1/8. Stereotactic intracavitary therapy of recurrent cystic craniopharyngioma by instillation of 90yttrium.Six consecutively presenting patients with craniopharyngiomas, (F:M = 4.2; mean age: 35.2 years, range 17-58) histologically proven by one or more previous operations, and with recurrence of a wholly or predominantly cystic nature, were treated by 90yttrium (90Y) radioisotope instillation into the cyst. Five patients had undergone external beam radiotherapy and the remaining patient had concomitant stereotactic radiosurgery to a co-existing solid component. Seven cysts in six patients have been treated. Five cysts, previously requiring repeated aspiration at intervals of 2-20 weeks have required no further surgical intervention following 90Y treatment (FU mean 3.5 years, range 1.2-7), although two of these required a second 90Y treatment. No patient developed a visual field defect or evidence of hypothalamic dysfunction. One patient died within a month of treatment from complications related to a solid recurrence. One patient developed a large solid/cystic recurrence at 4 months and died shortly thereafter from an unrelated cause. We summarize results from other series that have demonstrated the efficacy of this technique, usually as primary therapy, but this is the first series to demonstrate its usefulness as salvage therapy. The prospect of survival with good quality of life can be offered to patients with multiply recurrent disease who have exhausted all conventional means of treatment. In our experience intracavitary 90Y is a safe and highly effective means of controlling cystic recurrence in refractory craniopharyngioma. Some patients require more than one treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. Kerry's story: the challenges of facing a recurrent craniopharyngioma.Craniopharyngiomas account for approximately nine per cent of pediatric brain tumours and one to two per cent of adult brain tumours. Though considered benign, the compressive nature of these relentless tumours can produce catastrophic sequelae. This case study pays tribute to a 33-year-old woman who faced numerous surgeries, adjuvant therapy, and many of the complications associated with a craniopharyngioma. The interdisciplinary neuroscience team, along with colleagues from neuroradiology, ophthalmology, and endocrinology, joined together to care for Kerry and her family to meet their complex health and psychosocial needs. However, it was Kerry who taught us about perseverance, strength, and the power of an unconquerable human spirit.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. Suprasellar and intrasellar paragangliomas.neoplasms of the sellar region are entities with a large differential diagnosis. Although paraganglionic cells have not been demonstrated in the pituitary or adjacent structures, the existence of sellar region paragangliomas is well-documented. To elucidate, in this area the nature of these unusual tumors is relatively difficult. Clinical history, physical examination, radiographic investigation as well as intraoperative gross observation are the same as those of sellar meningioma or pituitary adenoma. immunohistochemistry, using neuroendocrine markers and electron microscopy are the two definitive diagnostic methods to differentiate among these entities. The clinical management, the possible pathogenesis of the tumor, the importance of immunohistochemistry in making the diagnosis and the clinical outcome of these patients are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Suprasellar mass lesion with unusual magnetic resonance imaging characteristics.Our case emphasizes the complex nature of signal abnormalities observed with MRI and underscores that a given histopathologic lesion (such as craniopharyngioma) may have variable appearances upon imaging with this modality.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. Computed tomography in intra- and suprasellar epithelial cysts (symptomatic Rathke cleft cysts).The computed tomographic (CT) and pathologic findings in three cases of intra- and suprasellar epithelial cysts (symptomatic Rathke cleft cysts) are described. literature review revealed that the characteristic CT finding is an intrasellar and/or suprasellar low-density mass that may or may not be enhanced. The enhancement is ringlike or capsular in nature. Whether the cyst wall is enhanced or not seems to be dependent on the histologic features. It is suggested that the enhancement may be caused by an inflammatory process, either septic or aseptic, or squamous metaplasia in the wall, which is possibly induced by degeneration or infection of the cyst contents. Without these additional pathologic processes, the Rathke cleft cyst, a simple retention cyst, may exhibit no contrast enhancement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. Occlusive arteriopathy and brain tumor.Four cases with the association of occlusive arteriopathy and brain tumor are presented. A clinical analysis of these cases and cases reported in the literature revealed that occlusive arteriopathy at the base of the brain was often associated with a slowly growing basal tumor in children. Possible causes of occlusive arteriopathy in these cases were compression of the circle of willis by a slowly growing basal tumor, secondary artial occlusive changes by radiation therapy for a basal tumor, or vasculopathy associated with neurocutaneous syndrome. Symptoms of sudden onset or episodic nature suggest the presence of occlusive arteriopathy rather than the mass effect of a tumor. cerebral angiography is mandatory whenever computerized tomography (CT), performed to rule out recurrence of a basal tumor, shows an ischemic lesion with low-density areas without any evidence of mass effect of the tumor. cerebral angiography is also necessary when a basal tumor is suspected in children, particularly in cases associated with neurocutaneous syndrome and a basal tumor. Care should be taken not to scarify the abnormal vascular network at the base of the brain at the time of operation, because it is considered to be functioning as collateral circulation. The potential hazards of radiotherapy to radiation-induced occlusive changes of the circle of willis must be considered in treating a benign basal brain tumor in children. Even in adults, repeated large doses of irradiation could cause occlusive arteriopathy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. The limitation of computerized tomographic diagnosis of intracranial midline cysts.The diagnosis of intracranial cystic lesions is greatly facilitated by cranial computerized tomography (CT) which eliminates the need for further invasive neuroradiological studies. However, cystic lesions with thin walls that do not enhance following intravenous contrast infusion, especially when they are located in the midline and at the base of the skull, may become a diagnostic problem preventing proper management and therapy. We discuss 12 midline intracranial lesions, including one that is noncystic, to emphasize the limitations of CT in showing these lesions and the need for further diagnostic studies such as pneumoencephalography and metrizamide CT. The limitations of CT in diagnosing these lesions are related to the variations in the anatomy at the base of the skull (supra-sellar region); the varying pathological nature and behavior of certain cystic lesions such as epidermoid tumors and craniopharyngiomas; and the compromising of the spatial and density resolutions due to the partial volume effect. The complementary role of studies such as pneumoencephalography and CT metrizamide cisternography for the evaluation of the dynamics of the cerebrospinal fluid that are necessary for the proper management and therapy of patients is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. MRI in seven cases of Rathke's cleft cyst in infants and children.Seven MRI observations of presumed Rathke's cleft cysts in infants and children are reported. Age ranged between 6 months and 13 years. Size of the cysts ranged between 4 and 20 mm. While 3 small cysts were detected incidentally, 4 were large enough to cause symptoms secondary to compression of the pituitary gland and suprasellar components. The MRI appearance of the Rathke's cleft cysts varied according to their nature. MRI provides a major contribution to the diagnosis of these lesions; nevertheless, it often remains difficult to differentiate complex Rathke's cleft cysts from cystic craniopharyngiomas. The difficulties related to this differentiation are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |