Shu Jiang

Three risk factors for WHO grade II and III meningiomas: A study of 1737 cases from a single center

BACKGROUNDnMeningiomas account for 35.5% of central nervous system (CNS) tumors, of which 21-37.8% are atypical or anaplastic/malignant. High-grade meningiomas have higher rates of recurrence and worse outcome than grade I/II meningiomas. Thus, it is of importance to assess the tumor biology before treatment initiation.nnnMATERIALS AND METHODSnThis study reviewed 1737 patients with histologically confirmed meningioma at a single institution. Meningiomas were classified according to World Health Organization (WHO) 2007 grading and the location of the tumor was confirmed from the operation records and preoperative imaging. Univariate and multivariate logistic regression were used to analyze the potential risk factors for high-grade pathology.nnnRESULTSnYoung men and pediatric patients were less likely to have meningioma, but they had high-grade meningioma. Tumors originated from non-skull base and lateral intracranial are more likely to be grade II/III meningioma.nnnCONCLUSIONSnLateral and non-skull base location, male sex, and the younger patients increase the risk for grade II and III pathology. These factors should be considered while deciding treatment choice, surgical resection, and prognosis as well.

Combined gangliocytoma and non-functioning pituitary adenoma of the pituitary gland

311 Neurology India | May-Jun 2012 | Vol 60 | Issue 3 pituitary adenomas develop, are also derived from the cells of Rathke’s pouch. Although RCC and pituitary adenoma have a shared ancestry, they rarely occur together. Common symptoms of RCC are headache, visual disturbance, hypopituitarism, and hypothalamic dysfunction. Other rare symptoms include decreased libido, impotence, and diabetes insipidus.[3] When RCC and pituitary adenoma are found together, symptoms of mass effect may be accompanied by hormonal changes caused by the functioning tumor as in this patient. MRI is the modality of choice in detecting RCC. MRI also helps to diagnose the coexisting RCC and pituitary adenoma. RCCs almost always are homogeneous in signal intensity, whereas other lesions, such as cystic craniopharyngiomas and hemorrhagic adenomas, more frequently have heterogeneous signal intensity. Kunii et al.[4] concluded that singleshot fast spin-echo (SSFSE), diffusion-weighted MR imaging (DWI) with apparent diffusion coefficient (ADC) can be employed in the differentiation of RCCs from craniopharyngiomas and hemorrhagic pituitary adenomas. Some cases may be mistakenly diagnosed as arachnoid cyst, craniopharyngioma, and pituitary apoplexy. A combination of clinical, biochemical, and radiographic findings must be used to establish a diagnosis of RCC and the histologic examination seems to be much more important. Pituitary adenoma can be easily diagnosed by histologic examination of the resected mass. Most RCC have cuboidal or columnar epithelium and ciliated epithelium. But some researchers note that 12% of RCC displayed stratified squamous epithelium, a characteristic feature commonly associated with craniopharyngioma.[5] Decompression and biopsy may represent the optimal surgical management of RCC, with low morbidity rates; this patient underwent a transsphenoidal approach, where we excised not only the adenoma but also the Rathke’s cleft cyst at one go. The recurrence rate during postoperative follow-up can be up to 19%. [5]

Fourth ventricle glioblastoma

Glioblastoma (GB), the most common and malignant primary erebral tumor, accounts for approximately 15% of all intracranial eoplasm in adults [1]. It usually occurs in the cerebral hemipheres. GB (World Health Organization grade IV) located within he fourth ventricle is extremely rare. To the best of our knowldge, there has been little discussion on GB arising from the specific natomic location. In this paper, we report a patient with GB arising rom the brainstem with an exophytic growth pattern to the fourth entricle.

Meningioma of the fourth ventricle with exceptional growth pattern.

