Cases reported "Astrocytoma"

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1/12. Neuroendoscopic biopsy of tectal glioma: a case report.

    OBJECTIVE AND IMPORTANCE: A type of intrinsic dorsal midbrain glioma known as benign tectal glioma can cause obstructive hydrocephalus. Because of its slow progress and relatively good prognosis, initial treatment should be cerebrospinal fluid diversion and biopsy. CLINICAL PRESENTATION: We report a 24-year-old man with obstructive hydrocephalus from a tectal glioma, who was admitted to the hospital for malfunction of a shunt placed 16 years previously. INTERVENTION: magnetic resonance imaging demonstrated enlargement of the dorsal midbrain associated with increased signal intensity on T2-weighted images and fluid attenuation inversion recovery (FLAIR) images. No enhancement occurred with contrast administration. We performed a neuroendoscopic third ventriculostomy and biopsy of the tumor. Histologic examination of the specimen obtained disclosed a low-grade astrocytoma. No postoperative neurologic complications occurred. CONCLUSION: FLAIR images were superior to T2-weighted images in demonstrating abnormal intensity in the dorsal midbrain. neuroendoscopy confirmed a yellowish tumor inferior to the posterior commissure occluding the entrance of the aqueduct, an observation useful in planning biopsy of the lesion. As the tumor apparently had existed for a number of years, the case supports the notion that the prognosis associated with these tumors is good.
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2/12. Application of endoscopy for a midbrain tumor.

    OBJECTIVE AND IMPORTANCE: It has been difficult to obtain a biopsy of a midbrain lesion. In addition, proper cerebrospinal fluid diversion should be secured because progressing tumor in the midbrain causes obstructive hydrocephalus. We report on the superiority of flexible neuroendoscopy to treat progressing midbrain tumor. CLINICAL PRESENTATION: A 64-year-old man presented with an occasional double vision. A magnetic resonance imaging scan disclosed an enhancing lesion in the midbrain. INTERVENTION: We performed a neuroendoscopic biopsy of the tumor and third ventriculostomy. neuroendoscopy confirmed a bulging of the posterior commissure, which caused stenosis of the entrance of the aqueduct. Histological examination of the specimen obtained disclosed a diffuse astrocytoma. No permanent postoperative complications occurred although the patient felt slight double vision for 2 days after the operation. Conventional radiation therapy was supplemented. CONCLUSION: Flexible neuroendoscopic biopsy with third ventriculostomy was a less-invasive and safer alternative for the progressing midbrain tumor bulging into the ventricles.
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3/12. One stage removal of periaqueductal glioma in adult via infratentorial supracerebellar and transaqueductal approaches.

    Most cases of periaqueductal tumours were found in children and adolescents, so treatment modalities in adults are not evaluated yet. A case of 40 years old woman with tectal and periaqueductal protoplasmatic astrocytoma grade II with history of headache and episodes of syncope is described. MRI showed triventricular hydrocephalus. After a shunt procedure she was doing well for about 15 months. Then she became somnolent, disoriented, and Parinaud syndrome appeared. The solid tumour was resected microsurgically in one stage. A part of it was removed via the supracerebellar infratentorial approach and tectal plate incision. The remainder of the tumour was removed through the fourth ventricle and the aqueduct which was filled by tumour mass. Postoperatively bilateral ptosis, vertical gaze palsy, slight horizontal gaze limitation and pupilloplegia were the main neurological sequelae. They all almost completely resolved within a year. The patient is doing well two and half years after the surgery. MRI showed patency of the aqueduct and no residual tumour. The authors suggest, that direct surgical attempt at total tumour removal should be considered in cases of periaqueductal and tectal gliomas. They also believe it is the first described case, in whom this type of tumour was totally removed by a combined transtectal and transaqueductal route.
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4/12. Late closure of the stoma by spreading of a periaqueductal glioma: an unusual failure of endoscopic third ventriculostomy. Case report.

