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Kameda-Smith MM, Ragulojan M, Elliott C, Bliss L, Moore H, Sader N, Alsuwaihel M, Tso MK, Dakson A, Ajani O, Yarascavitch B, Fleming A, Mehta V, Aminnejad M, Farrokhyar F, Singh SK. National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection. Childs Nerv Syst 2024; 40:1339-1347. [PMID: 38279985 DOI: 10.1007/s00381-024-06292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cerebellar mutism (CM) is characterized by a significant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate. Significant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts. METHODS A national multi-centered retrospective review of all children undergoing PF resection in four midsized Canadian academic pediatric institutions was undertaken. Patient, tumor and surgical factors associated with the post-operative development of CM were reviewed. Retrospective identification of PF surgery patients including those developing and those that did not (internal control). RESULTS The study identified 258 patients across the 4 centers between 2010 and 2020 (mean age 6.73 years; 42.2% female). Overall, CM was experienced in 19.5% of patients (N = 50). Amongst children who developed CM histopathology included medulloblastoma (35.7%), pilocytic astrocytoma (32.6%) and ependymoma (17.1%). Intraoperative impression of adherence to the floor of the 4th ventricle was positive in 36.8%. Intraoperative abrupt changes in blood pressure and/or heart rate were identified in 19.4% and 17.8% of cases. The clinical resolution of CM was rated to be complete, significant resolution, slight improvement, no improvement and deterioration in 56.0%, 8.0%, 20.0%, 14.0% and 2.0%, respectively. In the cohort of children who experienced post-operative CM as compared to their no-CM counterpart, proportionally more tumors were felt to be adherent to the floor of the 4th ventricle (56.0% vs 49.5%), intraoperative extent of resection was a GTR (74% vs 68.8%) and changes in heart rate were noted (≥ 20% from baseline) (26.0% vs 15.9%). However, a multiple regression analysis identified only abrupt changes in HR (OR 5.97, CI (1.53, 23.1), p = 0.01) to be significantly associated with the development of post-operative CM. CONCLUSION As a devastating surgical complication after posterior fossa tumor surgery with variable clinical course, identifying and understanding the operative cues and revising intraoperative plans that optimizes the child's neurooncological and clinical outcome are essential.
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Affiliation(s)
- Michelle M Kameda-Smith
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
- Great Ormond Street Hospital for Children, London, England.
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada.
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada.
| | - Malavan Ragulojan
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Cameron Elliott
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Lori Bliss
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Hanna Moore
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Nicholas Sader
- Division of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | | | - Michael K Tso
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Ayoub Dakson
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada
| | - Olufemi Ajani
- Great Ormond Street Hospital for Children, London, England
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Blake Yarascavitch
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Adam Fleming
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Vivek Mehta
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Minoo Aminnejad
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sheila K Singh
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
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Smalling S, Roberts J, Hendrick K, Gray M, Wyrwa JM. Vestibular Testing and Impairments in Postoperative Pediatric Cerebellar Mutism Syndrome: A Case Series. Pediatr Neurol 2024; 154:15-19. [PMID: 38447508 DOI: 10.1016/j.pediatrneurol.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Postoperative pediatric cerebellar mutism syndrome (CMS) may occur following a process affecting the posterior cranial fossa. Recent evidence demonstrates disabling and potentially lasting motor components of this syndrome, including ataxia, hemiparesis, and oculomotor dysfunction. These impairments may contribute to vestibular deficits. METHODS This case series contributes data to quantify vestibular dysfunction in postoperative CMS. The pair consisted of one female and one male. RESULTS Vestibular testing demonstrated both peripheral and central dysfunction. CONCLUSIONS Given these findings, a thorough vestibular assessment may be indicated as part of a comprehensive evaluation following a postoperative CMS diagnosis. Further research is needed to understand the pathophysiology, treatment, and long-term outcomes of postoperative pediatric CMS.
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Affiliation(s)
- Stephanie Smalling
- Department of Physical Therapy, Children's Hospital Colorado, Aurora, Colorado
| | - Jeremy Roberts
- Department of Physical Medicine & Rehabilitation, Department of Pediatric Rehabilitation, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
| | - Karen Hendrick
- Department of Audiology, Children's Hospital Colorado, Aurora, Colorado
| | - Margot Gray
- Department of Physical Therapy, Children's Hospital Colorado, Aurora, Colorado
| | - Jordan M Wyrwa
- Department of Physical Medicine & Rehabilitation, Department of Pediatric Rehabilitation, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
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Abidi R, Boussarsar A, Yahyaoui S, Aissaoui D, Mousli A, Kochbati L, Belaid A, Nasr C. Survival and prognostic factors in adult medulloblastoma: the Salah Azaiz Institute experience. Br J Neurosurg 2024; 38:472-475. [PMID: 33719800 DOI: 10.1080/02688697.2021.1895969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/28/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Medulloblastoma is the most common malignant brain tumor in children. This entity in adulthood is rare. The aim of our study is to evaluate therapeutic results and prognostic factors of adult medulloblastoma treated at our institute with post-operative radiotherapy. METHODS We retrospectively reviewed a cohort of 55 patients with medulloblastoma who underwent radiation in the department of radiation oncology of institute Salah Azaiz (Tunis) over a 18-year period (1994-2012). RESULTS The surgery was total or subtotal resection in 73% of cases. Forty-eight patients received radiotherapy to the entire craniospinal axis as part of the curative treatment. The median interval from surgery to the initiation of radiotherapy was 83 days. Etoposide-cisplatin chemotherapy was only performed in metastatic patients (n = 4). The 5-years and 10-years overall survival rates were respectively 53 and 34%. The dose of radiotherapy to the craniospinal axis was a prognostic factor. The 5-years and 10-years event-free-survival rates were 64 and 41%. Reduction in the dose of radiotherapy to the craniospinal axis and fourth ventricular floor involvement were correlated with a worse event-free survival. CONCLUSION Our results, compared to those of the literature, conclude that the reduction in the dose of radiotherapy to the craniospinal axis (<34 Gy) in the standard risk group of adult medulloblastoma could not be done without chemotherapy. In the high-risk group of adult medulloblastoma, radiotherapy to the cerebrospinal axis at the dose of 36 Gy with chemotherapy, is required for disease control.
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Affiliation(s)
- Rim Abidi
- Department of Radiation Oncology, Salah Azaiz Institute, Tunis, Tunisia
| | - Amal Boussarsar
- Department of Radiation Oncology, Salah Azaiz Institute, Tunis, Tunisia
| | - Safia Yahyaoui
- Department of Radiation Oncology, Salah Azaiz Institute, Tunis, Tunisia
| | - Dorra Aissaoui
- Department of Radiation Oncology, Salah Azaiz Institute, Tunis, Tunisia
| | - Alia Mousli
- Department of Radiation Oncology, Salah Azaiz Institute, Tunis, Tunisia
| | - Lotfi Kochbati
- Department of Radiation Oncology, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Asma Belaid
- Department of Radiation Oncology, Salah Azaiz Institute, Tunis, Tunisia
| | - Chiraz Nasr
- Department of Radiation Oncology, Salah Azaiz Institute, Tunis, Tunisia
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Svaldi C, Paquier P, Keulen S, van Elp H, Catsman-Berrevoets C, Kingma A, Jonkers R, Kohnen S, de Aguiar V. Characterising the Long-Term Language Impairments of Children Following Cerebellar Tumour Surgery by Extracting Psycholinguistic Properties from Spontaneous Language. Cerebellum 2024; 23:523-544. [PMID: 37184608 PMCID: PMC10951034 DOI: 10.1007/s12311-023-01563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
Following cerebellar tumour surgery, children may suffer impairments of spontaneous language. Yet, the language processing deficits underlying these impairments are poorly understood. This study is the first to try to identify these deficits for four levels of language processing in cerebellar tumour survivors. The spontaneous language of twelve patients who underwent cerebellar tumour surgery (age range 3-24 years) was compared against his or her controls using individual case statistics. A distinction was made between patients who experienced postoperative cerebellar mutism syndrome (pCMS) and those who did not. Time since surgery ranged between 11 months and 12;3 years. In order to identify the impaired language processing levels at each processing level (i.e., lexical, semantic, phonological and/or morphosyntactic) nouns and verbs produced in the spontaneous language samples were rated for psycholinguistic variables (e.g., concreteness). Standard spontaneous language measures (e.g., type-token ratio) were calculated as well. First, inter-individual heterogeneity was observed in the spontaneous language outcomes in both groups. Nine out of twelve patients showed language processing deficits three of whom were diagnosed with pCMS. Results implied impairments across all levels of language processing. In the pCMS-group, the impairments observed were predominantly morphosyntactic and semantic, but the variability in nature of the spontaneous language impairments was larger in the non-pCMS-group. Patients treated with cerebellar tumour surgery may show long-term spontaneous language impairments irrespective of a previous pCMS diagnosis. Individualised and comprehensive postoperative language assessments seem necessary, given the inter-individual heterogeneity in the language outcomes.
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Affiliation(s)
- Cheyenne Svaldi
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium.
- School of Psychological Sciences, Macquarie University, University Avenue, Macquarie Park, NSW, 2109, Australia.
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Newcastle University, Newcastle Upon Tyne, UK; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, , Groningen, the Netherlands.
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Avenue Franklin D. Roosevelt 50, 1050, Brussels, Belgium
- Department of Translational Neurosciences (TNW), Universiteit Antwerpen (UA), Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
| | - Henrieke van Elp
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
| | - Coriene Catsman-Berrevoets
- Department of Paediatric Neurology Erasmus Medical Centre, Sophia Children's Hospital Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Annet Kingma
- Department of Paediatrics, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Roel Jonkers
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
| | - Saskia Kohnen
- School of Psychological Sciences, Macquarie University, University Avenue, Macquarie Park, NSW, 2109, Australia
| | - Vânia de Aguiar
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
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Ho C, Crawford JR. Postoperative epidural enhancement in a child with metastatic medulloblastoma. BMJ Case Rep 2024; 17:e260468. [PMID: 38538097 PMCID: PMC10982746 DOI: 10.1136/bcr-2024-260468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Clarice Ho
- School of Medicine, University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - John Ross Crawford
- Pediatrics, University of California Irvine, Irvine, California, USA
- Pediatrics, Children's Hospital Orange County, Orange, USA
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Falco J, Broggi M, Rubiu E, Schiariti M, Restelli F, Mazzapicchi E, La Corte E, Ferroli P, Acerbi F. The Application of Sodium Fluorescein in Resection of Medulloblastoma Under YELLOW 560 Filter: Feasibility and Preliminary Results of a Monocentric Cohort and Systematic Review. World Neurosurg 2024; 183:e386-e394. [PMID: 38154682 DOI: 10.1016/j.wneu.2023.12.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Maximizing surgical resection of medulloblastoma (MB) affects overall survival; nevertheless, surgical resection remains a because of the infiltrative behavior of this tumor. Several dyes have been tested for improving tumor visualization; however, few reports with different protocols of fluorophores use are available and the results are inconsistent. Hence, we report our experience with sodium fluorescein in MB surgery, aiming to assess the role of this technique on the extent of resection. Furthermore, we performed a literature review of this topic. METHODS Fluorescence characteristics, extent of resection, and clinical outcome were analyzed in 9 consecutively operated patients with MB. A comprehensive literature search and review for English-language articles concerning fluorescein application in MB was conducted. RESULTS In our cohort, no side effect related to fluorescein occurred; all tumors presented with an intense or moderate yellow-green enhancement, and fluorescein was judged fundamental in distinguishing tumors from viable tissue in 7 of 9 cases. Gross total resection or near-total resection (i.e., a residual tumor volume <1.5 cm3) was achieved in 8 patients. The review explored the different techniques and surgical interpretations as well as surgical radicality; we did not find a homogenous protocol for fluorescein injection in the published articles. Fluorescence appeared moderate or intense in almost all cases, with a high percentage of usefulness and consensual achievement of a high rate of gross total resection. CONCLUSIONS Based on these results, we can infer that fluorescein-guided surgical resection is a safe and valuable method for patients with MB.
