Primary myxoid temporal bone tumor: A rare neurosurgical manifestation of Carney complex?

BACKGROUND: Carney complex (CNC) is a rare autosomal dominant syndrome, manifesting mainly with cardiac, cutaneous, and mucosal myxomas. Osteochondromyxoma is known as an extremely rare bone lesion of CNC which usually appears early in life; however, there were no reports of primary bone myxoma of the skull in the patients with CNC. We present the first case of primary myxoid skull tumor in the patient with CNC. CASE DESCRIPTION: We report the left temporal bone tumor with significant intracranial mass effect in a 58-year- old woman already diagnosed with CNC. Complete resection of the tumor with skull bone reconstruction was carried out. Pathological diagnosis was labeled the lesion as an atypical myxoid spindle cell neoplasm. The features were different from atrial myxoma and osteochondromyxoma which has been described in CNC. There have been no signs of recurrence in 9 years follow-up. CONCLUSION: To the best of our knowledge, there have been no reports of the primary myxoid tumors in the skull in the patients with CNC. This paper highlighted a possible important association between CNC and primary intracranial myxoid tumors.

Acromegaly in preadolescence: A case report of a 9-year-old boy with acromegaly.

BACKGROUND: Acromegaly has been reported in adolescents and young adults, but it is unusual in preadolescence. Diagnosis and management pose different challenges in this age group. Here, we present a rare case of acromegaly in preadolescence. CASE DESCRIPTION: A 9-year-old boy presented with acromegalic features and MRI revealed a pituitary tumor. He was diagnosed as having growth hormone secreting pituitary adenoma based on the multidisciplinary assessment, and underwent gross total tumor resection through an endoscopic endonasal approach (EEA) with subsequent normalization of the hormonal parameters. CONCLUSIONS: Advances in EEA have made safe removal and cure possible even in children. However, long- term follow-up is needed in such younger patients with multidisciplinary management by neurosurgeons, endocrinologists, pediatricians, and ENT surgeons.

Factors influencing the outcome of spontaneous intracerebral haematoma in a Neurosurgical Hospital in South-East Nigeria.

INTRODUCTION: Spontaneous intracerebral haemorrhage (SICH) is a major cause of stroke worldwide. SICH management is still challenging, especially in developing countries. This study highlights certain factors affecting outcome of SICH managed in a Nigerian Neurosurgical centre, on a background of the modernisation of the patient care facilities. MATERIALS AND METHODS: Retrospective analysis of patients managed for SICH at Memfys Hospital for Neurosurgery and Neurology in Enugu from years 2009-2016. All patients had computed tomography or magnetic resonance imaging for diagnosis. Treatment included medical, surgical and intensive care unit (ICU) care. Patients with aneurysmal subarachnoid haemorrhage and trauma were excluded. Factors analysed include age, admission Glasgow Coma Score (GCS), haematoma location, complications encountered during admission, duration of hospital stay and 6-month Glasgow Outcome Score (GOS). RESULTS: There were 66 cases, age range of 21-85 years (mean 57 years). A total of 30 (45.5%) patients were admitted with GCS ≤ 8/15; 63.3% of these died within 6 months. The proportion of mortalities was 63.6% (>70 years) and 35.6% (41-70 years). Most commonly associated complication was chest infection 27 (40.9%), with 56.6% mortality. Common haematoma locations were basal ganglia (43.9%) and lobar haemorrhage (40.9%) with a similar effect on outcome (P = 0.098). Outcomes were GOS 1: (43.9%), GOS 5: (30.3%) and GOS 4: (13.6%). Among 42 (63.3%) admitted to ICU, 25 (59.5%) died, while 11 (26.2%) achieved GOS of ≥ 4 at 6 months. Those discharged between days 11 and 20 had 26.7% mortality while 53.3% were independent. CONCLUSION: Good admission GCS, absence of chest infections, younger age group are predictors of good outcome following SICH. Anatomical location of haemorrhage alone does not have a significant impact on 6 months' mortality.

Significance and Indications of Surgery for Asymptomatic Nonfunctioning Pituitary Adenomas.

