Showing papers in "Neurologia Medico-chirurgica in 1986"
TL;DR: The literature is reviewed regarding perforation of various viscera by peritoneal catheters of ventriculo-peritoneal shunts, and the possible causative mechanism of migration of a peritoneals catheter into the thoracic cavity by perforations through the diaphragm is discussed.
Abstract: A rare complication, migration of the peritoneal catheter of a ventriculo-peritoneal shunt, is reported. The patient was a 23-year-old female who had a ventriculo-peritoneal shunt installed at the age of 19 years, for her hydrocephalus secondary to tuberculous meningitis. The patient had 3 days' history of seizure and recurrent bouts of fever. A plain chest X-ray revealed the tip of the peritoneal catheter in the right hilar area with local pneumonitis. Metrizamide shuntgram revealed seepage of the contrast material into the right lower thoracic cavity. A computed tomography scan of the thorax confirmed the presence of the tip of the catheter in the right hilar area, and the site of entry into the thoracic cavity was identified as the anterior portion of the right diaphragm. The patient underwent shunt revision and the peritoneal catheter was repositioned into the peritoneal cavity. Among various complications related to peritoneal catheters of ventriculo-peritoneal shunts, migration of a peritoneal catheter into the thoracic cavity by perforation through the diaphragm is extremely rare. The literature is reviewed regarding perforation of various viscera by peritoneal catheters of ventriculo-peritoneal shunts, and the possible causative mechanism of migration of a peritoneal catheter into the thoracic cavity is discussed. Although there is no consensus regarding the optimal length of a peritoneal catheter, unnecessarily long peritoneal catheters should be avoided.
18 citations
TL;DR: Cerebral blood flow was markedly decreased in both hemispheres disproportionally to the small size of the hemorrhages, probably due to a bilateral “diaschisis phenomenon, ” and the patient experienced severe neurological sequelae.
Abstract: A 45-year-old male suffered from bilateral putaminal hemorrhages that occurred simultaneously, followed by pseudo-bulbar palsy Administration of anticoagulants appeared to have caused the bleeding Cerebral blood flow was markedly decreased in both hemispheres disproportionally to the small size of the hemorrhages, probably due to a bilateral “diaschisis phenomenon, ” and the patient experienced severe neurological sequelae
16 citations
TL;DR: It was found that the intradermal brain tumors were completely diminished within 4 weeks by single local hyperthermia at 45 degrees C for 60 min.
Abstract: Experimental study was made on magnetic induction hyperthermia for brain tumor using ferromagnetic implant with low Curie temperature. Thermoseed (implant) was made of nickel-palladium alloy, which was confirmed to produce enough heat by eddy current and also to have low Curie point between 43 °C–58 °C. Using this implant heating system, the effect of hyperthermia on normal rat brain and intracutaneously innoculated rat gliosarcoma (T9) were studied. Heat conduction from seed was twice as much in tumor tissue as in normal brain. It was also found that the intradermal brain tumors were completely diminished within 4 weeks by single local hyperthermia at 45 °C for 60 min.
16 citations
TL;DR: Gross total removal of intramedullary tumors is technically feasible and compatible with neurological recovery, and these disease processes may span not only years but decades, long-term follow-up is inevitable.
Abstract: The authors have treated 14 cases of intramedullary spinal cord tumors (5 astrocytomas, 2 ependymomas, 5 hemangioblastomas, 1 dermoid, and 1 lipoma) during the past 12 years. They have analyzed their early and late results of surgical treatment, with follow-up periods ranging from 3 months to 10 years and 3 months. These tumors were treated according to the principle of radical resection using microsurgical techniques. Of the 14 patients, total removal of tumors was performed in 9 patients, subtotal removal in 4 patients, and only biopsy removal in 1 patient. Guidetti's criteria was adopted for assessing the results of surgery. Long-term results in the cases were as follows: 6 were very good, 2 were good, 3 were fair, and 2 were poor. One patient had a glioblastoma multiforme and died 1 month following decompressive surgery with biopsy and postoperative radiotherapy. Gross total removal of intramedullary tumors is technically feasible and compatible with neurological recovery. Since the majority of intramedullary tumors are benign and these disease processes may span not only years but decades, long-term follow-up is inevitable.
