Basal ganglia germinoma presenting with visual loss in male adult: A case report.

INTRODUCTION: Basal ganglia germ cell tumor (GCT) in an adult has been rarely reported Intracranial germ cells tumor usually occurs in the midline axis, involving pituitary, sellar region, or both. Only in rare circumstances GCTs developed in basal ganglia. CASE PRESENTATION: A 27-year-old male came to our academic general hospital outpatient clinic with main complaint of progressive visual loss of his right eye which started a year ago. Despite his visits to the opthalmologist, the complaint worsen. A brain MRI revealed a large left basal ganglia tumor with involvement of the hypothalamus and uncus, causing pressure on the optic and occulomotor nerve. Interestingly, the patient had no decrease in motor function. Complaint of severe headache, persistent vomiting, and decrease of vision of his left eye prompt us to conduct an urgent craniotomy tumor excision. As the patient had no motor deficit prior to surgery, we chose to do a transcortical approach through the left kocher point, entering the left ventricle, and accessing the tumor from the floor of the frontal horn. DISCUSSION: GCT is a rare and diverse group of tumors based on histology. It is more common in men and mostly affects the pediatric and adolescent populations. Usually located in the sellar or pineal regions, this tumor may infrequently spread to the basal ganglia. The gold standard for diagnosing germ cell tumors is histopathological analysis, particularly in regions of the basal ganglia with a wide range of potential aetiologies. Obtaining a biopsy sample surgically is difficult, particularly for patients whose motor function is preserved. The surgical strategy should be tailored to the patient's radiological and clinical results, ideally taking the surgeon's preferences into account as well. CONCLUSION: Basal ganglia germinoma in adult is a rare occurrence, and due to its location, the surgical approach to access the mass should be individualized in each patient. Transcortical approach from the left kocher's point was a safe and accessible approach for our patient.

AB065. Basal ganglia germ cell tumor presenting with visual loss in adult: a case report.

BACKGROUND: Basal ganglia germ cell tumor (GCT) in an adult male is quite rare. Intracranial germ cells tumor usually occurs in the midline axis, involving pituitary, sellar region, or both. Only in rare circumstances GCTs developed in basal ganglia. CASE DESCRIPTION: In this case report, we presented a patient with a main complaint of progressive visual loss from his right eye from one year prior. He had been going to the ophthalmologist but there was no improvement. A brain magnetic resonance imaging (MRI) revealed a large left basal ganglia tumor with involvement of the hypothalamus and uncus, causing pressure on the optic and oculomotor nerve. Interestingly, the patient had no decrease in motor function. Complaints of severe headache, persistent vomiting, and decrease of vision of his left eye prompt us to conduct an urgent craniotomy tumor excision. As the patient had no motor deficit prior to surgery, we chose to do a transcortical approach through the left Kocher's point, entering the left ventricle, and accessing the tumour from the floor of the frontal horn. The surgery went uneventfully. Following the surgery the patient had no motor weakness, no complaint of headache and vomiting. The visual complaints persisted. And the pathological anatomy resulted in germinoma, in which the patient underwent radiotherapy for the follow up treatment. CONCLUSIONS: Basal ganglia germinoma in adult is a rare occurrence, and due to its location, the surgical approach to access the mass should be individualized in each patient. Transcortical approach from the left Kocher's point was a safe and accessible approach for our patient. As the tumor was close to important structures such as hypothalamus, thalamus, and basal ganglia, only partial excision was done.

Occurrence of malignant cerebral infarction following intracranial hematoma evacuation in traumatic brain injury: A case report.

Background: Traumatic brain injury-related cerebral infarctions are well-documented in the literature. We want to report a case of malignant cerebral infarction that occurred at the contralateral location of evacuated epidural hematoma 3 days after surgery. The early-onset cerebral infarction's clinical presentation was already evident during the initial clinical examination, and it resembled "Kernohan's Notch Syndrome." Case Description: A 57-year-old male Indonesian was taken to our Academic General Hospital's emergency room following a motorcycle accident. His primary complaints were reduced consciousness and left-sided hemiparesis. A head computed tomography (CT) scan revealed an intracerebral hematoma beneath an epidural hematoma (EDH) at the left temporal area. The EDH was surgically removed promptly. The patient's Glasgow coma scale improved, and they were able to follow commands afterwards. The patient had a decreased consciousness 3 days after the surgery. A malignant infarction of the right middle cerebral artery region was identified from the head CT scan evaluation. He immediately had an emergency decompressive craniectomy and had an improvement of consciousness following the surgery. Conclusion: It is imperative to reassess the initial clinical signs of Kernohan's notch phenomenon to determine whether the offending mass was able to generate this clinical phenomenon. Initial cerebral infarction, which occurs concomitantly with traumatic intracranial hematoma, is a possible cause of clinical deterioration following the surgery.

