Epidermoid cyst of the brain: A common cystic lesion in rare location

Epidermoid cysts are common benign tumors comprising around 1% and 2% of all intracranial tumors. Their usual locations include the parasellar region and cerebellopontine angle, and less commonly, the Sylvian fissure, suprasellar region, cerebral, and cerebellar hemispheres. Epidermoid cysts located in the brain stem are rare. These epidermoid cysts are similar to epidermoids arising in the skin which contain cheesy and flaky-white soft pultaceous material. Epidermoid cysts are very slow-growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from the remnants of epidermal elements during the closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the 3rd and 5th weeks of embryonic life. The ideal treatment of choice is the removal of cystic components with the complete resection of the capsule. We are presenting an interesting case of an epidermoid cyst in the frontal lobe in a 42-year-old male along with radiological investigations.

Neoplasias encefálicas em 40 cães: aspectos clínico-epidemiológicos e patológicos / Brain neoplasms in 40 dogs: clinical, epidemiological and pathological aspects

Foi realizado um estudo retrospectivo de cães atendidos no Serviço de Neurologia (SN) do Hospital Veterinário Universitário (HVU), de 2006 a 2015, com o objetivo de identificar cães com neoplasias encefálicas e obter informações a respeito da raça, do sexo, da idade, dos sinais neurológicos, da localização, da evolução clínica, do tipo e origem do tumor e dos achados de exames complementares e de necropsia. Dos 40 cães com neoplasias encefálicas incluídos neste estudo, 67,5% foram classificadas como de origem primária. Cães sem raça definida e Boxers foram os mais acometidos. Os principais sinais clínicos observados incluíram crise epiléptica, alteração de comportamento e andar em círculo. A região tálamo-cortical foi a mais afetada. Quanto ao tipo do tumor, o meningioma (32,5%) e o oligodendroglioma (12,5%) foram os mais encontrados. A evolução dos sinais clínicos variou entre quatro e 210 dias (média de 44 dias).(AU)

A retrospective study including dogs with brain neoplasms was conducted at the Service of Neurology (SN) of the Veterinary Teaching Hospital, from 2006 to 2015, with the objective to identify and characterize breed, sex, age, neurological signs, the location, the clinical evolution, the type and origin of the tumor and the findings of complementary examinations and necropsy. Of the 40 dogs with brain tumors included in this study 67.5% were classified as primary origin. Mixed breed dogs and Boxers were the most affected. The main clinical signs observed included seizures, behavioral changes and walk in circle. The thalamus-cortex region was the most affected. Regarding the type of the tumor, the meningioma (32.5%) and oligodendroglioma (12.5%) were the most common. The evolution of the clinical signs varied from four to 210 days (mean 44 days).(AU)

Clinicoradiological profile of extra axial intracranial tumors

Background: Extra-axial tumors are the most common adult intracranial neoplasms. Meningiomas are the most common Extra-axial tumors. Their Clinical presentation, survival rates, and prognosis vary depending on the site and specific type of tumor, hence necessitating a detailed clinical and radiological evaluation. Materials and methods: A prospective observational study on 15 symptomatic subjects who presented to a tertiary care hospital with Supratentorial intracranial tumors confirmed by CT was done. After getting a detailed history, clinical examination and CT (including contrast) were done. Results: In the study population, 73% had meningioma. 13% had a Pituitary Adenoma. 13% had craniopharyngioma. A headache was the most commonly reported symptom (73%). Majority of meningiomas were located in convexity of the brain (36.4%) and parasagittal areas (36.4 %). Conclusions: Neuroradiology plays a key role in the identification of supratentorial extra-axial tumors with CT allowing accurate anatomical description which can go a long way in management and defining prognosis.