15 citations
TL;DR: It is strongly suggested that the amyloid in pituitary adenoma is a kind of AE protein and of hormonal origin and Serum hormonal level, radiation, and bromocriptine therapies might not contribute to amyloids deposits.
Abstract: Amyloid deposits in three functioning human pituitary adenomas (two prolactin (PRL) -secreting and one growth hormone (GH)-secreting) were studied by immunohistochemical techniques. Histological diagnosis was mixed pituitary adenoma in all cases. The amyloid deposits of all cases were negative for GH, AA protein, Aκ, Aλ, and γ-trace, but the amyloid deposits of two cases were strongly positive for PRL. Most cells surrounding amyloid were negative for all antibodies but a few cells were positive for PRL. From these findings, it was strongly suggested that the amyloid in pituitary adenoma is a kind of AE protein and of hormonal origin. Serum hormonal level, radiation, and bromocriptine therapies might not contribute to amyloid deposits.
14 citations
TL;DR: Therapeutic embolization for meningiomas and other highly vascular intracranial tumors has been established as a useful and relatively safe adjunctive preoperative measure, and an intratumoral massive hemorrhage in the period immediately following this procedure has seldom been reported in the literature.
Abstract: A 63-year-old female with a large meningioma of the middle cranial fossa was admitted. The tumor was fed mainly by the hypertrophied middle meningeal artery. Immediately following a seemingly successful embolization of that artery with gelfoam powder, consciousness of the patient rapidly declined and anisocoria and decerebrate posturing developed. An intratumoral massive hemorrhage ruptured into and extended widely in the subdural space was confirmed by computed tomography scan. The hematoma was evacuated and the tumor was radically removed by emergency craniotomy, and the patient recovered. Therapeutic embolization for meningiomas and other highly vascular intracranial tumors has been established as a useful and relatively safe adjunctive preoperative measure, and an intratumoral massive hemorrhage in the period immediately following this procedure has seldom been reported in the literature. However, the present case shows that it is apparently a potential complication of this procedure. The possible mechanisms of an intratumoral hemorrhage following therapeutic embolization of the feeding arteries are briefly discussed.
13 citations
TL;DR: After a thorough review of the literature, a 4-year-old female patient underwent surgery for an enterogenous cyst of the cervical spinal canal and a portion of the cyst wall was excised for histological and electron microscopic evaluation.
Abstract: A 4-year-old female patient underwent surgery for an enterogenous cyst of the cervical spinal canal. The cyst fluid was drained and a portion of the cyst wall was excised for histological and electron microscopic evaluation. Nine months after surgery the patient was doing well, with no signs of recurrence. Enterogenous cysts may be confused with ependymal cysts. After a thorough review of the literature, we based our diagnosis of enterogenous cyst on the results of periodic acid-Schiff staining and electron microscopic findings.
13 citations
TL;DR: The results were that the anastomotic orifice should be larger than twice the vessel diameter, and that the anterior wall should be sutured interruptedly.
Abstract: Side-to-side anastomosis is rarely performed by neurosurgeons, and the best conditions for microvascular side-to-side anastomosis are still unknown. To discover which conditions maximize blood flow through the anastomosis, side-to-side anastomosis between bilateral common carotid arteries was studied in 25 rats. The results were that the anastomotic orifice should be larger than twice the vessel diameter, and that the anterior wall should be sutured interruptedly. As clinical applications for side-to-side anastomosis, revascularization of the anterior cerebral artery (ACA) using inter-ACA anastomosis was performed in two patients with excellent results.
12 citations
TL;DR: The present case had a subarachnoid hemorrhage at the age of 23 years, which could have attributed to the rupture of the dural AVM found at theage of 52 years, thus resulting in intracranial hemorrhage.
