Sporadic supratentorial hemangioblastoma with meningeal affection: A case report and literature review

Background:

Hemangioblastomas are vascular tumors, of benign behavior, that originate in the central nervous system. Supratentorial hemangioblastomas are extremely rare and are generally associated with Von Hippel-Lindau disease (VHL). The involvement of structures by contiguity, such as blood vessels or meninges, is something exceptional. There are few references in the literature of supratentorial hemangioblastomas with meningeal involvement and most of them are described in reports or small case series.

Methods:

We performed a systematic review of the literature to observe the characteristics of patients with supratentorial hemangioblastomas with meningeal involvement. In addition, we present the case of a 43-year-old male patient with a sporadic supratentorial hemangioblastoma with both, meningeal and vascular involvement that recurred years after treatment.

Results:

The patients presented supratentorial tumors with meningeal involvement, we had a 1.2:1 ratio male-female distribution. The mean age was 50 years. Most tumors were located in the cerebral hemispheres, the lobe affected most frequently was the frontal lobe. About 67% of the cases were sporadic and only 21% were related to VHL disease. There were three cases of recurrence after surgery.

Conclusion:

Supratentorial hemangioblastomas are extremely rare lesions. It is rare for supratentorial hemangioblastomas to invade adjacent structures such as blood vessels or meninges, however, when this happens, it is recommended a preoperative vascular imaging study, especially in parasagittal hemangioblastomas where superior longitudinal sinus may be involved. In these cases, en bloc surgical resection is difficult and the probability of recurrence is higher. Although clinical trials and studies with a greater casuistry are necessary to establish guidelines for the management of supratentorial hemangioblastomas, nowadays, contribution of new cases is useful for understanding this pathology.

Intradural disc herniation: how I do it

BACKGROUND

Intradural disc herniation is a rare phenomenon in spine surgery. Diagnosis is difficult despite current neuroradiologic imaging techniques.

METHOD

We present a case of a 59-year-old man with lumbar and radicular pain and a recurrent lumbar herniation. A laminectomy was performed after no clear disc herniation in the epidural space was found and an intradural mass was palpable. A durotomy showed an intradural disc fragment that was removed, followed by an arthrodesis.

CONCLUSION

Only intraoperative findings lead to a definitive diagnosis for intradural herniation. A durotomy needs to be performed. In this case, an arthrodesis was necessary to avoid complications of segmental instability.

Glioblastoma: does the pre-treatment geometry matter? A postcontrast T1 MRI-based study

BACKGROUND

The potential of a tumour's volumetric measures obtained from pretreatment MRI sequences of glioblastoma (GBM) patients as predictors of clinical outcome has been controversial. Mathematical models of GBM growth have suggested a relation between a tumour's geometry and its aggressiveness.

METHODS

A multicenter retrospective clinical study was designed to study volumetric and geometrical measures on pretreatment postcontrast T1 MRIs of 117 GBM patients. Clinical variables were collected, tumours segmented, and measures computed including: contrast enhancing (CE), necrotic, and total volumes; maximal tumour diameter; equivalent spherical CE width and several geometric measures of the CE "rim". The significance of the measures was studied using proportional hazards analysis and Kaplan-Meier curves.

RESULTS

Kaplan-Meier and univariate Cox survival analysis showed that total volume [p = 0.034, Hazard ratio (HR) = 1.574], CE volume (p = 0.017, HR = 1.659), spherical rim width (p = 0.007, HR = 1.749), and geometric heterogeneity (p = 0.015, HR = 1.646) were significant parameters in terms of overall survival (OS). Multivariable Cox analysis for OS provided the later two parameters as age-adjusted predictors of OS (p = 0.043, HR = 1.536 and p = 0.032, HR = 1.570, respectively).

CONCLUSION

Patients with tumours having small geometric heterogeneity and/or spherical rim widths had significantly better prognosis. These novel imaging biomarkers have a strong individual and combined prognostic value for GBM patients.

KEY POINTS

• Three-dimensional segmentation on magnetic resonance images allows the study of geometric measures. • Patients with small width of contrast enhancing areas have better prognosis. • The irregularity of contrast enhancing areas predicts survival in glioblastoma patients.

Prevalence and risk factors of erectile dysfunction and testosterone deficiency symptoms in a rural population in Uganda

OBJECTIVES

To determine the prevalence and risk factors of erectile dysfunction (ED) and the prevalence of hypogonadism symptoms in Buluba, a rural population in Uganda.

METHODS

Prospective, consecutive, cross-sectional study was conducted between September and December 2010. 902 men attending the outpatient clinic of Saint Francis Hospital in Buluba were enrolled. From these 902 men, 204 had been previously diagnosed as HIV+ followed in a specific HIV outpatient clinic in the same centre. Variables age, weight, height, tobacco use and drinking habits, Erection Hardness Score and Aging Male Symptoms Scale (AMSS), as well as Hypertension, Diabetes, Dyslipidemia, lung diseases, peptic ulcer, urinary symptoms and HIV were prospectively recorded. A multivariate analysis was used to analyze the variables related to erectile function and AMSS.

RESULTS

Mean age was 39±11,8 years. ED rate was 47,8% (Mild ED 28,8%; Moderate 14%; Severe 5%). In the multivariate analysis, variables age (Odds ratio (OR) 1,032), HIV+ (OR 11,280), AMSS (OR 1,138) and AMSS≥50 (OR 1,164) were related to ED. When excluding HIV+ population, 36,8% of men suffered ED (Mild ED 23%; Moderate 10,2%; Severe 3,6%). 5,7% of men had severe symptoms(≥50) of hypogonadism according to AMSS. No clinical variable was related to the presence of AMSS≥50 in the multivariate analysis.

CONCLUSIONS

The rate of ED in a rural milieu in Uganda is high. Variables age, AMSS and AMSS≥50 and HIV+ were related to ED. The rate of AMSS≥50 was 5,7%. No variable was found to be related to AMSS≥50.

[Migraine-like headache secondary to pituitary macroadenoma]

INTRODUCTION

Differential diagnosis of migraine-like headache with and without aura needs to proceed with neuroimaging evaluation in order to rule out any secondary conditions. We report a patient with a 2 year history of migraine like headache with a good response to ergotics and due to pituitary macroadenoma.

CLINICAL CASE

A 44 year old man with no familiar history of migraine presented to our hospital because of campimetric failure and a change of his migrainous features. The patient started with migraine without aura 2 years ago and was well treated with ergotics from the beginning. Field testing showed a bitemporal hemianopsia. Magnetic resonance imaging revealed an unknown pituitary macroadenoma.

CONCLUSION

Pituitary macroadenoma must be included in the differential diagnosis of migraine headache although the presence of aura or the good response to ergotics.