Duration of symptoms in brain tumors: influencing factors and its value in predicting malignant tumors

BACKGROUND

Although brain tumor is a common neurosurgical condition, diagnosis is generally made after long duration of symptoms. This may have negative impact on treatment outcome.

OBJECTIVE

Study the duration of symptoms of brain tumor, how it is influenced by various factors, and find their value in predicting malignant tumors.

MATERIAL AND METHOD

The authors retrospectively reviewed 185 patients with pathologically proven brain tumors. Pertinent data including age, types of tumors, locations of tumors, symptoms, and duration of symptoms were analyzed by univariate and multivariate analysis.

RESULTS

There were 70 males and 115 females. The mean age at diagnosis was 47.3 years. The average duration of symptoms was 471 days with median of 120 days. On univariate analysis, hormone symptoms (p = 0.001), age more than 45 years old (p = 0.005), malignant tumor (p < 0.001), auditory symptoms (p = 0.004), and motor symptoms (p < 0.001) had significant influence on duration of symptom. In multivariate analyses, malignant types of tumor, age, and hormonal symptoms were significant. In addition, there was higher risk of malignant brain tumor in patients with duration of symptoms 1 month or less (p < 0.001).

CONCLUSION

Certain factors were associated with longer duration of symptoms in brain tumors. This information may lead to early diagnosis of brain tumors. Furthermore, duration ofsymptoms of 1 month or less was suggestive of malignant brain tumors.

The outcome of surgical treatment for tumors of the craniocervical junction

OBJECTIVE

The authors report the clinical, radiological, and surgicalfindings ofpatients with craniocervical junction tumors surgically treated in the institution over the last 8 years.

MATERIAL AND METHOD

A retrospective study was performed. Clinical, radiological, and operative data were evaluated, and follow-up information was obtained from outpatient examinations, and telephone interviews.

RESULTS

There were 25 patients consisting of nine chordomas, eight meningiomas, three cysts, two schwannomas, one each of aneurysmal bone cyst, plasmacytoma, and metastasis. Twenty-nine operative procedures were performed, classified as 12 anterior nine posterior-lateral, and eight posterior approaches. Gross total removal was achieved in 17 cases, subtotal removal in six cases, and partial removal in two cases. Re-operation was performed in six cases. Median follow-up time was 31 months. The authors found significant improvement in Karnofsky Performance Scale scores.

CONCLUSION

Appropriate surgical approaches provide successful tumor removal with less surgical morbidities, nevertheless recurrent tumors occasionally occur and so, long-term follow-up is mandatory.

Successful resection of Hypothalamic Hamartoma with intractable gelastic seizures--by transcallosal subchoroidal approach

A 19-year old female with intractable gelastic seizures was found to have 0.7 x 1.8 x 1.8 cm elliptical mass on the floor of the third ventricle. The signal intensity on the Magnetic Resonance Imaging (MRI) was consistent with the Hypothalamic Hamartoma (HH). Ictal EEG demonstrated rhythmic 7 Hz waves over Fp2, F4, and C4 with spreading to the right temporal region and then bilaterally. Ictal Single Photon Emission Computerized Tomography (SPECT) showed hyperperfusion at hypothalamic and medial frontopolar regions. The patient underwent surgical resection using Trans Callosal Subchoroidal Approach (TCSA) to the third ventricle. Pathological finding confirmed the diagnosis of hypothalamic hamartoma. Following the operation, she has been seizure free up to 12 months. Thereafter, provoked seizures seldom occurred and there has been improvement in her memory, emotional control and independence. This appears to be the first report of this surgical approach for HH, which is less likely to disturb memory function compared to previously described interfoniceal approach.

Three-dimensional frameless stereotactic-guided pedicle screw fixation of the spine: early experiences in King Chulalongkorn Memorial Hospital

OBJECTIVES

To study the accuracy and safety of pedicle screw insertion by three-dimensional frameless stereo-tactic-guided technique.

MATERIAL AND METHOD

Twelve patients underwent spinal surgery using three- dimensional frameless stereo-tactic-guided technique at King Chulalongkorn Memorial Hospital (KCMH) during June - December 2004. In all patients, post-operative CT scan of the operated spinal segments were obtained and evaluated for the position of each screw placed. Medical records were reviewed and all patients were interviewed by telephone to assess clinical outcomes and complications

RESULTS

5I pedicle screws were inserted in 12 patients. Postoperative CT scan of the instrumented spine revealed that 50 screws were considered grade I screw while one screw was considered grade II. No patient suffered direct vascular or neurological injury.

CONCLUSION

Three-dimensional frameless stereotactic-guided technique provides additional safety to spinal instrumentation

Currarino syndrome: report of two cases and review of the literature

In the present paper the authors examine two cases of Currarino syndrome and review the existing literature on the disease. Both cases presented with chronic constipation. The first concerns a two year old male born with anorectal stenosis and diagnosed with Currarino syndrome when scimitar sacrum and anterior meningocele were finally detected. The second concerns a 25 year old female who suffered from chronic constipation but was not diagnosed until thorough examination revealed ectopic anus with Hirschsprung disease, scimitar sacrum and anterior meningocele. Because these patients were not diagnosed with Currarino syndrome when first seen, the authors reviewed its prevalence, embryogenesis, clinical manifestations, diagnosis and treatment. The authors' research supports the significance of prompt diagnosis in effective treatment and reduction of morbidity.

