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A ct scan images of a patient with Hydrocephalus secondary to posterior fossa tumor, pre and post ETV.
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Introduction Brain tumors are of the most devastating forms of human disorders, particularly when they arise in the posterior fossa. The proximity of these lesions to the brainstem and fourth ventricle explains the common presentation of these patients. Obstructive hydrocephalus is described in about 80% of the cases, it can lead to herniation and...
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Background: Brainstem glioma is a rare brain tumor with poor prognosis and difficulty for surgical resection. We sought to retrospectively analyze and evaluate the clinical efficacy of CyberKnife for brainstem gliomas.
Methods: From 2006 to 2015, a total of 21 brainstem gliomas patients who received CyberKnife radiosurgery treatment enrolled in thi...
Citations
... Management of this condition is not well-defined. Some authors advocate pre-craniotomy ventriculoperitoneal shunt or endoscopic third ventriculostomy or external ventricular drain and subsequent craniotomy and excision of brain tumor, while others prefer initial tumor excision and subsequent treatment of hydrocephalus when it persists [13][14][15]. ...
Background: Brain tumors are the most prevalent type of solid malignancy among paediatric patients. Pilocytic astrocytoma (PCA), often discovered in the posterior fossa, is the most frequently encountered juvenile cerebral tumor. Although malignant progression is uncommon, this gradually developing neoplasia can present with a wide range of complications. Brainstem compression and hydrocephalus, both of which have the potential to be fatal, may be present in these patients and require urgent intervention. However, external ventricular drain (EVD)-associated ventriculitis may present in a minority of these patients and lead to neuroinfection with associated neurologic sequelae. Source control and total surgical resection of the neoplasm along with antibiotic therapy are often considered the cornerstone of therapy. Case presentation: We present the uncommon case of a 7-year-old white boy who was admitted to the hospital due to vomiting, severe headache and convulsions. CT scan of the brain showed a large cystic lesion with a bright mural nodule in the posterior fossa of the brain. Likewise, compression of the adjacent structures along with obstructive hydrocephalus and cerebellar herniation were the most worrisome radiographic findings. Following this, an EVD was immediately placed. The therapeutic regimen consisted of dexamethasone, mannitol, sodium chloride, moxastine teoclate, metoclopramide, vancomycin, paracetamol, metamizole, tramadol and phenobarbital. Conclusion: Children are most likely to develop this low-grade and often well-circumscribed tumor, which generally has a favorable prognosis. However, prompt detection and early surgical excision can significantly reduce neurological impairment and improve quality of life.
... Majority of patients with brain tumor-related hydrocephalus in developing countries/regions do report late to the hospital, mostly in acute situations requiring emergency treatments [3]. The optimal timing and type of treatment of hydrocephalus associated with brain tumor is controversial [4][5][6]. ...
... Some authors advocate pre-craniotomy ventriculoperitoneal shunt or endoscopic third ventriculostomy or external ventricular drain and subsequent craniotomy and excision of brain tumor, while others prefer initial tumor excision and subsequent treatment of hydrocephalus when it persists [4,5,7]. However, treatment of hydrocephalus associated with brain tumor should depend on acuity of presentation, availability of neurosurgical facilities and the skills of the surgeon. ...
... Children have higher incidence of 63.3% in the present study which was in tandem with the reports of other studies [1,11]. Some authors found a higher occurrence of about 70-90% in their studies [5,[12][13][14]. However, a study in Senegal, a west African country found tumoral hydrocephalus in 25% of their series [3]. ...
Introduction: Brain tumor is a common neurosurgical condition encountered by neurosurgeons in clinical practice. Hydrocephalus could be associated with brain tumor thereby increasing the burden of the disease to the affected patients. Characteristics and outcome of hydrocephalus resulting from brain tumors are almost unknown in our setting. The objectives of this study were to describe the characteristics and outcome of hydrocephalus caused by brain tumor in our center. Methods: A retrospective analysis of all cases of hydrocephalus resulting from brain tumor managed in our center between January 2015 to December 2019. Relevant data extracted from patient’s case files and operation register was analysed. Results: Out of the total sixty-eight cases of brain tumors, thirty (44.1%) cases of hydrocephalus caused by brain tumor were managed over the study period. The mean age of presentation was 14 years ± 2 SD with a slight male preponderance (M: F = 1.07:1). The most common clinical presentations were headache, progressive visual impairment, altered conscious level and ataxia. Posterior fossa tumors were the commonest (21/30), followed by craniopharyngioma (6/30) and one case each for pituitary macroadenoma, pineal region tumor and choroid plexus papilloma respectively. Pediatric age group was the most affected (19/30). All patients had ventriculoperitoneal shunting before definitive surgery. Postoperative outcome was good in the majority of cases (27/30), mortality was recorded in one patient (1/30). Conclusion: Hydrocephalus is a common association in patients with brain tumor in our center. Most cases of brain tumor associated hydrocephalus occur in children and posterior fossa tumor is the commonest aetiology. The outcome of ventriculoperitoneal shunting is relatively good in our setting.
