Hard calcified intrasellar schwannoma mimicking pituitary adenoma: a case report and review of the literature.

BACKGROUND: Intrasellar location of schwannoma is extremely rare, although intracranial schwannomas are common in the central nervous system. The aim of the present study is to describe a calcified intrasellar schwannoma case. MATERIALS AND METHODS: We represent a 45-year-old woman who had suffered from headaches; right side facial pain and visual disturbance which had worsen during the last week prior to admission. Physical examinations were normal except for the bitemporal visual field hemianopia which match with perimetry examination. MRI demonstrated an unusual seemingly calcified mass lesion in the sellar region which was mimicking pituitary macro adenoma. RESULT: Total resection of the tumor achieved through endoscopic transnasal transsphenoidal approach by extracapsular dissection and pathologic examination of the tumor revealed calcified schwannoma. CONCLUSION: The differential diagnoses of sellar and suprasellar lesions include pituitary adenomas, craniopharyngiomas, meningiomas, and many others. However, schwannoma is not usually included, because the occurrence of schwannoma in the sellar or suprasellar region is extremely rare. Only few cases of intrasellar schwannomas have been reported in the literature, all of which presented a suprasellar extension similar to that of our case. Fascinating surgical point is managing very firm tumor through transsphenoidal corridor which we handle it by very sharp, debulking and extracapsular removal.

Bilateral Choroid Plexus Metastasis from Papillary Thyroid Carcinoma: Case Report and Review of the Literature.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. It has an indolent clinical course and favorable prognosis. Brain metastasis is uncommon and complicates about 0.1%-5% of PTCs. Metastasis to the choroid plexus of the lateral ventricles has been reported in 7 cases of thyroid malignancies, all of which were unilateral. METHODS: We report a case of a 52-year-old woman with a history of PTC who presented with severe headache, nausea and vomiting, right hemiparesis, and speech disturbance. Imaging studies depicted lesions in both lateral ventricles. RESULTS: The patient underwent microsurgical tumor resection. Histopathologic examination revealed choroid plexus metastasis from PTC. CONCLUSIONS: Metastases to the choroid plexus from extracranial tumors are very rare, with only a few cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as renal cell carcinoma, for choroid plexus, especially in the lateral ventricles. We report the eighth case of choroid plexus metastasis, but it is the first bilateral one arising from thyroid cancer.

Intradiploic dermoid cyst: a rare cause of intracranial hypertension.

In this study, we report a rare case of intradiploic dermoid cyst in a patient who developed rapid symptoms of intracranial hypertension (ICH) that mimicked Pseudotumor cerebri syndrome clinically. A 25-year-old female presented with a history of headache, nausea, vertigo and blurred vision in the past 4 months. Images revealed a small supratentorial extradural intradiploic tumor. A midline occipital craniotomy was performed and total removal of the dermoid cyst was accomplished. Present case demonstrated that dermoid cysts can be considered an exceptionally rare basic cause of ICH.

Effects of lumbar discectomy on disability and depression in patients with chronic low back pain.

BACKGROUND: Back pain is one of the most prevalent health problems for which physicians are consulted. Back pain has many economic impacts, such as sickness absences and long-term disability. The prevalence of major depression in patients with chronic low back pain is approximately 3 to 4 times greater than the prevalence rate reported in the general population. OBJECTIVES: This study was designed to evaluate the depression and disability improvement after lumbar discectomy compared with presurgery levels in patients with chronic low back pain and radicular leg pain. PATIENTS AND METHODS: One hundred forty-eight patients with chronic low back pain and radicular leg pain were included in this analytic observational study. The study evaluated several main variables, including age; sex; educational level; job; height; weight; and patient history of abortion, leg pain, back pain, smoking, trauma, number of previous pregnancies, driving, long-term sitting, lifting heavy bodies, and disability and depression before and 6 and 12 months after laminectomy. RESULTS: The depression and disability scores of patients before lumbar discectomy significantly decreased after surgery. CONCLUSIONS: Our results indicate that lumbar discectomy surgery significantly improved depression and disability in patients with chronic herniated discs.

Quality-of-Life Evaluation of Patients Undergoing Lumbar Discectomy Using Short Form 36.

BACKGROUND: Back pain is one of the most common health problems for which physicians are consulted, and it can considerably decrease the quality of life of patients during a great part of their lives. OBJECTIVES: Our study was designed for assessing the improvement in the quality of life of patients undergoing lumbar discectomy for chronic low back pain. PATIENTS AND METHODS: We included 148 patients with chronic low back pain in the analytic observational study. Using the 36-Item Short-Form Health Survey (SF-36), we evaluated the quality of life before and 6 and 12 months after lumbar discectomy. RESULTS: Physical and mental health scores of patients significantly improved after 6 and 12 months of lumbar discectomy. The mean improvement in physical health scores was significantly higher in female patients than in male patients. However, the improvement in mental health scores was not significantly difference between the 2 sexes and the educational and body mass index (BMI) groups. CONCLUSIONS: Lumbar discectomy improves both the physical and mental health subscale of the quality of life in patients with chronic disc herniation.

Does drill-induced noise have an impact on sensorineural hearing during craniotomy procedure?

OBJECTIVE: It is well known that exposure to noise can lead to hearing loss. Craniotomy drills have significant noise and vibration. Since a noise induced by the drill during craniotomy is thought to be one of the causes, we examined its effect on the sensorineural hearing in this study. METHODS: Thirty-nine patients who had undergone craniotomy operations served as the basis for this study between Jul. 2007 and Dec. 2008. Standard pure-tone audiometry (PTA) and speech recognition thresholds (SRT) were calculated for all subjects before, one week and 1 year after craniotomy. RESULTS: Statistically significant differences were not observed at the lower and middle frequencies (0.25-2 kHz), however, differences in the hearing thresholds at higher frequencies (4-6 kHz) were statistically significant before and after craniotomy. Mean pure-tone thresholds obtained was significantly more in older subjects when compared to young patients. Moreover, the correlation between increased number of burr holes and sensorineural hearing loss (SNHL) was statistically significant. CONCLUSIONS: We conclude that drill-generated noise during craniotomy has been incriminated as a cause of SNHL. Possible noise disturbance to the inner ear can only be avoided by minimizing the number of burr holes and the duration of harmful noise exposure to the cochlear structures.