An adult case of medulloblastoma in the cerebellopontine angle extending to the supratentorial area

Medulloblastoma is an undifferentiated embryonic neuroepithelial tumor. It is a rare tumor in the central nervous system, with an even rarer occurrence during adulthood. It may develop at an atypical and uncommon site, such as the cerebellopontine angle （CPA）, and such tumors rarely present with supratentorial extension. The present study reports an adult case of medulloblastoma in the CPA extending to the supratentorial area. The patient presented with complaints of headache, vertigo, hearing difficulty in the left ear, nausea/vomiting, and unsteady gait. Disequilibrium began 4 weeks earlier. Examination revealed normal cranial nerves, and computed tomography showed a hyperdense lesion, with a heterogeneously enhancing mass, in the left CPA region. The patient underwent a nearly total excision of the lesion in the CPA region. Histopathological examination confirmed medulloblastoma, WHO grade IV. Postoperatively, the patient received radiotherapy and remained asymptomatic for 30 months. However, he received two more surgeries for relapse and progression of medulloblastoma and eventually died. A CPA medulloblastoma with supratentorial extension is relatively rare in the clinic.

Supratentorial hemangioblastoma at the anterior skull base:A case report

BACKGROUND Hemangioblastoma(HB)is a rare tumor,comprising about 2%of all intracranial tumors.Although it is a benign tumor,due to the abundant blood supply and its close relationship with adjacent cerebral blood vessels,surgical resection is difficult and may cause complications such as bleeding.If HB can be correctly diagnosed before surgery,complications can be avoided by methods such as vascular embolism before surgery.CASE SUMMARY A 51-year-old male patient was admitted to our hospital because of blurred vision in his left eye for 2 years.Ophthalmological examination revealed oculus dexter vision acuity of 1.0 and oculus sinister vision acuity of 0.6.His left vision had tubular visual field,while his right vision had a partial defect.Computed tomography and magnetic resonance imaging showed a mass lesion at the left anterior base of the skull,which could have been a meningioma.During the operation,the tumor was found to be located at the entrance of the left optic nerve tube,closely adhering to the left optic nerve and the blood supply was extremely abundant.The tumor was carefully separated and diagnosed as HB postoperatively after pathological examination.CONCLUSION A rare HB at the anterior skull base could be distinguished by its imaging features,which is essential to the surgical procedures.

Sepsis Associated Encephalopathy Predicts Poor Outcome among Acute Supratentorial Intracerebral Hemorrhage with Coma

Background: Both sepsis associated encephalopathy (SAE) and supratentorial intracerebral hemorrhage (SICH) are a significant cause of coma and death throughout the world. The aim of this study was to investigate whether the presence of SAE among acute SICH with coma would predict a poor outcome. Methods: A retrospective of consecutive patients was selected for study. All registered an adult intensive care unit (ICU) of university teaching hospital between June, 2013 and July, 2015. Brain computed tomography (CT) scans were analyzed on admission and at coma onset or after coma onset. Univariate and Cox regression analyses were performed. Results: A total of 379 SICH with coma was studied. Among these, 245 (64.6%) SICH patients with coma due to SAE and 134 (35.4%) SICH with coma no SAE was compared. Our data showed that the frequency of the SAE in SICH patients increased at about double the proportion over the four SIRS criteria. The SICH patients with SAE were more likely to present with infection (100% vs 35.8%) and multiple organ failure (1.2 ± 0.9 vs 0.1 ± 0.3), especially nosocomal brain failure (60.4%). The 30 days mortality was significantly higher in the SAE group than those who did not (60.8% vs 11.2%). In Cox multivariate logistic analysis, the SAE (RR, 4.4;95% CI, 2.296 - 8.422;P = 0.000) was more likely to related to risk on death in SICH patient with coma. Conclusions: SAE is a frequent complication of SICH, which greatly increased risk of death among SICH patients with coma.

Giant Supratentorial Acutely Hemorrhagic Enterogenous Cyst: Case Report and Literature Review

The authors report the first case of a giant supratentorial enterogenous cyst presenting with acute symptomatic hemorrhage within the cyst. We report the case of a 78-year-old Philipino female who was found to have a large right fronto-parietal mass after a minor fall. She had a small amount of hemorrhage within the cyst but was stable for discharge the following day. She was readmitted 5 days later with acute onset severe headache and leftside weakness. On repeat imaging, her cyst had grown in size and had large acute hemorrhage within it. She was taken to the operating room for craniotomy and cyst resection. She recovered well post-operatively. This is the first known case of a giant supratentorial enterogenous cyst presenting with symptomatic enlargement due to large hemorrhage within the cyst. Enterogenous cysts should be considered on the differential diagnosis of hemorrhagic supratentorial giant cysts.

Clinical analysis of 14 cases of supratentorial parenchymal ependymomas

Objective To study the clinical feature,image,treatment and prognosis of supratentorial parenchymalependymomas.Methods14cases of patients sufferedfrom supratentorial parenchymal ependymomas were treated.There were10ependymomas and4malignantependymomas.Tumor located in frontal lobe in4cases,

Multiple different remote epidural hematomas after craniotomy:A case report

BACKGROUND Epidural hematoma is one of the common postoperative complications after craniotomy.However,multiple remote epidural hematomas in different sites,including supratentorial and infratentorial regions,are exceedingly rare.CASE SUMMARY We present a rare case in which three remote epidural hematomas occurred after craniotomy.A 21-year-old woman was admitted with a headache for 1 mo,vomiting,and rapid vision loss for 1 wk.Brian magnetic resonance imaging indicated a right thalamic tumor.The intraoperative diagnosis was a cystic tumor,posterior cerebral artery aneurysm,and vascular malformation.The operation was successful.Unfortunately,the patient developed three extradural hematomas within 48 h.Family members consented to the first two hematoma evacuations but refused the third.CONCLUSION More attention should be paid to this kind of rare complication.Adequate preoperative evaluation is important,especially for acute patients.Monitoring neural function and early computed tomography scanning of the brain after surgery should be highlighted.

Supra-Tentorial Cortical Ependymoma in an Adult: Case Report and Review of the Literature

Supratentorial cortical ependymoma is a rare primary brain tumor in adults. Only 50 cases are reported in the literature including pediatric and adult patients. We report a 30-year-old male with sensory-type seizures who was found to have a right posterior frontal cortical lesion with large cystic component. The lesion was resected completely and histopathology and immunohistochemistry examinations confirmed anaplastic ependymoma WHO grade III. The patient received radiotherapy treatment post-surgery, and he was tumor free one year after treatment.