Intracranial extraosseous chondroblastoma simulating meningioma.

Extraosseous chondroblastoma had been reported in different parts of the body but not intracranially. We report a case of a pathologically proven intracranial extraosseous chondroblastoma of the right cavernous sinus in an 18-year-old woman with CT, MR, and conventional angiographic features simulating meningioma.

Arteriovenous malformations of the brain: Indications and outcome of microsurgical excision.

This study is based on a retrospective analysis of 30 consecutive patients with previously untreated cerebral arteriovenous malformations (AVMs), who were seen at King Khalid University Hospital between 1987 and 1994. There were 17 males and 13 females, ranging in age between nine and 52 years. Twenty patients presented with intracranial hemorrhage, while the remaining 10 complained of epilepsy. The lesions were located as follows: 15 at the convexity, seven interhemispheric, four central, three basal, and one cerebellar. Nineteen patients (63%) underwent microsurgical excision, which was complete in 16 and incomplete in three. There were no postoperative deaths. Fifteen patients had no additional postoperative neurological deficit, while four patients sustained neurological deterioration, which was severe one. Two patients refused surgical treatment and the risk of surgery was considered too high in nine patients. Our result suggest that the local neurosurgical management standard of selected AVMs is quite satisfactory. However, for a more comprehensive therapeutic approach to these difficult lesions, national expertise in other therapeutic modalities, such embolization techiques and radiosurgery, is urgently needed.

Trigeminal neuralgia related to cerebellopontine angle tumors.

A review of 30 cases with cerebellopontine angle tumors was carried out to identify patients with trigeminal neuralgia (TN) at presentation and to compare them with patients without TN. The study shows that dermoid tumors and the presence of tumor at the apex of petrous bone on CT are associated with a significantly higher incidence of TN, while the incidence did not appear to be influenced by age, sex, or size of tumor. In all patients but one (with medulloblastoma) that had surgery, there the TN disappeared following total or subtotal excision of the tumor, providing the trigeminal nerve was well decompressed. Patients with TN should be investigated carefully by CT or MRI irrespective of their age or the absence of neurological signs.

Survival in malignant astrocytoma at King Khalid University Hospital.

Malignant astrocytoma (Kernohan grade III and IV) still has one of the worst outcomes of all malignant tumors. To determine factors affecting the survival of patients with malignant astrocytoma in Saudi Arabia, a retrospective study of 76 cases that were treated at King Khalid University Hospital over one decade was carried out. Kaplan-Meier survival diagrams were constructed for each prognostic factor. Twenty-eight percent of cases survived two years. A significantly better survival rate was found in females, patients /=70 at presentation, patients who had craniotomy and excision and patients who had radiotherapy. It is suggested that to improve the outcome of patients with malignant astrocytoma, aggressive surgical excision with radiotherapy (and possibly chemotherapy) is required.

Intracranial mycotic infections in neurosurgical practice.

Intracranial mycotic infections requiring neurosurgical intervention are being diagnosed more frequently. This study is a review of 17 cases of intracranial mycotic infections that were treated in a neurosurgical unit in Saudi Arabia over an 8-year period. A primary focus of infection was identified in 41% of patients while 18% of patients had a predisposing factor. Forty-seven percent of patients presented with a brain abscess (solitary 29%, multiple 18%) while 35% had a granuloma. 18% meningitis and ventriculitis and 12% hydrocephalus. The Aspergillus species and Ramichloridium machenziei were the commonest pathogens. Following the appropriate surgical and antimicrobial treatment, the mortality rate was 41% and there was evidence of residual disease at follow-up in 18%. The reason for a fatal outcome was failure to consider a fungal aetiology and to obtain a tissue diagnosis early-because of late referral (2 cases), as well as failure to respond to antimycotic therapy (4 cases) and rupture of the internal carotid artery due to Aspergillus arteritis (one case). It is concluded that an early tissue diagnosis is crucial in the management of intracranial mycotic infection so that the appropriate surgical and antimycotic treatment can be started early.