Clear-cell meningioma of the anterior cranial fossa. Case report and review of the literature.

Clear-cell meningioma (CCM) is a rare subtype of meningioma which occurs at a younger age and has a higher recurrence rate than other subtypes (WHO grade II). CCM usually occur in younger patients and is located in the posterior fossa and spine. The authors report the first case of olfactory groove mixed clear-cell meningioma. A 66-year-old woman was admitted to the SS. Annunziata Hospital (Taranto, Italy) in January 2007 with a two-year history of subtle changes in personality and mental function. On neurologic examination she presented a loss of sense of smell. The magnetic resonance imaging (MRI) showed an olfactory groove meningioma. The computed tomography (CT) and MRI features of CCM are not different from those of common meningiomas. The tumor was totally removed by frontolateral approach on January 24, 2007). Histological examination showed that the tumor was composed of sheet-like uniform and polygonal cells, with abundant clear cytoplasm, and small and bland nuclei. The cytoplasm was heavily laden with granular periodic acid Schiff-positive and diastase-sensitive material representing glycogen. There were no rich vascular networks but scattered collagen bundles within the tumour, little foci areas of necrosis and whorls of meningothelial cells. The neoplastic cells were positive for epithelial membrane antigen (EMA) and vimentin, and negative for glial fibrillary acidic protein (GFAP)? S-100?chromogranin A; Ki-67 labelling showed an index of 1%. The final diagnosis was mixed clear-cell meningioma. Until now only 38 intracranial CCM cases had been reported in English language literature. Different diagnoses for CCM include lesions with clear cell appearance such metastases of renal cell carcinoma and sarcoma, hemangioblastoma, ependymoma, oligodendroglioma, germinoma, chordoma, pleomorphic xanthoastrocytoma, lipid-rich glioblastoma, microcystic and lipomatous meningioma.

From computerized tomography data processing to rapid manufacturing of custom-made prostheses for cranioplasty. Case report.

Cranioplasty is a surgical repair of a structural or morphological deformity of the skull, involving the resection, remolding and displacement of the bones of the head. As it pertains to abnormal head shape, cranioplasty is an operative procedure aimed to fill a gap in the cranial theca or to replace bone removed either as a result of trauma or infection, by means of a biocompatible artificial bony substitute. In the present paper authors report a case of custom-made cranioplasty for the reconstruction of a large bilateral skull defect, based on advanced computerized tomography data processing and rapid prototyping (stereolithography) techniques.

Minimally invasive anterior approach for kyphoplasty of the first thoracic vertebra in a patient with multiple myeloma.

A vertebral body collapse of the first thoracic vertebra (T1) was diagnosed after radiological investigation in an adult male suffering for severe dorsal pain due to suspected multiple myeloma (MM). According to the principles of minimally invasive neurosurgery and the aesthetic needs of the patient, an open T1 kyphoplasty was performed by means of a right anterior approach through the inferior brow of the neck, generally utilized for the anterior approaches to the cervical spine. The histological examination confirmed the diagnosis of MM and the postoperative radiological investigation showed a good vertebral body (VB) restoration. No gross neurological deficit was noted and the patient was discharged within a few days after a good recovery. Kyphoplasty is a percutaneous technique utilized by means of a posterior approach for VB restoration from T4 to the fifth lumbar vertebra (L5) in patients with vertebral body compression fractures (VCFs) of osteoporotic, traumatic and neoplastic origin. Anatomic obstacles make the performance of posterior kyphoplasty from T1 to T4 very difficult. To the best of our knowledge no anterior approach for T1 kyphoplasty has been reported in the literature. Our experience gives us the opportunity to emphasize this approach and this technique for the minimally invasive treatment of the VCFs of this segment of the spine.

Tapping of a type II Sylvian fissure arachnoid cyst: technical note.

A 28-year-old man with a large Sylvian fissure cyst was treated by making a small pre-coronal burr hole, and subsequently, under a direct view its wall was fenestrated with a Cushing's needle and the cyst fluid was tapped. The patient had complete neurological recovery. The follow-up was of 90 months.

Laparoscopic removal of two dislocated ventriculoperitoneal catheters: case report.

In a child two previously migrated abdominal catheters from ventriculoperitoneal shunts were removed from the abdominal cavity by use of laparoscopy. Avoiding the usually longitudinal laparatomy, two small incisions were necessary to insert the laparoscope (sub-umbilical incision) and grasping forceps (left iliac pit incision). Laparoscopy allowed for identification of a working ventriculoperitoneal shunt, that was correctly in place, and for removal of two old migrated catheters. The child was mobilized the same day and the post-operative course was uneventful.

Surgical resection of a cerebral metastasis from cervical cancer: case report and review of the literature.

AIMS AND BACKGROUND: Central nervous system metastasis from cervical carcinoma is uncommon. CASE REPORT: We report the case of a 51-year-old woman who developed a solitary cerebral metastasis 29 months after radical hysterectomy with pelvic lymphadenectomy for a stage IB, grade III cervical cancer. The patient suddenly complained of headache, confusion and dizziness; she was submitted to emergency surgical resection of a 2 x 3 cm metastasis in the right frontal lobe. The postoperative course was uneventful and she completely recovered from her neurological deficit. Following surgery the patient underwent careful restaging. Massive bilateral involvement of the pelvic wall was diagnosed, and the patient received three courses of cisplatin-based chemotherapy. She developed liver and lung metastases and died 10 months later of progressive disseminated disease, without, however, any sign of recurrent or persistent cerebral involvement. CONCLUSION: Neurosurgical resection should be considered in cervical cancer patients with solitary brain metastasis in the absence of systemic disease.

