ◽  
Content Type ◽  
The Mean ◽  
Cerebral Circulation Time ◽  
Fine Print

Object. Cerebral vasospasm that is caused by aneurysmal subarachnoid hemorrhage and that is refractory to maximal medical management can be treated with selective intraarterial papaverine infusions. The effects of single papaverine treatments on cerebral circulation time are well known. The purpose of this study was to assess the efficacy of multiple, repeated papaverine infusions on the cerebral circulation time in patients with recurrent vasospasm. Methods. A retrospective study was conducted in 17 patients who received multiple intraarterial papaverine infusions in 91 carotid artery (CA) territories for the treatment of cerebral vasospasm. Cerebral circulation times were measured from the first angiographic image, in which peak contrast was seen above the supraclinoid internal CA, to the peak filling of cortical veins. Glasgow Outcome Scale (GOS) scores assessed 12 months after discharge were reviewed. Cerebral circulation times in 16 CA territories were measured in a control group of 11 patients. Seventeen patients received a total of 91 papaverine treatments. Prolonged cerebral circulation times improved after 90 (99%) of 91 papaverine treatments. The prepapaverine mean cerebral circulation time was 6.54 seconds (range 3.35–27 seconds) and the immediate postpapaverine mean cerebral circulation time was 4.19 seconds (range 2.1–12.6 seconds), an overall mean decrease of 2.35 seconds (36%, p < 0.001). Recurrent vasospasm reflected by prolonged cerebral circulation times continued to improve with subsequent papaverine infusions. Repeated infusions were just as successful quantitatively as the primary treatment (mean change 2.06 seconds). The mean cerebral circulation time in the control group was 5.21 seconds (range 4–6.8 seconds). In five patients a dramatic reversal of low-attenuation changes was detected on computerized tomography scans. The mean GOS score at 12 months after discharge was 3.4. Conclusions. The preliminary results indicate that multiple intraarterial papaverine treatments consistently improve cerebral circulation times, even with repeated infusions in cases of recurrent vasospasm.

Salvage retreatment after failure of radiosurgery in patients with arteriovenous malformations

2003 ◽  
Vol 98 (2) ◽  
pp. 337-341 ◽  
Author(s):  
Kelly D. Foote ◽  
William A. Friedman ◽  
Thomas L. Ellis ◽  
Frank J. Bova ◽  
John M. Buatti ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Initial Treatment ◽  
Primary Treatment ◽  
Size Reduction ◽  
Cure Rate ◽  
Mr Images ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to evaluate the outcomes of patients who underwent repeated radiosurgery to treat a residual intracranial arteriovenous malformation (AVM) after an initial radiosurgical treatment failure. Methods. The authors reviewed the cases of 52 patients who underwent repeated radiosurgery for residual AVM at the University of Florida between December 1991 and June 1998. In each case, residual arteriovenous shunting persisted longer than 36 months after the initial treatment; the mean interval between the first and second treatment was 41 months. Each AVM nidus was measured at the time of the original treatment and again at the time of retreatment, and the dosimetric parameters of the two treatments were compared. After retreatment, patients were followed up and their outcomes were evaluated according to a standard posttreatment protocol for radiosurgery for AVMs. The mean original lesion volume was 13.8 cm3 and the mean volume at retreatment was 4.7 cm3, for an average volume reduction of 66% after the initial treatment failure. Only two AVMs (3.8%) failed to demonstrate size reduction after the primary treatment. The median doses on initial and repeated treatment were 12.5 and 15 Gy, respectively. Five patients were lost to follow up and five refused neuroimaging follow up. One patient died of a hemorrhage shortly after retreatment. Of the remaining 41 patients, 24 had evidence of cure, 15 on angiographic studies and nine on magnetic resonance (MR) images. Seventeen had evidence of treatment failure, 10 on angiographic studies and seven on MR images. By angiographic criteria alone, the cure rate after retreatment was 60%, whereas according to angiographic and MR imaging results, the cure rate was 59%. Conclusions. Although initial radiosurgical treatment failed to obliterate the AVM in these 52 patients, it did produce a substantial therapeutic effect (volume reduction). This size reduction commonly allowed higher doses to be delivered during radiosurgical retreatment. The results show rates of angiographically confirmed cure comparable to primary treatment and a low incidence of complications, indicating that salvage radiosurgical retreatment is a safe and effective therapy in cases of failed AVM radiosurgery.

