Supratentorial extra-axial anaplastic ependymoma: a rare case report.

Introduction and importance: Ependymomas are central nervous system tumors arising from the ependymal lining of the ventricle and spinal cord. Supratentorial extra-axial ependymomas are very rare, most commonly affecting the pediatric population and rarely in adults. Case presentation: The authors report a case of a 71-year-old female with a headache and blurred vision. An MRI scan revealed a lesion at the parafalcine region of the occipital lobe. A parieto-occipital craniotomy was performed. When the dura was opened during the operation, the extra-axially located, well-circumscribed, dirty yellow-white tumor dissected from the surrounding tissue was excised entirely by microdissection. Histopathological examination revealed supratentorial extra-axial anaplastic ependymoma. The patient received postoperative radiation therapy (54 Gray over 30 fractions). No recurrence of the tumor was observed during the 4-year follow-up. Discussion: Supratentorial ependymomas at the extra-axial region are uncommon; extra-axial anaplastic ependymoma and meningiomas have similar radiological findings, such as a dural tail, subarachnoid plane, and diffuse enhancement after contrast injection. This close similarity might cause misdiagnoses. Total surgical resection was followed by adjuvant radiotherapy and close follow-up in the gold standard of the treatment. Conclusion: The authors report a rare case of anaplastic ependymomas located at the extra-axial region. Anaplastic tumors are prone to recurrence despite total resection and radiation therapy; hence, a close follow-up is warranted.

Penetrating brain injury caused by tired bullet: First report from Somalia.

Background: Brain injuries caused by a tired bullet can range from headaches to severe brain injury and death. The question which poses a dilemma is whether extraction of retained bullets could decrease the late complications. This study aims to investigate the radiological findings, the neurological status of the patients, and different modalities of management for craniocerebral tired bullet injury. Method: This study retrospectively reviewed 21 patients with a tired bullet injury to the brain who were admitted into our hospital over five years. All patients were assessed for the Glasgow outcome scale as outpatients. Result: Of the 21 patients in the study, 11 (52.3%) were males, and 10 (47.6%) were females. The most common entry point of the bullet was frontal in 8 (38.0%) patients, followed by parietal in 7 (33.3%), and orbital in 5 (23.8%). The mortality rate was 23.8% (n = 5 patients). Bad outcomes were documented in patients with low GCS, with all patients who died having a GCS of (3-8). Bullet retrieval was performed for 7 of 21 patients, while all patients who were not candidates for emergency operation underwent local wound debridement. The GOS score was good [4 and 5] in 71.4% (15 of 21 patients). Conclusion: This study revealed that two-thirds of patients with tired bullet injury underwent conservative treatment with an excellent long-term outcome, particularly for patients with high GCS on admission. The mortality rate was high among children under 15 years and those with a GCS of 3-8.