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Klawinski DM, Cottrell CE, Schieffer KM, Indyk JA, Gandhi K, Mardis ER, Rodriguez DP, Breneman JC, Osorio DS. Fatal brainstem injury following proton radiation in a patient with medulloblastoma and a germline variant in RNF213. Pediatr Blood Cancer 2024; 71:e30739. [PMID: 37877896 DOI: 10.1002/pbc.30739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
Brainstem injury occurs secondary to radiation to the posterior fossa in up to 2% of pediatric patients. It may occur after months to years after treatment. It has been associated with age less than 5 years and with comorbid conditions such as cerebrovascular disease, diabetes mellitus, and hypertension. Radiation necrosis is often symptomatic and can be fatal. A pathogenic variant in RNF213 was found in a patient who suffered fatal radiation necrosis. This mutation has been associated with moyamoya disease and may predispose to radiation necrosis.
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Affiliation(s)
- Darren M Klawinski
- Department of Pediatrics, Nemours Children's Health Jacksonville, Jacksonville, Florida, USA
| | | | | | | | - Kajal Gandhi
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | | | - John C Breneman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Strebler P, Schmitt A. A - 114 Long Term Cognitive Sequela of Intracranial Radiation Therapy in a Pediatric Cerebellar Medulloblastoma Survivor. Arch Clin Neuropsychol 2023; 38:1286. [PMID: 37807253 DOI: 10.1093/arclin/acad067.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Intracranial radiation therapy (IRT) for pediatric brain tumors is associated with late delayed brain injury due to cerebrovascular abnormality, white matter necrosis, demyelination, and gliosis which are irreversible. As a result, persistent cognitive deficits in adulthood emerge which are aggravated by younger age at diagnosis, higher radiation dose, whole brain radiation (WBR), and concurrent chemotherapy. The case is a childhood brain tumor survivor seen 18 years post treatment who displayed cognitive deficits reflecting the cognitive sequela of WBR that overlapped with the anatomical distribution of white matter damage sustained. METHOD 23-year-old Black male with a history of childhood cerebellar medulloblastoma diagnosed at age 4, tumor resection, WBR, chemotherapy, more recent seizure disorder and medullary stroke, diabetes, and hypertension was seen for a neuropsychological evaluation due to memory complaints. His neuroimaging showed white matter hyperintensities in bilateral temporal and occipital lobes, bilateral cerebellar hemispheres, bilateral frontal lobes, medial posterior right cerebellar cyst, and 10 x 5 mm cyst in the left temporal lobe. RESULTS Results showed FSIQ = 59 and deficits in language, processing speed, visuospatial abilities, executive functioning, and verbal memory. His auditory working memory and visual memory were preserved. Based on his numerous adaptive limitations, moderate intellectual development disorder diagnosis was given. CONCLUSIONS Deficits across several cognitive domains were consistent with multi-focal white matter lesions seen in patient's neuroimaging which reflect radiographic findings related to long-term sequela of previous intracranial radiation. A unique finding was relatively preserved visual memory as findings related to asymmetrical memory dysfunction in childhood medulloblastoma survivors are scarce.
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Zhou W, Zhang H, An X, Li C, Gong J, Liu W, Sun T, Zhao F, Tian YJ. A nomogram for predicting post-operative hydrocephalus in children with medulloblastoma. Neurosurg Rev 2023; 46:246. [PMID: 37723329 DOI: 10.1007/s10143-023-02156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Abstract
Post-operative hydrocephalus is common among children with medulloblastoma after initial tumor resection. This study aimed to establish a novel model for predicting the development of post-operative hydrocephalus in children with medulloblastoma. Only pediatric patients who received initial medulloblastoma resection at Beijing Tiantan Hospital between January 2018 and May 2021 were included in this study. The potential risk factors associated with post-operative hydrocephalus were identified based on multivariate logistic regression and the nomogram. Receiver operating characteristic (ROC) curve were used to evaluate the performance of the nomogram model based on an independent cohort of medulloblastoma patients who underwent surgery from June 2021 to March 2022. A total of 105 patients were included in the primary cohort. Superior invasion (P = 0.007), caudal invasion (P = 0.025), and intraventricular blood ≥ 5 mm (P = 0.045) were significantly related to the development of post-operative hydrocephalus and thus were assembled into the nomogram model. The model accurately predicted post-operative hydrocephalus based on the calibration curve. The area under the ROC curves for the primary and validation cohorts was 0.849 and 0.855, respectively. In total, the nomogram we developed may aid clinicians in assessing the potential risk of pediatric patients with MB developing post-operative hydrocephalus, especially those who would otherwise not have received a diversionary procedure at presentation.
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Affiliation(s)
- Wentao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Heng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Gong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fu Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| | - Yong-Ji Tian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Alanazi R, Alkhaibary A, Alfaqawwy W, AlSufiani F, Ahmad N, Aljared T. Concurrent medulloblastoma and cardiac fibroma: a rare presentation of Gorlin-Goltz syndrome. Childs Nerv Syst 2023; 39:2499-2504. [PMID: 37160435 DOI: 10.1007/s00381-023-05970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Gorlin-Goltz syndrome is a rare autosomal dominant disorder resulting from PTCH1 gene mutation and presents with variable clinical manifestations. The co-occurrence of medulloblastoma and cardiac fibroma in Gorlin-Goltz syndrome is extremely rare. The present article discusses a patient diagnosed with Gorlin-Goltz syndrome and concurrent medulloblastoma and cardiac fibroma. CASE PRESENTATION A 19-month-old boy transferred to our hospital after a radiological finding of posterior fossa lesion and hydrocephalus. A pericardial mass was noted after persistent arrhythmias. Both tumors were excised for definitive management. The histopathological sections were diagnostic of desmoplastic nodular medulloblastoma, WHO grade 4 and cardiac fibroma. Molecular and genetic investigations confirmed a pathogenic variant of PTCH1 gene, suggestive of autosomal dominant Gorlin-Goltz syndrome. CONCLUSION Co-occurrence of medulloblastoma and cardiac fibroma is extremely rare and poses a management dilemma. Genetic counseling and antenatal screening are of utmost importance to early detect and manage patients with Gorlin-Goltz syndrome.
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Affiliation(s)
- Rahaf Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ar Rimayah, 14611, Riyadh, SA, 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Alkhaibary
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ar Rimayah, 14611, Riyadh, SA, 11426, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Wael Alfaqawwy
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, King Abdulaziz Medical City, King Abdullah Specialist Children's Hospital, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Fahd AlSufiani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Naveed Ahmad
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Pediatric Hematology/Oncology, Department of Oncology, King Abdulaziz Medical City, King Abdullah Specialist Children's Hospital, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Tariq Aljared
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ar Rimayah, 14611, Riyadh, SA, 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, King Abdulaziz Medical City, King Abdullah Specialist Children's Hospital, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Zhang Z, Wu Y, Zhao X, Zhou J, Li L, Zhai X, Liang P. The insertion and management of an external ventricular drain in pediatric patients with hydrocephalus associated with medulloblastoma. Neurosurg Rev 2023; 46:170. [PMID: 37433938 DOI: 10.1007/s10143-023-02080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
An external ventricular drain (EVD) is used to facilitate cerebrospinal fluid (CSF) removal in medulloblastoma patients suffering from hydrocephalus. It is essential to recognize that EVD management plays a crucial role in influencing the incidence of drain-related complications. However, the ideal method for EVD management remains undetermined. Our research sought to examine the safety of EVD placement and the impact of EVD on the incidences of intracranial infections, postresection hydrocephalus, and posterior fossa syndrome (PFS). We conducted a single-center observational study involving a cohort of 120 pediatric medulloblastoma patients who were treated from 2017 to 2020. The rates of intracranial infection, postresection hydrocephalus, and PFS were 9.2%, 18.3%, and 16.7%, respectively. EVD did not influence the occurrence of intracranial infection (p = 0.466), postresection hydrocephalus (p = 0.298), or PFS (p = 0.212). A gradual EVD weaning protocol correlated with an elevated incidence of postresection hydrocephalus (p = 0.033), whereas a rapid weaning approach resulted in 4.09 ± 0.44 fewer drainage days (p < 0.001) than the gradual weaning strategy. EVD placement (p = 0.010) and intracranial infection (p = 0.002) were linked to delayed speech return, whereas a longer duration of drainage was conducive to the recovery of language function (p = 0.010). EVD insertion was not correlated with the incidence of intracranial infection, postoperative hydrocephalus, or PFS. The optimal EVD management method should encompass a rapid EVD weaning strategy, followed by prompt drain closure. We have presented additional evidence to improve the safety of EVD insertion and management in neurosurgical patients to ultimately facilitate the establishment of standardized institutional/national implementation and management protocols.
