Mansour Mathkour

Primary High-Grade Osteosarcoma of the Clivus: A Case Report and Literature Review.

BACKGROUNDnOsteosarcoma is the second most common primary tumor of the skeletal system and the most common primary bone tumor. Usually occurring at the metaphysis of long bones, osteosarcomas are highly aggressive lesions that comprise osteoid-producing spindle cells. Craniofacial osteosarcomas comprise <8% and are believed to be less aggressive and lower grade. Primary osteosarcomas of the skull and skull base comprise <2% of all skull tumors. Osteosarcomas originating from the clivus are rare. We present a case of a primar, high-grade clival osteosarcoma.nnnCASE DESCRIPTIONnA 29-year-old man presented to our institution with a progressively worsening right frontal headache for 3 weeks. There were no sensory or cranial nerve deficits. Computed tomography revealed a destructive mass involving the clivus with extension into the left sphenoid sinus. Magnetic resonance imaging revealed a homogenously enhancing lesion measuring 2.7xa0× 2.5xa0× 3.2 cm. The patient underwent endonasal transphenoidal surgery for gross total resection. The histopathologic analysis revealed proliferation of malignant-appearing spindled and epithelioid cells with associated osteoclast-like giant cells and a small area of osteoid production. The analysis was consistent with high-grade osteosarcoma. The patient did well and was discharged on postoperative day 2. He was referred for adjuvant radiation therapy and chemotherapy. Two-year follow-up showed postoperative changes and clival expansion caused by packing material.nnnCONCLUSIONSnOsteosarcoma is a highly malignant neoplasm. These lesions are usually found in the extremities; however, they may rarely present in the craniofacial region. Clival osteosarcomas are relatively infrequent. We present a case of a primary clival osteosarcoma with high-grade pathology.

Insular and Sylvian Fissure Dermoid Cyst with Giant Cell Reactivity: Case Report and Review of Literature

BACKGROUNDnDermoid cysts are rare intracranial tumors that are most commonly found infratentorially and along the midline. Characterized by slow growth and often found incidentally, these lesions can nonetheless have severe complications, notably rupture leading to chemical meningitis. They infrequently present as a supratentorial and lateralized mass. As such, sylvian fissure dermoid cysts are exquisitely rare. We present a rare case of a dermoid cyst with giant cell reactivity suggestive of focal rupture and chronic inflammation.nnnCASE DESCRIPTIONnA 61-year-old female presented with new-onset seizures. Magnetic resonance imaging revealed a right insular mass measuring 4.3xa0× 4.5 cm with compression of the ipsilateral frontal and temporal lobes. The mass was nonenhancing; however, it was bright on diffusion-weighted imaging, suggesting a dermoid cyst. She underwent craniotomy for tumor resection. Histologic analysis revealed keratinizing squamous epithelium, sebaceous glands, and hair follicles associated with giant cell reaction involving the capsule of the cyst consisted with dermoid cyst. At 2.5 years post operation, she is seizure free and without evidence of recurrence.nnnCONCLUSIONnThe dermoid cyst in our patient was not grossly ruptured, but histopathologic analysis revealed giant cell reactivity, which may indicate focal rupture or chronic inflammation. The relationship between rupture of dermoid cysts and inflammation is not well elucidated. It is not known whether symptoms occur immediately after rupture or as an acute manifestation of a chronic process following rupture. As these lesions are quite rare and rupture is even rarer, more diligence on our part regarding details of histopathology for dermoid cysts is necessary.

Brain Tumors: Epidemiology and Current Trends in Treatment

Background: Brain tumors represent a group of neoplasms arising from brain tissue, each with their own unique biology, prognosis, and treatment. Included in this group are neoplasms not arising from brain parenchyma, which encompass meningiomas, lymphomas, and metastatic disease from other primary sources (often referred to as secondary brain tumors). Despite the diverse group of neoplasms represented, most intracranial tumors follow similar clinical presentations and diagnostic workups. nMethods: This review focuses on primary and secondary brain tumor epidemiology, imaging, and treatment modalities. In addition, we will highlight molecular genetic advances in the field that will help shape future treatment approaches. nResults: Although tumors affecting the Central Nervous System (CNS) are relatively uncommon, they are often very difficult to treat and cause disproportionate morbidity and mortality. Many of these neoplasms are universally fatal and our ability to treat both benign and malignant tumors is still in its infancy. Our lack of effective treatment leaves many of our patients with few options. nConclusions: The combination of poor prognosis and lack of therapeutic options make further innovation and investigation a priority to improve clinical outcomes for patients suffering from CNS malignancies.

