Giant Cell Tumor of the Clivus in a 19-Year-Old Male Presenting With Doubling of Vision: A Case Report.

Giant cell tumor (GCT) of the skull is an extremely rare condition, accounting for less than one percent of all bone GCTs. Clival GCT is even rarer, with only 25 cases documented to date. It generally follows a benign course; however, due to its location and vascularity, it can be locally aggressive. Complete resection of GCT in this location may be challenging, resulting in residual tumors. In this paper, we report a case of a 19-year-old male who presented with a chronic headache later accompanied by diplopia and was noted to have a mass spanning the sella and the clivus on cranial imaging. The histopathology report of the excised mass revealed findings compatible with GCT of the bone. Most GCTs remain stable in the first two years after initial treatment. However, four months after its partial excision, the clival GCT continued to progress. The patient underwent adjuvant radiation therapy, yet symptoms persisted. This profile highlights the crucial role of long-term surveillance and prompt adjuvant radiation therapy and chemotherapy.

Understanding the Brain-Heart Connection Through a Case of Angry Glioma Syndrome.

We discuss a patient with a tumor on the anterior corpus callosum who underwent open biopsy eventually succumbing to cerebrogenic fatal arrhythmia following wounded glioma syndrome. A healthy 37-year-old female patient was admitted to our department due to a history of headache for 13 months. MRI revealed a suspicious glioma infiltrating the anterior corpus callosum. Neurologic examination only showed low cognitive assessment score (Montreal Cognitive Assessment score 20/30). ECG was normal sinus rhythm. Steroids and levetiracetam were administered prior to operation. Patient underwent right frontal craniotomy and biopsy of tumor with unremarkable events. During the first hospital day, patient had episodes of bradycardia followed by decrease in sensorium. Brain CT scan showed progression of edema without hemorrhage within the tumor bed. This was followed minutes later by two episodes of generalized tonic-clonic seizures and pulseless ventricular tachycardia. Cardiac resuscitation was done for 24 minutes but patient eventually expired. Location of the lesion and the epileptogenicity of the peritumoral cortex greatly contributed to the patient's demise. Involvement of the fronto-mesial structures, particularly the insula and the cingulate cortex, and their connection to the central autonomic network, increased susceptibility to arrhythmias. Decreased seizure threshold worsened post-operative edema, further aggravating the dysregulation of the brain-heart-connection.

Concurrent Wounded Glioma Syndrome and Distant Wounded Glioma Syndrome Following a Gross Total Resection of Glioblastoma: A Case Report.

Surgery is the initial form of treatment for glioblastoma, and a maximum resection without impairing neurological function improves survival. Wounded glioma syndrome (WGS) is a clinical picture observed after the resection of high-grade tumors. This syndrome, developing within hours to a few days after glioma surgery, is characterized by hemorrhage into the postoperative cavity and cerebral edema and at times occurs in areas distant from the site of the resection, i.e., distant wounded glioma syndrome (DWGS). We report a case of a 70-year-old male presenting with acute-onset left leg weakness, with a large peripherally enhancing mass with central non-enhancement suggestive of necrosis in the right frontal lobe. A gross total resection of the tumor was done, and the histopathologic evaluation verified the diagnosis of glioblastoma World Health Organization (WHO) grade IV. During the postoperative period, he was drowsy and was able to move his right extremities. He had a series of generalized tonic-clonic seizures three hours after the operation. After eight hours, the patient became comatose with signs of increasing intracranial pressure. A cranial computed tomography (CT) scan revealed diffuse cerebral edema and hemorrhage into the operative site in the right frontal lobe, as well as subarachnoid hemorrhages in the bilateral frontoparietal sulci. There were also small hemorrhages seen in the left caudate head, midbrain, and left hemipons. Death occurred the following day. This case report demonstrates an unusual case of a WGS with a concurrent DWGS in the brainstem after a gross total resection of a frontal lobe glioma. This case shows a significantly uncommon sequela that a patient undergoing glioma surgery can present, leading to rapid deterioration and death. Resection of a glioma carries a significant risk, and its impact in the immediate postoperative period merits evaluation when planning perioperative management, taking prompt action if these syndromes occur.