Abstract: The patient is a 52-year-old man referred with an episode of loss of consciousness. His medical history showed a similar episode 30 years ago, with bloody cerebrospinal fluid. However, the etiology of the subarachnoid hemorrhage was not then established. He had been in good health until he experienced the loss of consciousness in August, 1980. Neurological and physical examinations were normal. Contrast-enhanced computerized tomography demonstrated an irregular linear density in the right anterior cranial base. Angiography revealed an arteriovenous malformation (AVM) in the anterior cranial base, fed by the anterior and posterior ethmoidal arteries, and draining into the olfactory and uncal veins via a dilated vascular sac. The diagnosis of dural AVM was made. A right frontal craniotomy was performed. Many feeding vessels penetrating the anterior cranial base were identified and coagulated. The dilated vascular sac on and in the dura mater was totally removed en-bloc with draining veins. Histologically, the wall of the vascular sac was thickened and degenerated. There were no angiomatous components. The postoperative course was uneventful, and an angiography revealed complete disappearance of the AVM. Only 17 patients with dural AVM in the anterior fossa are found in the literature. Most of them are male, and all are over 40 years old (average: 54 years). The present case had a subarachnoid hemorrhage at the age of 23 years, which could have attributed to the rupture of the dural AVM found at the age of 52 years. The most remarkable characteristic of dural AVMs in this location is the frequent finding of a dilated vascular sac which often ruptures, thus resulting in intracranial hemorrhage.
12 citations
TL;DR: The authors emphasize that SAH as initial symptom and hypertension as predisposition occur more frequently in vertebro-basilar dissecting aneurysms than previously described.
Abstract: An autopsy case of intracranial vertebral dissecting aneurysm associated with medial mucoid degeneration is reported and 54 cases of vertebro-basilar dissecting aneurysm in the literature are reviewed. A 37-year-old man with history of hypertension was admitted in a semicomatose state. Computed tomographic scan showed severe subarachnoid hemorrhage (SAH), especially in the posterior fossa with ventricular reflux, and vertebral angiography disclosed a fusiform dilatation with proximal narrowing of the left vertebral artery and narrowing in the midportion of the basilar artery. Continuous ventricular drainage was performed, but the patient died from rebleeding on the 14th hospital day. Autopsy revealed massive SAH around the brain stem and a fusiform aneurysm of the left vertebral artery. Microscopic examination demonstrated a local thickening of the wall with tearing of the intima and the media. A hematoma between the media and the adventitia communicated with the true lumen of the artery. The muscular layer was replaced by myxomatous connective tissue. The basilar artery had mild fibrous thickening of the intima and duplication of the internal elastica. The medial mucoid degeneration was discovered by iron-colloid stain in the intracranial arteries, especially in the vertebro-basilar system. However, arteriosclerotic change was minimal. The authors emphasize that SAH as initial symptom and hypertension as predisposition occur more frequently in vertebro-basilar dissecting aneurysms than previously described.
12 citations
TL;DR: The authors describe two criteria in current use for evaluating the direct effect of a treatment on brain tumors following the criteria for evaluating patients with a solid tumor and their role is discussed.
Abstract: The authors describe two criteria in current use for evaluating the direct effect of a treatment on brain tumors. One of them has been made by authors following the criteria for evaluating patients with a solid tumor which was reported by Koyama and Saito. In these criteria, the effect of therapy was evaluated mainly from the results of computed tomography (CT) scan. Complete response was defined as complete resolution of all radiographic signs of intracranial tumor; partial response as a 50% or greater decrease in tumor size; no change as a decrease less than 50% and increase less than 25%; progressive disease as a 25% or greater increase in tumor size. The other criteria were described by Levin, et al. in which the effect of therapy was evaluated from results of a neurological examination, radionuclide scintiscan and CT scan. Response was defined as an improvement in at least two of the three tests while the patient was receiving a stable or decreasing dose of steroids. Progressive disease was defined as a deterioration in at least two of the three tests while the patient was receiving a stable or increasing dose of steroids. No change was defined as disease which neither progressed nor regressed as defined above. The details of the criteria are described and their role is discussed.
TL;DR: A case of trigeminal neuralgia associated with hemifacial spasm (HFS) caused by a tortuous vertebrobasilar (V-B) artery is reported in this article.
