[Nerve sonography of intraneural ganglia as cause painful peroneal palsies: a case series]. / Nervensonographie intraneuraler Ganglien als Ursache schmerzhafter N.-peronaeus-Paresen: eine Fallserie.

In selected cases acquired peroneal palsy is caused by intraneural ganglia. In contrast to the much more frequent "loco typico" lesion which is caused by external pressure, intraneural ganglia can be treated by microscopic nerve surgery as part of primary treatment strategy. A careful clinical history as well as a profound clinical and electrophysiological examination is required to disclose unusual findings. These are common in non-typical peroneal palsy. In this situation high resolution nerve sonography is a fast and sensitive method to detect intraneural ganglia. We report a case series of three patients with peroneal palsy caused by intraneural ganglia and give a review of the literature.

Rarement la lésion du nerf péronier au niveau de la tête fibulaire suivie par une parésie des muscles innervés par ce nerf est causée par un ganglion appuyant sur les structures nerveuses. En ce cas une intervention chirurgicale peut souvant résondre le problème. Une anamnèse soigneusement menée, l'examen neurologique et des investigations neuromusculaires sont essentielles mais souvent atypiques comparés à la lésion péronière «loco typico¼. L'ultrasonographie à haute résolution est procédée facilement et plus sensible qu'une MRI. Nous allons décrire dans ce papier trois cas de parèsie du nerf péronier pour lesquels la diagnostic final a été posé par ultrasonographie.

Uncommon case of a cystic papillary meningioma in an adolescent.

INTRODUCTION: Meningiomas, especially papillary meningiomas, are rare tumours in childhood and adolescence. They are histologically classified as atypical. CASE REPORT: We present a 15-year-old girl with a cystic papillary meningioma extending from the infratentorial to the supratentorial region extracranially. After a two-stage gross total resection combined with fractionated radiotherapy of a small residual tumour in the infratemporal fossa, the clinical course was stable for at least 4 years. Then a new infratentorial cystic papillary meningioma with a histological change in tumour malignancy was recognised within only 1 year. DISCUSSION: Besides the rare histology of a cystic papillary meningioma in an adolescent, the case is remarkable due to the considerable extent of the tumour and the irregular course with rapid regrowth and change into malignancy after an initially stable and benign course. For a comparison, the current literature is reviewed and discussed with regard to sex and age distribution, histopathological features, clinical course and therapeutical options.

Pilocytic astrocytomas with leptomeningeal dissemination: biological behavior, clinical course, and therapeutical options.

BACKGROUND: The aim of this case-based update is to discuss the biological characteristics, clinical course, and optimal treatment of pediatric patients harboring pilocytic astrocytomas (PA) with leptomeningeal dissemination (LMD). PAs are well-recognized benign pediatric tumors of the central nervous system (CNS). Despite a favorable outcome in general, in rare cases LMD might occur and contribute to poor clinical course. Localization of the PA in the chiasmo-hypothalamic region seems especially predisposed to LMD. In addition, specific histological features might constitute the potential for subarachnoid metastases. The optimal treatment is still under discussion but studies suggest that chemotherapeutical treatment should be used as first choice therapy in order to avoid or delay radiotherapy. CASE REPORTS AND DISCUSSION: Two cases of subtotally resected chiasmo-hypothalamic PAs with synchronous LMD but with different rates of progression are described. The literature is reviewed and compared with our findings.