Desmoplastic Small Round Cell Tumor Presenting as an Intra/Extracranial Mass.

Desmoplastic small round cell tumors (DSRCTs) are highly malignant tumors, with distinct reciprocal chromosome translocation (11;22)(p13;q12). Intracranial metastasis is a very rare complication of this tumor, with only a few cases reported in the literature. To our knowledge, this is the only case presenting an extracranial extension of intracranial metastasis of DSRCT. A 33-year-old man was diagnosed with DSRCT in the pelvic cavity. He presented with a scalp lump and right-sided weakness. A biopsy showed metastasis from DSRCT. Metastatic DSRCT to the brain is extremely rare. Surgical resection followed by adjuvant treatment, including chemotherapy and radiation, is indicated as it has a poor prognosis. Moreover, aggressive treatment is warranted to prevent progression and relapse.

Gliosarcoma Invading the Temporal Bone, Temporalis Muscle, and Skull Base.

Gliosarcoma (GS) is a primary central nervous system tumor. It is an unusual type of glioblastoma multiforme (GBM) and rarely invades the skull base. It has a biomorphic tissue pattern with rapid alternation zones of glial and mesenchymal differentiation. We report the case of a 62-year-old male who presented with a one-month history of unsteady gait associated with dizziness. Brain MRI showed a right temporal mass that invaded the skull base with perilesional edema and a significant mass effect on the right lateral ventricle. The patient underwent a right-sided frontotemporal craniotomy with gross total resection. The pathology confirmed the diagnosis of GS. Postoperatively, the patient had an uneventful recovery with no complications and was discharged two days post-surgery.

Incidental and Clinical Significance of Slit Ventricles in Fixed Pressure Valves.

INTRODUCTION: Slit ventricle syndrome (SVS) is a recognized delayed complication of cerebrospinal fluid (CSF) shunting in children. It had been linked to the use of low-pressure shunts and considered an argument for the use of programmable valves. In this study, we aim to assess the rate of SVS in children that were shunted using fixed-pressure valves. METHODOLOGY: This study is a retrospective cohort study that occurred in King Abdulaziz Medical City, Jeddah, which reviews 100 patients with a median age of 15.5 months that were shunted by using fixed pressure valves during the period from 2010 to 2018. Fixed low-pressure valves were used in 69% of patients, while fixed medium-pressure valves were used in 31% of patients. SVS was defined by the presence of slit-like ventricles (fronto-occipital [F-O] horns ratio was ≤ 0.2 on any post-shunt CT scan) and the occurrence of slit-like ventricle-related symptoms (chronic headache, nausea, vomiting, and altered conscious level_ in the absence of other causes of shunt malfunction. RESULTS: The overall SVS rate in the cohort was 6%. Nine children had slit-like ventricles, but only six of them were symptomatic. Relatively higher SVS rates were observed in younger male children, obstructive hydrocephalus, and medium-pressure valves. Slit-like ventricle-related symptoms in the absence of a slit-like ventricle were reported in 24 out of 91 (26%) patients. A total of 42 patients underwent shunt revisions for other complications. All SVS patients were treated conservatively. There was a temporal fluctuation in the F-O horns ratio and in some patients with SVS their F-O horns ratio returned to normal at further follow-up without intervention. CONCLUSIONS: The overall SVS rate following the use of fixed-pressure CSF valves in children is low and managed conservatively. Not all patients with slit-like ventricles are symptomatic and the radiological appearance of SVS may improve on further follow-up without intervention. Fixed pressure valves remain an acceptable device in the treatment of hydrocephalus in children.

Cervical Spinal Cord Ischemic Reperfusion Injury: A Comprehensive Narrative Review of the Literature and Case Presentation.

Cervical spinal ischemic reperfusion injury (CSIRI) refers to a state of sudden neurological deterioration after surgical spinal decompression. The CSCIRI refers to a state of sudden neurological deterioration after surgical spinal decompression. The pathophysiology is hypothesized to be due to instant relief of a chronically compressed spinal cord, leading to an inflammatory cascade named ischemic reperfusion injury. Deterioration of neurological function after cervical spine decompression surgery often occurs secondary to direct cord injury, compressing hematoma, or hardware failure. Complete loss of neurological function with no organic explanation is an extremely rare complication, with only a few cases reported in the literature. We are reporting a 67-year-old male patient diagnosed with severe cervical spinal canal stenosis at level C5/6 who underwent anterior cervical discectomy and fusion (ACDF). The patient developed complete transient loss of neurological functions after the surgery and was labeled as a case of CSCIRI after excluding compressing pathology. A literature review of the CSCIRI was carried out, and ten articles were included. Due to the rarity of these cases, there is no class 1 or 2 evidence to establish management protocol nor identifiable risk factors to predict their occurrence. However, we recommend using an intra-operative neurophysiology monitor in cases with long-standing severe cervical canal stenosis with myelomalacia and managing these cases according to the acute spinal cord injury management protocol after excluding compressing pathologies.

Choroid Plexus Papilloma of the Fourth Ventricle in a Pediatric Patient: A Case Report.

Choroid plexus papilloma (CPP) is a rare intraventricular tumor. The common locations of the tumor vary based on the age of the patient. It usually occurs in the supratentorial region in children, however in adult patients, these tumors commonly present in the infratentorial region. We are presenting a rare case of a pediatric patient with a two month history of decreased activity and loss of interest in his surroundings and gait imbalance. He underwent a suboccipital craniotomy and excision of a CPP in the fourth ventricle. In conclusion, CCP should be considered as part of the differential diagnosis of intracranial tumors when the clinical presentation and investigations are suggestive regardless of the location to avoid misdiagnosing it when it occurs in an uncommon location.

An Acute Subdural Hemorrhage Due to a Left Supraclinoid Internal Carotid Artery Aneurysm Rupture Without a Subarachnoid Hemorrhage.

Acute subdural hemorrhage (SDH) is a rare complication that can occur after a spontaneous intracranial aneurysmal rupture. It is commonly associated with a subarachnoid and/or an intracerebral hemorrhage but rarely occurs as an SDH alone. A 52-year-old female presented to our institution with a severe headache and third cranial nerve palsy. A computed tomography (CT) scan revealed acute left SDH, without a subarachnoid hemorrhage (SAH), and a computed tomography angiogram (CTA) and cerebral angiography demonstrated the presence of a left supraclinoid aneurysm pointing towards the cavernous sinus. Endovascular occlusion of the aneurysm was performed using a flow diverter. A follow-up CT scan revealed a resolved SDH. In similar situations, vascular imaging, such as CTA and cerebral angiography, is required to assess the cerebral vasculature. This case report describes a patient presenting with the sudden onset of a severe headache associated with a cranial nerve palsy and a brain CT scan showing an acute SDH in the absence of trauma or an anticoagulation history. The treating physician should be highly vigilant of the possibility of a ruptured intracranial aneurysm as the underlying SDH etiology.

Ulnar Nerve Injury Following Open Carpal Tunnel Release: A Case Report.

Carpal tunnel syndrome (CTS) is one of the most common peripheral nerve diseases. It is managed medically and if not, resolved by surgical procedure. Decompression of the carpal tunnel is considered the definitive treatment. There are multiple complications after this procedure, which can be classified into three categories: (I) persistent, (II) recurrent, or (III) new symptoms, and ulnar nerve palsy after decompression of the carpal tunnel is a rare complication. In this study, we present a case of carpal tunnel decompression, which was complicated by ulnar nerve palsy, which exacerbated a pre-existing chronic ulnar nerve injury. We also explore the possible causes that may have led to this outcome.