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.

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.

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.

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

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.

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.

Diagnosis and surgical treatment of posterior fossa solid hemangioblastomas

Objective To elucidate the diagnosis and surgical treatment of the posterior fossa solid hemangio^blastomas (PFSHs) Methods The data from 22 patients with PFSHs verified by surgery and pathology were analyzed retrospectively and a review of relevant literature was conducted Results The preoperative definitive diagnosis rate was 13/22 Total tumor removal was achieved in 20 patients Two of the 22 patients died after surgery, one of brain stem injury and the other from an intracranial hemorrhage Twenty patients were followed up for 2 months to 8 yeas (average, 2 years) Karnofsky scale was 80 in 15 patients, 60-70 in 1 patient and not measured in 4 patients who died during follow up The causes of death were pneumonia (2 patients) and purulent meningitis (2) Conclusion MRI and DSA (digital subtraction angiography) are major preoperative diagnostic modalities for PFSH, but PFSH remains a challenging benign neoplasm Special microsurgical techniques and improved operative manipulation can improve surgical efficacy

Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

Purpose： Posterior fossa epidural hematomas （PFEDH） are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination minicraniectomy. Methods： We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015. Results： During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications. Conclusion： Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients＇ neurological functions or the hematomas are large and exerted severe mass effects.

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.

The Microscopic Surgical Treatment for Tumor of Posterior Cranial Fossa in Children

OBJECTIVE To analyze and discuss about the clinicalcharacteristics, pathological types, surgical modalities andtechniques, and postoperative complications in children withtumor of posterior cranial fossa .METHODS Retrospective study was conducted on 102 cases ofpediatric tumor of posterior cranial fossa, admitted and treated inour hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment. Fifty-eight were male and 44 cases were female. The age ranged from 9months to 14 years old, with an average of 6.1 ± 0.5 of age. CranialCT or MRI examination was conducted before and after thesurgery on all patients.RESULTS The primary manifestations for this group of patientswere increased intracranial pressure and/or ataxia. Postoperativepathological diagnoses showed: 46 cases of medulloblastoma, 43cases of astrocytoma, 11 cases of ependymoma (including 1 caseof degenerative ependymoma), 1 case of dermoid cyst, and 1 caseof teratoma. In this group of the patients, radical surgery wasused in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large section was performed on 3 cases.There were no deaths from surgery reported. Ninety-one casesshowed significant symptomatic improvement when comparedwith preoperative conditions, while 11 cases showed either noimprovement or more severely affected afterward. For 6 cases,postoperative ventriculoperitoneal shunt was performed within7 days to 2 months after the surgery. Sixty-three patients gainedfollow-up for 3 to 60 months in duration. Thirty-nine patientsregained normal life and were able to learn well, while there were7 patients who could not live normally on their own. During thefollow-up period, there were 17 cases of recurrence and 7 casesof death. In 23 cases of medulloblastoma in children with age of3 years old or above, 2 cases who underwent surgical removal ofintracranial ependymoma received small dosage of postoperativeX-ray radiotherapy on the the brain and spinal cord. Nine casesof medulloblastoma in children under age of 3 and 17 cases ofastrocytoma diagnosed after the surgery received chemotherapyof Carmustine.CONCLUSION Medulloblastomas and astrocytomas werethe most common types of pediatric tumor of posterior cranialfossa, right followed by ependymoma, and dermoid cysts andteratomas were rare. Early correct diagnosis, proper selection ofappropriate surgical modality and the surgical margin, propertreatment of postoperative complications, and the selecting rightradiotherapy or chemotherapy were the key factors in influencingthe prognostic outcome of children with tumor of posterior cranialfossa.

Adult Posterior Cranial Fossa Arachnoid Cyst: A Case Report

Adult posterior fossa arachnoid cysts are rare lesions that are considered to be mostly congenital in origin. We present 49-year-old man admitted with a chief complaint of tremor and balance problems for the past 2 months. He had ataxia on examination. Magnetic resonance imaging revealed a well circumscribed midline cystic lesion of the posterior fossa sharing the same signal characteristics as cerebrospinal fluid and non-communicating to the fourth ventricle. He underwent surgical treatment for his symptomatic posterior fossa arachnoid cyst with a good outcome at 2 years follow up.

