Intraventricular epidermoids.

To study the clinical characteristics of intraventricular epidermoids, we analysed retrospectively 12 patients treated in our hospital and reviewed the literature with regard to clinical manifestations, imaging features, diagnosis, surgical procedures and prognosis. Four patients with lateral ventricle epidermoid and eight in the fourth ventricle were included in this group. Intraventricular epidermoids are characteristically hypodense non-enhancing lesions on CT scans. MRI reveals them to have long T1 and T2 relaxation times with slight mass effect. Total removal is ideal, but special attention should be paid to preservation of important neurovascular structures. Close proximity of tumours to cranial nerves and the brain stem pose technical difficulties in total removal. Cranial nerve dysfunction and aseptic meningitis are the main postoperative complications. Long-term prognosis for patients with intraventricular epidermoids and well-preserved neurological conditions is good, even in the case of subtotal excision. Clinical follow-up and MRI allow earlier diagnosis of recurrence.     

Intraventricular cryptococcal granuloma.

A case is reported of a cryptococcal granuloma occurring within the lateral ventricle. The findings on angiography and brain-scanning led to a preoperative diagnosis of intraventricular meningioma. There are no previous reports of an isotope brain-scan in this condition and angiography usually shows an avascular swelling.     

Intraventricular central neurocytoma.

A case of central neurocytoma treated surgically is described. The authors review the literature. Emphasis is placed on radiological and pathological features not previously described. In particular, the intra-operative ultrasound appearance is described. The role of adjunctive radiotherapy is also discussed.     

Intraventricular rhabdoid meningioma.

Rhabdoid meningioma is a rare variant of meningioma, often found in tumour recurrences. We report a 55-year-old woman with a history of intraventricular fibroblastic meningioma, who developed headache and tinnitus 5 years after complete resection of the initial tumour. Imaging confirmed a recurrent tumour in the intraventricular location. Histological analysis revealed rhabdoid meningioma. We reviewed the literature and were unable to find any previously reported cases of intraventricular rhabdoid meningioma.     

Ectopic recurrence of craniopharyngioma.

A 50-year-old woman first presented with recurrent craniopharyngioma in the suprasellar region. The recurrent tumor was removed via the frontobasal interhemispheric approach. Two years later, magnetic resonance imaging revealed a further recurrence in the primary suprasellar region and a cystic mass with ring enhancement on the surface of the left frontal lobe. Both lesions were removed via the frontobasal interhemispheric approach. Histological examination showed the left frontal lesion was an ectopic recurrence of craniopharyngioma. Ectopic recurrence of craniopharyngioma is extremely rare.     

Infrasellar craniopharyngioma: case report.

We report a case of infrasellar craniopharyngioma in a 34 year-old woman who presented with progressive headache and diplopia. Computed tomographic and magnetic resonance images showed a heterogeneous tumor originating from the sphenoid bone with ethmoid sinus and sella turcica extension. A sublabial rhinoseptal transsphenoidal surgery was performed. Craniopharyngiomas with infrasellar development are very rare. Infrasellar craniopharyngioma is uncommon, thirty-five cases has been reported in literature. The embryology, clinical features and radiographic investigation of these tumors are discussed.     

Infrasellar craniopharyngioma

Object

Infrasellar craniopharyngioma (IC) is a rare tumor. This study aimed to investigate the clinical manifestations, treatment methods, and prognosis of IC, which invades the cranial base, nasal sinuses, nasopharynx and clivus.

Methods

Eleven consecutive cases of IC who received treatment in People's Liberation Army Navy General Hospital from 1988 to 2007 were retrospectively analyzed, and the clinical manifestations of IC were summarized. At the same time, literature pertinent to IC was reviewed. These patients consisted of six males and five females with an average age of 28.5 years (range 7–52 years old). Among them, nine cases were identified as simple IC and two cases as suprasellar and IC. Clinical manifestations included headache (seven cases), nasal obstruction (four cases), polydipsia and polyuria (four cases), visual disorder (five cases), delayed sex organ development (three cases), menstrual disorder (one case) and no symptoms (one case). Tumor invasion regions included sellar bottom, ethmoidal sinus, maxillary sinus, sphenoidal sinus, infrasellar region, clivus, nasopharynx and nasal cavity. Solid craniopharyngioma was observed in three cases, cystic craniopharyngioma in seven cases, and mixed cystic and solid type in one case. Four cases underwent craniotomy for tumor resection (three cases also received adjuvant external beam radiation therapy), two cases underwent transnasal approach tumor resection under endoscope guidance (one case simultaneously received adjuvant interstitial brachytherapy) and four cases underwent stereotactic interstitial radiation (radioisotope ³²P brachytherapy).

Results

All cases were followed up for an average of 22.5 years (range 9–98 months). Imaging results showed that tumors disappeared in one case, were clearly reduced in eight cases and were stable in two cases. Clinical symptoms disappeared in three cases, and improved in seven cases. No symptoms appeared in the case presenting with no symptoms. All patients were able to resume work, study and daily tasks.

Conclusions

IC is rare (the present cases account for 0.23% of all retrieved cases). Its chief clinical manifestations include headache, nasal obstruction, polydipsia and polyuria, and visual disorder. Lesions include solid, cystic, and mixed cystic and solid types. It is very difficult to resect the whole diseased region because this disease invades the cranial base, nasal sinuses and nasopharynx. Individualized treatments should be used according to lesion characteristics and invasion range, for example, stereotaxic interstitial brachytherapy. Radical resection or partial resection plus external beam radiation therapy produces better prognosis in IC than intracranial craniopharyngioma.     

