Spontaneous Regression of a Hypoglossal Neurinoma: Case Report and Review of the Literature.

BACKGROUND: Hypoglossal neurinomas are very rare intracranial tumors. The management choices include surgery, as the gold standard, and radiosurgery or a combination of both. Little is known about this condition and the behavior of this tumor. CASE DESCRIPTION: A 54-year-old woman presented with a right 12th nerve neurinoma with ipsilateral hemiatrophy of the tongue and spontaneous regression after 1 year of follow-up. CONCLUSIONS: Our case highlights the importance of considering careful observation and diligent follow-up as a treatment option, as these lesions can show spontaneous regression with no invasive approaches.

Complex form variant of dysembryoplastic neuroepithelial tumor of the cerebellum.

Dysembryoplastic neuroepithelial tumor (DNT) is a benign neoplasm with typical supratentorial location, but the possibility of these rare tumors can also be located in the posterior fossa must be taken into account. We report a 21-year-old woman that suffered gait instability, headache, and diplopia. On CT-scan, an intraparenchymatous cerebellar tumor was disclosed. It was isodense, showing light enhancement after contrast administration. On MRI (T1-weighted image) the tumor was isointense, showing inhomogeneous hyperintensity after-gadolinium administration. On T2-weighted MRI, the tumor was inhomogenously hyperintense. At surgery, a solid and hypervascularized tumor was completely removed. Two years after surgery, the patient is symptom-free. Pathological study showed coexistence of areas of pilocytic astrocytoma with areas in which small rounded oligodendrocyte-like cells (OLC), with strong synaptophysin expression were identified. These neurocytic areas showed an eosinophilic matrix forming microcysts, and cells with aspect of "floating neurons" were occasionally identified. A complex form variant of DNT was diagnosed. Our case suggests that in presence of a cerebellar tumor with features of pilocytic astrocytoma, the possibility of a complex form variant of DNT should be considered.

Calidad de vida de pacientes con tumores cerebrales: panorama actual / Quality of life of patients with primary brain tumors: actual status

El presente artículo revisa el panorama actual de la calidad de vida en el área de la salud, y de forma específica en tumores cerebrales primarios. Se inicia con una definición y clasificación de los tumores cerebrales de acuerdo a diferentes variables tales como edad, género origen celular y grado histológico. Posteriormente se enmarca el constructo de calidad de vida asociado a la salud, y se exponen los trabajos publicados en el área de la neurooncología en las dos últimas decadas, reflejando sus características metodológicas y los resultados más relevantes. En resumen, el estudio de la Calidad de Vida se esta convirtiendo en un aspecto relevante dentro de la neurooncología, debido a elevada neurotoxicidad y baja eficacia de los tratamientos multimodales en la supervivencia de esta población

The present article reviews the actual status of the quality of life in primary brain tumours. One begins with a definition and classification of the cerebral tumours according to different variables such as age, gender, cellular origin and histology degree. In addition the quality of life is framed associated to the health, and the works published in the neurooncology area in the two last decades are exposed, reflecting its methodological characteristics and the most important results.In summary, the study of quality of life is an important aspects within neurooncology area, due to high neuro-toxicity and low effectiveness of the multimodal treatments

Intradural extramedullary spinal ependymoma: a benign pathology?

STUDY DESIGN: Spinal ependymoma is a benign central nervous system tumor described as an intramedullary lesion more frequently located at the conus medullaris. It has been described exceptionally in the literature as an intradural extramedullary tumor. OBJECTIVE: Presentation of an extremelly rare location and evolution of extremedullary ependymoma and discussion of its probable origin, differential diagnosis, treatment options, and follow-up. SUMMARY OF BACKGROUND DATA: This case demonstrates an unusual location of a benign ependymal tumor in the extramedullary space with a total resection, which recurred in a lower level with a malignant transformation with the same extramedullary location. METHODS: The authors present the case of a 47-year-old woman with a subacute spinal cord dysfunction and an intradural extramedullary D2-D3 tumor mimicking meningioma or neurinoma. At surgery, an encapsulated intradural extramedullary mass was found, but neither dural attachment nor medullary infiltration was present. RESULTS: After complete resection, anatomic-pathologic studies confirmed that the lesion was a benign classic ependymoma. Good neurologic outcome was achieved, and no residual tumor was present at magnetic resonance imaging (MRI) control performed at 3 and 9 months later. One year after surgery, a new intradural extramedullary tumor was found at the D4 level without recurrence at D2. The patient was operated on again, but at this time the histologic study showed an anaplastic ependymoma with a proliferation index of 25% measured by Ki-67. Whole central nervous system radiotherapy was performed. CONCLUSION: All of the previously reported cases of spinal intradural extramedullary ependymomas carried out a benign course. The case we are reporting is the first one in which malignant transformation occurred. This tumor should be taken into account in the differential diagnosis of intradural extramedullary lesions. Moreover, close follow-up is recommended for this unusual location of ependymomas.

