Cases reported "Hemangioblastoma"

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11/55. Supratentorial hemangioblastoma in a patient with breast cancer. A case report.

    patients with breast cancer may develop cerebral metastasis. radio- and chemotherapy are advocated as an alternative to surgery in such patients. A woman operated on for breast cancer 2 years earlier developed a cerebral lesion. A definite preoperative diagnosis of the lesion was not possible on the basis of CT and MRI findings. The lesion proved to be a supratentorial hemangioblastoma. Neurosurgical treatment is recommended for patients with breast cancer who present a cerebral lesion, since a correct diagnosis may only be possible in the operating theater.
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12/55. anesthesia for cesarean section and posterior fossa craniotomy in a patient with von hippel-lindau disease.

    PURPOSE: To describe the care of a pregnant woman with von hippel-lindau disease (VHLD) and intracranial mass lesions. CLINICAL FEATURES: A 30-yr-old primigravida with VHLD at 35 weeks gestation was seen at the obstetric anesthesia clinic because she wished an epidural analgesia during labour. She had a history of headaches and dizziness. Further investigations showed an enlarged cerebellar hemangioblastoma with significant local mass effects. A combined cesarean section delivery and posterior fossa craniotomy was performed at 37 weeks gestation. A general anesthetic with fentanyl, rocuronium, nitrous oxide, oxygen and isoflurane was given for cesarean section delivery. After delivery, isoflurane was reduced and propofol infusion at 4-8 mg x kg(-1) x hr(-1) was initiated. The patient had an uneventful operative course and recovery. CONCLUSIONS: patients with VHLD may have worsening of preexisting lesions or develop other lesions during pregnancy. Some asymptomatic lesions can increase the risk for anesthesia complications. These patients need comprehensive assessment before administration of anesthesia.
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13/55. Tentorial vascularization in solid hemangioblastoma--case report.

    A 40-year-old female was admitted to the hospital with complaints of headache worsening gradually over a 1-month duration. Her past history included surgery to treat a left cerebellar cystic lesion 3 years before, and an untreated small solid right supracerebellar lesion of 1 cm diameter. On admission, magnetic resonance imaging showed that the right cerebellar lesion had grown to approximately 4 cm diameter abutting the tentorium and causing obstructive hydrocephalus. She also had two more small lesions, a right supratentorial solid lesion with cystic component near the splenium and an intramedullary cystic lesion at the C-2 level. Right suboccipital craniectomy was done. The vascular attachments between the superior aspect of the tumor and the tentorium were coagulated and the tumor was totally removed. C1-2 laminectomy was also performed to drain the intramedullary cyst. The patient deteriorated and lost consciousness with respiratory arrest 6 hours postoperatively and was reoperated for intracerebellar hematoma due to oozing from the tentorial vessels. Histological investigation revealed hemangioblastoma. Dural tentorial vascular attachments in solid hemangioblastomas located subjacent to the tentorium may cause early postoperative complications of hematoma at the site of vascular attachment following the resection. Computed tomography study in the early postoperative period is helpful to identify this problem.
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ranking = 3
keywords = operative
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14/55. Surgical treatment of hemangioblastomas with presurgical endovascular embolization.

    The usefulness of presurgical embolization of hemangioblastomas was evaluated retrospectively in eight of 30 operations performed on eight of 27 consecutive patients with histologically verified hemangioblastoma. All tumors had over 3.5 cm maximum diameter of the solid mass. Presurgical embolization achieved 100% embolization in one case, 95% to 80% in two, 70% to 50% in two, and less than 50% in three. Total obliteration was obtained only in one case with a single feeding artery. No permanent neurological deficits developed after embolization, but cerebellar infarction occurred in one patient. The surgery was definitely easier than expected in three cases with 80% or more obliteration of tumors. Tumor swelling and cerebellar hematoma occurred during operation in one case with 70% tumor embolization and another case with less than 50%. blood transfusion during operation was carried out in two cases with less than 50% tumor embolization. The clinical outcome was good recovery in one case, moderate disability in five, and severe disability in two. The reasons for residual neurological deficits were operation and meningitis in one patient, operative and preoperative symptoms in two, and residual preoperative symptoms in four. Neurological deterioration after surgery occurred in three patients with tumor embolization of less than 50%. Partial embolization of hemangioblastomas does not reduce operative complications or morbidity, unless almost complete embolization is achieved, which is not so easy.
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keywords = operative
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15/55. choroid plexus papilloma diagnosed by crush cytology.

    In a 32-yr-old man, an infratentorial cystic lesion with a mural nodule was interpreted to be either a hemangioblastoma or a cystic astrocytoma on CT scan. Intraoperative crush cytology revealed it to be a choroid plexus papilloma (CPP). The utility of crush cytology in the rapid diagnosis of central nervous system (CNS) tumors and the differential diagnosis of CNS papillary lesions are highlighted in this report.
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16/55. Suprasellar hemangioblastoma in a patient with von hippel-lindau disease confirmed by germline mutation study: case report and review of the literature.

