Primary intraosseous meningiomas of the skull

The plain film, computed tomography (CT) and angiographic findings in 10 patients with primary intraosseous meningioma were reviewed and the differential diagnosis considered. In nine patients with benign primary intraosseous meningioma, the radiological findings revealed intraosseous expansile growth. In one patient with the malignant form of the tumour, osteolytic growth was evident on plain film and CT. In eight patients, the tumour tissue was hyperdense (65-85 HU) on the unenhanced CT images and striking enhancement was shown in seven. In five patients angiography showed that the external carotid artery fed the tumour, while in one the vasculature was normal. Benign primary intraosseous meningioma showed expansile growth and malignant tumour showed osteolytic growth. If a combination of the plain film, angiogram and CT findings is considered, a diagnosis of the benign tumour can be made and a diagnosis of benign meningioma can be suggested.     

Primary non-Hodgkin''s lymphoma of the cranial vault

In the absence of a satisfactory interpretation, sudden sensorineural hearing loss is often attributed either to infective phenomena or to organic-type circulatory defects. This latter pathogenesis inevitably comes to mind in elderly patients or in the presence of signs of circulatory dysfunction. Nevertheless, the not-infrequent observation of sudden hearing loss in young persons lacking factors predictive of short-term vascular impairment makes us suppose the existence of etiopathogenetic mechanisms of a functional nature. A survey of our cases, matched with a control group, revealed the presence of lower mean blood pressure levels in the group of young patients with 'idiopathic' sudden hearing loss. This finding supports the hypothesis that a condition of haemodynamic imbalance linked to hypotension plays a role in the genesis of cochlear damage in young subjects. Such a mechanism would bear important therapeutic implications: should it be responsible for the damage in at least some cases, vasoactive drugs with a vasodilatative action could have adverse effects on the possibility of recovery.     

Primary intraosseous hemangioma of the orbit: CT and MR appearance

An 8-year-old girl had acute onset of blurred vision, proptosis, and lateral and vertical gaze palsies on the right. CT and MR examinations showed an expansile mass involving the greater wing of the right sphenoid bone. Pathologic analysis of the surgical specimen revealed a capillary hemangioma. The lesion was inhomogeneous but predominantly isointense with gray matter on T1-weighted images. On T2-weighted images the lesion was inhomogeneous with areas of both high and low signal intensity. The rim enhanced uniformly, and there was inhomogeneous enhancement of the bulk of the lesion.     

Primary pulmonary meningioma. Report of a case and review of the literature

Extracranial meningiomas are rare outside the head and neck region. We report a case of primary pulmonary meningioma, initially detected as a radiographic incidental finding, occurring in an asymptomatic 45-year-old woman. Light microscopic examination of both cytologic and histologic preparations was typical of a classical meningioma and included such features as intranuclear pseudoinclusions, psammoma bodies, and cellular whorls. Immunohistochemistry demonstrated tumor cell positivity for vimentin and epithelial membrane antigen, as is characteristic of meningioma. Ultrastructural analysis showed interdigitating cell membranes and desmosomes, with no evidence of basal lamina, neurosecretory granules, or microvilli. On short-term follow-up, the patient is well and has no evidence of a cranial or spinal meningioma. The previous 10 cases reported in the literature had similar characteristics, including a tendency toward occurrence in middle age to older women, asymptomatic presentation, peripheral lung location, and morphologic features. Finally, other conditions in the differential diagnosis and possible histogenesis are discussed.     

Apical vault repair, the cornerstone or pelvic vault reconstruction

Magnetic resonance angiography (MRA) and venography (MRV) are useful tools in the diagnosis and analysis of both intracranial and head and neck tumors. These procedures illuminate the three-dimensional relationships of the tumors and the adjacent cerebral vasculature. Contrast administration allows further analysis of these lesions. Research continues to improve the spatial resolution that may preclude conventional angiography. For the first time, MRA allows non-invasive diagnosis of neurovascular conditions such as trigeminal neuralgia and pulsatile tinnitus. This accurate diagnosis revolutionizes therapy. Although MRA has certain limitations, its role continues to expand. The value of MRA for diagnosis and treatment planning is paramount.     

