11/228. End-to-end anastomosis of the posterior inferior cerebellar artery before excision of a meningioma involving the lower clivus and the foramen magnum. Case report.BACKGROUND: Petroclival and foramen magnum meningiomas sometimes encase the vertebrobasilar arterial system. magnetic resonance imaging can clearly reveal such encasement. The case presented here was of a meningioma involving the lower clivus and the foramen magnum, encasing a lateral segment of the posterior inferior cerebellar artery (pica), despite the fact that no definitive diagnosis of the encasement of the pica was made on preoperative radiological examination. End-to-end anastomosis of the pica was necessary before excision of the tumor. methods: A 55-year-old woman presented with complaints of headache and numbness of the right upper extremity. gadolinium diethylene-thiamine-pentaacetic acid enhanced T1-weighted magnetic resonance (MR) images showed a homogeneously enhanced mass lesion involving the lower clivus and the foramen magnum. Direct surgery was then performed, and the lateral medullary segment of the left pica was found to be encased by the tumor. End-to-end anastomosis was performed using No. 10-0 interrupted monofilament nylon sutures. Total removal of the tumor was performed after completion of the anastomosis. The patient was free of neurological abnormalities and no recurrence of tumor was found during a 2-year follow-up period. CONCLUSIONS: Revascularization is sometimes thought to be required for resection of craniospinal meningiomas even when they do not appear to encase the vertebro-basilar arterial system on preoperative MR imaging and cerebral angiograms. In the present case, dissection of the pica from the tumor was attempted, but was difficult due to tight encasement of the pica by the tumor.- - - - - - - - - - ranking = 1keywords = headache, upper (Clic here for more details about this article) |
12/228. Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.A 62-year-old woman was evaluated for tinnitis and headache. magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.- - - - - - - - - - ranking = 0.98806043244606keywords = headache (Clic here for more details about this article) |
13/228. Long-term magnetic resonance imaging follow-up of asymptomatic sellar tumors. -- their natural history and surgical indications.Serial magnetic resonance (MR) images and clinical symptoms were analyzed in 23 patients with sellar lesions, who were followed up without initial therapy for mass reduction to evaluate their natural history and surgical indication for these lesions. The patients were aged 17 to 78 years (mean 47.3 years) and the follow-up period was 1.5 to 11.6 years (mean 5.1 years). Lesions were divided into two types based on the MR imaging findings, regardless of their histological types. Type C was cystic with or without enhancement of the smooth and thin wall. Type S had enhanced solid components. Ten patients had Type C tumors. Three patients presented with sudden onset of headache. The tumor size spontaneously decreased with intensity change, indicating pituitary apoplexy as the trigger of the onset and intensity change. Four patients presented with the visual disturbance which improved with the reduction of tumor size, but three patients deteriorated and required surgery. The operation revealed Rathke's cleft cyst. The remaining three patients were found incidentally and have been asymptomatic without MR imaging changes. Thirteen patients had Type S tumors. Six patients of nine with 14 mm or larger tumors developed symptomatic tumor enlargement over the follow-up period of 1.2 to 8.6 years (mean 4.9 years) and required treatment. The remainder showed no change. Type C tumors frequently shrink or even disappear spontaneously. We can justify conservative follow-up of Type C tumors in patients with no or only transient symptoms. Type S tumors, larger than 14 mm in size, need closer observation or treatment because they often enlarge and become symptomatic.- - - - - - - - - - ranking = 0.98806043244606keywords = headache (Clic here for more details about this article) |
14/228. meningioma metastatic to the lung.Meningiomas constitute 15% to 18% of all primary intracranial and intraspinal tumors. Distant extracranial metastases are reported to occur in fewer than 1 in 1000 cases. Of 1992 primary intracranial meningiomas seen at Mayo Clinic Rochester from 1972 through 1994, we identified 3 (0.15%) with documented extracranial metastasis. A review of the literature suggests that previous craniotomy, venous sinus invasion, local recurrences, histological malignancy, and papillary morphology may be risk factors for systemic spread, as demonstrated in our cases. Although rare, metastatic meningioma should be considered in the differential diagnosis of abnormal findings on chest radiography in patients with known or suspected intracranial meningioma.- - - - - - - - - - ranking = 0.0048154032887367keywords = chest (Clic here for more details about this article) |
15/228. Fibrous meningioma with tyrosine-rich crystals.A 58-year-old African-American woman presented with a 6-month history of headaches. A magnetic resonance imaging scan of the head revealed a 5-cm, enhancing dura-based mass in the left parietal region. The variably cellular tumor was composed of uniform spindle cells associated with intercellular collagen and numerous radially arranged "petal-shaped" clusters of eosinophilic crystals. The tumor was diagnosed by light microscopy as a fibrous meningioma. Ultrastructural examination disclosed cells with complex interdigitating processes connected by desmosome-like cell junctions, abundant intercellular collagen fibers, and prominent, densely osmiophilic crystals featuring radiating teardrop shaped petals emanating from a central core. A positive Millon reaction showed these crystals to consist at least in part of tyrosine. By morphology, histochemistry, and ultrastructure, the crystals resembled tyrosine-rich crystals occurring in salivary gland tumors. This is the first report of a fibrous meningioma containing tyrosine-rich crystals.- - - - - - - - - - ranking = 0.98806043244606keywords = headache (Clic here for more details about this article) |
