Alan R. Turtz

Endoscopic treatment of a symptomatic pineal cyst: technical case report.

Symptomatic pineal cysts are rare and typically managed with an open surgical approach. We report the successful treatment of a symptomatic pineal cyst using a stereotactic endoscopic technique.

Endoscopic Treatment of a Symptomatic Pineal Cyst

Symptomatic pineal cysts are rare and typically managed with an open surgical approach. We report the successful treatment of a symptomatic pineal cyst using a stereotactic endoscopic technique.

Transorbital endoscopic removal of posterior lateral orbital mass

INTRODUCTION Numerous endoscopic approaches to the orbit have been described in the literature and are typically performed using a transnasal route. These techniques are especially useful for medial orbital masses. Pathology located within the posterior and posterior-lateral orbit can create additional challenges for surgical access. Approaches for these hard-to-reach lesions include more invasive surgical corridors such as anterior and lateral orbitotomy as well as orbitozygomatic or frontal keyhole craniotomy. The endoscopic approach has proven useful to biopsy masses in this location, yet complete resection using endoscopic techniques has not been undertaken to date. We present a case of a posterior lateral orbital tumor where lesion location delivers classic surgical challenges for its removal. To avoid a craniotomy, large lateral wall orbitotomy, prolonged postoperative pain, or possible an aesthetically unappealing skin incision, we used a unique direct transorbital endoscopic approach (modified transorbital neuroendoscopic surgery [TONES]) to achieve a complete en bloc excision of this tumor. To our knowledge, this is the first time this adaptation of the endoscopic technique for a complete orbital tumor resection has been described.

Proposed Diagnostic Criteria, Classification Schema, and Review of Literature of Notochord- Derived Ecchordosis Physaliphora

Ecchordosis physaliphora (EP) is a benign notochordal remnant derived from ectopic nests found along the craniospinal axis. It typically presents asymptomatically and is diagnosed using classic radiologic features, particularly location, T1-hypointensity, T2-hyperintensity, and lack of enhancement following gadolinium (Gd) contrast administration. Distinguishing EP from its malignant counterpart, chordoma, is of paramount importance, given the aggressive nature of the latter. Advances in imaging and immunohistochemistry have aided in diagnosis to an extent but, to our knowledge, identification of the genetic fingerprint of EP has yet to take place. Further cytological analysis of these lesions in search of a genetic link is warranted. We propose here a set of diagnostic criteria based on features consistently cited in the literature. In this literature review, 23 case reports were identified and collated into a summary of symptomatic cases of ecchordosis physaliphora. An illustrative case report of two patients was also included.

Liposclerosing Myxofibrous Tumor of the Cranial Vault: A Case Report

BACKGROUND AND IMPORTANCE Liposclerosing myxofibrous tumors (LSMFTs) are rare benign fibro-osseous tumors most frequently occurring in the proximal femur. We report the first case of this rare tumor occurring within the calvarium. CLINICAL PRESENTATION Our patient presented with a 2-yr history of enlarging, painless, fixed mass over the left forehead. She underwent surgical resection and the mass was histologically confirmed to be a LSMFT. CONCLUSION LSMFT is a rare tumor that should remain on the differential for lesions of the calvarium. When diagnosed, this lesion can be removed with the goal of gross total resection and excellent cosmesis can be achieved.

In Reply to Vargas and Conill

Lutterbach et al (4) noted RPA3 was a heterogeneous group where KPS was important but primary tumor status and BM number also were independent prognostic factors; they then proposed 3 prognostic subgroups within the group of RPA3 patients. According to these aforementioned factors, the subgroups reached median survivals of 1.2, 1.9, and 3.2 months (4). Kubicek et al (1) also explain differences in survival and argued that patients with poor prognosis may receive limited treatment based on preconceived prognosis. Previous retrospective studies have reported a survival benefit of surgery plus WBRT and SRS in class 3 patients (5, 6). All these studies have assessed very selected patients, and it seems clear that prognosis in PPS patients with BMs is strongly determined by variables other than treatment (4). Additionally, as was noted by Lutterbach et al (4), whereas the attention of the scientific community has been focused on the few class 1 patients, little effort has been made to better define the much larger group of patients with unfavorable characteristics. Nowadays, WBRT remains the standard treatment in many patients with BMs. However, its clinical benefit compared with symptomatic treatment in PPS patients has been questioned by the interim analysis of the QUARTZ trial (7). Certainly, further studies are necessary to assess the feasibility and clinical benefit of SRS in PPS patients, mainly to avoid futile therapies and overtreatment in patients with advanced disease. The study of Kubicek et al (1) is a hopeful effort for contributing to this task.