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Affiliation(s)
- Zaiyu Zhang
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuxin Wu
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xueling Zhao
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianjun Zhou
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lusheng Li
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xuan Zhai
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ping Liang
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Satragno C, Verrico A, Giannelli F, Ferrero A, Campora S, Turazzi M, Cavagnetto F, Schiavetti I, Garrè ML, Garibotto F, Milanaccio C, Piccolo G, Crocco M, Ramaglia A, Di Profio S, Barra S, Belgioia L. High dose craniospinal irradiation as independent risk factor of permanent alopecia in childhood medulloblastoma survivors: cohort study and literature review. J Neurooncol 2022; 160:659-668. [PMID: 36369416 PMCID: PMC9758075 DOI: 10.1007/s11060-022-04186-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Our aim was to determine the main risk factors related to the occurrence of permanent alopecia in childhood medulloblastoma (MB) survivors. METHODS We retrospectively analyzed the clinical features of all consecutive MB survivors treated at our institute. We divided the patients into 3 groups depending on the craniospinal irradiation (CSI) dose received and defined permanent alopecia first in terms of the skin region affected (whole scalp and nape region), then on the basis of the toxicity degree (G). Any relationship between permanent alopecia and other characteristics was investigated by a univariate and multivariate analysis and Odds ratio (OR) with confidence interval (CI) was reported. RESULTS We included 41 patients with a mean10-year follow-up. High dose CSI resulted as an independent factor leading to permanent hair loss in both groups: alopecia of the whole scalp (G1 p-value 0.030, G2 p-value 0.003) and of the nape region (G1 p-value 0.038, G2 p-value 0.006). The posterior cranial fossa (PCF) boost volume and dose were not significant factors at multivariate analysis neither in permanent hair loss of the whole scalp nor only in the nuchal region. CONCLUSION In pediatric patients with MB, the development of permanent alopecia seems to depend only on the CSI dose ≥ 36 Gy. Acute damage to the hair follicle is dose dependent, but in terms of late side effects, constant and homogeneous daily irradiation of a large volume may have a stronger effect than a higher but focal dose of radiotherapy.
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Affiliation(s)
- C Satragno
- Dipartimento Di Medicina Sperimentale (DIMES), Università Degli Studi Di Genova, Via Leon Battista Alberti, 16132, Genova, GE, Italia.
| | - A Verrico
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - F Giannelli
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - A Ferrero
- Dipartimento Di Medicina Sperimentale (DIMES), Università Degli Studi Di Genova, Via Leon Battista Alberti, 16132, Genova, GE, Italia
| | - S Campora
- Dipartimento di Scienza Della Salute (DISSAL), Università Degli Studi di Genova, Genova, Italia
| | - M Turazzi
- Dipartimento di Scienza Della Salute (DISSAL), Università Degli Studi di Genova, Genova, Italia
| | - F Cavagnetto
- UO Fisica Sanitaria, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - I Schiavetti
- Dipartimento di Scienze Della Salute (DISSAL), Sezione di Biostatistica, Università Degli Studi di Genova, Genova, Italia
| | - M L Garrè
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - F Garibotto
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Ginecologia e Pediatria (DINOGMI), Università Degli Studi di Genova, Genova, Italia
| | - C Milanaccio
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - G Piccolo
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Ginecologia e Pediatria (DINOGMI), Università Degli Studi di Genova, Genova, Italia
| | - M Crocco
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Ginecologia e Pediatria (DINOGMI), Università Degli Studi di Genova, Genova, Italia
| | - A Ramaglia
- Unità di Neuroradiologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - S Di Profio
- Unità di Psicologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - S Barra
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - L Belgioia
- Dipartimento di Scienza Della Salute (DISSAL), Università Degli Studi di Genova, Genova, Italia
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italia
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Sundaram M, Mishra RK, Uppar AM. Neurogenic stunned myocardium resulting from surgical brainstem handling during resection of paediatric recurrent medulloblastoma-a possible brain heart interaction. Childs Nerv Syst 2022; 38:2025-2028. [PMID: 35460357 DOI: 10.1007/s00381-022-05523-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurogenic stunned myocardium (NSM) is characterised by an acute onset cardiac dysfunction following an acute neurological insult which mimics acute coronary syndrome. CASE DETAILS A 12-year-old male child was admitted to the neuro-intensive care unit (NICU) following midline suboccipital craniotomy and resection of recurrent medulloblastoma. Postoperatively, in NICU, he developed tachycardia and hypotension, which was unresponsive to fluid challenge requiring norepinephrine infusion. Intraoperatively, during tumour resection from the dorsal medulla, episodes of hypertension and bradycardia were observed. Intraoperative blood loss was adequately managed with a stable hemodynamic profile without postoperative anaemia. An electrocardiogram showed sinus tachycardia with T wave inversion, and blood investigation revealed elevated cardiac troponin T levels. Point of care ultrasound (POCUS) of heart and lung showed features of NSM. Infusion dobutamine was added to achieve a target mean arterial pressure of 65 mm Hg with concomitant furosemide infusion and fluid restriction. Daily POCUS assessment of cardiac contractility and volume status was done. The patient was weaned from vasoactive drugs and ventilator following improvement of cardiac function and was discharged from NICU after 17 days. CONCLUSION NSM results from the excessive release of catecholamines following stimulation of trigger zones in the brain. To date, a handful of cases of pediatric NSM following primary brain tumour are reported where hydrocephalus resulted in trigger zone activation. In this presented case, direct brain stem stimulation during tumour resection might have triggered NSM. Irrespective of the cause, timely diagnosis and execution of supportive management in our patient resulted in a positive outcome.
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Affiliation(s)
- Mouleeswaran Sundaram
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
| | - Rajeeb Kumar Mishra
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Chen ZH, Zhang XH, Lin FH, Li C, Jin JT, Zhou ZH, Zhu SH, Cheng ZQ, Zhong S, He ZQ, Duan H, Wen X, Wang J, Mou YG. The application of fluorescein sodium for the resection of medulloblastoma. J Neurooncol 2022; 158:463-470. [PMID: 35657459 PMCID: PMC9256568 DOI: 10.1007/s11060-022-04035-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
Introduction Surgical resection of medulloblastoma (MB) remains a challenge. At present, a variety of tracers have been used for intraoperative tumor visualization. However, there are few reports on the intraoperative visualization of MB. Hence, we reported our experience of applying fluorescein sodium (FS) in MB surgery. Methods We retrospectively analyzed the clinical information of patients with MB confirmed by surgery and pathology from January 2016 to December 2020 from Sun Yat-sen University Cancer Center. A total of 62 patients were enrolled, of which 27 received intraoperative FS and 35 did not. The intraoperative dose of FS was 3 mg/kg. Results Among the 62 patients, 42 were males, and twenty were females. The age of onset in the FS group was 9.588 ± 7.322, which in the non-fluorescein sodium group was 13.469 ± 10.968, p = 0.198. We did not find significant differences in tumor location, tumor size, tumor resection, tumor histology, and preoperative symptoms (hydrocephalus, headache, vomit, balance disorder) between the groups. There was no significant difference in the postoperative symptoms (hydrocephalus, headache, vomiting, balance disorder, and cerebellar mutism). However, patients in the FS group had a relatively low incidence of balance disorder and cerebellar mutism. There was definite fluorescence of tumor in all cases of the FS group, and even the tiny metastatic lesion was visible. No case had side effects related to the use of FS. Conclusions FS is safe and effective in MB surgery. Whether the application of FS for surgery can reduce complications remains to be studied in the future.