Mini-Open Thoracolumbar Corpectomy: Perioperative Outcomes and Hospital Cost Analysis Compared with Open Corpectomy

BACKGROUNDnStandard open surgical management of thoracolumbar infection, trauma, and tumor is associated with significant morbidity. We compared perioperative and immediate postoperative morbidity of open and mini-open thoracolumbar corpectomy techniques including direct hospital costs.nnnMETHODSnWe retrospectively reviewed medical records of all patients who underwent open or mini-open corpectomy. Demographics (age, sex, body mass index, primary diagnosis), operative data (length of surgery, estimated blood loss, blood transfusion), surgical level, preoperative and postoperative neurologic status (using American Spinal Injury Association Impairment Scale), immediate perioperative complications (within 30 days postoperatively), overall length of stay from admission, length of stay from surgery, and total direct hospital costs were tabulated and analyzed.nnnRESULTSnThe study included 43 patients, 20 (46.51%) undergoing open corpectomy and 23 (53.48%) undergoing mini-open corpectomy. Clinical and statistically significant findings in favor of mini-open corpectomy included lower estimated blood loss (1305 mL vs. 560 mL, Pxa0= 0.0072), less blood transfusion (241 mL vs. 667 mL, Pxa0= 0.029), shorter overall length of stay (7.2 days vs. 12.2 days, Pxa0= 0.047), and shorter surgery time (376 minutes vs. 295 minutes, Pxa0=xa00.035) as well as lower total direct hospital cost (

Endovascular Management of a Ruptured Basilar Perforator Artery Aneurysm Associated with a Pontine Arteriovenous Malformation: Case Report and Review of the Literature

34,373 vs.

Endovascular Management of Multiple Dysplastic Aneurysms in a Young Male With an Unknown Underlying Etiology: A Case Report and Review of the Literature

45,376, Pxa0= 0.044). There was no statistically significant difference in postoperative complications between the 2 groups (medical complications 5% vs. 4.3%, Pxa0= 0.891; surgical complications 5% vs. 8.69%, Pxa0= 0.534).nnnCONCLUSIONSnMini-open TL corpectomy is a safe, cost-effective, clinically effective, and less morbid alternative to standard open thoracotomy surgical techniques.

Primary Intraventricular Leiomyoma in an Immunocompetent Patient: First Case Report and Review of the Literature

BACKGROUNDnArteriovenous malformation (AVM)-associated aneurysms are common, reported in 15% of cases. Regarding the ruptured posterior fossa AVMs, associated aneurysms are present in 48% of cases and are the cause of the bleed in 37%. We present a 75-year-old female who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm arising from a flow-related basilar perforator artery feeder of an anterior pontine AVM. We report the successful treatment of the aneurysm with coil embolization.nnnCASE DESCRIPTIONnA 75-year-old female presented with subarachnoid hemorrhage primarily contained within the posterior fossa. Angiography demonstrated a 2xa0× 3-mm fusiform aneurysm arising from a basilar perforator feeding pedicle of an anterior 1xa0× 2-cm pontine AVM. Venous drainage from the AVM was predominantly to the superior petrosal vein. Under roadmap guidance, super-selective catheterization of the basilar perforator aneurysm was performed. Three HydroSoft 3D coils were deployed within the aneurysm, resulting in complete obliteration. The patient was discharged on postbleed day 15 to an inpatient rehabilitation facility. Follow-up angiography at 5 months demonstrated stable complete obliteration. The patient made a complete recovery and was living independently at the time of this report.nnnCONCLUSIONSnBasilar trunk perforator aneurysms are rare lesions, particularly in the setting of brainstem AVMs. We report successful endovascular treatment of a flow-related ruptured basilar perforator aneurysm associated with an anterior pontine AVM. To the best of our knowledge, this is the second report addressing this scenario. We hope that the information presented here serves to guide future surgical decision making and management.