Abstract: A case of trigeminal neuralgia (TGN) associated with hemifacial spasm (HFS) caused by a tortuous vertebro-basilar (V-B) artery is reported. Computed tomographic (CT) scan with contrast enhancement (CE) was significantly useful in the diagnosis of the tortuous V-B artery. A 72-yearold man, complaining of intermittent facial pain and twitching of the left facial muscles, had been unsuccessfully treated with carbamazepine and nerve block. On admission, muscle twitch was seen in the left orbicularis oculi, cheek, and platysma muscles. Sensory disturbance was noted in the territory of the left trigeminal nerve. Corneal reflex was decreased in the left side. CT with CE revealed a linear structure in the prepontine cistern, suggesting a tortuous V-B artery. Left vertebral angiogram showed a markedly enlarged and tortuous V-B artery, protruding into the left cerebellopontine cistern. It was suggested that the tortuous V-B artery was the cause of both symptoms of TGN and HFS. Neurovascular decompression was then successfully performed. Immediately after the operation, the facial pain and the twitch completely disappeared. Eleven such cases have been reported in the literature, but this is the first report of a successfully treated case by neurovascular decompression.
TL;DR: The case described here is the first report of a cystic tumor arising from the thalamus of an adult and containing pathologic features of a primitive neuroectodermal tumor.
Abstract: Primitive neuroectodermal tumors are very rare, malignant tumors of the cerebrum of young individuals, predominantly composed of undifferentiated cells, with differentiation along either neuronal or glial lines. Primary cystic tumors of the thalamus are also very rare and have been reported only in children. The case described here is the first report of a cystic tumor arising from the thalamus of an adult and containing pathologic features of a primitive neuroectodermal tumor. According to the literature, and in our clinical experience as well, primitive neuroectodermal tumors tend to diffusely disseminate into the subarachnoid space, which presents several diagnostic and therapeutic problems.
TL;DR: Five synchronous multiple primary malignant tumors accompanied by glioblastoma in which one of the primary sites was within the brain in a 27-year-old woman are reported.
Abstract: A case of synchronous multiple primary malignant tumors accompanied by glioblastoma is reported. The patient, a 27-year-old woman, was admitted with nausea, vomiting, and a slight consciousness disturbance. Five months before, she had noticed a lump in both breasts, and 1 month later, an abnormal shadow was noted on chest X-ray. Computed tomography scan showed a cystic lesion with ring-like enhancement in the left frontal lobe. Chest X-ray and the tomogram showed a tumor shadow in the right upper lung field. The brain tumor was totally removed. Histologically, it was glioblastoma (first primary focus). One month following brain surgery, a bilateral mastectomy with lymph-node dissection was performed. Histopathological examination revealed ductal carcinoma without metastasis to lymph-node, and they were diagnosed as bilateral primary breast carcinomas (second and third primary foci). Lung tumors gradually progressed in spite of chemotherapy, and she expired due to respiratory insufficiency. Histopathological examination of the autopsied lungs revealed primary papillary adenocarcinoma of apical portion of the upper lobe of right lung with numerous small hematogenously disseminated metastatic tumor nodules in entire lobes of both lungs (fourth primary focus). Moreover, an occult sclerosing carcinoma of papillary type was found in the thyroid (fifth primary focus). There have been no previous reports on five synchronous primary malignant tumors in which one of the primary sites was within the brain.
TL;DR: An unusual long survival case of malignant lymphoma involving the two unusual sites separately within 20 years of a 55-year-old male who had had a malignantymphoma of the testis 20 years earlier is reported.
Abstract: We report an unusual long survival case of malignant lymphoma involving the two unusual sites separately within 20 years. A malignant lymphoma occurred in the brain of a 55-year-old male who had had a malignant lymphoma of the testis 20 years earlier. This report was referred to discuss whether intracranial malignant lymphoma was primary or metastatic.
TL;DR: A review of the literature and the own operative findings suggest that the origin of this tumor is the cavernous sinus, and it should be stressed that correct preoperative diagnosis is very important in decreasing operative deaths.
Abstract: A 70-year-old female was treated surgically for an extracerebral cavernous hemangioma of the middle fossa. The literature contains reports of one autopsy and 20 operative cases of cavernous hemangioma of the middle fossa. We compared these cases with cerebral cavernous hemangiomas and found that the incidence is high in Japanese females and in individuals over 20 years of age (average age, 43 years). Signs and symptoms are usually disturbed visual acuity or ocular movement rather than manifestations of increased intracranial pressure. Plain x-rays showed destruction of the sella without hyperostotic changes of the sella or the middle cranial fossa. CT scans showed isodensity/high-density areas of a dumbbell configuration, with the smaller part in the sella and the larger part in the middle fossa. Other CT features were contrast enhancement and evidence of atrophic processes in the surrounding brain. Conventional angiography showed an avascular mass lesion, but tumor staining was demonstrated only by prolonged injection, selective angiography, or subtraction. A review of the literature and our own operative findings suggest that the origin of this tumor is the cavernous sinus. Total removal of such tumors is difficult because of profuse intraoperative bleeding, and operative mortality is high (38%). It should be stressed that correct preoperative diagnosis is very important in decreasing operative deaths.
