Sellar xanthogranuloma: A diagnostic challenge.

Background: Sellar xanthogranulomas are rare intracranial lesions comprising <1% of all sellar lesions. They were described as a separate entity by the World Health Organization in 2000. Because of the paucity of sellar xanthogranuloma cases reported in the literature, they remain a diagnostic challenge with indefinite origin, clinical course, and outcome. The present study reports a case of sellar xanthogranuloma describing the clinical presentation, radiological/pathological characteristics, and outcome. Case Description: A 43-year-old female, known to have diabetes, hypothyroidism, and polycystic ovarian syndrome, presented with a 2-week history of sudden right-sided facial deviation, periorbital pain, and moderate-intensity headache. The patient also reported amenorrhea not improving with polycystic ovarian syndrome treatment. Neurologic examination showed bilateral visual field defects and impaired visual acuity. Computed tomography scan, without contrast, revealed a hypodense sellar lesion with areas of hyperdensity. Magnetic resonance imaging showed a well-defined sellar lesion, exhibiting high signals on T1-weighted and T2-weighted images. The patient underwent microscopic trans-nasal trans-sphenoidal excision of the lesion. Histological sections of the sellar lesion revealed fibrous connective tissue with chronic inflammatory cells and cholesterol clefts, suggestive of xanthogranuloma. The patient is currently followed up at neurosurgery, endocrinology, and ophthalmology clinics with periodic laboratory/radiological investigations. Conclusion: Sellar xanthogranulomas remain rare intracranial lesions with few cases reported in the literature. Patients mostly present with severe hypopituitarism and visual dysfunction. They show no characteristic radiological features. The diagnosis is confirmed histopathologically, and the prognosis is generally favorable.

Effect of cranioplasty timing on the functional neurological outcome and postoperative complications.

BACKGROUND: The optimal timing for performing cranioplasty and its effect on functional outcome remains debatable. Multiple confounding factors may come into role; including the material used, surgical technique, cognitive assessment tools, and the overall complications. The aim of this study is to assess the neurological outcome and postoperative complications in patients who underwent early versus late cranioplasty. METHODS: A retrospective cohort study was conducted to investigate the neurological outcome and postoperative complications in patients who underwent cranioplasty between 2005 and 2018 at a Level l trauma center. Early and late cranioplasties were defined as surgeries performed within and more than 90 days of decompressive craniectomy, respectively. The Glasgow Outcome Score (GOS) and modified Rankin scale (mRS), recorded within 1 week of cranioplasty, were used to assess the neurological outcome. RESULTS: A total of 101 cases of cranioplasty were included in the study. The mean age of the patients was 31.4 ± 13.9 years. Most patients (n = 86; 85.1%) were male. The mean GOS for all patients was 4.0 ± 1.0. The mean mRS was 2.2 ± 1.78. Hydrocephalus was noted in 18 patients (early, n = 6; late, n = 12; P = 0.48). Seizures developed in 28 patients (early, n = 12; late, n = 16; P = 0.77). CONCLUSION: The neurological outcome in patients who underwent early versus late cranioplasty is almost identical. The differences in the rates of overall postoperative complications between early versus late cranioplasty were statistically insignificant. The optimal timing for performing cranioplasty is mainly dependent on the resolution of cerebral swelling.

Efficacy of routine post-operative head computed tomography on cranial surgery patients outcome.

OBJECTIVE: To identify the role of routine postoperative head CT in changing postoperative management after elective craniotomies. METHODS: We conducted a retrospective study on adult patients who underwent cranial surgery. Exclusion criteria includes cranial CTs done postoperatively for urgent clinical indications, pediatric patients, CSF diversion procedures and sedated patients. Patients were placed into "positive" group if the physical assessment changed from the baseline in the form of clinical deterioration, and the "negative" group if the exam did not change. The data then were analyzed to identify which patients needed further medical or surgical management based on CT findings only with "negative" physical examination. RESULTS: Total of 222 were included in the study. 151 patients had negative physical examination. Only 8 out of 151 patients had positive CT findings. Two patients out of 222 (0.9%) had a negative physical exam and positive CT findings that required additional action that wouldn`t be done urgently without routine postoperative brain CT. Only one patient out of 222 (0.4%) who was re-operated urgently based CT findings only and negative physical examination. CONCLUSION: Routine postoperative routine brain CT did not alter the course of medical management, even in the presence of significant radiological findings.

