A unique case of cerebral spleen

We present the first case of cerebral splenosis, occurring in a 20-year-old man 15 years after posttraumatic splenectomy. He became symptomatic through seizures and was operated on for suspected meningioma of the right occipital pole. Histologic evaluation of the lesion revealed splenic tissue with matching immunohistochemical results. Because no penetrating head injuries were reported at the time of trauma, a hematogenous spread of splenic tissue has to be assumed.     

A case of migraine with aura associated with meningioma

We reported a case of migraine with aura associated with meningioma. A 66-year-old female visited to our department in 1985, with occipital throbbing pain following visual hallucination and nausea. She had been diagnosed as migraine. CT scan, magnetic resonance image and angiography showed a right occipital tumor, which was totally removed in 1990. Postoperatively, the migraine disappeared completely. The tumor was histologically diagnosed as fibroblastic meningioma. We supposed that the migraine had been associated with meningioma. Although some previous papers reported correlation with brain tumor and migraine, as example of arteriovenous malformation or angioma, migraine associated with meningioma is very rare. In arteriovenous malformation, pathophysiology of migraine is unclear, but induction of circulatory disturbance in the distribution of the posterior cerebral, posterior communicating and basilar artery is supposed. And then a space occupying lesion in the occipital lobe is possible to cause in the circulatory disturbance of the posterior cerebral and basilar artery. In the diagnosis of migraine, we should consider its relation to brain tumors, such as meningioma.     

Cerebral gumma showing linear dural enhancement on magnetic resonance imaging--Case report

A 51-year-old male presented with a rare cerebral gumma accompanied by abducens nerve paresis and cerebellar infarction. Magnetic resonance (MR) imaging demonstrated a homogeneous enhance mass lesion and adjacent linearly enhanced dura mater. Histological examination of the mass revealed a caseating granuloma. Serological studies were positive for active syphilis. Although linear dural enhancement adjacent to the mass lesion on MR imaging is characteristic of meningioma, this finding is also demonstrated in cerebral gumma. Therefore, cerebral gummas should also be included in the differential diagnosis. Immunological tests for syphilis (serum, cerebrospinal fluid) can confirm the diagnosis.     

Meningiomas of the anterior skull base expanding into the orbit, paranasal sinuses, nasopharynx, and oropharynx

The natural progression of the infiltrative anterior skull base meningioma, expanding into orbit, paranasal sinuses, nasopharynx, and oropharynx during 12 years is presented. The development of the lesion is demonstrated on computed tomography. The patient was operated on six times from the age of 14. Pathological investigation revealed infiltrative meningoteliomatous meningioma without signs of malignancy.     

Health risk profile of prostitutes in Dublin

A 50-year-old male presented with a very unusual case of a calcified anterior communicating artery (AComA) aneurysm associated with a tuberculum sellae meningioma. Until 10 years previously, the patient had been a professional soccer player for 15 years. He noticed a slight decrease in visual acuity in the right eye 7 years before. The patient was in the care of an oculist throughout this period. Two months before admission, a significant and rapid decrease of vision in the right eye occurred. Computed tomography and magnetic resonance imaging showed a round-shaped, partially calcified tumorous lesion. Four-vessel angiography revealed a large AComA aneurysm. During surgery, a tuberculum sellae. meningioma was found in combination with an AComA aneurysm with a completely calcified wall. The meningioma was resected totally. The AComA aneurysm with a calcified wall could not be clipped or resected and was left alone. His visual deficit improved postoperatively.     

Cystic meningiomas in 2 dogs

Two dogs with signs of forebrain disease had hypodense lesions on computed tomography evaluation. Magnetic resonance imaging of the first dog showed a hypointense lesion on the T1-weighted scan and a hyperintense lesion on T2-weighted scanning. At surgery, both dogs had a primary cystic intracranial lesion, and the abnormal tissue adjacent to the cyst had histological features of meningioma. Each dog underwent whole brain irradiation after surgery, and 1 dog lived for 3 years after treatment. While uncommon, meningioma should be considered as a differential diagnosis in dogs with cystic intracranial lesions.     

成人复发性特巨大型脑膜瘤的临床分析(附1例报告)

The authors reported the case of a 35-year-old woman with an unusual huge recurrent meningioma in the left cerebral hemisphere confirmed by the pathological examination. This patient's clinical presentation was very unusual. Brain magnetic resonance imaging (MRI) demonstrated a huge tumor in the left frontal region. The extracranial surface dimensions of the mass were 12 cm craniocaudal × 11 cm transverse × 9 cm anteroposterior; and the intracranial dimensions were 9 cm craniocaudal × 7 cm transverse × 10 cm anteroposterior respectively. The patient underwent left frontal recurrent meningioma resection by microsurgery, with total tumor resection. Following which the patient was discharged in a stable condition. To the best of the authors' knowledge, such an unusual huge recurrent meningioma has not been reported. The authors reviewed the literatures with reference to recurrent meningioma, analyzed the unusual imaging appearances of this patient, and explored the mechanism underlying the huge volume formation. The fundamental principle to reducing or completely avoiding meningioma recurrence is to achieve total tumour resection. Recurrent meningiomas are also amenable to surgery.     

