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Posterior fossa tumors

David Pitskhelauri, Elina Kudieva, Dmitrii Moshchev, Evgeny Ananev, Michail Shifrin, Gleb Danilov, Tatiana Melnikova-Pitskhelauri, Igor Kachkov, Andrey Bykanov, Alexander Sanikidze
OBJECTIVE: A pseudomeningocele and an incisional cerebrospinal fluid leak are considered frequent complications following neurosurgical operations. The rate of these complications especially increases following neurosurgical procedures on the posterior cranial fossae. According to some publications, the rate of pseudomeningoceles has been reported as high as 40%, whereas that of incisional cerebrospinal fluid leaks is up to 17%. For the purposes of reducing the risk of these complications after a midline suboccipital craniotomy, we propose suturing the arachnoid membrane of the cisterna magna...
March 20, 2018: Acta Neurochirurgica
Michael J Link, Morten Lund-Johansen, Christine M Lohse, Colin L W Driscoll, Ehrling Myrseth, Oystein Vesterli Tveiten, Matthew L Carlson
BACKGROUND: The goal of microsurgical removal of a vestibular schwannoma is to completely remove the tumor, to provide long-term durable cure. In many cases, less than gross total resection (GTR) is performed to preserve neurological, and especially facial nerve function. OBJECTIVE: To analyze long-term quality of life (QoL) in a cohort of patients who received either GTR or less than GTR. METHODS: Patients operated for vestibular schwannoma less than 3...
April 1, 2018: Neurosurgery
Gopalakrishnan M Sasidharan
Epidermoid cysts are notorious for their propensity to sneak into deep recesses between cranial nerves in the posterior fossa. Attempts to achieve complete excision using ordinary instruments when tempted by the seeming ease of dissection is known to cause unacceptable deficits. The Xomed monopolar stimulator electrode probe of the nerve integrity electromyography monitor has several advantages when used as the primary dissection tool for deep-seated epidermoid cysts. Cerebellopontine angle epidermoid is the classical prototype of a strategically placed deep-seated epidermoid tumor...
January 12, 2018: Curēus
Khaled Elshazly, Varun R Kshettry, Christopher J Farrell, Gurston Nyquist, Marc Rosen, James J Evans
BACKGROUND: Giant pituitary adenomas represent a surgical challenge. We present the results of the endoscopic endonasal approach (EEA) for giant pituitary adenomas. METHODS: We retrospectively reviewed medical records of 55 patients with giant pituitary adenomas (> 4 cm in maximum diameter) that underwent an EEA from 2008 - 2016. Factors affecting the extent of resection (EOR) were evaluated. RESULTS: Mean age was 55.5 years. All tumors were non-functional except in four patients (GH-secreting [2], ACTH-secreting [1], prolactinoma [1])...
March 12, 2018: World Neurosurgery
M A Akulov, O R Orlova, T V Tabashnikova, V V Karnaukhov, A S Orlova
Surgical treatment of posterior cranial fossa and cerebellopontine angle tumors is associated with a risk of facial nerve dysfunction. The causes for facial muscle paresis include nerve compression by the tumor, destruction of the nerve structure by the tumor growing from nerve fibers, nerve injury during surgical removal of the tumor, etc. The first 3 months after facial nerve injury are a potential therapeutic window for the use of botulinum toxin type A (BTA). During this period, the drug is introduced both in the healthy side to improve the facial symmetry at rest and during mimetic movements and in the affected side to induce drug-induced ptosis...
2018: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Ali Harati, Rolf Schultheiß, Stefan Rohde, Thomas Deitmer
BACKGROUND: Jugulotympanic paraganglioma (JTP) are benign, high-vascularized lesions that frequently invade the jugular foramen, temporal bone, the upper neck, and the posterior fossa cavity, resulting in a wide variety of clinical symptoms. METHODS: In this retrospective study, we assess the clinical symptoms and discuss the individual multidisciplinary treatment and outcome of 22 patients with JTP. RESULTS: In 12 patients, a hearing deficit was the presenting symptom, whereas pulsatile tinnitus and otalgia were present in six and four patients respectively...
March 10, 2018: Journal of Clinical Medicine
Balagangadhar R Totapally, Ashish H Shah, Toba Niazi
OBJECTIVE: Posterior fossa tumor surgery in children poses a significant morbidity and mortality. Large multi-institutional datasets characterizing the epidemiology and morbidity of children undergoing posterior fossa tumor surgery are lacking. The objective of this study is to describe the epidemiology and short term surgical outcomes of children presenting with cerebellar tumors. PATIENTS AND METHODS: A retrospective review of the Kids Inpatient Database (KID) for all hospital discharges in 2012 with a diagnosis of cerebellar tumor (ICD-9 diagnosis code 191...