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Affiliation(s)
- Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy; Department of Neurosurgery, Experimental Microsurgical Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Del Baldo G, Cecinati V, Colafati GS, Carai A, Mastronuzzi A. Response to: Trigeminal nerve chronic motor denervation caused by cerebellar peduncle pilocytic astrocytoma. Childs Nerv Syst 2024; 40:611-612. [PMID: 38133685 PMCID: PMC10891178 DOI: 10.1007/s00381-023-06230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Giada Del Baldo
- Department of Pediatric Haematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valerio Cecinati
- Complex Structure of Pediatrics and Pediatric Oncohematology, "Nadia Toffa", Central Hospital Santissima Annunziata, Taranto, Italy
| | - Giovanna Stefania Colafati
- Department of Diagnostic Imaging Oncological Neuroradiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Haematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Xue J, Mo C. A case report of cerebellar hemangioblastoma simulated brain metastasis shown by magnetic resonance imaging. Medicine (Baltimore) 2024; 103:e37162. [PMID: 38335432 PMCID: PMC10860963 DOI: 10.1097/md.0000000000037162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE Hemangioblastomas occur both sporadically and as an important component of von Hippel-Lindau (VHL) disease. The typical MRI features of hemangioblastoma are cysts with enhanced cystic wall nodules in the cerebellum or lesions with uniform enhancement on the surface or inside the spinal cord. If there is edema around hemangioblastoma, it is easy to be misdiagnosed as brain metastasis on MRI. PATIENT CONCERNS A 41-year-old male patient was found to have a lump in the pancreas during a health examination 3 months ago. Subsequently, the patient underwent surgical treatment. The postoperative pathology suggests that the pancreatic lesion is a neuroendocrine tumor. The patient subsequently came to our hospital for consultation on further treatment plans. Abnormal signals were found in the right cerebellum during pituitary magnetic resonance imaging (MRI) before the development of a treatment plan for neuroendocrine tumors. Subsequently, the patient underwent cerebellar mass resection surgery. The pathological result after the surgery was hemangioblastoma. DIAGNOSIS The patient underwent surgery to remove the tumor and was diagnosed with hemangioblastoma by pathological examination. Subsequently, the patient's genetic testing results confirmed the diagnosis of VHL syndrome. INTERVENTIONS The patient underwent cerebellar mass resection surgery. OUTCOMES The patient recovered after surgical resection. LESSONS In this report, we emphasize the atypical MRI manifestations of hemangioblastoma. For patients with VHL syndrome-related hemangioblastoma, genetic testing is necessary for the patient and their family members.
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Affiliation(s)
- Jiaxing Xue
- Department of Neurosurgery, People’s Hospital of Dingzhou, Dingzhou, China
| | - Chenlong Mo
- Department of Neurosurgery, People’s Hospital of Dingzhou, Dingzhou, China
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9
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Fang CH, Wen C, Yang B, Song YH, Liu HQ, Tian L, Chen H, Bao N. Development and validation of a nomogram and risk stratification system to predict overall survival after surgical repair for pediatric patients with medulloblastoma based on easily accessible variables. Eur Rev Med Pharmacol Sci 2024; 28:969-980. [PMID: 38375704 DOI: 10.26355/eurrev_202402_35363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE This study aimed to develop and validate a nomogram and risk stratification system for the overall survival of pediatric patients with medulloblastoma after surgical repair. PATIENTS AND METHODS In this multicenter, retrospective study, consecutive patients who underwent surgery for medulloblastoma at Shanghai Children's Medical Center and the First Affiliated Hospital of Fujian Medical University from 2010 to 2022 formed the training and external validation datasets, respectively. Univariable and multivariable Cox regression analyses were performed to identify variables associated with mortality in the training dataset. A nomogram prediction model was developed based on independent variables in the multivariable Cox regression analysis to predict the 1-, 3-, and 5-year overall survival. The area under receiver operating characteristic curve (AUC) and calibration curve were used to evaluate the discrimination and calibration of the nomogram. A risk stratification system based on the median risk score was also established to divide patients into two risk groups. RESULTS In the training dataset, Cox regression analyses identified tumor size, brainstem involvement and chemotherapy as independent predictors for overall survival. The AUC of the nomogram was 0.75 at 1 year, 0. 75 at 3 years, 0.77 at 5 years in the training dataset, 0.74 at 1 year, 0.70 at 3 years, and 0.70 at 5 years in the validation dataset. The calibration curve for the probability of 1-, 3-, and 5-year survival showed good agreement between the nomogram prediction and actual observation in the training and validation datasets. The risk stratification system could perfectly classify patients into two risk groups, and the overall survival in the two groups had a good division. CONCLUSIONS This low-cost, convenient, and noninvasive nomogram can be translated into clinical practice as a tool for risk stratification and individualized prognosis prediction for children with medulloblastoma.
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Affiliation(s)
- C-H Fang
- Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Carrete LR, Morshed RA, Young JS, Avalos LN, Sneed PK, Aghi MK, McDermott MW, Theodosopoulos PV. Analysis of upfront resection or stereotactic radiosurgery for local control of solid and cystic cerebellar hemangioblastomas. J Neurosurg 2024; 140:404-411. [PMID: 37542443 DOI: 10.3171/2023.6.jns222629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/04/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The purpose of this study was to identify rates of and risk factors for local tumor progression in patients who had undergone surgery or radiosurgery for the management of cerebellar hemangioblastoma and to describe treatments pursued following tumor progression. METHODS The authors conducted a retrospective single-center review of patients who had undergone treatment of a cerebellar hemangioblastoma with either surgery or stereotactic radiosurgery (SRS) between 1996 and 2019. Univariate and multivariate regression analyses were performed to examine factors associated with local tumor control. RESULTS One hundred nine patients met the study inclusion criteria. Overall, these patients had a total of 577 hemangioblastomas, 229 of which were located in the cerebellum. The surgical and SRS cohorts consisted of 106 and 123 cerebellar hemangioblastomas, respectively. For patients undergoing surgery, tumors were treated with subtotal resection and gross-total resection in 5.7% and 94.3% of cases, respectively. For patients receiving SRS, the mean target volume was 0.71 cm3 and the mean margin dose was 18.0 Gy. Five-year freedom from lesion progression for the surgical and SRS groups was 99% and 82%, respectively. The surgical and SRS cohorts contained 32% versus 97% von Hippel-Lindau tumors, 78% versus 7% cystic hemangioblastomas, and 12.8- versus 0.56-cm3 mean tumor volumes, respectively. On multivariate analysis, factors associated with local tumor progression in the SRS group included older patient age (HR 1.06, 95% CI 1.03-1.09, p < 0.001) and a cystic component (HR 9.0, 95% CI 2.03-32.0, p = 0.001). Repeat SRS as salvage therapy was used more often for smaller tumor recurrences, and no tumor recurrences of < 1.0 cm3 required additional salvage surgery following repeat SRS. CONCLUSIONS Both surgery and SRS achieve high rates of local control of hemangioblastomas. Age and cystic features are associated with local progression after SRS treatment for cerebellar hemangioblastomas. In cases of local tumor recurrence, salvage surgery and repeat SRS are valid forms of treatment to achieve local tumor control, although resection may be preferable for larger recurrences.
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Affiliation(s)
| | | | | | | | - Penny K Sneed
- 2Radiation Oncology, University of California, San Francisco, California
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Bush S, Klimo P, Onar-Thomas A, Huang J, Boop FA, Gajjar A, Robinson GW, Khan RB. Application of the Rotterdam postoperative cerebellar mutism syndrome prediction model in patients undergoing surgery for medulloblastoma in a single institution. J Neurosurg Pediatr 2024; 33:174-178. [PMID: 38000061 PMCID: PMC10810679 DOI: 10.3171/2023.9.peds23160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/25/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Postoperative cerebellar mutism syndrome (CMS) develops in up to 40% of children with medulloblastoma. The Rotterdam model (RM) has been reported to predict a 66% risk of CMS in patients with a score of ≥ 100. The aim of this study was to retrospectively apply the RM to an independent cohort of patients with newly diagnosed medulloblastoma and study the applicability of the RM in predicting postoperative CMS. METHODS Participants had to have their first tumor resection at the authors' institution and be enrolled in the SJMB12 protocol (NCT01878617). All participants underwent structured serial neurological evaluations before and then periodically after completing radiation therapy. Imaging was reviewed by the study neurologist who was blinded to CMS status when reviewing the scans and retrospectively applied RM score to each participant. RESULTS Forty participants were included (14 females and 26 males). Four (10%) patients had CMS. The median age at tumor resection was 11.7 years (range 3.5-17.8 years). Tumor location was midline in 30 (75%), right lateral in 6 (15%), and left lateral in 4 (10%). The median Evans index was 0.3 (range 0.2-0.4), and 34 (85%) patients had an Evans index ≥ 0.3. Five participants required a ventricular shunt. The median tumor volume was 51.97 cm3 (range 20.13-180.58 cm3). Gross-total resection was achieved in 35 (87.5%) patients, near-total resection in 4 (10%), and subtotal in 1. The median RM score was 90 (range 25-145). Eighteen participants had an RM score of ≥ 100, and of these 16.7% (n = 3) had CMS. Of the 22 patients with an RM score < 100, 1 child developed CMS (4.5%, CI 0.1%-22.8%); 3 of the 18 patients with an RM score ≥ 100 developed CMS (16.7%, CI 3.6%-41.4%). The observed rate of CMS in the cohort of children with an RM score ≥ 100 was significantly lower than the observed rate in the original RM cohort (66.7%, CI 51%-80.0%, p < 0.001). A greater risk of CMS in patients with an RM score ≥ 100 could not be confirmed (p = 0.31). CONCLUSIONS At the authors' institution, the incidence of CMS in patients who had an RM ≥ 100 was significantly lower than the RM cohort. These findings raise questions regarding generalizability of RM; however, fewer cases of CMS and a relatively small cohort limit this conclusion.
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Affiliation(s)
- Savannah Bush
- University of Tennessee, School of Medicine, Memphis
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee, Memphis
| | | | | | | | | | | | - Raja B. Khan
- Division of Neurology, St. Jude Children’s Research Hospital, Memphis, Tennessee
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12
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Svaldi C, Ntemou E, Jonkers R, Kohnen S, de Aguiar V. Language outcomes in children who underwent surgery for the removal of a posterior fossa tumor: A systematic review. Eur J Paediatr Neurol 2024; 48:129-141. [PMID: 38377646 DOI: 10.1016/j.ejpn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Children who underwent posterior fossa tumor removal may have spoken or written language impairments. The present systematic review synthesized the literature regarding the language outcomes in this population. Benefits of this work were the identification of shortcomings in the literature and a starting point toward formulating guidelines for postoperative language assessment. METHODS A systematic literature search was conducted, identifying studies with patients who had posterior fossa surgery before 18 years of age. Included studies were narratively synthesized to understand language outcomes by language function (e.g., phonology, morphosyntax) at a group and individual level. Furthermore, the influence of several mediators (e.g., postoperative cerebellar mutism syndrome (pCMS), tumor type) was investigated. A critical evaluation of the language assessment tools was conducted. RESULTS The narrative synthesis of 66 studies showed that a broad spectrum of language impairments has been described, characterized by a large interindividual heterogeneity. Patients younger at diagnosis, receiving treatment for a high-grade tumor and/or radiotherapy and diagnosed with pCMS seemed more prone to impairment. Several gaps in language assessment remain, such as a baseline preoperative assessment and the assessment of pragmatics and morphosyntax. Further, there were important methodological differences in existing studies which complicated our ability to accurately guide clinical practice. CONCLUSION Children who had posterior fossa surgery seem to be at risk for postoperative language impairment. These results stress the need for language follow-up in posterior fossa tumor survivors.