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Affiliation(s)
- Zheng-he Chen
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Xiang-heng Zhang
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Fu-hua Lin
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Chang Li
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Jie-tian Jin
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060 People’s Republic of China
| | - Zhi-huan Zhou
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Si-han Zhu
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Zhu-qing Cheng
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Sheng Zhong
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Zhen-qiang He
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Hao Duan
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Xia Wen
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Jian Wang
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
| | - Yong-gao Mou
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060 People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, 510060 People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 People’s Republic of China
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9
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Paslaru FG, Panaitescu AM, Nestian E, Iancu G, Veduta A, Paslaru AC, Pop LG, Gorgan RM. Medulloblastoma Presenting as Severe Headache during Pregnancy: A Case Report and Review of the Literature. Medicina (Kaunas) 2022; 58:127. [PMID: 35056435 PMCID: PMC8778892 DOI: 10.3390/medicina58010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms-persistent headache followed by neurological deficit-in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.
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Affiliation(s)
- Francesca Gabriela Paslaru
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (E.N.); (R.M.G.)
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (G.I.); (A.V.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Elena Nestian
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (E.N.); (R.M.G.)
| | - George Iancu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (G.I.); (A.V.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alina Veduta
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (G.I.); (A.V.)
| | - Alexandru Catalin Paslaru
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Dr. Victor Gomoiu Children’s Clinical Hospital, 020021 Bucharest, Romania
| | - Lucian Gheorghe Pop
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania;
| | - Radu Mircea Gorgan
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (E.N.); (R.M.G.)
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Kajtazi NI, Nahrir S, Al Shakweer W, Al Ghamdi J, Al Fakeeh A, Al Hameed M. Malignant idiopathic intracranial hypertension revealed a hidden primary spinal leptomeningeal medulloblastoma. BMJ Case Rep 2021; 14:e243506. [PMID: 34321265 PMCID: PMC8319973 DOI: 10.1136/bcr-2021-243506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/04/2022] Open
Abstract
Frequently the cause of raised intracranial pressure remains unresolved and rarely is related to spinal tumours, moreover less to spinal medulloblastoma without primary brain focus. An 18-year-old woman had a 3-month history of headache and impaired vision. Neurological examination revealed bilateral sixth cranial nerve palsies with bilateral papilloedema of grade III. No focal brain or spine lesion was found on imaging. Consecutive lumbar punctures showed high opening pressure and subsequent increasing protein level. Meningeal biopsy was negative. At one point, she developed an increasing headache, vomiting and back pain. Spine MRI showed diffuse nodular leptomeningeal enhancement with the largest nodule at T6-T7. Malignant cells were detected in cerebrospinal fluid. She underwent laminectomy with excisional biopsy, and pathology showed medulloblastoma WHO grade IV. She was treated with chemotherapy and craniospinal irradiation and made a good recovery.
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Affiliation(s)
- Naim Izet Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shahpar Nahrir
- Department of Neurology, King Saud Medical Complex, Riyadh, Saudi Arabia
| | - Wafa Al Shakweer
- Pathology and Clinical Laboratory Administration Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Al Fakeeh
- Department of Oncology, Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majed Al Hameed
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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11
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Grosse F, Rueckriegel SM, Thomale UW, Hernáiz Driever P. Mapping of long-term cognitive and motor deficits in pediatric cerebellar brain tumor survivors into a cerebellar white matter atlas. Childs Nerv Syst 2021; 37:2787-2797. [PMID: 34355257 PMCID: PMC8423645 DOI: 10.1007/s00381-021-05244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Diaschisis of cerebrocerebellar loops contributes to cognitive and motor deficits in pediatric cerebellar brain tumor survivors. We used a cerebellar white matter atlas and hypothesized that lesion symptom mapping may reveal the critical lesions of cerebellar tracts. METHODS We examined 31 long-term survivors of pediatric posterior fossa tumors (13 pilocytic astrocytoma, 18 medulloblastoma). Patients underwent neuronal imaging, examination for ataxia, fine motor and cognitive function, planning abilities, and executive function. Individual consolidated cerebellar lesions were drawn manually onto patients' individual MRI and normalized into Montreal Neurologic Institute (MNI) space for further analysis with voxel-based lesion symptom mapping. RESULTS Lesion symptom mapping linked deficits of motor function to the superior cerebellar peduncle (SCP), deep cerebellar nuclei (interposed nucleus (IN), fastigial nucleus (FN), ventromedial dentate nucleus (DN)), and inferior vermis (VIIIa, VIIIb, IX, X). Statistical maps of deficits of intelligence and executive function mapped with minor variations to the same cerebellar structures. CONCLUSION We identified lesions to the SCP next to deep cerebellar nuclei as critical for limiting both motor and cognitive function in pediatric cerebellar tumor survivors. Future strategies safeguarding motor and cognitive function will have to identify patients preoperatively at risk for damage to these critical structures and adapt multimodal therapeutic options accordingly.
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Affiliation(s)
- Frederik Grosse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Berlin, Germany
| | | | - Ulrich-Wilhelm Thomale
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Neurosurgery, Berlin, Germany
| | - Pablo Hernáiz Driever
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Berlin, Germany.
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12
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Doger de Spéville E, Kieffer V, Dufour C, Grill J, Noulhiane M, Hertz-Pannier L, Chevignard M. Neuropsychological consequences of childhood medulloblastoma and possible interventions: A review. Neurochirurgie 2018; 67:90-98. [PMID: 29716738 DOI: 10.1016/j.neuchi.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 03/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Children who have been treated for a medulloblastoma often suffer long-term cognitive impairments that often negatively affect their academic performance and quality of life. In this article, we will review the neuropsychological consequences of childhood medulloblastoma and discuss the risk factors known to influence the presence and severity of these cognitive impairments and possible interventions to improve their quality of life. METHODS This narrative review was based on electronic searches of PubMed to identify all relevant studies. RESULTS Although many types of cognitive impairments often emerge during a child's subsequent development, the core cognitive domains that are most often affected in children treated for a medulloblastoma are processing speed, attention and working memory. The emergence and magnitude of these deficits varies greatly among patients. They are influenced by demographic (age at diagnosis, parental education), medical and treatment-related factors (perioperative complications, including posterior fossa syndrome, radiation therapy dose, etc.), and the quality of interventions such as school adaptations provided to the child or rehabilitation programs that focus on cognitive skills, behavior and psychosocial functioning. CONCLUSION These patients require specialized and coordinated multidisciplinary rehabilitation follow-up that provides timely and adapted assessments and culminates in personalized intervention goals being set with the patient and the family. Follow-up should be continued until referral to adult services.
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Affiliation(s)
- E Doger de Spéville
- Inserm U1129, CEA, Paris Descartes university, 75005 Paris, France; UNIACT, institut Joliot, DRF, Neurospin, CEA, Paris Saclay university, 91190 Gif-sur-Yvette, France; Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France
| | - V Kieffer
- Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France; CSI (Outreach team for children and adolescents with acquired brain injury), department for children with acquired brain injury, hôpitaux de Saint-Maurice, 94410 Saint-Maurice, France
| | - C Dufour
- Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France
| | - J Grill
- Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France
| | - M Noulhiane
- Inserm U1129, CEA, Paris Descartes university, 75005 Paris, France; UNIACT, institut Joliot, DRF, Neurospin, CEA, Paris Saclay university, 91190 Gif-sur-Yvette, France
| | - L Hertz-Pannier
- Inserm U1129, CEA, Paris Descartes university, 75005 Paris, France; UNIACT, institut Joliot, DRF, Neurospin, CEA, Paris Saclay university, 91190 Gif-sur-Yvette, France
| | - M Chevignard
- CSI (Outreach team for children and adolescents with acquired brain injury), department for children with acquired brain injury, hôpitaux de Saint-Maurice, 94410 Saint-Maurice, France; Rehabilitation department for children with acquired neurological injury, and outreach team for children and adolescents with acquired brain injury, Saint-Maurice hospitals, 14, rue du Val-d'Osne, 94410 Saint-Maurice, France; Sorbonne université, laboratoire d'imagerie biomédicale, LIB, 75006 Paris, France; GRC n(o) 18, handicap cognitif et réadaptation (HanCRe)- Sorbonne université, 75013 Paris, France.
