Massive congenital intracranial immature teratoma of the lateral ventricle with retro-orbital extension: a case report and review of the literature.

Germ cell tumors comprise 0.4-3.1% of all intracranial tumors, and teratoma constitutes 9-30% of them. Congenital intracranial tumors are very rare and only account for 0.5-1.5% of all childhood brain tumors. The most common type of these tumors present at birth is teratomas, which represent 0.5% of all intracranial tumors. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. In this study, we report a neonatal intracranial immature teratoma at the lateral ventricle because of its rare location. A 5-day-old female neonate presented with a history of irritability and left eye protrusion since birth. A head computed tomographic (CT) scan and magnetic resonance imaging (MRI) disclosed a large tumor filling the left lateral ventricle and extending into the ipsilateral retro-orbital space. With left frontotemporoparietal craniotomy, a large grayish-white lobulated vascular mass was encountered, and total removal of tumor was performed. Histological examination revealed the diagnosis of immature teratoma. The prognosis of congenital intracranial immature teratoma is usually poor because the lesions are extensive when they are identified. Prenatal ultrasonography is necessary for the prenatal diagnosis. Fetal MRI should be made for the evaluation of intracranial tumor. If the tumor is detected before the 24th week of gestation, termination of the pregnancy should be considered.

Effects of early versus delayed nutrition on intestinal mucosal apoptosis and atrophy after traumatic brain injury.

PURPOSE: To determine the optimal time to start nutritional support after traumatic brain injury (TBI). METHODS: Rats were divided into six groups of seven. All but one of these groups were subjected to moderate closed head trauma under general anesthesia. Groups Ia and Ib were commenced on immunonutrition and standard enteral nutrition, respectively, 8 h later; groups IIa and IIb were commenced on immunonutrition and standard enteral nutrition, respectively, 72 h later; and group III was commenced on a parenteral saline infusion 8 h later. Group IV was a control group fed a laboratory diet and not subjected to trauma. The rats were killed 7 days later, and ileal segments were examined using light and electron microscopy. We used the deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) technique to detect intestinal mucosal apoptosis. RESULTS: Group III had a lower body weight than the other groups (P < 0.005). The mean villous height was highest in groups Ia and IV and lowest in group III. The villi count was lower in groups Ib, IIa, IIb, and III than in group IV (P < 0.005). The apoptotic index counts were higher in groups IIa, IIb, and III than in group IV (P < 0.005). CONCLUSIONS: The addition of enriching immunonutrients to early enteral feeding helps preserve an almost normal gut mucosa.

Giant cranial extradural primary fibroxanthoma: a case report.

Primary fibroxanthoma of the cranium is an extremely rare condition. Xanthomatous tumors of the central nervous system are occasionally associated with diseases such as Hand-Schuler-Christian disease, malignant fibrous histiocytoma, hyperlipidemia, and a complication of metabolic or storage disorders. However, until 2003, only a few cases of primary fibroxanthoma have been reported. We report a giant fibroxanthoma destroying the lateral skull base unaccompanied by a systemic or metabolic disease.

Clinical course of spontaneous spinal epidural haematoma mimicking Guillain-Barré syndrome in a child: a case report and literature review.

We describe a 9-year-old female with thoracic epidural haematoma. The clinical course simulated Guillain-Barré syndrome (GBS) so intravenous immunoglobulin therapy was started at the paediatric clinic. Magnetic resonance imaging (MRI) 3 days after admission showed thoracic epidural haematoma between T2 and T8. An emergency laminectomy was performed and the patient's neurological symptoms began to improve immediately after surgery and she made a full recovery during the 2 weeks of follow-up. Time is a very important factor in achieving reversibility of symptoms of compressive cord lesions, such as spinal epidural haematoma, and MRI is mandatory for patients with progressive paraplegia, even though the signs and symptoms might suggest GBS.

Intratumoral haemorrhage: a clinical study.

Although the incidence of spontaneous intracranial haemorrhage associated with meningioma is 1.3%, the incidence of intratumoral haemorrhage could not be determined. The authors report on 11 patients, six men and five women, with meningiomas that presented as spontaneous intratumoral haemorrhage, among 126 meningioma cases which were evaluated radiologically and histopathologically. The average age of patients was 58.9 years (range 45-72 years). Two (1.5%) cases showed radiological, and nine cases (7.9%) showed microscopic bleeding. Most of these cases also showed microcysts (9.7%) and necrosis (6.3%). The location, histopathological types, sex, age, blood dyscrasia, hypertension do not influence the occurrence of intratumoral haemorrhages in meningiomas. We concluded that microcysts and necrosis are important in the occurrence of intratumoral haemorrhage in meningiomas.

Giant cystic primary cerebral neuroblastoma in a child and solid primary cerebral neuroblastoma in an adult: two case reports.

