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A solitary olfactory groove schwannoma: a rare tumour
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Abstracts / Surgical Neurology 72 (2009) 515–529
Lateral approach to voluminous premedullary cervical tumour: a safe procedure with preservation of the stability Colle D, MD, Van Roost D, MD [UZ Gent]
A solitary olfactory groove schwannoma: a rare tumour Rasschaert R, MD a, Verbeke SLJ, MD b, Walchenbach R, MD a [ aMC Haaglanden, bLUMC]
Introduction: Removal of ventrally and ventrolaterally located cervical spine tumours can present serious technical problems. A posterior approach requiring spinal cord retraction may be deleterious and is not adequate. The anterior approach often requires an extensive anterior vertebrectomy with bone fusion and postoperative immobilization, and tumour removal is done without visualizing the spinal cord. We present a case in which a lateral approach was used with an excellent exposure of the ventral and ventrolateral aspect of the spinal canal, that allowed safe dissection without retraction of the cord. Material and methods: A 37-year-old woman was admitted with a history of slight paresis in the right hand since six months, followed by a rapidly progressive, spastic tetraparesis. MRI showed a voluminous, inhomogeneously enhancing premedullar tumour from C2 to C5. The lesion was approached from the right side in a true lateral position under neuromonitoring (MEPs). The resection technique is described, consisting of drilling away the laminae between the facet joints and the processi spinosi from C2 to C5, providing an excellent visualisation of the schwannoma and allowing its safe dissection from the medulla spinalis and the right C3 and C4 radices. Results: The tumour was completely removed. Patient's neurological function progressively improved. Postoperative imaging showed no tumour rest. Conclusion: We described a case of lateral approach to the upper and midcervical spine with excellent exposure of the lateral and ventral portions of the spinal canal. The major advantages are a lateral line of vision avoiding retraction of the spinal cord and the preservation of cervical stability.
Introduction: An olfactory groove schwannoma is a very rare, but benign, slow growing tumour and always diagnosed postoperative. As the olfactory bulb is still a part of the central nervous system, it lacks a schwann cell layer and is therefore not the origin of the tumour. Dural branches of the ophtalmic part of the trigeminal nerve or the filia olfactoria are more likely candidates. Material and methods: A forty year old female patient presented at the emergency department with an epileptic seizure. Diagnostic imaging revealed a large cystic lesion in the left frontal region. A stereotactic biopsy provided no vital tissue for diagnosing the lesion and subsequently the patient underwent a midfrontobasal craniotomy with complete removal of the tumour and reconstruction of the frontobasal dura. Results: The patient recovered well and follow up scans show no residual tumour or recurrence. The histopathological investigations revealed a spindle cell tumour with distinct Antoni A and B areas, thick-walled vessels and iron depositions, consistent with the morphology of a schwannoma. S100 was strongly positive, supporting the diagnosis. Conclusion: We present a brief review of the literature and provide the radiological and pathological characteristics on this rare tumour.
Keywords: Lateral approach; Posterolateral; Cervical spine tumour
Extremely rare pediatric primary extradural temporal leiomyoma with paroxystic headache Thys M, MD a, Thys P, MD a, Ide C, MD b, Oana M, MD c, Delree P, MD c [ aNeurochirurgie GHdC, bRadiologie GHdC, cIPG Gosselies]
doi:10.1016/j.surneu.2009.08.047
Dural osteomas and chondromas: case reports and review of the litterature Nguyen Khac M-T, MD, Martin D, MD, Deprez M, MD, Raket D, MD, Scholtes F, MD, Racaru T, MD, Robe P, MD [CHU Liège]
Introduction: Osteocartilaginous tumours of the dural convexity are rare and may radiologically mimic meningiomas. More specifically, less than thirty cases of chondromas arising from the falx and the dural convexity have been cited in the literature even if they are more frequently found on skull base or in paranasal sinuses. Material and methods: We report two cases of such isolated dural convexity lesions that have been surgically resected. The operative and histological findings are also described. Results: In first patient, a frontal apical extra-axial mass was found in 1999 during an exploration for vertigos. The second one was admitted in 2008 for headache and a computed tomography associated with an MRI revealed a calcified tumor attached to the dura in the right frontal region. Histopathological analysis showed typical findings of a benign chondroma and osteoma, respectively. Patients are still free of symptoms and had no recurrence. Conclusions: Natural history, characteristics and management of these lesions are reviewed, as well as the embryological ground that might explain the occurrence of such tumors in pachymeninges. Keywords: Dura; Osteoma; Chondroma doi:10.1016/j.surneu.2009.08.048
Keywords: Schwannoma; Olfactory groove; Surgery doi:10.1016/j.surneu.2009.08.049
Objectives: We report a rare case of primary intracranial leiomyoma in a 9 year old boy presented with severe paroxystic headache for many years and located extradurally partially in the left temporal fossa, and in the petrous bone. Methods: Pain occurred two or three times a day, extremely intense during 1 to 10 minutes, more often during early morning and then resolved. The boy was followed for years by Pediatrician and ENT and made many stays in hospitals. Injected CT scanner showed a hypodense but enhancing tumor with small calcifications. MRI demonstrates a small tumor partially included in petrous bone, and partially intracranial isointense tumor, intensively enhancing with gadolinium. Meningioma or cartilagineous tumor were evoked. Mechanism of pain was unclear but location of the pain by the boy was precisely around left ear. After three month of observation, as pain was intensifying, surgery was performed by an extradural temporal posterior approach. Tumor was firmly attached to external layer of dura and not to the petrous bone. A vascular pedicle was seen and coagulated. Result: Histologically, the tumor had the characteristic appearance of a leiomyoma. Benign smooth muscle is only present in cranium in arterial media. Immunohistochemistry confirmed the diagnosis. Benign metastasis of the leiomyoma was excluded by imaging. Pain disappeared post-operatively. Follow-up at 2 year doesn't show any recurrence. Conclusions: Eight cases have been described intracranially. Leiomyoma is extremely rare but can be considered in the differential diagnosis of well-circumscribed enhancing calcified intracranial lesions. Paroxystic headache can be seen in extradural locations.
Abstracts / Surgical Neurology 72 (2009) 515–529
Lateral approach to voluminous premedullary cervical tumour: a safe procedure with preservation of the stability Colle D, MD, Van Roost D, MD [UZ Gent]
A solitary olfactory groove schwannoma: a rare tumour Rasschaert R, MD a, Verbeke SLJ, MD b, Walchenbach R, MD a [ aMC Haaglanden, bLUMC]
Introduction: Removal of ventrally and ventrolaterally located cervical spine tumours can present serious technical problems. A posterior approach requiring spinal cord retraction may be deleterious and is not adequate. The anterior approach often requires an extensive anterior vertebrectomy with bone fusion and postoperative immobilization, and tumour removal is done without visualizing the spinal cord. We present a case in which a lateral approach was used with an excellent exposure of the ventral and ventrolateral aspect of the spinal canal, that allowed safe dissection without retraction of the cord. Material and methods: A 37-year-old woman was admitted with a history of slight paresis in the right hand since six months, followed by a rapidly progressive, spastic tetraparesis. MRI showed a voluminous, inhomogeneously enhancing premedullar tumour from C2 to C5. The lesion was approached from the right side in a true lateral position under neuromonitoring (MEPs). The resection technique is described, consisting of drilling away the laminae between the facet joints and the processi spinosi from C2 to C5, providing an excellent visualisation of the schwannoma and allowing its safe dissection from the medulla spinalis and the right C3 and C4 radices. Results: The tumour was completely removed. Patient's neurological function progressively improved. Postoperative imaging showed no tumour rest. Conclusion: We described a case of lateral approach to the upper and midcervical spine with excellent exposure of the lateral and ventral portions of the spinal canal. The major advantages are a lateral line of vision avoiding retraction of the spinal cord and the preservation of cervical stability.