Crisis del lóbulo temporal registrada mediante magnetoencefalografía: caso clínico / Temporal lobe seizure recorded by magnetoencephalography: case report

La localización del inicio de las crisis es un factor importante para la evaluación prequirúrgica de la epilepsia. En este trabajo se describe la localización del inicio de una crisis registrada mediante magnetoencefalografía (MEG) en un niño de 12 años que presenta crisis parciales complejas farmacorresistentes. La RM muestra una lesión de 20mm de diámetro en el hipocampo izquierdo. EEG de superficie con ondas theta temporales izquierdas. Registro MEG interictal con punta-onda aislada posterior e inferior a la lesión de la RM. Registro MEG ictal con punta-onda (2 Hz). La localización de los dipolos indica el inicio de la crisis en la circunvolución temporal inferior en la misma localización que la actividad interictal MEG. Esta actividad ictal se propaga bilateralmente a áreas frontales. El registro corticográfico intraquirúrgico confirma los resultados de la localización interictal mediante MEG.

[Temporal lobe seizure recorded by magnetoencephalography: case report]. / Crisis del lóbulo temporal registrada mediante magnetoencefalografía: caso clínico.

Ictal onset localization is a important factor in presurgical evaluation of epilepsy. This paper describes the localization of a seizure onset recorded by magnetoencephalography (MEG) from a 12-year-old male patient who suffered from complex partial drug-resistant seizures. MRI revealed a 20mm diameter lesion located in left hippocampus. Scalp EEG showed left temporal theta waves. Interictal MEG registrations detected isolated spike-wave activity posterior and inferior to the MRI lesion. Ictal MEG showed continuous spike-wave activity (2 Hz). Dipole localization sited seizure onset in the inferior left temporal gyrus, the same localization of the interictal MEG activity. This ictal activity spreads bilaterally to frontal areas. Intrasurgical electrocorticography recording confirmed interictal MEG results.

Can small lesions induce language reorganization as large lesions do?

Shift of the cortical mechanisms of language from the usually dominant left to the non-dominant right hemisphere has been demonstrated in the presence of large brain lesions. Here, we report a similar phenomenon in a patient with a cavernoma over the anterolateral superior temporal gyrus associated with epilepsy. Language mapping was performed by two complementary procedures, magnetoencephalography, and electrocorticography. The maps, indicated right temporal lobe dominance for receptive language and left frontal lobe dominance for expressive language. These results indicate that a small lesion, associated with epilepsy, may produce selective shifting of receptive language mechanisms as large lesions have been known to produce.

Magnetoencephalographic localization of peritumoral temporal epileptic focus previous surgical resection.

UNLABELLED: Magnetoencephalography (MEG) is suggested as a localizing technique of epileptogenic areas in drug-resistant seizure patients due to intracraneal lesions. A male 42-year-old patient who begins at 26 with partial complex drug-resistant seizures is put forward. MRI shows a 9 mm diameter lesion located in left superior temporal gyrus which seems compatible with cavernoma. Both conventional and sleep deprivation EEGs have proved normal. Sleep EEG shows sharp waves in left temporal region. MEG helps to localize interictal spike and spike-wave activity, as well as wide slow wave (2-7 Hz) activity areas. Craniotomy under analgesia and aware sedation conditions is carried out. Intrasurgery cortical electric stimulation assisted by neuronavigator causes a limited partial complex seizure which the patient recognizes to be exactly like his. Thus, MEG localization of the epileptogenic area is confirmed. Surgical resection of both the lesion and the epileptogenic area is carried out. The patient remains free from seizures 9 months after surgery. A control MEG study reveals no epileptogenic nor slow wave activity. CONCLUSION: in this particular case, MEG has proven to be a useful presurgical evaluation technique to localize epileptogenic activity, validated by intrasurgical cortical stimulation.