Rosai-Dorfman disease presenting as a meningioma

This report documents an unusal case of extranodal sinus histiocytosis (Rosai-Dorfman disease) which produced a solitary intracranial mass lesion that was diagnosed clinically and radiologically as a meningioma. Morphological features have been described and literature extensively reviewed.     

Diffuse cerebral artery vasospasm following total resection of posterior fossa meningioma: a case report]

Diffuse cerebral artery vasospasm following brain tumor resection is a rare complication. The authors reported a case of symptomatic diffuse cerebral artery vasospasm of early phase following resection of a left posterior fossa meningioma. A 50-year-old female patient was admitted to our hospital complaining of headache. No neurological deficits were detected at the time of admission. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large mass in the left posterior fossa. Cerebral angiography demonstrated mildly diffuse stenosis of the bilateral internal carotid artery. The tumor was resected totally. CT after operation showed a small amount of subarachnoid hematoma in the superior aspect of the cerebellum. Pathological specimen of the tumor showed fibrous meningioma. One day after this radical operation, the patient was found to have weakness in her left leg. Then she developed left hemiparesis, weakness in the right leg and left homonymous hemianopsia. MRI showed ischemic lesions in the bilateral parietal and the occipital lobe. Angiography demonstrated diffuse severe vasospasm throughout the whole cerebral artery. Ten days after the operation, angiographical findings were improved. This case indicates that vasospasm may occur even after resection of brain tumors which are localized outside the suprasellar area.     

Inflammatory pseudotumor of the choroid plexus

A case of inflammatory pseudotumor is described, in which CT revealed a hyperdense intraventricular lesion with a trapped temporal horn, and MR imaging showed decreased T1 and markedly hypointense T2 signal with homogeneously intense enhancement. Radiologically and grossly the tumor resembled a meningioma; however, histologically it was composed purely of inflammatory, nonneoplastic components. The lesion was resected with no evidence of recurrence at 5-month follow-up.     

Intracranial repair of a divided trochlear nerve. Case report

The authors report the case of a 37-year-old woman in whom the trochlear nerve was transected during removal of a meningioma in the cavernous sinus and subsequently repaired by using microsurgical techniques. This patient presented with a tumor in the posterior part of the right cavernous sinus with expansion over the tentorium. Preoperatively, she suffered from partial deficit of the right trochlear nerve. Intraoperatively, the trochlear nerve was noted to be completely encased by the tumor and was totally divided during removal of the lesion. After tumor resection, the trochlear nerve was repaired by using a sural nerve fascicle secured with sutures and fibrin glue. Six months after the operation, trochlear nerve regeneration became evident as the patient's binocular vision gradually improved. The patient regained normal functioning of the superior oblique muscle 3.5 years after surgery. It is concluded that repair of a divided trochlear nerve is worthwhile and can be followed by successful regeneration and an excellent functional recovery of the superior oblique muscle.     

Chronic obstructive pulmonary disease is associated with an increase in urinary levels of isoprostane F2alpha-III, an index of oxidant stress

BACKGROUND: The natural history of cerebral venous malformations has not been well documented, and the clinical significance of these common lesions remains controversial. OBJECTIVE: The objective of this study was to follow longitudinally the clinical course of patients with cerebral venous malformations to document the natural history of the lesion. METHODS: Ninety-two patients with radiographically confirmed venous malformations were entered into the study between 1987 and 1996. Annual follow-up was maintained by clinic visits and/or phone interviews. Sixty-three patients (25 men and 38 women) with more than 1 year of follow-up were analyzed. McNemar's test and logistic regression analysis was applied to prevalence of presenting symptoms over time. An average per patient follow-up of 4.2 years yielded 2,721 retrospective and 301 prospective lesion-years for analysis. RESULTS: Average age at diagnosis was 39.1 years (SD, 18.7 years; range, 2 to 73 years). The most frequent lesion locations included the frontal lobe (55.6%, n=35) and the cerebellum (27%, n=17). The most frequent presentations included headache (50.8%, n=32), focal neurologic deficits (39.7%, n=25), and seizure (30.2%, n=19). Prevalence of headache (p=0.048) and seizure (p=0.016) decreased over time without treatment of the lesion. A second cerebrovascular lesion was identified in 12 patients (19%). Two patients had a symptomatic intracerebral hemorrhage attributable to their venous malformation. Risk of hemorrhage was 0.15% per lesion-year (95% CI, 0.06 to 0.38%). CONCLUSIONS: This study establishes that the natural history of venous malformations is benign, that the risk of hemorrhage from these lesions is negligible, and that conservative therapy is warranted.     

