Transventricular endoscopic investigation and treatment of suprasellar arachnoid cysts.

Three children with a suprasellar arachnoid cyst and characteristic neuropathological signs are presented. Through the use of CT scanning and NMR imaging the location, volume and attenuation factors of these cysts can be documented. Stereotactically guided endoscopic exploration of the third ventricle region with visualization and manipulation of the cyst have been performed. This technique should be considered a safe and accurate alternative to craniotomy.     

Endonasal endoscopic resection of suprasellar craniopharyngioma: A retrospective single-center case series

IntroductionEndoscopic endonasal approach (EEA) has recently been proposed as an option for resection of primary and recurrent suprasellar craniopharyngioma. However, surgical outcome has not yet been fully evaluated, especially in regards to recurrent cases.MethodsWe analysed our institution (Sir Charles Gairdner University Hospital, Perth, Australia) case-series retrospectively. There were 16 patients operated through an endonasal endoscopic approach from February 2014 to February 2019 for suprasellar craniopharyngiomas. There were 14 primary, and two recurrent lesions. Extent of resection, complications, visual and endocrinological outcomes are presented.ResultsMean age of the patients was 42.9 ± 19.3 years old, with 56% female. The most common clinical symptoms were headaches (9 patients, 56%) and bi-temporal hemianopsia (9 patients, 56%), followed by unilateral optic neuropathy (5 cases, 31%), memory loss (1 case, 6%), hydrocephalus (1 case, 6%), delayed growth and puberty (1 case, 6%), and secondary amenorrhoea (1 case, 6%). Only two cases (12%) initially presented with normal visual function. Gross total resection (GTR) was achieved in 10/16 patients (62.5%), with subtotal resection (STR) in the remainder. Visual symptoms improved in 13/16 patients (81%) and remained unchanged in 3/16 patients (19%). Most common complications included new endocrinological deficit in nine patients (56%), mostly diabetes insipidus, and cerebrospinal fluid leak requiring a new intervention in three patients (19%). There was one mortality case (complicated meningitis, stroke and vasospasm). Mean follow-up time was 22.05 ± 14 months and three patients (19%) had a recurrence of the disease during this period and were referred for radiation therapy.ConclusionEndonasal endoscopic approach is a safe and effective surgical option for both primary and recurrent suprasellar craniopharyngiomas.     

Endocrine complications of pediatric brain tumors: case series and literature review

The survival rate for childhood cancer, including brain tumors, is increasing. As a result, long-term sequelae of chemotherapy and radiotherapy are also increasing. The purpose of this study was to determine the frequency of endocrine complications of therapy for brain tumors in pediatric patients. Endocrinopathy was observed in 19 of 20 (95%) of patients with supratentorial midline tumors. Fifty-seven patients with nonmidline tumors (22 supratentorial, 35 posterior fossa) were followed for a mean of 4.6 +/- 2.4 years. Twenty-two endocrinopathies occurred in 16 patients treated as follows: one of 23 patients (0.4%) had surgery alone, zero of four (0%) had chemotherapy alone, eight of 18 (44%) had radiotherapy alone, and seven of 12 (58%) had both radiotherapy and chemotherapy. Endocrine disturbance was particularly common after craniospinal radiation (10 of 18 [55%]). Growth failure occurred in none of 23 patients who had surgery alone, in one of four patients who had chemotherapy (25%), in 11 of 18 patients who had radiotherapy (61%), in seven of 12 patients who received both radiotherapy and chemotherapy (58%), and in 12 of 18 patients who had craniospinal radiation (67%). In conclusion, endocrine and growth disturbances are uncommon with surgery alone, although they occurred in 53 and 60%, respectively, of patients treated with cranial irradiation for a brain tumor. This finding underscores the importance of routine endocrinology follow-up for all brain tumor patients receiving cranial irradiation. Literature review and endocrine surveillance recommendations are included.     

Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors,a case series

Background

Central nervous system (CNS) germ cell tumors account for 3 % of all pediatric brain tumors in the USA. Presenting symptoms are typically location based with pineal tumors presenting with obstructive hydrocephalus and suprasellar tumors with hypothalamic/pituitary dysfunction and ophthalmologic abnormalities. Psychiatric manifestations such as psychosis and behavioral changes are atypical presentations of CNS germ cell tumors, with only 11 previously reported cases.

Methods

This is a retrospective case series describing patients with CNS germ cell tumors with an atypical presentation including psychiatric manifestations. Information regarding clinical presentation, treatment course, and outcome were obtained.

Results

We report seven patients who presented with psychiatric symptoms consisting of psychomotor delay as well as behavioral and mood changes. Six of the seven patients were diagnosed ≥6 months after onset of psychiatric symptoms. All of the seven are alive but five continue to have neurologic and psychiatric issues post treatment.

