Radiation-induced schwannomas of the nervous system. Report of five cases and review of the literature

Radiation therapy has important delayed effects on the central nervous system. Prominent among these effects is radiation necrosis of nervous tissue, but an oncogenic effect is also recognized. Both benign and malignant intracranial tumors can develop in irradiated fields, particularly in children. Most of these tumors are sarcomas, meningiomas or gliomas and only occasionally schwannomas. We report 5 cases of postirradiation acoustic nerve schwannoma observed in our Department.     

A rare lesion of the central nervous system: inflammatory pseudotumor

Inflammatory pseudotumor is an uncommon tumor, initially described in the lung, but which can involve various organs. It is a controversial entity. We report the case of a 19-year-old-man with an inflammatory pseudotumor localized in the central nervous system, revealed by epilepsy. Characteristically, the inflammatory pseudotumor is an inflammatory mass leading to manifestations related to its localization. Relatively ubiquitous, this tumor is seldom described in the central nervous system. This uncommon lesion is part of a heterogeneous group of entities which are difficult to diagnose for both surgical pathologists and clinicians.     

Symptomatic subependymoma of the cervical spinal cord. Report of two cases

Subependymomas are relatively unusual tumors with a distinctive histological appearance. They are generally considered to be benign, and they are often found incidentally at autopsy. Most are located intracranially, and the most common site of origin is the fourth ventricle. Only two cases of subependymoma of the spinal cord have been reported previously. The authors present two additional cases of subependymoma of the cervical cord; both were symptomatic, and both were treated by microsurgical removal.     

Oligodendrogliomas arising in the scar of a brain contusion. Report of two surgically verified cases

Several years after sustaining head injuries, two patients developed oligodendrogliomas in the scar of brain contusions. Both cases seem to fulfill the criteria currently established for accepting the traumatic origin of a brain tumor. The literature concerning the relationship between head injury and intracranial tumor is reviewed.     

Surgical treatment of dumbbell-shaped neurinomas: report of an experience with 57 cases in a single hospital

BACKGROUND: Dumbbell-shaped trigeminal neurinomas are rare benign tumors with a controversy regarding their treatment and surgical approaches. We conducted an investigation on elucidating a strategy for the treatment of DSTNs. METHODS: One hundred thirty-seven patients with trigeminal neurinomas, accounting for 0.6% of all intracranial tumors and 3.8% of intracranial neurinomas, were screened out from the data bank on brain tumors in Hua Shan Hospital (Shanghai, China) from 1978 to 2003. Among them, 57 patients with DSTNs were found without Recklinghausen disease and analyzed retrospectively. Patients were divided into 2 groups. In the early group (1978-1984), a series of conventional intradural approaches were used, and in the latter group (1985-2003), an extradurotransdurotranstrigeminal pore approach with orbitozygomatic craniotomy was applied. After the tumor in the middle cranial fossa was resected, the tumor in the posterior fossa was resected via a suboccipital approach in the early group and through enlarged porus trigeminus without resection of the petrous apex in the latter group. RESULTS: There were 12 patients in the early group and 45 patients (including 6 patients with recurrent tumors) in the latter group. The mean age was 37 years (range, 14-56 years) and 39 years (range, 12-72 years), respectively, in the early and latter groups. There was no predominance in sex in the 2 groups. The mean duration of clinical manifestations before admission were 2.2 and 2 years, respectively, in the early and latter groups. Tumor size measured on MRI and/or CT were 30 to 40 mm in 4 (33%) cases from the early group and 14 (31%) cases from the latter group, 41 to 50 mm in 8 (67%) cases from the early group and 25 (56%) cases from the latter group, and more than 50 mm in 6 (13%) cases from the latter group. There were 3 patients in the latter group with a tumor extending into the infratemporal fossa and pterygopalatine fossa. Total tumor resection was achieved in 42% (5/12) of the early group and 87% (39/45) of the latter group (chi(2) = 10.897, P < .001); incomplete tumor removal was done in 58% (7/12) of the early group and 13% (6/45) of the latter group. One patient in the early group died of brainstem injury postoperatively. There was no surgical mortality in the latter group. Cranial nerve morbidities were seen in 80% of the early group and 41% of the latter group (chi(2) = 12.052, P < .01), when patients were discharged. Six months after operation, however, cranial nerve morbidities were seen in 55% of the early group and 18.6% of the latter group (chi(2) = 8.585, P < .01). A long-term follow-up study was available in 41 (75%) patients, with a period of 2 to 20 years (mean, 10 years). Karnofsky prognosis scale scores were at least 90 in 60% of the early group and 77% of the latter group and 70 to 80 in 40% of the early group and 23% of the latter group. Recurrent tumors occurred in 3 patients from the early group and were reoperated on. One patient with a recurrent tumor from the latter group underwent radiosurgery 5 years after the operation. CONCLUSION: The best treatment for large or giant DSTNs is microsurgery with extradurotransdurotranstrigeminal pore approach via single-stage skull-base craniotomy. It is not necessary to resect the petrous apex for removal of the tumor in the posterior fossa. Radiosurgery can be used for the residual or recurrent tumors.     