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Affiliation(s)
- Cheyenne Svaldi
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands.
| | - Effy Ntemou
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands; Linguistics Department, University of Potsdam, Haus 14, Karl-Liebknecht-Strasse 24-25, 14476, Potsdam, Germany.
| | - Roel Jonkers
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
| | - Saskia Kohnen
- School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia.
| | - Vânia de Aguiar
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
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Valetopoulou A, Aquilina K, Rennie A, Ganesan V, James G, Silva AHD. Rupture of a flow aneurysm secondary to spontaneous extracranial to intracranial revascularisation in the posterior fossa following radiation-induced vasculopathy for cerebellar tumour. Childs Nerv Syst 2024; 40:239-243. [PMID: 37594564 DOI: 10.1007/s00381-023-06126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
Paediatric patients receiving cranial irradiation therapy for brain tumours are at increased risk of cerebrovascular complications. Radiation-induced moyamoya syndrome (MMS) is a well-recognised complication of this. We present a case of an 8-year-old boy with a history of medulloblastoma, who underwent surgical excision followed by post-operative adjuvant oncological treatment. Six years later, he developed cerebellar/intraventricular haemorrhage. He underwent an emergency external ventricular drain (EVD) insertion followed by posterior fossa suboccipital craniotomy. On dural opening, an abnormal vessel was visualised on the surface of the right cerebellar hemisphere, which was not disturbed. No obvious abnormalities were identified intra-operatively. Cerebral catheter angiography confirmed the presence of a right-sided occipital artery (OA) to posterior inferior cerebellar artery (PICA) extracranial to intracranial (EC-IC) bypass with a zone of the distal PICA territory supplied by this EC-IC bypass. A presumed flow aneurysm originated from the bypass in the distal PICA, identified as cause for the haemorrhage. We highlight a rare cause for intracranial haemorrhage in this cohort of patients. Children who have undergone radiotherapy may have exquisitely sensitive cerebral vasculature and need careful vigilance and evaluation for vasculopathic complications following spontaneous haemorrhage.
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Affiliation(s)
- A Valetopoulou
- Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
| | - K Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - A Rennie
- Department of Interventional Neuroradiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - V Ganesan
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - G James
- Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - A H D Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Staribacher D, Kuzmin D, Britz G, Feigl GC. Surgical corridor formation by minimally invasive lateral occipital infracortical supra-/transtentorial (OICST) approach in pineal region tumor surgery: A review of 11 cases. Clin Neurol Neurosurg 2024; 236:108073. [PMID: 38091704 DOI: 10.1016/j.clineuro.2023.108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/19/2023] [Accepted: 11/26/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION The pineal region is a hard-to-reach part of the brain. There is no unequivocal opinion on the choice of a surgical approach to the pineal region. The surgical approaches described differ in both trajectory (infra- and supratentorial, interhemispheric) and size of craniotomy. They have advantages and disadvantages. The minimally invasive lateral occipital infracortical supra-/transtentorial (OICST) approach we have described has all the advantages of the standard supratentorial approach and minimizes its disadvantages, namely, compression and contusion of the occipital lobe. The minimally invasive craniotomy and small surgical corridor facilitate that. METHODS We describe 11 consecutive patients with various pineal region tumors (7 cases of pineal cysts, 2 cases of pinealocytoma, 1 case of medulloblastoma, and 1 case of meningioma) who were operated on in our hospital using the lateral OICST approach. Preoperative planning was performed using Surgical Theater®. The surgical corridor was formed using a retractor made from half of a syringe shortened according to the length of the surgical corridor. Preoperative lumbar drain was used. RESULTS The pineal region tumors were completely resected in all cases. The mean craniotomy size was 2.22 × 1.79 cm. No long-term neurological deficits were reported. CONCLUSIONS The use of semicircular retractors and intraoperative CSF drainage via a lumbar drain allows to form a small surgical corridor to the pineal region via minimally invasive craniotomy. This reduces traction and traumatization of the occipital lobe, as well as minimizes intra- and postoperative risks.
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Affiliation(s)
| | - Dzmitry Kuzmin
- Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany
| | - Gavin Britz
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Guenther C Feigl
- Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany; Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany; Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, USA.
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15
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Liu H, Sun P. A Nomogram Model for Predicting Prognosis of Patients with Medulloblastoma. Turk Neurosurg 2024; 34:38-45. [PMID: 37309623 DOI: 10.5137/1019-5149.jtn.40397-22.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM To identify the prognostic factors associated with cancer-specific survival in medulloblastoma (MB), and to use them for establishing a nomogram model to predict cancer-specific survival. MATERIAL AND METHODS In total, 268 patients with MB were included; they were rigorously respectively screened from the Surveillance, Epidemiology, and End Results database from 1988 to 2015 and statistically analyzed in R language. This study focused on cancer-specific death and used the cox regression analysis for variable filtering. The model was calibrated using C-index, area under the curve (AUC), and calibration curve. RESULTS As per our findings, it was determined that extension (localized: hazard ratio [HR]=0.5899, p=0.00963; further extension: indicator) and treatment modality (radiation after surgery chemotherapy sequence unknown: HR=0.3646, p=0.00192; no surgery: indicator) were statistically significant in the prognosis of MB and were finally utilized to construct a nomogram model for predicting the condition. The AUC values were 0.649, 0.629, and 0.64 at 2, 3, and 5 years, respectively. CONCLUSION Tumor extension and treatment modality were independent prognostic factors for MB.
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Affiliation(s)
- Hui Liu
- Affiliated Hospital of Qingdao University, Department of Neurosurgery, Qingdao, China
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16
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Haratek K, Bubeníková A, Entenmann CJ, Tomášek M, Zápotocký M, Sumerauer D, Kynčl M, Koblížek M, Libý P, Tichý M, Bradáč O, Beneš V. Predictors of postoperative complications and functional outcomes in pediatric patients with surgically treated fourth ventricle tumors. Acta Neurochir (Wien) 2023; 165:4279-4292. [PMID: 37535206 DOI: 10.1007/s00701-023-05729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Tumors of the fourth ventricle are frequently treated pathologies in pediatric neurosurgery. Data regarding predictors for permanent neurological deficits, long-term functional outcomes, cerebellar mutism (CM), the extent of resection (EOR), and oncological outcomes are scarce. We attempt to contribute to this topic with an analysis of our institutional cohort. METHODS A retrospective single-center study of patients aged ≤ 19 years who underwent primary surgical resection of a fourth ventricular tumor over a 15-year period (2006-2021). Predictors analyzed included age, gender, surgical approach, anatomical pattern, tumor grade, EOR, tumor volume, and others as appropriate. RESULTS One hundred six patients were included (64 males, mean age 7.3 years). The rate of permanent neurological deficit was 24.2%; lateral tumor extension (p = 0.036) and tumor volume greater than 38 cm3 (p = 0.020) were significant predictors. The presence of a deficit was the only significant predictor of reduced (less than 90) Lansky score (p = 0.005). CM occurred in 20.8% of patients and was influenced by medulloblastoma histology (p = 0.011), lateral tumor extension (p = 0.017), and male gender (p = 0.021). No significant difference between the transvermian and telovelar approach in the development of CM was detected (p = 0.478). No significant predictor was found for the EOR. EOR was not found to be a significant predictor of overall survival for both low-grade and high-grade tumors; however, gross total resection (GTR) was protective against tumor recurrence compared to near-total or subtotal resection (p < 0.001). In addition, survival was found to be better in older patients (≥ 7.0 years, p = 0.019). CONCLUSION The overall rate of postoperative complications remains high due to the eloquent localization. Older patients (> 7 years) have been found to have better outcomes and prognosis. Achieving GTR whenever feasible and safe has been shown to be critical for tumor recurrence. CM was more common in patients with medulloblastoma and in patients with tumors extending through the foramen of Luschka. The telovelar approach uses a safe and anatomically sparing corridor; however, it has not been associated with a lower incidence of CM and neurological sequelae in our series, showing that each case should be assessed on an individual basis.
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Affiliation(s)
- Kryštof Haratek
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Adéla Bubeníková
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | | | - Martin Tomášek
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
| | - Michal Zápotocký
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
- Department of Pediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - David Sumerauer
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
- Department of Pediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin Kynčl
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
- Department of Radiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Miroslav Koblížek
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Petr Libý
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
| | - Michal Tichý
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
- Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, 150 06, Prague 5, Prague, Czech Republic.
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Assi J, Chyta M, Mavridis I. Lhermitte-Duclos disease with concomitant KCNT2 gene mutation: report of an extremely rare combination. Childs Nerv Syst 2023; 39:3295-3299. [PMID: 37368068 DOI: 10.1007/s00381-023-06039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
Lhermitte-Duclos disease (LDD) refers to cerebellar dysplastic gangliocytoma, a slow-growing tumor. Pathogenic variants of voltage-gated potassium channels have been associated with epilepsy of variable severity. These include the sodium-activated potassium channel subfamily T member 2 (KCNT2) gene, which encodes for pore-forming alpha subunits. KCNT2 gene mutations have been recently described to cause developmental and epileptic encephalopathies (DEEs). The purpose of the present article is to describe an extremely rare case of a young child who has both LDD and KCNT2 mutation. Our patient is an 11-year-old boy who presented with an absence episode, and his investigations revealed electroencephalography (EEG) abnormalities, LDD, and a heterozygous KCNT2 mutation. Regarding LDD patients, epileptic seizures have been reported in very few cases. Reports of patients with mutated KCNT2 variants are also extremely rare. It is for sure that LDD and KCNT2 mutation is an extremely rare combination. Although further follow-up is mandatory in order to draw safe conclusions for our case, the available data support that our patient is either the first reported case of a subclinical KCNT2 mutation or the first case of its clinical expression in late childhood so far.
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Affiliation(s)
- Jeries Assi
- School of Medicine, Faculty of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marianna Chyta
- School of Medicine, Faculty of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Mavridis
- School of Medicine, Faculty of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece.
- Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
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Selim FM, Elshafey MA, El-Ayadi MM, Albeltagi DM, Ali MS. Efficacy of dual-task training on stability and function in children with ataxia after medulloblastoma resection: A randomized controlled trial. Pediatr Blood Cancer 2023; 70:e30613. [PMID: 37561355 DOI: 10.1002/pbc.30613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND/OBJECTIVE In children, medulloblastoma (MB) is the most prevalent posterior fossa tumor. The first line of treatment is maximal safe resection. Therefore, symptoms of ataxia are commonly seen. Training the brain on balance and cognitive tasks makes balance more automatic than without cognitive tasks. The goal was to assess the effectiveness of dual-task practice on balance after MB excision in children with ataxia. METHODS Thirty children with ataxia after MB resection at Children Cancer Hospital Egypt were randomized into two equal groups. Exercises for mobility, balance, and gait training were given to both groups. The research group underwent a specific dual-task program (balance and cognitive). The program ran 3 days per week for 8 weeks. Children were evaluated before and after the treatment regimen using the Scale of Assessment and Rating of Ataxia (SARA), the HUMAC Balance System, Pediatric Balance Scale, and Functional Independent Measurement. All children's legal guardians signed an ethical agreement. RESULTS A notable improvement in balance was found in the dual group in Pediatric Balance Scale (PBS) (p = .028) and stability test (p = .0001) in favor of the study group. No discernible difference was observed in the Functional Independent Measurement score among the two groups (p = .158), although there was a statistically significant increase in both groups after treatment. CONCLUSION Dual-task program is more effective than traditional physical therapy alone in improving balance in children with ataxia after MB resection.
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Affiliation(s)
- Fatma M Selim
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Dokki, Egypt
| | - Mohamed A Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Dokki, Egypt
| | - Moatasem M El-Ayadi
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children Cancer Hospital Egypt (CCHE-57357), Dokki, Egypt
| | - Doaa M Albeltagi
- Clinical Research Center, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Mostafa S Ali
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Dokki, Egypt
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, 6th of October University, 6th of October City, Egypt
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Kakodkar P, Houlihan LM, Preul M, Bermingham N, Lim C. Primary and metastatic paraganglioma of the cranial vault. Br J Neurosurg 2023; 37:967-975. [PMID: 33739182 DOI: 10.1080/02688697.2021.1902477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
AIM Primary paragangliomas (PGs) are extra-adrenal neuroendocrine tumours that are extremely rare. Multiple lesions in the central nervous system raise suspicion of a metastatic process. Lack of consensus on their management warrants the categorization of existing literature to evaluate management options. METHODS A systematic review of the medical literature on paraganglioma within the cranial vault was completed in accordance with PRISMA guidelines using the Medline database. Tumour physical measures, management parameters, and immunohistochemistry of all documented cases of primary and secondary paraganglioma within the cranial vault were descriptively compared. This review was augmented by comparison with our centre's case of a 48-year-old man diagnosed with metastatic PG originating in the cauda equina and seeding in the cerebellum. Histological parameters within the literature was also established. RESULTS The systematic literature review yielded published 52 papers. Most prevalent primary intracranial PGs (n = 37) were in the sellar region (78%, n = 23) and the cerebellum (21%, n = 6). The highest progression free survival was seen in primary sellar PGs (87.5% by 34.5 months) and cerebellar PGs (100% by 35.7 months) when treated with adjuvant radiotherapy with subtotal resection or gross total resection, respectively. Contrasting, the most frequent intracranial PGs metastases (n = 15) occurred in the cerebellum (36%, n = 6), and the cerebral parenchyma (29%, n = 4). Their recurrence rate was between 4 and 10% and these metastasized PG in the cerebellum are slow growing (8.9 years, range: 3-22 years). Adjuvant radiotherapy with Gross Total Resection resulted in the optimum progression-free survival (100% up to 48 months) for the patient with PGs metastasis to the cerebellum. CONCLUSION Metastatic PGs tend to be slow-growing and are clinically silent tumours. Diagnosed patients should undergo regular surveillance neuroradiological assessment, regardless of symptomatology, for metastases along the complete neural axis. We recommend operative management with GTR and adjunct RT in these patients.
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Affiliation(s)
- Pramath Kakodkar
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Lena Mary Houlihan
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Mark Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Niamh Bermingham
- Department of Neuropathology, Cork University Hospital, Cork, Ireland
| | - Chris Lim
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
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20
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Fukuoka K, Kurihara J, Shofuda T, Kagawa N, Yamasaki K, Ando R, Ishida J, Kanamori M, Kawamura A, Park YS, Kiyotani C, Akai T, Keino D, Miyairi Y, Sasaki A, Hirato J, Inoue T, Nakazawa A, Koh K, Nishikawa R, Date I, Nagane M, Ichimura K, Kanemura Y. Subtyping of Group 3/4 medulloblastoma as a potential prognostic biomarker among patients treated with reduced dose of craniospinal irradiation: a Japanese Pediatric Molecular Neuro-Oncology Group study. Acta Neuropathol Commun 2023; 11:153. [PMID: 37749662 PMCID: PMC10521425 DOI: 10.1186/s40478-023-01652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND One of the most significant challenges in patients with medulloblastoma is reducing the dose of craniospinal irradiation (CSI) to minimize neurological sequelae in survivors. Molecular characterization of patients receiving lower than standard dose of CSI therapy is important to facilitate further reduction of treatment burden. METHODS We conducted DNA methylation analysis using an Illumina Methylation EPIC array to investigate molecular prognostic markers in 38 patients with medulloblastoma who were registered in the Japan Pediatric Molecular Neuro-Oncology Group and treated with reduced-dose CSI. RESULTS Among the patients, 23 were classified as having a standard-risk and 15 as high-risk according to the classic classification based on tumor resection rate and presence of metastasis, respectively. The median follow-up period was 71.5 months (12.0-231.0). The median CSI dose was 18 Gy (15.0-24.0) in both groups, and 5 patients in the high-risk group received a CSI dose of 18.0 Gy. Molecular subgrouping revealed that the standard-risk cohort included 5 WNT, 2 SHH, and 16 Group 3/4 cases; all 15 patients in the high-risk cohort had Group 3/4 medulloblastoma. Among the patients with Group 3/4 medulloblastoma, 9 of the 31 Group 3/4 cases were subclassified as subclass II, III, and V, which were known to an association with poor prognosis according to the novel subtyping among the subgroups. Patients with poor prognostic subtype showed worse prognosis than that of others (5-year progression survival rate 90.4% vs. 22.2%; p < 0.0001). The result was replicated in the multivariate analysis (hazard ratio12.77, 95% confidence interval for hazard ratio 2.38-99.21, p value 0.0026 for progression-free survival, hazard ratio 5.02, 95% confidence interval for hazard ratio 1.03-29.11, p value 0.044 for overall survival). CONCLUSION Although these findings require validation in a larger cohort, the present findings suggest that novel subtyping of Group 3/4 medulloblastoma may be a promising prognostic biomarker even among patients treated with lower-dose CSI than standard treatment.
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Affiliation(s)
- Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shin-Toshin, Saitama, 330-8777, Japan.
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoko Shofuda
- Department of Biomedical Research and Innovation, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kai Yamasaki
- Department of Pediatric Hematology and Oncology, Osaka City General Hospital, Osaka, Japan
| | - Ryo Ando
- Department of Neurosurgery, Chiba Children's Hospital, Chiba, Japan
| | - Joji Ishida
- Department of Neurological Surgery, Okayama University Graduate School, Okayama, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsufumi Kawamura
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Chikako Kiyotani
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takuya Akai
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
| | - Dai Keino
- Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yosuke Miyairi
- Department of Neurosurgery, Nagano Children's Hospital, Azumino, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Saitama, Japan
| | - Junko Hirato
- Department of Pathology, Public Tomioka General Hospital, Gunma, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Atsuko Nakazawa
- Department of Clinical Research, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, 1-2, Shin-Toshin, Saitama, 330-8777, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School, Okayama, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yonehiro Kanemura
- Department of Biomedical Research and Innovation, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Japan
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Inoue M, Oya S, Yamaga T, Tajima T, Hanakita S. Pearls & Oy-sters: Cognitive and Affective Dysfunction Caused by a Small Cerebellar Hemangioblastoma. Neurology 2023; 101:e1272-e1275. [PMID: 37407260 PMCID: PMC10516281 DOI: 10.1212/wnl.0000000000207509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/24/2023] [Indexed: 07/07/2023] Open
Abstract
The primary function of the cerebellum is the coordination and regulation of movement; therefore, cerebellar tumors usually present with ataxia, dysarthria, and vertigo. Large tumors also cause elevated intracranial pressure that may lead to a disturbance of consciousness. Furthermore, it has become increasingly evident that the cerebellum plays a substantial role in cognitive and affective processing. A 44-year-old female patient presented with a 1-month history of depression and flat affect. She had no cerebellar symptoms including no coordination dysfunction or dysarthria. Cognitive function tests revealed impairments in attention, execution, and processing speed. Hamilton Depression Scale and Hospital Anxiety Depression Scale indicated moderate-to-severe depression. Magnetic resonance (MR) imaging revealed a 7-mm enhancing lesion in the culmen of the cerebellar vermis with surrounding edema. Technetium-99m ethyl cysteinate dimer single-photon emission tomography (SPECT) showed hypoperfusion in the left frontal lobe. Although she was initially treated with corticosteroids for presumed sero-negative autoimmune encephalitis, her symptoms persisted. She then underwent cerebellar lesion resection. The histologic diagnosis was hemangioblastoma. The patient's symptoms dramatically improved within 1 week of resection, including improved batteries for cognitive function and depression. Complete regression of cerebellar edema and left frontal lobe hypoperfusion was observed on MR and SPECT images, respectively. This case reiterates the crucial influence of the cerebellum on cognitive and affective function. Moreover, cognitive dysfunction may be masked in cases with focal cerebellar symptoms or elevated intracranial pressure and, consequently, not adequately evaluated.
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Affiliation(s)
- Mizuho Inoue
- From the Department of Neurosurgery (M.I., S.O., S.H.), and Department of Neurology (T.Y., T.T.), Saitama Medical Center, Kawagoe, Japan
| | - Soichi Oya
- From the Department of Neurosurgery (M.I., S.O., S.H.), and Department of Neurology (T.Y., T.T.), Saitama Medical Center, Kawagoe, Japan.
| | - Tetsuo Yamaga
- From the Department of Neurosurgery (M.I., S.O., S.H.), and Department of Neurology (T.Y., T.T.), Saitama Medical Center, Kawagoe, Japan
| | - Takashi Tajima
- From the Department of Neurosurgery (M.I., S.O., S.H.), and Department of Neurology (T.Y., T.T.), Saitama Medical Center, Kawagoe, Japan
| | - Shunya Hanakita
- From the Department of Neurosurgery (M.I., S.O., S.H.), and Department of Neurology (T.Y., T.T.), Saitama Medical Center, Kawagoe, Japan
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22
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Zhou W, Zhang H, An X, Li C, Gong J, Liu W, Sun T, Zhao F, Tian YJ. A nomogram for predicting post-operative hydrocephalus in children with medulloblastoma. Neurosurg Rev 2023; 46:246. [PMID: 37723329 DOI: 10.1007/s10143-023-02156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Abstract
Post-operative hydrocephalus is common among children with medulloblastoma after initial tumor resection. This study aimed to establish a novel model for predicting the development of post-operative hydrocephalus in children with medulloblastoma. Only pediatric patients who received initial medulloblastoma resection at Beijing Tiantan Hospital between January 2018 and May 2021 were included in this study. The potential risk factors associated with post-operative hydrocephalus were identified based on multivariate logistic regression and the nomogram. Receiver operating characteristic (ROC) curve were used to evaluate the performance of the nomogram model based on an independent cohort of medulloblastoma patients who underwent surgery from June 2021 to March 2022. A total of 105 patients were included in the primary cohort. Superior invasion (P = 0.007), caudal invasion (P = 0.025), and intraventricular blood ≥ 5 mm (P = 0.045) were significantly related to the development of post-operative hydrocephalus and thus were assembled into the nomogram model. The model accurately predicted post-operative hydrocephalus based on the calibration curve. The area under the ROC curves for the primary and validation cohorts was 0.849 and 0.855, respectively. In total, the nomogram we developed may aid clinicians in assessing the potential risk of pediatric patients with MB developing post-operative hydrocephalus, especially those who would otherwise not have received a diversionary procedure at presentation.
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Affiliation(s)
- Wentao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Heng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Gong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fu Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| | - Yong-Ji Tian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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23
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Yamaguchi S, Fujimura M. [Medulloblastoma]. No Shinkei Geka 2023; 51:858-866. [PMID: 37743337 DOI: 10.11477/mf.1436204827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
In the 5th edition of the WHO classification, medulloblastomas, which are representative pediatric brain tumors, are categorized into four groups: WNT, SHH-TP53 wild, SHH-TP53 mutant, and non-WNT/non-SHH, based on their molecular background. While the histopathological findings still hold importance in predicting prognosis, the histopathological classification is no longer utilized in this edition. SHH medulloblastomas are further subdivided into two groups based on the presence or absence of TP53 mutation, as their clinical characteristics and prognosis differ. Group 3 and Group 4 medulloblastomas, recognized as distinct molecular groups in clinical practice, are combined into a single group called "non-WNT/non-SHH", because they lack specific molecular pathway activation. Furthermore, based on methylation profiling, dividing SHH medulloblastoma into four subgroups and non-WNT/non-SHH medulloblastoma into eight subgroups was proposed. Understanding the unique clinical characteristics and prognosis associated with each group is crucial. However, it is important to acknowledge that our current understanding of prognosis is based on treatment approaches guided by clinical risk factors such as postoperative residual tumor volume and the presence of metastatic disease. This molecular-based classification holds promise in guiding the development of optimal treatment strategies for patients with medulloblastoma.
