Endoscopic third ventriculostomy before surgery of third ventricle and posterior fossa tumours decreases the risk of secondary hydrocephalus and early postoperative complications

Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus (HCP) at the level of third or fourth ventricle. To date, there is no consensus regarding its role as intervention preceding the operation of tumour removal. The aim of this prospective open-label controlled study is to assess if ETV prevents secondary HCP after tumour removal and if ETV influences the early results of tumour surgery. The study was performed on 68 patients operated for tumours of the third ventricle and posterior fossa. In 30 patients, ETV was performed several days before tumour removal, while in 38 patients, the tumour was removed during a one-stage procedure without ETV. Patients who did not receive ETV before the tumour removal procedure had a higher probability of developing postoperative HCP (n = 12, p = 0.03). They also demonstrated a substantially higher rate of early postoperative complications (n = 20, p = 0.002) and a lower Karnofsky score (p = 0.004) than patients in whom ETV was performed before tumour removal. The performance of external ventricular drainage in the non-ETV group did not prevent secondary HCP (p = 0.68). Postoperative cerebellar swelling (p = 0.01), haematoma (p = 0.04), cerebrospinal fluid leak (p = 0.04) and neuroinfection (p = 0.04) were the main risk factors of persistent HCP. Performance of ETV before tumour removal is not only beneficial for control of acute HCP but also prevents the occurrence of secondary postoperative HCP and may also minimize early postoperative complications.

Intracranial meningioma in two coeval adult cats from the same litter

Case summary In this report we describe the occurrence of intracranial meningioma in two adult cats from the same litter. The location of the meningioma varied: one tumour was at the level of the brainstem, and the other was affecting the temporal and piriform lobes. The cat with the brainstem meningioma was treated with radiotherapy and the littermate had a rostrotentorial craniectomy for tumour removal. Both cats had a histopathological diagnosis of grade I meningioma of a predominantly fibrous subtype. Relevance and novel information Cases of familial meningioma in cats have not previously been described in the veterinary literature. However, familial meningioma is well described in humans and it is possible that cases are underestimated in animals. We discuss the possible genetic background and other causes, as well as challenges we may face in veterinary medicine in identifying these associations.

Central precocious puberty after resection of a virilising adrenocortical oncocytic tumour

Adrenocortical oncocytic tumours are a histological subtype of adrenal neoplasms with a distinctive morphological appearance. Since these tumours are composed of cells of the adrenal cortex, they may act as functional tumours with excess hormone production. They may cause Cushing’s syndrome, inappropriate virilisation or precocious puberty. Though rare during childhood, adrenocortical oncocytic tumours should be suspected in a child with peripheral precocious puberty and marked elevation of dehydroepiandrosterone sulfate levels. We describe a 6-year girl who presented with peripheral precocious puberty due to a functional adrenocortical oncocytic tumour. Three months after tumour removal, she developed true central precocious puberty. This report highlights that peripheral precocious puberty may trigger central precocious puberty, particularly after resolution of the underlying cause of the peripheral precocious puberty.

Facial reconstructive surgery after tumour removal in a guinea pig (Cavia porcellus)

A 2-year-old male guinea pig (Cavia porcellus) presented with a pea-sized swelling on his right labium. The tumour was excised and reconstructive surgery was performed using a single pedicle advancement flap, leaving the bottom of the lip intact on account of it being essential for food apprehension and manipulation. Two parallel skin incisions were made in the rostrocaudal direction for almost half the length of the head and the resulting skin flap was carefully undermined, to avoid damaging the follicles and the muscles of the whiskers. The flap was carefully sutured over the excisional defect and at 1.5 months post-surgery, only a small residual scar remains. The lips are intact, the surgical site is covered with fur and many of the whiskers have regrown. Histopathology showed the excised mass to be a grade 1 soft tissue sarcoma, most likely a malignant peripheral nerve sheath tumour.