Multiple meningiomas of the central nervous system without the stigmata of neurofibromatosis. Clinical and therapeutic study

Multiple meningiomas are relatively rare tumors without known neurofibromatosis. In this paper, such eight cases of multiple meningiomas as described byCushing andEisenhardt are presented. Certain aspects of diagnosis and surgical management of this rare condition are discussed with particular emphasis on the importance of the distinction among multiple meningioma, meningiomatosis, or recurrences of these tumors. Fortunately, many of these patients tolerate multiple surgical interventions well, although the removal of these tumors in critical areas is a difficult problem. Thus, we think that it is important to examine and supervise all patients who have had a meningioma for a possible occurence of a second meningioma.     

Surgical treatment of idiopathic mediastinal fibrosis: report of five cases.

Idiopathic mediastinal fibrosis is a rare disease of unknown aetiology. It is a benign condition in which abnormal proliferation of fibrous tissue occurs within the mediastinum, leading to constriction and obliteration of local structures, particularly the great veins. It is a rare cause of superior vena caval obstruction (1-2%) but one that is potentially amenable to surgical palliation. The results of venous reconstruction in five patients with superior vena caval obstruction secondary to idiopathic mediastinal fibrosis are reported. Reversed autogenous saphenous vein grafts were used in two patients, woven silicone rubber prostheses in two, and bovine pericardial conduits in one patient. Useful long term results were obtained in three patients, but the bovine pericardial graft and one of the vein grafts failed within a few weeks.     

Surgical treatment of subependymomas of the central nervous system

The authors present a series of 8 pure subependymomas of the central nervous system surgically treated between 1965 and 1987. The clinico-pathological features and the results of surgical treatment of these benign tumours are discussed in the light of the most important literature on this topic.     

Combined endovascular-microsurgical treatment of tentorial-incisural dural arteriovenous malformations. Report of five cases.

Dural arteriovenous malformations of the tentorial edge are rare lesions with an unfavorable clinical course if left untreated. As yet no optimum treatment has been established. We retrospectively evaluated the results of our therapy concept, which consists of endovascular embolization followed by microsurgical obliteration, and compared the results to the relevant literature in order to clarify which therapeutic regimen seems to be optimum at the present time. In all of our five patients the lesion was completely obliterated, as proven by angiography, with favorable clinical results and low morbidity. Several other clinical series confirm our results, so we conclude that combined endovascular therapy and microsurgery is the optimum treatment for these lesions.     

Surgical treatment of congenital horseshoe kidney. Report of 21 cases]

From 1984 to 1989, we treated surgically 21 patients with horseshoe kidney. Clinically, urinary tract calculi was a common problem. In this group, 14 patients were complicated by urinary tract calculi. Diagnosis of horseshoe kidney was established roentgenographically in most cases. Twenty-one patients underwent 25 operative procedures for removal of the urinary tract stone and division of the isthmus. Eight operations were performed by classical extraperitoneal horizontal flank incision and 17 were done transperitoneally. We consider that the latter is more superior than the former.     

