RESUMEN

Background: Solitary fibrous tumors (SFTs) account for 3.7% of all soft-tissue sarcomas, with an annual incidence of 0.35/100,000 individuals. Notably, although 20% involve the central nervous system, only one in 10 occurs in the spine versus the brain. Case Description: A 46-year-old female presented with 18 months of left lower extremity sciatica. On examination, she had a 60° limitation of straight leg raising but was otherwise neurologically intact. The lumbar magnetic resonance revealed a dumbbell tumor at the L4-L5 level filing the canal, causing cauda equina compression and extending into the left L45 foramen. The patient successfully underwent a L4 left hemi-laminectomy for tumor resection. The postoperative World Health Organization (WHO) histopathology was consistent with a SFT/WHO Grade I hemangiopericytoma (HPC). Conclusion: A 46-year-old female with a lumbar L4 SFT with the left L45 foraminal extension successfully underwent a left hemilaminectomy for GTR of an SFT/WHO Grade I HPC.

RESUMEN

OBJECTIVE: To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report. METHODS: A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study. RESULTS: A total of 49 articles (91 patients) were included. The patients' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months. CONCLUSIONS: The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.

Asunto(s)

Malformaciones Arteriovenosas , Embolización Terapéutica , Cuero Cabelludo , Humanos , Cuero Cabelludo/irrigación sanguínea , Cuero Cabelludo/cirugía , Embolización Terapéutica/métodos , Malformaciones Arteriovenosas/cirugía , Malformaciones Arteriovenosas/diagnóstico por imagen , Procedimientos Endovasculares/métodos , Niño , Adulto , Cuidados Preoperatorios/métodos , Adolescente , Preescolar , Masculino , Femenino , Persona de Mediana Edad , Adulto Joven , Anciano , Lactante , Terapia Combinada/métodos

RESUMEN

Gliosarcoma (GS) is a primary central nervous system tumor. It is an unusual type of glioblastoma multiforme (GBM) and rarely invades the skull base. It has a biomorphic tissue pattern with rapid alternation zones of glial and mesenchymal differentiation. We report the case of a 62-year-old male who presented with a one-month history of unsteady gait associated with dizziness. Brain MRI showed a right temporal mass that invaded the skull base with perilesional edema and a significant mass effect on the right lateral ventricle. The patient underwent a right-sided frontotemporal craniotomy with gross total resection. The pathology confirmed the diagnosis of GS. Postoperatively, the patient had an uneventful recovery with no complications and was discharged two days post-surgery.

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Background: Primary mediastinal B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma that originates from a B cell in the thymus. It usually affects young female. Case description: A 30-year-old woman presented with mediastinal mass with history of shortness of breath and chest pain. blood analysis showed low levels of hemoglobin, hematocrit, and mean corpuscular volume and high red cell distribution width. A computed tomography (CT)-guided mediastinal core biopsy disclosed primary mediastinal large B-cell lymphoma (PMLBL) with a nongerminal center phenotype and lung tissue infiltrate. Moreover, after undergoing six cycles of rituximab, cyclophosphamide, hydroxydaunomycin, Oncovin, and prednisone (R-CHOP) chemotherapy and mediastinal radiotherapy, the patient presented with headache and visual disturbance due to multiple supratentorial lesions. Conclusion: Till date, only a few cases of central nervous system (CNS) metastasis have been reported in the literature. Moreover, CNS metastasis of refractory PMBCL is an uncommon event with a poor prognosis. Brain metastases are often the ultimate fatal consequence of many aggressive cancers, so early detection and treatment are important.

RESUMEN

Choroid plexus papilloma (CPP) is a rare intraventricular tumor. The common locations of the tumor vary based on the age of the patient. It usually occurs in the supratentorial region in children, however in adult patients, these tumors commonly present in the infratentorial region. We are presenting a rare case of a pediatric patient with a two month history of decreased activity and loss of interest in his surroundings and gait imbalance. He underwent a suboccipital craniotomy and excision of a CPP in the fourth ventricle. In conclusion, CCP should be considered as part of the differential diagnosis of intracranial tumors when the clinical presentation and investigations are suggestive regardless of the location to avoid misdiagnosing it when it occurs in an uncommon location.

