Edir B. Siqueira

Brain biopsy in tuberculoma: the risks and benefits.

In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.

Meningioma in children: A report of nine cases and review of the literature

BACKGROUND Meningioma is a common tumor of the central nervous system in adults, accounting for 10%-20% of all primary intracranial tumors. It is rare in children, with an incidence of 2.19% (0.85%-2.3%). Although there are numerous case reports in the literature, no firm conclusions can be drawn. For this report we accumulated, reviewed, and analyzed reports in the literature from 1960-93. METHODS A total of 318 patients with meningioma were managed in King Faisal Specialist Hospital and Research Centre from 1981-93. Nine of these patients (2.8%) were children aged 16 years or less. These cases were analyzed retrospectively with regard to age, sex, clinical presentation, radiologic finding, pathologic findings, management and outcome. RESULTS Childhood meningioma represented 2.8% of all meningioma cases and 2.2% of all central nervous system tumors seen in children. There were six males and three females. The average age at presentation was 10.1 years (range 1-16 years). There were four cases of meningioma in the orbit an one each in the temporal region, foramen magnum, tentorial region, subfrontal base, sellar region and ethmoidal air sinus. There were two cases of multiple meningioma. Meningothelial meningioma was the type most frequently seen. CONCLUSION Meningioma is rare in children and males are affected more than females. Tumor locations that are rare in adults are more common in children. The meningothelial type is most frequently seen. Prognosis is poor compared with that in adults, as the tumors tend to grow more rapidly and to a larger size, undergo malignant changes, and have a greater rate of recurrence. Whenever feasible, every effort should be made to achieve total resection of the tumor at the first attempt. If radiation therapy is used in children it should be limited to those who have recurrent tumors so as to minimize organic and psychologic complications.

Fibrosis of the dura mater: A Cause of “Failed Back” Syndrome

Abstract A patient is presented in which a persistent deformity of the dural sac was caused by fibrosis of the dura mater. Postmortem documentation is presented.

Cranial manifestations of aspergillosis

SummaryFive patients with differing forms and severity of cranial aspergillosis illustrate the range of neuroradiologic manifestations as evaluated with angiography, computed tomography and magnetic resonance imaging. Together with the physical findings, these subjects illustrate the dire clinical situation requiring immediate recognition in order to attempt to controll this devastating, treatment resistant pathologic fungal infection.

Cerebral Glioblastomas Can Be Cured

In 1959, a 30-year-old man underwent the removal of a glioblastoma multiforme from the right parietal lobe of his brain. After the operation, he received x-ray therapy. He made a complete recovery. Today, over 25 years later, he is alive and well and is regularly employed full-time. If glioblastomas and other cerebral gliomas are removed completely, the patients can be cured of their tumors.

Neurogenic tumors of the brachial plexus: report of two cases.

Two cases of solitary neurogenic tumors of the brachial plexus unassociated with von Recklinghausens disease are presented. One patient had a malignant schwannoma. The lesion of the other patient was benign and was diagnosed pathologically as a plexiform neurofibroma. These uncommon neurogenic tumors of the brachial plexus unassociated with von Recklinghausens disease pose diagnostic and surgical problems. The initial clinical presentation is usually that of a painless supraclavicular mass. At the time of surgical exploration, the exact site or nerve of origin cannot always be identified. If motor loss is caused by such a tumor of the brachial plexus, it usually indicates a malignant lesion and a poor prognosis. Although wide radical excision of a malignant neurogenic tumor is indicated surgically, one of our patients had an early malignant recurrence that necessitated immediate amputation.

Case Report: Chondroma Arising within a Mixed Glioma*†

A case is reported of a girl who had had 4 suboceipital craniotomies between February, 1957 and July, 1964. The tumor removed at the first two operations was entirely of glial nature (astrocytoma and ependymoma), but at the last two operations the mass contained increasing amounts of cartilaginous tissue. The chondroma appears to have arisen from a transformation of the gliomatous tumor. Such a development has also been reported by others.

Cervical interbody fusion using calf bone

Since 1972, Kiel Surgibone (calf bone) dowels have been inserted in the cervical intervertebral space of 221 patients. The anterior approach was used for cervical interbody fusion. Fusion occurred in every patient who survived long enough for it to occur. No complications occurred that specifically could be attributed to use of this type of grafting material. Kiel surgibone has the advantage of eliminating the need for osteotomy when autologous bone is used or for a bone bank when homologous bone is employed. Kiel Surgibone is supplied sterile and is precisely preshaped.

Case report: idiopathic giant cell granuloma of the hypophysis: an unusual cause of panhypopituitarism.

A 37-year-old man presented with headache and reduced libido. He suffered from panhypopituitarism, and the walls of the pituitary fossa were noted to be thickened, sclerotic, and irregular. Computed tomography scans showed an intrasellar and suprasellar, patchy enhancing tumor. From a biopsy taken at transsphenoidal surgery, a giant cell granuloma was diagnosed, for which there was no obvious cause. Inflammatory disease within the pituitary fossa should be suspected if a reaction is seen in the surrounding bone.

Suprasellar meningioma and blindness: A unique experience in Saudi Arabia

BACKGROUND The natural history of intracranial meningioma is no different in the Arabian peninsula than in other countries. The extent of the total loss of vision in one or both eyes, however, is unique to this area. METHODS A retrospective study was conducted at King Faisal Specialist Hospital and Research Centre, a tertiary care institution in Saudi Arabia, on all cases of intracranial meningioma seen over a period of 9 years. The following data were collated: clinical presentation, site and size of tumor, radiologic features, surgical methods, and preoperative and postoperative visual status. RESULTS Seventy of 232 cases (30.1%) of intracranial meningioma presented in the suprasellar area; the majority of these were more than 5 cm in diameter. Because of the large size it was not always possible to identify the exact point of origin or to achieve complete tumor removal. Deteriorating vision was the cardinal presenting feature and the incidence of blindness in one or both eyes at presentation was high (42.2%); 12.8% were totally blind on admission. None of these patients showed improvement after surgery (complete or subtotal removal of tumor). CONCLUSION Lack of understanding of the symptoms and cultural influences are direct contributing factors to this complication of a benign intracranial lesion. This represents a serious public health concern in the Arabian peninsula.