Primary intracranial endodermal sinus tumor with a skull base extension--a case report

The authors described a case of primary intracranial endodermal sinus tumor (EST), and presented a review of 24 reported cases. From the middle of December 1981, this 15-year-old boy experienced progressive diplopia. At the other hospital, partial removal of the intrasellar tumor was performed by a left frontotemporal craniotomy approximately 2 months after the onset of symptoms. The histological diagnosis was suspected to be a pituitary adenoma, and thereafter, 60Co irradiation was carried out for about a month. On June 5th. 1982, the patient was admitted to the Kochi Medical School Hospital, because of increasing headache with diplopia, hoarseness, dysphagia and limitation of tongue movement. On admission, he had a small stature for his age with moderate diabetes insipidus. Neurological examination showed left abducens, glossopharyngeal and vagal nerve palsies in addition to bitemporal hemianopsia. CT scans revealed a heterogenously enhanced high density mass lesion behind the dorsum sellae with an extension from the upper clivus to the sphenoid sinus. Cerebral angiograms showed posterior displacement of the basilar artery. In the endocrinological examination, panhypopituitarism was recognized with a high level of serum alfa-fetoprotein (AFP). While, serum carcinoembryonic antigen (CEA) and human chorionic gonadotropin (HCG) were in normal range. On July 1st. 1982, a left suboccipital craniectomy was performed. The tumor existed mainly in the extradural space along the clivus, and only a small intradural portion of the tumor was excited.(ABSTRACT TRUNCATED AT 250 WORDS)     

Schwannoma of the skull base with intracranial extension

A case is reported of solitary schwannoma involving the skull base with extension into the middle cranial fossa and parasellar region. The patient presented with an exophthalmos and ipsilateral facial numbness. The tumor was successfully excised via a two-stage procedure involving an initial intracranial and subsequent transmaxillary approach. The relevant literature on the presentation and treatment of schwannomas of the skull base with intracranial extension is also reviewed.     

Microsurgical fibular graft for full-length radius reconstruction after giant-cell tumor resection: a case report

In this article, we present the treatment of a recurrent giant-cell tumor of the radius with en bloc resection and full-length radius reconstruction with a 24-cm long microsurgical fibular graft. At time of 8-year follow-up, there was no evidence of tumor recurrence. A satisfactory range of motion of the elbow, wrist, and forearm was maintained. There was no instability in the joints, and grip strength measured 63% of the opposite side. With appropriate dynamic tendon transfer, this procedure can provide an alternative method for reconstruction of the full-length radius after tumor resection, with functional and durable results.     

Osteosarcoma of the skull base: a case report

Osteosarcoma, usually observed in long bones, is the second most frequent primitive malignant bone tumor after myeloma. The skull base is an exceptional localization. We report a case of skull base osteosarcoma managed in our department. A 23-year-old female was admitted for bilateral epistaxis, headache, decreasing visual acuity then blindness. Physical examination revealed bilateral blindness and exophthalmia. Cranial magnetic resonance imaging showed a voluminous mass in the skull base extending to the nasosinusal area. A rhinoseptal surgical approach was used but the tumor was so huge that excision was impossible. The biopsy identified at an osteoblastic osteosarcoma. Search for extension (chest computed tomography and abdominal ultrasonography) was negative. Chemotherapy was to be delivered before combination chemoradiotherapy but the patient died before any treatment could be started. Osteosarcoma of the skull base is very rare. The treatment is based on surgery which should be as complete as possible followed by chemoradiotherapy. Prognosis is poor. Median survival is around six months.     

Recurrent benign mixed tumor of lacrimal gland: report of a case with intracranial extension

A 66-year-old man with benign mixed tumor of the lacrimal gland underwent an excisional biopsy in 1966. Three recurrences subsequently developed, which resulted in an orbital exenteration. In 1979 he came to us. We discovered radiographic evidence and surgical confirmation of recurrent disease involving the lesser wing of the sphenoid and dura in the floor of the anterior cranial fossa. The natural history and management of this tumor is discussed and the relevant literature is reviewed.     

Successful removal of a giant skull base metastasis from hepatocellular carcinoma after direct ethanol injection: case report

Skull metastases from hepatocellular carcinoma (HCC) are extremely rich in vascularity, which sometimes makes surgery dangerous. For minimally invasive surgery, it is very important to diminish the intratumoral vascular flow preoperatively. We report the case of a 69-year-old man with a giant skull base metastasis from HCC that was successfully removed after two sessions of direct ethanol injection into the tumor as a preoperative treatment to diminish the intratumoral vascular flow. Direct ethanol injection is a modification of percutaneous ethanol injection therapy, which is widely used in the treatment of primary HCC. In this article, we describe in detail the practical procedures and the usefulness of this treatment for a giant skull base metastasis from HCC.     

