Cases reported "Astrocytoma"

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1/121. Spontaneous remission of chiasmatic/hypothalamic masses in neurofibromatosis type 1: report of two cases.

    We report two children with neurofibromatosis type 1 showing enhancing masses on MRI suggesting neoplasms in the chiasm and hypothalamic region. In both patients no visual or endocrinal dysfunction was present. On serial MRI spontaneous partial remission was found, implying that a cautious approach to therapeutic management of similar cases should be taken.
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2/121. Symptomatic vasospasm after resection of a suprasellar pilocytic astrocytoma: case report and possible pathogenesis.

    BACKGROUND: Cerebral vasospasm from pathology other than subarachnoid hemorrhage is uncommon. A case of severe vasospasm after resection of a suprasellar pilocytic astrocytoma is reported. methods: A 45-year-old male presented with headache, left facial numbness, bilateral visual loss, and ataxia. Evaluation revealed a large suprasellar tumor, which was resected. Pathologic examination showed pilocytic astrocytoma. The patient developed hemiparesis and aphasia on the fifth postoperative day. Vascular spasm was documented on angiography and by transcranial Doppler. RESULTS: Intraarterial papaverine resulted in moderate angiographic improvement. Attempts to open middle cerebral artery branches with angioplasty were unsuccessful. The patient subsequently developed a left middle cerebral artery infarct. CONCLUSIONS: To our knowledge, this is the first description of vasospasm after resection of an astrocytoma. Possible mechanisms contributing to this unusual complication after resection of tumors are discussed.
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3/121. Squash cytology of pleomorphic xanthoastrocytoma mimicking glioblastoma. A case report.

    BACKGROUND: Pleomorphic xanthoastrocytoma (PXA) is an uncommon, superficially located and well-circumscribed brain tumor that originates in astrocytic cells. Despite the fact that the tumor cells are pleomorphic, with bizarre nuclei, the clinical course is favorable. Cytologic and histologic differentiation from other high grade gliomas is necessary to determine adequate therapy during surgery. Cytomorphologic features of this tumor have been described only rarely. CASE: A 22-year-old male had complained of visual disturbance for about a year. Radiologic imaging revealed a well-circumscribed mass with cyst formation in the left temporal area. Squash specimens from fresh tissues were highly cellular. Tumor cells were markedly pleomorphic, with long and coarse cytoplasmic processes showing a fibrillary astrocytic appearance. Pleomorphic cells varied in shape from round to elongated and had large, multilobed, hyperchromatic nuclei but few nuclear mitoses. Sometimes eosinophilic granular bodies were also observed. blood vessels were found frequently in tumor cell clusters, but their endothelium was not swollen. In the background, considerable leukocytic infiltration, but no cellular debris, was observed. With immunohistochemical studies, most of the tumor cells were positive for glial fibrillary acidic protein and S-100 protein. Some of the mononuclear giant cells were positive for synaptophysin. CONCLUSION: Squash preparations showed the peculiar cytologic features of PXA. Together with the peculiar radiologic findings, the cytologic results make it possible to render a diagnosis of PXA.
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4/121. Intraoperative validation of functional magnetic resonance imaging and cortical reorganization patterns in patients with brain tumors involving the primary motor cortex.

    OBJECT: The purpose of the present study was to compare the results of functional magnetic resonance (fMR) imaging with those of intraoperative cortical stimulation in patients who harbored tumors close to or involving the primary motor area and to assess the usefulness of fMR imaging in the objective evaluation of motor function as part of the surgical strategy in the treatment of these patients. methods: A total of 11 consecutive patients, whose tumors were close to or involving the central region, underwent presurgical blood oxygen level-dependent fMR imaging while performing a motor paradigm that required them to clench and spread their hands contra- and ipsilateral to the tumor. Statistical cross-correlation functional maps covering the primary and secondary motor cortical areas were generated and overlaid onto high-resolution anatomical MR images. Intraoperative electrical cortical stimulation was performed to validate the presurgical fMR imaging findings. In nine (82%) of 11 patients, the anatomical fMR imaging localization of motor areas could be verified by intraoperative electrical cortical stimulation. In seven patients two or more activation sites were demonstrated on fMR imaging, which were considered a consequence of reorganization phenomena of the motor cortex: contralateral primary motor area (nine patients), contralateral premotor area (four patients), ipsilateral primary motor area (two patients), and ipsilateral premotor area (four patients). CONCLUSIONS: Functional MR imaging can be used to perform objective evaluation of motor function and surgical planning in patients who harbor lesions near or involving the primary motor cortex. Correlation between fMR imaging findings and the results of direct electrical brain stimulation is high, although not 100%. Based on their study, the authors believe that cortical reorganization patterns of motor areas might explain the differences in motor function and the diversity of postoperative motor function among patients with central tumors.
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keywords = cortex
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5/121. Intra-operative optical method using intrinsic signals for localization of sensorimotor area in patients with brain tumor.

    The purpose of this study is intra-operatively to localize the sensorimotor area by intrinsic optical method detecting the changes in regional cerebral blood flow (rCBF) and cortical temperature following neuronal activity during median nerve stimulation. In 18 patients with brain tumors located around the sensorimotor cortex, cortical recording of somatosensory evoked potentials (SEPs) was performed and localized changes in rCBF during median nerve stimulation were measured by a laser-Doppler flowmeter on the locations of SEPs and around the activation area obtained by functional magnetic resonance imaging (fMRI). In two patients, cortical thermomapping was also performed during median nerve stimulation. In fMRI study, the significant activation area of sensorimotor could be obtained in 17 of 18 patients. In cortical recording of SEPs, the polarity reversal of N20 and P20 was observed in 14 of the 18 patients. In 9 of the 14 patients in whom SEPs could be recorded, the localized changes in rCBF, corresponding to the stimulation, were detected in the N20 area. In 2 of the 4 patients in whom N20 could not be recorded successfully, the localized changes in rCBF could be detected. The increase in rCBF during the stimulation was 18.3% /- 5.3% (mean /- SD, n = 11). Thermomapping could demonstrate the localized area, where the increase in rCBF was also detected, by observation of the changes in cortical temperature during the stimulation. The intra-operative intrinsic optical method detecting rCBF and cortical temperature in combination with recording of SEPs may be considered useful for brain functional localization related to neurosurgical disorders.
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keywords = cortex
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6/121. Peduncular hallucinosis: an unusual sequel to surgical intervention in the suprasellar region.

