Extra-axial cavernous hemangioma: two case reports.

Two patients with extra-axial cavernous hemangioma who presented with headache and oculovisual disturbances were investigated with computed tomography and magnetic resonance imaging. The lesions masqueraded as basal meningioma, but this diagnosis was not supported by magnetic resonance spectroscopy in one patient. Cerebral angiography with embolization was indicated in one patient, but embolization was not justified in the other. Both patients underwent a pterional craniotomy. The lesions were extradural and highly vascular, necessitating excessive transfusion in one patient in whom gross total resection was achieved, and precluding satisfactory removal in the other. There was no mortality. Transient ophthalmoplegia, the only complication in one patient, was due to surgical manipulation of the cavernous sinus; it resolved progressively over 3 months. Extra-axial skull base cavernous hemangiomas are distinct entities with clinical and radiological characteristics that differ from those of intraparenchymal cavernous malformations. They can mimic meningiomas or pituitary tumors. In some cases, magnetic resonance spectroscopy may narrow the differential diagnoses. Surgical resection remains the treatment of choice, facilitated by preoperative embolization to reduce intraoperative bleeding and by the application of the principles of skull base surgery. Fractionated radiotherapy is an alternative in partial or difficult resections and in high-risk and elderly patients.

Suprasellar meningioma and blindness: a unique experience in Saudi Arabia.

BACKGROUND: The natural history of intracranial meningioma is no different in the Arabian peninsula than in other countries. The extent of the total loss of vision in one or both eyes, however, is unique to this area. METHODS: A retrospective study was conducted at King Faisal Specialist Hospital and Research Centre, a tertiary care institution in Saudi Arabia, on all cases of intracranial meningioma seen over a period of 9 years. The following data were collated: clinical presentation, site and size of tumor, radiologic features, surgical methods, and preoperative and postoperative visual status. RESULTS: Seventy of 232 cases (30.1%) of intracranial meningioma presented in the suprasellar area; the majority of these were more than 5 cm in diameter. Because of the large size it was not always possible to identify the exact point of origin or to achieve complete tumor removal. Deteriorating vision was the cardinal presenting feature and the incidence of blindness in one or both eyes at presentation was high (42.2%); 12.8% were totally blind on admission. None of these patients showed improvement after surgery (complete or subtotal removal of tumor). CONCLUSION: Lack of understanding of the symptoms and cultural influences are direct contributing factors to this complication of a benign intracranial lesion. This represents a serious public health concern in the Arabian peninsula.

Combined oral isoprinosine-intraventricular alpha-interferon therapy for subacute sclerosing panencephalitis.

Eighteen patients, 16 boys and 2 girls, aged 5-14 years, with subacute sclerosing panencephalitis (SSPE) were treated with oral isoprinosine (100 mg/kg/day) and intraventricular alpha-interferon 2b (Intron A, Schering Corp.), starting at 500,000 U twice a week and later increasing to 3 million U biweekly. Minimal follow-up of living patients is 12 months; maximal 40 months. On the basis of the Neurological Disability Index (NDI) scores and staging, 8 have treatment-induced remissions (3 improved, 5 arrested), 4 are worse and 6 died. This 44% (8/18) rate of remission/improvement compares well with the 9% (1/11) remission in historical controls in the same institution (p = < 0.05) and 5% spontaneous remission in the literature. Combined oral isoprinosine-intraventricular alpha-interferon appears to be an effective treatment for SSPE.

Brain tumors in pediatric patients at King Faisal Specialist Hospital and Research Centre.

We report our experience with brain tumors in pediatric patients, patients who came to our attention when they were aged 14 years or less. In general, the pattern of brain tumors at this Institution is similar to that reported in the neurosurgical literature. Fortunately we have modern diagnostic technology and modern operating instrumentation available to use for dealing with such lesions, which are often in their late stages.

Brain biopsy in tuberculoma: the risks and benefits.

In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.

Pituitary tooth: case report of a suprasellar teratoma.

A rare case of intracranial teratoma is reported in which a tooth-like structure was clearly defined in the pituitary fossa. The authors are unaware of any similar case having been reported previously.

Fracture of the penis.

We report on 4 patients with fracture of the penis who were managed conservatively with oxyphenbutazone and diazepam. All of our patients recovered completely within 6 to 8 weeks.