The Extended Pterional Approach and Microsurgery Resection for Craniopharyngiomas, Operative Nuances and Results: A Series of 29 Patients

Objective The aim of this paper is to observe if the extended pterional approach for the removal of craniopharyngiomas is safe and effective. The mortality, morbidity, and recurrence rates are presented and discussed. Method This is a retrospective analysis of 29 craniopharyngioma patients who underwent surgery between January 1988 and December 2014 at the Department of Neurosurgery of the Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil. The charts, operative reports and imaging studies were reviewed. Results We identified 17 males (58.6%) and 12 females (41.3%) ranging in age from 0.6 to 84 years (mean 57.4 years). Thirteen (44.8%) patients were infants or adolescents. Surgical mortality occurred in one patient (3.4%). Gross total tumor removal was achieved in 15 (51.7%) patients. The median follow-up time was 7.1 years. Conclusion The extended pterional approach provides adequate access to craniopharyngiomas, and the majority of lesions could be totally removed, with a low mortality rate, but the best treatment for craniopharyngiomas remains controversial.

Objetivo Observar se a craniotomia pterional estendida é uma técnica segura e efetiva. Método É um estudo retrospectivo de 29 pacientes com craniofaringiomas que foram submetidos a craniotomia pterional estendida entre 1988 e 2014. As imagens e os prontuários foram analisados. Resultados Esse grupo é composto por 17 homens (58,6%) e 12 mulheres (41,3%), e a idade variou de 0,6 a 84 anos (media 57,4 anos). Treze (44,8%) pacientes eram crianças ou adolescentes. A remoção total da lesão ocorreu em 15 (51,7%) indivíduos. A mortalidade cirúrgica: um paciente (3,4%). O follow-up médio é de 7,1 anos. Conclusão A craniotomia pterional estendida permitiu a remoção total da lesão na maioria dos pacientes, com baixa mortalidade, porém o melhor tratamento para o craniofaringioma ainda gera muita controvérsia.

Study of intraoperative squash cytology of intracranial and spinal cord tumors.

Background: The aim was to study the cytomorphology of neoplastic lesions of brain and spinal cord by intraoperative squash cytology, compare it with the histopathological diagnosis on excision biopsy/surgical specimen and establish a correlation. The causes of erroneous diagnoses achieved at squash cytology of intracranial and spinal cord tumors were ascertained. Tumor types having the advantage of diagnostic certainty by squash cytology of intracranial and spinal cord lesions was also determined. Methods: Squash preparations of 70 patients suspected to have neoplasia were made and stained with rapid hematoxylin and eosin stain and rapid Papanicolaou stain. A few squash smears were also dry fixed and stained with Giemsa stain. The smears were typed according to the cytomorphological criteria and the cytodiagnoses was compared with the histopathological diagnoses and a correlation was established. Results: A positive predictive value for intraoperative squash cytology for diagnosis of intracranial and spinal cord tumors was seen to be 100% and a negative predictive value of 97.22% were established by this study. The sensitivity was found to be 97.22% and the specificity was 100%. Thus, the accuracy of the study was 98.57%. Conclusions: Squash smear cytology of the brain and spinal cord tumors performed intraoperatively for diagnostic consultation fulfills all the determinants of an excellent diagnostic modality.

Meningioma vs. migraña. Reporte de caso / Meningioma vs. migraine. A case report

Introducción: Los meningiomas son tumores benignos que se originan en células aracnoideas y como consecuencia pueden crecer en cualquier lugar donde exista duramadre. Suelen aparecer generalmente entre los 35 y 55 años de edad y son más frecuentes en mujeres. Objetivo: Presentar un caso clínico cuyo diagnóstico pudo realizarse antes teniendo en cuenta la forma de presentación. Caso clínico: Mujer de 38 años de edad con antecedentes de estar diagnosticada de migraña de más de 1 año de evolución y que ingresa en el Servicio de Medicina Interna del Hospital General Docente Enrique Cabrera, de La Habana, con síntomas en los últimos 3 meses de intensificación de la cefalea y modificación de sus características, con hipertensión intracraneal y focalización motora. El examen clínico y la realización de TAC definen el diagnóstico y se corrobora con tratamiento quirúrgico. Posterior al tratamiento evoluciona satisfactoriamente. Conclusiones. Un correcto interrogatorio y examen del paciente, y el uso adecuado y preciso de las imágenes en los diagnósticos reduce la posibilidad de errores en la práctica clínica.