Conclusions

Atypical presentations of CNS germ cell tumors can delay diagnosis and treatment and may be secondary to atypical locations as well as endocrine dysfunction manifesting as psychiatric symptoms. Delayed diagnosis did not appear to affect survival but earlier diagnosis may potentially be associated with better neurologic and psychiatric outcome. Patients who present with these symptoms and atypical neuroimaging should have a thorough evaluation for CNS germ cell tumors including serum and CSF markers. Clinicians should be aware of these less common presentations to aid in prompt diagnosis and treatment.

     

Selective serotonin reuptake inhibitor-induced apathy: a pediatric case series

OBJECTIVES: Selective serotonin reuptake inhibitor (SSRI)-induced apathy is characterized by a lack of motivation that is not a result of sedation or symptoms of depression. This report describes two pediatric cases of SSRI-induced apathy, one of which is the first reported case in a child with a non-OCD (obsessive compulsive disorder) anxiety disorder. METHODS: The sample included 43 participants from the Johns Hopkins University site of the Research Units on Pediatric Psychopharmacology (RUPP) study of fluvoxamine in pediatric anxiety disorders. Data were reviewed for adverse events of at least moderate severity or that required a slowing of drug titration during the protocol; fluvoxamine blood levels were examined. RESULTS: Two (2) cases of apathy were identified (5%), 1 in a 9-year-old child and the other in a 16-year-old adolescent; neither had depressive illness. Similarities to existing reports included: Lack of insight, delayed onset, dose dependency, and reversibility with SSRI dose reduction or discontinuation. Plasma fluvoxamine levels were 459 ng/mL and 87 ng/mL, representing, respectively, the 90th percentile and 50th percentile, of the blood level sample groups at the time of apathy presentation (weeks 8 and 24). The 16-year-old also exhibited cooccurring disinhibition symptoms. CONCLUSIONS: Educating patients and families, and close monitoring by clinicians for symptoms of SSRI-induced apathy, are important to limit the impact of this reversible adverse event on compliance and quality of life.     

Feasibility of neuroendoscopic biopsy of pediatric brain tumors

Purpose  

The purpose of this study was to investigate the potential value of neuroendoscopic biopsies in pediatric patients with peri- or intraventricular tumors.     

Retinoblastoma with suprasellar extension: report of a case

The authors discuss a case of a two-years-old girl, who had a unilateral previous enucleated retinoblastoma, that died with a suprasellar mass and distant metastasis.     

Pituitary tooth: case report of a suprasellar teratoma

A rare case of intracranial teratoma is reported in which a tooth-like structure was clearly defined in the pitaitary fossa. The authors are unaware of any similar case having been reported previously.     

Stereotactic biopsy for brainstem tumors in pediatric patients

Objective  

Our aim is to describe clinical and paraclinical features in patients who underwent stereotactic-guided biopsy for brainstem tumors.     

Neuroendoscopic biopsy of pediatric brain tumors with small ventricle

Purpose

Intraventricular endoscopic procedures to resect or biopsy peri- or intraventricular tumors may have not been used in patients with small ventricles due to the presumed difficulties with ventricular cannulation and the perceived risk of morbidity. The purpose of this study is to review the feasibility and safety of neuroendoscopic procedures in the biopsy of pediatric brain tumors with a small ventricle.

Methods

Between January 2006 and January 2013, 72 children were identified with brain tumors confirmed by transventricular endoscopic biopsy. Patients were divided into non-hydrocephalus and hydrocephalus groups, and the ratio of the two groups was 20:52.

Results

In 20 pediatric brain tumors with small ventricle, the targeted lesion was successfully approached under the guidance of neuronavigation. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through the narrow foramen of Monro. The histopathologic diagnosis was established in all 20 patients: nine germinomas, three mixed germ cell tumors, two pilomyxoid astrocytomas, and two pilocytic astrocytomas. The tumor biopsy sites were the suprasellar area (n?=?10), pineal area (n?=?4), lateral ventricular wall (n?=?4), and mammillary body (n?=?1). There were no major morbidities related to the endoscopic procedure.

Conclusion

Neuroendoscopic biopsy or resection of peri- or intraventricular tumors in pediatric patients without hydrocephalus is feasible. Navigation-guided neuroendoscopic procedures improved the accuracy of the neuroendoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not serve as a contraindication to neuroendoscopic tumor biopsy.     

