RARE INTRACRANIAL MULTIFOCAL NON-GERMINOMATOUS GERM CELL TUMOR IN AN 18-YEAR-OLD MALE: A CASE REPORT.

Intracranial germ cell tumors are rare brain tumors that are distinguished based on their histology and selected tumor markers. Non-germinomatous germ cell tumors are a diverse group of such tumors having the poorest prognosis. Most commonly, they are located in the suprasellar and pineal regions. Since the exact treatment protocol has not yet been established, there is currently no standardized modality of management. We present a case of intracranial multifocal non-germinomatous germ cell tumor in an 18-year-old male, along with relevant literature review. We describe initial diagnostic and treatment procedures in a young adult presented with diplopia and ataxic gait. Neuroradiological findings and elevated alpha fetoprotein and beta chain of the human chorionic gonadotropin tumor markers indicated the possible mixed germ cell tumor. Chemotherapy regimen was adjusted accordingly, biopsy was not performed. The patient's clinical condition improved significantly and his alpha fetoprotein values decreased remarkably after initiation of chemotherapy. In conclusion, initial evaluation with neuroimaging, tumor markers, and cytology from cerebrospinal fluid is important as guidance to further treatment and prognosis. In selected cases, biopsy may not be indicated to start adjuvant chemotherapy. We emphasize the importance of specific treatment modality selection based mainly on tumor markers, regardless of the precise histologic classification.

Sphenoid sinus aspergilloma in trans-sphenoidal surgery for pituitary adenomas.

BACKGROUND: Simultaneous appearance of sphenoid sinus aspergilloma and pituitary adenoma is a very rare finding. METHODS: Retrospective analysis of patients with sellar and sphenoid sinus mass lesions who underwent trans-sphenoidal surgery was performed. Demographic data, medical history, predisposing factors, clinical picture, neurological status and radiological findings were reviewed. All patients underwent a trans-sphenoidal microsurgical treatment, and acquired specimens underwent both histopathological and microbiological analysis. RESULTS: Sphenoid sinus aspergilloma was encountered in seven patients. Three patients had an isolated sphenoid sinus aspergilloma and four patients with pituitary macroadenoma had a sphenoid aspergilloma as an incidental finding. CONCLUSIONS: Sphenoid sinus aspergilloma can be found during trans-sphenoidal surgery for pituitary adenomas. Sphenoid sinus extirpation followed by adenomectomy is the treatment of choice unless invasive aspergilloma is encountered requiring additional antifungal therapy.

[Guidelines for interventional and invasive treatment in patients with mechanical back pain]. / Smjernice za intervencijske i invazivne postupke u bolesnika s mehanickom krizoboljom.

Back pain caused primarily by mechanical disorders is the most common type of back pain and it is usually found in young and middle-aged population, i.e. active population. This is why back pain is one of the most important public health problems. Treatment of pain syndrome affecting spine depends on a variety of factors and generally includes conservative and invasive methods. Relative indication for interventional and surgical procedures is long lasting back pain, the symptoms of which, predominantly pain, cause significant problems for the patient on performing everyday activities. Invasive/surgical treatment is applied after minimally 3 months of unsuccessful conservative treatment. Invasive and surgical procedures comprise a wide spectrum of interventions, from interventional and semi-interventional procedures, minimally invasive procedures to extensive, invasive operations that include instrumentation. The choice of intervention is based on clinical findings, duration and severity of pain and other symptoms, as well as on diagnostic reports. Despite recommendations based on the results of clinical studies, individual approach to each patient is the main principle of successful treatment.

Complete resolution of medically refractory temporal lobe epilepsy after arachnoid cyst fenestration.

Intracranial arachnoid cysts are congenital lesions that are frequently detected incidentally. About 30% of patients have a symptomatic epileptic seizure as the presenting symptom, occasionally with other focal neurologic signs. A case is presented of a young male patient with medically refractory temporal lobe epilepsy. Following his neurological examination, epileptic zone was defined in the right temporal lobe that correlated with the MRI-detected sylvian arachnoid cyst. Microneurosurgical cyst fenestration with volume reduction was performed, which resulted in a decremental but eventually complete seizure freedom. In conclusion, the arachnoid microsurgical cyst reduction is a safe procedure and may result in complete remission of symptomatic epileptic seizures and favorable outcomes, as reported in other studies.