TL;DR: Two cases of glioblastoma multiforme of the cerebellum are reported and the biological behavior of these tumors is in all respects identical to those of the cerebral counterparts.
Abstract: Two cases of glioblastoma multiforme of the cerebellum are reported. Case 1, a 55-year-old male, was admitted in 1981 with a 3-week history of intermittent headache, vomiting, and gait instability. Case 2, a 27-year-old female suffering from von Recklinghausen's disease, was admitted in 1973 with a 6-week history of headache, vomiting, and blurred vision. On admission, cerebellar symptoms and bilateral papilledema were observed in both patients. Neuroradiological studies, including computed tomography scan and angiography, were of little help in predicting the exact nature of these tumors before surgery. At the operation, a tumor growing mainly in the right cerebellar hemisphere was found in each patient. On histological examination, hypercellularity with pleomorphism, small patches of necrosis, and vascular endothelial proliferation were noted, which appeared to be indistinguishable from those of cerebral glioblastoma. In spite of repeated operations followed by chemoradiotherapy, both patients died of tumor recurrence, 38 months and 25 months after the onset of the symptoms, respectively. Glioblastoma multiforme of the cerebellum is very rare and accounts for approximately 0.6% of all glioblastomas reported in the recent literature. Only 82 cases of the cerebellar glioblastoma have so far been reported. The biological behavior of these tumors is in all respects identical to those of the cerebral counterparts.
TL;DR: A 60-year-old female complained of right oculomotor palsy and syncopal attacks and pathological examination of the specimen showed malignant change in the BEC, and CT scan findings showed homogeneous or inhomogeneous enhancement in the lesion of the right temporal lobe.
Abstract: The authors report a case of malignant epidermoid cyst (MEC) and discuss the characteristic findings on computed tomography (CT) scan, the differential diagnosis and the difference from the atypical findings of benign epidermoid cyst (BEC) with a review of the literature A 60-year-old female complained of right oculomotor palsy and syncopal attacks Plain CT scan revealed an irregularly low-density lesion with a ring-like and nodular high-density area mainly in the suprasellar cistern and midbrain, and another iso- to a slightly high-density area in the medial aspect of the right temporal lobe On enhanced CT scan, a faint and inhomogeneous enhancement was observed in the lesion of the right temporal lobe Surgical treatment was performed, and pathological examination of the specimen from the medial aspect of the right temporal lobe showed malignant change in the BEC As a common and characteristic feature of CT scan findings of the present and the five previously reported cases, MEC shows homogeneous or inhomogeneous enhancement in the iso- to a slightly high-density lesion or the low-density lesion found in a typical BEC
TL;DR: Treatment and outcome in 31 cases of recurrent medulloblastoma arising in childhood are described, and patients who underwent extensive tumor resection and received higher doses of radiation to the entire neuraxis generally had longer remission.
Abstract: Treatment and outcome in 31 cases of recurrent medulloblastoma arising in childhood are described. As initial treatment, all patients underwent some degree of tumor resection, and 28 patients received radiation therapy postoperatively. The younger children tended to have recurrence earlier after the initial treatment and to die sooner after recurrence than the older children. Early recurrences (within the first 2 postoperative years) often took the form of spinal subarachnoid dissemination, whereas late recurrences (after more than 2 years postoperatively) most often involved intracranial regrowth. Patients who underwent extensive tumor resection and received higher doses of radiation to the entire neuraxis generally had longer remission than those who had less extensive tumor removal and lower doses of radiation. Two of four patients who received intrathecal chemotherapy with methotrexate, cytosine arabinoside, and hydrocortisone as part of the initial treatment had remission lasting more than 3 years. The usual treatment for recurrent medulloblastoma was reirradiation, which generally improved survival time. Tumor removal plus intrathecal chemotherapy in selected cases of recurrence also provided abatement of symptoms. Early recurrence was usually difficult to control, whereas treatment for late recurrence was generally palliative but not curative. Average survival was 4.3 months after early recurrence, and 21.9 months following late recurrence. Two of the nine patients subjected to autopsy had no local recurrence but had extensive spinal subarachnoid dissemination. At the time of initial extensive tumor resection, irradiation or intrathecal chemotherapy, or both, should be added to prevent regrowth of the tumor and subarachnoid dissemination.