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13
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Moteki H, Fujinaga Y, Goto T, Usami SI. Pneumolabyrinth, intracochlear and vestibular fluid loss after cochlear implantation. Auris Nasus Larynx 2018; 45:1116-1120. [PMID: 29680680 DOI: 10.1016/j.anl.2018.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 11/19/2022]
Abstract
The present case was a 38-year-old male who presented with progressive hearing loss, resulting in profound bilateral hearing loss. He had a past history of childhood medulloblastoma, which was treated with posterior fossa craniotomy and radiotherapy. A ventriculoperitoneal (VP) shunt was put in place to manage the hydrocephalus. Cochlear implantation (CI) was carried out on his right ear by a standard procedure. At CI activation, the electric impedance of the electrode was very high, and computed tomography revealed that there was no area of liquid density, suggesting depletion of the perilymph in the cochlea and vestibule. Eight months later, the impedance improved gradually, and the cochlea was filled with perilymph. Consequently, one of the causes of the pneumolabyrinth in the present case was that a scarred stenotic cochlear canaliculus secondary to surgery or radiation therapy might have prevented the CSF from filling the scala. In addition, it is also possible that the VP shunt might have altered the CSF pressure, leading to depletion of the perilymph.
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Affiliation(s)
- Hideaki Moteki
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan; Department of Hearing Implant Sciences , Shinshu University School of Medicine , Matsumoto , Japan.
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan; Department of Hearing Implant Sciences , Shinshu University School of Medicine , Matsumoto , Japan
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14
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Holsten T, Tsiakas K, Kordes U, Bison B, Pietsch T, Rutkowski S, Santer R, Schüller U. Group 3 medulloblastoma in a patient with a GYS2 germline mutation and glycogen storage disease 0a. Childs Nerv Syst 2018; 34:581-584. [PMID: 29167993 DOI: 10.1007/s00381-017-3666-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/15/2017] [Indexed: 12/16/2022]
Abstract
Glycogen storage disease (GSD) 0a is a rare congenital metabolic disease with symptoms in infancy and childhood caused by biallelic GYS2 germline variants. A predisposition to cancer has not been described yet. We report here a boy with GSD 0a, who developed a malignant brain tumor at the age of 4.5 years. The tumor was classified as a group 3 medulloblastoma, and the patient died from cancer 27 months after initial tumor diagnosis. This case appears interesting as group 3 medulloblastoma is so far not known to arise in hereditary syndromes and the biology of sporadic group 3 medulloblastoma is largely unknown.
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Affiliation(s)
- Till Holsten
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute, Children's Cancer Center Hamburg, Hamburg, Germany
| | - Konstantinos Tsiakas
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Bison
- Institute of Neuroradiology, University of Würzburg, Würzburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn, Bonn, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Santer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Research Institute, Children's Cancer Center Hamburg, Hamburg, Germany.
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15
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Hernández Cancela RM, Pombo Otero J, Concha-Lopez A. A case of multifocal medulloblastoma in an adult patient. Rev Esp Patol 2017; 50:45-48. [PMID: 29179964 DOI: 10.1016/j.patol.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/15/2022]
Abstract
Only five cases of multifocal medulloblastoma in the adult have been reported to date. We present a case in a male patient in his 50th decade of life who presented with three extra-axial lesions associated with a parenchymatous lesion of the right middle cerebellar peduncle. Sputum sample examination revealed larvae compatible with strongyloides stercoralis, which was our main differential diagnosis. Histological and immunohistochemical studies revealed the existence of a desmoplastic medulloblastoma.
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Affiliation(s)
| | - Jorge Pombo Otero
- Department of Pathology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Angel Concha-Lopez
- Department of Pathology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Zhao R, Shi W, Yu J, Gao X, Li H. Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children: A Report of 2 Cases and Systematic Literature Review. Medicine (Baltimore) 2015; 94:e1375. [PMID: 26313776 PMCID: PMC4602928 DOI: 10.1097/md.0000000000001375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ventriculoperitoneal (VP) shunt complications are common, but abdominal complications are rare. The objective of this report is to present 2 cases of intestinal obstruction due to a VP shunt and review the literature for data on this rare occurrence.A 4-month-old boy received surgical resection of a medulloblastoma and a VP shunt was inserted to manage progressive hydrocephalus. Two months later, he was admitted with intermittent vomiting, and plain abdominal radiography showed complete intestinal obstruction. Emergency laparotomy revealed an adhesive intestinal obstruction around the catheter, and approximately 5 cm of necrotic ileum was resected. His recovery was uneventful. In the second case, a 6-year-old boy was diagnosed with a primary nongerminomatous malignant germ cell tumor and a VP shunt was place to treat hydrocephalus. Two weeks after the first course of chemotherapy, he went into a coma; computed tomography demonstrated enlargement of the tumor and gross total resection was performed. Two weeks later, he developed abdominal distention; plain radiography showed intestinal obstruction and laparotomy revealed adhesive intestinal obstruction around the catheter with 15 cm of necrotic ileum. The necrotic bowel was resected. Unfortunately, the patient developed sepsis and despite treatment remained in a vegetative state.Medline, Central, Embase, and Google Scholar databases were searched up to May 9, 2014, using the terms VP shunt, shunting, and/or intestinal obstruction. Only cases involving children or adolescents were included. Eleven reports involving patients with abdominal complications resulting from a VP shunt for hydrocephalus were identified. The dates of the reports spanned from 1971 to 2014. Volvulus was the most common cause of VP shunt-related obstruction, and mechanical obstruction due to twisting of the catheter the second most common. Only 1 case in the literature review was related to intestinal adhesions. Treatment in most cases was laparotomy.Although intestinal obstruction is a rare complication of a VP shunt, it should be considered in the presence of abdominal symptoms and prompt treatment provided to have a good outcome.
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Affiliation(s)
- Rui Zhao
- Department of Pediatric Neurosurgery, Children's Hospital of Fudan University, Shanghai, China
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17
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Zhang R, Mirkovic D, Newhauser WD. Visualization of risk of radiogenic second cancer in the organs and tissues of the human body. Radiat Oncol 2015; 10:107. [PMID: 25927490 PMCID: PMC4422483 DOI: 10.1186/s13014-015-0404-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 04/11/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Radiogenic second cancer is a common late effect in long term cancer survivors. Currently there are few methods or tools available to visually evaluate the spatial distribution of risks of radiogenic late effects in the human body. We developed a risk visualization method and demonstrated it for radiogenic second cancers in tissues and organs of one patient treated with photon volumetric modulated arc therapy and one patient treated with proton craniospinal irradiation. METHODS Treatment plans were generated using radiotherapy treatment planning systems (TPS) and dose information was obtained from TPS. Linear non-threshold risk coefficients for organs at risk of second cancer incidence were taken from the Biological Effects of Ionization Radiation VII report. Alternative risk models including linear exponential model and linear plateau model were also examined. The predicted absolute lifetime risk distributions were visualized together with images of the patient anatomy. RESULTS The risk distributions of second cancer for the two patients were visually presented. The risk distributions varied with tissue, dose, dose-risk model used, and the risk distribution could be similar to or very different from the dose distribution. CONCLUSIONS Our method provides a convenient way to directly visualize and evaluate the risks of radiogenic second cancer in organs and tissues of the human body. In the future, visual assessment of risk distribution could be an influential determinant for treatment plan scoring.
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Affiliation(s)
- Rui Zhang
- Mary Bird Perkins Cancer Center, LA, Baton Rouge, USA.
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, LA, Baton Rouge, USA.
| | - Dragan Mirkovic
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Wayne D Newhauser
- Mary Bird Perkins Cancer Center, LA, Baton Rouge, USA.
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, LA, Baton Rouge, USA.
