Isolated intracranial myeloid sarcoma: report of a case and review of the literature.

Myeloid sarcoma is a rare malignant tumor of primitive myeloid cell origin often associated with hematologic disorders. The central nervous system is rarely involved and differentiating between myeloid sarcoma and other tumors is not possible on imaging. Here we present the rare case of an isolated intracranial myeloid sarcoma, initially misdiagnosed radiologically as a meningioma, treated with surgical total resection and subsequent chemotherapy, with no signs of any hematological disorder at follow up. Differential diagnosis and management strategies, as well as follow-up implications are discussed along with literature review, which pointed out that only five cases with no further signs of hematological disorders at follow up have been described in the literature so far and this case has the longest follow up of them at 9 years.

Late Intramedullary Spinal Metastases from Esthesioneuroblastoma: Case Report and Prognostic Implications.

BACKGROUND: Esthesioneuroblastoma (ENB) is an uncommon neuroectodermal tumor that originates from the olfactory mucosa and often recurs locally. Distant metastases of ENB have been described, but there are few reports of intramedullary metastases to the spinal cord. CASE DESCRIPTION: Here we report a case of a patient presenting with a progressive paraparesis and magnetic resonance imaging findings of multiple drop metastases to thoracic and lumbar regions of the spinal cord, 17 years after diagnosis and treatment for an intracranial ENB with subsequent neck nodal metastases. The dorsal symptomatic lesion was treated with resection, radiotherapy, and adjuvant chemotherapy. The implications of spinal metastases for the clinical prognosis of this disease are discussed, with a review of the few reported cases of spinal ENB metastases in the literature. CONCLUSIONS: Through the presentation of this case we hope to further contribute to a better understanding of this rare disease's prognosis.

Isolated Oculomotor Nerve Palsy as Presenting Symptom of Bilateral Chronic Subdural Hematomas: Two Consecutive Case Report and Review of the Literature.

BACKGROUND: Isolated oculomotor nerve palsy (ONP) is caused most commonly by vascular disease, posterior circulation aneurysms, and inflammatory or traumatic injury. ONP usually occurs in chronic subdural hematoma (CSDH) as a common sign of cerebral herniation that typically is associated with a deterioration of consciousness. CASE DESCRIPTION: We report 2 cases of bilateral CSDH who presented with ONP without deterioration of consciousness. An extensive literature review revealed this is an extremely rare finding. We also investigated all the possible pathogenic mechanisms producing nerve impairment and found a strong association with bilateral subdural hematoma. Vascular compression between posterior circulation arteries and tentorial edge abnormalities also could be involved. Vulnerability of the oculomotor nerve seems to be a necessary condition leading to clinical onset and is caused by predisposing factors to nerve damage, including vascular disease, head trauma, or herpes zoster infection. CONCLUSIONS: Although isolated ONP is a very rare presentation of CSDH, a differential diagnosis is absolutely necessary, because surgical treatment allows good recovery of third nerve palsy in most of the cases.

Multidisciplinary treatment of giant invasive prolactinomas in paediatric age: long-term follow-up in two children.

BACKGROUND: Invasive giant prolactinomas are rare tumours, still representing a therapeutic challenge due to their characteristics of invasiveness and variable clinical course. Giant prolactinomas in childhood are extremely rare. Only single case reports have been described in the literature. CASE PRESENTATION: We report on two children who presented a progressive visual deterioration. Magnetic resonance imaging showed extensive intra-suprasellar tumour invading the anterior skull base. The laboratory investigations detected markedly elevated prolactin levels. The patients were firstly started on dopamine agonist therapy with partial reduction in size of the tumours. The debulking of the residual lesions through a transsphenoidal approach was then performed in both patients, one of whom requiring a second surgical procedure for tumour regrowth. The complete shrinkage of the residual adenomas was achieved after the treatment with conventional radiotherapy, with a follow-up of 13 and 14 years, respectively. DISCUSSION: Multidisciplinary therapeutic approach for giant prolactinomas in paediatric patients can be an effective treatment; despite the invasiveness of these tumours, the efficacy of this combined treatment can reach a satisfactory control of the disease at long term, assuring a good quality of life as well.