Vascularized fibular graft after excision of giant cell tumor of the distal radius. A case report

Although hemiarthroplasty of the wrist using vascularized proximal fibula has been described often, long term results with documentation of results are insufficient. A case of giant cell tumor of the distal radius with remarkable extraskeletal extension is reported. Vascularized fibula including its proximal head was used to replace the defect created after en bloc resection of the tumor. There was no deterioration in radiographic findings or function of the new joint at the time of the 10-year followup. Satisfactory range of motion of the wrist and the forearm was maintained. There was no instability in the joint, and grip strength measured 65% of the opposite side. Postoperative magnetic resonance imaging showed survival of the whole graft, including the subchondral portion. In addition to thorough revascularization of the graft, appropriate soft tissue reconstruction using dynamic tendon transfer contributed to the success. When these requirements are fulfilled, the graft can provide a functional and durable result. Although this is a single experience, the authors recommend wrist arthroplasty, rather than arthrodesis, in carefully selected patients.     

Huge orbital teratoma with intracranial extension: a case report

The authors present an unusual case of huge orbital teratoma extended to the cranial fossa in a newborn baby. The clinical features, radiologic findings, and surgical approach are described. Discussion will focus on the surgical technique and on the sparing of the affected eye, comparing the authors approach with other few cases described in literature. Finally, detailed histopathologic finding is provided.     

Xanthogranuloma of the anterior skull base: a case report

A case of a xanthogranuloma arising in the anterior skull base involving the bone of the left orbital roof, the dura mater, and the periorbit is presented. The lesion was completely removed by a supraorbital "eyebrow" skin incision using frameless stereotactic image guidance. A reconstruction of the orbital roof was performed using a titanium mesh graft. The neuropathological investigation revealed all the characteristics of a xanthogranuloma. Intracranially, xanthogranulomas appear as rare tumors of the dura or choroid plexus, usually arising in association with histocytosis X or familial hyperlipoproteinemia. One case not associated with these diseases is discussed.     

Role of bone graft in reconstruction of skull base defect: is a bone graft necessary

Ten patients underwent reconstruction of skull base defects between 1989 and 1992. In this series, the maximum size of the skull base defect was 6 x 5 cm. Three patients underwent bone grafts to reinforce the skull base. The postoperative course of seven patients without bone grafts was uneventful. There was no cerebrospinal fluid leakage, meningitis, extradural abscess, on brain herniation. On the other hand, two of the three patients with bone grafts developed extradural abseesses requiring the bone grafts to be removed. Although the number of patients in this series is not large, this study demonstrates that the use of bone grafts in reconstruction of skull base detects could be one of the factors in increasing the chances of infectious complications. We think that a bone graft is not necessary to reconstruct moderate-sized skull base defects.     

Adenoid cystic carcinoma with striking intracranial extension: a case report

We report a case of intracranial adenoid cystic carcinoma in the middle cranial fossa. A 40-year-old woman had noticed a tumor in the left external auditory canal 8 years previously. It was totally resected at that time. Histologically, the tumor was diagnosed as an adenoid cystic carcinoma. Recently the patient presented with loss of consciousness, suffering from mild recent-memory disturbance. Neurological examination revealed no other abnormalities. Magnetic resonance imaging (MRI) demonstrated an enhanced solid mass with a multicystic component in the left temporal lobe. She underwent subtotal removal of the tumor. It was well-demarcated, and was confirmed to be adhesive to the dura matter of the middle cranial fossa. Histology of the tumor was the same as it was 8 years ago. She was discharged from our hospital without neurological deficits. Two months after surgery, gamma knife radiosurgery was performed against the residual tumor.     

Midfoot reconstruction with free vascularized fibular graft after wide resection: a case report

Malignant foot tumours are often treated with amputations due to anatomical difficulties. Limb salvage techniques are difficult to perform, as a stable, sensible and plantigrade foot should be obtained to prevent further problems.In this report, we present a midfoot reconstruction with a vascularized free fibula, osteomized in a V-shape after wide resection of a midfoot synovial sarcoma. We describe the reconstruction of both longitudinal arches in which using a vascularized autograft facilitated union, remodeling of the bone, and obtaining a functional foot.     

Gastrointestinal stromal tumor of the lesser omentum: report of a case

We describe herein an extremely unusual case of a gastrointestinal stromal tumor (GIST) of the lesser omentum. A 45-year-old man was admitted to our hospital with an intra-abdominal mass that was subsequently misdiagnosed as a submucosal tumor of the stomach. The tumor arose from the lesser omentum and was removed without difficulty. Histologically, the tumor was composed of spindle–shaped cells with an interlacing bundle pattern, and immunohistochemical examination showed that it was positive for myeloid stem cell antigen (CD34), but negative for HHF35 and S-100 protein. These findings were consistent with a GIST lacking myogenic features and neural attributes. The patient had an uneventful postoperative course, and was free of recurrence when last seen 11 months after his operation. Received: April 3, 2000 / Accepted: March 6, 2001     

Intranasal schwannoma with extension into the intracranial compartment: case report

The authors present a case of intranasal schwannoma with extension into the intracranial compartment. Computed tomographic findings are presented, and a combined intranasal and subfrontal operative approach is described. The pathology, origin, and clinical characteristics of intranasal schwannomas are reviewed.