Tension pneumoventricle after resection of a fourth ventricle choroid plexus papilloma: An unusual postoperative complication.

BACKGROUND: Pneumocephalus is defined as the presence of air within the intracranial vault. A common complication of head trauma and surgery, pneumocephalus is usually related to ventricular shunts, craniotomies, and surgery in the sitting position. Tension (symptomatic) pneumoventricle is a rare entity associated with significant clinical morbidity. CASE DESCRIPTION: We report an unusual case of a 15-year-old girl with tension pneumoventricle developed shortly after removal of a choroid plexus papilloma of the fourth ventricle by a midline suboccipital approach while in the sitting position. CONCLUSION: The presence of a cerebrospinal fluid (CSF) diversion system that causes a decrease in intracranial pressure and the existence of a craniodural defect with or without an obvious CSF leak may be the cause of tension pneumoventricule. According to our present understanding, this is the first report of this peculiar complication of fourth ventricular surgery. We discuss clinical manifestations, surgical management, contributing factors, and mechanisms involved in the pathogenesis of tension pneumoventricle.

Peripheral primitive neuroectodermal tumor of the cervical spine.

BACKGROUND: Primitive neuroectodermal tumor (PNET) is a malignant neoplasm that generally arises from bone and soft tissues, with predilection for young adults. This neural crest origin tumors share biologic and histologic features with Ewing's sarcoma (ES). CASE DESCRIPTION: We present a case of a 22-year-old woman with history of severe progressive neck pain, without radiation, associated with paresthesia in the right arm, and palpable right posterior cervical mass. Neurological examination showed increased reflexes in all four limbs, bilateral Hoffman's sign, right Babinski's sign, and right hemi-hypoesthesia. Neuroimaging revealed a right posterior cervical lesion with heterogeneous contrast enhancement extending to the neural foramina of the atlas and axis. Patient underwent microsurgical removal of the lesion, and histopathological and immunohistochemical analysis confirmed the diagnosis of peripheral primitive PNET (pPNET). The patient had adjuvant treatment with radiotherapy and chemotherapy. After twelve months, neuroimaging showed no signs of tumor regrowth and the patient had no neurological deficits. However, three months later, the patient developed hydrocephalus and cerebrospinal fluid (CSF) was positive for neoplastic cells. No other treatment was administered and the patient died. CONCLUSION: pPNET is a rare malignant tumor with poor prognosis, although promising results with multimodal treatment-surgery, radiotherapy, and chemotherapy. Diagnosis requires immunohistochemical analysis, with identification of neuronal differentiation markers.

Tectal plate tumors.

Tectal plate is a rare location for a tumor. Many papers have described different types of pathology arising in that location including tumors, vascular lesions, inflammatory and infectious processes. In this paper we describe our experience in treating seven patients with tectal plate lesions, with different ages and types of pathology: five patients presented with low grade gliomas, one with lung cancer metastasis and the last presenting with a tectal plate cavernoma. Open surgery was performed in three cases (due to tumor enlargement or need for the exact diagnosis). In the other cases, the treatment of non-communicating hydrocephalus was the only treatment employed. The prognosis is of course dependent on the underlining pathology. In our series, except in the metastatic tumor case and the cavernoma, the other types of lesion consisted of low grade gliomas. These lesions represent a different type of brain stem tumor sharing a common good prognosis, with a benign behavior. We believe that tectal tumors must be managed case by case. When a patient presents with a benign lesions in the tectal region, treating the main symptom--hydrocephalus--should be the first attempt in management of these lesions.

Tectal plate tumors

Tumores na região do teto mesencefálico são raros. Vários tipos de lesões como tumores, lesões vasculares, inflamatórias e infecciosas localizam-se nesta região. Nós revimos o tratamento adotado em sete pacientes com diferentes tipos de lesões tectais: cinco pacientes apresentando gliomas de baixo grau, um paciente com lesão metastática proveniente de câncer de pulmão e um com cavernoma. O tratamento cirúrgico com abordagem direta da lesão foi realizado em três casos (devido ao aumento do volume tumoral ou quando houve necessidade da confirmação diagnóstica). Nos demais casos o tratamento para a hidrocefalia não-comunicante foi o método empregado. O prognóstico dessas lesões é baseado no tipo de patologia em questão. Em nossa série, com exceção do caso de metástase e do paciente com cavernoma, as demais lesões foram gliomas de baixo grau. Estas lesões representam um subgrupo diferenciado de tumores de tronco encefálico, apresentando bom prognóstico e tendo comportamento benigno com sobrevida elevada. Acreditamos que tumores da região tectal devam ser avaliados caso a caso. Na hipótese diagnóstica de uma lesão benigna, o tratamento do principal complexo sindrômico – hidrocefalia não-comunicante – é provavelmente a melhor conduta a ser empregada.

Pseudoaneurisma da artéria carótida interna após ressecção transesfenoidal de macroadenoma hipofisário. Uma proposta de tratamento endovascular / Internal carotid pseudoaneurysm after transsphenoidal resection of a pituitary adenoma: an endovascular approach model

É apresentado um caso de pseudoaneurisma de artériacarótida interna após ressecção endoscópica transnasaltransesfenoidal de um adenoma de hipófise, com uma proposta de tratamento endovascular: como o paciente tornou-sesintomático no teste de oclusão da artéria carótida interna,um modelo alternativo - endovascular - foi proposto,consistindo no uso de molas e de um Stent vascular colocadoadjacente à luz do pseudoaneurisma.Após uma grave manifestação clínica, consistindo emhemorragia nasal maciça, o paciente evoluiu satisfatoriamenteapós o tratamento.