1/26. Use of a portable CT scanner during resection of subcortical supratentorial astrocytomas of childhood.The development of intraoperative imaging has made it possible to visualize shifting brain structures during surgery, and may allow greater intraoperative discrimination of normal and abnormal tissue. This may provide greater confidence to the neurosurgeon to proceed with a more extensive resection while decreasing postoperative morbidity. We investigated the intraoperative use of a portable CT scanner in the resection of 4 cases of supratentorial, subcortical astrocytomas of childhood to assess its usefulness in determining the endpoint of the dissection. We operated on 4 patients, ages 3-17, with astrocytomas. Three were thalamic, and 1 was based primarily in the caudate nucleus. The approach to the basal ganglia was transcallosal in 3 and transtemporal in 1. Specific observations on the intraoperative use of the portable CT scanner included its overall facility, any additional operative time required, the overall quality of the images, intraoperative decisions made based on the images and problems associated with its use. These observations are presented with a review of intraoperative imaging as it pertains to deep pediatric brain tumors. The CT scanner was helpful in limiting the dissection of the hypothalamic and midbrain regions and in localizing remaining abnormal tissue. The scans allowed informed decisions about leaving margins of the tumor which were adjacent to vital structures, but dit not prove to be a decisive factor in providing a complete resection. The following observations are worth noting: (1) average imaging time was 20 min per scan; (2) the extent and location of residual enhancing tumor was easily identified despite other materials in the surgical bed; (3) air/tissue interfaces limit resolution; (4) tumors retain contrast long enough to obtain multiple scans without additional dye, and (5) the cost profile of a mobile CT scanner is superior to that of a fixed intraoperative CT scanner.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
2/26. Hypothalamic and pancreatic lesions with diabetes mellitus.A case is reported of a neoplasm of mixed mesenchymal and neuroepithelial origin consisting of plasmacytoma, lymphoma, ganglioneuroma, and astrocytoma in the same mass. The tumour arose in the hypothalamus of a 43 year old diabetic woman who also had alpha cell hyperplasia and beta cell hypoplasia of the islets of langerhans. It is suggested that both hypothalamic and pancreatic lesions produced diabetes mellitus in this patient.- - - - - - - - - - ranking = 5.1888926944936keywords = ganglion (Clic here for more details about this article) |
3/26. Combined pleomorphic xanthoastrocytoma-ganglioglioma of the cerebellum.Combined pleomorphic xanthoastrocytoma-ganglioma is a rare neoplasm, occurring in patients younger than 30 years. The clinical course of these tumors is difficult to predict because of their rarity. We report a case of combined pleomorphic xanthoastrocytoma-ganglioma that, in addition to the patient's age, is unusual in several respects. The lesion was located in the cerebellar vermis of a 60-year-old man and was radiographically solid. Histologically, there was an admixture of markedly pleomorphic astrocytic cells and neoplastic ganglion cells, with permeation of the overlying leptomeninges and surrounding cerebellum. In addition, there was focal capillary endothelial proliferation. There was no necrosis, and mitotic activity was rare at 1 mitotic figure per 40 high-power fields. The patient underwent a near gross total resection and postoperative radiotherapy and remains well through 16 months of follow-up.- - - - - - - - - - ranking = 5.1888926944936keywords = ganglion (Clic here for more details about this article) |
4/26. Secondary parathyroid hyperplasia in tuberous sclerosis: report of a case with large eosinophilic ganglion-like cells similar to those of subependymal giant cell astrocytoma, tubers, and atypical angiomyolipoma.We report a case of secondary parathyroid hyperplasia in a 49-year-old man with tuberous sclerosis. Two parathyroid glands had collections of large, eosinophilic ganglion-like endocrine cells that to our knowledge have not been previously described at this site. These cells are morphologically similar to those of subependymal giant cell astrocytoma, tubers, and atypical angiomyolipoma, all of which may arise in the setting of tuberous sclerosis. These large, eosinophilic ganglion-like cells found in different affected organs appear to be distinctive of tuberous sclerosis. We suggest these large eosinophilic cells arise from a common stem cell precursor that acquires variable phenotypes according to alterations in the cellular microenvironment.- - - - - - - - - - ranking = 31.133356166961keywords = ganglion (Clic here for more details about this article) |
5/26. Dysembrioplastic neuroepithelial tumor: cytological diagnosis by intraoperative smear preparation.The dysembrioplastic neuroepithelial tumor (DNT) is a benign and slow-growing temporal lobe cortical lesion that presents with clinically unresponsive partial and complex seizures, with onset before age 20 yr. DNT shows a multinodular architecture and the presence of mixed glioneural elements. The authors report on a case of DNT diagnosed by the intraoperative smear cytological technique. We describe the cytological characteristics of smear preparations of DNT, with emphasis on the differential diagnosis. The authors present a 5-yr-old male with partial seizures for the preceding 3 yr. The patient showed no other neurological deficits. Magnetic resonance identified a lesion in the cortical area of the right temporal lobe. The smear cytology showed small, round, oligodendroglial-like cells arranged in lobules, with microcystic spaces containing ganglion cells floating in a fine fibrillary background. histology confirmed the diagnosis of DNT. This report shows that the smear preparation can be trustworthy for the intraoperative diagnosis of DNTs, helping to determine the appropriate neurosurgical procedure and thus avoiding extensive and unnecessary resections.- - - - - - - - - - ranking = 5.1888926944936keywords = ganglion (Clic here for more details about this article) |
