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Kirkova R, Dineva S, Stradiotto E, Tanev I, Di Maria A. The Riddle of the Double Vision-A Rare Case of Intracranial Tumor: When Imaging Resolves the Mystery. Diagnostics (Basel) 2024; 14:932. [PMID: 38732347 PMCID: PMC11083945 DOI: 10.3390/diagnostics14090932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
A 77-year-old-man with arterial hypertension, diabetes mellitus type II presented at our clinic for a routine ophthalmological exam. He complained of intermittent double vision. The ophthalmic examination revealed paralysis of III (n. oculomotorius) and VI (n. abducens) cranial nerves with ptosis, deficit in elevation and abduction of the left eye. The patient underwent urgent MRI imaging of the brain/orbits and paranasal sinuses, and urgent neurological assessment. MRI revealed a volume-occupying process, starting from the posterior wall of the left maxillary sinus with perineural diffusion and involvement of the homolateral trigeminal nerve, intracranial spread in the medial cranial fossa and involvement of the cavernous, sphenoidal sinuses and the orbital apex on the left side. Biopsy was performed, and the histology resulted in sinonasal squamous cell carcinoma with intracranial spread.
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Affiliation(s)
- Radina Kirkova
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Eye Clinic Zrenieto, 1000 Sofia, Bulgaria;
| | - Svetla Dineva
- Diagnostic Imaging Department, National Cardiology Hospital, 1000 Sofia, Bulgaria;
- Imaging Department, Medical University of Sofia, 1000 Sofia, Bulgaria
| | - Elisa Stradiotto
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy;
| | - Ivan Tanev
- Eye Clinic Zrenieto, 1000 Sofia, Bulgaria;
| | - Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
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Curcio A, Angileri FF, Zaccaria R, Germanò AF. Avoiding the Blinded Funnel: A Combined Single Piece Fronto-Temporo-Orbito-Zygomatic Craniotomy Endoscopic-Assisted Approach with Multimodal Assistance for an Epidermoid Tumor of Meckel's Cave-Case Report. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:109-114. [PMID: 38153457 DOI: 10.1007/978-3-031-36084-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
A Meckel's cave tumor poses a great challenge because of the peculiar neurovascular structure of the area and the deep location. Multiple surgical approaches have been designed for this area. In this report, we describe a case treated with a combined one step single piece fronto-temporo-orbito-zygomatic craniotomy (FTOZ) endoscopic-assisted approach for the treatment of an epidermoid tumor of Meckel's cave. A 51-year-old woman presented with a clinical history of left trigeminal neuralgia and paresthesia. CT imaging revealed a left basal temporal tumor. MR showed a tumor located in Meckel's cave near the cavernous sinus, with a good enhancement after gadolinium administration. The tumor was resected through a lateral basal subtemporal extradural approach followed by an intradural approach using intraoperative neuronavigation, endoscopic assistance, neurophysiological monitoring, and an intraoperative ultrasound probe. The lesion was completely removed. No new onset neurological damage has occurred. The symptoms improved following surgery. The aesthetic appearance of the patient was respected. The combined approach with a single piece fronto-temporo-orbito-zygomatic craniotomy has enabled us to work on a wider operating field to completely remove the lesion avoiding blind spots.
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Affiliation(s)
- A Curcio
- Department of Biomedical and Dental Science and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, Messina, Italy
| | - F F Angileri
- Department of Biomedical and Dental Science and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, Messina, Italy
| | - R Zaccaria
- Department of Biomedical and Dental Science and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, Messina, Italy
| | - Antonino Francesco Germanò
- Department of Biomedical and Dental Science and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, Messina, Italy.
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Sharifi G, Mohammadi E, Jafari A, Jamali E, Sabouri S, Akbari N. A case of Meckel’s cave epidermoid cyst with unilateral abducens nerve paresis as the sole presentation. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Horcajadas Almansa A, Jorques Infante AM, Chamorro Santos CE, Román Cutillas AM. Brain lymphoma development related to a long lasting epidermoid cyst. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:204-208. [PMID: 35256326 DOI: 10.1016/j.neucie.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/10/2021] [Accepted: 02/12/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.
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Kanaujia R, Aggarwal A, Misra RN. In Reply to the Letter to the Editor Regarding “Multicompartmental Epidermoid Cyst Causing Chronic Parotid Gland and Masticator Space Muscle Atrophy”. World Neurosurg 2022; 158:338. [DOI: 10.1016/j.wneu.2021.11.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
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Kiyofuji S, Kin T, Kakizawa Y, Doke T, Masuda T, Yamashita J, Shono N, Nakatomi H, Morita A, Harada K, Saito N. Development of Integrated 3-Dimensional Computer Graphics Human Head Model. Oper Neurosurg (Hagerstown) 2021; 20:565-574. [PMID: 33677574 DOI: 10.1093/ons/opab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding the complex anatomy of neurostructures is very important in various stages of medical education, from medical students to experienced neurosurgeons, and, ultimately, for the knowledge of human beings. OBJECTIVE To develop an interactive computer graphics (CG) anatomic head model and present the current progress. METHODS Based on the prior head 3-dimensional CG (3DCG) polygon model, 23 additional published papers and textbooks were consulted, and 2 neurosurgeons and 1 CG technician performed revision and additional polygon modeling. Three independent neurosurgeons scored the clear visibility of anatomic structures relevant to neurosurgical procedures (anterior petrosal and supracerebellar infratentorial approaches) in the integrated 3DCG model (i model) and patients' radiological images (PRIs) such as those obtained from computed tomography, magnetic resonance imaging, and angiography. RESULTS The i model consisted of 1155 parts (.stl format), with a total of 313 763 375 polygons, including 10 times more information than the foundation model. The i model was able to illustrate complex and minute neuroanatomic structures that PRIs could not as well as extracranial structures such as paranasal sinuses. Our subjective analysis showed that the i model had better clear visibility scores than PRIs, particularly in minute nerves, vasculatures, and dural structures. CONCLUSION The i model more clearly illustrates minute anatomic structures than PRIs and uniquely illustrates nuclei and fibers that radiological images do not. The i model complements cadaveric dissection by increasing accessibility according to spatial, financial, ethical, and social aspects and can contribute to future medical education.