Symptomatic subependymoma

1978 ◽  
Vol 49 (5) ◽  
pp. 689-696 ◽  
Author(s):  
Bernd W. Scheithauer
Keyword(s):  
Fourth Ventricle ◽  
Cyst Formation ◽  
Septum Pellucidum ◽  
Growth Potential ◽  
Content Type ◽  
Large Size ◽  
Microscopic Features ◽  
The Mean ◽  
Mixed Tumors ◽  
Fine Print

✓ Of 48 cases of subependymoma reported to date, 22 were associated with symptoms. In a personal series of 47 additional cases of subependymoma reviewed by the author, 21 were symptomatic. The mean age of patients with symptom-producing subependymomas was 39 years, that is, 20 years younger than that of patients with asymptomatic tumors. Symptoms were most often produced by large tumors, particularly those arising from the septum pellucidum (100%), the floor of the fourth ventricle (65%), and the lateral ventricular walls (55%). The majority of symptomatic tumors displayed the classic gross and microscopic features of subependymomas; however, large tumors more frequently demonstrated cyst formation, microcalcification, and vessel degeneration accompanied by hemorrhage. Of all subependymomas, 15% were microscopically composed of an admixture of classic subependymoma and cellular ependymoma; of these, one-half occurred within the first decade, all were situated in the fourth ventricle, and 80% were symptomatic. In contrast to pure subependymomas, the mortality rate of patients with mixed tumors was 80%, reflecting their growth potential, large size, and dangerous location.

Reduction of hemorrhage risk after stereotactic radiosurgery for cavernous malformations

1995 ◽  
Vol 83 (5) ◽  
pp. 825-831 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
John C. Flickinger ◽  
John R. W. Kestle
Keyword(s):  
Parietal Lobe ◽  
Vascular Lesion ◽  
Annual Rate ◽  
Surgical Removal ◽  
Cavernous Malformations ◽  
Content Type ◽  
History Of ◽  
The Mean ◽  
Latency Interval ◽  
Fine Print

✓ The benefits of radiosurgery for cavernous malformations are difficult to assess because of the unclear natural history of this vascular lesion, the inability to image malformation vessels, and the lack of an imaging technique that defines “cure.” The authors selected for radiosurgery 47 patients who harbored a hemorrhagic malformation in a critical intraparenchymal location remote from a pial or ependymal surface. Of these, 44 patients had experienced at least two hemorrhages before radiosurgery. The mean patient age was 39 years; six patients had previously undergone attempted surgical removal. The malformation was located in the pons/midbrain in 24 cases, the medulla in three, the thalamus in nine, the basal ganglia in three, deep in a parietal lobe in four, and deep in a temporal lobe in four. Patients had sustained initial hemorrhages from 0.5 to 12 years prior to radiosurgery (mean 4.12 years). In these patients, who were not typical of the majority of patients with cavernous malformations, there were 109 bleeds before radiosurgery in 193 prior observation-years, for a 56.5% annual hemorrhage rate (including the first hemorrhage), or an annual rate of 32% subsequent to the first hemorrhage. The mean follow-up period after radiosurgery was 3.6 years (range 0.33–6.4 years). The proportion of patients with hemorrhage after radiosurgery was significantly reduced (p < 0.0001), as was the mean number of hemorrhages per patient (p = 0.00004). In the first 2 years after radiosurgery, there were seven bleeds in 80 observation-years (8.8% annual hemorrhage rate). In the 2- to 6-year interval after radiosurgery, the annual rate decreased to 1.1% (one bleed). After radiosurgery, 12 patients (26%) sustained neurological worsening that correlated with imaging changes. In eight patients these deficits were temporary; two underwent surgical resection and died. Two patients had new permanent deficits (4%). A significant reduction was observed in the hemorrhage rate after radiosurgery in patients who had deep hemorrhagic cavernous malformations, especially after a 2-year latency interval. This evidence provides further support to the belief that radiosurgery is an effective strategy for cavernous malformations, especially when located within the parenchyma of the brainstem or diencephalon.