6/26. Geniculate hemianopias: incongruous visual defects from partial involvement of the lateral geniculate nucleus.Quantitative perimetric studies in 4 patients with involvement of a lateral geniculate nucleus revealed strikingly incongruous defects in the corresponding homonymous fields of vision. The patterns of these hemianopias are analysed and correlated anatomically with established retinotopic projections on the six cellular laminae of the geniculate nucleus. Incongruous wedge-shaped field defects appear to be pathognomonic of focal disease in the dorsal crest of the geniculate nucleus. Other patterns typify lesions of the medical or lateral horns of the nucleus. On theoretical grounds monocular hemianopic defects should result from unilaminar geniculate lesions, but this perimetric sign awaits confirmation. In each case of geniculate disease where the retinal nerve fibre layer has been examined specifically for efidence of retrograde homonymous atrophy, typical hemiretinal signs were found to be present.- - - - - - - - - - ranking = 8keywords = nucleus (Clic here for more details about this article) |
7/26. Anterior lateral ventricular subependymal giant cell astrocytomas. Microsurgical aspects of two cases.The surgical management of two cases of lateral ventricular subependymal giant cell astrocytoma, arising in the head of the caudate nucleus, and causing hydrocephalus due to obstruction of the foramen of Monro is described. One lesion, in a patient with tuberous sclerosis, was resected using a transcallosal approach and the other, in a patient with no stigmata of tuberous sclerosis, using a frontal, trans-cortical transcystoventricular approach. The microsurgical aspects of excision and pathological anatomy of both tumours were very similar. Following tumour excision and pellucidotomy both patients had partial resolution of their hydrocephalus with complete resolution of their preoperative symptoms. The merits of transcallosal and transcortical approaches to these lesions are discussed.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
8/26. Angioganglioglioma: a transitional form between angioglioma and gangioglioma?The authors describe for the first time an unusual cerebral tumor with unique clinical history, composed of 3 components: pilocytic astrocytoma, vascular proliferations similar to those described as arteriovanous malformations, and a neoplastic ganglion component. These three components were intimately entangled and created the tumor mass. Thus the authors propose the term angioganglioglioma for this entity. The relation to the historically defined anglioglioma and tumors related to ganglioglioma and dysembryoplastic neuroepithelial tumor is discussed. The authors believe that this lesion, in regard to the clinical presentation (long course of the disease, clinical symptoms), is closely associated with ganglioglioma and, with other morphological features, also to angioglioma. Further, it may constitute a new distinct clinicopathological entity with neoplastic and hamartomatous features.- - - - - - - - - - ranking = 5.1888926944936keywords = ganglion (Clic here for more details about this article) |
9/26. "One-and-a-half" syndrome after a resection of a midline cerebellar astrocytoma: case report and discussion of the literature.This report describes a rare complication after the resection of a tumor of the posterior fossa, the "one-and-a-half" syndrome. The one-and-a-half syndrome is a disturbance of horizontal eye movements in which patients have lateral gaze palsy in one direction and internuclear ophthalmoplegia in the other direction. The patient was a 54-year-old woman who developed headaches, diplopia, and blurred vision over 6 months. Computed tomographic scans and magnetic resonance imaging demonstrated an enhancing, mixed density, midline mass of the cerebellum. After a resection of the mass, an anaplastic astrocytoma, the patient complained of more severe diplopia and facial weakness. An examination disclosed a left one-and-a-half syndrome, left peripheral facial paralysis, dysarthria, dysphagia, mild left hemiparesis, dysmetria of the left upper limb, and truncal ataxia. The brain stem showed no abnormalities on postoperative computed tomographic scans. After 4 months of follow-up, the one-and-a-half syndrome had not improved, even though other signs had improved or resolved. This syndrome is caused by damage to structures within the pontine tegmentum: the medial longitudinal fasciculus, the ipsilateral paramedian pontine reticular formation, or the ipsilateral abducens nucleus. multiple sclerosis and brain stem infarction are the most common causes of the one-and-a-half syndrome. Less frequently, it is caused by primary and metastatic tumors of the brain stem and cerebellum. Rarely, the one-and-a-half syndrome can develop postoperatively after the removal of tumors of the posterior fossa. The mechanism of pontine tegmental injury remains unknown.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
10/26. The fastigial pressor response. Case report.A distinct vasomotor and cardioregulatory response first identified experimentally was elicited intraoperatively in a 6-year-old girl by local mechanical stimulation in the vicinity of the fastigial nucleus of the cerebellum. These findings are discussed in the light of current experimental knowledge of the anatomy and physiology of the fastigial pressor response.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
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