Persistent hydrocephalus following posterior fossa tuberculoma removal in pediatrics: A case report from a referral center in Indonesia.

INTRODUCTION: The threat posed by tuberculosis persists in developing countries. Individuals under the age of five were more likely to develop central nervous system (CNS) tuberculosis. CNS Tuberculoma of the posterior fossa has rarely been reported, and its consequences are more devastating due to the limited space of the posterior fossa. CASE PRESENTATION: A 4-year old male was referred to our academic general hospital with main complaint of decreased consciousness for the last 3 days. The patient has experienced a low-grade fever, cough, and an enlarging neck tumor for two months. Any contact with confirmed tuberculosis patients was denied by the family. A suspected cerebellar abscess and obstructive hydrocephalus led to the patient's referral. Urgent evacuation of the posterior fossa mass was conducted, revealing a histopathological diagnosis of tuberculoma. After the procedure, the patient experienced seizures and no improvement of GCS. A head CT scan evaluation revealed a communicating hydrocephalus. A ventriculoperitoneal shunt is done, resulting in improvement of the patient's consciousness after CSF diversion. DISCUSSION: The haematogenous spread of Mycobacterium, which causes granulomatous foci in the brain, is the cause of CNS tuberculoma. The neuroradiological characteristic of tuberculomas may mimic several conditions. Thorough history-taking and physical examination may lead to a focused differential diagnosis of the patient. Evacuated posterior fossa tuberculoma usually leads to resolved obstructing hydrocephalus. A persistent hydrocephalus leads to the possibility of communicating hydrocephalus due to tuberculous meningoencephalitis. Close monitoring following excision of posterior fossa tuberculoma may help identify persistent hydrocephalus early on. CONCLUSION: CNS tuberculoma should remain a differential diagnosis of ring-enhancing posterior fossa mass, especially in pediatrics. This condition may present concomitantly with tuberculous meningoencephalitis, and it may be presented as a persistent hydrocephalus following the surgical removal of the lesion.

Selection criteria for patch angioplasty material in carotid endarterectomy.

Background: Carotid endarterectomy (CEA) with patch angioplasty has been favored due to its lower reoccurrence of restenosis compared to primary CEA. There are multiple types of patch angioplasty material available. However, selection of patch material is based on uncertain criteria. The aim of this study is to determine the ideal criteria for selecting the best patch material for CEA. Methods: We conducted a comprehensive literature search for studies that describe the ideal criteria for selecting patch material for CEA. We compiled all of the criteria mentioned into one table and selecting the criteria which were most frequently mentioned with a simple scoring system. Results: A total of 65 studies out of 784 studies were assessed for its full-text eligibility. Thus, we found 23 studies that were eligible for analysis. There are 22 ideal criteria that were mentioned in the analyzed studies. We grouped these criteria into physical characteristics, safety, contribution to hemodynamic, contribution in tissue healing, economic aspect, and ability to prevent postsurgical complication. We proposed 10 ideal criteria for guiding vascular surgeon in selecting the best patch angioplasty material. Conclusion: To this day, no material has been discovered which meets all ten criteria. This study's proposed ideal criteria serve as the foundation for the creation of the best patch angioplasty material.

Extradural malignant peripheral nerve sheath tumor of the thoracic spine: A rare case report.

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) typically found in the trunk, limbs, head, and neck represent 3-10% of all soft-tissue sarcomas. Although they typically originating from peripheral nerve Schwann cells, 2-3% arise from the spinal nerves and may be found within the spinal canal. Here, we present a 43-year-old male with an extradural thoracic MPNST contributing to marked cord compression and a progressive paraparesis. CASE DESCRIPTION: A 43-year-old male presented with a progressive paraparesis of 16 months' duration. The MRI showed a posterior T2-T4 extradural tumor in the thoracic spine resulting in significant cord compression. Following a T2-T4 laminectomy and gross total excision of the epidural mass, the patient regained modest neurological function. Immunohistochemistry staining supported the diagnosis of thoracic spinal MPNST. CONCLUSION: Rarely, spinal MPNST can be considered amongst the differential diagnoses of an extradural spinal tumor. In this case, gross total excision of a posterior T2-T4 epidural MPNST resulted in improvement in the patient's original paraparesis. Notably, immunohistochemistry staining helped confirm the diagnosis of a MPNST.