Discussion of overlaped CT image in cerebral function of fossa cranii posterior

AIM:To discuss the value of technique of overlapped CT image in cerebral function of fossa cranii posterior.METHODS:27 cases of diseases of fossa cranii posterior were examined by three techenics(10 mm scan, 6 mm scan, 3mm scan and overlapped image),and then compare the quality of image, accuracy rate of diagnoses, misdiagnosis rate between the three techniques.RESULTS:The quality of image of ovelaped image was better than the other.The accuracy rate of diagnosis were 77.8%, 85.2%and 96.3%.The false positive rate were 14.8%,11.1%and 3.7%.The false negtive rates were 7.4%,3.7%and 0.CONCLUSION:There was important value for diagnosis of diseases of fossa cranii posterior with technique of overlapped CT image,and can provide help for estimation of the cerebral function.

增强MRI全域直方图鉴别儿童星形细胞瘤和室管膜瘤的价值

目的深入探究T_(1)全域灰度直方图分析在儿童后颅窝星形细胞瘤与室管膜瘤鉴别诊断中的实用价值。方法本研究对我院数据库中记录的51例经MRI检查及病理确诊的儿童后颅窝肿瘤病例进行了详尽的回顾性剖析。在这51例病例中,星形细胞瘤占26例(男性12例,女性14例),室管膜细胞瘤占25例(男性13例,女性12例)。患者年龄分布在1至12岁之间,平均年龄为(5.5±2.3)岁。我们运用Mazda软件,在两组MR增强T_(1)矢状位图像的每一层肿瘤层面上,精确地勾画出感兴趣区域,并进行全面的灰度全域直方图分析。接着,我们对这两组直方图参数特征进行了详尽的统计学对比,旨在深入剖析各参数在鉴别诊断中的统计意义,以期为儿童后颅窝肿瘤的精确诊断提供更为有效的辅助手段。结果在深入分析通过增强T_(1)全域灰度直方图所提取的九个参数时,我们发现其中四个参数——变异度(Variance)、偏度(Skewness)、第一百分位数(Perc.01%)以及第10百分位数(Perc.10%)在统计学上具有显著差异(P均<0.05),这一发现为我们的研究提供了强有力的数据支撑。特别是Variance这一参数,其灵敏度高达73.3%,特异度也达到了61.9%,且其曲线下面积(AUC)为0.731,展现出优秀的鉴别效能。进一步地,我们确定了Variance的最佳临界值为740.71,这一具体数值为我们的诊断提供了明确的参考标准。结论增强的T_(1)全域灰度直方图分析在儿童后颅窝星形细胞瘤和室管膜瘤的鉴别诊断中,展现出了不容忽视的价值。这一方法不仅能够为医生提供新的诊断视角,而且有望成为一种针对这两种儿童后颅窝肿瘤的有效辅助诊断工具,为我们的医疗实践带来积极的影响。

多模态图像融合及三维重建技术在后颅窝肿瘤手术中的应用

目的旨在探讨多模态图像融合及三维重建技术在后颅窝肿瘤手术治疗中的应用效果。方法回顾性分析2022年1月至2023年9月在江苏大学附属人民医院神经外科接受手术治疗的19例后颅窝肿瘤患者的临床资料。所有患者在术前均接受头部CT和MRI检查,并将影像数据输入影像融合工作站进行图像融合和三维重建。医生利用这些融合后的影像进行肿瘤空间评估和模拟手术入路。术后统计肿瘤全切除率和术后并发症,并对其应用价值进行评估。结果多模态图像融合及三维重建技术能清晰显示后颅窝肿瘤与周围结构的解剖关系,19例患者中肿瘤全切除15例(78.9%),次全切除4例,无围手术期死亡患者。术后并发症包括脑水肿2例,颅内感染1例,面瘫2例,吞咽困难1例。根据医生的反馈,多模态图像融合及三维重建技术在手术中表现出显著价值的案例有16例,辅助价值的案例有3例。结论多模态图像融合及三维重建技术可精准、清晰地显示后颅窝肿瘤与周围重要组织的空间关系,有助于医生设计更精准的手术切口和选择更合理的手术入路,对手术顺利完成有较高的辅助价值。

基于德尔菲法构建后颅窝肿瘤患儿家长健康教育护理路径

目的 构建导向明确、简洁易行的后颅窝肿瘤患儿家长健康教育护理路径。方法 通过查阅文献,访谈医务人员并结合临床患儿家长健康教育需求,初步构建健康教育护理路径表。进行两轮德尔菲专家咨询,将专家意见整理、修改后形成后颅窝肿瘤患儿家长健康教育护理路径。结果 两轮专家咨询问卷的有效回收率均为100%,专家权威系数为0.84。首轮函询所有指标的重要性赋值均数范围为(4.18~5.00)分,满分比范围为47.06%~100%。第二轮函询指标重要性赋值均数范围为(3.75~4.88)分,满分比范围为41.12%~88.24%。两轮函询专家意见协调系数分别为0.152和0.155,显著性检验P<0.05。通过两轮专家咨询和指标的筛选,构建了包含8个一级指标、46个二级指标的后颅窝肿瘤患儿家长健康教育护理路径表。结论 本研究构建的后颅窝肿瘤患儿家长健康教育护理路径表具有科学性,简便可行,可为临床护士的健康教育工作提供指导工具。

