Meningioma in the interpeduncular cistern in a child

The authors describe an 8-year-old boy who presented with progressive oculomotor palsy on the left side. The diagnostic evaluation with computerized transmission tomography (CTT), metrizamide CTT cisternography, and angiography indicated an extra-axial tumor in the left interpeduncular cistern, extending into the suprasellar and prepontine cisterns. A meningioma was demonstrated with attachment only to the interpeduncular portion of the left oculomotor nerve. The patient was treated successfully by complete removal through a pterional approach.     

Meningioma of the cavernous sinus in a child

Intracranial meningiomas in children are rare, representing 1–4.2% of central nervous system tumors and 1.5–1.8% of all intracranial meningiomas. Meningiomas arising from the lateral wall of the cavernous sinus account for less than 1% of all intracranial meningiomas. To our knowledge, only one case of a meningioma arising from the cavernous sinus has been reported in childhood. A 6-year-old boy presented with left ophthalmoplegia. A slight drooping of the left eyelid was noted at the age of 1 year. Magnetic resonance imaging (MRI) with contrast administration revealed an enhancing mass lesion located in the left cavernous sinus. The tumor, arising from the lateral wall of the cavernous sinus, was totally removed and the oculomotor nerve was reconstructed with a sural nerve graft. MRI displayed total tumor removal 1 month after the surgery. The pathological diagnosis was of a psammomatous meningioma. Received: 6 March 1998 Revised: 14 July 1998     

Meningioma in the anterior III ventricle in a child

A case is described of meningioma in the anterior part of the III ventricle in a 14-year-old girl. The mass was successfully removed through a transcallosal approach.     

Meningioma without dural attachment in a child

A case of posterior cranial fossa meningioma without dural attachment is presented. The patient was 8 years old. The tumour was mostly in the cerebellum and was presumably arising from the telechoroidea. Meningiomas without dural attachment are uncommon. They are rarer in the posterior fossa and in very young children.     

Massive cranial ossifying myxoma in a child

A case is presented in which a myxoma developed in the mastoid region in the cranium and extending to the middle and posterior fossa. The patient was an 11-year-old girl with a history from birth of a painless mass in the mastoid region. On admission, she had bilateral papilledema, left homonymous hemianopia, and right hearing impairment. The computerized tomography showed a massive low-density area with intralesional ossification. The extra-axial mass was completely removed. Skepticism toward the existence of myxoma affecting the cranium, in an extragnathic osseous site, is discussed.     

Localized cranial hyperostosis of meningiomas: a result of neoplastic enzymatic activity?

Cranial hyperostosis is a common secondary manifestation of intracranial meningiomas. This may occur with or without neoplastic invasion, apart or even remote from the growth. Alkaline phosphatase (AP) is one of many enzymes produced by meningiomas and is known to possess indirect ossifying properties. Meningiomatous cranial hyperostosis could possibly be mediated by a humoral mechanism. This hypothesis was tested using chemical and histochemical determination of the occurrence of the enzyme in a series of hyperostosing and non-hyperostosing meningiomas. In the hyperostosing type the content of AP was in average more than three times as high as in the non-hyperostosing type. The results thus are in favour of the induction hypothesis.     

颅底脑膜瘤骨增生与骨侵袭的相关性研究

目的探讨颅底脑膜瘤骨增生与骨侵袭的关系.方法选取49例需手术治疗的颅底脑膜瘤患者,术前均行CT检查,确定骨质增生的程度与部位;术中将肿瘤连同增生骨质进行病理检查,确定有无脑膜瘤细胞骨侵袭.结果 CT证实的34例有骨增生的颅底脑膜瘤患者,进行增生骨质活检有肿瘤细胞侵袭的31例.结论颅底脑膜瘤骨增生与肿瘤细胞骨侵袭有关,手术时应予充分切除.     

Neuroborreliosis causing focal cerebral arteriopathy in a child

A 9-year-old girl presented with an acute right-sided hemiparesis. Initially, the clinical presentation and stable vasculopathic abnormalities on MR and conventional angiography were suspicious of a so-called "transient cerebral arteriopathy". Mild but persistent pleocytosis and an elevated CSF IgG index led to an extensive search for infectious and immunological causes of cerebral vasculitis, eventually revealing neuroborreliosis. Although rare, infectious and potentially treatable causes of arterial ischemic stroke should be considered in every child with a documented cerebral arteriopathy.     