16/228. Intracerebral cyst associated with meningioma.A 27-year-old male had experienced an episode of severe headache and nausea, sometimes accompanied by an inability to name objects. magnetic resonance imaging showed a huge cyst within the left temporal lobe and a high degree of brain shift by it. A small round mass, which appeared to be a mural nodule, was located in the tip of left middle fossa. It was highly enhancing together with its attached dura mater, but the cyst wall was not enhanced. Sphenoid ridge meningioma with an associated intracerebral cyst or cystic glioma invading the dura mater was suspected. During surgery the small tumor was found to be arising from the sphenoid ridge and evaginating into the tip of the temporal lobe. The intracerebral cyst had a smooth surface and the tumor was visible outside the cyst through its wall. The tumor was totally removed, but the cyst wall was left without excision. Postoperatively he had no symptoms. Histological examination showed a microcystic meningioma. It is stressed that differentiations of cystic meningiomas from other cystic tumors and, of intratumoral from extratumoral cystic meningiomas using radiological, operative or histological findings are important.- - - - - - - - - - ranking = 0.98806043244606keywords = headache (Clic here for more details about this article) |
17/228. Extradural meningioma in the left fronto-temporo-parietal region.A case of a 47-year-old male patient who presented with a history of complaints of headache, vertigo and an expanding painful swelling on the left side of the head over the last year is reported. The lump was 15 x 15 cm and protruded 1-3 centimeters. Neurological examination revealed the presence of a mild right hemiparesis with right central facial palsy. Plain skull x-ray film demonstrates a heterogeneous bone thickening in the left fronto-temporo-parietal region with a small osteolytic focus and spotted shadows. Computed tomography scan of the skull showed that a major part of the squamas of the frontal and temporal bones were transformed into spiculoform structures turned outwards and inwards. Thus the bone appeared thickened overall. There were no alterations in the cerebral structures. The tumour was completely removed. It was located extradurally and through the bones extended to the soft tissues under the skin. The histological findings showed a meningioma with hemorrhages and necroses and the presence of lipids containing xanthochromic cells. After a surgical extirpation of the tumour a reduction of the neurological symptomatology and subjective complaints was observed.- - - - - - - - - - ranking = 0.98806043244606keywords = headache (Clic here for more details about this article) |
18/228. Neurotologic follow-up after radiation of posterior fossa tumors.OBJECTIVE: Stereotactic radiation treatment, also known as gamma knife surgery or radiosurgery, has come into acceptance as a treatment alternative to surgical removal for posterior fossa tumors. The purpose of this article is to describe the role of the neurotologist in the optimal management of neurotologic complications after stereotactic radiation, as illustrated by five patients. STUDY DESIGN: Retrospective chart review. patients: Five patients who underwent stereotactic radiation of posterior fossa tumors. MAIN OUTCOME MEASURES: Presence or absence of neurotologic complications (tumor growth, hearing loss, imbalance/ataxia, vertigo, and facial paralysis) or neurosurgical complaints (facial numbness, motor weakness, headache, hydrocephalus, and subarachnoid cysts). RESULTS: Postradiation neurotologic complaints included vertigo, imbalance/ataxia, and progressive hearing loss in four of the five patients. Continued tumor growth occurred in two patients; two patients had no growth; in one patient the tumor became smaller. The complications of facial nerve paralysis, facial numbness, motor weakness, headache, hydrocephalus, cerebellar edema, and posterior fossa arachnoid cyst formation occurred less frequently. CONCLUSIONS: Stereotactic radiation of posterior fossa tumors can produce significant neurotologic problems. It is imperative that neurotologists remain involved in the follow-up care of patients with posterior fossa tumors to offer optimal treatment alternatives for the neurotologic disorders.- - - - - - - - - - ranking = 1.9761208648921keywords = headache (Clic here for more details about this article) |
19/228. Fronto-orbitonasal intradiploic meningioma in a child.Intradiploic meningioma, which may be classified as a subgroup of intraosseous meningioma, is a rarely encountered disorder. To date, less than 10 cases have been reported. Here, we report a case of fronto-orbitonasal intradiploic meningioma. A 12-year-old female with exophthalmos and diplopia was operated on for a cranial intradiploic mass lesion. Histopathological evaluation of the specimen confirmed the diagnosis of intradiploic psammomatous meningioma. Her exophthalmos did not change, but the diplopia disappeared. This case is unique in that it is an extensive case of intradiploic meningioma of the orbital roof and frontal base in a child. Intradiploic meningiomas generally are of psammomatous type. Especially tumors adjacent to the orbita cause exophthalmos; cases located on the other side of the calvarium may not cause any symptom or sign other than headache or sometimes a mass on the scalp. Treatment, as with meningiomas located in the intracranial cavity, is total resection of the lesion.- - - - - - - - - - ranking = 0.98806043244606keywords = headache (Clic here for more details about this article) |
20/228. meningioma presented as subarachnoid haemorrhage: case report.A case of parasagittal meningioma causing subarachnoidal haemorrhage (SAH) is reported. Computed tomography (CT) was found negative in the patient with acute severe headache and haemorrhage was observed on cerebrospinal fluid (CSF) examination. Digital subtraction angiography (DSA) showed an avascular space over the convexity and magnetic resonance imaging (MRI) revealed the tumour. The importance of MRI for the detection of underlying pathology in SAH with unknown aetiology is emphasised.- - - - - - - - - - ranking = 0.98806043244606keywords = headache (Clic here for more details about this article) |
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