Primary meningioma intimately related to skull: case report and review of the literature

A report is made of a primary meningioma intimately associated with the left sphenoid ridge and temporal bone of a 41-year-old woman. The lesion produced hyperostosis of the involved bones, ipsilateral proptosis, and reduced vision for 4.5 years. The radiotherapy yielded little improvement of the exophthalmos and vision. Review of 125 reported meningiomas intimately related to the skull and presenting primarily with hyperostosis and minimal soft tissue component, including the current case, disclosed that all but one affected the cranium proper, particularly the middle ear, temporal bone, frontal bone, and parietal bone. The exceptional one was in the mandible. They tended to occur between the fifth and seventh decades of life with the peak occurrence between the fifth and sixth decades. The average age was 46 years for overall. The female-to-male ratio was 2:1. Six of 125 primary meningiomas closely associated with the skull were malignant and two of these spread to the lungs. The pulmonary metastasis was spontaneous in one case.     

Intraosseous schwannoma of the vault of the skull

Intraosseous schwannoma is a rare benign tumor of the bone with characteristic radiological and histological features. The most common sites of this tumor are mandible, sacrum, und vertebral bodies. Two cases, one of which is the first diagnosed with MRI, of this tumor in the vault of the skull are presented.     

Primary papillary meningioma of the optic nerve sheath: a case of unique location and benign pathology

I report here a case of primary papillary meningioma of the optic nerve sheath which developed in the left eye of a 54-year-old woman over a period of 20 years. A review of 123 primary papillary meningiomas, including the current instance, disclosed that they tended to occur in young patients of both sexes at an average age of 35 years, with one-fourth of them occurring in the first two decades of life, and with a female/male ratio of 3:2. These meningiomas were most frequent in the supratentorial compartment of the cranial cavity, especially on the cerebral convexity and in the parasagittal region. They were uncommon subtentorially, intraspinally, and outside the central nervous system. Most reported papillary meningiomas were claimed to be malignant, but the tumor of this particular woman was benign pathologically and clinically.     

Bilateral lunate intraosseous ganglia

An intraosseous ganglion is a relatively uncommon, benign, cyst-like lesion that occurs in young and middle-aged adults. Most commonly seen adjacent to the hip, ankle, knee, or wrist, they are histologically identical to their soft tissue counterparts. A review of the literature revealed only two previously reported examples of bilateral symmetrical ganglia of the lunate bones.     

Uterosacral ligament fixation for vaginal vault suspension in uterine and vaginal vault prolapse

OBJECTIVE: The purpose of this study was to determine the simplicity, safety, anatomic, and functional success of using the uterosacral ligaments for correction of significant complex uterine and vaginal vault prolapse by the vaginal route. STUDY DESIGN: Fifty women with uterine or vaginal vault prolapse with descent of the cervix or the vaginal vault to the introitus or greater were treated between 1993 and 1996 by the same surgeon with bilateral uterosacral ligament fixation to the vaginal cuff by the vaginal route. Included were patients with significant enterocele, cystourethrocele, rectocele, and stress urinary incontinence who had concomitant repair of coexisting pelvic support defects. An etiology of vaginal vault prolapse is discussed. RESULTS: Uterosacral ligaments were identified and used for successful vaginal vault suspension by the vaginal route in all 50 consecutive patients without subsequent failure or significant complications with a maximum follow-up of 4 years. One patient had recurrent stress urinary incontinence and two had asymptomatic cystoceles. Three patients had erosion of monofilament sutures at the vaginal apex. CONCLUSIONS: In these 50 patients with significant complex uterine or vaginal vault prolapse, uterosacral ligaments could always be identified and safely used for vaginal vault suspension by the vaginal route with no persistence or recurrence of vaginal vault prolapse 6 to 48 months after surgery. Excessive tension by the surgeon on tagged uterosacral ligaments at the time of hysterectomy may be an etiologic factor in vaginal vault prolapse.     

Solitary intraosseous infantile myofibroma of the orbital roof

BACKGROUND: There are several rare tumors that can cause proptosis in an infant, including infantile myofibroma. METHODS: A 3-month-old infant developed a painless, bone-destructive superomedial orbital mass, raising concern for orbital malignant neoplasms. Computed tomography disclosed a bone-destructive mass of the sphenoid wing. On magnetic resonance imaging, the intraosseous mass was well-circumscribed, surrounded by cortical bone, and showed prominent enhancement. RESULTS: Superomedial orbitotomy and biopsy revealed a lesion composed of spindled to stellate cells, without mitotic activity, set in a fibromyxoid stroma. Immunohistochemical stains were positive for vimentin and actin. Ultrastructurally, there were actinlike thin filaments, mitochondria, and rough endoplasmic reticulum confirming a myofibroblastic proliferation and supporting the diagnosis of congenital infantile myofibroma. CONCLUSION: Infantile myofibroma is a benign tumor that occurs rarely in the ocular region but can cause prominent bone destruction, misleading the clinician to suspect a malignant neoplasm.     

