Meningiomas of the lateral ventricles. A review of 10 cases.

BACKGROUND: Intraventricular meningiomas are rare tumours that represent about 2% of all intracranial meningiomas, and represent one of the most challenging problems in neurosurgery. They are located deep within the brain and often are sizable and highly vascular. We report on a series of 10 meningiomas of the lateral ventricles treated at our institution during the last 28 years. PATIENTS: Ten patients (6 women, 4 men; mean age 41.6 yrs) were admitted to our medical center between 1978-2005 with meningioma of the lateral ventricles. Headache was the first symptom in 8 cases and ocular signs were present in 5 patients. RESULTS: Seven tumours were located in the right ventricle (70%) ranging in size from 2-8 cm, with 7 tumours larger than 3 cm in diameter. Nine patients underwent surgery with total excision in 8 cases and subtotal in the other; the remaining patient only received radiosurgery. CONCLUSIONS: Total resection is the gold standard for treatment which was possible in all but one of the cases undergoing surgery.

[Spinal meningiomas]. / Meningiomas espinales.

OBJECTIVE: To present the incidence, clinical presentation, radiological features, localization, surgical techniques, and long term results of surgically treated spinal meningiomas. PATIENTS AND METHODS: We review retrospectively 57 spinal meningiomas in 55 patients operated between January 1980 and June 2004. Age, sex, duration and type of symptoms, radiological and surgical results, histological features and long term outcome are analyzed. RESULTS: Fifty five patients, consisting 46 females and 9 males, with an age range from 12 to 84 years (mean 65.2+/-9.2) were identified. The first symptom was motor deficit (N=34, 61.8%) and the mean duration symptoms were: 6.2 months. Distribution along the spinal axis was 51 thoracic, 5 cervical and 1 lumbar. The most common type was meningothelial (N=31, 54.3%). CONCLUSIONS: Meningiomas account in our experience, the 46% of spinal cord tumours and account the 7.5% of all meningiomas. They are more frequent in females most frequently occur in the thoracic region and have low recurrence rate. Typically, they are located in the intradural extramedullary space, grow slowly, and spread laterally in the subarachnoid space. Finally we concluded that magnetic resonance imaging is the best imaging technique for diagnosis and total tumour resection improved the surgical results of spinal meningiomas.

[Simultaneous bilateral epidural haematomas]. / Hematomas epidurales bilaterales simultáneos.

INTRODUCTION: Epidural haematomas are one of the most common complications of closed head injuries. Bilateral extradural haematomas are rare, usually acute, and generally associated with severe trauma and a high mortality. OBJECTIVE: The purpose of this paper is to present six cases of bilateral extradural haematomas seen at our service during the last 24 years and found an incidence of 2.5% of all cases of extradural haematomas surgically treated. RESULTS: There were 5 males and 1 female with a mean age of 32.6 years (range 16-55). In 3 cases haematoma was across the midline and in the other 3 cases haematomas was found at different locations on either side. Skull fracture was present in all cases. Surgical approach was the primary treatment in all cases. Mortality in our series was 50%. CONCLUSIONS: Bilateral extradural haematomas is a rare condition and the prognosis is mainly dependent of the pre-operative neurological state.

Intramedullary spinal neurofibroma diagnosed with computed tomography: report of a case.

A case of intramedullary neurofibroma of the cervical spine in a patient with no signs of von Recklinghausen's disease is presented. Intramedullary neurofibroma is extremely rare, accounting for less than 1% of spinal cord neurofibromas. This case is the first diagnosed with computed tomography.

Intradural cervical chordoma. Case report.

We describe a rare case of an intradural spinal chordoma. Only two cases have been previously reported and it is the second case diagnosed with MRI. A 65-year-old man presented with progressive disturbance of gait and weakness in the lower extremities. MRI revealed a intradural C6-C7 isointense mass, on T1- and T2-weighted images. The lesion enhanced after injection of gadolinium. The lesion was totally removed without difficulty by a C6-D1 laminectomy. Microscopic examination of the tumor revealed a chordoma. This is the third case in the literature of an intradural spinal chordoma. The appearance of this tumor with MRI may be similar to the chordomas of other locations.

Intradural extramedullar tuberculoma of spinal cord. Case report.

A case of intradural tuberculoma in an infant and the patient was diagnosed operated on successfully. The author's advice is to perform surgery followed by antituberculosis treatment during the recovery period.

Spontaneous spinal epidural hematoma diagnosed by MRI. Case report.

The case of a patient with a spinal epidural hematoma diagnosed by MRI is presented. There was no history of major trauma, anticoagulant use or coagulopathy. During the intervention didn't evidence an underlying tumor or vascular malformation.

[Epidermoid cyst of the third ventricle]. / Quiste epidermoide de tercer ventrículo.