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Affiliation(s)
- Shigeru Yamaguchi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University
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24
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De Pietro R, Zaccaro L, Marampon F, Tini P, De Felice F, Minniti G. The evolving role of reirradiation in the management of recurrent brain tumors. J Neurooncol 2023; 164:271-286. [PMID: 37624529 PMCID: PMC10522742 DOI: 10.1007/s11060-023-04407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
Despite aggressive management consisting of surgery, radiation therapy (RT), and systemic therapy given alone or in combination, a significant proportion of patients with brain tumors will experience tumor recurrence. For these patients, no standard of care exists and management of either primary or metastatic recurrent tumors remains challenging.Advances in imaging and RT technology have enabled more precise tumor localization and dose delivery, leading to a reduction in the volume of health brain tissue exposed to high radiation doses. Radiation techniques have evolved from three-dimensional (3-D) conformal RT to the development of sophisticated techniques, including intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and stereotactic techniques, either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Several studies have suggested that a second course of RT is a feasible treatment option in patients with a recurrent tumor; however, survival benefit and treatment related toxicity of reirradiation, given alone or in combination with other focal or systemic therapies, remain a controversial issue.We provide a critical overview of the current clinical status and technical challenges of reirradiation in patients with both recurrent primary brain tumors, such as gliomas, ependymomas, medulloblastomas, and meningiomas, and brain metastases. Relevant clinical questions such as the appropriate radiation technique and patient selection, the optimal radiation dose and fractionation, tolerance of the brain to a second course of RT, and the risk of adverse radiation effects have been critically discussed.
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Affiliation(s)
- Raffaella De Pietro
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lucy Zaccaro
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Marampon
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Paolo Tini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Francesca De Felice
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
- IRCCS Neuromed, Pozzilli (IS), Isernia, Italy.
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25
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Yeh P, Li TY, Cheng PW. Bruns Nystagmus in Cerebellopontine Angle Hemangioblastoma. World Neurosurg 2023; 176:140-141. [PMID: 37169073 DOI: 10.1016/j.wneu.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
Bruns nystagmus is a form of jerk nystagmus that has a localizing value in cerebellopontine angle (CPA) tumors. Hemangioblastomas involving the CPA is rare. A case of a 57-year-old male presented with Bruns nystagmus which led to the discovery of a large CPA hemangioblastoma is described. The nystagmus was compatible with the laterality of the tumor. High quality video of Bruns nystagmus was recorded.
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Affiliation(s)
- Peng Yeh
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Yu Li
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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26
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Zhang Z, Wu Y, Zhao X, Zhou J, Li L, Zhai X, Liang P. The insertion and management of an external ventricular drain in pediatric patients with hydrocephalus associated with medulloblastoma. Neurosurg Rev 2023; 46:170. [PMID: 37433938 DOI: 10.1007/s10143-023-02080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
An external ventricular drain (EVD) is used to facilitate cerebrospinal fluid (CSF) removal in medulloblastoma patients suffering from hydrocephalus. It is essential to recognize that EVD management plays a crucial role in influencing the incidence of drain-related complications. However, the ideal method for EVD management remains undetermined. Our research sought to examine the safety of EVD placement and the impact of EVD on the incidences of intracranial infections, postresection hydrocephalus, and posterior fossa syndrome (PFS). We conducted a single-center observational study involving a cohort of 120 pediatric medulloblastoma patients who were treated from 2017 to 2020. The rates of intracranial infection, postresection hydrocephalus, and PFS were 9.2%, 18.3%, and 16.7%, respectively. EVD did not influence the occurrence of intracranial infection (p = 0.466), postresection hydrocephalus (p = 0.298), or PFS (p = 0.212). A gradual EVD weaning protocol correlated with an elevated incidence of postresection hydrocephalus (p = 0.033), whereas a rapid weaning approach resulted in 4.09 ± 0.44 fewer drainage days (p < 0.001) than the gradual weaning strategy. EVD placement (p = 0.010) and intracranial infection (p = 0.002) were linked to delayed speech return, whereas a longer duration of drainage was conducive to the recovery of language function (p = 0.010). EVD insertion was not correlated with the incidence of intracranial infection, postoperative hydrocephalus, or PFS. The optimal EVD management method should encompass a rapid EVD weaning strategy, followed by prompt drain closure. We have presented additional evidence to improve the safety of EVD insertion and management in neurosurgical patients to ultimately facilitate the establishment of standardized institutional/national implementation and management protocols.
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Affiliation(s)
- Zaiyu Zhang
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuxin Wu
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xueling Zhao
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianjun Zhou
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lusheng Li
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xuan Zhai
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ping Liang
- Department of Neurosurgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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27
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Poiset SJ, Reddy A, Tucker CM, Kenyon LC, Judy KD, Shi W. Hemangioblastoma with late leptomeningeal metastasis: a case report. J Med Case Rep 2023; 17:102. [PMID: 36935497 PMCID: PMC10026473 DOI: 10.1186/s13256-023-03812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/08/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Hemangioblastoma of the central nervous system is an uncommon benign neoplasm, with about 25% of cases in patients with von Hippel-Lindau disease. The incidence of metastasis is rare, particularly in patients without von Hippel-Lindau disease. We report a case of hemangioblastoma with leptomeningeal dissemination as a late recurrence. CASE PRESENTATION A 65-year-old Caucasian man with a history of World Health Organization grade I hemangioblastoma of the cerebellar vermis underwent gross total resection in 1997. In early 2018, he developed intracranial recurrences with diffuse leptomeningeal disease of the entire spine. The patient underwent resection of intracranial recurrence, followed by palliative craniospinal irradiation. The disease progressed quickly, and he died 8 months after recurrence. CONCLUSIONS Despite a benign pathology, hemangioblastoma has a low risk of metastasis. The outcome for hemangioblastoma patients with metastasis is poor. Multidisciplinary care for patients with metastatic hemangioblastoma warrants further investigation, and an effective systemic option is urgently needed. Regular lifelong follow-up of at-risk patients is recommended.
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Affiliation(s)
- Spencer J Poiset
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 S 11 ST, Suite G301, Philadelphia, PA, 19107, USA
| | | | - Catherine M Tucker
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence C Kenyon
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin D Judy
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 S 11 ST, Suite G301, Philadelphia, PA, 19107, USA.
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28
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Afshari FT, Toescu S, Baig RA, Ong J, Lee KS, Cheng KKF, Solanki GA, Lo WB, Aquilina K. Molecular subgroup of medulloblastoma: evaluation of contribution to CSF diversion following tumour resection. Childs Nerv Syst 2023; 39:563-568. [PMID: 36749442 DOI: 10.1007/s00381-023-05853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/14/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Medulloblastoma is the commonest malignant brain tumour in children. Pre-operative hydrocephalus is present in up to 90% of these patients at presentation. Following posterior fossa surgery, despite resolution of fourth ventricular obstruction, a proportion of these children will still require cerebrospinal fluid (CSF) diversion for management of persistent or new hydrocephalus. Various scoring systems have been developed to predict the risk for CSF diversion following posterior fossa surgery. However, no accurate tool exists regarding which pathological subset or group of medulloblastoma patients will require a shunt post-operatively. In this study we investigated the impact of molecular subgroup of medulloblastoma on shunt dependency post-operatively in paediatric patients. METHODS We undertook a retrospective multi-centre study of children with medulloblastoma who underwent tumour resection. Those with available molecular subgroup were identified. Demographic data and clinical parameters including age, sex, presence of pre-operative hydrocephalus, extent of surgical resection, evidence of metastasis/leptomeningeal disease and need for CSF diversion post-operatively were further analysed. RESULTS Sixty-nine children with medulloblastoma with available molecular data were identified during the study period with male to female ratio of 1.5:1 (42M:27F). Twelve patients (17.4%) belonged to SHH, 10 (14.5%) Wnt, 19 (27.5%) Group 3 and 15 (21.7%) Group 4; 13 (18.8%) were non-specified Group 3 or 4. A total of 18 (26%) patients had evidence of leptomeningeal disease at presentation (20% of Wnt, 42% of Group 3, 33% of group 4, 23% of group 3/4, and 0% of SHH). Fifteen patients (22%) underwent post-operative ventriculoperitoneal (VP) shunt insertion. No patient in the Wnt group required ventriculoperitoneal (VP) shunt post-operatively in this cohort. Need for shunt was associated with pre-operative hydrocephalus, leptomeningeal disease, with molecular group 3 or 4 demonstrating higher rate of leptomeningeal disease, and pre-operative hydrocephalus. Age, extent of resection and pre-operative EVD were not associated with need for shunt in this cohort. Regression analysis identified only pre-operative hydrocephalus and leptomeningeal disease as independent predictors of need for shunt post-resection in this cohort. CONCLUSION All patients requiring permanent post-operative VP shunt belonged to non-Wnt groups, particularly group 3 and 4. Although medulloblastoma subgroup does not independently predict need for post-operative shunt, presence of leptomeningeal disease and pre-operative hydrocephalus, and their higher prevalence in group 3 and 4, likely account for observed higher rate of shunting in these groups.
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Affiliation(s)
- Fardad T Afshari
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
- Department of Neurosurgery, Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom.
| | - Sebastian Toescu
- Department of Neurosurgery, Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom
| | - Rehman Ali Baig
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - John Ong
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - Keng Siang Lee
- Department of Neurosurgery, Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom
| | | | - Guirish A Solanki
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom
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29
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Abbou W, Guerrouj I, Aichouni N, Nasri S, Kamaoui I, Skiker I. [Sporadic cerebellar hemangioblastoma]. Rev Prat 2023; 73:174-175. [PMID: 36916259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Widad Abbou
- Service de radiologie, CHU Mohammed-VI, université Mohammed-Ier, Oujda, Maroc
| | - Imane Guerrouj
- Service de radiologie, CHU Mohammed-VI, université Mohammed-Ier, Oujda, Maroc
| | - Narjisse Aichouni
- Service de radiologie, CHU Mohammed-VI, université Mohammed-Ier, Oujda, Maroc
| | - Siham Nasri
- Service de radiologie, CHU Mohammed-VI, université Mohammed-Ier, Oujda, Maroc
| | - Imane Kamaoui
- Service de radiologie, CHU Mohammed-VI, université Mohammed-Ier, Oujda, Maroc
| | - Imane Skiker
- Service de radiologie, CHU Mohammed-VI, université Mohammed-Ier, Oujda, Maroc
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Yang W, Li Y, Ying Z, Cai Y, Peng X, Sun H, Chen J, Zhu K, Hu G, Peng Y, Ge M. A presurgical voxel-wise predictive model for cerebellar mutism syndrome in children with posterior fossa tumors. Neuroimage Clin 2023; 37:103291. [PMID: 36527996 PMCID: PMC9791171 DOI: 10.1016/j.nicl.2022.103291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed to investigate cerebellar mutism syndrome (CMS)-related voxels and build a voxel-wise predictive model for CMS. METHODS From July 2013 to January 2022, 188 pediatric patients diagnosed with posterior fossa tumor were included in this study, including 38 from a prospective cohort recruited between 2020 and January 2022, and the remaining from a retrospective cohort recruited in July 2013-Aug 2020. The retrospective cohort was divided into the training and validation sets; the prospective cohort served as a prospective validation set. Voxel-based lesion symptoms were assessed to identify voxels related to CMS, and a predictive model was constructed and tested in the validation and prospective validation sets. RESULTS No significant differences were detected among these three data sets in CMS rate, gender, age, tumor size, tumor consistency, presence of hydrocephalus and paraventricular edema. Voxels related to CMS were mainly located in bilateral superior and inferior cerebellar peduncles and the superior part of the cerebellum. The areas under the curves for the model in the training, validation and prospective validation sets were 0.889, 0.784 and 0.791, respectively. CONCLUSIONS Superior and inferior cerebellar peduncles and the superior part of the cerebellum were related to CMS, especially the right side, and voxel-based lesion-symptom analysis could provide valuable predictive information before surgery.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zesheng Ying
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - HaiLang Sun
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jiashu Chen
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Kaiyi Zhu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 030032, China
| | - Geli Hu
- Department of Clinical and Technical Support, Philips Healthcare, Beijing 100600, China
| | - Yun Peng
- Department of Image Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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31
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Yang W, Zhang H, Cai Y, Peng X, Sun H, Chen J, Ying Z, Zhu K, Peng Y, Ge M. Postoperative MRI features of cerebellar mutism syndrome: a retrospective cohort study. J Neurosurg Pediatr 2022; 30:567-577. [PMID: 36208442 DOI: 10.3171/2022.8.peds22294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to investigate the relationship between postoperative MRI features and cerebellar mutism syndrome. METHODS A retrospective cohort of patients who underwent tumor resection from July 2013 to March 2021 for midline posterior fossa tumors was investigated. All patients were followed up at least once. Clinical data were extracted from medical records and follow-up databases. Two neuroradiologists independently reviewed preoperative and postoperative MRI. Univariable and multivariable analyses were performed to compare the postoperative cerebellar mutism syndrome (pCMS) and non-pCMS groups. Correlation analysis was performed using the Spearman correlation coefficient analysis. RESULTS Of 124 patients, 47 (37.9%) developed pCMS. The median follow-up duration was 45.73 (Q1: 33.4, Q3: 64.0) months. The median duration of mutism was 45 days. The median tumor size was 48.8 (Q1: 42.1, Q3: 56.8) mm. In the univariable analysis, abnormal T2-weighted signal of the left dentate nucleus (DN) (74.5% in the pCMS group vs 36.4% in the non-pCMS group, p < 0.001), right DN (83.0% vs 40.3%, p < 0.001), left superior cerebellar peduncle (SCP) (74.5% vs 27.3%, p < 0.001), right SCP (63.8% vs 23.4%, p < 0.001), left middle cerebellar peduncle (MCP) (51.1% vs 26.0%, p = 0.008), and right MCP (61.7% vs 26.0%, p < 0.001); male sex (83.0% vs 45.5%, p < 0.001); vermis 3 impairment (49.4% vs 19.1%, p = 0.002); solid tumor (91.5% vs 72.7%, p = 0.022); and hydrocephalus (72.3% vs 45.5%, p = 0.006) were more frequent in the pCMS group than in the non-pCMS group. Multivariable logistic analysis showed that male sex (adjusted OR 4.08, p = 0.010) and the cerebro-cerebellar circuit score of T2-weighted images (adjusted OR 2.15, p < 0.001) were independent risk factors for pCMS. The cerebro-cerebellar circuit score positively correlated with the duration of mutism. In Cox regression analysis, the cerebro-cerebellar integrated circuit injury score of T2 (adjusted HR 0.790, 95% CI 0.637-0.980; p = 0.032) and injury of vermis 3 (adjusted HR 3.005, 95% CI 1.197-7.547; p = 0.019) were independently associated with the duration of mutism. CONCLUSIONS Male sex and cerebro-cerebellar circuit damage are independent risk factors for pCMS. The cerebro-cerebellar circuit score indicates the duration of mutism.
