Lung destruction secondary to intrapulmonary migration of a ventriculoperitoneal shunt catheter: report of an unusual case and literature review.

Ventriculoperitoneal shunt placement for the treatment of hydrocephalus is one of the most common pediatric neurosurgical procedures. Complications, including infections, catheter obstruction, shunt breakdown, and hemorrhage, have been described in the literature. Occasionally, however, uncommon and devastating complications occur. We report a case of a 10-year-old female patient who at birth underwent surgical closure of lumbar myelomeningocele and placement of a CSF shunt at another center. Her neurosurgical follow-up was poor. She presented at our institution with a history of recurrent pneumonia. Control chest X-rays showed a right pulmonary infiltrate with lung retraction and mediastinal shift. Chest and brain CT scans confirmed the intrapulmonary location of the distal catheter tip and ventricular dilation. Surgical shunt revision was performed with removal of the intrapulmonary catheter and placement of a new intraperitoneal catheter. Subsequently, right pneumonectomy was performed with good postoperative recovery of the patient. Intrathoracic migration of the distal catheter of the CSF shunt is an extremely rare complication that may produce severe morbidity. To our knowledge, there have been no previous reports on extensive lung destruction secondary to intrathoracic and intrapulmonary ventriculoperitoneal shunt migration. In patients with CSF shunts and pulmonary symptoms, intrapulmonary catheter migration should be considered.

Melanotic neuroectodermal tumor of infancy arising from the skull: report of an unusual case, review of the literature, and a diagnostic approach.

INTRODUCTION: Melanotic neuroectodermal tumor of infancy is a rare neoplasm mainly seen in children under 1 year of life. The most common location of the tumor is the maxilla followed by the cranial vault. Surgery is the treatment of choice and outcome mainly depends on extent of resection. OBJECTIVES: To report an atypical case of an 8-year-old patient with a melanotic neuroectodermal tumor of infancy, to review the cases with melanotic neuroectodermal tumor of infancy arising from the skull published over the last 13 years, and to provide a diagnostic approach that may allow recognition of a pattern in these rare neoplastic lesions. METHODS: A case is reported with a description of the clinical, radiological, surgical, and histopathological features. Additionally, the literature was reviewed to identify reports of patients with melanotic neuroectodermal tumor of infancy arising from the cranial vault and all cases published in PubMed over the last 13 years were included. Only studies that evaluated clinical, radiological, surgical, and histopathological findings were included. CONCLUSION: Melanotic neuroectodermal tumor of infancy is a rare entity that may present with unusual features, but nevertheless has an identifiable pattern that allows the tumor to be considered in the differential diagnosis of intracranial space-occupying lesions in children.

Neurosurgical training with simulators: a novel neuroendoscopy model.

PURPOSE: The aim of this study is to present a novel neuroendoscopy simulation model in live animals, with the objective of enhancing patient safety with realistic surgical training. METHODS: A simulation model using live Wistar rats was designed after the approval of the Institutional Committee for the Care and Use of Laboratory Animals. Under anesthesia, a hydroperitoneum was created in order to simulate a cavity with mesenteric membranes and vessels, viscera, and a solid and bleeding tumor (the liver) floating in a liquid environment. For validation purposes, we evaluated trainees' basal and final skills for each neuroendoscopic procedure, and we also acknowledged trainees' and instructors' opinion on the model's realism. RESULTS: This model is simple and low cost effective for complete and real-life training in neuroendoscopy, with the possibility of performing all the basic and advanced endoscopic procedures, such as endoscopic exploration, membrane fenestration, vessel coagulation, hematoma evacuation, and endoscopic tumor biopsy and resection using a ventricular neuroendoscopy set. Although the model does not represent human ventricular anatomy, a reliable simulation is possible in real living tissue in a liquid environment. Trainees' skills improvements were notorious. CONCLUSION: Minimally invasive endoscopic techniques require specific training. Simulation training can improve and accelerate the learning curve. The presented training model allows simulating the different neuroendoscopic procedures. We believe that due to its practical possibilities, its simplicity, low cost, reproducibility, and reality, being live animal tissue, it can be considered a fundamental model within a complete training program on neuroendoscopy.

Supratentorial intraventricular solitary schwannoma. Case report and literature review.

OBJECTIVE: The objectives of this study were to present a case of a solitary intraventricular schwannoma with a review of the literature and to analyse the current theories of its origin. DESCRIPTION: A 16-year-old male patient, without any pathological, genetic or familial history of significance, presented with symptoms of intracranial hypertension and progressive left brachiocrural paresis. The magnetic resonance image showed a bulky intraventricular space-occupying lesion emerging from the posterior horn of the right lateral ventricle, with an irregular nodular component intimately connected to the choroid plexus, and a multiloculated cystic component extending beyond the ventricle. SURGICAL APPROACH: A right parietal craniotomy was performed, revealing a multiloculated cyst with xantochromic fluid and a soft brownish red nodule. The lesion was dissected surrounding the periphery and coagulating a vascular pedicle related to the wall of the right lateral ventricle and its choroid plexus. Total excision was achieved. The pathological exam reported an intraventricular schwannoma (WHO grade 1). The patient evolved favourably, with no recurrence at 36-month follow-up. CONCLUSION: The literature describes less than 45 cases of schwannomas not associated to cranial nerves of the following locations: intramedullary, leptomeningeal and only 12 intraventricular cases. The three theories explaining the origin of this last group describe: (1) a neoplastic transformation of peripheral nerve fibres, (2) a neoplastic transformation of autonomic neural tissue located within the intraventricular choroid plexus and (3) an abnormal embryogenesis leading to a failed migration of the neural crest cells. Complete resection is the therapeutic goal for this benign pathology to avoid recurrence.

