Preoperative embolization of intracranial meningiomas with Embosphere microspheres.

BACKGROUND: To reduce intraoperative bleeding and to facilitate surgery by inducing tumor softening, a preoperative embolization of meningiomas is commonly recommended. PATIENTS AND METHODS: We report on our experience with non-resorbable microspheres (Embosphere) in the preoperative endovascular embolization of 17 intracranial meningiomas. After adding contrast media to the particles sized 40-500 micron, the embolization process was followed under fluoroscopy. There was a good passage of microcatheters if high concentrations of particles were avoided. RESULTS: The obstruction of the tumor feeders by particles was accompanied by a regression of tumor blush in DSA. CT controls showed a diminished contrast accumulation of the tumors already 1-2 days after embolization. Histologically, Embosphere microspheres were easy detectable with all commonly used staining methods. Embolization triggered, microscopically detectable necrosis was found in 77 % of the tumors. The mean interval between embolization and tumor extirpation was 2.5 days. The average time required for tumor extirpation was 244 minutes, while the average blood loss was 749 ml. CONCLUSIONS: Our experiences show that Embosphere microspheres are effective embolic agents in obstructing meningeal feeders of preoperatively treated meningiomas.

Xanthogranuloma of the Erdheim-Chester type within the sellar region: case report.

Manifestations of Erdheim-Chester disease in the central nervous system are very rare. Cases with localization in the retroorbital space, hypothalamic area and posterior pituitary as well as intracerebral lesions are known. In our neurosurgical unit, a 51-year-old male patient with a history of hypophyseal insufficiency and visual deficits underwent surgery for a pituitary lesion. Histological and immunohistochemical examination revealed a xanthogranulomatous lesion composed of very large CD68-positive foam cells with small nuclei and some Touton-like giant cells, histiocytes, as well as loci with small lymphocytes and isolated eosinophilic granuolcytes, embedded in fibrotic tissue. Based on these findings, the histological diagnosis was a xanthogranuloma of the Erdheim-Chester type.

Lhermitte-Duclos disease (Dysplastic gangliocytoma of the cerebellum).

OBJECTIVE: Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) is a rare hamartomatous lesion of the cerebellar cortex. The pathogenesis of the disease is still poorly understood. Lhermitte-Duclos disease was recently considered to be part of a multiple hamartoma-neoplasia syndrome (Cowden disease). We add two further cases to this rare entity. PATIENTS: A 24-year old woman presented with occipital headaches, blurred vision, diplopia and ataxia of gait. Physical examination revealed turricephaly. The second patient was a 37-year old woman, who presented with progressive occipital headache with nausea and vomiting. Physical examination revealed congenital facial asymmetry. Computed tomography and NMR-imaging, respectively demonstrated a space occupying mass of a cerebellar hemisphere in both cases. RESULTS: Suboccipital craniotomy and complete removal of the infratentorial tumour were performed in both patients. Histopathological findings clinched the diagnosis of Lhermitte-Duclos disease. Postoperative course was uneventful in the first and complicated by progressive occlusive hydrocephalus in the second patient, necessitating permanent surgical shunt drainage. Both patients were discharged free of complaints. CONCLUSIONS: Dysplastic cerebellar gangliocytoma is commonly associated with progressive mass effects in the posterior fossa and typically presents with headaches, cerebellar dysfunction, occlusive hydrocephalus and cranial nerve palsies. The disease usually manifests in young adults, but the age at presentation ranges from birth to the sixth decade. There is no sex predilection. NMR-imaging became a useful clue to the diagnosis within the last decade. Therapy consists of decompression of the posterior fossa by total surgical removal of the tumour mass.

Intracerebral paraganglioma.

Paragangliomas of the CNS are relatively rare. Cases of location in the pineal and pituitary glands, cerebellopontine angle, cauda equina and filum terminale are known. In our neurosurgical unit a 42-year-old male patient with a history of vertigo and a generalized seizure underwent an operation for a fronto-temporal tumour. The histological diagnosis was paraganglioma.

Intraneural growth of a capillary haemangioma of the cauda equina.

Solitary intraneural haemangiomas are very rare. A case of intraneural capillary haemangioma involving two nerve roots of the cauda equina is reported. The patient was a 63-year-old woman with a three years history of intermittent lumbalgia and numbness of the ventral surface of the left thigh. Magnetic resonance imaging detected an intradural extramedullary nodular space occupying mass at the level of the conus medullaris. Laminectomy of T12 and complete removal of the tumour were performed. Histopathological analysis demonstrated a capillary haemangioma. The tumour was located within the sheaths of a spinal nerve root. The lesion consisted of a myriad of small and very small vessels, reticularly arranged with normal nerve fascicles dispersed within the nodules of clustered capillaries. The present case of an intraneural capillary haemangioma of the cauda equina appears to be one of the first reported examples of this entity in the world's literature. The clinical presentation, diagnostic procedures and therapeutic options of intraneural haemangiomas of the conus medullaris and cauda equina are discussed. The current literature is reviewed.

Unusual clinical presentation of a meningeal melanocytoma with seizures: case report and review of the literature.

The 17th case of an intracranial meningeal melanocytoma is presented in a 67-year old man. It is the 6th melanocytoma arising from the cavum Meckeli and the first presenting with seizures. Surgical removal was curative for a follow up period of 32 months. Besides the clinical and neuroradiological presentation, the histological, ultrastructural and immunohistochemical features are described. A review of the literature including cases with malignant transformation is given and differential diagnostic problems are discussed.