RESUMEN
Pilocytic astrocytoma is a histological subtype of astrocytoma classically located in the cerebellum of children and young adults. Cases occurring over the age of 30 years are rare and have not been classified in terms of their clinical features and management. Suitable cases were identified using diagnostic coding and by reviewing a neuropathology database. Casenotes and neuroradiology were reviewed retrospectively. Ten cases were identified over a 6 year period with an incidence of 0.49 cases per million population per year. Tumours were equally distributed between the supra- and infra-tentorial spaces. The most common symptom was headache occurring in 90%. No patient suffered seizures. Total macroscopic treatment remains the treatment of choice. Pilocytic astrocytoma of the adult is a rare tumour with a favourable prognosis.
Asunto(s)
Astrocitoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Adulto , Anciano , Astrocitoma/patología , Astrocitoma/cirugía , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Neurilemoma/diagnóstico , Neoplasias de la Médula Espinal/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neurilemoma/complicaciones , Neurilemoma/cirugía , Compresión de la Médula Espinal/etiología , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/cirugía , Vértebras Torácicas/patologíaRESUMEN
Central neurocytoma is an unusual tumour that arises in the supratentorial ventricular system of young adults. Similar lesions, termed simply neurocytoma, have been described at a variety of locations outside the ventricular system. Here, we report the case of a 50-year-old man who presented with pain and a rapidly progressive myelopathy due to a neurocytoma of the upper thoracic spinal cord. The literature on spinal neurocytoma and its relation to central neurocytoma are discussed.
Asunto(s)
Neurocitoma/patología , Neoplasias de la Médula Espinal/patología , Progresión de la Enfermedad , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neurocitoma/complicaciones , Neurocitoma/cirugía , Dolor/etiología , Parálisis/etiología , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/cirugíaRESUMEN
A 24-year-old woman presented with a 7-week history of headache and left frontal scalp swelling. A plain radiograph and CT demonstrated a 2-cm lytic lesion in the frontal bone which was excised via craniotomy. Histology showed this to be an osteoma. Osteomas very rarely, if ever, appear as lytic lesions. The differential and radiological diagnoses are discussed.
Asunto(s)
Osteoma/diagnóstico por imagen , Neoplasias Craneales/diagnóstico por imagen , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Tomografía Computarizada por Rayos XRESUMEN
We describe a case of a cotton gauze foreign-body granuloma developing 2 months after microvascular decompression for trigeminal neuralgia and hemifacial spasm. This complication has not been previously described. Moreover, the patient's initial clinical and radiological findings were suggestive of an acoustic neuroma or meningioma at the time.
Asunto(s)
Descompresión Quirúrgica , Granuloma de Cuerpo Extraño/etiología , Complicaciones Posoperatorias/etiología , Tapones Quirúrgicos de Gaza , Neuralgia del Trigémino/cirugía , Femenino , Granuloma de Cuerpo Extraño/patología , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/patologíaRESUMEN
We report a case of a 40-year-old man presenting with acute vertigo and deafness. Computed tomography (CT) scanning at initial presentation was normal. However, one year later he developed numbness on the right side of his face and examination revealed fifth, seventh and eighth cranial nerve palsies as well as cerebellar dysfunction. Magnetic resonance imaging (MRI) demonstrated a cerebellopontine angle lesion. He underwent near total excision followed by neuro-axis irradiation. The main mass of the tumour projected into the cerebellopontine angle. Histology showed this to be a medulloblastoma. All features of this case are unusual; hence we discuss the pathogenesis and management of this very rare tumour.
Asunto(s)
Neoplasias Cerebelosas/complicaciones , Ángulo Pontocerebeloso , Pérdida Auditiva Sensorineural/etiología , Meduloblastoma/complicaciones , Vértigo/etiología , Enfermedad Aguda , Adulto , Neoplasias Cerebelosas/patología , Pérdida Auditiva Sensorineural/patología , Humanos , Masculino , Meduloblastoma/patología , Vértigo/patologíaRESUMEN
The long-term outcome of 78 patients with spinal meningiomas operated on over 20 years at a single neurosurgical unit was analysed. Age, sex and tumour location were similar to those reported by others. Overall, 95% of our patents were independently mobile postoperatively, despite 25% of the group being unable to walk before operation, including four paraplegic patients. Only two tumours were entirely extradural, and a further two were both intra- and extradural. In all cases, tumour exposure was by posterior laminectomy, without recourse to more complex approaches. Complete tumour resection was achieved in 77 (98%) of cases. The dural attachment was excised in 20 cases and diathermy was applied in 58. There was one recurrence, 14 years after the original surgery. Complex and technically challenging surgical approaches are unnecessary to obtain complete removal even for anteriorly placed tumours. Excision of the dural base would seem unnecessary to attain a low recurrence rate.
