1/4. moyamoya disease associated with a brain stem glioma.An 8-year-old boy was found to have primary moyamoya disease associated with a brain stem glioma. For over 3 years the child had experienced transient ischemic attacks induced by hyperventilation. One month before referral to our hospital he had presented with progressive left facial nerve palsy. magnetic resonance imaging showed a cystic mass in the lower pons. angiography revealed severe bilateral stenosis of the internal carotid arteries and prominent moyamoya vessels in the basal ganglia. Partial resection of the tumor yielded a histological diagnosis of pilocytic astrocytoma. Local radiation therapy reduced the size of the tumor. Anastomosis of the superficial temporal arteries and middle cerebral arteries on both sides was then performed. After direct bypass surgery, the patient remained in a good condition for a 5-year follow-up period. Clinical investigation of the coincidence of primary moyamoya disease and brain stem glioma led the authors to conclude that these two diseases coexisted independently.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/4. Giant cavernoma of the brain stem: value of delayed MR imaging after contrast injection.Cavernous angiomas are vascular malformations composed of slowly perfused, sinusoidal vessels which can be located in any part of the central nervous system. Whereas diagnosis is mostly straightforward in typical cases, some lesions may present in unusual locations or with unusual imaging characteristics. Because of the slow perfusion, contrast enhancement is not regarded as a characteristic imaging feature of cavernomas. We report a large brain stem cavernoma with signs of recent bleeding, in which the differential diagnosis against other mass lesions was facilitated by the demonstration of slow, but intense, contrast enhancement on MRI 1 h after contrast injection. We conclude that contrast enhancement in delayed images may contribute to a safe diagnosis of cavernous haemangiomas and should be performed in atypical cases.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/4. Radical resection for intrinsic midbrain pilocytic astrocytoma: report of two cases.BACKGROUND: Intrinsic midbrain glioma has been one of the most challenging therapeutic tasks in neurosurgery due to its prognosis and risks associated with surgical procedures. It is known that the prognosis of pilocytic astrocytoma is relatively good if radical resection can be achieved without severe complications. In order to remove pilocytic astrocytoma within the midbrain radically, we used microsurgical techniques. METHOD: Two patients with intrinsic pilocytic astrocytomas located at the midbrain were operated on. The subtemporal approach was used with a point of entry on the lateral surface of the midbrain just behind the cerebral peduncle. Major vessels were preserved, followed by resection of the intrinsic tumor making the cleavage between tumour and midbrain. FINDINGS: In both patients, intrinsic pilocytic astrocytoma was grossly totally removed with minimal permanent morbidity. They have been able to maintain independent activities in their daily lives without tumor recurrance. CONCLUSIONS: Surgical cure can be accomplished in some cases of midbrain pilocytic astrocytoma, even if the lesions are intrinsic to the midbrain. To remove the tumor totally without further neurological deficits, it is necessary to select a safe access or entrance point to the tumor, and to demarcate the gliotic plane between tumour and midbrain. A long-term follow up with a larger number of patients is needed to establish the significance of radical resection for intrinsic midbrain pilocytic astrocytoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/4. hemifacial spasm caused by pontine glioma: case report and review of the literature.hemifacial spasm (HFS) is an involuntary paroxysmal contractions of the facial musculature, caused generally by vascular compression of the seventh cranial nerve at its root exit zone from the brain stem. The case of an adult man harbouring brain stem glioma (BSG) whose only neurological signs were left HFS and mild facial weakness is reported. Radiological and neurophysiological findings are described. No responsible vessel could be identified during surgery, but the causative lesion was found to be an astrocytic tumour encasing the facial nerve at its root exit zone from the brain stem. The rarity of such a condition prompted us to review the literature. Nine cases, including our patient presenting with HFS caused by BSG, are reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |