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Meningiomas account for more than 30% of all intracranial brain tumors, with 25% of them originating somewhere along the skull base and about 20% of these located in the posterior fossa. The intimate relation of these tumors with neural and vascular structures make them difficult to treat, both surgically and nonsurgically. Their treatment is furth...
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Meningioma is a common primary tumor of the central nervous system and one of the most encountered brain tumors. Although classic histopathologic features of meningioma are relatively common and make its diagnosis straightforward, certain variants possess unusual histologic features causing diagnostic challenges. We reported three cases of clear ce...
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... Surgical strategy in TS is generally tailored on the tumor and no definitive recommendations can be made. Because of the difference in the classification systems, lack of volumetric studies and report of trigeminal function, there is an inevitable difficulty in comparing different series, the same as in the case of other complex skull base tumors[6,9]. Some authors divide the possible approaches into conventional approaches and skull-base approaches[14]. ...
Trigeminal schwannomas (TS) are rare tumors that are located in the posterior and middle cranial fossae in about a quarter of the cases. The presentation pattern is different according to the involved compartment and the goal of surgery is complete removal. We present the case of a 35-year old woman who presented a left sided TS extending from the posterior to the middle fossa and cavernous sinus. We review the relevant literature regarding diagnosis and surgical treatment of these tumors.
Intracranial epidermoid cysts are benign slow-growing ectodermal inclusions that account for less than 1% of all intracranial tumors. We retrospectively reviewed 36 such cases to evaluate the demographic characteristics, clinical manifestations, anatomical distribution, surgical management, and treatment outcome of these tumors. Additionally, we sought to identify the relationship between median or paramedian cistern tumor localization and clinical parameters, such as recurrence risk, hospitalization duration, and postoperative complication rates. The most frequently observed neurological symptoms were transient headaches (77.8%), dizziness (36.1%), CN VII palsy (19.4%), CN VIII hearing difficulty (19.4%) and cerebellar signs (19.4%). The most common surgical approaches included retrosigmoid (36.1%), subfrontal (19.4%) and telovelar (19.4%) approaches; gross total resection was feasible in 83.3% of cases. The postoperative complication rate was 38.9%. Tumors were more frequently found in the paramedian cisterns (47.2%), followed by the median line cisterns (41.6%). Multivariate analysis revealed that postoperative hydrocephalus and age < 40 years were prognostic factors for tumor recurrence. Median-like tumor location was a risk factor for the presence of symptomatic hydrocephalus both preoperatively and postoperatively, increasing the likelihood of protracted hospitalization (> 10 days). Despite their benign histopathological nature, these tumors have an important clinical resonance, with a high rate of postoperative complications and a degree of recurrence amplified by younger age and hydrocephalus.
Cavernous malformations (CMs) of the brain represent low-flow vascular lesions comprised of dilated sinusoid blood vessels with thin walls, containing blood or clots in various stages of degradation. They are mostly congenital in nature, but acquired CMs have been reported, for instance, after radiotherapy. Frequently, they are discovered incidentally, and a significant number of these lesions can remain clinically silent over a long period of time. Depending on the exact location within the brain, CMs may cause epilepsy, headache, focal neurological deficit, and hemorrhagic stroke. Owing to the proximity of the pineal region to the sylvian aqueduct, a hemorrhagic presentation from a cavernoma in this location may lead to acute obstructive hydrocephalus, loss of consciousness, and, on very rare occasions, even to death. Only a small number of pineal region CMs have been described in the literature. In this chapter, we provide a short overview of pineal region CMs and their surgical management, and discuss the controversies regarding their treatment.
Meningiomas represent 3–8% of the tumors located in the pineal region. The exact definition of pineal region meningiomas and the best treatment strategy are still a subject of debate. Surgery represents the mainstay of treatment and aims at achieving a complete resection whenever possible. The venous drainage and an arachnoidal plane separating the tumor from the surrounding cerebrovascular structures represent crucial factors in the treatment decision-making algorithm.
