1/10. Repeated hemorrhage in ciliated craniopharyngioma--case report.A 49-year-old female presented with a ciliated craniopharyngioma manifesting as repeated intratumoral hemorrhage. Histological examination suggested that the hemorrhage originated from the many thin blood vessels in the cyst wall stroma associated with inflammation. Symptomatic hemorrhage in cystic craniopharyngioma may mimic pituitary apoplexy but the etiology is quite different. Minor hemorrhage may recur unless the cyst wall is totally removed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/10. Surgical outcomes in 31 patients with craniopharyngiomas extending outside the suprasellar cistern: an evaluation of the frontobasal interhemispheric approach.OBJECT: Craniopharyngiomas frequently grow from remnants of the Rathke pouch, which is located on the cisternal surface of the hypothalamic region. These lesions can also extend elsewhere in the infundibulohypophyseal axis. The aim of this study was to establish the usefulness of the frontobasal approach made through a relatively small craniotomy window for the removal of tumors protruding from the sellar-suprasellar region into the third and basal cistern. methods: Thirty-one patients who were surgically treated for craniopharyngiomas extending outside the sellar-suprasellar region were evaluated. The diagnoses were established in all cases by using magnetic resonance and computerized tomography imaging. The initial symptoms and signs were increased intracranial pressure in eight, vision impairment or visual field defect in 16, hypopituitarism in 17, and psychological disturbances in three cases. All patients underwent surgery via the frontobasal interhemispheric approach, and the average follow-up period was 30 months. Total removal of the lesion was achieved in 22 cases, six patients underwent subtotal resection, and three underwent partial removal due to tumor recurrence after previous surgeries performed with or without adjunctive radiotherapy. Major complications, including impairment of the cranial nerves, were not observed in the immediate postoperative period. One patient exhibited transient memory disturbance due to infarction of the perforating vessels; after 3 months this symptom was ameliorated. None of the patients died during long-term follow up; however, four of the 22 who underwent total removal and six of the nine patients who underwent subtotal or partial removal suffered recurrence. Of the 10 patients with recurrence, six experienced a small recurrence of the lesion (average 3 months postsurgery); after gamma knife surgery (GKS), the size of two of the lesions was unchanged and in four reoperation was performed due to tumor enlargement during the follow-up period. Ultimately, a total of eight patients (four with recurrence and four who had been treated with GKS) underwent reoperation, with gross-total removal via the same approach or combined with the orbitozygomatic approach in patients with very short optic nerves. In no patient was deterioration of visual acuity and visual field observed after surgery. Although all patients except four children and one adult were receiving some form of hormone replacement therapy, their endocrine status was stably controllable. CONCLUSIONS: In the authors' experience, the frontobasal interhemispheric approach, even made through a small craniotomy window, is a valid choice for the removal of craniopharyngiomas extending outside the sellar-suprasellar region. Via this approach, tumors can be removed without significant sequelae related to the surgical method, due to ease of preservation of the pituitary stalk, hypothalamic structures, and perforating vessels. This approach offers a safe and minimally invasive means of treating craniopharyngiomas.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/10. Post-irradiation vasculopathy of intracranial major arteries in children--report of two cases.We report two rare cases of post-irradiation vasculopathy of intracranial major arteries in children. A 13-year-old girl suffered from transient right hemiparesis 1 year after irradiation for suprasellar germinoma. Left carotid angiograms revealed marked stenoses of the intracranial internal carotid, middle cerebral, and anterior cerebral arteries, which were previously normal, and moyamoya vessels. A 2.5-year-old girl underwent internal irradiation with 198Au colloid for cystic craniopharyngioma. At the age of 10 years, she suddenly became unconscious after vomiting. Computed tomographic scans showed a right frontal intracerebral hematoma. Right carotid angiograms disclosed complete obstruction of the intracranial internal carotid, middle cerebral, and anterior cerebral arteries and moyamoya vessels, previously not present. The danger of radiation therapy causing occlusive vasculopathy in small and major cerebral arteries in children is emphasized. To prevent permanent ischemic neurological deficits, vasculopathy should be treated either medically or surgically as early as possible.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/10. Initial experience with MR-imaging of intracranial midline-lesions and lesions of the cervical spine at half Tesla.Fifty-two patients were examined both with computed tomography using a different third generation scanner and by magnetic resonance imaging (MRI) at half Tesla field strength (Philips Gyroscan 5 S). Excellent contrast and spatial resolution as well as initial comparative results of normal anatomy and also selected clinical cases were demonstrated with the spin-echo (SE) and/or inversion recovery (IR) technique. The clinical material included a residual prolactinoma after transphenoidal surgery, follow-up of a recurrent partly calcified solid and cystic intra-/supra-sellar craniopharyngioma, low-grade glioma under stereotactic-like conditions, suspected pinealoma, recurrent astrocytoma (II-III) and ganglioneuroma at the posterior aspect of the middle and/or lower brain stem, small scar after lower brain stem infarction, stenosing degenerative disease of the cervical spine and multicystic lesion with an underlying benign ependymoma of the cervical spinal cord. MRI--although duplicating some CT results--provided better two- or three-dimensional anatomical detail as well as display of relevant vessels without need of contrast agent. It also gave more specific information in suprasellar tumours containing fat, afforded uniquely specific diagnosis in a bleeding venous malformation of the midbrain and defined more sensitively extra-/intra-axial lesions of the brain stem and cervical spinal cord. Small bony structures (erosions) and punctate calcifications may be missed by MRI. Although ferromagnetic material distorts the MR image, compared with CT, it is not impaired by non-ferromagnetic clips. This is an advantage with respect to postoperative control examinations.