FUNCTIONING PITUITARY TUMOURS: A CLINICOBIOCHEMICAL CORRELATION

Introduction Pituitary tumours may be functioning or non-functioning. Functioning tumours secrete PRL, GH, ACTH, TSH, FSH, LH and have clinical features pertaining to the hormones. We in our study tried to analyze the pre-op and post-op clinicoendocrinological( biochemical) status. Materials and methods Over a span of 10 years from Jan 2010 to Jan 2020 we studied the pre-op and post-op clinical features, radiology (CT, MRI) and endocrine levels of 20 patients with functioning pituitary adenomas. Results Completeness of tumour removal dictates normalization of clinical features and endocrine levels. Microadenomas pose a more remission rate than macroadenomas. Conclusion Total tumour removal in a functioning pituitary adenoma normalizes the clinicoendocrinological parameters. Normalization rates are far more for microadenomas than macroadenomas.

Foetal virilisation caused by overproduction of non-aromatisable 11-oxygenated C19 steroids in maternal adrenal tumour

It is widely believed that adrenal tumours and ovarian luteomas in pregnant women cause virilisation of female foetuses through overproduction of testosterone and/or androstenedione. However, this notion raises a fundamental question as to how these classic androgens pass through the placenta without being converted by aromatase into oestrogens. Here, we report a case of maternal adrenal tumour, in which overproduction of 11-oxygenated C19 steroids (11ox C19s), newly characterised non-aromatisable androgens in humans, caused foetal virilisation. The female proband presented with severely virilised external genitalia at birth. The mother exhibited hirsutism, hyperglycaemia and hypertension and was diagnosed as having adrenal tumour. The mother was subjected to comprehensive steroid measurement. Serum levels of 11ox C19s were markedly elevated. In contrast, testosterone and androstenedione levels remained within the normal range, and levels of most other steroids in the conventional and backdoor androgenic pathways were normal or only mildly elevated. After tumour removal, levels of 11ox C19s were markedly reduced. These results provide the first evidence that 11ox C19s can be synthesised in adrenal adenomas and, due to their non-aromatisable nature, can pass through the placental barrier to cause foetal virilisation. These findings highlight a unique pathogenic property of these newly specified androgens in humans.

A rare case of brain metastasis

Head and neck squamous cell carcinoma metastasis to brain is unusual and rare. We present a case of a 61-year-old man with a primary oral squamous cell carcinoma who was referred to our department for evaluation of decreased sensorium and hemiparesis. Magnetic resonance imaging of the brain revealed a ring enhancing central hypo-intense lesion with surrounding perilesional oedema on T1WI in the left frontal lobe. Left frontal craniotomy with gross total tumour removal was performed. Histopathological examination confirmed metastatic squamous cell carcinoma. The patient was subsequently offered adjuvant radiation therapy. To the best of our knowledge, few such cases have been reported.

Prism adaptation treatment for spatial neglect post brain tumour removal: A case report

Purpose/aim: Spatial neglect is caused by damage to neural networks critical for spatial attention. Spatial neglect without proper treatment impedes rehabilitation outcomes. Prism adaptation treatment, a visuomotor protocol, has been used with stroke survivors with spatial neglect to improve function. This case report explored the feasibility and potential effects of prism adaptation treatment in an individual with spatial neglect after glioblastoma removal. Methods Feasibility was designed and tested to include acceptability and implementation. Exploratory aim on the effectiveness of the intervention was determined using the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process, star cancellation, line bisection and scene copying. Results The patient reported favouring the treatment. Eight sessions, one session a day, were completed over two weeks. The patient’s spatial neglect symptoms reduced on all assessments. Conclusion Prism adaptation treatment was feasible and effective; however, further research is needed to understand the complete benefits of prism adaptation treatment in this population.

Immature neck teratoma in the newborn

One of rare location of teratoma in children is head and neck region. Treatment options, including surgery, are determined by tumour location, its grade of differentiation, and patients age. This article presents case report of immature paratracheal neck teratoma in a 3-month old child, subjected for second-look surgery for residual tumour removal due to the risk of life-threatening complications.