A. Celal Iplikcioglu

Intradiploic epidermoid cysts of the skull: a report of four cases.

Epidermoid cysts are uncommon, benign and slow-growing lesions. They may often reach an enormous size without producing neurological symptoms. Intradiploic epidermoid cysts are nearly 25% of all epidermoids. They are derived from ectodermal remnants that stay within the cranial bones during embryonic development. Intradiploic epidermoid cysts can be located in any part of the skull. Two of our four cases were located in left occipital bone and the others were in the frontal bone. These tumours can occur at any age from the first to the seventh decade of life. Our cases had a mean age of 38.75 years (19-55 years). They may reach great sizes before the initial diagnosis and may produce major neurological signs. For good long-term prognosis, correct radiological assessment and complete removal of the tumour with its capsule are essential. We report four cases of intradiploic epidermoid cysts of the skull and analyse the clinical, radiological features and treatment of these lesions in the light of relevant literature.

Recurrent solitary fibrous tumour in the cerebellopontine angle.

Solitary fibrous tumours (SFT) of the central nervous system are rare. They resemble meningioma in clinical presentation, imaging features and appearance at surgery. Schwannoma, hemangiopericytoma and other spindle cell mesenchymal neoplasms should also be considered in the differential diagnosis. Although the histogenesis of this tumour is still debated, strong CD34 reactivity of the tumour cells suggests that SFT is mesenchymal. We present the clinical, radiological, and pathological features of an SFT located in the cerebellopontine angle (CPA). A 55-year-old female presented with 6 months of headache. The MRI scan showed a contrast enhancing ovoid mass in the left CPA. At craniotomy, the tumour was completely resected. Histolopathological diagnosis was of meningioma. Three years later, the symptoms recurred and an MRI scan demonstrated tumour recurrence. A repeat craniotomy was performed and the lesion was again completely excised. Tumour morphology on histopathology and immunoreactivity for CD34 of the tumour cells supported the diagnosis of SFT. Review of the original tumour also disclosed immunoreactivity for CD34. Ki67 labeling indices were less than 1% in both tumours.

Abscess formation within invasive pituitary adenoma

Pituitary abscess secondary to an adenoma is rare. To date, only 19 cases have been reported. This is the first report of a patient who presented with bilateral total ophthalmoplegia. A 59-year-old male patient presented with headache, nausea, vomiting, decreasing visual acuity, diplopia and bilateral ophthalmoplegia with ptosis. Magnetic resonance imaging was suggestive of a pituitary abscess with adenoma. Transphenoidal surgery was performed and, during debulking of the tumour, the abscess was seen and excised. After the operation, the patient received antibiotic therapy and his neurological condition improved. Pituitary abscess with adenoma is a serious condition that has a high mortality rate. Therefore, early diagnosis and surgical intervention with antibiotic therapy are necessary.

Primary meningioma of the paranasal sinus.

We report a 17 year old man with a primary ectopic meningioma in the right ethmoid and maxillary sinus. He underwent endoscopic surgery. After total removal of the tumour his subsequent clinical course was good. The clinical and pathologic features of the 32 previously reported cases in the literature are also reviewed. The pathogenesis and treatment of primary paranasal sinus meningioma is briefly discussed.

Cystic giant prolactinoma in childhood

In childhood and adolescence, pituitary adenomas are rare and half are prolactinomas. However, cystic giant prolactinoma in prepuberty is extremely rare. In this report, we present a 10-year-old boy with a cystic giant prolactinoma who was treated with two-stage surgery as the tumor was dumbbell shaped. To our knowledge, this is the second reported case of a cystic giant prolactinoma in a prepubertal child.

Primary solitary cervical amyloidosis: case report and review of the literature.