Acute pancreatitis causing death in a child on the ketogenic diet

The ketogenic diet has demonstrated good efficacy in children with pharmacologically resistant seizures. Relatively few serious complications have been reported in the more than 70 years in which the diet has been used. We report a child who developed acute pancreatitis and died. A 9-year-old girl had a seizure disorder with associated developmental delay owing to glucose transport protein deficiency. The ketogenic diet with medium chain triglyceride oil had been initiated shortly after diagnosis in infancy. She was not on anticonvulsants. She presented in coma with decreased respiratory effort and shock, requiring resuscitation. Investigations were consistent with pancreatitis. Despite fluid resuscitation and inotropic support, she had prolonged hypotension and acidosis. She subsequently had a cardiac arrest and died. A postmortem examination confirmed hemorrhagic pancreatitis. Hypertriglyceridemia is a risk factor for developing acute pancreatitis. The high fat content of the ketogenic diet often causes hyperlipidemia. The outcome for this patient raises concern regarding a potential consequence of the ketogenic diet.     

Hypertrophic granulomatous cranial pachymeningitis causing progressive blindness in a chronic dialysis patient.

A patient on chronic haemodialysis because of renal failure developed progressive visual field loss and eventual blindness. A postmortem examination indicated that the blindness was caused by granulomatous thickening of the pachymeninges which constricted the optic nerves as they passed through the optic foramina. Exhaustive bacteriological and histopathological studies failed to identify a specific cause for this hypertrophic cranial pachymeningitis.     

Pseudomigraine with prolonged aphasia in a child with cranial irradiation for medulloblastoma

We report a 12-year-old child with episodes of migraine-like headaches with visual and motor auras a year after the surgical resection and radiation therapy for medulloblastoma The patient presented with an episode of headache, prolonged aphasia, right hemiparesis, status epilepticus, and salt wasting. There was no evidence of a structural lesion. The neurologic deficits resolved over a period of 6 weeks. Because of the progressive deterioration in neurologic deficits, the patient underwent an extensive battery of laboratory tests and multiple neuroimages, all of which were normal. The unusually prolonged neurologic deficit in this patient without demonstrable structural lesions and his eventual complete recovery were most likely caused by ischemia in the left hemisphere secondary to vasospasm. This presentation mimics migraine headache. Evidence suggesting that this represents a long-term complication of treatment of children with central nervous system neoplasia is presented.     

Rhabdoid meningioma with cranial nerve involvement: case report of a child

CASE REPORT: A 13-year-old girl presented with off and on headache for 1 year, hearing loss for 6 months and difficulty in closing eyes for 5 months along with mild cerebellar signs. Histopathologic evaluation of the tumor showed a rhabdoid meningioma (WHO Grade III). DISCUSSION: Rhabdoid meningiomas are uncommon in children, and only 4 cases have been reported so far. None of them presented with cranial nerve involvement. This unusual presentation is reported here. CONCLUSION: Though rare, rhabdoid meningiomas can occur in children. This, to the best of the authors' knowledge, is the first case of rhabdoid meningioma presenting with cranial nerve involvement.     

A case of chronic hypertrophic cranial pachymeningitis causing cranial polyneuropathy and unilateral central retinal vein occlusion]

We presented a 70-year-old woman who developed unilateral visual loss due to central retinal vein occlusion caused by chronic hypertrophic cranial pachymeningitis. She had developed right blindness with optic atrophy due to chronic intracranial pachymeningitis one year before admission. In June 1999, she noticed visual loss of the left eye. On admission, neurological examination revealed left visual loss and sensory impairment in the first branch area of bilateral trigeminal nerves. Ophthalmological examination revealed central retinal vein occlusion of the left eye. Brain MRI showed dural thickening with gadolinium enhancement of the cavernous sinus near the left optic nerve and dilatation of the left supraorbital vein. There was no compression of the left optic nerve. We suggest that central retinal vein occlusion may be caused by compression of the supraorbital vein by dural thickening. This is the first case report of central retinal vein occlusion associated with chronic hypertrophic cranial pachymeningitis.     

Meningioma in a 20-month-old boy

A 20-month-old boy presented with a intraparenchymal mass in the right frontoparietal area manifesting as complex partial seizure, secondary generalization and left hemiparesis. Magnetic resonance images (MRI) of the brain showed inhomogeneously enhancing mass in the right frontoparietal area which has irregular margin and perilesional edema. Based on the radiological findings, a preoperative diagnosis was an intraaxial tumor, such as pilocytic astrocytoma or dysembryoplastic neuroepithelial tumor. The patient underwent a surgery including frontal craniotomy. The tumor had a partially extreme adherence to the surrounding brain tissue but it showed no dural attachment. Gross-total resection of the tumor was achieved. Postoperative follow-up computed tomography scans showed no residual tumor. The pathological findings confirmed the tumor as a WHO grade I meningioma, transitional type. Nine months after the surgery, follow-up brain MRI showed no recurrence of the tumor, porencephaly in site where the tumor was resected; the patient's symptoms had fully recovered. We report the case of a meningioma in a 20-month-old boy.