Introduction: Meningiomas are benign tumors which are originated in arachnoid cells so they can grow anywhere it exists dura mater. They generally appear in ages between 35 and 55 years. They are more frequently found in women. Objective: To present a case report that could be diagnosed long before taking into account its form of manifestation. Case report: It's a 38 years old woman already diagnosed for migrain with more than a year of evolution who enters the service of internal medicine at the teaching hospital "Enrique Cabrera" in Havana. She has symptoms in the last three months of a strong migraine and modification of its characteristics with motor focalization and intracranial hypertension.After clinical examination with computed axial tomography included a diagnosis is established and surgical treatment is corroborated. After this treatment the patient evolves satisfactorily. Conclusions: Correct questioning and clinical examination of the patients and use of images when necessary reduces the possibility of errors in clinical practice.

Primary central nervous system lymphoma: A study of clinicopathological features and trend in western India.

Introduction: Primary central nervous system lymphoma (PCNSL) is rare and accounts for 1-2% of all primary intracranial tumors (ICT). There are conflicting reports regarding the increased incidence of PCNSL over the last two decades in both immunocompromised and immunocompetent patients. Aim: This study was designed to study the clinicopathological characteristics of PCNSL and to access the trend of PCNSL at our institute. Materials and Methods: All the histopathologically proven cases of PCNSL were reviewed from January 1997 to December 2009 (13 years). Immunophenotyping was performed on available paraffin-embedded tissue blocks. Immune status was evaluated and human immunodeficiency virus (HIV) serology was performed in all cases. Cerebrospinal fluid (CSF) findings were recorded whenever available. Possibility of secondary involvement by a systemic lymphoma was excluded in every case. Statistical analysis was done using χ2 -test. Results: During the study period (13 years), a total of 4715 cases of ICT were diagnosed, out of which 66 cases were PCNSL, which accounted for 1.4%. The age ranged from 10 to 75 years with a median age of 46 years. All the patients were immunocompetent. Frontal lobe was the most common site of involvement. Diffuse large B-cell lymphoma was the histological pattern in all the cases. CSF involvement was seen in only one case. Conclusions: In this study, no significant increase in the incidence of PCNSL was found at our institute. Association of PCNSL cases with HIV or acquired immunodeficiency syndrome was not found in our study.

Tumores intracraneanos del niño / Pediatric intracranial tumors

Introducción. Los tumores intracraneanos (TIC) pediátricos son las neoplasias sólidas más frecuentes en niños. Se presenta la experiencia del Hospital Infantil de México Federico Gómez (HIMFG) de los últimos 36 años. Material y métodos. Se utilizaron los siguientes archivos del HIMFG: Clínico, de los Departamentos de Neurocirugía y de Patología. Los resultados se compararon con los datos del Hospital for Sick Children de Toronto y del Instituto Nacional de Pediatría de México, D. F. Resultados. En el HIMFG, 55% de los pacientes eran del sexo masculino. Predominaron desde lactantes mayores hasta escolares, con más de 50%. Los tumores fueron: 397 supratentoriales y 413 infratentoriales. Los más frecuentes fueron: astrocitomas (32%), meduloblastomas (19%), craneofaringiomas (11%) y ependimomas (10%); en el quinto lugar quedaron los germinomas (4%). Los gliomas mixtos, los meningiomas, los tumores neuroectodérmicos primitivos y los ependimoblastomas representaron de 1 a 3%. Conclusiones. En el HIMFG, los 4 tipos más frecuentes de tumor fueron: astrocitomas, meduloblastomas, craneofaringiomas y ependimomas. El trabajo de campo del HIMFG ha tenido un desarrollo exponencial desde la mitad de los años setenta. Actualmente, el volumen de pacientes manejado por el HIMFG es semejante a, o rebasa discretamente, al de otras instituciones.

