Treatment of large vestibular schwannomas: towards a compromise between recurrence and facial function preservation

Ideal treatment of large vestibular schwannomas [VS] is complete removal without significant morbidity. The aim of this study is to assess the long-term outcome of surgery, focusing on factors influencing facial function and recurrence. Large VS were removed from 76 consecutive patients, through the retrosigmoid approach, from 1990-2004. Prognostic factors evaluated were age, size hydrocephalus, IX[th] and X[th] nerve signs, extent of surgical removal, and tumours's consistency. Statistics were taken by assessment of Chi-square, Fisher, student t-test. The mean age was 40 +/- 14 years, and the mean diameter was 45 +/- 9 mm. Preoperatively, 93% had significant hearing loss, 74% had cerebellar ataxia, 77% had high intracranial pressure and 40% had IX[th] and X[th] nerve signs. The perioperative mortality dramatically decreased from 17.6% in the earlier period [1990-1996] to 4.5% in the latter period [1997-2004]. At long-term follow-up, 84% of the patients had a Karnofsky score superior to 80%. Mean facial function was better for solid tumours [mean House-Brackmann [HB] standard deviation [SD], 3.7 [1.7] vs. 4.5 [1.7], p = 0.035]. Facial anatomical continuity was preserved in 76% of the cases [n = 58] and was correlated with a better facial function [mean HB [sd], 3.1 [0.7] vs. 5.8 [1.3], p < 0.001]. Excluding patients with a preoperative facial palsy, good facial function was achieved in 58% of the patients, without statistical difference between gross total and subtotal resection [mean HB [SD], 4.3 [1.4] vs. 4.8 [1.9], p=0.229]. The method resulted in improved outcome. Subtotal resection is a good strategy with high likelihood of preserving facial nerve function, without significantly increasing the risk of recurrence. New strategies associating subtotal resection and radiosurgery must be evaluated

Intraventricular cavernoma

Intraventricular cavernoma is rare; only 45 cases have been reported in the literature. Magnetic resonance imaging has wildly contributed in the diagnosis and the surgical approach. Case file: We report a 45-year-old man presenting with syndrome of intracranial hypertesion and retrograde amnesia for one year. CT scan and MRI revealed an intraventricular tumour, which was responsible for active hydrocephalus. A ventriculo-peritoneal shunt was performed and a stereotactic biopsy allowed the diagnosis of cavernoma. Post operative follow-up was uneventful, the patient rests asymptomatic. Ventricular cavernoma is rare and should be suspected in atypical localisations in order to chosse the best surgical approach. The author attack the attention to that rare localisation of cavernoma and for its hemorrhagic risles

Spinal arachnoid cysts - 10 cases

The authors report their experience of 10 patients with spinal arachnoid cyst at the Hopital des specialties in Rabat. There were 5 females and 5males. The mean age was 27 years [range 6 to 70 years]. Eight patients had sings of spinal cord compression and the other two were admitted with severe sciatica. All patients had computed tomography-myelography or magnetic resonance imaging. The lesion involved the thoracic spine in 7, lumbar in 2 and cervical in 1 patient. The cysts were intradural in 6 an extradural in 4 patients. Treatment consisted of complete removal in 5 patients, marsupalisation in 3 and perforation aspiration in 2 patients. Follow-up ranging between 2-7 years, showed total improvement in 6 patients, partial recovery in 3 patients and 1 patient remained unchanged. Recurrence of the cyst was seen in 2 patients. The authors discuss the aetiology, pathogenesis, clinical, radiological and therapeutic aspects of this benign condition

Parinaud syndrome from tuberculoma of pineal area

Computerised tomography and magnetic resonance imaging [MRI] revealed obstructive hydrocephalus and a pineal mass in a 44-year-old woman who presented with headaches and Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, stereotactic biopsy of the lesion revealed it to be a tuberculoma. MRI showed resolution of the lesion following antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumours are discussed