Oncocytic meningioma

Feeding behavior of adult rainbow trout (Oncorhynchus mykiss) is released by visual and/or chemical stimuli. Detection of either a conditioned visual or a conditioned chemical stimulus creates an excitatory feeding state within the central nervous system which turns on feeding behavior composed of swimming, turning and biting/snapping actions. Particular amino acids that are highly effective physiological taste stimuli that are also detected through olfaction (e.g. L-proline, L-alanine, L-leucine) release the initial sequence of food searching and biting/snapping behaviors; however, an effective olfactory, but poor gustatory, stimulus (e.g. L-arginine) is rarely effective behaviorally. After bilateral removal of the paired olfactory organs, visual stimuli alone release the entire set of feeding behavior patterns. Since amino acids that are highly potent physiological taste stimuli do not release either feeding behavior or reflex biting/snapping actions in adult anosmic rainbow trout, it is postulated that the olfactory system detects potent taste stimuli and provides the afferent input for arousal and the release of all feeding activity patterns.     

Intraepithelial neoplasia and carcinoma in the vaginal vault

An 11-year biopsy material from the vagina is presented. The indication for taking the 370 vaginal biopsies was abnormal cytology, polyps, or suspicion of tumor tissue. The material was found to include 10 cases of intraepithelial neoplasia, viz. 4 primary, 6 secondary, and 2 late cases of secondary invasive carcinoma. The interval between the primary and secondary diagnosis ranged from 7 months to 19 years. It is concluded that the risk of secondary changes in the vaginal mucosa is slight, but cytological follow-up is recommended.     

Recurrent spheno-orbital meningioma

A series of 15 patients who underwent neurosurgical procedures for recurrent spheno-orbital meningioma is reported. There were 11 women and four men, with a mean age of 46 years. The mean duration between the first and second operations was 46 months. Progressive proptosis without neurological deficit was the most common symptom. All tumors were large at the time of reoperation and involved the greater and lesser wings of the sphenoid bone and the orbit. Aggressive resection in all patients resulted in no deaths and only slight morbidity, with the exception of one patient who developed blindness 24 hours after surgery due to central retinal artery occlusion. Fourteen patients were improved cosmetically and one patient, treated early in the series, had persistent proptosis due to inadequate bone removal. No attempt was made to remove tumor within the cavernous sinus in patients who were neurologically normal. Although postoperative imaging demonstrated complete gross excision of tumor in nine patients, 10 underwent conventional radiation therapy for residual tumor visualized at the time of surgery in the dura of the superior orbital fissure, the cavernous sinus, or the basal optic canal. Although this study is inconclusive and requires further long-term documentation, no recurrences have been seen to date in the follow-up period, ranging from 16 to 95 months. The following important points are discussed: 1) the failure by experienced surgeons to radically excise bone, tumor, and involved dura at the first operation; 2) the importance of early aggressive therapy, depending upon the patient's age and medical condition; 3) the almost invariable intracranial dural involvement, which at times was seen only by gadolinium-enhanced magnetic resonance imaging and not visualized on computerized tomography; 4) an illustrated stepwise surgical technique for complete resection through a small craniotomy without the need for complicated reconstruction of the orbit or temporal fossa; 5) the role of radiation therapy when removal is incomplete or deemed hazardous because of cavernous sinus involvement; and 6) the excellent cosmetic results possible with minimal morbidity and no mortality.     

Cranial vault moulding by the transcutaneous activation of implanted magnets

The present paper surveys the published HPLC methods evaluating profens in biological materials and reports a HPLC method for the determination of ibuprofen in the samples of whole blood. For liquid-liquid extraction, ibuprofen was analyzed on the reverse phases Separon SGX C18 with the mobile phase methanol-water (pH 3.0) and detected at 222 nm. The elaborated method was employed in a pharmacokinetic study of ibuprofen on laboratory rabbits.     

Jugular foramen meningioma

We present a 79-year-old man diagnosed with immune thrombocytopenia (ITP), treated with danazol, who died as a result of a spontaneously ruptured spleen. The histopathological diagnosis was splenic peliosis. This patient presents a chronological association between the treatment with danazol and the development of peliosis, which suggests a clear cause-effect relationship. Facing an individual patient with ITP, clinicians should weigh the potential benefits of danazol with the possible development of serious complications, such as hepatic failure or splenic rupture due to peliosis.