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Xu EX, Lu SY, Chen B, Ma XD, Sun EY. Manifestation of the malignant progression of glioma following initial intracerebral hemorrhage: A case report. World J Clin Cases 2023; 11:1576-1585. [PMID: 36926402 PMCID: PMC10011987 DOI: 10.12998/wjcc.v11.i7.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/03/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Intracranial hemorrhage is extremely rare during the initial stages of glioma. Here, we report a case of glioma with unclassified pathology and intracranial bleeding.
CASE SUMMARY After the second surgery for intracerebral hemorrhage, the patient experienced weakness in the left arm and leg, but could walk unassisted. One month after discharge, the weakness in the left limbs had exacerbated and the patient also suffered from headaches and dizziness. A third surgery was ineffective against the rapidly growing tumor. Intracerebral hemorrhage may be the initial symptom of glioma in some rare cases, and atypical perihematomal edema can be used for diagnosis during an emergency. Certain histological and molecular features seen in our case were similar to that of glioblastoma with a primitive neuronal component, which is termed diffuse glioneuronal tumor with features similar to oligodendroglioma and nuclear clusters (DGONC). The patient underwent three surgeries to remove the tumor. The first tumor resection had been performed when the patient was 14-years-old. Resection of the hemorrhage and bone disc decompression were performed when the patient was 39-years-old. One month after the last discharge, the patient underwent neuronavigation-assisted resection of the right frontotemporal parietal lesion plus extended flap decompression. On the 50th d after the third operation, computed tomography imaging showed rapid tumor growth accompanied by brain hernia. The patient was discharged and died 3 d later.
CONCLUSION Glioma can present as bleeding in the initial stage and should be considered in such a setting. We have reported a case of DGONC, which is a rare molecular subtype of glioma with a unique methylation profile.
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Affiliation(s)
- En-Xi Xu
- Department of Neurosurgery, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
| | - Si-Yuan Lu
- Department of Radiology, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
| | - Bo Chen
- Department of Neurosurgery, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
| | - Xiao-Dong Ma
- Department of Anesthesia, The Affiliated People’s Hospital, Zhenjiang 212002, Jiangsu Province, China
| | - Er-Yi Sun
- Department of Neurosurgery, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu Province, China
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2
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Hemorrhagic presentation of previously silent brain tumors. NEUROCIRUGIA (ENGLISH EDITION) 2023:S2529-8496(22)00098-3. [PMID: 36775742 DOI: 10.1016/j.neucie.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/12/2022] [Indexed: 02/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Acute presentation with intracranial hemorrhage owing to a previously silent brain tumor (BT) is rare. Although any BT can bleed, the frequency and type of bleeding varies across tumor types. MATERIALS AND METHODS We aimed to retrospectively review our experience with 55 patients with BTs presenting with ICH. RESULTS Signs of increased intracranial pressure were the most common symptoms. The temporal lobe was the most common lesion site (n=22). Hemorrhages were mainly confined to the tumor margins (HCTs) (n=34). Extensive intraparenchymal hemorrhages (EIHs) were mainly associated with moderately/severely decreased levels of consciousness (LOCs) (n=15/16). High-grade glioma (HGGT) (n=25) was the leading pathological diagnosis followed by metastasis (MBT) (n=16/55). The hemorrhage type was associated with the pathological diagnosis of the tumor. Patients with HGGT (n=19/25) and MBT (n=9/16) mainly presented with HCTs, whereas low-grade gliomas (LGGT) primarily caused EIHs (n=6/7). CONCLUSIONS Hemorrhagic presentation is a rare occurrence in BTs. Among all, MBT and HGGT are responsible for majority of the cases. Importantly, despite their relatively benign characteristics, LGGTs mainly result in extensive parenchymal destruction once they bleed. Maximum surgical resection of hemorrhagic BTs and decompression of the affected brain regions followed by histological confirmation of the diagnosis should be the main goals of treatment in cases with hemorrhagic BTs.
