1/136. Non-surgical treatment of meningioma: a case report and review.A woman initially presented with a right hemiparesis and subsequently underwent subtotal resection of a left parietal meningioma arising from the lateral wall of the sagittal sinus. She again presented 18 months after surgery with a hemiparesis and repeat MRI showed tumour spreading into the sagittal and the transverse sinuses. She had a therapeutic abortion at 8 weeks gestation 3 weeks prior to her representation. gestrinone, a synthetic steroid and an antiprogesterone was commenced. Two months later she stopped her medication and is asymptomatic at 16 months. A follow-up MRI revealed that the tumour had shrunk dramatically. This case is the first of its kind with tumour size reduction to less than 20%. We feel that the future of meningioma treatment will be multi-disciplinary and non-surgical options should be considered.- - - - - - - - - - ranking = 1keywords = hemiparesis, paresis (Clic here for more details about this article) |
2/136. Multiple spinal meningiomas--a case report.Multiple spinal meningiomas are relatively rare and account for only 2 to 3.5% of all spinal meningiomas. A case of multiple meningiomas of the thoracic (T) spine was reported. This 77-year-old woman was admitted with progressive motor weakness and sensation disturbance in both legs for 4 months. Neurological findings on admission revealed paraparesis, hyperesthesia, and hypalgesia below the dermatome of T10 level and hyporeflexia of both ankles. Urinary and stool incontinence were also noted. magnetic resonance imaging (MRI) documented two intradural extramedullary lesions with different intensity at the T9 and T12 levels. Both tumors were totally resected. Histopathologic examination showed all psammomatous meningiomas with more or less psammoma bodies. There were no any manifestations of von Recklinghausen's disease in this patient. MRI is a choice of diagnostic tool to detect spinal tumors, especially multiple spinal meningiomas. Different intensities in MRI may infer different components of meningiomas. Follow-up study after operation three months later disclosed she could walk very well.- - - - - - - - - - ranking = 0.23466874163163keywords = paresis (Clic here for more details about this article) |
3/136. meningioma with sarcomatous change and hepatic metastasis.A 72-year-old patient had a meningotheliomatous meningioma that invaded through the skull and into temporalis muscle. One year following craniotomy for removal of the neoplasm, he developed headaches, diplopia, and proptosis of the left eye. biopsy of the orbital contents revealed a malignant supporting tissue neoplasm having a resemblance to the previous meningioma. No curative therapy was possible and the patient died 33 months after diagnosis. autopsy examination showed extensive residual intracranial neoplasm and a 3-cm metastasis in the liver. The metastatic tumor appeared similar to the meningioma and did not appear malignant histologically. The case illustrates the distinct histologic variations in meningiomas and the difficulties in predicting their biologic activity. Aggressive local behavior may indicate possible malignant areas in the neoplasm. Therefore, examination of the neoplasm should be thorough. Such a correlation may suggest malignant biologic potential.- - - - - - - - - - ranking = 0.0041121051371703keywords = muscle (Clic here for more details about this article) |
4/136. Reverse U-shaped split temporalis musculofascial flap in cranial base reconstruction.To extend the versatility and range of the temporalis muscle, a new type of temporalis musculofascial flap was developed. This was achieved by dividing the muscle into two portions--anterior and posterior-while maintaining vascular communication between the deep and the middle temporal arteries. This flap is reverse U-shaped with one of the arms of the "U" corresponding to a pedicle, which supplies the blood, and the other corresponding to the recipient region. The bottom of the U corresponds to continuity between the anterior and posterior portions of the muscle, which contains the vascular communication. In two patients with meningioma, the flap was applied to occupy the extradural dead space combined with a pericranial flap to prevent leakage of cerebral spinal fluid to the dural defect. The reverse U-shaped split temporalis musculofascial flap has some advantages for intracranial reconstruction: sufficient rotational arc, adequate thickness, and rich vascularity. A reverse U-shaped split temporalis musculofascial flap is useful and of benefit, especially for reconstruction at the region of the anterior midline skull base.- - - - - - - - - - ranking = 0.012336315411511keywords = muscle (Clic here for more details about this article) |