Cavernous sinus tuberculoma mimicking a neoplasm: Case report, literature review, and diagnostic and treatment suggestions for tuberculomas in rare locations.

BACKGROUND: Cavernous sinus tuberculomas are extremely rare, but the increasing incidence worldwide of central nervous system (CNS) tuberculosis, mostly due to human immunodeficiency virus and poor sanitary conditions, and the ability of tuberculomas to mimic a brain neoplasm makes cavernous sinus tuberculomas a suspicious pathologic finding in the differential diagnosis of a brain space-occupying lesion. CASE DESCRIPTION: We present an immunocompetent patient with no signs of systemic tuberculosis and an isolated right cavernous sinus space-occupying lesion. A skull base approach was performed and tumor resection achieved. The postoperative course was uneventful. Pathologic findings consisted of a tuberculoma and antituberculous treatment was immediately begun with total tumor regression after a 12-month regimen. After reviewing the literature, we propose suggestions to orient the diagnosis and a treatment algorithm for tuberculomas in rare locations. CONCLUSION: Tuberculomas in rare locations, as the cavernous sinus, are a challenging pathology as they have the ability to mimic a brain neoplasm. Although first line treatment are antituberculous therapy (4 drugs for at least 12 months) and adjuvant steroids, in inconclusive cases, surgical biopsy or excision is recommended for histopathologic confirmation and to reduce the mass effect, always following with antituberculous therapy and adjuvant steroids.

Tratamiento endoscópico en neurocisticercosis de cisternas basales e intraventriculares / Endoscopic treatmente in basal cisterns and intraventricular neurocisticercosis

Objetivo: presentar nuestra experiencia en neurocisticercosis intraventricular y cisternal basal tratados con técnicas mínimamente invasivas endoscópicas y exponer los conceptos actuales del tratamiento de esta patología. Material y método: se trataron tres pacientes, todos con síntomas de hipertensión endocraneana secundaria a hidrocefalia y diagnóstico definitivo de neurocisticerosis. Caso 1: presentó dos quistes en cisternas interpeduncular y prepontina. Caso 2: presentó dos quistes en ventrículo lateral. Caso 3: quiste en la cisterna interpeduncular. Todos recibieron tratamiento médico (albendazol + dexametasona por 1 mes) y quirúrgico, realizando resección parcial (caso 3) o total (caso 1 y 2) de los quistes por via endoscópica transventricular y derivaciones internas (tercerventriculostomia o septopelucidostomia) en dos pacientes (caso 1 y 3). Resultados: dos casos requirieron derivación valvular a posteriori por hidrocefalia comunicante. Todos evolucionaron favorablemente, sin ventriculitis ni disfunción valvular en el seguimiento. Conclusiones: el tratamiento mínimamente invasivo endoscópico para la neurocisticercosis intraventricular y de cisternas basales ofrece una alternativa terapéutica simple y de baja morbilidad a esta grave y compleja patología. Permite remover los quistes, en casos seleccionados, evitando la degeneración quística, y realizar derivaciones internas reduciendo la necesidad de derivación valvular, y así sus complicaciones.

Tratamiento endoscópico en neurocisticercosis de cisternas basales e intraventriculares / Endoscopic treatmente in basal cisterns and intraventricular neurocisticercosis

Objetivo: presentar nuestra experiencia en neurocisticercosis intraventricular y cisternal basal tratados con técnicas mínimamente invasivas endoscópicas y exponer los conceptos actuales del tratamiento de esta patología. Material y método: se trataron tres pacientes, todos con síntomas de hipertensión endocraneana secundaria a hidrocefalia y diagnóstico definitivo de neurocisticerosis. Caso 1: presentó dos quistes en cisternas interpeduncular y prepontina. Caso 2: presentó dos quistes en ventrículo lateral. Caso 3: quiste en la cisterna interpeduncular. Todos recibieron tratamiento médico (albendazol + dexametasona por 1 mes) y quirúrgico, realizando resección parcial (caso 3) o total (caso 1 y 2) de los quistes por via endoscópica transventricular y derivaciones internas (tercerventriculostomia o septopelucidostomia) en dos pacientes (caso 1 y 3). Resultados: dos casos requirieron derivación valvular a posteriori por hidrocefalia comunicante. Todos evolucionaron favorablemente, sin ventriculitis ni disfunción valvular en el seguimiento. Conclusiones: el tratamiento mínimamente invasivo endoscópico para la neurocisticercosis intraventricular y de cisternas basales ofrece una alternativa terapéutica simple y de baja morbilidad a esta grave y compleja patología. Permite remover los quistes, en casos seleccionados, evitando la degeneración quística, y realizar derivaciones internas reduciendo la necesidad de derivación valvular, y así sus complicaciones. (AU)