... Pilocytic astrocytoma shows low mitotic activity and very low malignant transformation potential [9]. Innovative progressions in radiological modalities (apparent diffusion coefficient (ADC)) and treatment options have shown a great improvement in survival in these patients over the past few decades [4,[10][11][12][13][14]. Large multi-institutional reports illustrating the epidemiology of pilocytic astrocytoma surgery especially in developing countries are lacking [15][16][17]. ...
Vol.26 No.3 DEC 2019
57
Unraveling The M0Tysterious0T Pilocytic Astrocytoma: Cardinal
Epidemiological Features Rummage
Alqroom Rami*, Malabeh Qamar**, Al wakfi Ola***, Al-zoubi Mohamad*, Al dalahmeh ala'*, Haddad Feras*, Younes Basel*, Khasawneh Nidal*, Al Shurbaji Amer****.
ABSTRACT
Introduction: Pilocytic astrocytoma is classified as grade I glioma by the (WHO), and although it remains one of the most frequent oncological pathologies located in posterior fossa, it is an intriguing and unpredictable entity. Pilocytic astrocytomas might be identified supratentorially or in the optic pathway. The close vicinity of these lesions to the brainstem and fourth ventricle zone explains the hazardous presentation of these patients. Large multi-institutional reports illustrating the epidemiology of pilocytic astrocytoma surgery especially in developing countries are lacking.
Objectives: The current research is supplementary to other published works, and it aimed to use a retrospectively collected data registry of surgically treated patients to primarily delineate the relative frequencies of pilocytic astrocytomas. Special emphasis was devoted to analyzing the cardinal epidemiological features and major concurrent issues.
Methods & Patients: This retrospective review data in the Institutional patient database for all patients who
underwent surgical intervention in the Department of Neurosurgery at a single referral center – King Hussein
Medical Center-over an 18-year period from January 2000 to December 2018 were scrutinized. Clinical records,
as well as computed tomography and magnetic resonance imaging (MRI) reports, surgical notes, follow up
records , and histopathological reports were obtained from all indexing systems that are used, and the data were
analyzed for all patients. Patients within the age range of 1 to 37 years were included in the study.
Results: There were 102-patients in this study; 53 were females and 49 were males (male-to-female ratio of 1:1.1). The mean age was 12.01 years. Topographically, the posterior fossa was the most common region where pilocytic astrocytomas are found, followed by 13 in the supra-sellar region. The most common clinical presentation of pilocytic astrocytoma was a marked increased intracranial pressure. There was cranial nerves involvement in 2.94% of cases. Symptomatic hydrocephalus was evident in 39-patients as the primary presentation. Endocrinological disturbances were manifested in seven Patients. Visual difficulties were identified in six patients. Nine patients showed lesion recurrence and underwent a second surgery and one patient showed a second recurrence with transformation to a grade III tumor. The general complication rate in our study was 21.56 %. Overall, no mortality was correlated to pilocytic astrocytoma.
Conclusions: Pilocytic astrocytoma data from our analysis revealed: a slight female predominance and younger age and presentation in our patients in addition to an insidious clinical demonstration with marked increased intracranial pressure. The largest proportion of pilocytic astocytomas located in the posterior fossa. Treatment options have improved the survival rate, and recurrence rates are very low because of a feasible gross total excision.
Keywords: Pilocytic astrocytoma; grade I; Posterior fossa tumor; Hydrocephalus; Endoscopic third ventriculostomy.