Surgical treatment of internal duodenal diverticulum. Report of 2 clinical cases

Internal duodenal diverticulum is a rare disease. Nowadays, less than 100 cases are reported in Western literature. Even if it is a pathology of malformative origin, the first clinical manifestations occur quite always during the III decade. Main symptom is a violent, suddenly arisen, abdominal colic, often associated with meals and with spontaneous remission. Frequency of accesses is variable in time; in most serious cases, colics are so close to cause a considerable reduction of nutrition. Among diagnostical means, very useful are Rx enema (that offers pathognomonical images) and endoscopy, by which the formation can be visualized directly and its connection with papilla can be delineated. In some rare cases, differential diagnosis has to be made with cystic dilatations of bile duct, and particularly with type III according to Alonso-Lej classification or choledochocele. When such a distinction is not possible, differential diagnosis will be made on the basis of histological examination of the type of mucosa present in the internal aspect of the diverticulum. Therapy of symptomatic forms is surgery. The technique of choice is transduodenal diverticulectomy. Cannulation of bile duct is a useful means to found the papilla during intervention, to protect duodenal suture in the postoperative period and to control it radiologically. Two cases of internal duodenal diverticulum operated on in the last 2 years are described and diagnostical and therapeutical items are discussed.     

Malignant cerebellar astrocytoma. Report of five cases

Five cases of malignant cerebellar astrocytoma observed during a seven-year period are reported. The analysis of the cases allows us to conclude that malignant cerebellar astrocytoma represents a true tumoral entity quite distinct from cerebellar glioblastoma as well as from medulloblastoma. A perfect correspondence between the histological malignancy and the duration of survival has been noted in all the cases.     

Surgical treatment for fungal infections in the central nervous system

The hospital records of 78 patients who underwent surgical therapy for fungal infections of the central nervous system (CNS) between 1964 and 1984 are summarized. Nine different fungal types were identified, but Coccidioides immitis and Cryptococcus neoformans accounted for most (67.1%) of the infections. A variety of clinical syndromes were seen, including chronic basal meningitis (45 patients), intracranial mass lesions (12 patients), and communicating hydrocephalus (six patients). Thirteen patients had rhinocerebral forms of fungal infection, and two presented with spinal involvement. Delays in diagnosis were frequent and ranged from 2 months to 11 years. In 31 patients the CNS lesion was the first indication of a fungal infection, and lesion biopsy or cerebrospinal fluid (CSF) examination confirmed the diagnosis. A total of 144 surgical procedures were carried out, including lesion biopsy or excision in 13 patients, primary CSF shunting in 22, and placement of an Ommaya reservoir for administration of intraventricular or intracisternal antifungal agents in 48. All patients received parenteral and, in some cases, intrathecal or oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 43.6% (34 deaths). With prompt diagnosis and treatment, the mortality rate was 39% whereas, when appropriate treatment was delayed, the mortality rate was 64%. An additional 14 surviving patients (17.9%) exhibited permanent morbidity due to neurological deficits, seizure disorders, or renal toxicity following treatment with amphotericin B. The combined mortality and morbidity rate was 62.8%. Clinical symptoms were resolved completely in 29 patients, although in 10 evidence of disease persisted and chemotherapy was continued. Fungal infections of the CNS are being recognized with increased frequency. It is suggested that a high index of suspicion, aggressive attempts to obtain a diagnosis, and early and vigorous therapy may reduce the unfortunate outcome seen in a relatively high proportion of patients with CNS fungal infections.     

原发性肝脏淋巴瘤五例的临床特点及其外科治疗

目的 总结原发性肝脏淋巴瘤(PHL)的临床病理学特点。方法 对10年来我院手术切除的5例PHL患者的临床资料进行回顾性分析。结果 本组5例均为男性，平均年龄43．6岁；肿瘤长径平均7．8cm。HBsAg阳性4例(80％)。术前误诊为原发性肝癌4例，病理学检查提示为B细胞源性淋巴瘤2例，T细胞源性淋巴瘤2例，何杰金病1例；2例为多原发瘤。结论 肝炎病毒感染可能与PHL发病有关；对肝占位性病变伴发热者，应警惕PHL的可能；手术切除仍为首选治疗方式。