RESUMEN

Acute subdural hemorrhage (SDH) is a rare complication that can occur after a spontaneous intracranial aneurysmal rupture. It is commonly associated with a subarachnoid and/or an intracerebral hemorrhage but rarely occurs as an SDH alone. A 52-year-old female presented to our institution with a severe headache and third cranial nerve palsy. A computed tomography (CT) scan revealed acute left SDH, without a subarachnoid hemorrhage (SAH), and a computed tomography angiogram (CTA) and cerebral angiography demonstrated the presence of a left supraclinoid aneurysm pointing towards the cavernous sinus. Endovascular occlusion of the aneurysm was performed using a flow diverter. A follow-up CT scan revealed a resolved SDH. In similar situations, vascular imaging, such as CTA and cerebral angiography, is required to assess the cerebral vasculature. This case report describes a patient presenting with the sudden onset of a severe headache associated with a cranial nerve palsy and a brain CT scan showing an acute SDH in the absence of trauma or an anticoagulation history. The treating physician should be highly vigilant of the possibility of a ruptured intracranial aneurysm as the underlying SDH etiology.

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Carpal tunnel syndrome (CTS) is one of the most common peripheral nerve diseases. It is managed medically and if not, resolved by surgical procedure. Decompression of the carpal tunnel is considered the definitive treatment. There are multiple complications after this procedure, which can be classified into three categories: (I) persistent, (II) recurrent, or (III) new symptoms, and ulnar nerve palsy after decompression of the carpal tunnel is a rare complication. In this study, we present a case of carpal tunnel decompression, which was complicated by ulnar nerve palsy, which exacerbated a pre-existing chronic ulnar nerve injury. We also explore the possible causes that may have led to this outcome.

RESUMEN

Hydrocephalus, which is caused by the accumulation of cerebrospinal fluid (CSF), is a common condition in children. It is known to be most likely treated by the insertion of a ventriculoperitoneal (VP) shunt. However, a VP shunt can lead to multiple complications. The upward migration of a VP shunt is considered rare. A newborn male baby with a known case of Chiari malformation type 2 associated with myelomeningocele (MMC) and hydrocephalus had a VP shunt inserted for control of the hydrocephalus. He presented two months after the surgery with occipital swelling at the surgical site. Shunt series followed by Computerized tomography (CT) scan showed that the distal end of the catheter had migrated upward and coiled around the valve. Urgent revision of the VP shunt was performed. Reabsorption of subgaleal fluid, increased abdominal pressure, repeated abdominal wall contraction, and repeated head motion of the child are the previously suggested theories of upward migration of distal catheter to the site of the valve. However, the combination of multiple theories can be the logical explanation, as they do not oppose each other.

RESUMEN

Enterococci are responsible for an increasing number of human infections. They are normally part of the flora of the human gastrointestinal tract, buccal cavity, perineal skin, vagina, urethra and gallbladder, but may occur as pathogens in several sites causing urinary tract infections, intra-abdominal infections, fatal bacteremia, meningitis and endocarditis. Enterococcus avium is a rare cause of infection in humans. Here, we report a 19-year-old Saudi girl diagnosed as a case of astrocytoma grade II arising from the right thalamus. She underwent treatment with radiotherapy followed by 5 chemotherapy sessions. She subsequently developed a cerebral abscess, and we performed mini craniotomy of the left parietal region with drainage of the brain abscess. The pus obtained from the abscess grew Enterococcus avium. We successfully treated her with antibiotics and discharged her home. The rarity of the organism causing cerebral abscess has motivated the documentation of this case and the pathogenesis of Enterococcus avium.