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18
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Furuhata M, Aihara Y, Eguchi S, Horiba A, Tanaka M, Komori T, Okada Y. [Pediatric medulloblastoma presenting as cerebellar hemorrhage: a case report]. No Shinkei Geka 2014; 42:545-551. [PMID: 24920742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medulloblastomas usually cause cerebellar ataxia and acute hydrocephalus owing to their increase in size. Cerebellar hemorrhage is an extremely rare initial clinical presentation of medulloblastoma. Herein, we report a case of medulloblastoma in an 8-year-old girl who presented with initial cerebellar intratumoral hemorrhage. The patient initially presented with mild headache;the differential diagnosis by using the initial computed tomography and magnetic resonance images was difficult, as bleeding from a cerebellar vascular malformation(cavernous angioma or arteriovenous malformation)was considered more likely. Hydrocephalus or typical findings indicative of medulloblastoma were not observed. We initially only observed the patient at another institution because the hematoma was relatively small(1.5×1×1cm). After follow-up imaging for pathological diagnosis, surgical removal was performed at our institute 49 days after the hemorrhage was observed. Complete tumor removal was achieved, and the histopathological diagnosis was medulloblastoma. The patient received whole brain and spinal irradiation(23.4Gy;posterior fossa local:50.4Gy)and chemotherapy(cyclophosphamide, 1,000mg/m2/day on day 1;vincristine, 1.5mg/m2/day on day 1;etoposide, 100mg/m2/day on days 1-3;cisplatin, 90mg/m2/day on day 2). No recurrences or neurological deficits were observed during a 2-year follow-up. This was a rare case of medulloblastoma presenting as cerebellar hemorrhage. Cerebellar medulloblastoma is among the common pediatric brain tumors;therefore, it should be diagnosed accurately and quickly.
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Affiliation(s)
- Masanori Furuhata
- Department of Neurosurgery, Tokyo Women's Medical University Hospital
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19
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Ji W, Liang P, Zhou Y, Li L, Zhai X, Xia Z. [Management of obstructive hydrocephalus before posterior fossa tumor resection in children]. Nan Fang Yi Ke Da Xue Xue Bao 2013; 33:1696-1698. [PMID: 24273282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the management of obstructive hydrocephalus caused by posterior fossa tumors before tumor resection in children. METHODS The clinical data were reviewed of 162 pediatric patients of posterior fossa tumors with obstructive hydrocephalus undergoing surgical tumor removal between January 2008 and June 2012. Ninety children received preoperative Ommaya external drainage (group A) and 72 underwent preoperative ventriculo-peritoneal shunting (V-Ps) (group B). The therapeutic effects were evaluated and compared between the two groups. RESULTS Postoperative complications found in a total of 67 cases including infection (27), shunt blockage (19), subdural hematoma or effusion (16), ventricle fissure syndrome (5), and tumor hernia (4). Significant differences were found in the incidences of shunt blockage (P=0.047) and subdural hematoma or effusion (P=0.039) but not in the incidences of intracranial infection (P=0.478) or tumor hernia (P=0.462) between the two groups. CONCLUSION Ommaya reservoir can produce good results through simple surgical procedures for treatment of acute hydrocephalus in children with posterior fossa tumors and is associated less trauma and complications.
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Affiliation(s)
- Wenyuan Ji
- Department of Neurosurgery, Children's Hospital Affiliated to Chongqing Medical University, Chongqing 400014, China.E-mail:
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Ho CH, Chen SJ, Juan CJ, Lee HS, Tsai SH, Fan HC. Sudden death due to medulloblastoma: a case report. Acta Neurol Taiwan 2013; 22:76-80. [PMID: 24030040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Medulloblastoma is one of the notorious CNS malignancies for subtle and atypical clinical presentations, causing rapid neurological deterioration and death, especially in pediatric patients. The delay in diagnosis leads to painful remorse, conflicts, and lawsuits for parents and medical staff. CASE REPORT We report a 2 year old girl with initial presentation of febrile pyuria. Soon after admission, a generalized clonic-tonic seizure attacked to her and led to an impression of febrile convulsion. However, an unusual postical slowness of pupils to light stimulation propelled a further investigation. A contrast enhanced brain computer tomography (CT) unexpectedly showed a mass occupied the fourth ventricle resulting in obstructive hydrocephalus and compressed adjacent brain stem and cerebellum. The disease rapidly progressed and she died 18 hours after an emergent decompression with extraventricular drainage (EVD) installation. Cytology of cerebrospinal fluid proved medulloblastoma. CONCLUSION This case report highlights the importance of clinical suspicion, such as a trivial but unusual presentation, a lagged pupil response to light stimulation. A brain CT scan should be done to rule out any possibility of an organic lesion. Close monitor is required in order to catch and treat medulloblastoma early. However, once discovered, the cancer has spread.
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Affiliation(s)
- Cheng-Hsuan Ho
- Department of Pediatrics,Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Affiliation(s)
- Benjamin R T Jones
- Bristol University Medical School, University of Bristol, Bristol BS8 1TH, UK.
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Hasegawa K, Minami Y, Inuzuka H, Oe S, Kato R, Tsukada K, Udagawa Y, Kuroda M. Female pseudohermaphroditism associated with maternal steroid cell tumor, not otherwise specified of the ovary: a case report and literature review. CLIN EXP OBSTET GYN 2013; 40:591-595. [PMID: 24597265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Maternal virilization in pregnancy with or without fetal female pseudohermaphroditism has several etiologies. Of these, pregnancy luteoma is the most common cause of maternal virilization during pregnancy, and approximately 20 cases have been reported in recent years. Moreover, four cases of pregnancy luteomas with female pseudohermaphroditism have been reported. However, the extremely rare steroid cell tumor, not otherwise specified (NOS), has been reported only once as a cause for maternal virilization. Herein, the authors report the first case of maternal virilization with female pseudohermaphroditism associated with steroid cell tumor-NOS along with the clinical course, pathological features, and a review of the literature.
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Affiliation(s)
- K Hasegawa
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Y Minami
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - H Inuzuka
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - S Oe
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - R Kato
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - K Tsukada
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Y Udagawa
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - M Kuroda
- Department of Pathology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Brinkman TM, Reddick WE, Luxton J, Glass JO, Sabin ND, Srivastava DK, Robison LL, Hudson MM, Krull KR. Cerebral white matter integrity and executive function in adult survivors of childhood medulloblastoma. Neuro Oncol 2012; 14 Suppl 4:iv25-36. [PMID: 23095827 PMCID: PMC3480251 DOI: 10.1093/neuonc/nos214] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Survivors of pediatric medulloblastoma are at risk for neurocognitive dysfunction. Reduced white matter integrity has been correlated with lower intelligence in child survivors, yet associations between specific cognitive processes and white matter have not been examined in long-term adult survivors. Twenty adult survivors of medulloblastoma were randomly recruited from a larger institutional cohort of adult survivors of childhood cancer. Survivors underwent comprehensive neurocognitive evaluations and MRI. Data on brain volume and cortical thickness and diffusion tensor imaging were acquired, including measures of fractional anisotropy, apparent diffusion coefficient, and axial and radial diffusivity. Observed neurocognitive scores were compared with population norms and correlated to MRI indices. Survivors were, on average, 29 years of age and 18 years postdiagnosis. Mean full-scale intelligence quotient was nearly 1 SD below the normative mean (86.3 vs 100, P = .004). Seventy-five percent of survivors were impaired on at least one measure of executive function. Radial diffusivity in the frontal lobe of both hemispheres was correlated with shifting attention (left: r(s) = -0.67, P = .001; right: r(s) = -0.64, P = .002) and cognitive flexibility (left: r(s) = -0.56, P = .01; right: r(s) = -0.54, P = .01). Volume and cortical thickness were not correlated with neurocognitive function. Neurocognitive impairment was common and involved many domains. Reduced white matter integrity in multiple brain regions correlated with poorer performance on tasks of executive function. Future research integrating diffusion tensor imaging should be a priority to more rigorously evaluate long-term consequences of cancer treatment and to inform cognitive intervention trials in this high-risk population.
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Affiliation(s)
- Tara M Brinkman
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA.
