Atypical presentation of a posterior fossa tumour:A case report

BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the patient had no other symptomatology,especially given the size of the mass,which would typically cause a pressure effect leading to neurological and auditory symptoms.CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard.He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler.He initially presented to our facility with severe respiratory distress.He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator.He had no constitutional symptoms or impairment of hearing.On clinical examination,the patient’s chest was“silent.”Our initial assessment was status asthmaticus with type 2 respiratory failure,based on the history of asthma,a“silent chest,”and the arterial blood gas results.CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy.The patient’s chief presenting feature was severe respiratory distress,which combined with his background medical history of asthma,was misleading.Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.

基于THEMIS图像分析的火星Icaria Fossae地区古老火山地貌特征与形成时间

Icaria Fossae地区位于火星Tharsis火山高原的南部。通过对高分辨率的THEMIS图像分析，在该区新识别出了20多个小火山，它们的直径为45～100km，高度为800～3000m。通过对这些火山建造表面撞击坑直径-频率统计的分析，认为这些火山年龄约4Ga。这是到目前为止在火星上发现的最古老的火山。与火星上其他地区相比，这些火山表现出后期被强烈改造的特征，其间发育丰富的撞击坑、熔岩流、河道等地质现象。

Imaging of the Extra-axial Tumors and Tumor-like Lesions Involving both Middle and Posterior Cranial Fossae: Classification and Diagnosis

Objective: To study the imaging features of extra-axial tumors and tumor-likelesions involving both middle and posterior cranial fossae and to make a classification. Methods:Sixty cases of pathologically confirmed extra-axil tumors and tumor-like lesions involving bothmiddle and posterior cranial fossae were analyzed. They were divided into central and lateral types,the latter of which were subdivided into three types: middle cranial fossae type, posterior cranialfossae type and the over-riding type. The constitution and imaging features of each type wereanalyzed. Results: There were 12 cases of central type, including chordoma (n=5), pituitary adenoma(n=3), nasopharyngeal carcinoma (n=2), craniopharyn-gioma (n=1) and meningioma (n=l). 48 cases oflateral type including trigeminal nerve tumors (n=14), meningioma (n=12), epidermoid cyst (n=11),dural cavernous hemangioma (n=4), dermoid cyst (n=2), metastasis (n=2), hemangiopericytoma (n=1),paraganglioma of glonius jugular (n=1) and nasopharyngeal carcinoma (n=1). Each type of the lesionshad its own shape features, some of which were characteristic for some specific tumors. Most of thetumors and tumor-like lesions could be qualitatively diagnosed according to their imagingcharacteristics and the extent of the lesions could be defined definitely. Conclusion: It is helpfulto categorize extra-axial tumors and tumor-like lesions involving both middle and posterior cranialfossae according to their location for qualitative diagnosis and description of the extent of theselesions. It is of great clinical value in providing more precise and thorough imaging informationfor planning therapeutic methods and route of operation.

Treatment implications of posterior fossa ependymoma subgroups

Posterior fossa ependymoma comprises two distinct molecular entities,ependymoma_posterior fossa A(EPN_PFA)and ependymoma_posterior fossa B(EPN_PFB),with differentiable gene expression profiles.As yet,the response of the two entities to treatment is unclear.To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment,we studied a cohort of 820 patients with molecularly profiled,clinically annotated posterior fossa ependymomas.We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA,which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era:a retrospective multicohort analysis" in the Journal ofClinical Oncology.Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy,whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.