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Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Japanese Red Cross Society Suwa Hospital, Suwa, Japan
| | | | - Taisuke Masuda
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Juli Yamashita
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology, Sapporo, Japan
| | - Naoyuki Shono
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | | | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Kanako Harada
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
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Horcajadas Almansa A, Jorques Infante AM, Chamorro Santos CE, Román Cutillas AM. Brain lymphoma development related to a long lasting epidermoid cyst. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00028-2. [PMID: 33745844 DOI: 10.1016/j.neucir.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/10/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.
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Thenmozhi S, Girija S, Viswanathan KN, Karthikeyan KV. Unraveling a cephalalgic quagmire from a cavern to a cave. J Postgrad Med 2021; 67:96-99. [PMID: 33835060 PMCID: PMC8253333 DOI: 10.4103/jpgm.jpgm_809_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Headache in women in their late forties can be primary or secondary. We report a 48-year-old female with chronic slowly progressive left temporal headache for 1 year. She also had ipsilateral eye pain and facial numbness for 1 month, with restricted abduction in the left eye and diplopia. On neurological examination, she had isolated left abducent nerve palsy, with loss of corneal and conjunctival reflexes, localizing the pathology to the cavernous sinus or its adjacent structures. Anatomically, cranial nerves V and VI are in close proximity to each other in the region of Meckel's cave. In view of her age, insidious onset, progressive symptoms and clinical findings, the provisional diagnosis in this patient was a Meckel's cave tumor. Magnetic resonance (MR) imaging revealed a 2 cm × 2 cm × 1.7 cm enhancing dumb-bell-shaped mass lesion with mild restricted diffusion in the Meckel's cave projecting into cavernous sinus with alanine, myoinositol and glutamine peaks on MR spectroscopy. Intradural debulking was done; lesion was confirmed by histopathology and patient was cured of her symptoms. An algorithm for diagnosing this entity at the bedside is presented.
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Affiliation(s)
- S Thenmozhi
- Department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - S Girija
- Department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - K N Viswanathan
- Department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - K V Karthikeyan
- Department of Neurosurgery, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India
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Lopez Gomez P, Mato Mañas D, Marco de Lucas E. Epidermoid Cyst Extending Along Trigeminal Nerve Pathway with Unusual Imaging Findings. World Neurosurg 2020; 146:75-77. [PMID: 33144211 DOI: 10.1016/j.wneu.2020.10.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
Epidermoid cysts (ECs) are benign extraaxial tumors. They frequently occur at the cerebellopontine angle and parasellar regions. However, they rarely occur in the Meckel's cave. Typically, ECs appear as a hypointense mass on T1-weighted magnetic resonance imaging (MRI) and hyperintense on T2-weighted MRI. However, ECs may occasionally present as hyperintense on T1-weighted imaging and hypointense on T2-weighted imaging. When this occurs, they are known as white epidermoid cysts. We present a case of a 25-year-old woman with a 3-month history of hypoesthesia in the distribution of the right trigeminal nerve. MRI showed a lesion located within the Meckel's cave. The MRI signal was heterogeneous, with hyperintense areas on T1-weighted images, being hypointense on T2-weighted imaging. Preoperative suspicion was trigeminal schwannoma with unusual radiologic features. Finally, the pathologic diagnosis was epidermoid cyst. Therefore to establish a proper preoperative diagnosis, one should be aware that ECs can occur in Meckel's cave and with unusual radiologic features, as occurred in the case described earlier.
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Affiliation(s)
- Patricia Lopez Gomez
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
| | - David Mato Mañas
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Enrique Marco de Lucas
- Department of Neurorradiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Cuoco JA, Rogers CM, Busch CM, Apfel LS, Entwistle JJ, Marvin EA. Intracranial Squamous Cell Carcinoma Arising From a Cerebellopontine Angle Epidermoid Cyst Remnant Four Decades After Partial Resection. Front Oncol 2019; 9:694. [PMID: 31428577 PMCID: PMC6689955 DOI: 10.3389/fonc.2019.00694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Intracranial epidermoid cysts are benign lesions that typically remain asymptomatic; however, although histopathologically benign, these cysts can rarely undergo malignant transformation into squamous cell carcinoma. Primary intracranial squamous cell carcinoma carries a poor prognosis as optimal treatment modalities remain unclear due to their low incidence. Here, we present a case of a cerebellopontine angle epidermoid cyst remnant that underwent malignant transformation into squamous cell carcinoma 40 years after partial resection. To our knowledge, this case establishes the longest time interval to date for an intracranial epidermoid cyst to undergo malignant transformation. We also review the relevant literature and discuss recent retrospective clinical studies that have analyzed the effect of multimodal treatment approaches on survival outcomes in patients with these lesions.
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Affiliation(s)
- Joshua A Cuoco
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Cara M Rogers
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Christopher M Busch
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Lisa S Apfel
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - John J Entwistle
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - Eric A Marvin
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.,Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Virginia Tech School of Neuroscience, Blacksburg, VA, United States.,Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
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