Tentorial meningiomas: surgical experience with 61 cases and long-term results

1988 ◽  
Vol 69 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Beniamino Guidetti ◽  
Pasquale Ciappetta ◽  
Maurizio Domenicucci
Keyword(s):  
Clinical History ◽  
Long Term Results ◽  
Surgical Experience ◽  
Content Type ◽  
X Ray ◽  
Suboccipital Craniectomy ◽  
Lesion Topography ◽  
The Mean ◽  
Fine Print

✓ The authors report their experience and long-term results in the surgical treatment of 61 tentorial meningiomas. These cases were operated on between 1951 and 1985 and represented 4.8% of all intracranial meningiomas operated on in that period. The mean duration of clinical history was 29 months, except for cases of meningioma of the posteromedial border, for which it was 5 years. Plain x-ray films and cerebral angiograms were obtained in all cases. Computerized tomography, performed in the last 20 cases (32.7%), supplied much better lesion topography and early diagnosis. The tumor site was posterolateral in 26 cases (42.6%), anterolateral in 14 (22.9%), posteromedial in eight (13.1%), at the free border in seven (11.4%), and in the tentorium itself in six (9.8%). Lateral and medial tumors with solely or mainly supratentorial development were approached from above. The approach from below was reserved for meningiomas with subtentorial involvement only. In meningiomas with both supra- and subtentorial growth, a supratentorial bone flap was combined with a suboccipital craniectomy using a retromastoid incision. The mortality rate was 9.8%. Of the remaining 42 patients, who were followed for at least 5 years, long-term results were good in 26 cases (61.9%), fair in 11 (26.2%), and poor in five (11.9%). Postoperative complications arose in 34% of the patients, but cleared in 27%.

Management of cerebellar ptosis following craniovertebral decompression for Chiari I malformation

2001 ◽  
Vol 94 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Langston T. Holly ◽  
Ulrich Batzdorf
Keyword(s):  
Symptom Relief ◽  
Chiari I Malformation ◽  
Neurological Deficits ◽  
Specific Patient ◽  
Content Type ◽  
Shunt Placement ◽  
Suboccipital Craniectomy ◽  
Chiari I ◽  
The Mean ◽  
Fine Print

Object. In this report the authors review their experience in the treatment of seven patients with symptomatic cerebellar ptosis following craniovertebral decompression (CVD) for Chiari I malformation. Methods. The mean age of the patients was 37 years and the average amount of time between the initial suboccipital craniectomy and evaluation for cerebellar ptosis was 6.8 years. Five patients presented primarily with intractable headache and the remaining two patients with neurological deficits caused by recurrent syringomyelia. Three different surgical modalities were used to treat these patients: ventriculoperitoneal shunt placement (one patient), syringoperitoneal shunt placement (two patients), and partial suboccipital cranioplasty with or without intradural exploration (four patients). The mean follow-up period was 51 months. The three patients who underwent shunt placement procedures experienced poor results, with no evidence of symptom relief and continued neurological deterioration. In contrast, all four patients who underwent cranioplasty experienced good or excellent clinical outcomes. Postoperative magnetic resonance imaging studies revealed a reduction in the size of the syrinx cavity in patients who simultaneously underwent intradural exploration. Conclusions. The emergence of symptomatic cerebellar ptosis following CVD for Chiari I malformation is primarily caused when the suboccipital craniectomy is too large for the specific patient. The cerebellar ptosis usually presents with severe headache and/or neurological deficit due to persistent or recurrent syringomyelia. Partial suboccipital cranioplasty, with or without intradural exploration, is effective in treating this condition.

Symptomatic subependymoma of the fourth ventricle

1981 ◽  
Vol 55 (5) ◽  
pp. 841-844 ◽  
Author(s):  
Angelo Gandolfi ◽  
Riccardo E. Brizzi ◽  
Filomeno Tedeschi ◽  
Paolo Paini ◽  
Pellegrino Bassi
Keyword(s):  
Differential Diagnosis ◽  
Computerized Tomography ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Frozen Section ◽  
Surgical Removal ◽  
Tumor Type ◽  
Content Type ◽  
Direct Involvement ◽  
Fine Print

✓ Symptomatic subependymomas of the fourth ventricle are rare and usually not included in the preoperative differential diagnosis of tumors in this region. The case of a 63-year-old man with fourth ventricle subependymoma is described. For several years he had suffered with nausea and vomiting, and now presented signs of direct involvement of the posterior fossa. He was investigated preoperatively with computerized tomography, but the ultimate diagnosis was not suspected at that time. The tumor was diagnosed as an subependymoma at operation and was totally excised. This tumor type can easily be recognized on intraoperative frozen section, and its diagnosis should always lead to an attempt at complete surgical removal.

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