Primary Endodermal Sinus Tumor in the Posterior Cranial Fossa:Clinical Analysis of 7 Cases

Objective To clarify the clinical features,therapeutic method and outcomes of the primary endodermal sinus tumors(ESTs)in the posterior cranial fossa.Methods The English literatures on EST in the posterior cranial fossa were retrieved from PubMed and reviewed.And a 4-year-old boy diagnosed with EST in our hospital was reported.The clinical manifestations,therapy,pathologic features,and prognosis of these cases were analyzed.Results Only seven cases of the ESTs in the posterior cranial fossa were enrolled in this review,including six cases searched from the PubMed and one case from our hospital.Six patients were boy and one patient’s gender was not available from the report.Ages ranged from 1 to 5 years(mean 3.14 years).The mean tumor size in our cohort was 4.4 cm.Six cases came from East Asia.Schiller-Duval bodies were found in all seven neoplasms.All tumors were positive for alpha-fetoprotein.The alpha-fetoprotein level in serum was increased to a very high level before therapy and depressed quickly after the effective chemotherapy.The mean follow-up time was 24.4 months(range 5-52 months).Six tumors were totally removed,and four of them recurred.Three cases died including one whose tumor was partially removed.Conclusions The serum alpha-fetoprotein level is well correlated with the severity of the tumor.A combination of operation and chemotherapy might be the effective management for EST in the posterior cranial fossa.The prognosis of extragonadal intracranial EST is poor.

Inflammatory Myofibroblastic Tumor Mimicking Malignant Meningioma in the Middle Cranial Fossa:a Case Report

INFLAMMATORY myofibroblastic tumor（IMT）,alsoknown as inflammatory pseudotumor or plasma cellgranulomas,is an uncommon fibro-inflammatorylesion which is composed of inflammatory cells andmyofibroblastic spindle cells.1Its pathogenesis is still un-known.The tumor commonly occurs in the lung,upperrespiratory tract,live,orbit,abdominal membrane,retro-peritoneum,and genitourinary tract.2-4It rarely involvesthe central nerve system,5,

Ondine's curse after posterior fossa decompression: report of one case

Objective and Methods: A case of Ondine’s curse after posterior fossa decompression was reported. A 33-year-old woman was admitted complaining 2 years of dizziness and progressive worsening of gait disturbances, and 1 year of repetitively ictal nausea. The diagnosis of Arnold-Chiari malformations was established. Results: The patient underwent suboccipital craniectomy and C1-3 laminectomy. In addition to this decompression measure, a fascial graft was sutured between the edges of the dural incision. Postoperatively, the patient lost automatic control of her respiration doting sleep and became hypercapnic and hypoxemic. Assisted ventilation was initiated. Conclusion: Ondine’s curse is possibly due to insensitivity of central chemoreceptors to carbon dioxide resulting in defective control of minute ventilation. Propofol is not recommended in eases of Ondine’s curse, and assisted ventilation until the restoration of automatic control of respiration can be of value. Oxygen inspiration alone is rather harmful than beneficial.

DIFFERENTIATION OF NASAL FOSSA INVOLVEMENT AND ITS CLINICAL SIGNIFICANCE IN NASOPHARYNGEAL CARCINOMA

Objective: To evaluate the prognostic influence on local control and survival in vary patterns of nasal fossa involvement in nasopharyngeal carcinoma (NPC) after radiation therapy. Methods: Between November 1989 and July 1991, 218 patients with histologically diagnosed local-regional NPC were treated with radiotherapy. Based upon the fiberscope finding, we separated nasal fossa involvement into two types: exophytic protruding (EP), which indicated exophytic bulky tumor arising from the nasopharynx and protruding into the nasal fossa, and mucosal infiltration (MI), which indicated that the nasal cavity mucosa was clinically infiltrated by tumor. Of the 218 patients, 87 had nasal involvement. Sixty of them had a pattern of MI and another 27 had an EP component. Results: The likelihood of residual disease after irradiation, the local relapse rate, 5-year free from progression rate (FFP) and death rate associated with nasopharynx relapse (DRANP) of MI and EP were 36.7% vs 3.7%, 30.0% vs 7.4%, 26.7% vs 51.8% and 25.0% vs 3.7% with P<0.004, P<0.005, P<0.02 and P<0.03, respectively. Multivariate analysis in this selected group demonstrated that infiltration of nasal fossa mucosa was an independent prognostic factor on primary control and FFP. Conclusion: Differentiation of nasal fossa involvement according to MI or EP is of value in predicting the outcome of treatment. A specific biological difference between the MI and EP group might contribute to the statistical differences in the treatment endpoints we have observed.