Saudi women's physical activity habits during pregnancy.

BACKGROUND: Despite many benefits of physical exercise to women during pregnancy, the majority of Saudi women do not engage in an adequate amount of activity because of common barriers such as fatigue, lack of motivation, and childcare. The purpose of this study was to estimate the proportion of Saudi women who get adequate exercise during pregnancy as well as to evaluate their knowledge of, attitude toward, and barriers to physical exercise during pregnancy. METHODS: This study had a cross-sectional design. Data were collected retrospectively (average time: 1 year after the birth), using translated questionnaires (English to Arabic), from primary health care centers and from the Maternity and Children Hospital in Qassim, Saudi Arabia. Logistic regression was employed to assess the a priori correlates of adequate exercise during pregnancy (primary outcome). RESULTS: The sample included 274 women, who had a mean age of 31.9 years. A majority of the women thought that physical exercise during pregnancy was necessary and had high knowledge levels (mean = 77; median = 75) about types and amount of physical activity. Less than half of the women were either walking (26%) or exercising (42%) adequately (i.e. ⩾150 min/week). Age (odds ratio: 1.79), number of pregnancies (odds ratio: 2.41), attitude toward exercise (odds ratio: 2.71), and self-rated health (odds ratio: 2.50) were significant correlates of adequate exercise during pregnancy. Among those who reported no physical exercise during pregnancy (n = 68), the following barriers were most common: tiredness (25.0%), fear (18.1%), dislike of exercise (16.7%), and lack of information (16.7%). CONCLUSION: For Saudi women, interventions are needed during pre-natal checkups to promote and maintain adequate physical activity levels during pregnancy.

Cervical epidural neurosarcoidosis: A case report and literature review.

BACKGROUND: Neurosarcoidosis is a rare disease. In the spine, it commonly presents as an intramedullary lesion. Epidural spinal lesions are extremely rare. CASE DESCRIPTION: A 29-year-old patient presented with a 22-month history of progressive neck, upper limb pain, and myelopathy. The cervical MRI showed a large epidural mass infiltrating the paraspinal soft tissue. After an open biopsy, the diagnosis of neurosarcoidosis was established and was followed-up by appropriate medical management. CONCLUSION: To manage cervical epidural neurosarcoidosis, first, you must obtain a tissue diagnosis and then follow with appropriate medical management.

Nasolabial cyst: case report and review of management options.

BACKGROUND: Nasolabial cysts are rare, non-odontogenic, soft-tissue cysts that develop between the upper lip and nasal vestibule with an overall incidence of 0.7% out of all maxillofacial cysts. The predominant presentation of a nasolabial cyst is a painless localized swelling with varying degrees of nasal obstruction. Several treatment modalities have described in the management of the nasolabial cyst. In this paper, we present a case of a nasolabial cyst in a 44 years old man with discussions of the treatment modalities in the lights of the literature. CASE PRESENTATION: We present a case of a nasolabial cyst in a 44-year-old man that slowly increased in size through a period of 3 years, with associated mild pain and nasal obstruction. It had caused a mass effect upon the maxilla, resulting in scalloping. The cyst was excised entirely with no evidence of recurrence at the two months follow up. CONCLUSIONS: The nasolabial cyst is a rare soft-tissue cyst. Complete surgical excision using an open approach performed to our case, which considered with the complete endoscopic removal of the best treatment for the nasolabial cysts with a rare recurrence rate.

Unilateral internal jugular vein phlebectasia in an adult: Management and one year follow-up.

Phlebectasia describes an anomalous, fusiform dilatation of a vein. In the neck region, the internal and external jugular veins are mostly affected. To our knowledge, this is the first case in Saudi Arabia of internal jugular phlebectasia affecting an adult female. We describe a 61-year-old female with complaints of a neck swelling she noticed 4 years ago. Initially, the swelling increased in size and reached a stable level. It was asymptomatic and only enlarged during Valsalva maneuver. Flexible nasolaryngoscopy and computerized tomography scan showed unremarkable examination. Follow-up after 1 year with US Doppler showed no progression. Internal jugular phlebectasia is a rare disorder which is often diagnosed during childhood. More often than not, it does not cause any significant morbidity. Since it is a benign condition, observation is advised with regular monitoring. For asymptomatic lesions, surgical intervention is recommended if cosmetic or psychologic concerns are present.