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Neurosurgical aspects of Noonan syndrome. Childs Nerv Syst 2023; 39:849-856. [PMID: 36847963 DOI: 10.1007/s00381-023-05888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Noonan syndrome (NS) is a rare neurodevelopmental syndrome characterized by dysmorphic features, congenital heart defects, neurodevelopmental delay, and bleeding diathesis. Though rare, several neurosurgical manifestations have been associated with NS, such as Chiari malformation (CM-I), syringomyelia, brain tumors, moyamoya, and craniosynostosis. We describe our experience in treating children with NS and various neurosurgical conditions, and review the current literature on neurosurgical aspects of NS. METHODS Data were retrospectively collected from the medical records of children with NS who were operated at a tertiary pediatric neurosurgery department, between 2014 and 2021. Inclusion criteria were clinical or genetic diagnosis of NS, age < 18 years at treatment, and need for a neurosurgical intervention of any kind. RESULTS Five cases fulfilled the inclusion criteria. Two had tumors, one underwent surgical resection. Three had CM-I, syringomyelia, and hydrocephalus, of whom one also had craniosynostosis. Comorbidities included pulmonary stenosis in two patients and hypertrophic cardiomyopathy in one. Three patients had bleeding diathesis, two of them with abnormal coagulation tests. Four patients were treated preoperatively with tranexamic acid, and two with Von Willebrand factor or platelets (1 each). One patient with a clinical bleeding predisposition developed hematomyelia following a syringe-subarachnoid shunt revision. CONCLUSIONS NS is associated with a spectrum of central nervous system abnormalities, some of which with known etiology, while in others a pathophysiological mechanism has been suggested in the literature. When operating on a child with NS, a meticulous anesthetic, hematologic, and cardiac evaluation should be conducted. Neurosurgical interventions should then be planned accordingly.
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Clinical and Radiologic Characteristics, Surgical Outcomes, and Its Possible Origins of Chondroma of the Dural Convexity. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5961358. [PMID: 33381561 PMCID: PMC7759409 DOI: 10.1155/2020/5961358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 12/20/2022]
Abstract
Chondroma of the dural convexity (CDC) is a benign and extremely rare type of intracranial chondroma. In this study, we reported five CDCs in a single center and reviewed the available literature to determine the clinical characteristics and surgical outcomes and possible origins of the disease. The clinical data of five patients (4 females) who confirmed to be CDC between 2000 and 2019 in our single center was collected together with 22 cases from literatures. The clinical characteristics and surgical outcomes were reviewed and analyzed. Among all the available CDC cases, the mean age was 31 ± 13.7 years; the mean tumor volume was 42.3 ± 40.9 cm3, showing a female predominance (63% vs. 37%). The tumors showed calcification in 88.2% cases (15/17) on CT scans and hypointense on T1WI (15/19, 78.9%), mixed intense on T2WI (10/18, 55.6%), and inhomogeneous enhancement without dural tail sign after administration of gadolinium (20/21, 95.2%). Almost all the tumors were misdiagnosed as meningiomas preoperatively. In addition, almost all image available CDC lesions (24/25, 96%) located across the cranial sutures indicating that the tumor originated from ectopic chondrocytes from adjacent skull sutures. No tumors recurred after total resection in follow-up. CDCs are characterized with female predominance and may originate from ectopic chondrocytes from adjacent skull sutures. The lesion with inhomogeneous contrast enhancement without dural tail sign and avascular in cerebral angiography are key points to be differentiated from meningioma. The most effective treatment is total resection.
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Weng JC, Li D, Li H, Ma JP, Tian KB, Wang L, Zhang LW, Jia W, Wu Z, Zhang JT. Surgical Management and Outcomes of Intracranial Chondromas: a Single-Center Case Series of 66 Patients. World Neurosurg 2017; 108:264-277. [DOI: 10.1016/j.wneu.2017.08.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022]
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Narro-Donate JM, Huete-Allut A, Velasco-Albendea FJ, Escribano-Mesa JA, Mendez-Román P, Masegosa-González J. [Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report]. Neurocirugia (Astur) 2016; 27:144-8. [PMID: 26944382 DOI: 10.1016/j.neucir.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/11/2015] [Accepted: 01/02/2016] [Indexed: 11/28/2022]
Abstract
Cranial chondromas are tumours arising from chondrocyte embryonic remnants cells that usually appear in the skull base synchondrosis. In contrast to the rest of the organism, where chondroid tumours are the most common primary bone tumour just behind the haematopoietic lineage ones, they are a rarity at cranial level, with an incidence of less than 1% of intracranial tumours. The case is reported on a 42 year-old male referred to our clinic due to the finding of an extra-axial lesion located close to the Meckel's cave region, with extension to the posterior fossa and brainstem compression after progressive paraparesis of 6 months onset. With the diagnosis of trigeminal schwannoma, a subtotal tumour resection was performed using a combined supra-infratentorial pre-sigmoidal approach. The postoperative histopathology report confirmed the diagnosis of cranial chondroma.
