Multiple and recurrent intracranial pseudolymphoma mimicking multiple skull base meningioma, a case report.

INTRODUCTION AND IMPORTANCE: Primary central nervous system (CNS) lymphomas (PCNSLs) comprise a heterogeneous subset of intracranial disorders, predominantly of the intraparenchymal high-grade non-Hodgkin's lymphoma. Intracranial pseudolymphoma represents an exceedingly rare entity; as few as 3 reports in the English literature. We describe the first multiple large intracranial pseudolymphomata leading to increased intracranial pressure, visual loss, and recurrence during a short while. It also represents the first report of intracranial pseudolymphoma presented as a skull base tumor. CASE PRESENTATION: We describe a 67-year-old female suffering from left-sided loss of visual acuity, headache, nausea, vomiting, and improper balance. Axial brain computed tomography (CT) scan revealed an isodense anterior interhemispheric mass lesion with surrounding edema in both frontal lobes. T1 and T2 weighted magnetic resonance imaging (MRI) and T1 weighted with gadolinium injection revealed two extra-axial isointense dural-based mass lesions with homogenous enhancement compressing both frontal lobes. The morphologic findings favored B cell pseudolymphoma and meningeal B cell lymphoid hyperplasia. One year later, she developed headaches, disorientation, and progressive meaningless speech lasting 2 months. Subsequent MRI demonstrated the rapid growth of the lesion of the lesser sphenoid wing and recurrence of the lesion at the same site of surgery, thereby undergoing revision surgery in which both tumors were maximally resected using a pterional approach. CLINICAL DISCUSSION: Intracranial pseudolymphoma remains exceedingly rare, and despite its benign cellular nature, it may proliferate and recur quickly. CONCLUSION: Intracranial pseudolymphoma should always be considered a rare but potentially differential diagnosis leading to the intraventricular lesion.

Cerebellopontine angle meningioma originating from choroid plexus of the foramen of Luschka: An extremely rare entity and overlook of literature.

INTRODUCTION AND IMPORTANCE: Meningiomas without dural attachments are quite a novelty, with such meningiomas in the posterior fossa being even more far and few between. The authors describe an extremely rare cerebellopontine angle (CPA) meningioma lacking a dural attachment arising from the choroid plexus of the foramen of Luschka (CPFOL). CASE PRESENTATION: A 35-year-old male presented to our center complaining of a generalized and progressive headache for 10 months. A 3 cm × 4 cm well-defined lesion in the left CPA, hypointense in T1 and hyperintense in T2-weighted magnetic resonance imaging (MRI), was noted with no evident dural base or dural attachment. CPFOL was appreciated right at the point where the tumoral base was detected, which implied that the tumor originated from CPFOL. A gross total resection (GTR) was achieved, with the postoperative period remaining uneventful. The histopathologic investigation confirmed a transitional meningioma World Health Organization (WHO) grade I with no atypical features. CLINICAL DISCUSSION: Meningioma without dural attachment remains a rare phenomenon, with few available in English literature, and such pathology in the posterior fossa is even more unusual. Discriminating between CPFOL and another kind of CPA meningioma is mandatory when dealing with intracranial meningioma surgeries. CONCLUSION: While managing a space-occupying lesion around CPA, although extremely rare, a meningioma originating from CPFOL is suggested to be included in the differentials with necessary imaging analysis and advised to be imperatively pursued before proceeding for surgical intervention.

The Sensorineural Hearing Loss Related to a Rare Infratentorial Developmental Venous Angioma: A Case Report and Review of Literature.

BACKGROUND: Developmental venous anomaly (DVA) is a benign venous abnormality draining normal brain parenchyma. It is mostly asymptomatic; however, rare complications such as hemorrhage may lead to symptomatic conditions. Headache and seizure are the most common symptoms. Hearing loss is an extremely rare presentation of DVA. To our knowledge, only five cases of DVA, presenting with hearing loss, had been reported so far. CASE PRESENTATION: We report the case of a 27-year-old woman who presented with a sensorineural hearing loss followed by facial paresis. Magnetic resonance imaging (MRI) and computed tomography (CT) angiography revealed hematoma with adjacent converging veins showing a typical "caput medusa" sign in the left middle cerebellar peduncle, in favor of DVA. Due to the compression effect of hematoma, she underwent surgery. Hearing loss and facial paresis improved significantly during the postoperative follow-up. CONCLUSION: Although DVA is mostly benign and asymptomatic, complications such as hemorrhage rarely occur. Hearing loss is an extremely rare presentation that can be attributable to the compression effect on the cranial nerve VII to VIII complex. In the case of compression effect or progression of symptoms, surgical intervention is necessary. A good clinical outcome could be expected postoperatively.

A rare case of iatrogenic intracranial hypotension due to a minor CSF leakage.

Intracranial hypotension (IH) represents a rare complication, mainly following cerebrospinal fluid (CSF) leakage at the thoracic or cervicothoracic junction level. Iatrogenic IH may be expected secondary to the previous surgery or other procedures invading the patient's dura. Magnetic resonance imaging (MRI), computerized tomography (CT) scan images, CT cisternography, and magnetic resonance cerebrospinal fluid flow (MR CSF) remains the modality of choice to establish the diagnosis. The patient is in her late sixth decade, reflecting a history of progressive headaches, nausea, and vomiting. Once a diagnosis of foramen magnum meningioma was established using MRI, total microscopic resection was applied. Brain sagging and subdural fluid collection were identified on postoperative day three, suggesting intracranial hypotension due to cerebrospinal fluid leakage. Diagnosing IH following the CSF leak during the postoperative phase remains challenging. Although rare, early clinical suspicion must be considered to establish the diagnosis.