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Affiliation(s)
- Wei Yang
- 1Departments of Neurosurgery and
| | - Hong Zhang
- 2Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | | | | | | | | | | | - Kaiyi Zhu
- 3Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan; and
- 4Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Peng
- 2Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Ming Ge
- 1Departments of Neurosurgery and
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32
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Adachi S, Yamashita K, Nakamizo A, Amano T, Momosaki S, Noguchi T. Unusual imaging characteristics of cystic meningioma in cerebellopontine angle. Neuroradiol J 2022; 35:777-779. [PMID: 35503008 PMCID: PMC9626835 DOI: 10.1177/19714009221096831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of cystic meningioma at the left cerebellopontine angle (CPA). Magnetic resonance imaging demonstrated both solid and cystic components in the tumor. The cystic component appeared slightly hyperintense compared to cerebrospinal fluid on fluid-attenuated inversion recovery (FLAIR) imaging. A hypointense tubular structure was identified in the cystic component on 3D driven equilibrium sequencing. These imaging findings are unusual for cystic meningioma. However, awareness of these unusual imaging features is important to determine appropriate treatment strategies although cystic meningioma at the CPA is extremely rare.
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Affiliation(s)
- Saki Adachi
- Department of Radiology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Koji Yamashita
- Department of Radiology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Akira Nakamizo
- Department of Neurosurgery, Clinical
Research Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Toshiyuki Amano
- Department of Neurosurgery, Clinical
Research Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Seiya Momosaki
- Department of Pathology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Tomoyuki Noguchi
- Department of Radiology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
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Borni M, Abdelmouleh S, Cherif I, Daoud H, Boudawara MZ. Pediatric synchronous multifocal and disseminated cerebrospinal classic medulloblastoma revealed by bilateral decreased visual acuity: a case report. Childs Nerv Syst 2022; 38:2211-2215. [PMID: 35590112 DOI: 10.1007/s00381-022-05546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Medulloblastoma (MB) is a rapidly growing malignant solid tumor that arises from stem cells located in the subependymal germinal matrix or outer granular layer of the cerebellum. It represents 15 to 30% of pediatric brain tumors and less than 1% of primary brain tumors. The reason for the high incidence of MB in children compared to adults is the embryonic origin of the tumor. In typical cases, MB manifests as a solitary lesion in the fourth ventricle or in the cerebellar parenchyma; cases of synchronous multifocal and disseminated MB are quite rare in patients without familial tumor syndromes. To date, only 7 cases in adults and a single pediatric case with Gorlin syndrome have been described previously. Here, the authors report a new case of synchronous multifocal classic cerebrospinal histologically confirmed MB in a 10-year-old male patient revealed by bilateral decreased visual acuity without any other localizing neurological signs. The authors will proceed with a review of the current literature regarding this rare entity.
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Affiliation(s)
- Mehdi Borni
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia.
| | | | - Ines Cherif
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
| | - Hatem Daoud
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
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Sundaram M, Mishra RK, Uppar AM. Neurogenic stunned myocardium resulting from surgical brainstem handling during resection of paediatric recurrent medulloblastoma-a possible brain heart interaction. Childs Nerv Syst 2022; 38:2025-2028. [PMID: 35460357 DOI: 10.1007/s00381-022-05523-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurogenic stunned myocardium (NSM) is characterised by an acute onset cardiac dysfunction following an acute neurological insult which mimics acute coronary syndrome. CASE DETAILS A 12-year-old male child was admitted to the neuro-intensive care unit (NICU) following midline suboccipital craniotomy and resection of recurrent medulloblastoma. Postoperatively, in NICU, he developed tachycardia and hypotension, which was unresponsive to fluid challenge requiring norepinephrine infusion. Intraoperatively, during tumour resection from the dorsal medulla, episodes of hypertension and bradycardia were observed. Intraoperative blood loss was adequately managed with a stable hemodynamic profile without postoperative anaemia. An electrocardiogram showed sinus tachycardia with T wave inversion, and blood investigation revealed elevated cardiac troponin T levels. Point of care ultrasound (POCUS) of heart and lung showed features of NSM. Infusion dobutamine was added to achieve a target mean arterial pressure of 65 mm Hg with concomitant furosemide infusion and fluid restriction. Daily POCUS assessment of cardiac contractility and volume status was done. The patient was weaned from vasoactive drugs and ventilator following improvement of cardiac function and was discharged from NICU after 17 days. CONCLUSION NSM results from the excessive release of catecholamines following stimulation of trigger zones in the brain. To date, a handful of cases of pediatric NSM following primary brain tumour are reported where hydrocephalus resulted in trigger zone activation. In this presented case, direct brain stem stimulation during tumour resection might have triggered NSM. Irrespective of the cause, timely diagnosis and execution of supportive management in our patient resulted in a positive outcome.
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Affiliation(s)
- Mouleeswaran Sundaram
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
| | - Rajeeb Kumar Mishra
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Moscovici S, Candanedo C, Spektor S, Cohen JE, Kaye AH. Solid vs. cystic predominance in posterior fossa hemangioblastomas: implications for cerebrovascular risks and patient outcome. Acta Neurochir (Wien) 2022; 164:1357-1364. [PMID: 33811520 DOI: 10.1007/s00701-021-04828-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemangioblastomas (HGBs) are highly vascular benign tumors, commonly located in the posterior fossa, and 80% of them are sporadic. Patients usually present with features of raised intracranial pressure and cerebellar symptoms. HGB can be classified as either mostly cystic or solids. Although the solid component is highly vascularized, aneurysm or hemorrhagic presentation is rarely described, having catastrophic results. METHODS We identified 32 consecutive patients with posterior fossa HBG who underwent surgery from 2008 through 2020 at our medical center. Tumors were classified as predominantly cystic or solid according to radiological features. Resection was defined as gross total (GTR) or subtotal (STR). RESULTS During the study period, 32 posterior fossa HGBs were resected. There were 26 cerebellar lesions and 4 medullar lesions, and in 2 patients, both structures were affected. Predominant cystic tumors were seen in 15 patients and solids in 17. Preoperative digital subtraction angiography (DSA) was performed in 8 patients with solid tumors, and 4 showed tumor-related aneurysms. Embolization of the tumors was performed in 6 patients, including the four tumor-related aneurysms. GTR was achieved in 29 tumors (91%), and subtotal resection in 3 (9%). Three patients had postoperative lower cranial nerve palsy. Functional status was stable in 5 patients (16%), improved in 24 (75%), and 3 patients (9%) deteriorated. One patient died 2 months after the surgery. Two tumors recurred and underwent a second surgery achieving GTR. The mean follow-up was 42.7 months (SD ± 51.0 months). CONCLUSIONS Predominant cystic HGB is usually easily treated as the surgery is straightforward. Those with a solid predominance present a more complex challenge sharing features similar to arteriovenous malformations. Given the important vascular association of solid predominance HGB with these added risk factors, the preoperative assessment should include DSA, as in arteriovenous malformations, and endovascular intervention should be considered before surgery.
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Affiliation(s)
- Samuel Moscovici
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Carlos Candanedo
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Sergey Spektor
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - José E Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Andrew H Kaye
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
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36
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Chatelain C, Piette C, Bex A, Bex V, Janin N, Salmon JP, Cabay JE, El Hachemi M, Jaspers A, Ben Mustapha S, Louviaux I. [Medulloblastoma : management of a usually pediatric tumour in a young adult]. Rev Med Liege 2022; 77:153-160. [PMID: 35258863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Medulloblastoma is a cerebellar grade IV tumour according to the WHO classification, mainly seen in children under the age of 15. This cancer can nevertheless occur in adults. We report the case of a 22-year-old patient with a medulloblastoma disseminated in the spine. The patient had a type 1 Arnold-Chiari malformation causing hydrocephalus treated by ventriculoperitoneal shunt. The current condition began with perineal and lower limb hypoesthesia, ataxic gait, erectile dysfunction and urinary incontinence. Subsequently, a predominant paraparesis of the right lower limb appeared. The patient was treated according to the PNET HR+5 protocol combining two courses of conventional chemotherapy followed by two courses of high-dose chemotherapy with autograft recovery. Given the excellent response, a proton therapy was then delivered to the whole cerebrospinal axis with boosts to the primary tumour sites. The case of this young adult patient shows on the one hand an atypical presentation, and on the other hand underlines, in the absence of a specific therapeutic strategy established for adults, the importance of collaboration between the adult and pediatric oncology departments, with management integrating innovations such as proton therapy and molecular typing.
