Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collis...Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.展开更多
Primary intracranial ependymomas originate from ependymal cells. They may migrate mainly in the spinal cord but rarely metastasize outside the central nervous system. Metastases outside the central nervous system are ...Primary intracranial ependymomas originate from ependymal cells. They may migrate mainly in the spinal cord but rarely metastasize outside the central nervous system. Metastases outside the central nervous system are rare. Metastatic diffusion from the central nervous system is low due to the unique interaction of the brain and the tumor with the blood-brain barrier. Nevertheless, three main hypotheses have been mentioned in the literature, the tumor growth, the surgical manipulation (which may be considered to be the case in our patient), and the aggressiveness of the tumor according to the Ki67 index. We report the case of a 16-year-old female, who underwent complete surgical removal of a left occipital 2007 WHO grade II ependymoma. 3 years later, the patient presented multiple cervical and occipital indurated masses. MRI showed a left hemispheric meningeal infiltration, with multiple nodules located on the neck, occiput and mastoid. Histopathological study of a left temporal surgical biopsy and resection of an occipital subcutaneous nodule turned to be metastases of an anaplastic ependymoma. The ependymoma considered as a benign tumor could very quickly turn into malignancy by its metastatic potential. Early diagnosis and longer follow-up of patients would be recommended for a rapid management.展开更多
<b><i><span style="font-family:Verdana;">Background</span></i></b><b><span style="font-family:Verdana;">:</span></b><span style="...<b><i><span style="font-family:Verdana;">Background</span></i></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">The intracranial mycotic aneurysm is known to be a rare complication of infective endocarditis and it is more clinically challenging to get this diagnosis right when it happened to be in a patient without a past medical history of heart diseases. We report a documented case of mycotic aneurysm revealed by isolated left hemiparesis and our management with the collaboration of the cardiology department. </span><b><i><span style="font-family:Verdana;">Case</span></i></b> <b><i><span style="font-family:Verdana;">Description</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> A 48-year-old male patient with a history of teeth loss, a chronic smoker presented with sudden heaviness in the left upper and lower limbs. No fever. Physical examination revealed a left hemiparesis of 3/5 on the muscle tone scale without the stiffness of the neck. The CT-Scan and the MRI conclude of subarachnoid and cerebral hemorrhage with right temporal hematoma being most probably a vascular malformation. The cerebral arteriography concluded of a right Sylvian mycotic distal aneurysm in the M4 segment. Transesophageal echocardiography was performed and concluded of infectious endocarditis with mitral and aortic valvular disease grade II. Positive blood culture for staphylococcus coagulase-negative. The patient was managed with antibiotic therapy and clinically stable after 28 days. He was then transferred to the cardiology department for follow-up. Six (6) months later a CT-angiography was done for a check-up and shows no further changes in the aneurysm. The patient underwent surgery, two (2) months later, for clipping the aneurysm because the aneurysm did not regress in size. The aneurysm was then excluded with an eventless post-operative period, confirmed by controlled cerebral arteriography. The patient was discharged five (5) days later and he is doing well. </span><b><i><span style="font-family:Verdana;">Conclusion</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Mycotic aneurysm is a rare consequence of infective endocarditis. The distal sites of the middle cerebral artery are commonly found, and conservative treatment with a long course of antibiotics like amoxicillin 12 g/24h for 6 weeks or direct surgical clipping or excision can manage it.展开更多
Meningiomas are the most common extra-axial central nervous system tumours and often discovered in the middle to late adult life and especially in women. About 85%-90% of meningiomas are benign, 5%-10% are intermediat...Meningiomas are the most common extra-axial central nervous system tumours and often discovered in the middle to late adult life and especially in women. About 85%-90% of meningiomas are benign, 5%-10% are intermediate-grade, and 3%-5% are malignant. Metaplastic meningioma is a rare subtype of WHO Grade I meningioma histologically characterized by the presence of mesenchymal components. The presence of pure and extensive cartilaginous differentiation in meningiomas is extremely rare and remains a diagnostic dilemma. We report, perhaps the first case of this entity in a 52-year-old woman and discuss the pathogenesis, the imaging features and the histopathologicals data.展开更多
Pituitary abscess gland is an uncommon lesion on sellar region. Clinical diagnosis is not easy to make and it is difficult to make difference from other pituitary lesions on clinical and sometimes on Neuroimaging. Thi...Pituitary abscess gland is an uncommon lesion on sellar region. Clinical diagnosis is not easy to make and it is difficult to make difference from other pituitary lesions on clinical and sometimes on Neuroimaging. This pathology is characterized by vague symptoms, headaches, generalized tiredness and hypopituitarism manifestations. A 35-year-old woman was admitted to neurosurgery with complaints of headaches and blurred vision. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity. Treatment of the lesion of this lesion pituitary area through a transsphenoidal approach and spectrum antibiotic therapy with ceftriaxone metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and is treated with oral hydrocortisone. After the diagnosis, the surgery and antibiotics should be commenced rapidly. Our aim is to report this rare case and to show how sometimes it is difficult to make diagnosis and clinical features vary mimicking other pituitary lesions before pre-operative and how to manage pituitary abscess gland. The outcome is usually good with proper treatment.展开更多
Five million neurosurgical cases go untreated each year.This is in part due to the lack of neurosurgical care providers.The World Federation of Neurosurgical Societies has spearheaded efforts to monitor the number of ...Five million neurosurgical cases go untreated each year.This is in part due to the lack of neurosurgical care providers.The World Federation of Neurosurgical Societies has spearheaded efforts to monitor the number of neurosurgical providers around the globe since 2016.In this perspective,we discuss why,when,and how the neurosurgical workforce should be measured.展开更多
文摘Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.