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Affiliation(s)
| | - Antonio Huete-Allut
- Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España
| | | | | | - Paddy Mendez-Román
- Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España
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Doukas A, Tallo A, Parvin R, Hans V, Daemi P, Cheko A, Scholz M, Petridis AK. Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself. Clin Pract 2015; 5:777. [PMID: 26918096 PMCID: PMC4745590 DOI: 10.4081/cp.2015.777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022] Open
Abstract
Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary.
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Affiliation(s)
| | | | - Richard Parvin
- Department of Neurosurgery, Wedau Kliniken, Duisburg; International Graduate School of Neuroscience, Ruhr-University, Bochum
| | - Volkmar Hans
- Institute of Neuropathology, University Hospital , Essen, Germany
| | - Pooya Daemi
- Department of Neurosurgery, Wedau Kliniken , Duisburg
| | - Azad Cheko
- Department of Neurosurgery, Wedau Kliniken , Duisburg
| | - Martin Scholz
- Department of Neurosurgery, Wedau Kliniken , Duisburg
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Abstract
Intracranial chondromas are benign, slow-growing, cartilaginous tumors, which comprise only about 0.2% of all intracranial tumors. The majority of these lesions occur at the base of the skull, where they are thought to arise from residual embryonic chondrogenic cells along the basal synchondrosis. Very rarely, they may also originate from the convexity dura, falx cerebri, or the brain parenchyma. We present a patient with a dural based chondroma to highlight the technical considerations of surgical resection. The recent literature on intracranial chondromas regarding incidence, pathophysiologic origin, clinical symptoms, imaging, histopathology and prognosis is reviewed.
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Miyamoto JJ, Yabunaka T, Moriyama K. Cervical characteristics of Noonan syndrome. Eur J Orthod 2013; 36:226-32. [DOI: 10.1093/ejo/cjt019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Somerset H, Wilkinson CC, Kleinschmidt-Demasters BK. 18-year-old woman with a dural mass. Brain Pathol 2012; 23:113-6. [PMID: 23217009 DOI: 10.1111/bpa.12012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report a case of a dural-based chondroma in the right frontal extra-axial region. Chondromas are benign cartilaginous tumors which are uncommon intracranially. Their diagnosis should be predicated on the exclusion of a chondrosarcoma and clinical studies should be performed to rule out any underlying tumor predisposition syndromes.
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Duan F, Qiu S, Jiang J, Chang J, Liu Z, Lv X, Feng X, Xiong W, An J, Chen J, Yang W, Wen C. Characteristic CT and MRI findings of intracranial chondroma. Acta Radiol 2012; 53:1146-54. [PMID: 22983260 DOI: 10.1258/ar.2012.120433] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracranial chondromas are rare benign tumors. To date, few data are available on their neuroradiological features. PURPOSE To describe a series of patients with intracranial chondroma and to analyze and discuss the computed tomography (CT) and magnetic resonance imaging (MRI) features that may distinguish chondromas from other intracranial neoplasms. MATERIAL AND METHODS We retrospectively analyzed clinical and medical imaging data of six patients who had pathologically confirmed intracranial chondromas in our two institutions between July 2006 and September 2011. Both CT and MRI scanning were performed in all six cases. RESULTS Five tumors were located at the skull base and one originated from the falx. CT images revealed well-demarcated, irregular lobulated and variable density masses with obvious calcification (6/6), no or slight enhancement, without peritumoral edema, and frequently accompanied by erosion and destruction of surrounding bone (5/6). Tumor parenchyma appeared heterogeneously hypointense on T1WI, and hyperintense or mixed hyperintense and hypointense on T2WI, while the calcification appeared hypointense on T1WI and T2WI in five cases, demonstrating significant inhomogeneous enhancement on postcontrast MRI, which revealed the typical "punica granatum seeds" sign. Only one case showed homogeneous low signal intensity on T1WI and high signal intensity on T2WI, and relatively uniform obvious enhancement on postcontrast scans. CONCLUSION These characteristic CT and MR findings, combined with the location of the lesions and the history of a long duration of clinical symptoms, may prove helpful in differentiating intracranial chondromas from other more common tumors.