Primary intracranial peripheral primitive neuroectodermal tumor/Ewing's sarcoma presenting with acute intracerebral hemorrhage

OBJECTIVE

To report two cases of intracerebral hemorrhage due to primary intracranial peripheral primitive neuroectodermal tumor (pPNET)/Ewing's sarcoma (ES) and review of related literatures.

MATERIAL

Two cases of 17-year-old patients presented with acute increased intracranial pressure one of which also had left hemiparesis.

METHOD

On neuroimaging studies, the first patient had an intraparenchymal hematoma with a size of 4 cm at the right fronto-parietal junction adjacent to tumor infiltrating the superior sagittal sinus. The second patient had a large left temporal tumor with intraventricular hemorrhage. Both patients underwent craniotomy with complete removal of tumor and hematoma.

RESULTS

Pathological examination in both cases revealed numerous small round tumor cells with stippled chromatin pattern and scanty cytoplasm. Tumor cells strongly expressed CD99. Vimentin immunoreactivity was observed. The final diagnosis of pPNET/ES was rendered. There was no evidence of extracranial disease in both cases. Both patients were doing well without evidence of recurrent disease at 12 and 24-month follow-up respectively.

CONCLUSIONS

Peripheral primitive neuroectodermal tumor (pPNET)/Ewing's sarcoma (ES) is a malignant small round cell tumor, commonly arising in soft tissue of the trunk and lower extremity. Those occurring in the intracranium are rare, and most patients present with progressively increased intracranial pressure and/or cranial nerve deficit. The occurrence of intracerebral hemorrhage due to primary intracranial pPNET/ES is exceedingly rare. The role of adjuvant therapy in this condition is yet to be investigated.

Supratentorial lobar anaplastic ependymoma resembling cerebral metastasis: a case report

A 45-year-old man presented with progressive deterioration of vision. Visual acuity test revealed no light perception in both eyes. The fundoscopic examination demonstrated pale optic discs, consistent with secondary optic atrophy. Preoperative neuroimaging studies revealed a well-defined contrast-enhancing mass, 3 cm in diameter, at the left parietal region. Its radiologic appearances simulated those of cerebral metastases. A totally removed lesion was verified pathologically as an anaplastic clear cell ependymoma, which is rare in this location. A brief review of clinical features and neuroimaging of supratentorial lobar ependymoma is also included.

Anesthetic management of cerebral aneurysm clipping using the deep hypothermic circulatory arrest technique: a case report

Deep hypothermic circulatory arrest may prove advantageous during surgery of some technically difficult brain lesions. This technique was first applied in one patient with a large intracavernous aneurysm which had failed standard neurosurgical techniques. For this technique to be successful the cooperation of neurosurgeons, cardiovascular surgeons, anesthesiologists, perfusionists and nurses is essential. Techniques aimed at improving the outcome include a short period of circulatory arrest, the depth of hypothermia, barbiturate administration, coagulation management and well-controlled blood glucose levels. The total time of circulatory arrest and the thiopentone dosage were 61 minutes and 1,700 mg respectively. The lowest core temperature was 13.9 degrees C. The positive outcome supports the use of this technique in selected patients with complex intracranial vascular lesions who may not be operable by standard techniques.

Successful surgical removal of intrinsic medullar vascular malformation: a case presentation

A 22-year-old man with an intrinsic arteriovenous malformation (AVM) of the medulla, who presented with recurrent subarachnoid hemorrhage and bulbar palsy was described. The successful total surgical removal of this AVM was demonstrated. The clinical, roentgenographic, pathological features and surgical approach of the brainstem vascular malformation were summarized.

Intracranial primitive neuroectodermal tumors: experience of 7 cases with particular reference to survival

A group of neoplasms consisting of undifferentiated neuroepithelial cells being capable of differentiating into either neuronal or glial line or both directions has been termed "Primitive Neuroectodermal Tumors (PNETs)". They have been shown to possess several similarities in clinical, radiological, and pathological features to the cerebellar medulloblastomas. The latter are well treated by surgical removal followed by radiotherapy. Therefore, we used the same regimen in treating 7 patients with intracranial PNETs and obtained an average survival of 28.7 months which is longer than those of previous reports. The analysis of our patients disclosed an optimistic view that the ideal prognosis of PNETs should be better than this.

Posttraumatic arachnoid cyst at the cranial base with unusual manifestations

A posttraumatic epidural arachnoid cyst embedded within the left petrous bone of a 25-year-old woman is reported. The lesion produced clinical manifestations of cerebrospinal fluid rhinorrhea, recurrent meningitides, and neuropathy affecting all divisions of the fifth cranial nerve as well as the eighth cranial nerve on the left side. The location of posttraumatic arachnoid cyst is rare at the cranial base, and the described clinical manifestations are unique.