February 26, 2018: Clinical Neurology and Neurosurgery
Alexandre Bossi Todeschini, Alaa S Montaser, Douglas A Hardesty, Ricardo L Carrau, Daniel M Prevedello
Endoscopic endonasal approaches (EEA) have gained popularity and acceptance in skull base surgery over the last two decades. So-called expanded EEA allow access in the sagittal plane from the frontal sinus to the odontoid process. The endoscopic endonasal transclival approach allows a unique trajectory into the midline clivus and skull base that is unachievable from traditional craniotomy approaches to lesions such as chondrosarcomas, chordomas, and posterior fossa meningiomas. In this review, we will assess the benefits and drawbacks to using an endoscopic endonasal approach versus transcranial approach to these challenging lesions, assess the anatomical limits of endoscopic endonasal transclival surgery, and discuss the published literature on the topic...
March 8, 2018: Journal of Neurosurgical Sciences
Felipe de Oliveira, José Alberto Landeiro, Igor de Castro
Background: Medulloblastoma is an embryonal neoplasm and accounts for 1% of all adult intracranial tumors. It is associated with many familiar cancer syndromes, but there is no known cause for medulloblastoma. Many studies have documented differences between childhood and adult medulloblastomas in terms of location, proliferation, and apoptotic indices. There are four histological groups - classic and the variant forms (desmoplastic/nodular, anaplasic, and large cell). There are four major subgroups according to molecular configuration: wingless (WNT), sonic hedgehog (SHH), group 3, and group 4 with differences between them according to prognostic outcomes...
2018: Surgical Neurology International
Sofiene Bouali, Nidhal Maatar, Alia Zehani, Maha Mahmoud, Jalel Kallel, Hafedh Jemel
Background: Anaplastic posterior fossa ganglioglioma in adults is exceedingly rare. To date, only one case of adult anaplastic posterior fossa ganglioglioma has been reported in the English literature and none has been described at the cerebellum. To our knowledge, this report is the third case of malignant posterior fossa ganglioglioma in adults and the first at the cerebellum. In general, this entity can be misdiagnosed preoperatively as a primary posterior fossa neoplasm, and by reporting our clinical and radiographic observations we want to add to the existing literature on this rare entity...
2018: Surgical Neurology International
Sreedharan Thankarajan Arunraj, Girish Kumar Parida, Nishikant Avinash Damle, Saurabh Arora, Sreenivasa Reddy, Dhritiman Chakraborty, Meghna Prabhu, Madhavi Tripathi, Chandrasekhar Bal
Medulloblastoma, also known as cerebellar primitive neuroectodermal tumor, is the most common brain tumor in children and arises in the posterior cranial fossa. We present the case of a patient with desmoplastic type of medulloblastoma, which showed recurrence more than once. When Ga-DOTANOC PET-CT was done, the lesions showed somatostatin receptor expression, opening another potential therapeutic option for this patient.
February 27, 2018: Clinical Nuclear Medicine
Sascha Marx, Maresa Reinfelder, Marc Matthes, Henry W S Schroeder, Joerg Baldauf
BACKGROUND: There is paucity of information about the frequency of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients and about the best way it should be managed. The present study was conducted to determine the frequency of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients as well as the value of an endoscopic third ventriculostomy (ETV) prior to posterior fossa tumor surgery with regard to the rate of perioperative complications and persistent hydrocephalus...
February 17, 2018: Acta Neurochirurgica
Michelle S Gentile, Beow Y Yeap, Harald Paganetti, Claire P Goebel, Dillon E Gaudet, Sara L Gallotto, Elizabeth A Weyman, Michael L Morgan, Shannon M MacDonald, Drosoula Giantsoudi, Judith Adams, Nancy J Tarbell, Hanne Kooy, Torunn I Yock
PURPOSE: Proton radiation therapy is commonly used in young children with brain tumors for its potential to reduce late effects. However, some proton series report higher rates of brainstem injury (0%-16%) than most photon series (2.2%-8.6%). We report the incidence of brainstem injury and a risk factor analysis in pediatric patients with posterior fossa primary tumors treated with proton radiation therapy at our institution. METHODS AND MATERIALS: The study included 216 consecutive patients treated between 2000 and 2015...
