ABSTRACT
We report an unusual case of a patient with a sphenoid wing meningioma that after a few years of static radiological appearance presented with sudden deterioration following rapid growth of tumor with intratumoral infarct. The patient underwent surgery and malignant melanoma deposits within the meningioma were demonstrated on histopathological examination. She had a history of a malignant melanoma (MM) excised from the left forearm 10 months ago with no evidence of recurrence. Although metastasis to meningioma has been widely reported, this is only the second report where the primary tumor is MM. In addition, to the best of our knowledge, intratumoral hypodensity from metastasis is unusual. The tumor-to-tumor phenomenon is discussed and the literature is reviewed.
Subject(s)
Melanoma/secondary , Meningeal Neoplasms/pathology , Meningioma/pathology , Neoplasms, Second Primary/pathology , Skin Neoplasms/pathology , Female , Humans , Melanoma/surgery , Meningeal Neoplasms/surgery , Meningioma/surgery , Middle Aged , Neoplasms, Second Primary/surgery , Skin Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
Pseudomeningocele is a rare but well recognised complication of lumbar surgery (microdiscectomy and laminectomy). Most of the patients tolerate the presence of the cyst well, however some present with back pain and spinal claudication, presumably due to neural compression. We report a case who presented following three operations (microdiscectomy, laminectomy and excision of a pseudomeningocele) with symptoms of spinal claudication and bilateral radicular pain. The cause of her pain was evident only at operation and was due to herniation of nerve roots through the dural defect.
Subject(s)
Diskectomy/adverse effects , Dura Mater/injuries , Laminectomy/adverse effects , Meningocele/etiology , Postoperative Complications/etiology , Spinal Nerve Roots/injuries , Cauda Equina/injuries , Cauda Equina/pathology , Cauda Equina/physiopathology , Cerebrospinal Fluid/physiology , Cysts/diagnosis , Cysts/etiology , Cysts/physiopathology , Decompression, Surgical/methods , Dura Mater/pathology , Dura Mater/physiopathology , Female , Humans , Intervertebral Disc/pathology , Intervertebral Disc/surgery , Low Back Pain/etiology , Low Back Pain/physiopathology , Lumbar Vertebrae/pathology , Lumbar Vertebrae/surgery , Magnetic Resonance Imaging , Meningocele/diagnosis , Meningocele/physiopathology , Middle Aged , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/surgery , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Radiculopathy/diagnosis , Radiculopathy/etiology , Radiculopathy/physiopathology , Spinal Nerve Roots/pathology , Spinal Nerve Roots/physiopathology , Tissue Adhesions/diagnosis , Tissue Adhesions/etiology , Tissue Adhesions/physiopathology , Treatment OutcomeABSTRACT
OBJECTIVE: To study the value of an improvement of the presigmoid petrosal approach to the petroclival area by the addition of partial labyrinthectomy and petrous apicectomy and to document hearing and other results. METHODS: Thirty-six consecutive patients treated by this technique during a 2-year period were studied prospectively. The lesions treated included 33 petroclival neoplasms (25 meningiomas, 5 chordomas, 1 chondrosarcoma, 1 trigeminal schwannoma, and 1 epidermoid cyst) and 3 vertebrobasilar aneurysms. The patients underwent clinical, radiological, and neuro-otological examinations. RESULTS: There was no perioperative mortality. Cranial nerve deficits involving Cranial Nerves III, IV, V, and VI occurred in 17 patients (47%) postoperatively. Cerebrospinal fluid leak occurred in 12 patients (33%). Four of these patients were treated by lumbar drainage, two patients were treated by lumboperitoneal shunt, and six patients required reoperation and repacking of the middle ear. Hydrocephalus occurred in five patients (13.9%). There was one case of meningitis and another of systemic sepsis. All 36 patients underwent postoperative audiometric evaluation. When serviceable hearing was present preoperatively (Gardner-Robertson Grades I or II), it was determined to be preserved at postoperative follow-up in 81% of the patients (26 of 32 patients). CONCLUSION: The partial labyrinthectomy petrous apicectomy approach provided improved access to neoplasms of the clivus and petrous apex and the posterior cavernous sinus area and to vertebrobasilar aneurysms in the midclival area. This improvement in access permits more controlled and thorough treatment of these lesions, with reduced brain retraction and acceptable morbidity with respect to auditory function.