文摘Primary intracranial ependymomas originate from ependymal cells. They may migrate mainly in the spinal cord but rarely metastasize outside the central nervous system. Metastases outside the central nervous system are rare. Metastatic diffusion from the central nervous system is low due to the unique interaction of the brain and the tumor with the blood-brain barrier. Nevertheless, three main hypotheses have been mentioned in the literature, the tumor growth, the surgical manipulation (which may be considered to be the case in our patient), and the aggressiveness of the tumor according to the Ki67 index. We report the case of a 16-year-old female, who underwent complete surgical removal of a left occipital 2007 WHO grade II ependymoma. 3 years later, the patient presented multiple cervical and occipital indurated masses. MRI showed a left hemispheric meningeal infiltration, with multiple nodules located on the neck, occiput and mastoid. Histopathological study of a left temporal surgical biopsy and resection of an occipital subcutaneous nodule turned to be metastases of an anaplastic ependymoma. The ependymoma considered as a benign tumor could very quickly turn into malignancy by its metastatic potential. Early diagnosis and longer follow-up of patients would be recommended for a rapid management.
文摘<b><i><span style="font-family:Verdana;">Background</span></i></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">The intracranial mycotic aneurysm is known to be a rare complication of infective endocarditis and it is more clinically challenging to get this diagnosis right when it happened to be in a patient without a past medical history of heart diseases. We report a documented case of mycotic aneurysm revealed by isolated left hemiparesis and our management with the collaboration of the cardiology department. </span><b><i><span style="font-family:Verdana;">Case</span></i></b> <b><i><span style="font-family:Verdana;">Description</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> A 48-year-old male patient with a history of teeth loss, a chronic smoker presented with sudden heaviness in the left upper and lower limbs. No fever. Physical examination revealed a left hemiparesis of 3/5 on the muscle tone scale without the stiffness of the neck. The CT-Scan and the MRI conclude of subarachnoid and cerebral hemorrhage with right temporal hematoma being most probably a vascular malformation. The cerebral arteriography concluded of a right Sylvian mycotic distal aneurysm in the M4 segment. Transesophageal echocardiography was performed and concluded of infectious endocarditis with mitral and aortic valvular disease grade II. Positive blood culture for staphylococcus coagulase-negative. The patient was managed with antibiotic therapy and clinically stable after 28 days. He was then transferred to the cardiology department for follow-up. Six (6) months later a CT-angiography was done for a check-up and shows no further changes in the aneurysm. The patient underwent surgery, two (2) months later, for clipping the aneurysm because the aneurysm did not regress in size. The aneurysm was then excluded with an eventless post-operative period, confirmed by controlled cerebral arteriography. The patient was discharged five (5) days later and he is doing well. </span><b><i><span style="font-family:Verdana;">Conclusion</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Mycotic aneurysm is a rare consequence of infective endocarditis. The distal sites of the middle cerebral artery are commonly found, and conservative treatment with a long course of antibiotics like amoxicillin 12 g/24h for 6 weeks or direct surgical clipping or excision can manage it.
文摘Meningiomas are the most common extra-axial central nervous system tumours and often discovered in the middle to late adult life and especially in women. About 85%-90% of meningiomas are benign, 5%-10% are intermediate-grade, and 3%-5% are malignant. Metaplastic meningioma is a rare subtype of WHO Grade I meningioma histologically characterized by the presence of mesenchymal components. The presence of pure and extensive cartilaginous differentiation in meningiomas is extremely rare and remains a diagnostic dilemma. We report, perhaps the first case of this entity in a 52-year-old woman and discuss the pathogenesis, the imaging features and the histopathologicals data.
文摘Pituitary abscess gland is an uncommon lesion on sellar region. Clinical diagnosis is not easy to make and it is difficult to make difference from other pituitary lesions on clinical and sometimes on Neuroimaging. This pathology is characterized by vague symptoms, headaches, generalized tiredness and hypopituitarism manifestations. A 35-year-old woman was admitted to neurosurgery with complaints of headaches and blurred vision. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity. Treatment of the lesion of this lesion pituitary area through a transsphenoidal approach and spectrum antibiotic therapy with ceftriaxone metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and is treated with oral hydrocortisone. After the diagnosis, the surgery and antibiotics should be commenced rapidly. Our aim is to report this rare case and to show how sometimes it is difficult to make diagnosis and clinical features vary mimicking other pituitary lesions before pre-operative and how to manage pituitary abscess gland. The outcome is usually good with proper treatment.
文摘Five million neurosurgical cases go untreated each year.This is in part due to the lack of neurosurgical care providers.The World Federation of Neurosurgical Societies has spearheaded efforts to monitor the number of neurosurgical providers around the globe since 2016.In this perspective,we discuss why,when,and how the neurosurgical workforce should be measured.