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24
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Brodin NP, Vogelius IR, Maraldo MV, Munck af Rosenschöld P, Aznar MC, Kiil-Berthelsen A, Nilsson P, Björk-Eriksson T, Specht L, Bentzen SM. Life years lost--comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale. Cancer 2012; 118:5432-40. [PMID: 22517408 DOI: 10.1002/cncr.27536] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND The authors developed a framework for estimating and comparing the risks of various long-term complications on a common scale and applied it to 3 different techniques for craniospinal irradiation in patients with pediatric medulloblastoma. METHODS Radiation dose-response parameters related to excess hazard ratios for secondary breast, lung, stomach, and thyroid cancer; heart failure, and myocardial infarction were derived from large published clinical series. Combined with age-specific and sex-specific hazards in the US general population, the dose-response analysis yielded excess hazards of complications for a cancer survivor as a function of attained age. After adjusting for competing risks of death, life years lost (LYL) were estimated based on excess hazard and prognosis of a complication for 3-dimensional conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT). RESULTS Lung cancer contributed most to the estimated LYL, followed by myocardial infarction, and stomach cancer. The estimates of breast or thyroid cancer incidence were higher than those for lung and stomach cancer incidence, but LYL were lower because of the relatively good prognosis. Estimated LYL ranged between 1.90 years for 3D CRT to 0.28 years for IMPT. In a paired comparison, IMPT was associated with significantly fewer LYL than both photon techniques. CONCLUSIONS Estimating the risk of late complications is associated with considerable uncertainty, but including prognosis and attained age at an event to obtain the more informative LYL estimate added relatively little to this uncertainty.
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Affiliation(s)
- N Patrik Brodin
- Radiation Medicine Research Center, Department of Radiation Oncology, Rigshospitalet, University of Copenhagen, Denmark.
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25
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Edelstein K, Spiegler BJ, Fung S, Panzarella T, Mabbott DJ, Jewitt N, D'Agostino NM, Mason WP, Bouffet E, Tabori U, Laperriere N, Hodgson DC. Early aging in adult survivors of childhood medulloblastoma: long-term neurocognitive, functional, and physical outcomes. Neuro Oncol 2011; 13:536-45. [PMID: 21367970 PMCID: PMC3093335 DOI: 10.1093/neuonc/nor015] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/11/2011] [Indexed: 12/22/2022] Open
Abstract
Treatment for medulloblastoma during childhood impairs neurocognitive function in survivors. While those diagnosed at younger ages are most vulnerable, little is known about the long-term neurocognitive, functional, and physical outcomes in survivors as they approach middle age. In this retrospective cohort study, we assessed 20 adults who were treated with surgery and radiotherapy for medulloblastoma during childhood (median age at assessment, 21.9 years [range, 18-47 years]; median time since diagnosis, 15.5 years [range, 6.5-42.2 years]). Nine patients also underwent chemotherapy. Cross-sectional analyses of current neurocognitive, functional, and physical status were conducted. Data from prior neuropsychological assessments were available for 18 subjects; longitudinal analyses were used to model individual change over time for those subjects. The group was well below average across multiple neurocognitive domains, and 90% had required accommodations at school for learning disorders. Longer time since diagnosis, but not age at diagnosis, was associated with continued decline in working memory, a common sign of aging. Younger age at diagnosis was associated with lower intelligence quotient and academic achievement scores, even many years after treatment had been completed. The most common health complications in survivors were hearing impairment, second cancers, diabetes, hypertension, and endocrine deficiencies. Adult survivors of childhood medulloblastoma exhibit signs of early aging regardless of how young they were at diagnosis. As survival rates for brain tumors continue to improve, these neurocognitive and physical sequelae may become evident in survivors diagnosed at different ages across the lifespan. It will become increasingly important to identify factors that contribute to risk and resilience in this growing population.
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Affiliation(s)
- Kim Edelstein
- Psychosocial Oncology and Palliative Care, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, ON, Canada.
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26
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Sockel K, Ordemann R, von Bonin M, Jahn S, Prange-Krex G, Ehninger G, Kroschinsky F. Hip pain in medulloblastoma as first symptom of extraneural relapse. Onkologie 2011; 34:196-198. [PMID: 21447979 DOI: 10.1159/000327002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Katja Sockel
- Medizinische Klinik I mit Schwerpunkt Hämatologie und Onkologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany.
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Moreira NC, Nylander R, Briaukaitė I, Vėlyvytė S, Gleiznienė R, Monastyreckienė E. Superficial siderosis: a case report. Medicina (Kaunas) 2011; 47:320-322. [PMID: 21968884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Superficial siderosis of the central nervous system is the result of chronic recurrent hemorrhages (e.g., arteriovenous malformations, tumors, or trauma), which leads to the accumulation of cytotoxic hemosiderin and presents with hearing loss, cerebellar dysfunction, and myelopathy. This article presents a clinical case of an 11-year-old boy in whom the diagnosis of medulloblastoma was established. He underwent surgery, and after a few years, he began to complain of hearing loss. Magnetic resonance imaging revealed the cause of the hearing disturbance. The aim of this article is to review the recent literature related to the etiology, clinical and radiologic features of superficial siderosis, emphasizing the role of magnetic resonance imaging.
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28
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Alter BP, Olson SB. Wilms tumor, AML, and medulloblastoma in a child with cancer prone syndrome of total premature chromatid separation and Fanconi anemia. Pediatr Blood Cancer 2010; 54:488; author reply 489. [PMID: 19856400 DOI: 10.1002/pbc.22333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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29
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Soto-Cabrera E, González-Aguilar A, Márquez-Romero JM. [Klüver-Bucy syndrome secondary to medulloblastoma metastasis]. Neurologia 2010; 25:135-136. [PMID: 20487715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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30
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El Hassani Y, Burkhardt K, Delavellle J, Vargas MI, Boex C, Rilliet B. Symptomatic syringomyelia occurring as a late complication of posterior fossa medulloblastoma removal in infancy in a boy also suffering from scaphocephaly. Childs Nerv Syst 2009; 25:1633-7. [PMID: 19662425 DOI: 10.1007/s00381-009-0968-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The association of a medulloblastoma and a syringomyelia has been already described in rare instances albeit without symptoms related to the syrinx. CASE REPORT The case of a 23-year-old man operated in infancy for a medulloblastoma and then treated solely with adjuvant chemotherapy is reported. He was also operated in infancy for a scaphocephaly. With a very long time delay, he has developed a Chiari I and a symptomatic cervico-dorsal syringomyelia. The symptoms attributed to the syrinx consisted of a unilateral prurigo over the left arm which was so severe to lead to self-mutilation. DISCUSSION Clinical and magnetic resonance imaging follow-up after cervico-dorsal decompression shows a significant improvement of the symptoms together with a reduction of the size of the syrinx. This case is discussed in the light of the presumed pathophysiology of the syrinx and its exceptional clinical presentation.
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Affiliation(s)
- Yassine El Hassani
- Service de Neurochirurgie, Hôpital Cantonal Universitaire, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
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31
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Poleck-Dehlin B, Duell T, Bartl R, Lohse P, Rhein A, Diebold J, Kohl P, Mittermueller J, Schmetzer H. Genetic Analyses Permit the Differentiation Between Reactive Malfunctions (‘Promyelocyte Arrest’) and Arising Promyelocyte Leukemia in a Pregnant Patient With a History of a Medulloblastoma. Leuk Lymphoma 2009; 45:1905-11. [PMID: 15223653 DOI: 10.1080/10428190410001697377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report the case of a 24-year-old woman with a history of radiotherapy for a cerebellar medulloblastoma 2 years prior to detection of a lymph node metastasis of the former disease and a pancytopenia in the peripheral blood. On bone marrow (BM) examination promyelocyte leukemia vs. a reactive 'promyelocyte arrest' were discussed. The translocation t(15;17) was found in some nuclei and there was a PML-RARalpha gene rearrangement detectable by RT-PCR. Furthermore, there was BM infiltration by the primary cancer. All these results led to the diagnosis of a relapse of the medulloblastoma and of a beginning promyelocyte leukemia. As the patient was pregnant, she had to be parted with the baby to facilitate intensive chemotherapy. She did not respond to a therapeutic regimen specific for promyelocytic leukemia but achieved complete remission of the medulloblastoma as well as the leukemia after the administration of polychemotherapy specific for medulloblastoma. One year later, she suffered from a relapse of her leukemia. Now nearly all cells showed a t(15;17) aberration. Immunophenotype analyses showed a shift to a more undifferentiated blast phenotype that was, however, still HLA-DR negative. The patient again received chemotherapy for leukemia but developed a sepsis 3 months later and died of pancytopenia ensuing her leukemia. There was no clinical evidence for recurrence of the medulloblastoma.
