Pineal epidermoid cysts: a study of 24 cases.

BACKGROUND: A retrospective analysis of clinical features and management strategy in 24 cases of epidermoids in the pineal region is done. Long-term outcome of radical surgical resection is analyzed. METHODS: Twenty-four patients having epidermoids in the pineal region were surgically treated in our department during an 11-year period (1992 up to 2003). These cases were retrospectively analyzed. The average duration of follow-up was 5.2 years. RESULTS: The age at the time of presentation ranged from 13 to 51 years (mean, 29.2 years). There were 15 male and 9 female patients. The average duration of complaints was 7 months. Headache and ataxia were the commonest symptoms. The infratentorial-supracerebellar approach and the interhemispheric posterior parietooccipital route were used to excise the epidermoids in 20 and 3 patients, respectively. In one patient, the tumor was removed in 2 stages, first by the infratentorial-supracerebellar approach and subsequently by the interhemispheric posterior parietooccipital surgical approach. Total excision of the solid part of the tumor and the capsule was achieved in 6 patients. In 13 cases, the solid part of the tumor was completely resected, but at least, a part of the tumor capsule was left behind. In 5 cases, a part of the solid portion of the tumor was either deliberately or inadvertently left behind. Incomplete tumor resection was primarily due to adhesions of the capsule to large veins in the region, dissection around which was considered hazardous, and extensive and invasive nature of extension of the tumor. During the period of follow-up, one patient had asymptomatic growth of the residual tumor after 6 years of surgery. One patient with residual tumor continued to get generalized seizures. All patients are leading active lives. CONCLUSION: Radical surgery for pineal region epidermoid tumors is associated with an excellent immediate postoperative and long-term outcome.

Hemangiopericytoma in the trigone of the lateral ventricle--case report.

A 40-year-old male presented with hemangiopericytoma in the lateral ventricle manifesting as headaches persisting for 6 months associated with vomiting and visual obscurations for one month. Computed tomography and magnetic resonance imaging of the brain showed a large tumor in the trigone of the right lateral ventricle. The highly vascular tumor was completely excised. The histological diagnosis was hemangiopericytoma. Hemangiopericytoma is rarely located in the lateral ventricle and is difficult to differentiate from meningioma by neuroimaging methods.

Intracranial optic nerve germinoma.

A 11-year-old boy presented with complaints of diminution of vision in the left eye for three months. On examination, the vision in this eye was reduced to only perception of light. Magnetic resonance imaging revealed a thickened left intracranial optic nerve. The lesion was explored by a pterional craniotomy. At surgery, the left optic nerve was diffusely thickened. The biopsy of a fleshy mass along the optic nerve showed that it was a germinoma on histopathology. Isolated optic nerve germinomas are extremely rare. Exclusive primary involvement of the intracranial portion of the optic nerve by a germinoma has not been reported in the literature. This rare case is discussed and the relevant literature has been reviewed.

Imaging features of calvarial tuberculosis: a study of 42 cases.

BACKGROUND AND PURPOSE: Tuberculosis of the calvaria is a rare entity, and only anecdotal reports describing its imaging features have been previously published in the literature. We report the role of conventional radiography and CT findings on in the evaluation of calvarial tuberculosis in 42 cases. METHODS: Forty-two cases of pathologically verified calvarial tuberculosis were analyzed retrospectively by using conventional radiography and CT imaging. The patients included 28 male and 14 female subjects ranging in age from 5 to 48 years (mean age, 16 years). Surgery was performed in 28 patients, and the remaining 14 patients underwent fine needle aspiration cytology. The histologic findings were consistent with the diagnosis of tuberculosis. At follow-up after 2 years, all patients had completely recovered. RESULTS: The male-to-female ratio was 2:1 (28 male and 14 female). The maximum number of patients affected by calvarial tuberculosis ranged in age from 11 to 20 years (61.2%). The average duration of symptoms was 2.5 months. Thirty-nine (92.8%) patients had subgaleal soft tissue swelling, whereas 31(73.8%) patients had a well-defined lytic lesion in the calvaria. The parietal bone was most commonly affected site of the calvaria (ie, in 22 patients [52.4%]). These lesions were detected at conventional radiography in 34 (80.95%) patients. CT depicted bone destruction in 36 patients (85.7%) cases. Extradural lesions and intraparenchymal pathologies were detected in 22 (52.3%) patients and 5 (11.9%) patients, respectively. CONCLUSION: In calvarial tuberculosis, conventional radiographs of the skull show focal bone destruction often with accompanying soft tissue opacity. CT helps in assessing the extent of bone destruction, scalp swelling, and degree of intracranial involvement. Surgery involving bone debridement is resorted to only in cases where bone destruction is extensive.