Cognitive disturbances with neglect-like features have been reported occasionally in patients with chiasmal disorders, so far however with no obvious substrate by conventional brain imaging. Thus, there were no right ...Cognitive disturbances with neglect-like features have been reported occasionally in patients with chiasmal disorders, so far however with no obvious substrate by conventional brain imaging. Thus, there were no right hemisphere lesions that could explain the lateralised visual inattention as observed in particular during monocular visual acuity testing. On this background, we further examined four adult patients who consented to functional 18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET) scan. In three there were no significant findings. The fourth patient, a 26-year-old male with cognitive defects after surgery for craniopharyngioma, will be discussed in more detail. His PET scan demonstrated a widespread reduction of regional metabolic activity in left hemisphere primary visual cortex and higher order visual areas, despite absence of explanatory pathological signal changes on MRI. As present in only one out of four patients, however, the findings do not allow specific pathogenetic mechanisms to be suggested, nor generally to substantiate involvement of higher cerebral circuits. Obviously, even developed imaging has its limits, and in the very theory the visual dysfunctions observed might still depend on higher brain centres’ faulty adaptation to loss of pre-geniculate visual information.展开更多
Background:Meningiomas are rather uncommon tumors in the pediatric population,differing significantly from those found in adults by their atypical location,higher rate of more malignant types,consequently higher risk ...Background:Meningiomas are rather uncommon tumors in the pediatric population,differing significantly from those found in adults by their atypical location,higher rate of more malignant types,consequently higher risk of recurrence and a less favorable outcome.Even in children,suprasellar meningiomas without dural matrix are rare findings mimicking more common suprasellar lesions.Case presentation:Here we describe a case of a 12-year-old girl who presented with a rapidly progressing chiasmal syndrome and was diagnosed by MRI with an unusual suprasellar tumor that could not fit the diagnoses expected in a case of a parasellar mass in a child,similar to a craniopharyngioma or optic pathway glioma.After multiple clinical investigations,the tumor etiology was still unclear,so the preferred option of treatment was surgical resection.An endoscope-assisted gross total resection through a supraorbital keyhole approach was performed uneventfully,with total vision recovery in a short time.Benign meningiomas located in the skull base without dural attachment appear to be rare,even in pediatric patients.Conclusion:Differential diagnoses of suprasellar and para sellar tumor lesions in pediatric patients can be confusing.There are peculiar features of pediatric tumor diseases that should be considered while working out the management strategy.The main principle of meningioma treatment is the highest possible extent of resection minimally affecting the quality of life.展开更多
文摘Cognitive disturbances with neglect-like features have been reported occasionally in patients with chiasmal disorders, so far however with no obvious substrate by conventional brain imaging. Thus, there were no right hemisphere lesions that could explain the lateralised visual inattention as observed in particular during monocular visual acuity testing. On this background, we further examined four adult patients who consented to functional 18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET) scan. In three there were no significant findings. The fourth patient, a 26-year-old male with cognitive defects after surgery for craniopharyngioma, will be discussed in more detail. His PET scan demonstrated a widespread reduction of regional metabolic activity in left hemisphere primary visual cortex and higher order visual areas, despite absence of explanatory pathological signal changes on MRI. As present in only one out of four patients, however, the findings do not allow specific pathogenetic mechanisms to be suggested, nor generally to substantiate involvement of higher cerebral circuits. Obviously, even developed imaging has its limits, and in the very theory the visual dysfunctions observed might still depend on higher brain centres’ faulty adaptation to loss of pre-geniculate visual information.
文摘Background:Meningiomas are rather uncommon tumors in the pediatric population,differing significantly from those found in adults by their atypical location,higher rate of more malignant types,consequently higher risk of recurrence and a less favorable outcome.Even in children,suprasellar meningiomas without dural matrix are rare findings mimicking more common suprasellar lesions.Case presentation:Here we describe a case of a 12-year-old girl who presented with a rapidly progressing chiasmal syndrome and was diagnosed by MRI with an unusual suprasellar tumor that could not fit the diagnoses expected in a case of a parasellar mass in a child,similar to a craniopharyngioma or optic pathway glioma.After multiple clinical investigations,the tumor etiology was still unclear,so the preferred option of treatment was surgical resection.An endoscope-assisted gross total resection through a supraorbital keyhole approach was performed uneventfully,with total vision recovery in a short time.Benign meningiomas located in the skull base without dural attachment appear to be rare,even in pediatric patients.Conclusion:Differential diagnoses of suprasellar and para sellar tumor lesions in pediatric patients can be confusing.There are peculiar features of pediatric tumor diseases that should be considered while working out the management strategy.The main principle of meningioma treatment is the highest possible extent of resection minimally affecting the quality of life.