Introduction. Pediatric intracranial tumors (PIC) make up the most frequent solid neoplastic pathology in children. We present an analysis of the experience of Hospital Infantil de Mexico Federico Gomez (HIMFG), in Mexico City, over the course of 36 years in this regard. Material and methods. Cases from the archives of the Department of Clinical Records, Department of Neurosurgery and Department of Pathology at HIMFG were used for this analysis. Results were compared to data published by the Hospital for Sick Children of Toronto (HSCT) and by Instituto Nacional de Pediatria (INP) in Mexico City. Results. Of 810 cases reviewed at HIMFG, 55% belonged to the male gender. By age, older-infant and grade-school-children cases predominated (> 50%). Of those, 397 cases were supratentorial and 413 infratentorial. Most frequent tumors were: astrocytomas (23%), medulloblastomas , craniopharyngiomas (11%) and ependymomas (10%). Fifth place was occupied by germinomas (4%). Mixed gliomas, meningiomas, primitive neuroectodermal tumors and ependymoblastomas were the last (1 to 3%). Conclusions. At HIMFG, the most frequent tumour types were: astrocytomas, medulloblastomas, craniopharyngiomas and ependymomas. Since the 70s, on the number of patients presenting with intracranial tumors at HIMFG has grown exponentially, and the amount carried out till now at this hospital parallels, or slightly exceeds, that carried out at similar institutions in Mexico and abroad.

Predictive value of electrocorticography on postoperative epilepsy in patients with intracranial tumors / 第三军医大学学报

0.05).Conclusion The variety of ECoG on patients with intracranial tumors undergone surgery is helpful to prognosticate postoperative early epilepsy.

Clinical Experience in Conformal Stereotactic Radiotherapy of Irregularly Shaped Intracranial Tumors / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The dosimetric advantages of multiple non-coplanar stationary fields for stereotactic radiotherapy or adiosurgery (SRT/S) are well known. However, this technique is not widely used due to the logistical problems associated with producing and testing customized collimators. We report our experience of SRT/S using multiple non-coplanar stationary fields (conformal SRT/ S). MATERIALS AND METHODS: Between August 1997 and February 2002, we performed frameless SRT/S in 63 patients. We chose conformal SRT/S when the tumor was of a very irregular shape or larger than 4 cm. We obtained three pieces of information: 1) the couch translations required to bring the target point to the isocenter, 2) the distance between the stereotaxic markers in the CT study, and the distance between the markers determined from orthogonal beam films, taken in the anterior- posterior and lateral directions, and 3) the rotational movement of the head position between the CT study and actual treatment position. We evaluated two kinds of data: 1) the precision of the isocenter setup, and 2) the reproducibility of the head position in the a) translational and b) rotational components. RESULTS: Twenty-six of the 63 patients receiving stereotactic treatment received conformal SRT/S. The precision of the isocenter setup for the conformal SRT/S was x=-0.03+/-0.26 mm, y=0.19+/-0.25 mm and z=-0.20+/-0.27 mm. The reproducibilities of the head position with the conformal SRT/S were 0.5 mm and less than 1degrees C, for the translational and rotational components, in any plane. CONCLUSION: We were able to apply conformal stereotactic irradiation, which has a dosimetric advantage, to irregularly shaped intracranial tumors, with precision and reproducibility of head position for the isocenter setup nearly equivalent to that of frame-based SRS or multiple-arc SRT/S.

