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Dang DD, Gong AD, Dang JV, Mugge LA, Mansinghani S, Ziu M, Cohen AL, Vyas N. Systematic Review of WHO Grade 4 Astrocytoma in the Cerebellopontine Angle: The Impact of Anatomic Corridor on Treatment Options and Outcomes. J Neurol Surg Rep 2023; 84:e129-e139. [PMID: 37854309 PMCID: PMC10580070 DOI: 10.1055/a-2172-7770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/03/2023] [Indexed: 10/20/2023] Open
Abstract
Background Despite advances in multimodal oncologic therapies and molecular genetics, overall survival (OS) in patients with high-grade astrocytomas remains poor. We present an illustrative case and systematic review of rare, predominantly extra-axial World Health Organization (WHO) grade 4 astrocytomas located within the cerebellopontine angle (CPA) and explore the impact of anatomic location on diagnosis, management, and outcomes. Methods A systematic review of adult patients with predominantly extra-axial WHO grade 4 CPA astrocytomas was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through December 2022. Results Eighteen articles were included comprising 21 astrocytomas: 13 exophytic tumors arising from the cerebellopontine parenchyma and 8 tumors originating from a cranial nerve root entry zone. The median OS was 15 months with one-third of cases demonstrating delayed diagnosis. Gross total resection, molecular genetic profiling, and use of ancillary treatment were low. We report the only patient with an integrated isocitrate dehydrogenase 1 (IDH-1) mutant diagnosis, who, after subtotal resection and chemoradiation, remains alive at 40 months without progression. Conclusion The deep conical-shaped corridor and abundance of eloquent tissue of the CPA significantly limits both surgical resection and utility of device-based therapies in this region. Prompt diagnosis, molecular characterization, and systemic therapeutic advances serve as the predominant means to optimize survival for patients with rare skull base astrocytomas.
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Affiliation(s)
- Danielle D. Dang
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Andrew D. Gong
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - John V. Dang
- Department of Internal Medicine, Walter Reed Military Medical Center, Bethesda, Maryland, United States
| | - Luke A. Mugge
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Seth Mansinghani
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Mateo Ziu
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Adam L. Cohen
- Department of Neuro-Oncology, Inova Schar Cancer Institute, Inova Health System, Fairfax, Falls Church, Virginia, United States
| | - Nilesh Vyas
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
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Lee C, Kim MS, Hwang JH, Park SH, Park KS, Yoon SY. Venous ectasia preceding intra-tumoral hemorrhage in a case of gliosarcoma with transverse sinus involvement. J Surg Case Rep 2023; 2023:rjad429. [PMID: 37525746 PMCID: PMC10387368 DOI: 10.1093/jscr/rjad429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023] Open
Abstract
Although intratumoral hemorrhage is common in patients with malignant brain tumors, reports on its clinical course are scarce. This report presents a rare case of a patient with intratumoral hemorrhage with gliosarcoma invading the venus sinus. This invasion and a small draining vein were observed at diagnosis. Magnetic resonance imaging performed 1 week later showed new-onset venous ectasia, which caused intratumoral hemorrhage. This case provides insight into the mechanisms underlying intratumoral hemorrhage and highlights the emergence of new intratumoral vasculature as a potential warning sign for hemorrhage.
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Affiliation(s)
- Chaejin Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mee-Seon Kim
- Department of Pathology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea
| | - Ki-Su Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea
| | - Sang-Youl Yoon
- Correspondence address. Department of Neurosurgery, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea. Tel: +82-10-9545-4515, Fax: +82-53-200-7239, E-mail:
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Zaidi SAA, Amanullah, Jafri SKK, Sharif S. Glioblastoma multiforme at internal auditory canal. Surg Neurol Int 2023; 14:2. [PMID: 36751450 PMCID: PMC9899477 DOI: 10.25259/sni_815_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Background Glioblastomas are the most common adult primary brain tumor present supratentorially. The presence of true extra-axial GBM infratentorially, especially in the internal auditory canal, is extremely rare with only three cases reported previously in the literature. We report the fourth case of primary internal auditory canal/cerebellopontine angle (CPA) glioblastoma which initially mimicked vestibular schwannoma on the basis of its location and presentation. Case Description A 65-year-old male presented with headache, vertigo, and progressive right ear deafness for 5 months. His preoperative magnetic resonance imaging findings were consistent with vestibular schwannoma. Maximum safe resection (near total) was done. The final histopathology report showed glioblastoma multiforme. Conclusion As per our knowledge, this is the fourth reported case of an extra-axial VIII cranial nerve glioblastoma located in internal auditory canal. Hence, despite being very rare, they should be considered as a differential in tumors at CPA.