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Affiliation(s)
| | - C Piette
- Service d'Hémato-Oncologie pédiatrique, CHR Citadelle-CHU Liège, Belgique
| | - A Bex
- Service de Neurochirurgie, CHR Citadelle, Liège, Belgique
| | - V Bex
- Service de Neurochirurgie, CHR Citadelle, Liège, Belgique
| | - N Janin
- Service d'Oncologie, CHR Citadelle, Liège, Belgique
| | - J P Salmon
- Service d'Oncologie, CHR Citadelle, Liège, Belgique
| | - J E Cabay
- Service de Radiologie, CHR Citadelle, Liège, Belgique
| | - M El Hachemi
- Service de Radiologie, CHR Citadelle, Liège, Belgique
| | - A Jaspers
- Service d'Hématologie clinique, CHU Liège, site CHR Citadelle, Belgique
| | | | - I Louviaux
- Service d'Oncologie, CHR Citadelle, Liège, Belgique
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Ellis TW, Goates AJ, Eschbacher KL, Giannini C, Lane JI, Van Gompel JJ, Carlson ML. Lipochoristoma of the Cerebellopontine Angle. Otol Neurotol 2022; 43:e394-e396. [PMID: 34772883 DOI: 10.1097/mao.0000000000003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology
- Department of Neurologic Surgery
| | - John I Lane
- Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota
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Zhang HW, Zhang YQ, Liu XL, Mo YQ, Lei Y, Lin F, Feng YN. MR imaging features of Lhermitte-Duclos disease: Case reports and literature review. Medicine (Baltimore) 2022; 101:e28667. [PMID: 35089210 PMCID: PMC8797601 DOI: 10.1097/md.0000000000028667] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Lhermitte-Duclos disease (LDD) is a rare tumor of the nervous system with a typical "tiger striped'" sign, but its features on functional magnetic resonance imaging (fMRI) are still inconclusive. PATIENT CONCERNS To explore the characteristics of LDDs using fMRI. DIAGNOSES We report 3 cases of pathologically confirmed LDDs. INTERVENTIONS Three patients underwent brain tumor surgery. OUTCOMES All the patients had a good prognosis. LESSONS Magnetic resonance spectroscopy and susceptibility-weighted imaging combined with conventional MRI can be used to better diagnose LDDs. Perfusion-weighted imaging is not specific for distinguishing cerebellar tumors. The combined application of fMRI and conventional MRI can improve the accuracy of LDD diagnoses.
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Affiliation(s)
- Han-wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, China
| | - Yuan-qing Zhang
- Special Clinic, Shenzhen Children's Hospital, Shenzhen, YiTian Road, China
| | - Xiao-lei Liu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, China
| | - Yong-qian Mo
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, China
| | - Yu-ning Feng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen, China
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Li L, Xie HM, Richard SA, Lan Z. Hemangioblastoma masquerading as a ring enhancing lesion in the cerebellum: A case report. Medicine (Baltimore) 2022; 101:e28665. [PMID: 35060562 PMCID: PMC8772639 DOI: 10.1097/md.0000000000028665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Hemangioblastomas (HGBMs) are very rare, and the cerebellum is usually the most common site of occurrence. HGBMs with ring-enhanced walls are often misdiagnosed as metastases, abscesses, glioblastomas, tuberculomas, and demyelinating diseases. Thus, we present a rare case of HGBM masquerading as a ring-enhancing lesion in the cerebellum. PATIENT CONCERNS We present a 33-year-old female who was admitted to our department because of headaches, unstable walking, and visual loss in both eyes. Cranial nerve examination revealed deficits in cranial nerve II. DIAGNOSIS Magnetic resonance imaging revealed 2 cystic lesions in the cerebellum, with irregular ring-enhanced cyst walls composed of smaller nodular parts. Immunohistochemical staining of resected specimens established HGBM. INTERVENTIONS The lesions were completely resected using a right retrosigmoid approach. OUTCOMES Two years of follow-up revealed no recurrence of her symptoms or tumor. She is currently well and performs her daily duties. LESSONS HGBMs with enhanced cysts are often misdiagnosed by radiology because of their ring-enhanced nature. Computed tomography angiography may be the best modality for differentiating cerebellar HGBM from other ring-enhancing lesions. Surgery is the gold standard of treatment for these lesions.
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Affiliation(s)
- Li Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hui-Min Xie
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Department of Medicine, Princefield University, Ghana, West Africa
| | - Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Mishra P, Tripathi YB. Impact of Nano Preparation of Phytoconstituents in Medulloblastoma. Methods Mol Biol 2022; 2423:115-122. [PMID: 34978694 DOI: 10.1007/978-1-0716-1952-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The conventional cancer treatment strategies from chemotherapy to surgery often lead to inadequate results which in some cases lead to relapsing of the tumor being treated. Medulloblastoma witness 30% relapse rate which is universally fatal among children. Although the treatment of primary medulloblastoma is well established including surgical excision, postsurgical irradiation, and, more recently, chemotherapy, there is no established treatment for its recurrence. Despite efforts to improve its therapy, frequent long-haul survivors have been recorded in the world's medical literature. In this book chapter, we have attempted to focus light on the nano preparation of phytoconstituents as an alternative approach as it has advantage of providing better bioavailability of the compound in terms of crossing the blood-brain barrier and an additional benefit in terms of limited adverse effects of the natural product over the traditional chemotherapeutic approaches. In recent times, biological methods or green approaches in the case of plants have received immense attention due to its safety and lack of contamination in the process. In this chapter, we will explore some plant products that have been incorporated into nanocarriers to improve their bioavailability in this tumor treatment.
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Affiliation(s)
- Priyanka Mishra
- Department of Medicinal Chemistry, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Y B Tripathi
- Department of Medicinal Chemistry, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Zheng H, Li J, Liu H, Wu C, Gui T, Liu M, Zhang Y, Duan S, Li Y, Wang D. Clinical-MRI radiomics enables the prediction of preoperative cerebral spinal fluid dissemination in children with medulloblastoma. World J Surg Oncol 2021; 19:134. [PMID: 33888125 PMCID: PMC8063474 DOI: 10.1186/s12957-021-02239-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Medulloblastoma (MB) is the most common pediatric embryonal tumor. Accurate identification of cerebral spinal fluid (CSF) dissemination is important in prognosis prediction. Both MRI of the central nervous system (CNS) and CSF cytology will appear false positive and negative. Our objective was to investigate the added value of preoperative-enhanced T1-weighted image-based radiomic features to clinical characteristics in predicting preoperative CSF dissemination for children with MB. MATERIALS AND METHODS This retrospective study included 84 children with histopathologically confirmed MB between November 2006 and November 2018 (training cohort, n=60; internal validation cohort, n=24). A set of cases between December 2018 and February 2020 were used for external validation (n=40). The children with normal head and spine magnetic resonance images (MRI) and no subsequent dissemination in 1 year were diagnosed as non-CSF dissemination. The CSF dissemination was manifested as intracranial or intraspinal nodular-enhanced lesions. Clinical features were collected, and conventional MRI features of preoperative head MRI examinations were evaluated. A total of 385 radiomic features were extracted from preoperative-enhanced T1-weighted images. Minimum redundancy, maximum correlation, and least absolute shrinkage and selection operator were performed to select the features with the best performance in predicting preoperative CSF dissemination. A combined clinical-MRI radiomic prediction model was developed using multivariable logistic regression. Receiver operating curve analysis (ROC) was used to validate the predictive performance. Nomogram and decision curve analysis (DCA) were developed to evaluate the clinical utility of the combined model. RESULTS One clinical and nine radiomic features were selected for predicting preoperative CSF dissemination. The combined model incorporating clinical and radiomic features had the best predictive performance in the training cohort with an AUC of 0.89. This was validated in the internal and external cohorts with AUCs of 0.87 and 0.73. The clinical utility of the model was confirmed by a clinical-MRI radiomic nomogram and DCA. CONCLUSIONS The combined model incorporating clinical, conventional MRI, and radiomic features could be applied to predict preoperative CSF dissemination for children with MB as a noninvasive biomarker, which could aid in risk evaluation.
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Affiliation(s)
- Hui Zheng
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinning Li
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huanhuan Liu
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenqing Wu
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Gui
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Liu
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuzhen Zhang
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaofeng Duan
- GE Healthcare, Pudong New Town, No.1, Huatuo Road, Shanghai, 210000, China
| | - Yuhua Li
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Liu Z, He Y, Fu J, Wu J, Song T, Wang Y, Huang T. Lhermitte-Duclos disease: A case report and literature review. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:195-199. [PMID: 33678658 PMCID: PMC10929790 DOI: 10.11817/j.issn.1672-7347.2021.190574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Indexed: 11/03/2022]
Abstract
Lhermitte-Duclos disease (LDD) is a type of rare brain tumor located in posterior fossa. A patient with LDD located in the left cerebellum and vermis was admitted by the Department of Neurosurgery, Xiangya Hospital, Central South University. MRI scan showed slightly heterogeneous enhancement at the region close to vermis. The patient underwent partial resection on August 11, 2016 without postoperative chemoradiotherapy. The progress free survival was 11 months and the overall survival was 17 months. What the case reveals is that the partial resection is not beneficial to these patients with LDD as the residual lesion probably recurs in a short term after operation. The pathogenesis, diagnosis and treatment of LDD are explored and summarized in combination with relevant literature.
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Affiliation(s)
- Zhiqiang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008.
| | - Yanqing He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008
| | - Jiaxin Fu
- Grade of 2015 in Oral Medicine, Medical College of Jinzhou Medical University, Jinzhou Liaoning 121001, China
| | - Jun Wu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008
| | - Tao Song
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008
| | - Ying Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008
| | - Tianxiang Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008.
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Ke D, Deng X, Li X, Li J, Hui X. Calcified extra-axial cavernous malformation arising from lower cranial nerves: A case report and literature review. Medicine (Baltimore) 2021; 100:e24566. [PMID: 33592913 PMCID: PMC7870219 DOI: 10.1097/md.0000000000024566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Extra-axial cavernous malformations (ECMs) arising from cranial nerves (CNs) are rare. Complete "en bloc" lesion resection and hemosiderin-stained tissue preservation remain the standard treatment, while a different strategy may be needed when the lesion is highly calcified . We report the 3rd calcified ECM-CN and review the clinical features and surgical strategy for this rare condition considering previous literature. PATIENT CONCERNS We present a 52-year-old woman with a calcified lesion located in the right lower 1/3 of the cerebellopontine angle. DIAGNOSIS The diagnosis was calcified ECM-CNs according to the pathological and radiological features. INTERVENTIONS A posterior midline craniotomy was performed, and piecemeal resection of the lesion was carried out. Subtotal resection of the lesion was achieved with a small piece left in situ. OUTCOMES No symptom or lesion-related recurrence was found during 28 months of follow-up. LESSONS Calcified ECM-CNs are unique cavernous malformations arising from CNs. Piecemeal resection and subtotal or near-total excision are 2 major aspects that differ from the surgical strategy for general ECM-CNs.
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Affiliation(s)
- Daibo Ke
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Xueyun Deng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Xiang Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan
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Ueno K, Nonaka M, Isozaki H, Kamei T, Takeda J, Asai A. Resection of a recurrent medulloblastoma in the anterior middle part of the aqueduct with a flexible endoscope: a case report. Childs Nerv Syst 2021; 37:665-669. [PMID: 32666154 DOI: 10.1007/s00381-020-04799-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/09/2020] [Indexed: 11/26/2022]
Abstract
Resection or biopsy of intraventricular brain tumors using an endoscope has become common, but the limitations of these procedures are not clear. Manipulation to access a tumor that arises from the blind angle of the rigid endoscope, such as the anterior part of the aqueduct, is limited. We report here that we successfully resected a recurrent medulloblastoma in the anterior part of the aqueduct using only a flexible endoscope. This method appears to be suitable for poorly vascularized and suctionable tumors that arise in the blind angle of a rigid endoscope.