Asunto(s)
Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico , Meningioma/complicaciones , Meningioma/diagnóstico , Persona de Mediana Edad , Trastornos del Movimiento/etiología , Trastornos del Movimiento/cirugía , Recurrencia Local de Neoplasia , Cuidados Posoperatorios , Resultado del Tratamiento , Enfermedades de la Vejiga Urinaria/etiología , Enfermedades de la Vejiga Urinaria/cirugíaRESUMEN
Spontaneous spinal epidural haematoma can occur in the elderly and is a reversible cause of neurological deficit if treated promptly. The diagnosis can be made from a careful history and a simple neurological examination, but it can be confused with myocardial infarct, musculoskeletal pain, vasculitis and acute dissection of an aortic aneurysm. For a favourable outcome, early decompressive laminectomy and evacuation of the haematoma are necessary. We report an unusual case of acute quadriplegia in which prompt diagnosis and early intervention led to almost complete functional recovery with minimal disability.
Asunto(s)
Hematoma Epidural Craneal , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Hematoma Epidural Craneal/complicaciones , Hematoma Epidural Craneal/diagnóstico , Hematoma Epidural Craneal/cirugía , Humanos , Imagen por Resonancia Magnética , Cuadriplejía/etiologíaRESUMEN
Two cases of primary intracranial choriocarcinoma are reported. One patient died with raised intracranial pressure and pulmonary metastases whereas the second patient, who was diagnosed early, has remained well a year after chemotherapy. Human chorionic gonadotrophin level estimation in serum and cerebrospinal fluid is a useful marker in suspected cases, and chemotherapy following biopsy appears to be the treatment of choice.
Asunto(s)
Neoplasias Encefálicas/patología , Coriocarcinoma/patología , Adolescente , Neoplasias Encefálicas/terapia , Niño , Coriocarcinoma/terapia , Terapia Combinada , Humanos , Neoplasias Pulmonares/secundario , MasculinoRESUMEN
Five hundred and fifty-three patients with intracranial metastases were analysed, before and after the availability of CT scanning, from three neurosurgical centres. A further analysis of 318 patients, who had a total excision carried out, was made from the six groups (i.e. posterior fossa or craniotomy in each centre) before and after CT scanning was available. A statistically significant reduction in the excision rate occurred in one group after the CT scan was available, and the very small number of patients who survived for more than 12 months was not significantly increased in the groups who had a CT scan carried out. Median survival in the various groups, whether analysed on a unit basis or with all three units combined, was not only poor (two to five months) but was not significantly better in the groups investigated with CT scanning. It would therefore appear that the use of the CT scan has not enabled a more careful selection of patients suitable for excision to take place or improved the median survival. Thus, by implication, and from the evidence of the literature, a more intensive preoperative investigation should be considered in order to exclude possible extracranial metastases and appraise the place of cranial irradiation.
Asunto(s)
Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Fosa Craneal Posterior , Femenino , Humanos , Yotalamato de Meglumina , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Of 223 patients with intracranial metastases, 161 underwent removal of a presumed solitary lesion and 29 were treated by burr-hole biopsy. Results of radical surgery were better than those of biopsy alone in terms of survival. Quality and duration of survival were poorer in patients who had infratentorial metastases removed than in those who underwent surgery for supratentorial metastases. In this second group only patients with breast cancer benefited from surgery, though a few women with bronchial carcinoma also did well. The interval removal of a primary tumour and development of intracranial symptoms did not influence outcome. Evidence of a previous primary tumour should not lead to the assumption that intracranial symptoms are caused by a metastasis.
Asunto(s)
Neoplasias Cerebelosas/cirugía , Biopsia , Neoplasias Cerebelosas/mortalidad , Humanos , Metástasis de la Neoplasia , Pronóstico , Calidad de Vida , Factores de TiempoRESUMEN
A 59 year old man had 6 ml of unbuffered methylene blue injected into the lumbar theca in an attempt to localise the source of cerebrospinal fluid rhinorrhoea. After injection of the dye he became shocked, and within the next few days he developed a mild paraparesis which subsequently progressed to a total paraplegia. The distribution of the spinal cord damage found at necropsy, eight and a half years after injection of the dye, is described and its relationship to the clinical picture discussed.
Asunto(s)
Azul de Metileno/efectos adversos , Enfermedades de la Médula Espinal/inducido químicamente , Médula Espinal/patología , Otorrea de Líquido Cefalorraquídeo/diagnóstico , Humanos , Infarto/inducido químicamente , Infarto/patología , Inyecciones Espinales , Masculino , Persona de Mediana Edad , Necrosis , Enfermedades de la Médula Espinal/patologíaRESUMEN
Of 157 patients with trigeminal neuralgia, referred for neurosurgery, 81 underwent 85 ganglion or root injections. The results, which are analysed with regard to pain relief and sensory loss, compare favourably with results from the literature of other forms of surgery, particularly open temporal root section.
Asunto(s)
Etanol/administración & dosificación , Adulto , Anciano , Femenino , Humanos , Inyecciones/efectos adversos , Inyecciones/métodos , Masculino , Persona de Mediana Edad , Nervio Trigémino , Neuralgia del Trigémino/terapiaRESUMEN
Seventy-three patients presented with either chronic urinary symptoms such as incontinence, retention, and recurrent urinary infection or chronic low back pain and neurogenic claudication. Lumbar spondylosis was considered to be the major cause of the urological and skeletal symptoms; the diagnosis of a neuropathic bladder depended as much on features in the history as on the results of urological and neurological investigations. The preoperative demonstration of significant lumbar spondylosis was often difficult, but decompressive laminectomy in 34 patients produced relief of urinary symptoms and improvement in bladder function in 75%.