Surgical management of the fourth ventricular tumors using telovelar approach and the role of neuroendoscopy: Post-operative outcome and long-term results in a series of 52 cases.

OBJECTIVES: The telovelar approach is a surgical method performed through natural corridors of the brain to access the fourth ventricle. The aim of this study is to assess the results of this approach as well as the role of neuroendoscopy in surgical management of fourth ventricle tumors. MATERIAL AND METHODS: A retrospective study was designed, and a series of 52 consecutive patients (32 male, 20 female) with fourth ventricle tumor undergoing telovelar approach was undertaken. In 10 patients (19 %) with a tumor invading the rostral fourth ventricle, an adjustable angle endoscope was also used to ensure total resection of the tumor. RESULTS: Complete resection was obtained in majority of patients (94 %). 30 patients (57 %) required insertion of an external ventricular drain which was discontinued in all patients after 72 h. 2 patients (4 %) underwent permanent ventriculoperitoneal shunt. The postoperative complications included meningitis (8 %), transient facial nerve paralysis (8 %), transient sixth cranial nerve paralysis (6 %) and transient unilateral absence of the gag reflex (4 %). No patient experienced mutism and there was a mortality rate of 2 % (1 case) in current study. CONCLUSION: In our experience, a high rate of total resection of the fourth ventricle tumors could be achieved with the telovelar approach associated with a low risk of surgical morbidity and mortality. Moreover, the use of an adjustable angle endoscope could be useful in patients with a tumor involving the rostral fourth ventricle to ensure total resection of the tumor and also to minimize the extent of telovelar dissection.

Surgical Outcomes of Sphenoorbital En Plaque Meningioma: A 10-Year Experience in 57 Consecutive Cases.

OBJECTIVE: Sphenoorbital en plaque meningioma is located in a sensitive and complex cranial region. Therefore the therapeutic approach for this type of tumor is of great importance. We aimed to examine the clinical and radiologic outcomes of patients diagnosed with sphenoid wing en plaque meningioma undergoing surgery. METHODS: In this case series, the results of clinical and functional assessments, as well as appearance before and after surgery, were examined in 57 patients with sphenoorbital en plaque meningioma undergoing surgery with the frontotemporal approach during 2007-2017. Data were entered in the designed forms and statistically analyzed. RESULTS: Proptosis, headache, and vision impairment were detected in 47 (83%), 33 (58%), and 16 (28%) patients, respectively. Eight (14%) patients complained of diplopia, while 3 (8%) patients complained of ptosis. In all patients, proptosis improved following surgery. Complete treatment of proptosis was reported in 42 cases, and significant improvement was observed in 5 cases. Sixteen patients experienced visual impairment before surgery, 7 of whom showed improvements after surgery, while 1 showed deteriorated visual acuity after surgery. Total tumor resection was achieved in 48 (84%) patients. Tumor relapse was reported in 7 (12.5%) patients during follow-up. One patient had undergone repeated surgery, 1 patient was treated with radiotherapy alone, and 5 patients underwent combined treatment. CONCLUSIONS: Total tumor resection can be achieved with minimal complications by using microscopic dissection and sufficient bone and orbital wall resection. An important point in the treatment of these patients is the appropriate restoration of the orbital wall.

Third ventricle hydatid cyst: A rare case report and review of the literature.

A primary intraventricular hydatid cyst is a very rare phenomenon, which is mostly located in the lateral ventricle. To the best of our knowledge, only two cases of third ventricle hydatid cyst have been reported. Herein, we present a very rare case of third ventricle hydatid cyst in a four- year-old boy with nausea, vomiting, and progressive drowsiness. Neuroradiological examination revealed a large, spherical, well-defined cystic lesion within the third ventricle. The patient underwent surgery using the anterior interhemispheric transcallosal approach, and the cyst was successfully removed using the Dowling's technique. In this case report, we described the first case of transcallosal removal of a rare third ventricle hydatid cyst, which can be considered in the differential diagnosis of suprasellar arachnoid cysts. Caution must be taken in determining the best surgical approach to prevent unexpected complications.

A Comparison Between MRIT2 and NT-ProBNP in Early Detection of Heart Diseases in Thalassemia Major Patients: A Cross-Sectional Study.

One of the most common causes of mortality in major thalassemia is cardiac complications. Despite existence of several methods for diagnosis of cardiac complications in thalassemia, this sequel persists as a major problem in these patients. The aim of this study is to compare the level of serum NT-ProBNP and cardiac MRI T2* in early detection and treatment of cardiac disorders in beta thalassemia major patients. 35 major thalassemic patients on regular transfusion were selected in our center from 2013 to 2014. All of the patients were at least 8 years old. NT-ProBNP and MRIT2* analyses were carried out for these patients, and consequently the findings were compared together and analyzed. There is a strong correlation between NT-ProBNP and MRIT2* (p value < 0.001) in early detection of cardiac disorders. NT-ProBNP is an important marker for diagnosis of cardiac complications before emergence of heart failure in thalassemic patients. Given the findings of this study, it is recommended that this marker be used on a regular basis for thalassemic patients on regular transfusion.