    Peduncular hallucinations are formed visual images often associated with sleep disturbance, and are caused by lesions in the midbrain, pons and diencephalon. In the present study, we report two patients who developed peduncular hallucinations following surgery in the suprasellar region. In one of these, the peduncular hallucinations were a sequel to endoscopic third ventriculostomy, while in the other, they were due to diencephalon and mid-brain compression by a postoperative clot following excision of a hypothalamic astrocytoma.
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7/121. Use of a portable CT scanner during resection of subcortical supratentorial astrocytomas of childhood.

    The development of intraoperative imaging has made it possible to visualize shifting brain structures during surgery, and may allow greater intraoperative discrimination of normal and abnormal tissue. This may provide greater confidence to the neurosurgeon to proceed with a more extensive resection while decreasing postoperative morbidity. We investigated the intraoperative use of a portable CT scanner in the resection of 4 cases of supratentorial, subcortical astrocytomas of childhood to assess its usefulness in determining the endpoint of the dissection. We operated on 4 patients, ages 3-17, with astrocytomas. Three were thalamic, and 1 was based primarily in the caudate nucleus. The approach to the basal ganglia was transcallosal in 3 and transtemporal in 1. Specific observations on the intraoperative use of the portable CT scanner included its overall facility, any additional operative time required, the overall quality of the images, intraoperative decisions made based on the images and problems associated with its use. These observations are presented with a review of intraoperative imaging as it pertains to deep pediatric brain tumors. The CT scanner was helpful in limiting the dissection of the hypothalamic and midbrain regions and in localizing remaining abnormal tissue. The scans allowed informed decisions about leaving margins of the tumor which were adjacent to vital structures, but dit not prove to be a decisive factor in providing a complete resection. The following observations are worth noting: (1) average imaging time was 20 min per scan; (2) the extent and location of residual enhancing tumor was easily identified despite other materials in the surgical bed; (3) air/tissue interfaces limit resolution; (4) tumors retain contrast long enough to obtain multiple scans without additional dye, and (5) the cost profile of a mobile CT scanner is superior to that of a fixed intraoperative CT scanner.
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8/121. Neuropsychological consequences of cerebellar tumour resection in children: cerebellar cognitive affective syndrome in a paediatric population.

    Acquired cerebellar lesions in adults have been shown to produce impairments in higher function as exemplified by the cerebellar cognitive affective syndrome. It is not yet known whether similar findings occur in children with acquired cerebellar lesions, and whether developmental factors influence their presentation. In studies to date, survivors of childhood cerebellar tumours who demonstrate long-term deficits in cognitive functions have undergone surgery as well as cranial irradiation or methotrexate treatment. Investigation of the effects of the cerebellar lesion independent of the known deleterious effects of these agents is important for understanding the role of the cerebellum in cognitive and affective development and for informing treatment and rehabilitation strategies. If the cerebellar contribution to cognition and affect is significant, then damage in childhood may influence a wide range of psychological processes, both as an immediate consequence and as these processes fail to develop normally later on. In this study we evaluated neuropsychological data in 19 children who underwent resection of cerebellar tumours but who received neither cranial irradiation nor methotrexate chemotherapy. Impairments were noted in executive function, including planning and sequencing, and in visual-spatial function, expressive language, verbal memory and modulation of affect. These deficits were common and in some cases could be dissociated from motor deficits. Lesions of the vermis in particular were associated with dysregulation of affect. Behavioural deficits were more apparent in older than younger children. These results reveal that clinically relevant neuropsychological changes may occur following cerebellar tumour resection in children. Age at the time of surgery and the site of the cerebellar lesion influence the neurobehavioural outcome. The results of the present study indicate that the cerebellar cognitive affective syndrome is evident in children as well as in adults, and they provide further clinical evidence that the cerebellum is an essential node in the distributed neural circuitry subserving higher-order behaviours.
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9/121. Head trauma and brain tumours revisited.

    The authors report a case of an anaplastic astrocytoma which on magnetic resonance imaging and direct visualisation was continuous with an area of gliosis in the left frontal lobe. This gliosis was secondary to a head injury received 19 years earlier that required evacuation of an intracerebral haematoma. This case largely meets the accepted criteria for brain tumour associated with head trauma.
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10/121. Contralateral cortical diaschisis in a patient with cerebellar astrocytoma after radiation therapy.

    Contralateral cerebellar diaschisis, hypometabolism in the cerebellum contralateral to a cortical lesion, is a well described phenomenon in patients with stroke and brain tumor. However, few reports exist of patients with cerebellar lesions with the finding of contralateral cortical hypometabolism. The authors present a case of a patient with a right cerebellar astrocytoma after surgical resection and radiation therapy in which fluorine-18 fluorodeoxyglucose positron emission tomographic imaging, performed to rule out recurrent tumor, revealed global hypometabolism in the left cerebral cortex. The concept of contralateral cortical diaschisis and possible mechanisms and clinical implications are reviewed.
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