A 23-year-old male was referred to our department with a 1ear history of intermittent headache and hearing loss on the left ar. His neurological examination mainly demonstrated left-sided II, VIII and partial lower cranial nerve palsies. Computed tomograhy (CT) scan showed a mixed-dense mass lesion locating in both he fourth ventricle and left cerebellopontine angle (CPA) region Fig. 1). Magnetic resonance imaging (MRI) revealed the homogeously enhanced and dumbbell-shaped mass with flow void signal n the fourth ventricle and left CPA, mild obstructive hydrocephalus nd significant brain stem compression (Fig. 2). Computed tomoraphy angiography (CTA) and digital subtraction angiography DSA) demonstrated a clump of blood vessels of which the supply-

A retrospective review of 34 cases of pediatric pituitary adenoma

PurposeThe purpose of this paper is to study invasiveness, tumor features and clinical symptoms of pediatric pituitary adenoma, and to discuss some inconclusive results in prior studies.MethodsWe retrospectively reviewed 34 cases of children (<20xa0year-old) who were pathologically diagnosed with pituitary adenoma and surgically treated from 2010 to 2017. Data of general information, clinical symptoms, invasive behaviors, surgery approaches, and tumor features were collected and analyzed.ResultsSixteen boys and 18 girls aged from 12 to 19xa0years old were included. Prolactinoma was most suffered, followed by GH-, none- and ACTH-secreting pituitary adenoma. Invasive behaviors were observed frequently and suprasellar extensions were most found. Macroadenoma account 70% of all cases. Meanwhile, unlike prior studies, a significant raise of incidence on invasive tumor and pituitary adenoma apoplexy were observed. Craniotomy and transsphenoidal surgery were both applied with zero mortality. Nine cases occurred with transient hypopituitarism and diabetes insipidus. Three cases of tumor recurrence received secondary surgery or radiotherapy.ConclusionsInvasive behaviors were more frequent than previous prediction. Craniotomy is worth considering for total tumor removal. Pituitary adenoma apoplexy needs further studies since its different features between children and adults in present study. Specialized care and teamwork of neurosurgeons, pediatricians, and endocrinologists are important.

Ruptured Anterior Communicating Artery Aneurysm With Untreated Craniopharyngioma: A Case Report

Coexistence of intracranial aneurysm and craniopharyngioma has been reported in several patients who have undergone postoperative radiotherapy. However, we present an extremely rare case of ruptured aneurysm of anterior communicating artery (AComA) complicating with naive craniopharyngioma. The blood supply of A2 segment of left anterior cerebral artery was mainly from the right side through AComA in digital subtraction angiography. We suggest that by pressing the A1 segment of left anterior cerebral artery, the tumor imposed heavy burden to the AComA, which promoted the genesis and rupture of this aneurysm.

Multidisciplinary treatment of a giant craniofacial neurofibroma with intratumoral hemorrhage

A 19-year-old man presented with a rapidly growing right craniofacial lump and headache for 9 days, with vision loss in the right eye and no other manifestation of neurofibromatosis or neurologic disturbance. Imaging revealed a giant lesion with intratumoral hematoma and adjacent bone dysplasia (figure, A and B). The tumor and the involved right eye (figure, C) were removed following preoperative embolization. The wound was repaired using dorsal and lateral cervicothoracic flap grafting. Pathologic examination revealed a neurofibroma without malignant transformation.1 Solitary giant craniofacial neurofibromas with intratumoral hemorrhage are rare and require multidisciplinary care2 for optimal outcome (figure, D). Early intervention is preferable.

A refractory lower extremity variceal ulcer associated with perimedullary arteriovenous fistula

A 16-year-old male presented with a 3-year history of bilateral lower limb paresthesia and a refractory ulcer next to the swollen right medial malleolus (figure 1A). Lumbar MRI revealed a spinal vascular malformation (figure 2A). Digital subtraction angiography demonstrated a giant perimedullary arteriovenous fistula (PMAVF)1 originating from an anterior spinal artery at T10-11, draining into the inferior vena cava, and a few vascular malformations involving the right ankle (figure 2, B–F). Combination surgery and embolization was successfully performed for the PMAVF. Of note, the ulcer resolved without any direct treatment within 7 days (figure 1B).