Unusual anatomic location of a primary intracranial yolk sac tumor

A nongerminomatous germ cell tumor occurring in the brain parenchyma is extremely rare. A 2-year-old boy presented with symptoms of abnormal movements in the hand and mouth. MRI scanning revealed a lesion occupying the left temporoparietal region. Craniotomy was performed and the tumor was removed by en bloc resection. Histological examination revealed that the tumor was arranged in a reticular pattern, and Schiller-Duval bodies were evident at the center of the tumor. Immunohistochemical study showed that the tumor cells were positive for alpha-fetoprotein and vimentin, but negative for glial fibril-lary acidic protein. The histological diagnosis was pure yolk sac tumor

Hydrocephalus in posterior fossa tumours: ventriculoperitoneal shunt versus endoscopic third ventriculostomy

The purpose of the present study is to describe our experience with endoscopic third ventriculostomy [ETV] in children with obstructive hydrocephalus secondary to posterior fossa tumours. Between January 2000 and January 2006, 42 children with posterior fossa tumour were treated. Thirty patients had symptomatic hydrocephalus. Third ventriculostomy was performed to relieve intracranial pressure [ICP] in all cases as an urgent procedure after admission. The other 12 cases had no hydrocephalus or non symptomatic mild dilatation of ventricles and thus were excluded from the study. Preoperative ETV procedures were technically successful. One case was complicated with infection. The ETV resolved the increased ICP before posterior fossa surgery in all cases. One case developed postoperative hydrocephalus and was treated by VP shunt insertion. Endoscopic third ventriculostomy is a plausible choice for the emergency control of severe hydrocephalus caused by posterior fossa tumours. It can quickly eliminate symptoms and in addition, it eliminates the risks of cerebrospinal fluid [CSF] infection related to external drainage. It also minimizes the risk of over drainage because it provides more physiological CSF drainage than the other procedures and avoids the complications of shunting procedures

Advantages of neuroendoscope-assisted microneurosurgery in Spina Bifida

The efficacy, safety and advantages of endoscope-assisted microneurosurgery were evaluated in radical operation for spina bifida. The neuroendoscope [2 mm-diameter rigid endoscope] was applied during microsurgery in fifty cases of spina bifida that were operated upon at King Hussein Medical Centre between January 2006 and January 2008. It was used prior to the incision of the sac in cystic cases and after the dura was opened in non-cystic cases. The cases included nearly all types of spina bifida. The neuroendoscope showed pathology with clarification of surgico-anatomical structures and defined its relation to the normal structures. There were no technical difficulties or complications. It was of value in assessing the type of lipoma, the extent of cord involvement, identified the roots at exit from the cord invaded by lipoma and reduced both manipulation and retraction. It gave an excellent view of the anterior part of the malformed cord with detailed view of nerve roots and vessels before the surgical intervention. Filum terminale and sacral roots were visualized in all cases of tethered cord making resection of the spinal lipoma easier and safer. There was no increase in infection rate, no effect on the primary surgical procedure, no bleeding or nervous tissue injury. Application of the neuroendoscope to microsurgery of spina bifida is very useful in showing the pathology with more clarity and its relation to normal structures. It can enhance surgical quality and reduce possible complications, allowing meticulous and more complete resection while preserving neurological function. There was a highly magnified panoramic view of the anatomy and pathology through the neuroendoscope