Introduction: An olfactory groove schwannoma is a very rare, but benign, slow growing tumour and always diagnosed postoperative. As the olfactory bulb is still a part of the central nervous system, it lacks a schwann cell layer and is therefore not the origin of the tumour. Dural branches of the ophtalmic part of the trigeminal nerve or the filia olfactoria are more likely candidates. Material and methods: A forty year old female patient presented at the emergency department with an epileptic seizure. Diagnostic imaging revealed a large cystic lesion in the left frontal region. A stereotactic biopsy provided no vital tissue for diagnosing the lesion and subsequently the patient underwent a midfrontobasal craniotomy with complete removal of the tumour and reconstruction of the frontobasal dura. Results: The patient recovered well and follow up scans show no residual tumour or recurrence. The histopathological investigations revealed a spindle cell tumour with distinct Antoni A and B areas, thick-walled vessels and iron depositions, consistent with the morphology of a schwannoma. S100 was strongly positive, supporting the diagnosis. Conclusion: We present a brief review of the literature and provide the radiological and pathological characteristics on this rare tumour.
Keywords: Lateral approach; Posterolateral; Cervical spine tumour
Extremely rare pediatric primary extradural temporal leiomyoma with paroxystic headache Thys M, MD a, Thys P, MD a, Ide C, MD b, Oana M, MD c, Delree P, MD c [ aNeurochirurgie GHdC, bRadiologie GHdC, cIPG Gosselies]
doi:10.1016/j.surneu.2009.08.047
Dural osteomas and chondromas: case reports and review of the litterature Nguyen Khac M-T, MD, Martin D, MD, Deprez M, MD, Raket D, MD, Scholtes F, MD, Racaru T, MD, Robe P, MD [CHU Liège]
Introduction: Osteocartilaginous tumours of the dural convexity are rare and may radiologically mimic meningiomas. More specifically, less than thirty cases of chondromas arising from the falx and the dural convexity have been cited in the literature even if they are more frequently found on skull base or in paranasal sinuses. Material and methods: We report two cases of such isolated dural convexity lesions that have been surgically resected. The operative and histological findings are also described. Results: In first patient, a frontal apical extra-axial mass was found in 1999 during an exploration for vertigos. The second one was admitted in 2008 for headache and a computed tomography associated with an MRI revealed a calcified tumor attached to the dura in the right frontal region. Histopathological analysis showed typical findings of a benign chondroma and osteoma, respectively. Patients are still free of symptoms and had no recurrence. Conclusions: Natural history, characteristics and management of these lesions are reviewed, as well as the embryological ground that might explain the occurrence of such tumors in pachymeninges. Keywords: Dura; Osteoma; Chondroma doi:10.1016/j.surneu.2009.08.048
Keywords: Schwannoma; Olfactory groove; Surgery doi:10.1016/j.surneu.2009.08.049
Objectives: We report a rare case of primary intracranial leiomyoma in a 9 year old boy presented with severe paroxystic headache for many years and located extradurally partially in the left temporal fossa, and in the petrous bone. Methods: Pain occurred two or three times a day, extremely intense during 1 to 10 minutes, more often during early morning and then resolved. The boy was followed for years by Pediatrician and ENT and made many stays in hospitals. Injected CT scanner showed a hypodense but enhancing tumor with small calcifications. MRI demonstrates a small tumor partially included in petrous bone, and partially intracranial isointense tumor, intensively enhancing with gadolinium. Meningioma or cartilagineous tumor were evoked. Mechanism of pain was unclear but location of the pain by the boy was precisely around left ear. After three month of observation, as pain was intensifying, surgery was performed by an extradural temporal posterior approach. Tumor was firmly attached to external layer of dura and not to the petrous bone. A vascular pedicle was seen and coagulated. Result: Histologically, the tumor had the characteristic appearance of a leiomyoma. Benign smooth muscle is only present in cranium in arterial media. Immunohistochemistry confirmed the diagnosis. Benign metastasis of the leiomyoma was excluded by imaging. Pain disappeared post-operatively. Follow-up at 2 year doesn't show any recurrence. Conclusions: Eight cases have been described intracranially. Leiomyoma is extremely rare but can be considered in the differential diagnosis of well-circumscribed enhancing calcified intracranial lesions. Paroxystic headache can be seen in extradural locations.