Metastatic craniocervical hemangiopericytoma presenting with hydrocephalus and papilledema - Case review.

Hemangiopericytomas are rare mesenchymal tumors with propensity to recur locally and metastasize. We report the unique case of a fifty-five-year-old male with recurrence of a previously resected craniocervical hemangiopericytoma presenting with obstructive hydrocephalus secondary to new metastatic cerebellar deposits. Emergent surgical resection of the cerebellar hemangiopericytomas was performed prior to adjuvant radiotherapy. Hemangiopericytomas are rare but important differentials for craniocervical junction lesions. Gross total resection remains the cornerstone of management with post-operative radiotherapy and chemotherapy as potential adjuncts. Tumors located in deep regions pose complex management challenges as safe maximal excision may be limited by proximal eloquent structures.

[Brain X-radiation for Childhood Epilepsy, Hydrocephalus or Mental Retardation? Research at Tuebingen University, 1940-1946]. / Röntgenbestrahlung des Gehirns zur Behandlung von kindlicher Epilepsie, Hydrocephalus oder Schwachsinn? Forschungen an der Tübinger Universitätsklinik von 1940-1946.

Brain X-radiation for Childhood Epilepsy, Hydrocephalus or Mental Retardation? Research at Tuebingen University, 1940-1946 We reconstructed 65 cases out of a series of "experimental" X-ray-therapy by chart review and reanalysis of publications from a contextual historical perspective. The research procedures in the context of NS-pressure for effectiveness soon dismissed structured scientific procedures and surrendered own standards, whereas radiation impact did not transgress the contemporary guidelines.

Communicating Hydrocephalus Associated with Intracranial Schwannoma Treated by Gamma Knife Radiosurgery.

OBJECTIVE: Gamma knife radiosurgery (GKRS) has been established as an effective and safe treatment for intracranial schwannoma. However, serious complications can occur after GKRS, including hydrocephalus. The pathophysiology and risk factors of this disorder are not yet fully understood. The objective of the study was to assess potential risk factors for hydrocephalus after GKRS. METHODS: We retrospectively reviewed the medical radiosurgical records of 244 patients who underwent GKRS to treat intracranial schwannoma. The following parameters were analyzed as potential risk factors for hydrocephalus after GKRS: age, sex, target volume, irradiation dose, prior tumor resection, treatment technique, and tumor enhancement pattern. The tumor enhancement pattern was divided into 2 groups: group A (homogeneous enhancement) and group B (heterogeneous or rim enhancement). RESULTS: Of the 244 patients, 14 of them (5.7%) developed communicating hydrocephalus. Communicating hydrocephalus occurred within 2 years after GKRS in most patients (92.8%). No significant association was observed between any of the parameters investigated and the development of hydrocephalus, with the exception of tumor enhancement pattern. Group B exhibited a statistically significant difference by univariate analysis (P = 0.002); this difference was also significant by multivariate analysis (P = 0.006). CONCLUSION: Because hydrocephalus is curable, patients should be closely monitored for the development of this disorder after GKRS. In particular, patients with intracranial schwannomas with irregular enhancement patterns or cysts should be meticulously observed.

Temporary ventricular drainage and emergency radiotherapy in the management of hydrocephalus associated with germinoma.

OBJECT: The authors used an alternative strategy to avoid shunt placement for hydrocephalus associated with germinoma, and the ensuing complications. METHODS: Between 1998 and 2000, five patients presenting with germinomas of the pineal area and symptomatic obstructive hydrocephalus were treated with a novel strategy. On arrival, they underwent ventriculostomy placement and one of several surgical procedures to obtain tissue for diagnosis. Within several days of the initial diagnosis, stereotactically guided fractionated radiotherapy was started. All patients experienced rapid tumor shrinkage and resolution of hydrocephalus, allowing discontinuation of external ventricular drainage without the need for permanent shunting of cerebrospinal fluid. To date, follow up reveals 100% radiographically and clinically confirmed tumor control. CONCLUSIONS: Prompt resolution of hydrocephalus and absence of complications make this a potentially valuable therapy for control of germinomas and their symptoms.

Prognostic significance of 111indium-DTPA CSF flow studies in leptomeningeal metastases.

We assessed the clinical significance of interruption of CSF flow documented by radionuclide ventriculography (111Indium-DTPA CSF flow study) in patients with leptomeningeal metastases. Forty patients (25 men and 15 women) ranging in age from 6 to 70 years (median 38.5 years) with cytologically documented leptomeningeal metastases were demonstrated to have interruption of CSF flow by radionuclide ventriculography. All patients were treated with radiotherapy (30 Gy in 10 fractions) to the site of CSF obstruction after which intra-CSF chemotherapy (methotrexate or cytarabine followed by cytarabine or thio-TEPA if clinically indicated) was administered. Twenty patients (group 1) after radiotherapy to the site of CSF flow block demonstrated reestablishment of normal CSF flow. By contrast, 20 patients (group 2) treated in a similar manner had persistent CSF flow obstruction. All patients were treated with intraventricular chemotherapy. Median survival was 6 months in group 1 (range 3 to 15 months) compared with 1.75 months in group 2 (range 1 to 4 months) (p < 0.0001). Cause of death differed between groups with 20% of group 1 patients dying of progressive leptomeningeal disease compared with 70% of group 2 patients (p < 0.0006). In patients with leptomeningeal metastases and CSF flow obstruction, 111Indium-DTPA CSF flow studies predict patient survival and are useful in determining which patients would be candidates for intra-CSF chemotherapy administration.

Apport de l'échographie dans le diagnostic de l'hydrocéphalie chez le nourrisson: à propos de 55 cas

Les aspects radiologiques de l'hydrocéphalie ont été décrits chez les nourrissons de 0 a 26 mois; d'octobre 1992 à décembre 1995: une série rétrospective de 55 cas d'hydrocéphalie ont été diagnostiques sur 120 enfants (45;8 pour cent) adresses a la radiologie pour échographie transfontanellaire au cours du bilan de méningite; de souffrance cérébrale ou de prématurité. Les nourrissons étaient âgés de 0 a 26 mois. La tranche d'âge la plus touchée a été celle des nourrissons de 0 a 6 mois (18/55 cas soit 32;7 pour cent). Le sexe ratio était de 0;34 en faveur des filles (14/41). L'étiologie la plus fréquente a été la méningite bactérienne. En plus de l'échographie transfontanellaire deux enfants ont bénéficié de la radiographie du crâne. La dilatation des ventricules latéraux a été plus fréquente (44/55 soit 80 pour cent des cas); et 20 pour cent des cas restants étaient des dilatations triventriculaires (ventricules latéraux et troisième ventricule). Les aspects échographiques sont dominés par une collection anechogene. Rarement il a été retrouve l'aspect hypoéchogène contenant de fins échos ou l'aspect hyperéchogène periventriculaire témoignant d'une ventriculite. Le traitement de l'étiologie méningitique a été essentiellement médical. Les grosses hydrocéphalies ne sont pas traitées faute de neurochirurgie

Interstitial irradiation of a large, low grade ependymoma with stereotactically implanted iodine-125 seeds. Case report.

In this case report a patient with a large intraventricular benign ependymoma is presented. The tumour was treated with stereotactically implanted Iodine-125 seeds and interstitial irradiation. Extension (diameter: 6.5 cm) and volume (112.5 ml) of the lesion caused the application of an unusually low dose (tumour surface dose: 40 Gy). The tumour shrank significantly within a few weeks. Follow-up at nearly 5 years shows the patient to be tumour free.

[A case with postoperative calcified epidural hematoma].

In the literature, postoperative calcified epidural hematoma is not common. The authors report a case of calcified epidural hematoma after ventriculoperitoneal shunt, and radiotherapy for pinealoma. A 14-year-old boy was admitted to author's department on December 9, 1983, complaining of headache. He underwent a ventriculoperitoneal shunt on August 28, 1980 under the diagnosis of hydrocephalus caused by pinealoma. After the operation hydrocephalus improved. The patient had radiotherapy of 5090 rad. CT scan taken after the irradiation revealed reduction of the size of the tumor. On August 30, 1983, a ring calcification of epidural hematoma in the right parietal region was noticed on CT and plain skull X-rays. He was readmitted because of headache. There was no history of head injury. The calcified epidural hematoma was totally removed on December 12, 1983. The extirpated calcified epidural hematoma was 7.0 X 7.5 cm and 2.5 cm in thickness. Capsule formation was observed and ossification was also seen at dural side. No inflammatory finding was seen on histological examination. The postoperative course was uneventful. Etiology of calcified intracranial hematoma was discussed in relation to the present report, the relevant literature reviewed.

[Diagnostic and therapeutic problems in the treatment of tumors of the epiphyseal region of the brain]. / Diagnostische und therapeutische Probleme bei der Behandlung der Tumoren der Epiphysengegend des Gehirns.

The case is described of a 17 year-old male, who was treated because of a large tumour in the region of the pineal gland. The diagnostic and therapeutic problems are presented and discussed.