Applications of three newer contrast-enhaced MRI sequences in the diagnosis of intracranial tumors / 中国癌症杂志

Purpose:To investigate the values of three newer contrast enhanced MRI sequences including gadolinium-enhanced FLAIR MRI(CE FLAIR), dynamic contrast-enhanced MRI (DCE MRI) and perfusion- weighted MRI(PWI) by comparing their advantages and disadvantages respectively in the diagnosis of intracranial tumors. Methods:43 patients with intracranial tumors underwent DCE MRI, CE FLAIR and PWI respectively. The gadolinium-enhanced FLAIR, dynamic enhanced MR and perfusion-weighted MR images were evaluated independently by two radiologists for the number of examinations with one or more enhancing lesions, the number and location of enhancing lesions per examination, the detectability for different lesions in different locations, size and extent of the lesions. Results:Perfusion-weighted MR images showed poor quality and could not give a diagnosis in 5 of 43 cases because of heavy susceptibility artifacts. There were 47 lesions in the 38 cases. However, 41 lesions were found on CE FLAIR MR images and 42 on DCE MRI and 45 on PWI. 3 lesions(2 located in the subcortical area and 1 in paraventricle) were only revealed on the CE FLAIR images. 4 lesions in the basal ganglia area were only found on dynamic enhanced images. 7 lesions in the cerebral hemisphere were only found on perfusion-weighted images. So there were significant differences in revealing lesions of different locations with the three MR modalities(P

The Value of Imprint Cytology in Diagnosis of Intracranial Tumors During Operation and Cytological Features of Intracranial Tumors / 中国医师杂志

Objective To evaluate the diagnostic accuracy of imprint cytology for intracranial tumors during operation. Methods 150 cases of intracranial tumors were diagnosed by imprint cytology. The imprint was prepared by touching the specimens several times with clean slide, and then the slides were fixed and stained with HE. The diagnostic results obtained by imprint cytology were compared with those made by frozen and routine paraffin sections. Results The accurant rates of diagnosing for non-glial tumors, classifying for incracranial tumors and grading for glial tumors were 100%, 91.3% and 88.3%, respectively. In addition, the morphological features of glial tumors, meningioma, pituitary adenoma on imprint cytology were briefly described. Conclusion The accurant rate of imprint cytology is almost equal to that of frozen section, and both the detection methods have a supplementary effect to each other.

Intracranial neoplasms: A ten year experience

The epidemiologic features of 652 histologically confirmed intracranial tumors were reviewed. 600 were primary tumors and 52 were metastatic. 17.4% of all tumors were gliomas and 23.2% were meningiomas. 73% of adult tumors were supratentorial, most commonly meningiomas, while 10% of pediatric tumors (age14) were infratentorial, predominantly medulloblastomas. There was an equal distribution of the tumors in the first decades of life. The medulloblastomas and astrocytoma I-II, peaked in early childhood whereas meningiomas, neurilemmomas and metastatic tumors increased in frequency with advancing age. The overall risk for intracranial tumors was the same for both sexes. However, women had greater susceptibility for meningiomas, pituitary adenomas and merilemmomas. The features of intracranial tumors in Filipinos mirrored those seen in Blacks and other Asians, and differed from most Western profiles. It is possible that racial difference play a role in the development of intracranial tumors.

Stereotactic Radiosurgery for Intracranial Tumors : Early Experience with Linear Accelerator / 대한치료방사선과학회지

Between August 1988 and December 1991, 24 patients with intracranial tumors were treated with stereotactic radiosurgery(RS) using a 10 MV linear accelerator at Severance Hospital, Yonsei University College of Medicine. There were 5 meningiomas, 3 craniopharyngiomas, 9 glial tumors, 2 solitary metastases, 2 acoustic neurinomas, 2 pineal tumors, and 1 non-Hodgkin's Iymphoma. Ten patients were treated as primary treatment after diagnosis with stereotactic biopsy or neuroimaging study. Nine patients underwent RS for post-op. residual tumors and three patients as a salvage treatment for recurrence after external irradiation. Two patients received RS as a boost followed by fractionated conventional radiotherapy. Among sixteen patients who were followed more than 6 months with neuroimage, seven patients (2 meningiomas, 4 benign glial tumors, one non-Hodgkin's lymphoma) showed complete response on neuroimage after RS and nine patients showed decreased tumor size. There was no acute treatment related side reaction. Late complications include three patients with symptomatic peritumoral braid edema and one craniopharyngioma with optic chiasmal injury. Through this early experience, we conclude that stereotactically directed single high doses of irradiation to the small intracranial tumors is effective for tumor control. However, in order to define the role of radiosurgery in the management of intracranial tumors, we should get the long-term results available to demonstrate the benefits versus potential complications of this therapeutic modality.