TL;DR: In a 57-year-old female patient, a solitary skull metastasis of endometrial stromal sarcoma of the uterus was found under the left parietal region of the cranium 1 year after total removal of the primary lesion.
Abstract: In a 57-year-old female patient, a solitary skull metastasis of endometrial stromal sarcoma of the uterus was found under the left parietal region of the cranium 1 year after total removal of the primary lesion. The histological features of the skull mass were similar to those of the original tumor. Fifteen months after excision of the skull metastasis the patient remains asymptomatic. This is the first such case reported.
TL;DR: The redistribution of membrane enzymes in the endothelial cells of the transplanted brain tumors is presumed to be related at least partly to the changes in the vascular junction.
Abstract: We studied the fine structure and ultracytochemical features of microvessels of both normal rat cerebrum and brain tumors transplanted into rats. Ultrastructurally, the endothelial cells of the tumor vessels showed alterations, compared to those of normal vessels, such as attenuation, thickening, and/ or abnormal endothelial junctions. In the control rats, an ultracytochemical study revealed alkaline phosphatase (AlPase) and adenosine triphosphatase (ATPase) activities were located mainly on the luminal plasma membrane of the endothelial cells, and 5'-nucleotidase (5'-N) activity on the abluminal plasma membrane. In the transplanted brain tumors, the sites of AlPase and 5'-N activities were similar to those of the controls, but the extent of the reactions on the abluminal and luminal membranes of the endothelial cells was greater. ATPase activity occurred mainly on the luminal plasma membrane of the endothelial cells in the controls, and on the abluminal membrane in the transplanted brain tumors. The number of pinocytotic vesicles showing positive reactions for AlPase, 5'-N, and AT-Pase was not higher in the tumor vessels than in the normal vessels. The redistribution of membrane enzymes in the endothelial cells of the transplanted brain tumors is presumed to be related at least partly to the changes in the endothelial junction.
TL;DR: It may be concluded that cortical veins play an important role as a collateral channel in sinus occlusion in dogs to study the regional cerebral blood flow (r-CBF) change in intracranial venous hypertension.
Abstract: A new experimental model of cerebral sinus occlusion was devised, using 16 mongrel dogs to study the regional cerebral blood flow (r-CBF) change in intracranial venous hypertension. A mixture of α-cyanoacrylate monomer and pantopaque was injected through a catheter introduced into the superior sagittal sinus (SSS). According to the extent of the sinus occlusion, the animals were divided into three groups: group A, SSS occlusion only; group B, SSS occlusion+ transverse sinus (TS) occlusion; group C, SSS occlusion+TS occlusion+cortical vein occlusion. To make a model of the dural arteriovenous malformation, normal saline was infused under constant pressure through a catheter introduced into the SSS and the sinus pressure was elevated from 10 mmHg to 60 mmHg in group D. Changes in intracranial pressure (ICP), SSS pressure (SSSP), and r-CBF and histological changes were evaluated in these groups. Before sinus occlusion, ICP and SSSP were 9±3.2 mmHg and 4±2.5 mmHg, respectively. After sinus occlusion, ICP and SSSP were 20±5.5 mmHg and 27±4.5 mmHg in group A, 30±5.4 mmHg and 38± 5.1 mmHg in group B, and 65±7.9 mmHg and 74±6.1 mmHg in group C. No ICP change was noted in group D. r-CBF showed no change in group A or D, and minimal reduction for a short period in group B. In group C, r-CBF decreased to 20-30% of the value prior to sinus occlusion due to marked venous congestion, which was complicated by subarachnoid hemorrhage and intracerebral hematoma. From the above results, it may be concluded that cortical veins play an important role as a collateral channel in sinus occlusion.