Intracranial epidermoid tumours are very rare lesions of ectodermal origin that account for 1% of all intracranial tumours. The favourite sites affected by these tumours are the cerebellopontine angle and the chiasmal region. They also appear in the cerebral hemisphere and the intraventricular cavities. We report a case of epidermoid tumour of the third ventricle. The patient was a 68 year-old woman admitted in our service with a 7-days history of headaches and intermittent nausea and vomiting. A CT scan of the brain revealed a large hypodense mass in the third ventricle associated with hydrocephalus. An MRI was performed and revealed, on T1-weighted image, an irregular nonhomogeneous lower signal in relation with CSF. This tumour showed a very bright signal intensity on T2-weighted images. A transcallosal approach of the tumour mass was performed via a right frontal craniotomy. Using an ultrasonic aspirator, the tumour was removed. In a review of the literature, we found only 8 reported cases.

[Spinal epidural empyema. Analysis of 14 cases]. / Empiema epidual espinal. Análisis de 14 casos.

OBJECTIVE: The goal of this study was to review our series of spinal epidural empyema diagnosed in the last 20 years and review the literature regarding the pathogenesis, diagnosis and treatment of these lesions. PATIENTS AND METHODS: This is a retrospective study over 14 patients diagnosed of spinal epidural empyema. We review the epidemiological data, clinical symptoms, laboratory and imaging data, the treatment regimen and the results. RESULTS: Fourteen patients, 7 males and 7 females, with an age range from 8 to 76 years (mean 48.9) were identified. The first symptom was localized back/ neck pain in 12 patients and the mean duration of symptoms was 9.3 days. Erythrocyte sedimentation rate (ESR) was elevated in all patients; peripheral leukocyte count was elevated in 13 cases (92.9%). Site of spinal epidural empyemas was distributed along the axis but in 11 cases the location was thoracic. Thirteen patients had surgery for debridement and spinal decompression and one patient was treated successfully with antibiotics alone. CONCLUSIONS: Patients with localized back pain and fever who are at risk for developing such empyemas with elevation of white blood cells and increased ESR, should have an immediate magnetic resonance imaging sean. Urgent surgical drainage and antibiotic use are the treatment of choice in order to prevent irreversible neurological deficits. Nonsurgical treatment should be reserved for poor surgical candidates and patients without neurological deficits.

[Orbital meningocystocele]. / Meningocistocele orbitario.

Encephalocele is defined as a protrusion of cranial contents beyond the normal confines of the skull. Encephaloceles occur with an incidence of approximately 1 in 3,000-10,000 births and are categorized based on location in the skull. Orbital meningoencephalocele is a rare congenital abnormality caused by a defect of the cranio-orbital bones that usually manifests soon after birth as a soft mass associated with exophthalmos. We present a case of a giant orbital meningocele presenting as an orbital mass in a 15 months-old girl. Preoperative diagnosis was confirmed by CT-scan and magnetic resonance imaging.

[Intracranial ependymomas]. / Ependimomas intracraneales.

INTRODUCTION: Ependymomas are tumours derived from ependymal cells, found lining the cerebral ventricles and central canal of spinal cord. Intracranial ependymomas account for 2 6% of all neoplasms of the central nervous system and at least half present in the first two decades of life. DEVELOPMENT: We review the epidemiological, clinical, neuropathological details, neuroradiological aspects and treatment of intracranial ependymomas. CONCLUSIONS: Ependymomas of the posterior fossa predominate in children, while supratentorial tumours are more common in adults. This analysis of the literature further highlight that total tumour removal is the treatment of choice for intracranial ependymomas. Postoperative survival was predominantly dependent on the histological grade of malignancy, the extension of surgery and the age of the patient.

Spinal cord compression caused by adjacent adenocystic carcinoma of the skin.

Adenocystic carcinomas are malignant tumours that arise from the major accessory salivary glands. Cutaneous involvement can result from direct extension from a salivary gland neoplasm. Cutaneous adenocystic carcinomas remote from adjacent salivary tissue are rare. We present the case of an elderly patient with primary cutaneous adenoid cystic carcinoma causing spinal cord compression at the L1-L2 level. The patient was operated on and the tumour totally removed. No similar cases have been found in our review of the literature.

[Meningioma of the third ventricle. Presentation of a case]. / Meningioma del tercer ventrículo. Presentación de un caso.

Meningiomas of the third ventricle are extremely rare; the authors report a case of meningothelial meningioma located in the anterior part of the third ventricle. The tumor was successfully removed through a trans-ventricular approach. The clinical presentation, radiological findings and surgical management of these tumors are reviewed.

[Thalamic abscess. A stereotaxically treatable lesion]. / Absceso talámico. Una lesión tratable estereotácticamente.

Solitary abscesses of the thalamus are an infrequent entity which carry serious problems with regard to treatment. We present a patient with an unknown septic focci who developed a right thalamic abscess due to Streptococcus constellatus and was treated by stereotaxic drainage for the suppuration and antibiotics. The patient was clinically and radiologically (CAT) controlled up until total cure of the lesion. Complications included dissemination of the infection to the meningeal space and a residual coreic picture controlled with tetrabenzine. The authors believe that evacuation by stereotaxic punction should be included among the therapeutic options available for deeply localized cerebral abscesses.