Mohamed Badri

Hemangiopericytoma of the Cerebellopontine Angle: A Wolf in Sheep's Clothing.

Primary meningeal hemangiopericytoma (HPC) is a rare, aggressive dura based tumor that remarkably mimics a meningioma clinically and radiologically. Its occurrence within the cerebellopontine angle (CPA) is exceptional, and establishing the exact diagnosis is of the utmost importance since total resection remains the cornerstone of treatment. A 42-year-old man presented with a three-month history of progressively worsening vertigo and difficulty in walking. On admission, his neurological examination revealed a right peripheral facial palsy, right abducens palsy and left hemiparesis, suggesting the diagnosis of Millard-Gubler syndrome. Computed tomography and magnetic resonance imaging demonstrated a homogeneously enhancing dura based lesion of the right CPA causing major brain stem compression. There was no widening of the ipsilateral internal auditory canal. A standard retrosigmoid craniotomy was performed to access the right CPA. Exposure of the lesion revealed a well-encapsulated, gray, fibrous lesion, which appeared to originate from the tentorium. Gross total resection was achieved and confirmed radiologically. The microscopic features and the immunohistochemical profile confirmed the diagnosis of a HPC, and adjuvant radiation therapy was administered. Ten years later, the patient presented with a severe neurological deficit due to a local recurrence, but at that time refused any second intervention. He died three months later. HPC can locate within the CPA and present as a Millard-Gubler syndrome. The diagnosis should be kept in mind in case of a CPA dura based tumor. Radical surgery plus radiation therapy can maximize the recurrence-free survival and close follow-up remains mandatory to spot recurrences early.

Cervicothoracic syringomyelia caused by cervical spinal stenosis: Case report and literature review

Background: Syringomyelia is commonly associated with Chiari malformations, spinal trauma, arachnoiditis, or tumors. However, rarely, cervical canal stenosis is implicated in intramedullary cavitations. Case Discription: Here, we report the case of a 60-year-old male patient who presented with loss of pain and temperature sensation in upper extremities associated with a spastic tetraparesis. On magnetic resonance imaging, the patient was found to have syringomyelia extending from C1 to Th3. Following posterior decompressive surgery, the syrinx resolved along with the patients neurological complaints. Conclusion: Here, the authors presented a case and reviewed the literature regarding how cervical spinal stenosis may contribute to cervical or thoracic syringomyelia.

Atypical imaging features of posterior fossa's dermoid cyst: Case report and review of literature

Background: Intracranial dermoid cysts are uncommon lesions with characteristic imaging appearances. Symptomatic clinical presentation usually occurs in one of two ways: mass effect or rupture. Radiologically, dermoid cysts typically present as low density masses on computed tomography (CT) scan and are generally hyperintense on T1-weighted magnetic resonance imaging (MRI) sequences with variable signal on T2-weighted sequences. Case Description: We present the case of a 35-year-old female presented with symptoms of increased intracranial pressure. Radiological investigations showed a cystic posterior fossa tumor that was not only hyperdense on CT scans but also hypointense on MRI T1-weighted images. The patient underwent a total-gross resection of an extra-parenchymal posterior fossa tumor. Pathologic examination of the specimen concluded to dermoid cyst. Conclusion: Dermoid cyst of the posterior fossa is a benign lesion surgically treatable. Only an appropriate radiological diagnosis of this lesion would permit a well-targeted therapeutic approach.

A Rare Complication of Chronic Subdural Hematoma Evacuation: Brain Stem Hemorrhage: A Case Report

Abstract Chronic subdural hematoma (CSDH), which commonly affects the elderly, is one of the most frequent, but also benign neurosurgical pathologies. Burr hole drainage is the standard surgical modality for evacuation of a CSDH. This technique is known to be safe, with low morbidity and mortality rates. However, postoperative complications have occasionally been reported. We report the case of a 70-year-old man who presented a fatal brain stem hemorrhage after burr-hole drainage for unilateral chronic subdural hematoma. Asymmetrical and rapid decompression were thought to be leading to vascular disruption or sudden increase in cerebral blood flow, was probably responsible for the secondary brain stem bleeding. Therefore, a slow rate of evacuation of chronic subdural hematomas, as well as rigorous postoperative reanimation, are recommended in order to prevent serious complications.

Transoral migration of the inferior end of a ventriculoperitoneal shunt: A case report with literature review

Ventriculoperitoneal (VP) shunt surgery is the most widely used technique for the treatment of hydrocephalus. However, it can incur certain complications. Beside frequent complications (infection, obstruction), migration of the peritoneal catheter is a rare but dangerous complication. This report presents the case of a 4-year-old boy who had undergone VP shunt for hydrocephalus. One month later, the patient presented with protrusion of the peritoneal catheter through his mouth. He underwent another procedure to remove the peritoneal catheter, retaining the original ventricular catheter and valve chamber. Progression was favorable. To the best of our knowledge, only 7 cases of VP shunt transoral extrusion were reported, but many risk factors were identified. Bowel perforation is a serious complication of VP shunt surgery, sometimes leading to fatal outcome.

Skull metastasis revealing a renal tumor: A case report and review of the literature

Highlights • Skull metastases are rare forms of manifestations of renal tumors.• Any unusual lesion of the skull should be thoroughly evaluated whether the patient has a prior history of cancer or not.• Treatment of metastatic renal cell carcinoma is complex, and the optimal regimen for achieving a lasting response without severe toxicity has not yet been defined.

Cerebellar metastasis of gastrointestinal stromal tumor: A case report and review of the literature

Highlights • Brain metastases are rare forms of manifestations of gastro-intestinal stromal tumors.• Brain metastases of gastro-intestinal stromal tumors are usually supra-tentorial. Infra-tentorial localizations are very rare.• The treatment is based on surgery and radiotherapy. Chemotherapy has only limited interest.

Transventricular endoscopic management of a suprasellar arachnoid cyst causing precocious puberty.

Suprasellar cysts arachnoid cysts (SSAC) are relatively uncommon making up less than 2% of all arachnoid cysts. Suprasellar arachnoid cyst causing precocious puberty is infrequent. The pathogenesis remains unknown in the majority of patients with precocious puberty. Endoscopic ventriculocystocisternostomy procedure is an effective and minimally invasive method in the treatment of these cysts. This report describes a 7-year old male who had a huge intracranial arachnoid cyst with initial symptoms and signs of sexual precocity. Magnetic resonance image (MRI) of the brain revealed the presence of large suprasellar cystic lesion. Case Study Badri et al.; BJMMR, 7(9): 795-800, 2015; Article no.BJMMR.2015.390 796