RARE-52. SACRAL LIPOMATOSIS OF THE NERVE: A RARE CASE PRESENTATION AND LITERATURE REVIEW

BACKGROUNDnIntracranial aneurysms are the leading cause of nontraumatic subarachnoid hemorrhage and are most commonly associated with the anterior cerebral artery (ACA) and anterior communicating artery complex. We describe the presentation and management of a 27-year-old man with concurrent bilateral A1-2 junction aneurysms and fusiform intraorbital ophthalmic artery (OA) aneurysms.nnnCASE DESCRIPTIONnA 27-year-old man with no past medical history presented with 3 months of headaches. Imaging showed a large dysplastic left A1-2 junction aneurysm and a smaller saccular right A1-2 junction aneurysm, with potentially adherent domes. Two fusiform aneurysms of the intraorbital segment of the left OA were also identified. The patient underwent coil-assisted pipeline embolization of the left A1-A2 aneurysm, with complete obliteration and reconstitution of the normal parent vessel. The patient underwent coil embolization of the right A1-2 aneurysm 3 weeks later, which was found to have grown significantly at the time of treatment. Three-month follow-up showed spontaneous resolution of the OA aneurysms, persistent obliteration of the left aneurysm, and significant recurrence of the right aneurysm, which was treated with stent-assisted coil embolization. A second recurrence 3 months later was successfully treated with repeat coiling. At the time of this treatment, the patient was also found to have 2 de novo distal middle cerebral artery and ACA dysplastic aneurysms, which were not treated. Follow-up angiography 6 weeks later showed stable complete obliteration of the right A1-2 aneurysm and interval complete resolution of the dysplastic middle cerebral artery aneurysm. The distal ACA aneurysm was observed to have minimally increased in size; however, the parent vessel showed signs of interval partial thrombosis with contrast stasis within the aneurysm. This final aneurysm is being followed with serial imaging. The patient remains neurologically intact with complete resolution of his headaches.nnnCONCLUSIONSnWe report the case of a young man with no past medical history who presented with multiple dysplastic aneurysms. Successful staged endovascular intervention resulted in obliteration of aneurysms with spontaneous obliteration of the intraorbital OA aneurysms observed at 3 months. We present this case to review the multiple challenges of managing complex ACA aneurysms and to highlight the usefulness of endovascular intervention in their treatment.

RARE-48. PAPILLARY TUMOR OF THE PINEAL REGION IN PEDIATRIC POPULATION ASSOCIATED WITH TRISOMY 21: FIRST CASE REPORT AND LITERATURE REVIEW

BACKGROUNDnPrimary intracranial leiomyoma is an extremely rare occurrence of a low-grade mesenchymal tumor characterized by a proliferation of smooth muscle cells. When present, these lesions predominantly occur in immunocompromised patients in the setting of infection or transplant and have not been known to involve the ventricular system of the brain. In this report, we describe a case of primary leiomyoma of the lateral ventricle in an immunocompetent patient.nnnCASE DESCRIPTIONnA 30-year-old man with no medical history presented with progressive diplopia and occipital headaches. Magnetic resonance imaging of the brain revealed a homogenously enhancing mass of the left lateral ventricle with associated cerebral edema. The patient underwent interhemispheric transcallosal craniotomy for resection for symptom alleviation and surgical diagnosis. Histopathology and immunohistochemistry was subsequently consistent with that of leiomyoma. Genetic probing for Epstein-Barr virus was negative. Computed tomography of the chest and abdomen failed to uncover a primary tumor. The patient did well postoperatively and was discharged 3 days after resection. At a two-and-a-half year follow-up, there continued to be no radiologic or clinical evidence of recurrence.nnnCONCLUSIONSnTo date and to our knowledge, there are fewer than 25 reported cases of primary intracranial leiomyoma, with only 13 occurring in immunocompetent individuals. We believe this is the first report of this tumor type occurring within the ventricular system of the brain. As such, leiomyoma should be considered as a rare etiology in the differential diagnosis of intraventricular lesions.