1/28. The Chiari II malformation: lesions discovered within the fourth ventricle. Structural lesions associated with the Chiari II malformation have been identified within the fourth ventricle in 8 patients. During the 42-month period encompassing the operations of the 7 patients treated surgically, only 9 other patients were explored without the discovery of some associated structural lesion. The patients ranged in age from 2 to 26 years. The following lesions were identified: glial or arachnoidal cysts (3 patients), glial or choroidal nodules (3 patients) and subependymoma (2 patients). These lesions were all situated in the roof of the fourth ventricle adjacent to or interspersed with the choroid plexus. Only the cystic lesions were identified by preoperative imaging. In only 1 case did the associated lesion, a 2-cm cyst, seem to contribute to the patient's clinical presentation. Structural lesions of the fourth ventricle associated with the Chiari II malformation are common in patients who are submitted to decompression. These lesions may be dysplasias of developmental origin, or they may be reactive lesions related to chronic compression and ischemia. They do not necessarily required biopsy or excision. ( info) |
2/28. Traumatic subependymal hematoma during endoscopic third ventriculostomy in a patient with a third ventricle tumor: case report. Endoscopic third ventriculostomy has become a routine intervention for the treatment of non-communicating hydrocephalus. This technique is largely considered safe and a very low incidence of complications is reported. However, hemorrhage in the course of neuroendoscopy is still a problem difficult to manage. The authors present a case in which endoscopic third ventriculostomy and tumor biopsy were performed in a young patient with a huge tumor growing in the posterior part of the third ventricle. The surgical approach to realize the stoma was difficult because the tumor size reduced the third ventricle diameter. Surgical manipulation produced a traumatic subependymal hematoma. This hematoma drained spontaneously after few minutes into the ventricle and the blood was washed away. The postoperative neurological course was uneventful and the ventriculostomy showed to work well by reducing the size of the lateral ventricles and the intracranial pressure in three days. This complication during endoscopic third ventriculostomy has never been reported before. We emphasize the difficulty of endoscopic procedures in patients with huge tumors in the third ventricle. Where reduction in size of the third ventricle and of the foramen of Monro ist present we suggest a careful approach to the third ventricle. ( info) |
| spinal cord subependymoma is a rare tumour with only 39 reported cases in the literature. The authors report a further case of this neoplasm in a 53 year old man with a progressive paraparesis, paraesthesias of the lower limbs and sphincter disturbance. The tumour was partly removed, without progression 5 years after surgery. After a careful review of the literature, the optimal treatment of this spinal tumour is debated. ( info) |
| We report a rare child case of symptomatic subependymoma in the fourth ventricle without hydrocephalus. The upper half of the tumor was demonstrated as a non-enhancing isodense mass with punctate calcification on CT, whereas the lower portion showed slightly irregular ring-like enhancement with a central hypodense area. The tumor was heterogeneously hyperintense on T2-weighted magnetic resonance (MR) images. When scanned with a T1-weighted sequence, the upper portion of the tumor was isointense to brain, but the lower portion was hypointense. However, using Gd-enhanced T1-weighted imaging, such as in postcontrast CT, the upper portion did not enhance, whereas the lower portion revealed similar ring-like enhancement, which was suggestive of necrosis. To further confirm the nature of the tumor, a diffusion-weighted imaging study with echo-planar technique was performed, and it indicated the solid nature of the tumor, which was confirmed histopathologically. ( info) |
5/28. Pedunculated subependymomas of lateral ventricle. The authors describe two cases of extremely rare, pedunculated subependymomas of lateral ventricle. One patient presented with symptoms of intracranial hypertension (case 2); CT scan revealed evidence of intraventricular mass, but in second patient (case 1) coexisting symptomatic anaplastic astrocytoma masked on CT-scan the presence of asymptomatic intraventricular tumour, which was found no earlier than at autopsy. The cellular origin of this rare intracranial neoplasm is discussed. ( info) |
6/28. Sudden unexpected death resulting from previously nonsymptomatic subependymoma. A 34-year-old, previously healthy man died suddenly and unexpectedly. The autopsy showed brain and pulmonary edema, numerous small meningeal meningiomas, bilateral and symmetrical juxtaventricular meningiomas, and a well-demarcated gray tan tumor in the medulla oblongata and upper cervical spinal cord. The latter tumor was a subependymoma with features of ependymoma in places. The authors describe and discuss the characteristics of this rare central nervous system tumor, its histogenesis, and its coexistence with other intracranial tumors. The possible mechanisms of death in the present case include compression of vital centers and acute obstruction of the cerebrospinal fluid flow. ( info) |
7/28. Neonatal subependymal giant cell astrocytoma. Subependymal giant cell astrocytoma (SEGCA) is a benign, slow-growing glial tumor that manifests with signs and symptoms of obstructive hydrocephalus most often in adolescent patients with tuberous sclerosis complex (TSC). Neonatal highly aggressive SEGCA is very rare. We report a 5-month-old child with TSC presenting with a cystic mass lesion in the left frontal lobe as well as multiple other periventricular masses. After initial conservative treatment, the child was readmitted with intractable seizures, a massive increase in the size of the left frontal lobe tumor and obstructive hydrocephalus. Despite surgical interventions, the child succumbed to the intracranial lesions. In this report, we discuss the challenges of managing SEGCA and the importance of further studies, including genetic studies, that may lead to a better understanding of its pathophysiology. ( info) |
8/28. Intramedullary subependymoma occupying the right half of the thoracic spinal cord--case report. A 37-year-old female presented with a rare spinal subependymoma manifesting as progressive weakness of her right lower extremity over an 8-month period. She had a 10-year history of back pain and urinary disturbance. magnetic resonance imaging showed diffuse enlargement of the spinal cord from T-2 to T-7 on the T1-weighted images. The enlarged spinal cord was divided into two compartments by a vertical septum-like structure on the T2-weighted images. The tumor occupied the right half of the thoracic spinal cord, and was totally removed through a laminectomy from T-2 to T-7. The histological diagnosis of the resected specimen was subependymoma. Subependymomas are slow-growing tumors usually found in the ventricular system. Spinal subependymomas are difficult to distinguish from other intramedullary spinal tumors based on neuroradiological findings. Subependymomas are surgically curable tumors, so if the tumor is well demarcated and a subependymoma is indicated, an attempt should be made to totally remove the tumor. ( info) |
9/28. Subependymomas in children: a report of five cases including two with osseous metaplasia. Subependymomas are highly differentiated slow growing gliomas. They are one of the few gliomas which are biologically benign. They are extremely rare in children. However, after going through the histopathology records of our department of fourteen years (1983-1997) we found that five (20%) cases of subependymomas have been diagnosed in children out of a total of twenty-six subependymomas. Two of our cases showed the presence of osseous metaplasia, a hitherto undescribed finding. ( info) |
10/28. Intramedullary subependymoma of the spinal cord: a case report and review of literature. A case of cervical spine intramedullary subependymoma in a 52-year-old female is reported. Also, the relevant literature on the 40 cases reported till date is reviewed. magnetic resonance imaging, even with enhancement, does not show any distinctive features making pre-operative diagnosis often difficult. These tumours are eccentrically located within the spinal cord, thus enabling complete tumour removal in most cases. They are benign with low proliferative potential and hence no post-operative radiotherapy should be administered. ( info) |