... [1][2][3][4] The close vicinity of these lesions to the nearby brainstem and fourth ventricle explains the common presentation of these patients who show a significant increase in intracranial pressure, obstructive hydrocephalus, and cranial nerve involvement in about 80% of the cases leading to herniation and death. [5][6][7][8] Innovative evolutions in radiological modalities and treatment options have promised about a great improvement in survival in these patients over the past few decades. 1,[9][10][11] Large multiinstitutional reports exemplifying the epidemiology of posterior fossa tumour surgery, especially in developing countries, are lacking. ...
... A pre-operative ventriculoperitoneal shunt was inserted in 47 cases while 136 cases underwent ETV, and 21 post-tumour resection cases needed shunt procedures. 1,2,5,7 A wide variety of histological subtypes were seen, each requiring tumour-specific treatment approaches. The most recent histopathological classification (2016) confers a combination of both histological and genetic conclusions. ...
Abstract
Objectives: Posterior fossa tumors are the most frequent neuro-oncological pathology in children. The current review, as a supplement to other published works, aimed to use a retrospectively collected data registry of surgically treated cases of posterior fossa lesions to primarily delineate the relative frequencies of tumors patterns in our setup. Special emphasis was given to analyzing the cardinal epidemiological features.
Methods & Patients: This retrospective review was conducted under approval by the institutional ethical committee. The institutional patient database of 201 patients who underwent surgical intervention by the Department of Neurosurgery in a single referral center (King Hussein Medical Center) over a 15years period from January 2002 to January 2017 was scrutinized.
Results: The study population after applying the exclusion criteria was 201 patients with a male: female ratio of 1:1.1. Most (61.7%) of the posterior fossa tumors involved children <14 years with 23.9% in children <5 years. The most common clinical presentation was the significant increase in intracranial pressure. Cranial nerve involvement was observed in 2.6% of the cases. The general surgery-related complication rate in our study was 41.29 %, affecting 83 patients. The overall surgical-related mortality rate was 6.47% in 13 patients.
Conclusions: Posterior fossa tumors, known for high morbidity- and mortality-related complications. Female children were more affected with tumours. Clinical demonstration is insidious with a significant increased intracranial pressure. Evolution in treatment options offers great improvement in survival with very low recurrence rates.
Keywords: posterior fossa tumor, hydrocephalus, endoscopic third ventriculostomy,
... Dilated ventricular system revealed in 57-cases at the time of diagnosis. Symptomatic hydrocephalus was evident in 29-cases as primary presentation, Pre-operative ventriculo-peritoneal shunt inserted in 18-cases, especially before we introduced the cranial endoscope to perform endoscopic third ventriculostomy [13]. While 22-cases underwent ETV, the reset underwent direct tumor resection. ...
... Based on histological match between medulloblastomas and other small round blue cell tumors arising in areas outside of the posterior fossa, it was proposed that these tumors be classified together under the egis group of primitive neuroectodermal tumors (PNETs) [13,14]. However, the most recent WHO classification, distinguishes medulloblastoma and its subtypes from other CNS PNETs, pineoblastomas, and atypical teratoid/rhabdoid tumors [14][15][16]. ...
... Posterior midline cranioectomy is our standard approach. Staging is dependent upon extent of resection, evidence of tumor spread, and CSF cytology so we perform early post-operative radiological surveillance [13,21]. ...
INTRODUCTION: Medulloblastoma is one of the most frequent, violent, invasive, malignant embryonal tumor of the posterior fossa with a partisan demonstration in children. Of 2200 children diagnosed with a brain tumor in the United States, medulloblastoma accounts for 22% of all childhood primary tumors OBJECTIVES: Current study aims to use a retrospectively collected data registry of the surgically treated cases of medulloblastoma to clarify the relative frequencies in our setup over a period of 15-years. METHODS: This retrospective study was conducted under approval by the institutional ethical committee. Institutional patient database of 82-patients who underwent surgical intervention by the Department of Neurosurgery in a single referral center-King Hussein medical center-over a fifteen-year period from January 2002 to January 2017 scrutinized. The clinical diagnosis was confirmed by radiological studies and histopathological reports in all patients. Patients with age ranging from neonate to 18 years were included in the study. RESULTS: Of the total population consisted of 82-patients, 34 were females and 48 were, 17.1% of medulloblastomas were in children 1-4 years, 39.02% in the 5-9 years, 35.4 % was in 10-14 age group, while 8.53% in older children (14-18 years). Headache and recurrent vomiting were the most common presenting symptoms. Cerebellar ataxic gait was the most common manner of presentation in children younger than 14 years. Drop Mets were present in approximately 29.3% of patients at time of diagnosis. Dilated ventricular system revealed in 57-cases at the time of diagnosis. Symptomatic hydrocephalus was evident in 29-cases as primary presentation, Pre-operative ventriculo-peritoneal shunt inserted in 18-cases, while 22-cases underwent ETV, the reset underwent primary tumor resection. Post tumor resection 16-cases needed shunt procedures. All patients above 4-year old were sent to radiotherapy. Cerebellar mutism syndrome observed in 18-patients. In total, eleven patients underwent a second operation-resection. CONCLUSION: Medulloblastoma considered one of the most devastating illnesses, predominantly showing up in children with peak incidence in the first decade, clinical presentation is insidious. Management of medulloblastoma include surgery, adjuvant radiation therapy and/ or chemotherapy. Recent advances in imaging modalities and treatment options and molecular fields, have conveyed about a great improvement in survival in these patients, with recurrence rates relatively low due to a feasible gross total excision and relatively longer survival rate.
