Recurrent cerebellar liponeurocytoma with anaplastic features at initial presentation: A case report.

BACKGROUND: Cerebellar liponeurocytoma is a rare entity with fewer than 100 reported cases and series in the available literature to date. Although the cerebellum remains the typical primary site, the entity has been shown to demonstrate increased aggressiveness and malignant progression with multiple recurrences. CASE DESCRIPTION: We present a unique case in a 64-year-old gentleman of a cerebellar liponeurocytoma with multiple recurrences and progressive anaplasia. The tumor showed anaplastic features at first presentation and recurred in a more aggressive fashion in a short 2-year period despite surgical debulking and post-operative radiotherapy. It re-recurred within 6 months with subsequent re-debulking without further radiotherapy. At latest follow-up almost 3 years since surgical management of the patient's second recurrence, the patient remains well with minimal neurological impairment and no radiological signs of recurrence. CONCLUSION: Cerebellar liponeurocytoma may present with increasingly atypical histological features that may warrant more aggressive post-operative treatment to prevent disease recurrence and clinical deterioration. This may include a more aggressive surgical resection margin and consideration of adjuvant radiotherapy in all cases.

Evaluation of readability and reliability of online patient information for intracranial aneurysms.

INTRODUCTION: Intracranial aneurysms are common. Receiving this diagnosis can have a profound impact on patients and their families and this is compounded by the nuanced complexities around their management. An overwhelming majority of patients research health information using the internet. Patient-centred care and informed consent requires patients to have access to information that is readable and reliable. The aim of this study was to assess the readability and reliability of online health information about intracranial aneurysms. METHOD: A Google search was conducted using the terms 'brain aneurysm', 'cerebral aneurysm', and 'intracranial aneurysm' and the first 75 websites were screened for assessment. The readability of each website was assessed using the Flesch reading ease score (FRE), the Flesch-Kincaid grade level (FKGL), the gunning fog index (GFI) and the simple measure of gobbledygook (SMOG) indices. Reliability was assessed using the DISCERN instrument and the Journal of the American Medical Association benchmark criteria (JAMA). RESULTS: Following exclusion, 36 websites were analyzed. The websites collectively scored as 'difficult' readability and 'poor' reliability on average. Statistically significant differences in readability were observed between websites categorized as patient health information and commercial compared with academic and physician. Differences in readability were also observed between search results of 'brain aneurysm' compared with 'intracranial aneurysm'. CONCLUSION: The readability and reliability of online health information about intracranial aneurysms is suboptimal. Health professionals must ensure their patients are well informed which includes directing them to high quality resources which are readable and reliable and use layperson-oriented language during the consultation.

Symptomatic delayed trans-dural herniation and strangulation of cauda equinae following resection of Myxopapillary ependymoma.

Pseudomeningocoele is a recognised complication of spinal surgery. It could be either asymptomatic or symptomatic. We present a 63-year-old male who developed a delayed pseudomeningocoele and symptomatic transdural herniation and strangulation of the cauda equinae following resection of a Myxopapillary ependymoma. He underwent successful operative re-exploration, un-tethering of the cauda equinae and re-closure of the dural defect with resolution of his symptoms. We discuss the clinical features, operative technical factors involved and the essential importance of neuroimaging with critical analysis of the imaging findings and correlation of the clinical symptoms, when such a diagnosis is being considered.

Pre-operative cerebellar mutism secondary to vagus nerve schwannoma.

Cerebellar mutism, also known as 'posterior fossa syndrome,' is an uncommon condition often reported after posterior fossa tumour resection in the paediatric population. It is infrequently associated with other intrinsic cerebellar pathologies. We hereby report a rare case of pre-operative cerebellar mutism associated with an extrinsic posterior fossa lesion - vagus nerve schwannoma.

Metastasis of breast cancer to a lumbar spinal nerve root ganglion.

STUDY DESIGN: A case report of a surgically treated metastasis of breast cancer to the L2 nerve root ganglion. OBJECTIVES: To report of an uncommon site of metastasis as the first manifestation of distant hematogenous spread of breast cancer mimicking a benign lesion. SUMMARY OF BACKGROUND DATA: Although metastatic disease is a common condition there are limited reports of metastases to the spinal nerve root ganglion. To our knowledge this is the fourth reported case and the first report of a metastasis of a breast carcinoma. METHODS: A 46-year-old female patient was admitted with severe right sided radicular pain and moderate weakness of hip flexion and knee extension. Magnetic resonance imaging revealed a small lesion of the L2 nerve root. Intraoperatively an intradural tumor was encountered and debulked. The procedure was followed by radiation therapy. RESULTS: The operative procedure resulted in complete pain resolution with improved motor function. The histologic examination confirmed the tumor to be a metastasis of breast cancer as determined by immunohistological staining. The patient remained recurrence free at 6 month follow-up. CONCLUSION: Although very rare, metastasis to the spinal nerve root ganglion can be the first manifestation of distant hematogenous metastases of breast cancer. The clinical course is characterized by increasing radicular symptoms-especially intractable pain. The radiologic appearance might mimic a benign lesion. Surgical intervention with tumor debulking followed by radiotherapy provides local tumor control and palliation from pain.