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Background: Intracranial hydatid cyst is an exceedingly uncommon condition. Typically, it manifests as hydatid cysts in the liver, lungs, kidney, and spleen. In this report, we present a rare case of a hydatid cyst located in the brain, exhibiting atypical radiological characteristics, and successfully treated with complete microsurgical excision. Case Description: A 45-year-old male, a former smoker, presented with a new-onset seizure. Brain imaging revealed a solitary, intra-axial, and cystic lesion with wall enhancement in the right temporal region. The cyst extended into the temporal horn of the right lateral ventricle, surrounded by mild edema. Differential diagnoses included brain metastasis, abscess, and tuberculoma. However, following computed tomography (CT) scans of the chest, abdomen, and pelvis (CAP) and serological tests, the provisional diagnosis included a hydatid cyst. The CT CAP showed diffuse non-specific cystic lesions of variable sizes in the liver and spleen, along with numerous bilateral pulmonary cysts. A right temporal craniotomy was performed, and the cyst was microsurgically excised without rupture. Microscopic and histopathological examination confirmed the presence of a hydatid cyst. Conclusion: Intracranial hydatid cyst is an extremely rare condition and should always be considered a possible differential diagnosis in cases of cerebral cystic lesions. Hydrodissection is the preferred surgical method for resection; however, in atypical cases such as the one described here, meticulous dissection of the cyst capsule from the brain parenchyma may be successful with minimal risk of intraoperative rupture.
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Calvarial lymphoma is radiologically similar in many respects to meningiomas, solid fibrous tumours, osteomyelitis, and metastatic carcinomas. Even though it is an extremely rare phenomenon, the initial suspicion and detection of calvarial lymphoma are paramount to establishing a correct diagnosis which helps to determine an appropriate management strategy. We present an illustrative rare case of primary calvarial lymphoma along with a literature review focusing on the best management strategy for this rare entity. A 45-year-old female presented to our center in March 2022. She had a history of forehead swelling, which was progressively increasing in size over time. The metastatic workup and bone marrow biopsy were negative. Initially, extensive surgery was planned to resect the lesion, but after a discussion with the multidisciplinary team, a biopsy of the lesion was taken, which revealed a large B-cell lymphoma. It is prudent to consider calvarial lymphoma in the differential diagnosis of a progressively growing skull lesion, which may obviate the need for large resective surgery. A biopsy plus chemoradiation may be all that is required.
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BACKGROUND: The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus. METHODS: We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope. RESULTS: In the three patients, ventriculostomy and endoscopic biopsies were conducted. There was no death or morbidity throughout the 45-min procedure. All of the patients' histological findings were confirmed. Germinoma was diagnosed in two patients who recieved postoperative radiotherapy, and the third patient diagnosed with a pineocytoma. Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery. CONCLUSION: Biportal endoscopic approach enables better visual control of both procedures. Furthermore, it allows the surgeon to safely pass the ventriculoscope via the foramen of monro, even if it is narrow. Moreover, during endoscopic tumor biopsy and third ventriculostomy, the intracranial pressure can be smoothly managed using the outlet tubes accessible. This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.
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Epidermoid cysts are benign congenital tumors that originate from the ectodermal tissue. The sellar/suprasellar region is an infrequent location for epidermoid cysts and such cases are rarely reported in pediatric patients, as these become symptomatic only when they reach 30 years of age. Surgical intervention is considered the ideal treatment option in patients with suprasellar epidermoid cysts, either via open or endonasal approach. We discuss a case of a 12-year-old male who presented with left visual impairment and was treated with successful resection through an endoscopic endonasal approach (EEA). We also engage in a literature review of the use of EEA in the management of sellar/suprasellar epidermoid cysts in the pediatric age group.