Cystic craniopharyngioma: trans-sphenoidal surgery and intra-cystic apposition of "bleomycin wax".

BACKGROUND: The current therapeutic approach to craniopharyngioma is multidisciplinary. Sub-total removal, followed by adjuvant treatments, especially in large cystic tumours, is an accepted regime reported by many authors. CASE REPORT: A young patient with an intra- and suprasellar cystic craniopharyngioma was operated on via a microsurgical trans-sphenoidal approach, achieving sub-total removal and bleomycin mixed with bone wax ("bleomycin wax") applied to the capsular remnant. RESULTS: Pre-operative neurological and endocrinological deficit improved after surgery. There was no evidence of tumour recurrence after a follow-up period of 5.4 years. CONCLUSIONS: The intra-operative use of "bleomycin-wax" should be limited to those patients in whom intra-operative CSF fistula does not occur.

Validity of percutaneous controlled radiofrequency thermocoagulation in the treatment of isolated third division trigeminal neuralgia.

BACKGROUND: Of 756 percutaneous controlled radiofrequency thermocoagulations of gasserian ganglion and/or retrogasserian rootlets for idiopathic trigeminal neuralgia or for trigeminal neuralgia in multiple sclerosis, the results in 158 patients who had isolated third division trigeminal neuralgia were reviewed. METHODS: In 129 patients, percutaneous thermocoagulation was fluoroscopic guided, whereas in the last 29 the procedure was performed under CT control. In all cases, the goal was to achieve selective anesthesia limited to the third trigeminal division. RESULTS: Complete pain relief was obtained immediately after the procedure in all patients and selective anesthesia in the third division was achieved in all of them, except for 2 patients in whom unwanted first and second division anesthesia/hypoesthesia also occurred. Other significant complications were transient sixth cranial nerve palsy in 1 patient and masseter muscle dysfunction, which improved during follow-up, in another one. The selected sensory impairment was well tolerated in all patients. During an average follow-up period of 8.8 years, recurrences occurred in 12 patients, together with a partial regression of the anesthesia: in 10 patients the procedure was repeated successfully. In 2 patients with multiple sclerosis, the procedure was repeated twice and 3 times, respectively. CONCLUSIONS: Percutaneous controlled radiofrequency thermocoagulation is quite easy to perform under fluoroscopic or CT control, and it involves no mortality and very low morbidity; it is an immediately effective procedure and the rate of recurrence is low. Last, but not least, if the anesthesia is limited to the third division, no anesthesia dolorosa occurs and patients are very grateful.

Low-grade primary meningeal lymphoma: case report and review of the literature.

Primary meningeal lymphoma is a rare occurrence. We present a case of an immunocompetent patient operated on for a fronto-parietal lesion similar to a meningioma, which the histological examination diagnosed as a mucosa-associated lymphoid tissue (MALT)-type lymphoma. She received no further post-operative treatment and after 36 months showed no evidence of disease. In a review of the literature, we identified 14 similar cases of MALT lymphoma pre-operatively diagnosed as meningioma. Recognition of this rare meningeal location of a lymphoma involving the central nervous system is useful for a proper diagnosis and adequate treatment.

Spinal epidural abscess complicating chemotherapy in patients with leukemia.

The authors reviewed the basic facts about infections that complicate chemotherapy, and found that a difference exists between those that are medically treated, for which several standard protocols have been adopted, and infections amenable to surgical treatment, such as spinal epidural abscess, which are managed according to the experience at individual institutions. The authors believe that patients with leukemia who manifest a spinal epidural abscess should always be surgically treated when the infection occurs between the induction and remission phases, whereas medical treatment options can be considered for spinal epidural abscesses occurring at the end of the chemotherapy course.