Study Design. A case report and literature review are presented. Objective. To describe and review the clinical presentations, characteristic findings from imaging studies, types, differential diagnosis, prognosis, and treatment of amyloidoma arising within the vertebrae. Summary of Background Data. Amyloidoma can occur in the bone, skin, larynx, lymph nodes, urinary bladder, eye, tongue, and gastrointestinal system. However, amyloidomas affecting the vertebral bones are very rare. To our knowledge, only 3 cases of amyloidoma involving cervical spine have been reported previously. Methods. In this report, we present a case of solitary amyloidosis of the cervical spine. Results. The differential diagnosis of primary solitary spinal amyloidoma includes metastasis, infection, primary bone tumors, plasmocytoma, and Potts abscess. The correct diagnosis can be achieved only after the specific staining of tissue. The prognosis of amyloidosis is related to the specific form of amyloidosis. However, primary solitary amyloidosis has the best prognosis, although a limited number of patients without long-term follow-up studies have been reported. Conclusions. Primary solitary amyloidosis is a rare form of the amyloidosis, which is different from the other forms of amyloidosis because of excellent prognosis with surgical excision. Combined surgical excision and spinal stabilization is the best treatment.

Primary lymphoma of the trigeminal nerve

Although malignant lymphoma of the central nervous system (CNS) is rarely seen, its frequency is increasing as a result of more common observation of immunocompromised patients. Primary CNS lymphoma arise usually in the white matter of brain and account for only 0.5 – 1.5% of all primary brain tumours. However, skull base and cranial nerve lymphomas are extremely rare. We present here the third primary lymphoma of the trigeminal nerve in the literature.

Intracranial falcine and convexity chondromas: two case reports

Intracranial chondromas are uncommon intracranial tumours that most frequently arise from the skull base. They can, however, arise from the calvarium or the meninges. In these cases their neuroradiological features may mimic other intracranial tumours. We present two cases of intracranial chondroma, one that originated from the convexity and the other from the falx. Total excision was achieved in both cases. The literature on intracranial chondromas is reviewed.

The effect of short-term antifibrinolytic therapy on experimental vasospasm.

BACKGROUND Antifibrinolytic therapy is effective in preventing rebleeding in cases of aneurysmal subarachnoid hemorrhage (SAH). The major disadvantage of this therapy is the increase in ischemic complications, which is supposed to be due to cerebral vasospasm. In this study the effect of short-term antifibrinolytic therapy on arterial vessel narrowing after SAH was investigated utilizing the rat femoral artery vasospasm model. METHODS Twenty-four rats were divided into four groups of six animals each. Autologous blood (0.1 mL) was applied to the 1-cm segment of right femoral artery wrapped with a silicone cuff. In Group 1 the animals did not receive any treatment. In Groups 2, 3, and 4 150 mg/kg tranexamic acid (AMCA) was given orally for 3, 5, or 7 days respectively, starting from postoperative day 1. A 1 cm segment of each femoral artery was harvested on the 8(th) postoperative day. Morphologic analyses were performed using the parameters, radial wall thickness and cross luminal area under the light microscope. In addition, two samples from each group were examined by transmission electron microscope (TEM) to confirm the morphologic changes. RESULTS There was a gradual decrease in cross luminal area and gradual increase in vessel wall thickness directly proportional with time. However, the vasospastic changes that occurred in Group 2 (received AMCA for 3 days) were not significantly different from those of Group 1 (nontreated). CONCLUSION It was concluded that antifibrinolytic treatment for the first 3 days may prove useful in cases of clinical aneurysmal SAH. However, if this treatment is used for more than 3 days, arterial vessel narrowing is significantly increased.

Spontaneous cerebrospinal fluid rhinorrhoea due to temporosphenoidal encephalocele.

A 57-year old man was referred to our hospital with spontaneous cerebrospinal fluid (CSF) rhinorrhoea of 6 years duration. He had an episode of meningitis 2 months previously. CT cisternography and cranial MRI revealed a defect in the lateral wall of the sphenoid sinus, with an anteromedial temporosphenoidal encephalocele. Surgery was performed transcranially through a pterional approach. The temporal encephalocele was amputated, the sphenoid sinus obliterated and the dural defect repaired. Lumbar drainage was used for 5 days after surgery. Spontaneous CSF rhinorrhoea is only infrequently due to temporal encephalocele. Anteromedial temporosphenoidal encephaloceles are the least common type of temporal encephalocele, with only 12 reported in the literature.