Evaluation of laser surgery against brain tumor (author's transl)

A surgical carbon dioxide laser unit (Laser) has been used in 26 cases of various brain tumors, including 10 meningioma (4 sphenoid ridge, 3 parasagittal, 1 falx, 1 olfactory, 1 posterior fossa); 12 glioma (7 glioblastoma, 5 astrocytoma); two metastatic brain tumors; 1 hemangioblastoma, and 1 AVM. Criteria for Laser use based on evaluation and location of meningioma were: grade 1, convenient but adjuvant; grade 2, also necessary; grade 3, indispensable. Most meningioma in convexity and parasagittal were grade 1-2, with those in the sphenoid ridge grade 2-3. In the glioma group, hemorrhage in 3 cases of glioblastoma was easily Laser-controlled, and the tumors wasted away in a short time with vaporization. There was minimal mechanical effect on the adjacent tissue. Conclusion: In neurosurgery, Laser is obligatory in sphenoid ridge meningioma to dissect the internal carotid artery, middle cerebral artery, cavernous sinus, sphenoid ridge, etc. It is very useful in glioma, especially glioblastoma, considering shortened surgical duration, decreased blood loss and extended tumor resection. Laser surgery is proposed as most appropriate for brain tumors in elderly and poor risk cases mainly for its vaporizing function.     

The tentorium in axial section. II. Lesion localization

Most juxtatentorial lesions may be localized accurately on contrast-enhanced axial section CT scans by use of the opacified tentorial bands. Lesions that lie lateral edge of the diverging bands are supratentorial. Lesions that lie medial to the V-shaped tentorial bands are infratentorial and/or incisural. Flattening of the tentorial border of a lesion helps to identify its location. Use of the tentorial bands identifies transincisural extension of meningioma reliably, but does distinguish well between true transtentorial growth of meningioma and marked upward bulging of the tentorium from purely infratentorial meningioma.     

A case of thoracic meningioma presenting paraplegia at 4.5 years after removal of a falx meningioma

A case of a thoracic meningioma presenting paraplegia 4.5 years after removal of a falx meningioma is reported. A 73-year-old woman, complaining of diplopia, was admitted to our department. Neurological examination revealed right abducens palsy. CT demonstrated a well-enhanced right frontal mass beneath the falx. The mass was totally removed under right frontal craniotomy. Its histology was transitional meningioma with rich fibroblasts. 4.5 years after craniotomy, she complained of progressing gait disturbance and nocturnal leg pain. Neurological examination revealed paraplegia, complete loss of leg sensation, loss of patellar and ankle reflex, bilateral positive Babinski reflex and urinary disturbance. Rectal function and anal reflex were preserved. Thoracic MRI demonstrated an intradural extramedullary mass which was well enhanced with Gd-DTPA at Th6-7. Under laminectomy, the mass was totally removed. Its histology was transitional meningioma with rich psammoma bodies and whirl formations. 4 months after removal, her palsy and sensory loss were almost completely recovered. We were able to find 15 cases of combined intracranial and spinal meningiomas in the literature. A young woman of neurofibromatosis suffered from tentorial, intraventricular and C1-2 meningiomas. Of 15 cases without neurofibromatosis including our case, 4 cases were of young boys and 11 cases were of women. Their initial symptoms originated from intracranial meningiomas in 8 cases. Multiple intracranial meningiomas were revealed in only 4 cases. In 9 cases, one case presented a combination of one intracranial meningioma and one spinal meningioma. Histology of intracranial meningioma was almost the same that of spinal meningioma in almost half of the 10 cases. These findings suggest the multi sentricity theory of multiple meningiomas originating in other neuroaxial compartments. Severe spinal dysfunction was recovered after removal in our case. Rectal function and anal reflex were preserved. These anorectal findings suggest that spinal dysfunction is either complete or incomplete. Motor evoked potentials are hopeful tools which can select reversible spinal motor dysfunctions.     

Giant aneurysm of the middle cerebral artery

A case of a giant aneurysm of the middle cerebral artery, (4.5 X 4.5 X 9.5 CM) presenting as a mass lesion, which was successfully excised is described. This case is compared to the few previous accounts of giant aneurysms of the middle cerebral artery larger than 3 cm in diameter.     

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.     

MRI of an unenhancing tuberculum sellae meningioma

We present a tuberculum sellae meningioma with intrasellar extension which did not enhance with intravenous gadolinium. Identification of the diaphragma sellae, possible only on the unenhanced short TR/TE sequence, was crucial for differentiating the lesion from a pituitary adenoma, and therefore for the correct surgical approach.     

A case of dural arteriovenous fistula in the transverse and sigmoid sinus which developed over five years

We report a case of dural arteriovenous fistula (dAVF) of the transverse and sigmoid sinus which developed over five years. The patient was a 64-year-old man, who had a history of congestive heart failure and transient ischemic attack (TIA). No abnormal lesions were detected in the cerebral angiograms five years prior to the time the etiology of his TIA was investigated. He suddenly suffered from left hemiparesis and the CT scan showed right parietal subcortical hemorrhage. Right carotid angiogram demonstrated dAVF of the transverse and sigmoid sinus supplied by the right occipital and ascending pharyngeal arteries. We thought the reason for the subcortical hemorrhage in this patient was due to the disturbance of venous return in the right cerebral hemisphere. We underwent direct embolization of the right transverse sinus by interlocking detachable coils. Postoperative cerebral angiograms demonstrated the disappearance of dAVF and he was discharged. Whether dAVF is a congenital anomaly or not, has been controversial. Since the dAVF in this case had newly developed over five years, it is suggested that dAVF is an acquired lesion.     

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.