TL;DR: A fistula between the sphenoid sinus and the intracranial cavity, probably the subarachnoid space, was detected during puncture and irrigation of the spheroid sinus in a male patient with a pneumocephalus secondary to acute sinusitis.
Abstract: We encountered a male patient with a pneumocephalus secondary to acute sinusitis. A fistula between the sphenoid sinus and the intracranial cavity, probably the subarachnoid space, was detected during puncture and irrigation of the sphenoid sinus. This fistula might have been quite small and might have closed spontaneously. Sellar tomograms and metrizamide computed tomographic cisternography had failed to disclose the fistula.
TL;DR: It was disclosed that this tumor was a craniopharyngioma, originating from the remnant of Rathke's pouch in the tuber cinereum, and proliferating exclusively in the third ventricle, which was considered to be the origin of the tumor.
Abstract: A case of craniopharyngioma confined to the third ventricle is reported. A 49-year-old male was admitted because of progressive memory defects. No abnormal neurological findings were present. Post-contrast axial computed tomography (CT) scan showed a large, homogeneously enhanced mass in the third ventricle. Coronal CT showed this mass separated from the sella turcica and confined in the third ventricle. The tumor was partially removed by a transcallosal approach under an operating microscope. Histologically, this tumor was a squamous cell type craniopharyngioma. The patient died of the tumor recurrence 5 months after surgery. Autopsy demonstrated that the tumor did not become exposed on the basal surface of the brain, and that no tumor was found around the hypophyseal stalk. A stalk-like structure in this tumor was found at the base of the third ventricle wall, which was considered to be the origin of the tumor. It was disclosed that this tumor was a craniopharyngioma, originating from the remnant of Rathke's pouch in the tuber cinereum, and proliferating exclusively in the third ventricle.
TL;DR: Although chemodectoma of the glomus jugulare is generally considered to be a rare benign tumor, slow metastatic spread to various organs is not uncommon and a careful search for metastatic lesions is essential when following up the patient.
Abstract: A relatively rare case of chemodectoma of the glomus jugulare with multiple metastases is reported. Ten years ago, a 37-year-old male was seen because of dysphagia and a mass in the right retro-auricular region. The mass in the right jugular foramen was partially resected and irradiated. Histological examination revealed a chemodectoma. Five years thereafter the patient was readmitted with an epidural mass involving the left eighth cervical nerve root. One year later he developed a chest pain and lumbago. A bone scan revealed multiple skeletal metastases. Histologically, specimens from the right parietal bone and the right 10th rib showed a chemodectoma. He was again irradiated. He was again admitted with paraplegia, 9 years after the first admission. With repeated irradiation with a total dose of 16, 700 rads in 10 years, he died with cachexia and aspiration pneumonia at the age of 47. The autopsy revealed multiple metastases of chemodectoma to bone, spinal epidural space, lung, and pancreas. Although chemodectoma of the glomus jugulare is generally considered to be a rare benign tumor, slow metastatic spread to various organs is not uncommon. A careful search for metastatic lesions, possibly for years is essential when following up the patient.
TL;DR: The anomalous ACA had been gradually occluded in the course of the progression of moyamoya disease and should contribute as a circulatory collateral pathway in association with occlusive cerebrovascular diseases.
Abstract: Two cases of anomalous origin of the anterior cerebral artery (ACA) associated with occlusive cerebrovascular diseases are presented. Case 1, a 4-year-old boy, was admitted because of right-sided hemiparesis. Cerebral angiography revealed moyamoya disease and an anomalous artery originating at the right carotid siphon to join the ACA. The right ophthalmic artery and bilateral A, segment of the ACA were hypoplastic. The anomalous ACA had been gradually occluded in the course of the progression of moyamoya disease. Case 2, a 2-year-old boy, was admitted with right-sided hemiparesis following a nonpenetrating blunt head injury. Cerebral angiography revealed severe stenosis at the cervical segment of the left internal carotid artery and the anomalous origin of ACA on the right. This anomalous artery joined the anterior communicating artery to perfuse both ACA territories. In the past, this anomalous artery has only been debated in view of its embryological interest, but it should contribute as a circulatory collateral pathway in association with occlusive cerebrovascular diseases.