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/10. Wallenberg's syndrome caused by a craniopharyngioma "en plaque".Wallenberg's syndrome is the clinical manifestation of the obliteration of arterial blood vessels supplying the dorsolateral part of the medulla oblongata, the posterior inferior cerebellar artery being involved in most cases. A patient is described in whom the typical features of Wallenberg's syndrome correlated with cystic necrosis in the perfusion area of the posterior inferior cerebellar artery. A craniopharyngioma spreading along the pons and involving the posterior inferior cerebellar artery, the basilar artery, and its branches was found to be responsible for the infarction of the dorsolateral medulla oblongata.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/10. Retinal vascular changes in retrograde optic atrophy.Five patients with unilateral optic atrophy of extraocular origin had a normal retinal vasculature. Clinical examination of the patients included color fundus photographs and fluorescein angiography. After comparing the blood vessels in the blind eye with those in the normal fellow eye, we concluded that vascular attenuation is neither invariably associated with optic atrophy, nor solely caused by decreased local oxygen demand in the retina.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/10. MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma.We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7% of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. Complete surgical resection, particularly of large tumors, is complicated by the fact that the lesions are usually found within the circle of willis, with displacement and adherence to the adventitia of these vessels [1, 2]. Recent reports in the neurosurgical literature have described aneurysmal dilatation of the supraclinoid internal carotid arteries following aggressive surgical resection of craniopharyngioma [3, 4].- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/10. Progressive cerebral occlusive disease after radiation therapy.BACKGROUND: A case of progressive irradiation-induced cerebral vasculopathy with abnormal netlike vessels and transdural anastomoses (moyamoya syndrome) is presented. Radiological findings in an additional 40 cases reported in the literature are analyzed, and their clinical relevance is discussed. CASE DESCRIPTION: A 19-year-old woman presented with recurrent ischemic brain lesions after radiation therapy for treatment of a craniopharyngioma during childhood. cerebral angiography 6 and 12 years after completion of radiation therapy revealed progressive cerebral arterial occlusive disease involving the internal carotid artery on either side of the circle of willis, with abnormal netlike vessels and transdural anastomoses (moyamoya syndrome). CONCLUSIONS: Extensive similarities between irradiation-induced cerebral vasculopathy and primary moyamoya syndrome (Nishimoto's disease) support the notion that both disorders share common pathophysiological mechanisms. The occurrence of moyamoya-like vascular changes may not depend on specific trigger mechanisms but may rather represent a nonspecific response of the developing vascular system to a number of various noxious events.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/10. Vasoreconstructive surgery for radiation-induced vasculopathy in childhood.BACKGROUND: Cerebral vasculopathy associated with the appearance of netlike vessels can develop following irradiation therapy for parasellar brain tumors, especially in children. However, little is known regarding the clinical course of this disease or the appropriate therapy for it. case reports: We experienced two surgically-treated patients with radiation-induced vasculopathy and reviewed the previously reported cases. Both of our patients were treated with encephalo-duro-arterio-myo-synangiosis combined with superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Their ischemic symptoms improved following the surgery, associated with a good angiographic neovascularization from the STA-MCA bypass, as well as dural and muscular arteries. CONCLUSION: Our findings and the review of the previous reports suggested that surgical therapy may be beneficial for the patients with radiation-induced vasculopathy with the appearance of netlike vessels.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/10. Symptomatic vessel narrowing caused by spontaneous rupture of craniopharyngioma cyst--case report.A 36-year-old female presented with cerebral infarction due to severe vessel stenosis after spontaneous rupture of a craniopharyngioma, manifesting as aphasia and drowsiness. neuroimaging showed the suprasellar cystic tumor with wall enhancement and cerebral infarction in the left temporoparietal region, and also enhancement of the left sylvian fissure and prepontine cistern. Angiography showed severe narrowing at the C1 portion of the left internal carotid artery (ICA) and the M1 portion of the left middle cerebral artery (MCA). The tumor was subtotally removed via a bifrontal craniotomy. There was accumulated milky-white debris around the left ICA and MCA. She became alert within a few days postoperatively. Repeat angiography 1 month after surgery demonstrated slight improvement of vessel narrowing. The neuroimaging and intraoperative findings suggested that the stenosis was due to vasospasm induced by chemical meningitis resulting from cyst rupture.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
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