BACKGROUND: The availability of magnetic resonance imaging (MRI) has led to an increase in the detection of pituitary incidentaloma (PI). However, there are no robust data on surgical treatment of PI on which to base therapeutic recommendations. This study was performed to investigate the significance of surgery for asymptomatic nonfunctioning pituitary adenoma (NFPA) among PIs. METHODS: A total of 180 patients that underwent tumor resection of pituitary adenoma via the transsphenoidal approach between 2005 and 2017 were reviewed. Thirty-three consecutive patients with subjectively asymptomatic NFPA were included in this study. Our surgical indications for asymptomatic NFPAs were categorized as follows: macroadenoma with optic chiasma compression (group A, n = 14), solid tumor ≥2 cm in size (group B, n = 7), and tumor growth on follow-up MRI (group C, n = 12). The clinical outcomes were analyzed accordingly. RESULTS: Seven patients (50%) in group A showed subjective improvement of visual function after tumor resection even though they had no complaints preoperatively. On the other hand, no changes occurred in any cases in group B or group C. Although there were no critical complications in this series, the incidence of nonnegligible nasal complications was relatively high (24.2%) and may decrease the patient's quality of life. CONCLUSIONS: Surgery should be recommended for asymptomatic NFPA with optic chiasma compression to improve visual outcome. On the other hand, immediate intervention for other asymptomatic NFPA to reduce the likelihood of the appearance of tumor-related symptoms remains questionable considering its invasiveness to the nose.

Superficial Siderosis Associated with Craniopharyngioma.

BACKGROUND: Superficial siderosis (SS) associated with craniopharyngioma is an extremely rare occurrence. To our knowledge, only 3 cases have been reported in literature. Two of the cases occurred following resection of the tumor. Similar to the present case, 1 of the cases was discovered before surgical intervention, "pure tumor-related" SS. The clinical presentation, diagnosis, management, and outcome are discussed in this article. CASE DESCRIPTION: A 50-year-old man presented with an 11-month history of left-sided tinnitus, hearing impairment, and a 2-month history of visual disturbance. Cerebellar ataxia and gait disturbance were found on examination. Brain magnetic resonance imaging findings were consistent with SS. Cerebrospinal fluid (CSF) analysis before surgery revealed xanthochromia confirming an existing chronic sustainable subarachnoid hemorrhage. He underwent a tumor resection in endoscopic endonasal approach followed by stereotactic radiosurgery. On follow-up, the visual symptoms resulting from craniopharyngioma subsided, whereas hearing impairment, cerebellar ataxia, and gait disturbance associated with SS did not progress but were unchanged despite subsequent evidence of watery-clear CSF. CONCLUSIONS: In the present case, SS could be associated with craniopharyngioma on the basis of CSF findings and clinical symptoms. Detection and early treatment aimed at eliminating the bleeding source offer the best chance of halting the disease process.

Some characteristics of gliomas managed at a Neurosurgery centre in Nigeria.

BACKGROUND: Gliomas are important primary brain tumours with varying prognosis. AIM: To study the histology characteristics of brain gliomas managed in a Neurosurgical centre in Nigeria. MATERIALS AND METHODS: A retrospective analysis of prospectively recorded data of patients managed for intracranial gliomas at our Hospital for Neurosurgery, between year 2006 and 2015. Only the patients with conclusive histology diagnosis following surgery were analysed. RESULTS: Glioma was 23.8% of the 252 histology-confirmed brain tumours. Male-to-female ratio was 1.4:1.0. Peak age at diagnosis was in the fifth decade of life. There was an increase in the frequency of diagnosis from seven (2006-2009) to 15 (2011 and 2012) and 39 patients managed (2013 and 2015). In sub-group analysis, grade IV tumour was the most common (34.6%) followed by grade II (30.7%), grade I (18.3%) and grade III (16.7%). Seven patients of grade II oligodendroglioma and one patient each of anaplastic oligodendroglioma, subependymal giant cell astrocytoma and astroblastoma were seen. The anatomical location of the tumour was the frontal lobe in 23.3% of patients followed by the parietal lobe in 16.7% of patients. The pre-operative Karnofsky score was ≥70% in 36.7% of the patients. CONCLUSION: Gliomas are more common brain tumours than were imagined. Most patients present relatively late and with advanced disease. High-grade gliomas seem to mostly affect the middle age population in the study environment with higher proportion of grade IV lesions.

Isolated Meckel's diverticulum perforation as a sequel to blunt abdominal trauma: a case report.

INTRODUCTION: Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Its infrequent occurrence is mirrored by the paucity of large series of data on it in the literature. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Perforation of Meckel's diverticulum following blunt abdominal injury is very rare indeed. We present what we believe to be the first case to be published from Africa. CASE PRESENTATION: A 29-year-old Nigerian Igbo man presented with progressively worsening abdominal pain following a road traffic accident. He was a front-seat passenger traveling without a seat belt. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of peritonitis secondary to perforation of intestinal viscus was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum was discovered. A segmental resection of his ileum and reanastomosis were done. He had postoperative surgical site infection, but was asymptomatic for three months of follow-up. CONCLUSION: Perforation of Meckel's diverticulum is rarely suspected as a cause of peritonitis following blunt abdominal injury. This case indicates the need to be aware of the possibility to limit morbidity associated with delayed management of such a perforation.