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3
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Turkkan A, Khezri MK, Eser P, Kuytu T, Tolunay S, Bekar A. Hemorrhagic presentation of previously silent brain tumors. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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4
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Alotaibi AS, Mahroos RA, Al Yateem SS, Menezes RG. Central Nervous System Causes of Sudden Unexpected Death: A Comprehensive Review. Cureus 2022; 14:e20944. [PMID: 35004089 PMCID: PMC8730823 DOI: 10.7759/cureus.20944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 01/03/2023] Open
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5
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Teshigawara A, Kimura T, Ichi S. Critical cerebellar hemorrhage due to pilocytic astrocytoma in a child: A case report. Surg Neurol Int 2021; 12:448. [PMID: 34621563 PMCID: PMC8492438 DOI: 10.25259/sni_430_2020] [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: 07/13/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cerebellar hemorrhage is rare in children, and its cause is usually vascular disorders such as arteriovenous malformations or hematological disorders. CASE DESCRIPTION A previously healthy 10-year-old girl presented with a loss of consciousness following sudden headache and vomiting. A non-contrast brain computed tomography (CT) scan revealed a massive cerebellar hemorrhage with obstructive hydrocephalus; however, subsequent CT angiography (CTA) showed no vascular abnormalities. An emergency craniotomy was performed to evacuate the hematoma, and histological analysis of the specimen obtained from the tissue surrounding the hematoma revealed a pilocytic astrocytoma (PA). Six months after the ictus, her recovery was scored at 2 on the modified Rankin Scale. CONCLUSION PA can be a cause of critical cerebellar hemorrhage. In this case of life-threatening massive hematoma, CTA was useful to exclude a major vascular pathology and to save time.
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Affiliation(s)
| | - Toshikazu Kimura
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
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6
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Ishi Y, Yamaguchi S, Hatanaka KC, Okamoto M, Motegi H, Kobayashi H, Terasaka S, Houkin K. Association of the FGFR1 mutation with spontaneous hemorrhage in low-grade gliomas in pediatric and young adult patients. J Neurosurg 2021; 134:733-741. [PMID: 32059187 DOI: 10.3171/2019.12.jns192155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to investigate genetic alterations in low-grade gliomas (LGGs) in pediatric and young adult patients presenting with spontaneous hemorrhage. METHODS Patients younger than 30 years of age with a pathological diagnosis of World Health Organization (WHO) grade I or II glioma and who had undergone treatment at the authors' institution were retrospectively examined. BRAF V600E, FGFR1 N546/K656, IDH1 R132, IDH2 R172, and KIAA1549-BRAF (K-B) fusion genetic alterations were identified, and the presence of spontaneous tumoral hemorrhage was recorded. RESULTS Among 66 patients (39 with WHO grade I and 27 with grade II tumors), genetic analysis revealed K-B fusion in 18 (27.3%), BRAF V600E mutation in 14 (21.2%), IDH1/2 mutation in 8 (12.1%), and FGFR1 mutation in 4 (6.1%). Spontaneous hemorrhage was observed in 5 patients (7.6%); 4 of them had an FGFR1 mutation and 1 had K-B fusion. Univariate analysis revealed a statistically significant association of an FGFR1 mutation and a diencephalic location with spontaneous hemorrhage. Among 19 diencephalic cases including the optic pathway, hypothalamus, and thalamus, an FGFR1 mutation was significantly associated with spontaneous hemorrhage (p < 0.001). Four FGFR1 mutation cases illustrated the following results: 1) a 2-year-old female with pilomyxoid astrocytoma (PMA) harboring the FGFR1 K656E mutation presented with intraventricular hemorrhage (IVH); 2) a 6-year-old male with PMA harboring FGFR1 K656E and D652G mutations presented with intratumoral hemorrhage (ITH); 3) a 4-year-old female with diffuse astrocytoma harboring FGFR1 K656M and D652G mutations presented with IVH; and 4) a young adult patient with pilocytic astrocytoma with the FGFR1 N546K mutation presented with delayed ITH and IVH after 7 years of observation. CONCLUSIONS Although the mechanism remains unclear, the FGFR1 mutation is associated with spontaneous hemorrhage in pediatric and young adult LGG.
