ABSTRACT
INTRODUCTION: Spinal dumbbell-shaped meningioma is a rare condition usually mistaken preoperatively for schwannoma. The present study reported a case of dumbbell-shaped meningioma, with an extensive review of literature. METHODS: A documented case of thoracic spine dumbbell-shaped meningioma is reported, followed by an extensive review of the literature to analyze epidemiological features, pathogenesis, histopathological diagnosis, location, Eden classification, surgical treatment and outcome in such tumors. RESULTS: Case report: A 55 year-old woman was admitted with paraparesis and paresthesia of lower limbs. MRI showed a dumbbell-shaped meningioma of the thoracic spine. The tumor was totally removed via a posterolateral approach. REVIEW OF THE LITERATURE: Twenty-one spinal dumbbell-shaped meningiomas were reported in the last twenty years (1997-2017). Mean patient age was 46.57 years, with female predominance. Mean disease progression was 23.11 months. The thoracic spine was the predominant site (38.09%), followed by the cervical spine (33.33%). Eden type-3 was the most frequent tumor type, accounting for 66.67% of cases. In all cases, meningiomas were classified as WHO grade I. Complete removal (Simpson I-II) was achieved in 75% of cases. There was recurrence in 3 patients (14%), including 1 case of malignant transformation leading to death at 12 years post-surgery. CONCLUSION: Spinal dumbbell-shaped meningioma is mainly of the benign subtype. Long-term follow-up shows low rates of morbidity and mortality.
Subject(s)
Meningeal Neoplasms/surgery , Meningioma/surgery , Neoplasm Recurrence, Local/surgery , Neurilemmoma/surgery , Female , Humans , Magnetic Resonance Imaging/methods , Meningeal Neoplasms/diagnosis , Meningioma/diagnosis , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neurilemmoma/diagnosis , Thoracic Vertebrae/surgeryABSTRACT
INTRODUCTION: The anterior communicating artery (ACoA) gives perforating branches to the optic chiasma, the hypothalamus and the corpus callosum. Perforating branches are variable (number, direction). Nevertheless, their knowledge is crucial during surgery of this area to spare injuries leading to ischemic post-operative complications. OBJECTIVE: The objective was to update the anatomical knowledge about perforating branches of the ACoA. METHODS: The study was led on a series of seven brains taken from human cadavers. An injection of latex neoprene was performed for every case. The region of interest was observed under operating microscope. Were examined: the length of the ACoA, its diameter, its orientation, its configuration and perforating branches (number and areas). RESULTS: Three cases on five presented with an anatomical variation at the level of the ACoA. The average length of AcoA was 2.1 millimeters (min: 2, max: 2.2). The average diameter of the ACoA was 1.67 mm (min: 1.1, max: 2.1). The average number of perforating branches was 4.2 (min: 2, max: 6). The presence of a median artery of the corpus callosum seemed to correlated with a low number of perforating branches. Branches supplying the optic chiasma seemed to be more numerous.
Subject(s)
Anterior Cerebral Artery/anatomy & histology , Anterior Cerebral Artery/surgery , Cadaver , Humans , MicrosurgeryABSTRACT
BACKGROUND AND IMPORTANCE: Surgery is the recommended treatment for unique significant cerebellar metastasis, particularly in cases of hydrocephalus. Complications of posterior fossa surgery are associated with high risk of morbidity and mortality. We present a unique case of unexpected peroperative rupture of a cerebellar superior artery aneurysm during posterior fossa surgery. CLINICAL PRESENTATION: During posterior cranial fossa surgery, severe arterial bleeding occurred in front of the medulla oblongata. Immediate postoperative computed tomographic (CT) angiography revealed a fusiform aneurysm from a distal branch of the left superior cerebellar artery. CONCLUSION: To our knowledge, this is the first reported operative case of unexpected infratentorial ruptured aneurysm during posterior fossa surgery.
Subject(s)
Aneurysm, Ruptured/surgery , Cerebral Arteries/surgery , Cerebral Hemorrhage/surgery , Hydrocephalus/surgery , Intracranial Aneurysm/surgery , Aneurysm, Ruptured/diagnosis , Aneurysm, Ruptured/etiology , Cerebellum , Cerebral Angiography/methods , Cerebral Hemorrhage/etiology , Female , Humans , Hydrocephalus/diagnosis , Intracranial Aneurysm/diagnosis , Middle Aged , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
BACKGROUND AND IMPORTANCE: If ophthalmic artery's (OphA) origin anomalies are frequent, the superolateral origin of the OphA was rarely described. CLINICAL PRESENTATION: During an aneurysmal surgery, a superolateral origin of the left OphA was found. This variation was associated with a sylvian aneurysm. The anatomical, embryological features, the neurosurgical implications of this origin such as treatment of carotid-ophthalmic aneurysm or intra arterial retinoblastoma chemotherapy are discussed. CONCLUSION: To the best of our knowledge, this is a very rare operative case of both superolateral origin and initial course of OphA.
Subject(s)
Ophthalmic Artery/anatomy & histology , Anatomic Variation , Carotid Artery, Internal/anatomy & histology , Female , Humans , Middle AgedABSTRACT
OBJECTIVE: Because of the difficulties to manage the post-operative digestive fistulas (FDPO) and their disappointing results, the authors led this survey. It's objective is to identify the prognosis factors in order to optimize their management and improve their prognosis. PATIENTS AND METHOD: It is a retrospective survey during 12 years, from January 1992 to December 2004 in the general and digestive surgery adult service of CHU Yopougon. It included 86 files of patients aged of 15 years at least presenting a FDPO. RESULTS: The middle age was of 36.8 years. The death rate was 29.06%. It rose with age. The risk of death was multiplied by 5.54 over age of 55 years (OR = 5.54 and p = 0.012). The number of death rose meaningfully with the length of the diagnostic delay (p = 0.016 for OR1 = 1.64 and OR2 = 8.94. The death rate was raised more in the exposed fistulas that in the controlled fistulas (87% against 45%). In 50% of the cases the death occurred when the debit was superior or equal to 500 cc daily. Among the patients submitted to the medical treatment 69.70% had a spontaneous closing of their fistula in a middle delay of 27.18 days for extremes varying between 13 and 47 days. CONCLUSION: The affection is very serious considering it's death rate. A precocious diagnosis and a fast and adapted management should permit to reduce this higher mortality.