    BACKGROUND: hemangioblastoma (HBL) in the suprasellar region is extremely rare.CASE DESCRIPTION: A suprasellar mass was found in a 33-year-old woman with retinal HBL and bilateral adrenal pheochromocytomas. The diagnosis of von Hippel-Lindau (VHL) disease was confirmed preoperatively not only by these clinical manifestations but also by germline mutation study. The existence of VHL disease indicated a diagnosis of HBL for the suprasellar mass. The results of our mutation study indicated that this patient had type II VHL disease, suggesting that careful follow-up is essential for the early detection of renal cell carcinoma, which is often associated with type II VHL disease. Here, we summarize the previously reported features of sellar and suprasellar HBLs.CONCLUSIONS: HBLs in this region may be one manifestation of VHL disease. genetic testing of the VHL gene of our patient could provide useful information to determine appropriate medical care and management.
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17/55. aneurysm of the anterior inferior cerebellar artery (AICA) associated with high-flow lesion: report of two cases and review of literature.

    OBJECTIVE AND IMPORTANCE: Although aneurysms of the anterior inferior cerebellar artery (AICA) are rare lesions, their occurrence in combination with high-flow lesions in the same arterial territory is even more striking. Two cases of an AICA aneurysm in combination with a high -flow lesion are described. CLINICAL PRESENTATION: In one case, a 52-year-old female presented with cerebellar syndrome as the result of a left-sided cerebellar tumor. angiography revealed a highly vascularized tumor and a broad-based aneurysm at the offspring of the left AICA. In the second case, a 17-year-old female presented with a right-sided cerebellar hemorrhage. angiography revealed a large peripheral AICA aneurysm and a distal arteriovenous malformation (AVM) fed by the AICA. INTERVENTION: In the first case, a left lateral suboccipital craniotomy was performed and a highly vascularized tumor was removed. The AICA aneurysm could not be adequately clipped and was subsequently wrapped with muscle and reinforced with fibrin glue. Pathological examination of the tumor revealed a hemangioblastoma. Five years after surgery, the patient experienced a subarachnoid hemorrhage. Subsequent vertebral angiography revealed local enlargement of the known AICA aneurysm just at the superior aspect, but the patient refused further treatment. In the second case, the patient sustained a novel cerebellar rebleed while awaiting surgery. A right-sided lateral retromastoid suboccipital craniotomy was performed and the AICA aneurysm could be successfully clipped. More peripherally, the AVM with two draining veins could be totally removed. Postoperative angiography revealed no residual aneurysm or AVM. CONCLUSION: Several aspects of these cases are discussed, such as the rare occurrence of AICA aneurysm and the contribution of high-flow lesions to the genesis of the AICA aneurysms.
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ranking = 1
keywords = operative
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18/55. Cerebellar hemangioblastoma simulating arachnoid cyst on imaging and surgery.

    A case of posterior fossa hemangioblastoma simulating arachnoid cyst on imaging and peroperatively is presented. In vivo proton MR spectroscopy showed evidence of large lactate and resonance at 2.37 ppm not observed earlier in the cystic lesions, including arachnoid cyst. The demonstration of this resonance may help in characterization of these lesions that may be confused with arachnoid cysts on imaging and during surgery.
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19/55. Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma.

    Haemangioblastomas are vascular tumours which mainly involve the central nervous system and retina, often in the setting of von hippel-lindau disease. Haemangioblastomas occurring outside the central nervous system are uncommon. Wherever it is, recognising this tumour prior to surgery is desirable, as preoperative embolisation may be considered. We report the clinical, imaging and pathological features of a sporadic sacral root haemangioblastoma in a 58-year-old man with chronic sciatica and myelopathy. The diagnosis was questioned preoperatively because an enlarged sacral foramen, seen to be filled by a highly vascular, enhancing mass and dilated vessels. Myelopathy was attributed to the presumed high venous pressure resulting from increased flow in veins draining the vascular tumour. Microneurosurgical excision was performed after endovascular embolisation and led to persistent clinical improvement.
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ranking = 2
keywords = operative
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20/55. Atraumatic bloodless removal of intramedullary hemangioblastomas of the spinal cord.

    OBJECT: The goal of this study was to summarize the author's personal experience in the surgical treatment of 19 patients with intramedullary spinal cord hemangioblastomas. methods: All cases were from the author's private practice and were treated between 1967 and 1990. In all cases the intramedullary hemangioblastomas were totally removed by using a unique microsurgical technique of bipolar coagulation, which is fully described in this paper. A bipolar forceps was used to shrink each tumor and detach it from its feeding and draining vessels. Tumor resection was successfully accomplished in all patients. Blood loss was minimal, averaging less than 100 ml, and what little bleeding occurred did so during laminotomy or laminectomy. No bleeding occurred during tumor removal, and no transfusions were given. All patients were symptomatic preoperatively, and all recovered or improved following surgery. CONCLUSIONS: The technique described in this paper makes tumor removal safe, effective, and relatively easy.
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keywords = operative
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