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Affiliation(s)
- Yukitomo Ishi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Shigeru Yamaguchi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Kanako C Hatanaka
- 2Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Sapporo; and
| | - Michinari Okamoto
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Hiroaki Motegi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Hiroyuki Kobayashi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
- 3Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Shunsuke Terasaka
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
- 3Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Kiyohiro Houkin
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
- 3Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Toyohira-ku, Sapporo, Hokkaido, Japan
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7
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Abstract
Both the onset of various malignancies as well as the treatment of cancer can lead to neurologic symptoms which can be difficult to diagnose. In this review, we highlight the varied ways in which neurologic sequelae of cancer and its treatment manifest in children. Initial neurologic presentation may be secondary to mass effect or to immune-mediated paraneoplastic syndromes. Treatment effects on the nervous system may arise from surgery, chemotherapy, radiation, or bone marrow transplantation. In addition, the rapidly expanding field of immunotherapies for cancer has generated numerous new approaches to eradicating cancer including monoclonal antibodies, checkpoint inhibitors, and chimeric antigen receptor T cells (CAR-T cells), which have neurologic side effects mediated by immune responses that are also being recognized. Here we review common consult questions to the neurologist and our general approach to these scenarios including altered mental status, headaches, seizures, and sensorimotor complaints, considering the multifactorial nature of each.
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Affiliation(s)
- Caren Armstrong
- Department of Neurology, Johns Hopkins Hospital, 200 N Wolfe St Suite 2158, Baltimore, MD, 21287, USA
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins Hospital, 200 N Wolfe St Suite 2158, Baltimore, MD, 21287, USA.
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8
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Ahluwalia R, Rocque BG, Shannon CN, Blount JP. The impact of imposed delay in elective pediatric neurosurgery: an informed hierarchy of need in the time of mass casualty crisis. Childs Nerv Syst 2020; 36:1347-1355. [PMID: 32435890 PMCID: PMC7239607 DOI: 10.1007/s00381-020-04671-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Children, unlike adults, have dynamic anatomy and are still developing neural networks. Delaying seemingly elective surgery can affect a child's already vulnerable health state by further impacting their neurocognitive development, neurologic functioning, and potential long-term health states. The purpose of this paper is to demonstrate that "elective" pediatric neurosurgery should be risk-stratified, and multi-institutional informed guidelines established.
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Affiliation(s)
- Ranbir Ahluwalia
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
- Florida State University College of Medicine, 1115 W Call St., Tallahassee, FL, 32304, USA.
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey P Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA
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9
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Parenrengi MA, Aji YK. Multiple Lesions Accompanied by Postoperative Spontaneous Intracystic Hemorrhage in a Pediatric Patient with Pilocytic Astrocytoma. Asian J Neurosurg 2020; 15:409-413. [PMID: 32656142 PMCID: PMC7335113 DOI: 10.4103/ajns.ajns_308_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/30/2019] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
Pilocytic astrocytoma is the most common primary brain tumor in the pediatric population and has a classic imaging manifestation of a solitary, cyst-like mass with a strong contrast-enhancing mural nodule. Here, we report a case of multiple lesions in pilocytic astrocytoma in a pediatric patient accompanied by postoperative spontaneous intracystic hemorrhage. We describe the case of a 14-year-old female patient with a history of surgery for right cerebellar tumor 6 years ago. Computed tomography (CT) and magnetic resonance imaging showed cystic lesion with a mural nodule in the cerebellum and right retrothalamic area, suggesting a pilocytic astrocytoma. Emergency surgery was done. Pathology confirmed a pilocytic astrocytoma World Health Organization Grade 1. During postoperative course, clinical outcomes of the patient did not improve. Follow-up CT showed cystic remnant compressing the brain stem with spontaneous intracystic hemorrhage. The second surgery was done to evacuate the hemorrhage and to remove the cyst. Serial CT was made after the second surgery with no cyst growth nor hemorrhage present. Only three other pediatric multiple pilocytic astrocytomas have been reported previously, and there were only 11 publications about spontaneous intracystic hemorrhage in pediatric pilocytic astrocytoma. Our review of all previously reported cases found that the patients were predominantly male, and some had a history of neurofibromatosis type 1.