Primary cerebral neuroblastoma is a rare entity in neurosurgical practice. They occur primarily in young children and are extremely rare in adults. Primary cerebral neuroblastoma is one of a group of highly malignant undifferentiated primitive neuroectodermal tumours arising from germinal matrix cells of the embryonic neural tube. They are difficult to diagnose preoperatively and pathologically. We present two cases of primary cerebral neuroblastoma.

Shunt dysfunction due to calcification of a ventriculo-peritoneal shunt: a case report.

Calcification and related dysfunction of ventriculo-peritoneal shunts are rare events in neurosurgical practice. Shunt calcification causes shunt dysfunction in two ways, namely disconnection and obstruction. We present a 16-year-old girl with shunt malfunction due to disconnection secondary to calcification. The shunt tubing fractured during attempted removal and some of the remaining components, including the ventricular catheter, had to be left in situ. The shunt was revised and the patients symptoms resolved. Replacement of the calcified and perished shunt components with a new shunt is essential. Aggressive surgical manipulation for removal of the remaining shunt components is not advisable as this may increase morbidity and mortality.

Ligamentum flavum cyst.

INTRODUCTION: Although magnetic resonance imaging (MRI) of ligamentum flavum and other spinal cysts have been well described, the role of contrast enhancement in this diagnosis has been neglected. We describe such a case and correlate the MRI findings with the histopathology. CASE REPORT: A 71-years-old woman was admitted with of neurogenic lumbar claudication. X-rays of the lumbar spine showed degenerative changes with scoliosis. Lumbar magnetic resonance imaging demonstrated a L3/4 extradural cystic mass. An L3 laminectomy was performed and the mass excised. The histopathological diagnosis was consistent with a ligamentum flavum cyst. Postoperatively, the patient's symptoms resolved completely. CONCLUSION: The possibility of a ligamentum flavum cyst should be considered whenever a hyperintense extradural mass with a peripheral hypointense rim on T2 weighted and slightly contrast enhanced peripheral rim on T1 weighted MRI is identified in a patient with degenerative changes of the lumbar spine.

Pilocytic astrocytoma of neurohypophysis.

A case of pilocytic astrocytoma of neurohypophysis is presented. The clinical, pathological and MRI features of a rare tumor of the neurohypophysis are described. A 5-year-old girl presented with a 3 month history of lethargy, imbalance and visual disturbances. A MRI revealed a large suprasellar mass. Histopathological examination demonstrated a pilocytic astrocytoma. Its astrocytic nature was confirmed by positive immunostaining for GFAP and the findings of an electron microscopy.

Clear cell meningioma: case report and literature review.

The clear cell meningioma is rare and a recently described histologic variant of meningioma. The most interesting aspect of clear cell meningioma is the high recurrence rate and agressiveness. Until now 17 intracranial clear cell meningioma cases had been reported in the English language literature. We present 2 new cases of clear cell meningioma which is discussed with the relevant literature.

Solitary plasmacytoma with intracranial intraorbital and, paranasal sinus extension.

Intracranial solitary plasmacytomas (ICSPs) are extremely rare tumours in neurosurgical practice, and are often misdiagnosed preoperatively. Here we present a solitary intracranial plasmacytoma with orbital, nasal and paranasal sinus extension. A subtotal excision of the tumour was performed and the complete response was seen after postoperative radio-chemotherapy. The neuroradiological and neurosurgical features of the case are discussed with the pertinent literature.

Posterior epidural migration of lumbar disc fragments: report of three cases.

STUDY DESIGN: Report of three cases. OBJECTIVES: To describe a rare location of intervertebral disc migration. SUMMARY OF BACKGROUND DATA: Migration of sequestered disc fragments to the posterior extradural space is rare, and posterior migration of the free fragments causing cauda equina syndrome is exceptionally rare. METHODS: Three patients with posteriorly migrated epidural disc fragments were evaluated with radiograph, computed tomography, and magnetic resonance imaging and underwent surgery. RESULTS: All of the patients responded well to operative therapy with complete relief of symptoms. CONCLUSIONS: Early surgery should be the first choice of therapy in patients with large posteriorly migrated sequestered disc fragments, to prevent severe neurologic deficits such as cauda equina and conus medullaris syndromes.

Primary parenchymal cerebral cystic haemangiopericytoma: a 5-year follow up of disease progression.

Haemangiopericytoma (HPC) is a rare tumour of the central nervous system. Previously, HPCs were thought to originate from meninges and ventricular walls. Currently, they are accepted as distinctive mesenchymal neoplasms unrelated to meningiomas. Imaging appearances, clinical progression and haemorrhage into a cystic tumour is documented in an 18-year-old man where the final diagnosis, with histopathological verification, proved to be a cystic HPC. This interesting and illustrative case is discussed with the relevant literature.