Monstrous craniopharyngioma

Introduction Craniopharyngiomas (CF) are benign tumors, which can be cured by total resection; however, this is not always possible to achieve, thus leading to tumor recurrence. When these tumors achieve disproportionate growth, the treatment is even more difficult, fortunately grotesque CF are not frequent, making experience and data collection more arduous to obtain.Case reports Four patients are presented here to illustrate the need for the use of a new term, monstrous craniopharyngioma, which is proposed with the aim of making the evaluation of the different kinds of treatment available more accurate.Conclusions Craniopharyngiomas that have grown into more than one cranial fossa with mixed solid and cystic components pose a special challenge for resection, and therefore a systematic classification and approach are required in order to obtain the best surgical results.A commentary on this paper is available at     

Asymptomatic spontaneous rupture of craniopharyngioma cyst.

Spontaneous rupture of craniopharyngioma cyst is a rare phenomenon. Either chemical meningitis or neurological improvement is usually associated with spontaneous cyst rupture. We experienced two patients who underwent asymptomatic spontaneous cyst rupture. MRI revealed reductions in the sizes of cysts in the left cerebellopontine cistern and middle fossa in a 4-year-old girl and a cyst in the suprasellar region of a 47-year-old man. These patients did not develop chemical meningitis, nor was there any change in neurological symptoms related to the craniopharyngioma cysts. According to our review of the literature, spontaneous rupture of craniopharyngioma cysts can be divided into three subtypes: (i) cyst rupture associated with chemical meningitis; (ii) cyst rupture with improvement in symptoms related to the craniopharyngioma and not associated with chemical meningitis; and (iii) asymptomatic rupture. It is important to be aware of unexpected cyst rupture during observation of craniopharyngiomas.     

A long-term postoperative follow-up in craniopharyngioma.

The long-term postoperative follow-up of children treated for craniopharyngioma is influenced by the patient's age at time of diagnosis, tumor location, texture, interface and adherence to brain, and achievements of the first operation. These factors will be examined as they apply to 51 children treated at the Hospital for Sick Children, Toronto. A brief comment on the role of irradiation treatment is also provided.     

Intraventricular schwannoma

A case of schwannoma occurring in the right lateral ventricle of an 8 year-old boy is described. The child made an excellent recovery. Three years later there is no evidence of recurrence. The precise origin of such an unusual tumor is uncertain, but it probably arises from the sympathetic nerve supply to the choroid plexus.     

Intraventricular ganglioglioma

Gangliogliomas are mixed tumors consisting of both glial elements and differentiated neurons. Although any part of the central nervous system can be affected, little is known about intraventricular gangliogliomas. A patient with a ganglioglioma is presented in the previously unreported location of the anterior third ventricle at the foramen of Monro, mimicking a colloid cyst. We review all other reported cases of intraventricular ganglioglioma (n=6) to characterize this entity. Intraventricular gangliogliomas typically affect younger patients with female predominance (male:female, 2:5; median age 25 years). Symptoms occur secondary to obstruction of physiological cerebrospinal fluid circulation. Complete surgical resection with re-establishment of cerebrospinal fluid drainage is the goal of treatment.     

Intraventricular meningiomas: a surgical challenge.

BACKGROUND: Primary intraventricular meningiomas (IVM) pose a surgical challenge as they often remain asymptomatic until they become very large; have close proximity to vital intraventricular structures; and, their vascular supply is often encountered only after significant tumor debulking. In this study, the surgical management of IVM is discussed. METHODS: Between 1989 and 2003, nine patients (7 with lateral and 2 with fourth ventricular) IVM, were operated upon. Raised intracranial pressure, gait ataxia, memory impairment, seizures (motor and sensory) were the main presentations. Four had hydrocephalus while five had either a sequestered temporal or occipital horn. All were large tumors with an average size more than 5.3 cm. The lateral ventricular IVM were accessed by the posterior middle temporal gyrus (n=5) or the superior parietal lobule (n=2) approach. A midline suboccipital craniectomy was used for the fourth ventricular IVM. RESULTS: Total excision was achieved in eight and partial excision in one. Patients with lateral ventricular tumors required a postoperative intraventricular drain for a minimum period of 48 hours. The main morbidity included visual field defects and transient hemiparesis, seizure and meningitis. The one patient with partial excision died 6 weeks later due to transtentorial herniation as a result of intratumoral bleed and lateral ventricular sequestration. CONCLUSIONS: An IVM, being initially asymptomatic, usually attains a large size before detection. During surgery, its devascularisation is usually achieved only after significant tumor debulking. Development of hydrocephalus or ventricular sequestration should be constantly monitored and may be avoided in the postoperative period by continuous external ventricular drainage.     

Intraventricular meningioma of the fourth ventricle.

A rare case of meningioma of the fourth ventricle is reported. A review of the literature revealed only 24 reported cases of this type of tumor.     

Monstrous craniopharyngioma. Case presentations and term proposal.

INTRODUCTION: Craniopharyngiomas (CF) are benign tumors, which can be cured by total resection; however, this is not always possible to achieve, thus leading to tumor recurrence. When these tumors achieve disproportionate growth, the treatment is even more difficult, fortunately grotesque CF are not frequent, making experience and data collection more arduous to obtain. CASE REPORTS: Four patients are presented here to illustrate the need for the use of a new term, "monstrous craniopharyngioma," which is proposed with the aim of making the evaluation of the different kinds of treatment available more accurate. CONCLUSIONS: Craniopharyngiomas that have grown into more than one cranial fossa with mixed solid and cystic components pose a special challenge for resection, and therefore a systematic classification and approach are required in order to obtain the best surgical results.