March 1, 2018: International Journal of Radiation Oncology, Biology, Physics
Aijun Liang, Bin Xi, Chaoyang Zhou, Yu Yang, Jianzhong Zhang, Shaogao Gui, Fanghua Xu, Dengfeng Wan
Although benign trigeminal schwannomas are uncommon, malignant peripheral nerve sheath tumors (MPNSTs) of the trigeminal nerve are extraordinarily rare. This study aimed to describe an exceedingly rare case of MPNST of the trigeminal nerve involving the middle and posterior cranial fossa. Only 20 similar cases of MPNSTs of the trigeminal nerve have been reported so far. The clinical characteristics and management of these extremely rare tumors have also been explored in this study.
February 2, 2018: World Neurosurgery
Sachin Ranganatha Goudihalli, Hiroki Morisako, Wimba Prastarana, Takeo Goto, Hiroki Ohata, Kenji Ohata
Retrochiasmatic craniopharyngiomas (RC) are a challenge for the neurosurgeon to treat surgically, restrained by their location in the interpeduncular fossa, surrounded by vital neurovascular structures, narrow corridor and poor visibility. Many approaches are possible and elucidated in the literature, which the surgeon chooses, based on multiple factors, such as the size of tumor, calcification, laterality, preoperative neurological deficits and the endocrine function status, recurrence, postradiotherapy status, or significant superior and/or posterior extension...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Bette K Kleinschmidt-DeMasters, Jean M Mulcahy Levy
BACKGROUND: H3 K27M mutation was originally described in pediatric diffuse intrinsic pontine gliomas (DIPGs), but has been recently recognized to occur also in adult midline diffuse gliomas, as well as midline tumors with other morphologies, including gangliogliomas (GGs), anaplastic GGs, pilocytic astrocytomas (PAs), and posterior fossa ependymomas. In a few patients with H3 K27M-mutant tumors with these alternate morphologies, longer survival has been reported, making grading difficult for the neuropathologist...
February 2, 2018: Clinical Neuropathology
Fei Wang, Shiying Ling
BACKGROUND: and Importance Primary meningeal melanocytoma (PMM) is a benign lesion in the central nervous system derived from leptomeningeal melanocytes, most commonly growing in the posterior fossa and cervical spinal cord. The primary sellar melanocytoma is an exceptionally rare tumor. The authors reported the ninth published case of a sellar primary meningeal melanocytoma (SPMM). CLINICAL PRESENTATION: The patient presented only with visual impairment and irregular menstruation without other symptoms...
January 27, 2018: World Neurosurgery
Mehmet Resid Onen, Kelli Moore, Ulas Cikla, Melih Ucer, Bradley Schmidt, Aaron S Field, Mustafa K Baskaya
INTRODUCTION: Hypertrophic olivary degeneration (HOD) occurs as a result of posterior fossa or brainstem lesions that disrupt the dentato-rubro-olivary tract, well known as the Guillain-Mollaret triangle. Clinical and radiological hallmarks of this condition are palatal myoclonus and T2 hyperintensity of the inferior olivary complex on MRI, respectively. Since symptomatic HOD may complicate the recovery of patients with posterior fossa or brainstem lesions, the purpose of this study is to evaluate clinical and imaging findings of patients with HOD...
January 27, 2018: World Neurosurgery
Banu Atalar, Mahmut Ozsahin, Jason Call, Aleksandra Napieralska, Serra Kamer, Salvador Villa, Petek Erpolat, Laura Negretti, Yasmin Lassen-Ramshad, Cem Onal, Serap Akyurek, Gamze Ugurluer, Brigitta G Baumert, Stephanie Servagi-Vernat, Robert C Miller, Enis Ozyar, Terence T Sio
BACKGROUND AND PURPOSE: The optimal treatment for adults with newly diagnosed medulloblastoma (MB) has not been defined. We report a large series of cases from the Rare Cancer Network. MATERIAL AND METHODS: Thirteen institutions enrolled 206 MB patients who underwent postoperative radiotherapy (RT) between 1976 and 2014. Log-rank univariate and Cox-modeled multivariate analyses were used to analyze data collected. RESULTS: Median patient age was 29 years; follow-up was 31 months...
January 17, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Arnold C Paulino, Anita Mahajan, Rong Ye, David R Grosshans, M Fatih Okcu, Jack Su, Mary Frances McAleer, Susan McGovern, Victor A Mangona, Murali Chintagumpala
PURPOSE: To compare ototoxicity rates between medulloblastoma patients treated with protons vs. photons. MATERIALS AND METHODS: The study included 84 children diagnosed with medulloblastoma treated with either passively scattered protons (n = 38) or photons (n = 46). Patients underwent maximal safe resection followed by craniospinal irradiation, posterior fossa and/or tumor bed boost and chemotherapy according to one of 3 multi-institutional trials. Median audiogram follow-up was 56 months for protons and 66 months for photons...
January 17, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
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