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Affiliation(s)
- Muhammad Arifin Parenrengi
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Yunus Kuntawi Aji
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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10
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Repeat Bleeding 18 Years After Hemorrhagic Pilocytic Astrocytoma: Prognostic Implications of Conservative Management-Case Report and Literature Review. World Neurosurg 2018; 123:328-338. [PMID: 30579034 DOI: 10.1016/j.wneu.2018.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute hemorrhagic occurrence of pilocytic astrocytomas is extremely rare but has become increasingly recognized and often presents in clinically emergent situations. The precise significance of hemorrhage in these tumors and its pathogenetic mechanisms have not yet been defined. Nothing is known about the natural history of bleeding pilocytic astrocytomas. CASE DESCRIPTION A 21-year-old man presented with acute biventricular hydrocephalus for repeat bleeding of a midbrain lesion that had been diagnosed 18 years earlier after a similar acute hemorrhagic episode. The patient had been initially treated conservatively, considering the high risk of surgery. He underwent urgent biventricular external shunt surgery and, subsequently, total removal of the lesion. Histopathological analysis revealed pilocytic astrocytoma. Including the present case, 59 cases were analyzed and reviewed, including 5 cases with a pilomyxoid variant. Different pathogenetic mechanisms have been proposed, including histological characteristics, rupture of the bridging veins torn by the neoplastic mass, and vascular instability determined by overexpression of vascular endothelial growth factor. CONCLUSIONS To the best of our knowledge, the presented case is completely unique owing to the long-term observational follow-up data available. The hemorrhagic potential did not decrease over time, representing a specific feature of this tumor. The occurrence of bleeding might not reflect either malignancy or aggressiveness. However, the worse prognosis is related to the clinical behavior, with life-threatening complications often associated. Surgery remains the standard treatment and will influence the final prognosis.
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11
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Sun S, Zhou H, Ding ZZ, Shi H. Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in the elderly: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e11329. [PMID: 30075500 PMCID: PMC6081062 DOI: 10.1097/md.0000000000011329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Pilocytic astrocytoma (PA) is the most common pediatric central nervous system glial tumor. Adult occurrence is rare, especially in elderly adults. How to manage the pilocytic astrocytoma with spontaneous intratumoral hemorrhage in the elderly is still unfamiliar with clinician. PATIENT CONCERNS Reports of tumors with intratumoral hemorrhage in elderly adults are extremely rare. We report a case of a 62-year-old male diagnosed with cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage. Informed consent was obtained from the patient. DIAGNOSES Histological examination of the specimens revealed pilocytic astrocytomas, including a hemorrhagic portion. INTERVENTIONS The patient underwent the radical resections of tumour and was given the regular follow-up. OUTCOMES 12 months later, he recovered without evidence of disease. LESSONS Cerebellar pilocytic astrocytomas associated with hemorrhages occur over the age of 60 is extremely rare. Removing the tumor and hematoma completely is the best treatment options. Long term follow-up is very necessary for this tumor.
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12
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Donofrio CA, Gagliardi F, Callea M, da Passano CF, Terreni MR, Cavalli A, Spina A, Acerno S, Bailo M, Elbabaa SK, Mortini P. Pediatric cerebellar pilocytic astrocytoma presenting with spontaneous intratumoral hemorrhage. Neurosurg Rev 2018; 43:9-16. [PMID: 29569086 DOI: 10.1007/s10143-018-0969-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 11/25/2022]
Abstract
Pilocytic astrocytomas (PAs) are benign glial tumors and one of the most common childhood posterior fossa tumors. Spontaneous intratumoral hemorrhage in PAs occurs occasionally, in about 8-20% of cases. Cerebellar hemorrhages in pediatric population are rare and mainly due to head injuries, rupture of vascular malformations, infections, or hematological diseases. We have investigated the still controversial and unclear pathophysiology underlying intratumoral hemorrhage in PAs. Bleeding in low-grade tumors might be related to structural abnormalities and specific angio-architecture of tumor vessels, such as degenerative mural hyalinization, "glomeruloid" endothelial proliferation, presence of encased micro-aneurysms, and glioma-induced neoangiogenesis. The acute hemorrhagic presentation of cerebellar PA in childhood although extremely uncommon is of critical clinical importance and necessitates promptly treatment. We described a case of hemorrhagic cerebellar PA in a 9-year-old child and reviewed the English-language literature that reported spontaneous hemorrhagic histologically proven cerebellar PA in pediatric patients (0-18 years). According to our analysis, the mortality was not related to symptom onset, tumor location, hemorrhage distribution, presence of acute hydrocephalous, and timing of surgery, while the GCS at hospital admission resulted to be the only statistically significant prognostic factor affecting survival outcome. The abrupt onset of signs and symptoms of acute hydrocephalous and consequent raised intracranial pressure are life-threatening conditions, which need emergent medical and neurosurgical treatments. At a later time, the identification of posterior fossa hemorrhage etiology is crucial to select the appropriate treatment and address the surgical strategy, optimizing the postoperative results.