Contrast Analysis of C T Diagnosis and Pathological Examination of 90 Intracranial-Tumor Cases / 昆明医科大学学报

90 cases of intracranial tumors confirmed by CT diagnosis and perative pathological ex- amination were reported in this article.According to the typical CT findings in combination with clinical manifestations,a qualitative diagnosis of the tumors might be made.Atypical CT findings in some cases were analyzed and correlated with pathological data in order to raise the accurate rate in the qualitative disgnosis of tumors.Authors' experience in the misdiagnostic cases was summed up.

Clinical Evaluation of Ultrasonic Aspiration of Intracranial Tumors

The Cavitron ultrasonic Surgical Aspirator has been used clinically in 79 cases for removal of intracranial tumors. Ultrasonic aspiration of intracranial tumors has definite advantage in comparison with the previous conventional technique. The results were summarized as follows; 1) Ultrasonic aspirator provides a method of removing intracranial tumors that are not of a consistency to allow removal with suction and cautery alone. 2) There is a good proprioceptive feedback for the surgeon while using the ultrasonic aspirator. So the blood vessels were selectively exposed, operation was performed without severe bleeding. 3) Ultrasonic aspirator obviates the need for the cautery cutting loop. This is particularly advantageous when dealing with tumors in the cerebellopontine angle or close to important structures, such as the optic nerve or carotid artery. 4) Ultrasonic aspirator allows direct visualization of the tissue being removed.

Stereotactic Radiotherapy by 6MV Linear Accelerator / 대한치료방사선과학회지

Eight patients with intracranial tumors or arteriovenous malformation (AVM)s which were less than 3 cm in diameter were treated by a technique of stereotactic radiotherapy during the 4 months period from July 1988 through October 1988 at the Division of Radiation Therapy, Kang-Nam St. Mary's Hospital, Catholic University Medical College. The patients were diagnosed as AVMs in 3 cases, acoustic neurinoma, craniopharyngioma (recurrent), hemangioblastoma, pineocytoma, and pituitary microadenoma in each case. There are several important factors in this procedure, such as localization system, portal, field size, radiation dose, and perioperative supportive care. It is suggested that stereotactic radiotherapy may be performed safely with a radiation dose of 12-30 gy. So this noninvasive procedure can be used to treat unresectable intracranial tumors or AVMs. Of these, clinical symptoms had been regressed in AVMs in 2 cases at 3 months and 2 months after Stereotactic radiotherapy, one of whom was confirmed slightly regressed on the follow-up angiogram. And also craniopharyngioma and pineocytoma was minimally regressed on 3 month follow-up CT.

Dynamic CT Study of Intracranial Tumors / 昆明医科大学学报

The time-density curves were collected in 106 patients with intracranial tumors.A de- tailed analysis was made among 66 of them whose illness was determined surgically and pathologically.The scanning technique,method of administration of contrast material in dy- namic CT and its value in the qualitative and differential diagnosis of intracranial tumors were discussed.We consider that 1.dynamic CT scan is performed safely and reliably without trauma or pain on patients.2.Due to their various degrees of vascularity and disorders in the blood-brain barrier,different histological kinds of brain tumors have their own typical time-density curves.3.Vascular disorders such as aneurysm,angioma and arteriovenous mal- formation can be determined and differentiated from intracranial tumors or granuloma based on the typical time-density curves.4.Dynamic CT study is of some value in differential diagnosis of various kinds of brain tumors and is important in differentiation between brain tumors and granulomatous lesions.