Comparative Study on Two Surgical Procedures for Middle Cranial Fossa Arachnoid Cysts

In this study, we explored the operation options for middle cranial fossa arachnoid cysts （MCFAC）. One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y （mean=5.4 y）. All these patients were divided into three subgroups according to Galassi classification. Long-term outcome and complications were studied respectively. Fenestration （F） resulted in a more favorable long-term outcome and less complication for cysts of types I and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting （S）. We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ （Galassi classification）, cysto-peritoneal shunting is better for cysts of type Ⅲ.

Concurrent chemotherapy and reduced - dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average - risk medulloblastoma: efficacy and patterns of failure

PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional

Cerberus Fossae, Mars: The Case for Dike Intrusion-related Formation and Modification

Cerberus Fossae(CF)is a large fracture system on Mars that extends for more than 1200 km.The structures,or fossae,are southeast of,and oriented approximately radially to,the large shield volcano Elysium Mons.An

Trigeminal Ganglioneuroma in the Middle-posterior Cranial Fossa： a Case Report

GANGLIONEUROMA is considered as the most mature and noninvasive form of neuroblastic tumors. It derives from neural crest cells, and can arise from wherever sympathetic tissue exists, including neck, posterior mediastinum, adrenal gland, retroperitoneum and pelvis. The two most common locations for this tumor are retroperitoneum and posterior mediastinum; infrequently it occurs in the intracranial re-gion,2-8 with only three cases has been reported arising from trigeminal nerve.2-4 The current paper presents a 49-year-old male patient with a ganglioneuroma arising from right trigeminal ganglion and extending to the mid-dle-posterior cranial fossa. We summarized the clinical and diagnostic characteristics of this extremely rare tumor, in comparison with the three reported cases in literatures.

Temporal Fossa Abscess Caused by Apical Periodontitis: A Case Report

According to the progress of the antibiotic medicine, the severe infection case is decreasing recently. We recently experienced a case of temporal fossa abscess caused by periapical periodontitis the upper left side of the second molar. A 79-year-old woman visited to Showa University Dental Hospital complaining of the painful swelling at the left side of the temporal and trismus. The routine blood test exhibited a severe inflammation. We performed drainage treatment at temporal skin and normal oral bacterial flora was detected by the bacteriological examination. Under treatment included the administration of antibiotics, the inflammation healed without serious complication and she recovered completely.

SOME CLINICAL ASPECTS OF SURGICAL MANAGEMENT OF INFRATEMPORAL FOSSA MALIGNANCIES

Thirteen patients with infratemporal fossamalignancies treated in the Sichuan Cancer Hospitalfrom 1988 to 1993 are reported. All cases were treatedsurgically with combined therapy. The survival rate ofthe patients with survival period beyond 2 years was53.8o/o. The survival was associated with the extent ofdissection (P<0.01). The operation value, surgicalapproaches, resection range, stylohamular line and repairare analyzed and discussed. A new surgical approach, amodified stylohamular line and a new surgical conceptfor resection of the infratemporal fossa malignanciesbony boundary of surgery are introduced in detail.