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Affiliation(s)
- Katsuya Ueno
- Department of Neurosurgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Haruna Isozaki
- Department of Neurosurgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Takamasa Kamei
- Department of Neurosurgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Junichi Takeda
- Department of Neurosurgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
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Grassiot B, Beuriat PA, Di Rocco F, Leblond P, Faure-Conter C, Szathmari A, Mottolese C. Surgical management of posterior fossa medulloblastoma in children: The Lyon experience. Neurochirurgie 2021; 67:52-60. [PMID: 33482236 DOI: 10.1016/j.neuchi.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/22/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Modern approach for the treatment of posterior fossa medulloblastomas remains a challenge for pediatric neurosurgeons and pediatric oncologists and requires a multidisciplinary approach to optimize survival and clinical results. MATERIAL AND METHODS We report the surgical principles of the treatment of posterior fossa medulloblastomas in children and how to avoid technical mistakes especially in very young patients. We also report our experience in a series of 64 patients operated from a medulloblastoma between 2000 and 2018 in Lyon. RESULTS All patients had a craniospinal MRI. Eighty-one percent of the patients (n=50) had strictly midline tumor while 19% (n=14) had lateralized one. Eleven percent (n=7) had metastasis at diagnosis on the initial MRI. Forty-one percent (n=29) had an emergency ETV to treat hydrocephaly and the intracranial hypertension. All patient underwent a direct approach and a complete removal was achieved in 78% (n=58) of the cases on the postoperative MRI realized within 48h postsurgery. Histological findings revealed classical medulloblastoma in 73% (n=46), desmoplastic medulloblastoma in 17% (n=11) and anaplastic/large cell medulloblastoma in 10% (n=7). Patients were classified as low risk in 7 cases, standard risk in 30 cases and high risk in 27 cases. Ninety-six percent (n=61) of the patient received radiotherapy. Seventy-six percent (n=48) received pre-irradiation or adjuvant chemotherapy. At last follow-up in December 2018, 65% (n=41) of the patient were in complete remission, 12% (n=8) were in relapse and 27% (n=15) had died from their disease. The overall survival at five , ten and fifteen years for all the series was of 76%, 73% and 65.7% respectively. CONCLUSIONS Medulloblastomas remain a chimiosensible and radiosensible disease and the complete surgical removal represents a favorable prognostic factor. The extension of surgery has also to be weighted in consideration of the new biomolecular and genetic knowledge that have to be integrated by surgeons to improve quality of life of patients.
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Affiliation(s)
- B Grassiot
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - P A Beuriat
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - P Leblond
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - C Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France.
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Jiang C, Lu WX, Yan GZ, Bai RB, Wang ZN, Chen Y, Hou B, Ren HJ. Bilateral Dysplastic Gangliocytoma with Concurrent Polyostotic Fibrous Dysplasia: A Case Report and Literature Review. World Neurosurg 2020; 141:421-424. [PMID: 32561490 DOI: 10.1016/j.wneu.2020.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dysplastic gangliocytoma is a sporadic cerebellar benign tumor with the characteristics of hamartoma and true tumor, also known as Lhermitte-Duclos disease (LDD). Bone fibrous dysplasia (FD) is a slowly progressive self-limited benign bone tissue disease. Cowden syndrome, an autosomal dominant genetic disorder caused by germline mutations in the PTEN gene, is considered to be closely related to dysplastic gangliocytoma. McCune-Albright syndrome is a disease characterized by café-au-lait skin macules, polyostotic FD, and precocious puberty. The etiologic mechanism of both conditions is not yet clear. We report a rare case of bilateral dysplastic gangliocytoma with concurrent polyostotic FD. CASE DESCRIPTION We describe a 16-year-old boy with both LDD and FD. He presented for medical examination with headache and poor eyesight. Magnetic resonance imaging revealed proliferation of the skull and abnormal signals in the cerebellum, and supratentorial hydrocephalus. Subtotal resection of the cerebellar tumor was performed, and the diagnosis of LDD and FD was confirmed by histopathology. No other abnormal changes were found in systemic medical examination and no PTEN gene mutation was found in the genetic analysis; therefore, the diagnoses of Cowden syndrome and McCune-Albright syndrome were excluded. CONCLUSIONS LDD and FD are 2 rare diseases, and the simultaneous occurrence of the 2 conditions has not been reported before, to our knowledge. Our report challenges the etiology of the 2 diseases and the relationship between them, hoping to provide a reference for the study of the 2 diseases.
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Affiliation(s)
- Cheng Jiang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China; Institute of Neurology, Lanzhou University, Lanzhou, Gansu, China
| | - Wei-Xin Lu
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Gui-Zhong Yan
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Ruo-Bing Bai
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Ze-Ning Wang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China; Institute of Neurology, Lanzhou University, Lanzhou, Gansu, China
| | - Yi Chen
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China; Institute of Neurology, Lanzhou University, Lanzhou, Gansu, China
| | - Boru Hou
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Hai-Jun Ren
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China; Institute of Neurology, Lanzhou University, Lanzhou, Gansu, China.
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Paquier PF, Walsh KS, Docking KM, Hartley H, Kumar R, Catsman-Berrevoets CE. Post-operative cerebellar mutism syndrome: rehabilitation issues. Childs Nerv Syst 2020; 36:1215-1222. [PMID: 31222445 PMCID: PMC7250945 DOI: 10.1007/s00381-019-04229-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Tumors of the cerebellum are the most common brain tumors in children. Modern treatment and aggressive surgery have improved the overall survival. Consequently, growing numbers of survivors are at high risk for developing adverse and long-term neurological deficits including deficits of cognition, behavior, speech, and language. Post-operative cerebellar mutism syndrome (pCMS) is a well-known and frequently occurring complication of cerebellar tumor surgery in children. In the acute stage, children with pCMS may show deterioration of cerebellar motor function as well as pyramidal and cranial neuropathies. Most debilitating is the mutism or the severe reduction of speech and a range of neurobehavioral symptoms that may occur. In the long term, children that recover from pCMS continue to have more motor, behavioral, and cognitive problems than children who did not develop pCMS after cerebellar tumor surgery. The severity of these long-term sequelae seems to be related to the length of the mute phase. AIM OF THIS NARRATIVE REVIEW The impact of pCMS on patients and families cannot be overstated. This contribution aims to discuss the present knowledge on the natural course, recovery, and rehabilitation of children with pCMS. We suggest future priorities in developing rehabilitation programs in order to improve the long-term quality of life and participation of children after cerebellar tumor surgery and after pCMS in particular.
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Affiliation(s)
- Philippe F Paquier
- Department of Neuropsychology, University Hospital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Clinical and Experimental Neurolinguistics, Center for Linguistics (CLIN), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Unit of Translational Neurosciences, School of Medicine and Health Sciences, Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Karin S Walsh
- Division of Pediatric Neuropsychology, Children's National Health System, Departments of Pediatrics and Psychiatry, The George Washington University Medical Center, Washington DC, USA
| | - Kimberley M Docking
- Discipline of Speech Pathology, University of Sydney, and Sydney Children's Hospital Network, Sydney, Australia
| | - Helen Hartley
- Department of Physiotherapy, Alder Hey Children's Hospital, Liverpool, UK
| | - Ram Kumar
- Department of Paediatric Neurology, Alder Hey Children's Hospital, Liverpool, UK
| | - Coriene E Catsman-Berrevoets
- Department of Pediatric Neurology, Erasmus University Hospital/ Sophia Children's Hospital, Postbox 2040, 3000 CA, Rotterdam, The Netherlands.
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Hassaan SA, Tamura R, Morimoto Y, Kosugi K, Mahmoud M, Abokerasha A, Moussa A, Toda M, Yoshida K. Surgical outcomes of anterior cerebellopontine angle meningiomas using the anterior transpetrosal approach compared with the lateral suboccipital approach. Acta Neurochir (Wien) 2020; 162:1243-1248. [PMID: 32056016 DOI: 10.1007/s00701-020-04236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anterior transpetrosal approach (ATPA) and lateral suboccipital approach (LSO) are the major surgical approaches for cerebellopontine angle (CPA) meningiomas. Particularly, anterior CPA meningiomas are challenging lesions to be treated surgically. To date, only a few studies have directly compared the outcomes of both approaches focusing on the anterior CPA meningiomas. METHODS For the comparative analysis, anterior CPA meningiomas that were eligible for both APTA and LSO were collected in our hospital from April 2005 to March 2017. Anterior CPA meningiomas targeted for this study were defined as follows: (1) without cavernous sinus, clivus, and middle cranial fossa extension, (2) the posterior edge is 1 cm behind the posterior wall of the internal auditory canal, and (3) the inferior edge is above the jugular tuberculum. Based on these criteria, the operative outcomes of 17 patients and 13 patients who were operated via ATPA and LSO were evaluated. RESULTS The complication rate of the LSO group was significantly higher than that of the ATPA group (30.7% vs. 0%, p = 0.033). The removal rate did not differ between the ATPA and LSO groups (97.35% vs. 99.23%, p = 0.12). The operative time was significantly shorter in the LSO group than in the ATPA group (304.3 min vs. 405.8 min, p = 0.036). CONCLUSIONS Although the LSO is more widely used for CPA meningiomas, ATPA is also considered for these anterior CPA meningiomas.
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Affiliation(s)
- Shady A Hassaan
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Neurosurgery, Assiut University, Assiut Governorate, 71515, Egypt
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yukina Morimoto
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mohamed Mahmoud
- Department of Neurosurgery, Assiut University, Assiut Governorate, 71515, Egypt
| | - Ahmed Abokerasha
- Department of Neurosurgery, Assiut University, Assiut Governorate, 71515, Egypt
| | - Abdelhai Moussa
- Department of Neurosurgery, Assiut University, Assiut Governorate, 71515, Egypt
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Yue X, Huang J, Zhu Y, Du Y. Solitary fibrous tumor/hemangiopericytoma in the cerebellopontine angle mimicking vestibular schwannoma: A case report and literature review. Medicine (Baltimore) 2020; 99:e19651. [PMID: 32221091 PMCID: PMC7220372 DOI: 10.1097/md.0000000000019651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
RATIONALE Intracranial solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) are rare spindle cell tumors of mesenchymal origin that include benign and malignant neoplasms. PATIENT CONCERNS We present a 66-year-old male with a 5-year history of headache and dizziness, with left progressive sensorineural hearing loss over 1 month. DIAGNOSES WHO grade II SFT/HPC originating from the internal auditory canal in the left cerebellopontine angle. INTERVENTIONS surgical resection. OUTCOMES No local recurrence or metastases were observed in the follow-up 3 months after the surgery. LESSONS Intracranial SFTs/HPCs are rare mesenchymal neoplasms that are challenging to manage. If the imaging characteristics of tumor are not typical, clinicians should depend on tissue biopsy and immunohistochemistry to make a definitive diagnosis.
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Kocharyan AH, Briggs S, Cosetti MK, Heman-Ackah SM, Golfinos JG, Roland JT. Atypical Schwannoma: A 10-year experience. Am J Otolaryngol 2020; 41:102309. [PMID: 31727334 DOI: 10.1016/j.amjoto.2019.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this study was to describe the clinical presentation associated with atypical schwannoma of the cerebellopontine angle, characterize the pathologic findings and describe the long-term outcome. MATERIALS AND METHODS The study design was retrospective case review of patients with the histopathologic diagnosis of atypical and benign schwannoma of the cerebellopontine angle diagnosed at the study institution over a 10-year period. SETTING Tertiary referral center. MAIN OUTCOMES MEASURE Demographic data of the cohort were recorded. Findings on pathology were evaluated. Initial treatment and post-operative course was recorded. Main outcome measures were clinical presentation, including cranial nerve deficits at the time of presentation, complication and recurrence rates. RESULTS At presentation, a somewhat accelerated course of cranial nerve deficit was noted among patients with atypical schwannoma as compared to benign schwannoma. In the immediate post-operative period, there were no differences noted in the complication rate. Atypical schwannomas appear to have higher recurrence rate compared to benign schwannomas. CONCLUSIONS Atypical schwannoma is an intermediate disease process with an accelerated clinical course and higher recurrence rate as compared to vestibular schwannoma. Traditional operative approaches may be employed without increased concern for post-operative complications. Thorough counseling and close follow-up should be offered to these patients given the higher recurrence rate. Larger studies are required to determine if these patients need more frequent MRIs for long-term surveillance.
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Affiliation(s)
- Armine H Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Selena Briggs
- Department of Otolaryngology, MedStar Georgetown University Medical Center, Washington, DC, USA; Department of Otolaryngology, MedStar Washington Hospital Center, Washington, DC, USA; Department of Otolaryngology, New York University School of Medicine, New York, NY, USA.
| | - Maura K Cosetti
- Department of Otolaryngology, Eye and Ear Infirmary of Mount Sinai, The Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA
| | - Sabrina M Heman-Ackah
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - John G Golfinos
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - J Thomas Roland
- Department of Otolaryngology, New York University School of Medicine, New York, NY, USA; Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
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