Aggressive Brainstem Glioblastoma in a 9-Year-Old Child with Neck Node Metastases: A Case Report and Review of Literature.

Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and diffusely infiltrates the surrounding brain tissue. Despite their malignant nature, extraneural metastases from glioblastomas are rare with an estimated incidence of <2%. We present a case of a 9-year-old boy with exophytic brainstem GBM who developed cervical node metastases. He had undergone gross total excision of GBM in January 2017. Histopathological examination confirmed the diagnosis of glioblastoma multiforme. The patient underwent chemotherapy and radiotherapy as per hospital protocol. He developed hydrocephalus after 3 months, which required ventriculoperitoneal shunt. Two more months later, he developed drowsiness and was found to have shunt dysfunction causing hydrocephalus and multiple enlarged cervical lymph nodes. Cerebrospinal fluid diversion and neck node biopsy were performed for the patient but he died. The histopathological examination of the neck node biopsy revealed metastases from glioblastoma. We report this case to create awareness regarding possibility of extraneural metastases even in pediatric brainstem glioblastoma.

Endovascular pulmonary artery inflatable balloon-induced hypotension: A novel technique for clipping giant intracranial aneurysms.

Management of giant intracranial aneurysms presents unique challenges to the neurosurgical team. Various techniques such as adenosine-induced hypotension, rapid ventricular pacing, and inducing deep hypothermia are described in the literature to effect circulatory arrest for the successful obliteration of giant aneurysms. We describe a novel technique of induced hypotension for clipping a giant aneurysm by using an inflatable balloon across the main pulmonary artery with a successful outcome. This technique has not been described earlier in the literature.

Rosai-Dorfman disease of the central nervous system.

Rosai-Dorfman disease (RDD) is an idiopathic, non-neoplastic, lymphoproliferative disorder characterized by sinus histiocytosis and massive lymphadenopathy. When RDD involves the central nervous system the lesion simulates a meningioma. Histological and immunohistochemical confirmation is essential for a definitive diagnosis. In this paper, ten cases of RDD confined to the central nervous system are reported. Another case with orbital RDD was excluded. Nine cases involved the cranial cavity alone; in one, the cervical extradural region was also involved. Treatment consisted of surgical excision or biopsy. Histology and immunohistochemistry revealed a mixed cell population of predominantly mature histiocytes with evidence of emperipolesis and strong positivity for S100 protein in all cases. No recurrence was observed during follow up ranging from three months to eight years.