5/136. Far lateral approach with intraoperative ultrasound Doppler identification of the vertebral artery.A 69-year-old woman presented with right hemiparesis and magnetic resonance imaging revealed a meningioma at the ventral aspect of the foramen magnum. We used a retromastoid curvilinear incision down the lateral aspect of the neck to expose the semispinalis and other muscles. Guided by ultrasound to avoid damage to the vertebral artery beneath the semispinalis, we incised the semispinalis muscle in a U-shape that hinged at the retromastoid curvilinear incision with its one limb along the border of the foramen magnum and the other limb along the posterior arch of the atlas. The other muscles were divided in line with the curvilinear incision and retracted posteriorly with the bulk of semispinalis to expose the bones, not disturbing the U-shaped piece of semispinalis that covered the vertebral artery. Similarly guided by ultrasound, we performed far lateral suboccipital craniectomy and laminectomy, exposed the dura above and below the dural entry of the vertebral artery, opened the dura cephalad and caudal to the dural entry of the vertebral artery, and excised the tumor. This method provided adequate exposure to the lateral aspect of the cranio-vertebral junction and minimized the risks of dissecting the whole extradural segment of vertebral artery. It requires more cases to determine whether the results of this patient can be generalized.- - - - - - - - - - ranking = 0.51233631541151keywords = hemiparesis, paresis, muscle (Clic here for more details about this article) |
6/136. Extradural meningioma in the left fronto-temporo-parietal region.A case of a 47-year-old male patient who presented with a history of complaints of headache, vertigo and an expanding painful swelling on the left side of the head over the last year is reported. The lump was 15 x 15 cm and protruded 1-3 centimeters. Neurological examination revealed the presence of a mild right hemiparesis with right central facial palsy. Plain skull x-ray film demonstrates a heterogeneous bone thickening in the left fronto-temporo-parietal region with a small osteolytic focus and spotted shadows. Computed tomography scan of the skull showed that a major part of the squamas of the frontal and temporal bones were transformed into spiculoform structures turned outwards and inwards. Thus the bone appeared thickened overall. There were no alterations in the cerebral structures. The tumour was completely removed. It was located extradurally and through the bones extended to the soft tissues under the skin. The histological findings showed a meningioma with hemorrhages and necroses and the presence of lipids containing xanthochromic cells. After a surgical extirpation of the tumour a reduction of the neurological symptomatology and subjective complaints was observed.- - - - - - - - - - ranking = 0.5keywords = hemiparesis, paresis (Clic here for more details about this article) |
7/136. Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome.OBJECT: The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA). methods: The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa. Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III). and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients. CONCLUSIONS: The approach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.- - - - - - - - - - ranking = 0.23466874163163keywords = paresis (Clic here for more details about this article) |
8/136. Multiple meningiomas in different neuraxial compartments. Report of two cases.Multiple meningiomas in different neuraxial compartments are quite rare. The authors report two new cases of association between cranial and spinal meningiomas, one of them in a patient operated upon for multiple intracranial meningiomas. The first case was a 60-year-old woman with progressive paraparesis who had been operated on 13 years earlier for multiple intracranial meningiomas. A myelo-CT scan showed a block of contrast medium at T1-T2; the lesion was removed via a standard laminectomy. The second patient was a 76-year-old woman with a 6-month history of spastic paraparesis. MRI detected an extramedullary intradural lesion at T6-T7. A cerebral MRI, performed because of the onset of seizures, showed a right parietal lesion. Removal of the thoracic lesion was followed, 6 months later, by removal of the cerebral one. Both patients presented a progressive improvement of the paraparesis and returned to normal daily activities.- - - - - - - - - - ranking = 0.7040062248949keywords = paresis (Clic here for more details about this article) |
9/136. Ectopic epidural calvarial meningioma.A rare case of ectopic epidural calvarial fibroblastic meningioma is reported in a 31-year-old male. Arising from the inner table of the skull, it produced an intracranial mass which resulted in hemiparesis and Jacksonian epilepsy.- - - - - - - - - - ranking = 0.5keywords = hemiparesis, paresis (Clic here for more details about this article) |
10/136. Primary extracranial meningioma of the foot: a case report.We present a rare case of primary extracranial meningioma in a 36-year-old man, who had a solitary multinodular mass located in the plantar muscle of the foot. The histology of specimens from simple excision was typical of meningioma, showing bland spindle cell proliferation with a whorl pattern. Immunohistochemical analysis demonstrated that the tumor cells showed diffuse and strong positivity for epithelial membrane antigen as well as moderate reactivity for cytokeratin and vimentin. Ultrastructurally, the tumor cells were characterized by thin bipolar cytoplasmic processes and joined by multiple small desmosomes. There were frequent pinocytotic vesicles and a distinct external lamina on the cell surface. These findings suggest that this primary ectopic meningioma, arising in the soft tissue, may have been derived from perineurial cells of the peripheral nerve, but was morphologically distinguishable from perineurioma. Primary extracranial meningioma should be included in the differential diagnosis of soft-tissue spindle cell tumors, especially those of peripheral nerve origin.- - - - - - - - - - ranking = 0.0041121051371703keywords = muscle (Clic here for more details about this article) |
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