Mucoepidermoid carcinoma in the infratemporal fossa: A case report

BACKGROUND Mucoepidermoid carcinoma is the most common primary epithelial salivary gland malignancy.It mostly occurs in the major or intraoral minor salivary glands but rarely in the infratemporal fossa.Here,we present a case of aggressive mucoepidermoid carcinoma in the infratemporal fossa with neck lymph node metastasis and also discuss diagnostic and treatment strategies.CASE SUMMARY A 39-year-old woman with a mass located in the right submandibular area presented to our department.Physical examination revealed lymphadenopathy on the right submandibular side measuring 2.5 cm×3 cm that was hard and had poor mobility.Results of nasal endoscopy were unremarkable.Ultrasound examination revealed an enlarged lymph node at level II of the right side.Fine needle aspiration cytology of the metastatic lymph node revealed malignant cells with infection.Contrast-enhanced computed tomography revealed an enhancing ill-defined soft tissue mass in the right infratemporal region.Positron emission tomography/computed tomography revealed hyperintensity in the right infratemporal fossa along with lymphadenopathy at level II of the right-side lymph node.The patient underwent extended resection of the primary tumor,and ipsilateral radical neck dissection was also completed.Hematoxylin-eosin staining and immunohistochemistry revealed a high-grade mucoepidermoid carcinoma.No signs and symptoms of recurrence of the neoplasm were present after 20 mo of follow-up.CONCLUSION Positron emission tomography/computed tomography play a key role in primary tumor localization.Furthermore,histopathology and immunohistochemistry play pivotal roles in disease diagnosis.

Duration of Preoperative External Ventricular Drain in Pediatric Posterior Fossa Tumors—Does It Matter?

Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: The study was conducted in the Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia from January 2010 to December 2013. The data were collected retrospectively. The patients who had emergency insertion of external ventricular drain (EVD) due to hydrocephalus before the definitive posterior fossa tumor surgery were included in the study. Results: The preoperative emergency insertion of EVD was done in 38 patients with pediatric posterior fossa tumors. The patients were divided into two groups. Group A consists of those patients who had duration of preoperative EVD equal or less than 7 days. Group B includes those patients who had duration of preoperative EVD more than 7 days. Group A has 16 patients while Group B has 22 patients. The predominant clinical feature was symptoms and signs of raised intracranial pressure (ICP) only. Infection related to EVD was seen in seven patients. Ventriculoperitoneal (VP) shunt was required in 31.25% of Group A patients and 18.18% of Group B patients (p value = 0.35). Overall shunt rate was 23.68%. Conclusion: There are well known number of factors that can determine the need of permanent CSF diversion in patients with posterior fossa tumors. However, there is no effect of preoperative duration of EVD in determining the requirement of postoperative VP shunt.

Extrapineal mature teratoma of the posterior fossa in a child

Introduction: teratomas are non-malignantgerm cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically are midline or paraxial lesions located in the pituitary stalk or the pineal region. We report our experience with mature teratomas of the posterior fossa. Case report: we present the case of an 11-year-old caucasian female with progressive headache that caused interrupted sleep. Cerebral magnetic resonance imaging showed a midline lesion in the posterior fossa with mass effect and without contrast enhancement. Anatomic pathology revealed a mature teratoma. Conclusion: differential diagnosis of midline lesions in pediatric patients must include teratomas in spite of being posterior fossa lesions.

Decompressive Craniectomy in Posterior Fossa Ischemic Stroke

Ischemic damage produced in the posterior cerebral territory causes significant morbidity and urgently must be considered if the patient need a surgical attitude. Surgical decompression by suboccipital craniectomy seams to be effective to treat secondary edema due to cerebellar damage or in posterior fossa, when medical treatment is not able to control side effects. We report a clinical case of a patient with a subacute ischemic infarction in the vertebro-basilar territory, with perilesional edema, and a posterior fossa decompressive craniectomy (DC) was carried out.

Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa:Two case reports

BACKGROUND Pseudogout is a benign joint lesion caused by the deposition of calcium pyrophosphate dihydrate crystals,but it is invasive.Pseudogout of the temporomandibular joint(TMJ)is uncommon,and it rarely invades the skull base or penetrates into the middle cranial fossa.The disease has no characteristic clinical manifestations and is easily misdiagnosed.CASE SUMMARY We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa.A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region.Another patient,a 52-year-old man with a mass in the left TMJ for 6 years,was admitted to the hospital.Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area.Both patients underwent excision of the lesion.The lesion was pathologically diagnosed as tophaceous pseudogout.The symptoms in these patients were relieved after surgery.CONCLUSION Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction.A pathological examination is the gold standard for diagnosing this disease.Surgical treatment is currently the recommended treatment,and the prognosis is good after surgery.

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx? with 38-mm broadband linear array, 13-6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites.