ABSTRACT
OBJECTIVE: To report two cases of intracerebral hemorrhage due to primary intracranial peripheral primitive neuroectodermal tumor (pPNET)/Ewing's sarcoma (ES) and review of related literatures. MATERIAL: Two cases of 17-year-old patients presented with acute increased intracranial pressure one of which also had left hemiparesis. METHOD: On neuroimaging studies, the first patient had an intraparenchymal hematoma with a size of 4 cm at the right fronto-parietal junction adjacent to tumor infiltrating the superior sagittal sinus. The second patient had a large left temporal tumor with intraventricular hemorrhage. Both patients underwent craniotomy with complete removal of tumor and hematoma. RESULTS: Pathological examination in both cases revealed numerous small round tumor cells with stippled chromatin pattern and scanty cytoplasm. Tumor cells strongly expressed CD99. Vimentin immunoreactivity was observed. The final diagnosis of pPNET/ES was rendered. There was no evidence of extracranial disease in both cases. Both patients were doing well without evidence of recurrent disease at 12 and 24-month follow-up respectively. CONCLUSIONS: Peripheral primitive neuroectodermal tumor (pPNET)/Ewing's sarcoma (ES) is a malignant small round cell tumor, commonly arising in soft tissue of the trunk and lower extremity. Those occurring in the intracranium are rare, and most patients present with progressively increased intracranial pressure and/or cranial nerve deficit. The occurrence of intracerebral hemorrhage due to primary intracranial pPNET/ES is exceedingly rare. The role of adjuvant therapy in this condition is yet to be investigated.
Subject(s)
Brain Neoplasms/diagnosis , Cerebral Hemorrhage/etiology , Neuroectodermal Tumors, Primitive, Peripheral/diagnosis , Sarcoma, Ewing/diagnosis , Acute Disease , Adolescent , Antigens, CD/metabolism , Brain Neoplasms/complications , Brain Neoplasms/metabolism , Brain Neoplasms/surgery , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Neoplasm Proteins/metabolism , Neuroectodermal Tumors, Primitive, Peripheral/complications , Neuroectodermal Tumors, Primitive, Peripheral/surgery , Sarcoma, Ewing/complications , Sarcoma, Ewing/metabolism , Sarcoma, Ewing/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Deep hypothermic circulatory arrest may prove advantageous during surgery of some technically difficult brain lesions. This technique was first applied in one patient with a large intracavernous aneurysm which had failed standard neurosurgical techniques. For this technique to be successful the cooperation of neurosurgeons, cardiovascular surgeons, anesthesiologists, perfusionists and nurses is essential. Techniques aimed at improving the outcome include a short period of circulatory arrest, the depth of hypothermia, barbiturate administration, coagulation management and well-controlled blood glucose levels. The total time of circulatory arrest and the thiopentone dosage were 61 minutes and 1,700 mg respectively. The lowest core temperature was 13.9 degrees C. The positive outcome supports the use of this technique in selected patients with complex intracranial vascular lesions who may not be operable by standard techniques.
Subject(s)
Anesthesia , Cardiopulmonary Bypass , Hypothermia, Induced , Intracranial Aneurysm/surgery , Humans , Male , Middle Aged , PremedicationABSTRACT
A 22-year-old man with an intrinsic arteriovenous malformation (AVM) of the medulla, who presented with recurrent subarachnoid hemorrhage and bulbar palsy was described. The successful total surgical removal of this AVM was demonstrated. The clinical, roentgenographic, pathological features and surgical approach of the brainstem vascular malformation were summarized.
Subject(s)
Arteriovenous Malformations/surgery , Medulla Oblongata/blood supply , Subarachnoid Hemorrhage/diagnosis , Adult , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnosis , Humans , Magnetic Resonance Imaging , Male , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/etiology , Tomography, X-Ray ComputedABSTRACT
A group of neoplasms consisting of undifferentiated neuroepithelial cells being capable of differentiating into either neuronal or glial line or both directions has been termed "Primitive Neuroectodermal Tumors (PNETs)". They have been shown to possess several similarities in clinical, radiological, and pathological features to the cerebellar medulloblastomas. The latter are well treated by surgical removal followed by radiotherapy. Therefore, we used the same regimen in treating 7 patients with intracranial PNETs and obtained an average survival of 28.7 months which is longer than those of previous reports. The analysis of our patients disclosed an optimistic view that the ideal prognosis of PNETs should be better than this.
Subject(s)
Brain Neoplasms/mortality , Neuroectodermal Tumors, Primitive, Peripheral/mortality , Adolescent , Adult , Biopsy , Brain Neoplasms/diagnosis , Brain Neoplasms/therapy , Cause of Death , Child , Child, Preschool , Combined Modality Therapy , Female , Humans , Infant , Male , Middle Aged , Neuroectodermal Tumors, Primitive, Peripheral/diagnosis , Neuroectodermal Tumors, Primitive, Peripheral/therapy , Prognosis , Survival Rate , Tomography, X-Ray ComputedABSTRACT
A posttraumatic epidural arachnoid cyst embedded within the left petrous bone of a 25-year-old woman is reported. The lesion produced clinical manifestations of cerebrospinal fluid rhinorrhea, recurrent meningitides, and neuropathy affecting all divisions of the fifth cranial nerve as well as the eighth cranial nerve on the left side. The location of posttraumatic arachnoid cyst is rare at the cranial base, and the described clinical manifestations are unique.
