Combined endoscopic transorbital and transnasal approach for the management of a solitary plasmacytoma of the sphenoid bone: A case report and literature review.

Background: Parasellar plasmacytomas are rare neurosurgical entities. Intrinsic characteristics of these tumors, such as adjacent bone erosion and symptoms resulting from invasion and mass effect, may lead to the possibility of a solitary extramedullary plasmacytoma (SEP) as a differential diagnosis. Case Description: We present the case of a 39-year-old male with a 1-month history of bilateral decreased visual acuity, retroocular pulsating pain, and chromatic vision loss. A computed tomography scan of the head revealed a parasellar lesion causing chiasmatic compression, as well as clival, orbital, sphenoidal, and ethmoidal invasion. A combined transorbital and endonasal endoscopic approach was found suitable, and gross total resection was achieved. Histological analysis of the lesion established the diagnosis of a SEP. After radiotherapy, a new magnetic resonance imaging was performed, revealing a recurrence of the lesion with a high grade of invasion. The patient was treated with palliative radiotherapy, as surgical resection did not seem feasible. Conclusion: Surgical resection and radiotherapy may achieve remission of these lesions; however, recurrence rates remain high despite any treatment modality. Patients with this condition must be followed up with a multidisciplinary team due to the high risk of multiple myeloma progression.

Tuberculous brain abscesses in immunocompetent patients: management and outcome.

BACKGROUND: Tuberculosis (TB) remains an important public health problem in developing countries. OBJECTIVE: To evaluate the clinical presentation, management, and long-term outcome in 6 patients with tuberculous brain abscesses (TBA), an uncommon form of central nervous system (CNS) TB. METHODS: A search of medical records of a single referral neurological center in Mexico City from 2002 to 2007 retrieved 149 patients with CNS TB; 6 of them (4%) met Whitener's criteria for TBA and were included in this review. RESULTS: Five of six patients had a previous history of TB. Three patients were referred to our center under antituberculous treatment (ATT) for pulmonary and lymph node TB, and two patients were receiving ATT for TB meningitis at diagnosis of TBA. All presented with symptoms of intracranial hypertension and hemiparesis. On imaging studies, 3 patients had a single, deep multiloculated lesion and another three had separated lesions, all patients underwent surgery and received long courses of ATT. One patient died after surgery and the rest recovered with moderate to severe neurological sequelae. The residual lesions in 5 patients resolved in follow-up CT or MRI studies at a mean time of 10 months. CONCLUSIONS: Early surgery confirms the diagnosis of TBA. Some patients may require additional surgical procedures if enlargement or recurrence of the lesion occurs. No evidence of drug resistance was found in our cases, and we found only two reports of TBA with primary resistance to ATT in a selective literature review. TBA does not seem to be a consequence of drug resistance. Sequelae are common, and long-term ATT with close clinical and imaging follow-up is mandatory.