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Affiliation(s)
- Fuhong Duan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Shijun Qiu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Jianwei Jiang
- Department of Radiology, The Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China
| | - Jun Chang
- Department of Radiology, The Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China
| | - Zhenyin Liu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Xiaofei Lv
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Xia Feng
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Wei Xiong
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Jie An
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Jing Chen
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Weicong Yang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Chuhong Wen
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong
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Abeloos L, Maris C, Salmon I, Balériaux D, Sadeghi N, Lefranc F. Chondroma of the dural convexity: a case report and literature review. Neuropathology 2011; 32:306-10. [PMID: 22017366 DOI: 10.1111/j.1440-1789.2011.01264.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chondromas are unusual tumors that arise from the base of the skull and have a predilection for the spheno-ethmoidal region. Chondromas represent less than 0.5% of all intracranial tumors. In rare instances, these tumors originate from the dura mater of the convexity. Fewer than 30 cases of dural chondromas arising from the convexity or the falx are reported in the literature. In this study, we describe a new case of convexity chondroma. We discuss the radiological and histological features of this case and also review the literature.
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Affiliation(s)
- Laurence Abeloos
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles-U.L.B., Brussels, Belgium.
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Zhan RY, Pan XF, Wan S, Lan P, Zhang YC, Weng NC, Yan M, Zhou YQ. Solitary intracerebral chondroma without meningeal attachment: a case report with review of the literature. J Int Med Res 2011; 39:675-81. [PMID: 21672374 DOI: 10.1177/147323001103900238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracranial chondromas are rare, benign cartilaginous tumours that account for < 0.3% of primary intracranial tumours. They usually originate from the basal synchondrosis and are extradural though, extremely rarely, they can be intracerebral. Here the case of a 45-year old female is presented with a solitary intracerebral chondroma located in the right frontal lobe with no meningeal attachment. The epidemiology, aetiology, clinical behaviour, radiological features, histological features and treatment of the case are discussed with a review of previous cases reported in the literature.
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Affiliation(s)
- R-Y Zhan
- Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Microsurgical treatment of intracranial chondroma. J Clin Neurosci 2011; 18:1064-71. [DOI: 10.1016/j.jocn.2010.12.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 12/01/2010] [Accepted: 12/07/2010] [Indexed: 11/18/2022]
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Somerset HL, Kleinschmidt-DeMasters BK, Rubinstein D, Breeze RE. Osteochondroma of the convexity: pathologic-neuroimaging correlates of a lesion that mimics high-grade meningioma. J Neurooncol 2009; 98:421-6. [PMID: 20012156 DOI: 10.1007/s11060-009-0089-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
Abstract
Intracranial chondromas are uncommon benign lesions usually attached to dura and located over the convexity of the skull. Osteochondromas are even rarer and additionally contain a benign bony component. Both lesions are reportedly difficult to distinguish from meningiomas on pre-operative neuroimaging studies, although few detailed pathologic-neuroimaging correlation studies have appeared in the literature, particularly for intracranial osteochondromas. A 33-year-old woman with a 4-year history of headaches presented with recent onset of left-sided muscle spasms and weakness. Two days prior to admission to our hospital, neuroimaging studies had shown a large right convexity mass with unusual multifocal bright signal intensities throughout an otherwise isointense mass. The bright signals were interpreted as showing multifocal hemorrhage and the mass was felt to be a convexity meningioma. However, subsequent catheter angiography characterized the lesion as being avascular. The mass was resected en bloc. Extensive histological sectioning revealed a benign osteochondroma predominantly composed of lobules of hypocellular cartilage. Microdissection of the different components revealed that the multifocal, spicule-like bright foci interpreted as hemorrhage on neuroimaging studies were instead foci of benign bone containing metaplastic bone marrow with trilineage hematopoietic cell populations and adipose tissue. Centrally, the hilum of the lesion contained avascular loose connective tissue. No recent or remote hemorrhage was identified anywhere in the lesion. Rare convexity osteochondromas may be mistaken for high-grade meningiomas on neuroimaging studies; their avascular nature, coupled with their complex signal pattern can serve as clues to the correct pre-operative diagnosis.
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Affiliation(s)
- Hilary L Somerset
- Department of Pathology, The University of Colorado Health Sciences Center, Aurora, CO, USA
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Schuettpelz LG, McDonald S, Whitesell K, Desruisseau DM, Grange DK, Gurnett CA, Wilson DB. Pilocytic astrocytoma in a child with Noonan syndrome. Pediatr Blood Cancer 2009; 53:1147-9. [PMID: 19621452 DOI: 10.1002/pbc.22193] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Noonan syndrome (NS; MIM 163950) is an autosomal dominant dysmorphic syndrome characterized by distinct facial features, cardiac anomalies, short stature, and motor delay. Activating mutations in PTPN11, encoding the protein tyrosine phosphatase SHP2, are associated with about 50% of cases. Mutations in other genes in the RAS/mitogen-activated protein kinase signaling pathway are responsible for many of the remainder of cases. While mutations in this pathway are found in a variety of malignancies, including solid tumors, there are few reports of solid tumors in individuals with NS. We report here a patient with PTPN11 mutation-associated NS and a pilocytic astrocytoma.
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Affiliation(s)
- Laura G Schuettpelz
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri 63110, USA.
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