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Affiliation(s)
- Carmine Antonio Donofrio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Marcella Callea
- Service of Pathology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Camillo Ferrari da Passano
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Rosa Terreni
- Service of Pathology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Cavalli
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Stefania Acerno
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Samer K Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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13
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Hemorrhagic presentation of intracranial pilocytic astrocytomas: literature review. Neurosurg Rev 2017; 42:97-106. [PMID: 28980149 DOI: 10.1007/s10143-017-0915-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/13/2017] [Accepted: 09/26/2017] [Indexed: 10/24/2022]
Abstract
Pilocytic astrocytomas (PAs) are seemingly innocuous and benign tumors. However, in recent times, many case series have documented high rates of hemorrhage in these neoplasms. We hereby provide a detailed analysis on hemorrhagic pilocytic astrocytomas (HPA) in adults and report one such case managed at our institute. In addition, salient differences between adult and pediatric hemorrhagic PA have been briefed. Hospital records were retrieved for our case. Literature review was conducted by searching online databases for the following keywords-pilocytic astrocytoma, hemorrhage, cranial, pediatric, and adults. A 22-year-old male with neurofibromatosis-1 presented with sudden onset headache and vomiting of 3-day duration. Imaging revealed a lobulated suprasellar lesion with obstructive hydrocephalus. Pterional transsylvian approach and subtotal resection were performed. Histopathology showed features of PA with bleed. Including current report, a total of 26 cases have been reported. Mean age was 37 years (21-75 years) and they are mostly found in the third decade. The male:female ratio was 2.1:1. Sudden headache with vomiting was the most common symptoms. Tumors were mostly located in cerebral hemispheres (n = 9/34.6%), hypothalamus/suprasellar region (n = 7/27%), and cerebellum (n = 6/23%). Two-thirds underwent gross total excision. There were two deaths and except one case, no recurrences were reported in those with available follow-ups. Hemorrhagic presentation of a PA is rare, although more commonly seen in adults and most commonly located in cerebral hemispheres. Maximal safe resection is the standard treatment and recurrences are rare.
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Gaha M, Bouzayen F, Limam Y, Mokni M, Jemni-Gharbi H, Tlili-Graiess K. Pilocytic astrocytoma mimicking cavernous angioma: Imaging features and histological characteristics. Neurochirurgie 2017; 63:330-333. [PMID: 28919136 DOI: 10.1016/j.neuchi.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/20/2017] [Accepted: 04/09/2017] [Indexed: 10/18/2022]
Abstract
Pilocytic astrocytoma (PA) commonly occurs during the first two decades of life. Typical locations include cerebellum, optic nerve, optic chiasm/hypothalamus and brainstem. PA should be considered in the differential diagnosis of patients with brain tumors manifesting with hemorrhagic onset. We report a case of a hemorrhagic onset of cerebellar PA in a young adult with imaging findings mimicking cavernous angioma. We also discuss imaging features and histological characteristics with a focus on the etiology of the hemorrhagic onset.
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Affiliation(s)
- M Gaha
- Department of radiology, Sahloul university hospital, university of Sousse, Sousse, Tunisia; Department of radiology, King Saud medical city, King Saud university, Riyadh, Saudi Arabia.
| | - F Bouzayen
- Department of radiology, Sahloul university hospital, university of Sousse, Sousse, Tunisia
| | - Y Limam
- Department of radiology, Sahloul university hospital, university of Sousse, Sousse, Tunisia
| | - M Mokni
- Department of pathology, Farhat Hached university hospital, university of Sousse, Sousse, Tunisia
| | - H Jemni-Gharbi
- Department of radiology, Sahloul university hospital, university of Sousse, Sousse, Tunisia
| | - K Tlili-Graiess
- Department of radiology, Sahloul university hospital, university of Sousse, Sousse, Tunisia
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