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Guyot E, Carillion A, Poli-Mérol ML, Ferrand I, Chauvet P, Nguyen P, Malinovsky JM. Use of rFVIIa in two children presenting major bleeding not controlled by the usual treatments before emergent surgery. Paediatr Anaesth 2008; 18:1226-8. [PMID: 19076583 DOI: 10.1111/j.1460-9592.2008.02722.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Mathew J, Chacko A. Spontaneous re-ossification of a large calvarial defect in an older child. Turk Neurosurg 2008; 18:407-408. [PMID: 19301488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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34
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Roncadin C, Dennis M, Greenberg ML, Spiegler BJ. Adverse medical events associated with childhood cerebellar astrocytomas and medulloblastomas: natural history and relation to very long-term neurobehavioral outcome. Childs Nerv Syst 2008; 24:995-1002; discussion 1003. [PMID: 18581121 DOI: 10.1007/s00381-008-0658-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of the study are to document the incidence of medical events in survivors of childhood posterior fossa astrocytoma or medulloblastoma in four time periods (diagnosis, perioperative, short-term survival, long-term survival), and to study whether medical events predict neurobehavioral outcome. MATERIALS AND METHODS Twenty-nine astrocytoma and 29 medulloblastoma survivors were studied at least 5 years post-diagnosis. The incidence of medical events in each time period was compared in each group in relation to long-term intelligence, memory, functional independence, and health-related quality of life. As expected, medical and neurobehavioral outcome were poorer in the medulloblastoma group. In the astrocytoma group, poorer long-term neurobehavioral outcome was associated with more adverse medical events in the perioperative and short-term survival periods. CONCLUSIONS Long-term neurobehavioral outcome is related to time-dependent medical events in astrocytoma survivors. The data confirm earlier reports of poorer outcome after medulloblastoma and add new information about clinical markers of poor neurobehavioral outcome in survivors of childhood astrocytoma.
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Affiliation(s)
- Caroline Roncadin
- Peel Children's Centre, 85A Aventura Court, Mississauga, ON, L5T 2Y6, Canada.
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35
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Gonçalves MIR, Radzinsky TC, da Silva NS, Chiari BM, Consonni D. Speech-language and hearing complaints of children and adolescents with brain tumors. Pediatr Blood Cancer 2008; 50:706-8. [PMID: 17534932 DOI: 10.1002/pbc.21209] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Central nervous system (CNS) tumors generally leave sequelae that may compromise speech, language, swallowing, hearing, and voice functions. This report describes the incidence of speech-language and hearing complaints and disorders in children and adolescents with CNS tumor under treatment at one of the most important Brazilian reference center for pediatric cancer. One-hundred ninety patients were examined for speech-pathology screening and analysis: forty-two percent presented with complaints and symptoms. From the remaining patients, 68% presented clinical symptoms and 32% were actually free from any speech-language and hearing-related symptoms. The high incidence of complaints and symptoms indicate that these patients might benefit from specific rehabilitation interventions.
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Pearlman LS, McVittie A, Hunter K. Discharge management of an adolescent female with posterior fossa syndrome: a case report. Can J Neurosci Nurs 2008; 30:14-20. [PMID: 18856094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Posterior Fossa Syndrome (PFS) is a constellation of neurological, behavioural and psychological symptoms occurring in pediatric patients following surgical resection of posterior fossa brain tumours. The clinical presentation of PFS typically includes cerebellar mutism, bulbar dysfunction, ataxia, cranial nerve palsies, flaccid hemiparesis and emotional lability. The intent of this paper is to (a) provide an overview of PFS, (b) explore the case of a 16-year-old adolescent who presented with PFS following surgical resection of a fourth ventricle medulloblastoma, (c) reveal the complexity of her discharge, and (d) describe a discharge management framework used by the authors to guide the discharge process from a general pediatric unit in a tertiary care hospital.
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Gavilán B, Fournier-Del Castillo C, Bernabeu-Verdú J. [Differences between the neuropsychological profiles of Asperger's syndrome and non-verbal learning disorder]. Rev Neurol 2007; 45:713-719. [PMID: 18075984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The validity of the Asperger syndrome (AS) diagnose continues to be debated due to the lack of consensus on its definition, specially regarding higher-functioning autism. Previous research has suggested that the neuropsychological profile of the non verbal learning syndrome (NVLS) might be utilized to sustain a differential diagnose of the AS with other diseases associated with development. AIM To analyze the neuropsychological profile of children diagnosed with AS and compare with those obtained from children with NVLS. SUBJECTS AND METHODS All cognitive domains from 15 children have been evaluated with an extensive variety of tests; 5 were diagnosed with AS and 5 with NVLS, all of them submitted to the Nino Jesus Children's University Hospital. As a control group, another 5 children with no pathology were evaluated. RESULTS Obtained data shows significant differences between the two groups under study. Profile from individuals under AS shows deficit in linguistic as well as non verbal skills and, when compared to the control group, executive functions seem to be generally more altered. CONCLUSIONS Further investigation is suggested to determine that the NVLS could be an explanation model for AS. On the other hand, we stress the need to deepen the study of the executive functions and their relationship with the mind's theory, as an hypothesis to explain the AS.
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Affiliation(s)
- B Gavilán
- Unidad de Daño Cerebral Benito Menni, Hermanas Hospitalarias del Sagrado Corazon de Jesus, Valladolid, Espana.
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Stiefel M, Reiss T, Staege MS, Rengelshausen J, Burhenne J, Wawer A, Foell JL. Successful treatment with voriconazole of Aspergillus brain abscess in a boy with medulloblastoma. Pediatr Blood Cancer 2007; 49:203-7. [PMID: 16333861 DOI: 10.1002/pbc.20628] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Invasive aspergillosis is an increasing problem in immuno-incompetent patients after prolonged steroid therapy, cancer radio-chemotherapy, and bone marrow or solid organ transplantation. Cerebral aspergillosis is a well-described complication of the invasive aspergillosis but only in rare cases, the brain is the sole site of infection. Despite increasing availability of antifungal drugs, the prognosis of cerebral aspergillosis is poor. We report on an 11-year-old boy with medulloblastoma in the area of the fourth ventricle. Following tumor surgery and radio-chemotherapy, several abscess-like structures occurred in the operating field. After incomplete abscess, resection histology and culture confirmed a localized Aspergillus fumigatus infection. The initial treatment of the Aspergillus fumigatus infection with conventional amphotericin B failed, and treatment with the triazole voriconazole was started. Intravenous treatment with voriconazole resulted in a reduction of the Aspergillus fumigatus abscess. After switching to oral ambulatory therapy, the Aspergillus fumigatus abscess increased in size. To improve treatment, voriconazole dosage was adapted to reach drug concentrations in cerebrospinal fluid (CSF) above the minimal fungicidal concentration and plasma specimens. During the concentration-controlled voriconazole therapy for a period of 18 months, a complete response was achieved.
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Affiliation(s)
- M Stiefel
- Department of Pediatric, Hematology-Oncology, Martin-Luther University Halle-Wittenberg, Halle, Germany
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40
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Santi M, Kadom N, Vezina G, Rushing EJ. Undiagnosed medulloblastoma presenting as fatal hemorrhage in a 14-year-old boy: case report and review of the literature. Childs Nerv Syst 2007; 23:799-805. [PMID: 17279429 DOI: 10.1007/s00381-006-0290-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A 14-year-old boy with no significant medical history presented to the emergency room with a sudden onset of severe headache of 1 day's duration. On admission, a non-contrast computed tomography (CT) of the head showed a posterior fossa hemorrhagic mass. MATERIALS AND METHODS He was immediately intubated and underwent placement of an external drainage tube. A magnetic resonance imaging (MRI) was performed, which showed a large hemorrhagic mass with upward cerebellar herniation. RESULTS Despite aggressive measures, he deteriorated and was pronounced brain dead 2 days after admission. Pathological examination of the mass revealed a medulloblastoma with extensive neuronal and astrocytic differentiation. CONCLUSION This case represents one of the few cases of rapid, hemorrhagic expansion associated with a previously undiagnosed medulloblastoma. The topic of hemorrhage due to previously unrecognized brain tumors is discussed and the value of imaging methods used in the diagnostic assessment is emphasized.