    The late failure of endoscopic third ventriculostomies (ETVs) has been described as a consequence of scarring phenomena involving the third ventricular floor. Although the possibility of closure of the stoma by intraventricular tumor seeding has been hypothesized, no case of ETV failure caused by tumor diffusion has been reported in the literature. The authors report on a 19-year-old patient, affected by obstructive hydrocephalus associated with a periaqueductal pilocytic astrocytoma, who underwent late secondary lesional obstruction of an ETV performed at diagnosis. The authors suggest tumor extension along the diencephalic neural pathways as the possible cause of ETV failure in this patient.
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5/12. Aqueductal (pencil) glioma presenting as neurogenic pulmonary edema: a case report.

    A case of neurogenic pulmonary edema due to hydrocephalus, without initial neurological deficit, is described. Computed tomography demonstrated a ring enhancing lesion in the tectum of the mesencephalon obstructing the aqueduct of Sylvius. The lesion, on autopsy, was a rare mesencephalic glioma described in the literature as a "pencil glioma" of the aqueduct.
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keywords = aqueduct
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6/12. Ptosis and supranuclear downgaze paralysis.

    A patient developed the unusual combination of a supranuclear downward gaze paralysis and bilateral ptosis. It was caused by a single midbrain glioma. Other ocular motor functions were intact. The neuropathologic examination showed a tumor growing mainly around the third ventricle and the aqueduct. The findings agree with recent experimental evidence that a network of neural elements involved in eyelid control lies in the supraoculomotor area immediately dorsal to the oculomotor nucleus.
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7/12. Neurofibromatosis presenting with aqueductal stenosis due to a tumor of the aqueduct: case report.

    A 17-year-old boy with neurofibromatosis presented with delayed puberty and epileptic seizures of recent onset. A computed tomographic scan revealed aqueductal stenosis due to a tumor of the aqueduct. This tumor was found at autopsy to be a pilocytic astrocytoma. Aqueductal stenosis in neurofibromatosis is uncommon and has been considered to be a result of periaqueductal gliosis. This seems to be the first report of neurofibromatosis associated with a tumor of the aqueduct.
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ranking = 12
keywords = aqueduct
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8/12. Periaqueductal tumor as a cause of late-onset aqueductal stenosis.

    Localized periaqueductal tumors usually present as hydrocephalus, which is then thought to be late-onset congenital aqueductal narrowing. In the past, radiological investigations, including positive contrast ventriculography, pneumoencephalography and even contrast CT scanning, have frequently failed to show tumors in this region in the early stages. However, recent experience using MRI on patients with unexplained late-onset aqueductal stenosis has in some instances shown the presence of a localized periaqueductal tumor as the cause of obstruction of the aqueduct. Four patients are described with hydrocephalus secondary to presumed late-onset congenital aqueductal stenosis, all of whom were shown to have a periaqueductal tumor. One patient had been investigated with a pneumoencephalogram and positive contrast ventriculogram and CT with an early-generation scanner, but the tumor was diagnosed only at the time of autopsy. In one patient, the tumor was diagnosed by CT and also confirmed with MRI; a histologic diagnosis has been obtained. In two other patients, CT with and without contrast enhancement was negative and in one of these, a positive contrast ventriculogram was also negative, but the tumor was easily identified on MRI scans. In both of these patients, a histologic diagnosis was obtained by stereotactic biopsy. Periaqueductal tumors must be considered in the differential diagnosis of patients who present with late onset aqueductal occlusion and in such patients, MRI would appear to be the investigation of choice.
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ranking = 17
keywords = aqueduct
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9/12. astrocytoma of the cerebral aqueduct.

    The authors report the case of a 9-year-old girl with a low-grade astrocytoma of the mesencephalon that occluded the sylvian aqueduct. Symptoms, signs, and neuroradiological investigations led to the clinical impression of aqueductal stenosis. The presence of a tumor was diagnosed by cerebrospinal fluid cytology and confirmed at postmortem examination. This is the first reported instance of this tumor being diagnosed by cerebrospinal fluid cytology and the third report of a diagnosis in a living patient. The authors stress the value of CSF cytology in evaluating a typical case of hydrocephalus.
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ranking = 6
keywords = aqueduct
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10/12. Polar spongioblastoma of the cervical spinal cord: case report.

    Polar spongioblastomas are rare, histologically distinctive glial neoplasms that have been reported to involve the brain stem, third ventricle, aqueduct, and fourth ventricle. In this case report we describe a polar spongioblastoma of the cervical spinal cord in a patient who has survived 2 1/2 years without evidence of recurrent neoplasm.
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