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Affiliation(s)
- Syeda Alisha Ali Zaidi
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan,Corresponding author: Syeda Alisha Ali Zaidi, Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan.
| | - Amanullah
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | | | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
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Primary Gliosarcoma of the Cerebellum in a Young Pregnant Woman: Management Challenges and Immunohistochemical Features. Case Rep Surg 2019; 2019:7105361. [PMID: 31396432 PMCID: PMC6664503 DOI: 10.1155/2019/7105361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Gliosarcoma (GS) represents a rare, high-grade (WHO Grade IV), central nervous system neoplasm, characterized by a very poor prognosis. Similar to other high-grade gliomas, GS affects mainly adults in the 5th-7th decade of life and presents a higher incidence in males. The most reported locations of GS are the temporal lobe and the frontal lobe, while only eight cases of GS originating from the posterior cranial fossa are reported in the literature. Case Description We report the first case occurring during pregnancy in a 33-year-old patient. Diagnosis was obtained on the 15th week of gestation when patient presented with signs and symptoms of life-threatening raised intracranial pressure. Surgical excision was followed by early recurrence and eventually disease progression because the patient refused adjuvant treatment to save her fetus. Conclusions GS should be considered in the differential diagnosis of posterior cranial fossa tumors with radiological features of meningioma or glioblastoma, even in young patients. To this regard, sarcomas, solitary fibrous tumors, and even metastases should be considered, especially in light of the tendency of GS to give rise to extracranial localizations. Whenever an aggressive management with radical excision and adjuvant treatment is not safely achievable, disease progression is likely to be unavoidable.
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Takami H, Prummer CM, Graffeo CS, Peris-Celda M, Giannini C, Driscoll CL, Link MJ. Glioblastoma of the cerebellopontine angle and internal auditory canal mimicking a peripheral nerve sheath tumor: case report. J Neurosurg 2018; 131:1835-1839. [PMID: 30579279 DOI: 10.3171/2018.8.jns181702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/03/2018] [Indexed: 11/06/2022]
Abstract
Glioblastoma (GBM) of the internal auditory canal (IAC) is exceedingly rare, with only 3 prior cases reported in the literature. The authors present the fourth case of cerebellopontine angle (CPA) and IAC GBM, and the first in which the lesion mimicked a vestibular schwannoma (VS) early in its natural history. A 55-year-old man presented with tinnitus, hearing loss, and imbalance. MRI identified a left IAC/CPA lesion measuring 8 mm, most consistent with a benign VS. Over the subsequent 4 months he developed facial weakness. The tumor grew remarkably to 24 mm and surgery was recommended; the main preoperative diagnosis was malignant peripheral nerve sheath tumor (MPNST). Resection proceeded via a translabyrinthine approach with resection of cranial nerves VII and VIII, followed by facial-hypoglossal nerve anastomosis. Intraoperative frozen section suggested malignant spindle cell neoplasm, but final histopathological and molecular testing confirmed the lesion to be a GBM. The authors report the first case in which absence of any brainstem interface effectively excluded a primary parenchymal tumor, in particular GBM, from the differential diagnosis. Given the dramatic differences in treatment and prognoses between malignant glioma and MPNST, this case emphasizes the importance of surgical intervention on an aggressively growing lesion, which provides both the best probability of local control and the critical tissue diagnosis.
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Affiliation(s)
| | | | | | | | - Caterina Giannini
- 3Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael J Link
- Departments of1Neurologic Surgery
- 2Otorhinolaryngology-Head and Neck Surgery, and
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Peckham ME, Osborn AG, Palmer CA, Tsai A, Salzman KL. Gliosarcoma: Neuroimaging and Immunohistochemical Findings. J Neuroimaging 2018; 29:126-132. [DOI: 10.1111/jon.12565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Miriam E. Peckham
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Anne G. Osborn
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Cheryl A. Palmer
- Department of Pathology; University of Utah Health Sciences Center; Salt Lake City UT
| | - Amy Tsai
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Karen L. Salzman
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
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Yoon GY, Oh HJ, Oh JS, Yoon SM, Bae HG. Gliosarcoma of Cerebello-Pontine Angle: A Case Report and Review of the Literature. Brain Tumor Res Treat 2018; 6:78-81. [PMID: 30381921 PMCID: PMC6212687 DOI: 10.14791/btrt.2018.6.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/18/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022] Open
Abstract
Gliosarcoma (GS), known as variant of glioblastoma multiforme, is aggressive and very rare primary central nervous system malignant neoplasm. They are usually located in the supratentorial area with possible direct dural invasion or only reactive dural thickening. However, in this case, GS was located in lateral side of left posterior cranial fossa. A 78-year-old man was admitted to our hospital with 3 month history of continuous dizziness and gait disturbance without past medical history. A gadolinium-enhanced MRI demonstrated 5.6×4.8×3.2 cm sized mass lesion in left posterior cranial fossa, heterogeneously enhanced. The patient underwent left retrosigmoid craniotomy with navigation system. The tumor was combined with 2 components, whitish firm mass and gray colored soft & suckable mass. On pathologic report, the final diagnosis was GS of WHO grade IV. In spite of successful gross total resection of tumor, we were no longer able to treat because of the patient's rejection of adjuvant treatment. The patient survived for nine months without receiving any special treatment from the hospital.
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Affiliation(s)
- Gi-Yong Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyuk-Jin Oh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Sang Oh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seok-Mann Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hack-Gun Bae
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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