The supraorbital keyhole approach to supratentorial aneurysms: concept and technique.

BACKGROUND: Anterior surgical approaches to the base of the brain have always required relatively large craniotomies, most larger than the lesion itself. Especially in aneurysm surgery, the size of the lesion is not always proportionate to the extent of brain exposure. The improvement of surgical techniques and diagnostic imaging, as well as the introduction of neuroendoscopy and new surgical instruments, enable us now to treat various intracranial lesions through small keyholes. In particular, cerebral aneurysms, because of their anatomic characteristics, are apt to be treated by the keyhole approach. The supraorbital keyhole approach has the broadest field of indications, although its technical aspects have not yet been evaluated. METHODS: The concept and technique of the supraorbital keyhole approach are presented in detail. We conducted a retrospective study in which we evaluated the technical aspects of the supraorbital keyhole approach considering the indications, limitations, and complications of this approach as well as new instrumentation in surgery of supratentorial aneurysms. RESULTS: The use of 139 supraorbital keyhole approaches for 197 aneurysms is described. Multiple aneurysms have been treated by one approach in 38 patients. Clipping of the aneurysm was performed in 94% and wrapping in 6% of patients. Eighteen aneurysms were contralateral to the approach. In four patients, intraoperative accidental aneurysm rupture occurred. There were no approach-related complications. CONCLUSIONS: The supraorbital keyhole approach offers equal surgical possibilities with less intraoperative accidental rupture and less approach-related morbidity as conventional approaches in the treatment of supratentorial aneurysms.

Pituitary adenomas: the role of 111In-DTPA-octreotide SPET in the detection of minimal post-surgical residues.

Scintigraphy with 111In-DTPA-octreotide (111In-octreotide) enables the localization of tumours with somatostatin receptors on their cell membranes, of which pituitary adenomas are an example. Trans-sphenoidal excision of such tumours is sometimes incomplete and the detection of post-surgical residues is a difficult diagnostic task. In this study, we used 111In-octreotide SPET to visualize pituitary adenomas and their minimal residues. In positive cases, the indirect demonstration of the presence of somatostatin receptors may be decisive for the planning of treatment. 111In-octreotide SPET was able to visualize adenomas in 21 of 27 patients (77.7%) (10 GH-secreting, 10 PRL-secreting and 1 non-secreting). Repeat SPET after the recurrence of clinical symptoms and hormone hypersecretion revealed intense 111In-octreotide uptake by residues in 8 of 10 patients (4 GH-secreting and 6 PRL-secreting). Magnetic resonance imaging was positive in only 3 of these 10 patients. Our results suggest that 111In-octreotide SPET, in combination with other imaging modalities, is useful in the diagnosis and follow-up pituitary adenomas. It ensures better selection of patients for treatment with somatostatin analogues, both pre- and post-operatively, and assists in the development of personalized treatment plans.

Central nervous system involvement secondary to metastatic mixed müllerian tumor of the uterus.

The central nervous system is traditionally considered an uncommon site for metastatic disease from female genital tract tumors. We report the case of a 48-year-old woman with malignant mixed müllerian tumor of the uterus, who developed spinal cord compression by epidural metastasis a few days after the diagnosis of the uterine malignancy. Emergency decompressive laminectomy was performed and a good recovery of the neurological function was achieved. In the following days, while submitted to extensive staging for the uterine malignancy, the patient complained of headache, confusion and visual disturbance. CT scan revealed multiple brain metastases. No other site of metastatic disease could be detected. The patient refused any further treatment and died 1 month later from progressive cerebral disease. Attention should be paid to the possibility of unusual distant metastases associated to uterine sarcoma in order to treat these patients promptly.

Chronic subdural hematomas in adults: prognostic factors. Analysis of 70 cases.

We did a prospective study of 70 adults with chronic subdural hematomas. We looked at the correlation between some aetiological, clinical, and radiological factors and outcome. The present analysis found a significant positive correlation of cephalea, isodense aspect of the hematoma at CT scan, and pulsatance of the encephalon at surgery to good clinical outcome. Viceversa, alcoholism and intracranial hypotension associated with postoperative pneumocephalus are factors usually correlated with a negative clinical course.

Two meningiomas and an astrocytoma of the third ventricle in the same patient. Report of a case with review of the literature.

The association in the same patient between two meningiomas and an astrocytoma of the third ventricle is presented. All tumors were removed in two surgical sessions. The unusual occurrence of such associations, except for the so-called phakomatoses, is emphasized. Other similar cases drawn from the literature are tabled.

Recurrent meningioma within pericranial tissues outside a cranioplasty.

A case of meningioma recurring twice in pericranial tissues after complete removal of intracranial mass and overhanging bone is reported. The second recurrence developed outside an acrylic cranioplasty. Previous reports of recurrent meningiomas outside the skull are reviewed.

Polyamines: current review and their perspectives in neurosurgery.

A short review of polyamines and their possible clinical interest and applications in the field of brain neoplasms is presented. Dosage of CSF polyamines was proved to be useful in monitoring patients with medulloblastomas and others malignancies with meningeal involvement. Polyamines and their enzymes in neoplastic tissue may correlate to tumor growth. Inhibition of polyamines synthesis by drugs may be a possible way of slowing down tumor growth.