颅后窝畸胎瘤的影像及临床特点分析

目的探讨分析后颅窝畸胎瘤的影像与临床特点。方法回顾性分析5例颅后窝畸胎瘤病人的CT、MRI资料及临床资料。病变位于小脑蚓部4例,右桥脑小脑角1例。采用枕下后正中入路4例,乙状窦后入路1例。结果肿瘤全切除3例,近全切除2例。术后病理均提示:成熟囊性畸胎瘤。术后症状大多缓解,术后发生无菌性脑炎1例,癫痫伴精神异常1例,共济失调加重1例。5例病人均获随访,时间3个月~5年,1例复发。结论颅后窝畸胎瘤非常罕见,多发生于中线部位,典型者有特异的影像表现,非典型者诊断主要依据病理结果。显微手术切除是主要治疗方式。

后颅窝室管膜瘤临床病理分析

目的探讨后颅窝室管膜瘤临床病理特征。方法收集2022年10月-2023年10新疆医科大学第一附属医院病理科存档的后颅窝室管膜瘤共6例。调阅组织切片,分析免疫组化法检测相应指标表达情况,并收集随访信息,查阅相关文献总结其临床病理学表现。结果6例后颅窝室管膜瘤中PFA组4例,PFB组2例。临床表现为头疼,呕吐,继发性脑积水等。PFA组患者均为儿童,年龄10个月-11岁,其中女性3例,男性1例;肿瘤3例位于四脑室,1例位于脑干。2例PFB组患者均为成年女性,年龄分别为32岁和45岁,肿瘤均位于四脑室。肿瘤组织学形态呈片状生长模式,出现血管周围假性菊形团,真性室管膜菊形团,组织学分级CNS WHO 2级1例,3级5例。6例后颅窝室管膜瘤免疫组化染色结果显示肿瘤细胞GFAP、S-100均弥漫性强阳性表达,EMA、D2-40表现为核旁点状及腔缘阳性,P53大部分为野生型,oligo-2、Neu-N均阴性。PFA组出现特征性H3 K27Me3细胞核表达缺失,Ki-67增殖指数20%-60%。PFB组H3 K27Me3细胞核未缺失,Ki-67增殖指数4%-15%。结论后颅窝室管膜瘤PFA组好发于儿童且预后较差,通过H3 K27me3免疫组化染色初筛并分组,对于明确诊断及指导临床辅助治疗具有重要临床意义。

3D-ASL的rCBF max值在儿童后颅窝肿瘤鉴别诊断中的价值

目的:探讨三维动脉自旋标记成像(3D-ASL)参数rCBF_(max)对儿童后颅窝肿瘤的诊断价值。方法:回顾性分析2018年1月-2022年12月在本院经手术病理证实的52例后颅窝肿瘤患儿的临床和术前MRI资料(平扫、增强和3D-ASL)。其中,髓母细胞瘤28例,毛细胞星形细胞瘤11例,室管膜瘤13例。测量肿瘤实性区域的最大脑血流量(CBF_(max))值,并计算最大相对脑血流量(rCBF_(max)=CBF_(max)/CBF_(健侧正常脑灰质))。采用Kruskal-Wallis检验比较3组肿瘤的rCBF_(max)值,采用ROC曲线和约登指数来确定rCBF_(max)鉴别肿瘤病理类型的最佳阈值、敏感度、特异度和曲线下面积(AUC)。结果:室管膜瘤的rCBF_(max)值最高,为1.53(1.27,2.04),毛细胞星形细胞瘤的rCBF_(max)值最低,为0.69(0.56,0.76),髓母细胞瘤的rCBF_(max)值为0.90(0.84,1.00)。三组肿瘤的rCBF_(max)值比较,差异有统计学意义(P<0.001)。ROC曲线分析显示鉴别室管膜瘤与髓母细胞瘤的rCBF_(max)最佳阈值为1.13,相应的诊断敏感度为100%,特异度为82.1%,AUC为90.7%;鉴别髓母细胞瘤与毛细胞星形细胞瘤的rCBF_(max)最佳阈值为0.80,相应的诊断敏感度为85.7%,特异度为100%,AUC为97.1%。结论:3D-ASL定量参数rCBF_(max)对常见儿童后颅窝肿瘤的鉴别诊断具有较高的临床应用价值。