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Affiliation(s)
- Mariarita Santi
- Division of Pathology, Children's National Medical Center, Washington, DC, USA
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Huber JF, Bradley K, Spiegler B, Dennis M. Long-term neuromotor speech deficits in survivors of childhood posterior fossa tumors: effects of tumor type, radiation, age at diagnosis, and survival years. J Child Neurol 2007; 22:848-54. [PMID: 17715277 DOI: 10.1177/0883073807303995] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The cerebellum is important for the coordination of fluent speech. The authors studied how childhood cerebellar tumors affect long-term neuromotor speech outcomes, including the relation between outcome and tumor type, radiation, age at diagnosis, and survival years. Videotaped speech samples of child and adult long-term survivors of childhood cerebellar astrocytoma (nonradiated) and medulloblastoma (radiated) tumors and healthy controls were analyzed by 2 speech pathologists for ataxic dysarthria, dysfluency, and speech rate. Ataxia varied with tumor type/radiation. Medulloblastoma survivors had significantly more ataxic dysarthric features than either survivors of astrocytomas or controls, who did not differ from each other. Dysfluency varied with a history of a posterior fossa tumor. Medulloblastoma and astrocytoma survivors were each significantly more dysfluent than controls but did not differ from each other. Speech rate varied with age and tumor type. Adult controls were significantly faster than child controls, although adult tumor survivors were comparable to their child counterparts. Adult controls had significantly faster speech rates than adult survivors of medulloblastoma tumors. Ataxic dysarthric speech characteristics are more frequent in radiated survivors of medulloblastoma tumors than nonradiated survivors of astrocytoma tumors. Dysfluent and slow speech occur in cerebellar tumor survivors, regardless of tumor type and radiation history. Cerebellar tumors in childhood limit speech rate in adulthood.
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Affiliation(s)
- Joelene F Huber
- Department of Pediatrics, University of Toronto, Ontario, Canada
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Ruggiero A, Buonuomo PS, Maurizi P, Cefalo MG, Cefalo MP, Corsello M, Riccardi R. Stevens-Johnson syndrome in children receiving phenobarbital therapy and cranial radiotherapy. J Neurooncol 2007; 85:213-5. [PMID: 17589805 DOI: 10.1007/s11060-007-9399-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to medication. In this report, we present two children with brain tumour who developed SJS while receiving cranial irradiation and anticonvulsant therapy with phenobarbital. Concomitant application of these two therapies may play an important role in the occurrence of the disease.
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Affiliation(s)
- Antonio Ruggiero
- Department of Paediatrics, Pediatric Oncology, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
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Silvani A. [Experience with the intrathecal use of liposomal cytarabine at the Besta Institute]. Tumori 2007; 93:suppl 6-8. [PMID: 17679480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Banka S, Walsh R, Brundler MA. First report of occurrence of choroid plexus papilloma and medulloblastoma in the same patient. Childs Nerv Syst 2007; 23:587-9. [PMID: 17106748 DOI: 10.1007/s00381-006-0249-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2006] [Revised: 07/07/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Choroid plexus papilloma is a benign epithelial brain tumour showing a striking predilection for infants and occurring most frequently in the lateral and fourth ventricles. Medulloblastoma, on the other hand, is a primitive neuroectodermal tumour and is the most frequent malignant brain tumour of the posterior fossa in children. In this study, we report a metachronous occurrence of choroid plexus papilloma and medulloblastoma in the same patient, which has not been reported before to the best of our knowledge. CASE REPORT The authors describe the case of a girl who presented with an atypical choroid plexus papilloma on the posterior wall of the left lateral ventricle at 3 months of age that was resected completely. She was followed up regularly after surgery and made good progress with normal development. At 8 years of age, she presented with right cerebellar medulloblastoma. DISCUSSION The authors review literature for incidence and aetiology of the two tumours.
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Affiliation(s)
- Siddharth Banka
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Abstract
MATERIALS AND METHODS A 7-year-old boy diagnosed with Duchenne muscular dystrophy (DMD) presented with clinical features of raised intracranial tension. A CT scan revealed an enhancing vermian mass extending on to the fourth ventricle, which was excised and reported to be medulloblastoma. The patient was treated with craniospinal radiotherapy but progressed after 6 months. DISCUSSION Neoplasms associated with DMD are rare and the present case may well be the first one with medulloblastoma. Interestingly, all neoplasms associated with DMD reported so far have been round cell tumors, which may lead to insights into their possible molecular associations.
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Affiliation(s)
- Harsha Doddihal
- Department of Radiation Oncology, 116 Tata Memorial Hospital, Parel, Mumbai, 400 012, India
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Anoop P, Vaidya SJ, Zacharoulis S, Hargrave D. On-treatment relapse of medulloblastoma as prolonged pyrexia of unknown origin. J Pediatr Hematol Oncol 2007; 29:347-8. [PMID: 17483718 DOI: 10.1097/mph.0b013e3180547588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Due-Tønnessen BJ, Helseth E. Management of hydrocephalus in children with posterior fossa tumors: role of tumor surgery. Pediatr Neurosurg 2007; 43:92-6. [PMID: 17337918 DOI: 10.1159/000098379] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 07/19/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The majority of children with posterior fossa tumors have hydrocephalus (HC) at the time of presentation. There is no consensus regarding the management of HC in these children. Here, we report the rate of cure of HC with tumor surgery alone. PATIENTS AND METHODS This is a retrospective study of 87 children with posterior fossa tumors in which 35 patients had medulloblastoma, 38 had astrocytoma and 14 had ependymoma. The mean age at presentation was 7.3 years (range: 0.2-19.7 years). All patients underwent tumor resection and were followed with close clinical and image surveillance to detect persistent HC. HC was treated with endoscopic third ventriculostomy (ETV) or shunt. We have focused on patients who needed permanent cerebrospinal fluid diversion (ETV or shunt) within 30 days of tumor resection. HC presenting after this time period is, in the majority of cases, due to tumor recurrence or progression. In this series, 24/87 (28%) patients had a suboccipital craniectomy and 63/87 (72%) had a craniotomy. RESULTS At the time of presentation, 69/87 (79%) patients had symptomatic HC. In 41/69 (59%) patients presenting with HC, the HC was cured by tumor resection alone. The HC cure rate for patients with astrocytoma was 83%, whereas it was 47% for patients with medulloblastoma and 54% for patients with ependymoma. The cure rate was equal in the craniectomy and craniotomy groups. CONCLUSIONS An 87% cure rate of HC by tumor resection alone in children with posterior fossa astrocytoma warrants no change in treatment strategy. However, the low cure rate of HC by tumor resection alone in patients with medulloblastoma and ependymoma raises the issue of whether these patients would benefit from preresection ETV.
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Cannas A, Solla P, Mascia MM, Floris GL, Tacconi P, Uselli S, Ambu R, Marrosu MG. Medulloblastoma induces unusual headache with clinical picture of basilar-type migraine complicated by ischaemic infarcts. Cephalalgia 2006; 26:1238-41. [PMID: 16961793 DOI: 10.1111/j.1468-2982.2006.01176.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Cannas
- Dipartimento di Scienze Cardiovascolari e Neurologiche, Sez. Neurologia, University of Cagliari, Cagliari, Italy
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Abstract
We report a case of bloodstream infection caused by Candida thermophila, a yeast not previously associated with human disease. The infection occurred in a 13-year-old boy with medulloblastoma who presented with 1 day of fever. Multiple blood cultures were positive for yeast. Removal of the catheter resulted in prompt resolution of the fever and sterilization of the blood cultures. The species was identified by sequencing domains 1 and 2 of the large subunit rRNA gene. Antifungal susceptibility testing was also performed.
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Affiliation(s)
- Maskit Bar-Meir
- Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, 2300 Children's Plaza, Box 53, Chicago, IL 60614, USA
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