Epidermoid tumors of the fourth ventricle.

BACKGROUND: Epidermoids of the brain are rare tumors. Their fourth ventricle localization is about the rarest localization. No series of such tumors has been reported. Their manifestations and management are therefore not well understood. METHODS: Four epidermoid tumors of the fourth ventricle were collected over a period of 39 years from the neurosurgical units of the American University of Beirut Medical Center and the Orient Hospital. These were retrospectively studied and the medical literature reviewed. RESULTS: Epidermoids of the brain form 1% of all brain tumors, and those located in the fourth ventricle are 16.7% of the epidermoids. They rarely present symptoms of increased intracranial pressure. They commonly present in adults with only cerebellar signs. The duration of symptoms may be short, medium, or long. The diagnosis, when clinically suspected, should be confirmed by magnetic resonance imaging. An early diagnosis is the key for a good outcome. CONCLUSION: Although a rare condition, these tumors can be lethal if not treated. Total excision should be attempted. Because this tumor is very slow-growing, a near-total excision is acceptable in cases where complete removal may endanger function or life.

Abscess superimposed on brain tumor: two case reports and review of the literature.

BACKGROUND: An abscess involving an already present brain tumor is a rare occurrence. METHOD: Two cases of an abscess superimposed on a brain tumor are presented and discussed. The medical literature is reviewed, and all reported cases are compared to our own. RESULTS: Only 15 cases of an abscess associated with a brain tumor were found in the literature, to which we add 2 of our own. About 60% were intrasellar or parasellar tumors. The origin of such an abscess at this location is by direct extension of the germs from a contiguous infected sinus. Our 2 additional cases were away from the sinuses. One is an ependymoma of the posterior fossa, and the other, a falcotentorial occipital meningioma, each with a superimposed abscess. CONCLUSIONS: We propose an alternate route for the formation of an abscess in conjunction with a brain tumor.

Thoracic vertebral hemangioma with extradural extension and spinal cord compression. Case report.

A 45-year-old man presented with progressive numbness of lower extremities and unsteady gait. Magnetic resonance imaging of the dorsal spine demonstrated multiple hyperintense inactive vertebral hemangiomas on T-1 weighted images. There was an active hemangioma involving D7 vertebral body and neural arch with epidural extension and spinal cord compression. He underwent embolization of the main feeders of the lesion and subsequent surgery. The patient's symptoms resolved after treatment. The clinical, magnetic resonance imaging findings, and treatment of this condition are discussed.

Vascularized fascial patch for repair of suboccipital dural defect.

Advanced knowledge about cutaneous vascularity has enabled the development of axial flaps such as fasciocutaneous, septocutaneous, and musculocutaneous flaps. It has also laid the foundation for microsurgical free flaps. The newly emerging concept of angiosomes sheds yet more light on the complexity and multiplicity of peripheral blood supply. We describe the use of an extended vertical trapezius flap carrying a segment of latissimus dorsi muscle with the underlying paraspinal fascia to close an infected and irradiated posterior fossa craniectomy and dural defect. This flap illustrates the elevation of an angiosomal block of tissues as an axial flap vascularized by the alternative major blood supply of one of its constituents. The potentials of this "angiosomal flap" are explored. A brief review of dural defect repair is also presented.

Thyrotropin secreting pituitary tumours: a cause of hyperthyroidism.

Pituitary thyrotropin excess resulting in hyperthyroidism has been previously reported in only 25 patients, of whom 19 had a pituitary tumour. This report describes a patient in whom a thyrotropin-producing pituitary tumour was associated with triiodothyronine thyrotoxicosis. Hypophysectomy was followed by a prompt fall in serum thyrotropin and a return to a euthyroid state.