World Neurosurg
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Choroid plexus papillomas (CPPs) are rare benign intracranial tumors. We report a rare case of CPP manifesting with typical symptoms of normal-pressure hydrocephalus rather than obstructive hydrocephalus. ⋯ The hydrocephalus was of a communicating type and caused by CSF overproduction. The lateral route of the trans-CMF approach is useful for the dissection of tumors that extend into the unilateral cerebellomedullary cistern through the CMF. This approach not only enables sufficient exposure for resection but also avoids damage to the surrounding structures.
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Case Reports
BRAF-mutated pleomorphic xanthoastrocytoma of the spinal cord with eventual anaplastic transformation.
Pleomorphic xanthoastrocytoma (PXA) is an uncommon, primary neoplasm of the central nervous system with a relatively favorable prognosis. Most patients are managed with surgery alone and experience significant long-term survival. PXAs occur most commonly along the superficial surfaces of the temporal lobes. Although these tumors may occur in other regions of the brain, their origin within the spinal cord is rare, and it is unclear whether spinal cord PXAs should be managed differently from their intracranial counterparts. ⋯ To our knowledge, our patient represents the seventh reported case of PXA of the spinal cord but is the first described to have a BRAF mutation. Specifically, both the initial and recurrent tumors of the patient showed the same BRAF V600E mutation, which refutes previous suggestions that BRAF mutations may be limited to intracranial PXAs and also shows that BRAF mutations may occur earlier in PXA tumorigenesis.
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Chordomas in children and adolescents are rare, and minimal published information is available. Our aim was to research clinical features and prognostic factors associated with clival chordomas in younger patients. ⋯ In children and adolescents with clival chordomas, higher preoperative Karnofsky performance scale score, total resection, and lower levels of Ki-67 and CK8 expression are favorable prognostic factors. Platelet-derived growth factor receptor-β may play a role in tumorigenesis and epithelial-mesenchymal transition of clival chordomas.
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Studies have demonstrated certain hemodynamic characteristics featuring the rupture status of cerebral aneurysms using computational fluid dynamics. These studies were conducted based on the comparison of a large number of ruptured and unruptured aneurysms. However, not only aneurysm size and location but also perianeurysm environment, such as hemorrhage and intracranial pressure, affect hemodynamic changes. We hypothesized that a case in which ruptured and unruptured cerebral aneurysms simultaneously exist in the same location would be an ideal model to demonstrate hemodynamic characteristics of the rupture status. ⋯ Quantitative characterization of the hemodynamic environment can distinguish the rupture status by using appropriate models minimizing certain bias caused by subarachnoid hemorrhage and aneurysm location.
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The mainstay treatment of primary malignant bone tumors is wide surgery in the spine. Unfortunately, most cases undergo the first approach in a nonspecialized center; this often means adopting an inappropriate approach with contamination, which consistently decreases the effectiveness of a second surgery. The aim of the present paper is to evaluate recurrence and survival rates after en-bloc resection. ⋯ In our series, the first inappropriate approach had already compromised patient prognosis, so in case of suspicious primary spine tumor, the patient had to be referred to a specialized center. The margin obtained during salvage surgery does not appear to influence recurrence and survival, probably because it is already compromised by the first surgery. More prospective studies are necessary to confirm our data and verify the impact of the margin obtained during salvage surgery on patients' survival.