Combined endoscopic and microscopic management of pediatric pituitary region tumors through one nostril: technical note with case illustrations

Objective  Sellar and parasellar lesions in the pediatric population have traditionally been approached through either a transsphenoidal hypophysectomy or craniotomy or a combination of the two, with the surgical approach being dictated by the anatomical location and extent of the pathology. The introduction and evolution of the endonasal endoscopic technique has provided a minimally invasive method alone or in combination with the operative microscope for removal of these lesions in the pediatric population. The authors have implemented in their practice the use of endonasal endoscopic-assisted microsurgery in the pediatric population harboring sellar and/or lesions extending to the suprasellar space and report our experience in nine patients. Materials and methods  Five craniopharyngiomas, one Rathke’s cleft cyst, and two pituitary tumors were treated via endonasal endoscopic-assisted microsurgery. Histopathologic examination revealed lymphocytic hypophysitis in one patient with an enhancing lesion in the pituitary stalk. The approach utilized by the authors is performed through one nostril without any resection of the nasal turbinates or nasal septum. The middle turbinate is displaced laterally, while the nasal septum is moved medially. Conclusion  Gross total, near-total, and subtotal resections and a diagnostic biopsy were obtained in six, one, one, and one patients, respectively. The authors were able to safely perform this procedure in nine pediatric patients, and the lack of turbinate or septum resection minimized postoperative discomfort.     

Institutional experience of endoscopic suprasellar arachnoid cyst fenestration

Introduction

Suprasellar arachnoid cysts can differ from other arachnoid cysts in several ways, making a separate analysis of these cysts worthwhile. Herein, we present the outcome and perform volumetric analysis of six children with suprasellar arachnoid cysts treated with endoscopic ventriculocystocisternostomy in order to evaluate the long-term outcomes.

Patients and methods

Operative and postoperative data were retrospectively reviewed for six patients harboring suprasellar arachnoid cysts. Imaging was then used to follow success of surgical intervention.

Results

Six patients with suprasellar arachnoid cysts underwent ventriculocystocisternostomy. Presenting symptoms were headaches in three patients, developmental delay in another, and an incidental finding in the remaining patients. All patients had enlarged lateral and third ventricles on initial imaging. Average age at presentation was 145.7 months (65.4–250.2). Follow-up was an average of 46.5 months (3–84). The average cyst size was 153.96 cm³ (42.98–369.20) preoperatively and an average of 39.92 cm³ (3.20–101.47) at follow-up.

Conclusions

Based on our experience, suprasellar arachnoid cyst treatment with ventriculocystocisternostomy is an adequate surgical intervention. Suprasellar and third ventricular size does respond to the surgical intervention at long-term follow-up.     

扩大经鼻入路至鞍上区的内镜解剖学研究

目的 研究内镜下扩大经鼻入路至鞍卜区域的解剖.方法 选用20例尸头标本,模拟神经内镜下扩人经鼻入路,显露至鞍上区域,研究其周围解剖.结果 提出蝶安腔骨性后壁解剖学分区方法,描述视交叉上间隙、视交叉下间隙和眼动脉三角等解剖学慨念及其临床意义.结论 神经内镜下扩大经鼻人路可以较好地显露鞍上区域.     

Asymptomatic spontaneous rupture of suprasellar dermoid cyst: a case report

Suprasellar dermoid cysts are uncommon intracranial lesions. CT and MRI findings in a rare case of asymptomatic rupture of suprasellar dermoid cyst with subarachnoid dissemination is described.     

Imaging of suprasellar and parasellar tumors.

A large number of entities can present as a suprasellar or parasellar mass. These include benign and malignant tumors as well as inflammatory and other lesions that can mimic a neoplasm. Imaging features and distinguishing characteristics of juxtasellar masses are described.     

Computer assisted stereotactic biopsy and volumetric resection of pediatric brain tumors

Like adults, children may undergo stereotactic CT, MRI, and digital angiography with their heads fixed in an imaging compatible head holder. Tumor volumes are digitized from stereotactic CT and MRI slice images. The tumor volume can then be sliced perpendicular to the surgical view line, which is the surgical approach expressed in terms of angular settings on the stereotactic instrument. These sliced images are displayed on a computer monitor in the operating room and are used to guide the surgery and help the surgeon identify the plane between tumor and surrounding brain tissue.     

Bobble-head doll syndrome due to a suprasellar arachnoid cyst: endoscopic treatment in two cases

Object We report two cases of bobble-head doll syndrome associated with a large suprasellar arachnoid cyst successfully treated with a minimally invasive endoscopic approach.Methods The clinical history, surgical treatment and results of two children, a 9-year-old boy and a 1-year-old girl, both presenting the clinical features of the bobble-head doll syndrome, are described. As a first procedure, a ventriculo-cystostomy was endoscopically performed in both patients, obtaining either resolution of the symptoms or notable cyst reduction. In the girl, a re-closure of the stoma, with cyst re-expansion, was observed after 18 months. She then underwent a second procedure, a ventriculo-cysto-cisternostomy, with a good result. After 3 years follow-up, the neurological condition of both patients remains good with complete resolution of abnormal head movement.Conclusion In our opinion, endoscopic treatment is the procedure of choice for this condition, as it involves few complications and gives good results.