... Pre-operative ventriculo-peritoneal shunt needed in few cases (in the case of obstructive hydrocephalus and raised intra-cranial pressure features) or in some cases postoperatively to the definitive tumor removal procedure especially before we introduced the cranial endoscope to perform endoscopic third ventriculostomy. The majority did not need diversion procedure [9]. In total, twenty eight patients underwent a second operation-resection during the follow-up within 1-68 months. ...
Objectives: Current study aims to use a retrospectively collected data registry of the surgically treated cases of the Posterior fossa lesions to clarify the relative frequencies of histological patterns in our setup over a period of 15-years. Methods: Institutional patient database of 201-patients who underwent surgical intervention by the Department of Neurosurgery in a single referral center-King Hussein medical center-over a fifteen-year period from January 2002 to January 2017 scrutinized retrospectively. The clinical diagnosis was confirmed by radiological studies (CT scan, MRI…) and histopathological reports in all patients. Results: Of total population, 104 were females and 97 were males. In our series, 61.7% of posterior fossa tumors were in children <14 years. Cerebellar symptoms were the most common manner of presentation followed by headaches and vomiting. All patients underwent surgical intervention employing posterior craniectomy with excision of tumor. Histopathological patterns identified were: Medulloblastoma reported in 82-cases, followed by Pilocytic astrocytoma 39-cases, while in descending order hemangioblastoma, Anaplastic ependymoma, Dermoid/ Epidermoid cyst, meningioma were recognized. Conclusion: Posterior fossa tumor considered one of the most devastating forms of human illnesses, predominantly showing up in children with peak incidence in the first decade, clinical presentation is insidious. Advances in imaging modalities and treatment options have conveyed about a great improvement in survival in these patients over the past few decades, with recurrence rates very low due to a feasible gross total excision. KEYWORDS Posterior fossa; medulloblastoma; anaplastic astrocytoma; Choroid Plexus Papilloma. Introduction: Posterior fossa tumor is one of the most devastating forms of human illnesses. Cerebellum is the most common site of appearance of central nervous system tumors in children, reports state more than 60% of these tumors in children arising in the posterior fossa [1]. New progresses in imaging modalities and treatment options (particularly surgery and radiotherapy) have conveyed about a great improvement in survival in these patients over the past few decades [2-6]. Large multi-institutional reports illustrating the epidemiology and morbidity of posterior fossa tumor surgery are lacking [7]. Current study aims to use a retrospectively collected data registry of the surgically treated cases of the Posterior fossa lesions to delineate the relative frequencies of histological patterns in our setup over a period of 15-years. Special emphasis devoted to analyze the incidence, impact in such cases.
... 2,4,6,7 Some studies have confirmed the high success rate and low complication rate of ETV. 5 One series reported that ETV successfully controlled all 8 cases of post-PFBT excision hydrocepha-lus, even when there was already subarachnoid seeding at the time of ETV. 7 Progressive hydrocephalus as a result of subsequent shunt failure in 3 patients in another series was successfully managed with ETV. 2 Furthermore, when done prior to PFBT resection, ETV has been shown to significantly reduce the risk of postoperative hydrocephalus. 1,7 These benefits are important for patients with PFBT in whom longer survival is anticipated. ...
