scholarly journals Calvarial lesions: overview of imaging features and neurosurgical management

2021 ◽  
Author(s):  
Isabella Nasi-Kordhishti ◽  
Johann-Martin Hempel ◽  
Florian Heinrich Ebner ◽  
Marcos Tatagiba
Keyword(s):  
Adjuvant Treatment ◽  
Clinical Signs ◽  
Complete Resection ◽  
Neurological Deficits ◽  
Imaging Features ◽  
Histological Findings ◽  
Partial Removal ◽  
Adjacent Tissue ◽  
Local Pain ◽  
Suspected Diagnosis

AbstractCalvarial lesions are rare and can present as a variety of different diseases. The lesions can be palpable on the skin and cause local pain and paraesthesia and, depending on the location, neurological deficits can also occur. This research aims to present an overview of typical imaging features as well as neurosurgical management. We examined the charts of patients who underwent surgery on a calvarial lesion in our department between 2004 and 2017 (n=133). Retrospectively, the pre-, intra-, and postoperative data were analyzed with morphological and histological findings and compared with each other. Pain, swelling, cosmetically disturbing, and neurological deficits were the main complaints. Seventy-seven lesions were limited to the bone, while another 56 lesions showed an infiltrating growth in the adjacent tissue. Depending on the clinical signs and suspected diagnosis, a biopsy, a partial removal, or a complete resection was performed. Histiocytosis (n=20), meningiomas (n=20), metastases (n=19), and osteomas (n=16) were the most common lesions. Fibrous dysplasia (n=6) and intraosseous hemangioma (n=9) were less common; other lesions were present only in isolated cases. Imaging features may suggest the lesion to be benign or malignant, but the diagnosis can be only confirmed by histological examination. The surgical strategy depends on the complaints, location of the lesion, and suspected diagnosis. Adjuvant treatment should be initiated according to the histological findings.

scholarly journals Calvarial Lesions: Overview of Imaging Features and Neurosurgical Management

2021 ◽  
Author(s):  
Isabella Nasi-Kordhishti ◽  
Johann-Martin Hempel ◽  
Florian Heinrich Ebner ◽  
Marcos Tatagiba
Keyword(s):  
Adjuvant Treatment ◽  
Clinical Signs ◽  
Complete Resection ◽  
Neurological Deficits ◽  
Imaging Features ◽  
Histological Findings ◽  
Partial Removal ◽  
Adjacent Tissue ◽  
Local Pain ◽  
Suspected Diagnosis

Abstract ObjectiveCalvarial lesions are rare and can present as a variety of different diseases. The lesions can be palpable on the skin, cause local pain and paraesthesia and, depending on the location, neurological deficits can also occur. This research aims to present an overview of typical imaging features as well as neurosurgical management. MethodsWe examined the charts of patients who underwent surgery on a calvarial lesion in our department between 2004 and 2017 (n=133). Retrospectively, the pre-, intra- and postoperative data were analyzed with morphological and histological findings and compared with each other.ResultsPain, swelling, cosmetically disturbing and neurological deficits were the main complaints. Seventy-seven lesions were limited to the bone, while another 56 lesions showed an infiltrating growth in the adjacent tissue. Depending on the clinical signs and suspected diagnosis, a biopsy, a partial removal or a complete resection was performed. Histiocytosis (n=20), meningiomas (n=20), metastases (n=19) and osteomas (n=16) were the most common lesions. Fibrous dysplasia (n=6) and intraosseous hemangioma (n=9) were less common; other lesions were present only in isolated cases. ConclusionImaging gives a hint, but the diagnosis can be only confirmed by histological examination. The surgical strategy depends on the complaints, location of the lesion and suspected diagnosis. Adjuvant treatment should be initiated according to the histological findings.

scholarly journals Surgical Management of Sporadic Peripheral Nerve Schwannomas in Adults: Indications and Outcome in a Single Center Cohort

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1017
Author(s):  
Julian Zipfel ◽  
Meizer Al-Hariri ◽  
Isabel Gugel ◽  
Alexander Grimm ◽  
Volker Steger ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Clinical Signs ◽  
Complete Resection ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Primary Tumors ◽  
Surgical Interventions ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath

Most sporadic peripheral nerve sheath tumors in adults are schwannomas. These tumors usually present with significant pain but can also cause neurological deficits. Symptomatology is diverse, and successful surgical interventions demand interdisciplinarity. We retrospectively reviewed 414 patients treated between 2006 and 2017 for peripheral nerve sheath tumors. We analyzed clinical signs, symptoms, histology, and neurological function in the cohort of adult patients with schwannomas without a neurocutaneous syndrome. In 144 patients, 147 surgical interventions were performed. Mean follow-up was 3.1 years. The indication for surgery was pain (66.0%), neurological deficits (23.8%), significant tumor growth (8.8%), and suspected malignancy (1.4%). Complete tumor resection was achieved on 136/147 occasions (92.5%). The most common location of the tumors was intraspinal (49.0%), within the cervical neurovascular bundles (19.7%), and lower extremities (10.9%). Pain and neurological deficits improved significantly (p ≤ 0.003) after 131/147 interventions (89.1%). One patient had a persistent decrease in motor function after surgery. Complete resection was possible in 67% of recurrent tumors, compared to 94% of primary tumors. There was a significantly lower chance of complete resection for schwannomas of the cervical neurovascular bundle as compared to other locations. The surgical outcome of sporadic schwannoma surgery within the peripheral nervous system is very favorable in experienced peripheral nerve surgery centers. Surgery is safe and effective and needs a multidisciplinary setting. Early surgical resection in adult patients with peripheral nerve sheath tumors with significant growth, pain, neurological deficit, or suspected malignancy is thus recommended.

MRI in 30 cats with traumatic brain injury

2018 ◽  
Vol 21 (12) ◽  
pp. 1111-1119 ◽  
Author(s):  
Abby Caine ◽  
Robert Brash ◽  
Luisa De Risio ◽  
Jan Van Dijk ◽  
Giunio Bruto Cherubini ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Tissue Injury ◽  
Brain Mri ◽  
Soft Tissue Injury ◽  
Clinical Signs ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Neurological Deficits ◽  
Imaging Features

Objectives The aim of this study was to evaluate the MRI findings in cats following traumatic brain injury (TBI), and establish which features identified might correlate with prognosis. Methods The magnetic resonance images of 30 cats with clinical signs attributed to the brain following TBI were retrospectively reviewed to assess the imaging features seen and their correlation with outcome. Results Twenty-one of 30 cats had a good outcome (full recovery or minor ongoing neurological deficits); the other nine either died or had ongoing neurological deficits that significantly affected quality of life. There was evidence of parenchymal injury in only 20/30 cats, including 8/9 that had a poor outcome. The frequency of bilateral or multifocal parenchymal lesions on T2-weighted imaging, and mass effect, particularly caudal transtentorial herniation, was statistically significantly higher in patients with a poorer outcome. Extra-axial haemorrhage was not identified. Concurrent soft tissue injury was noted in all cats, with a poorer prognosis statistically associated with a peripharyngeal pattern of injury and orbital trauma. Conclusions and relevance The number of cases with MRI-identified brain pathology, the patterns of injuries identified and the specific imaging features that appear to have effects on prognosis differ in this series of cats from those published in similar case series of dogs. Further work is needed to establish if cat-specific guidelines are needed to assess brain MRI following trauma.

scholarly journals Investigation of an EHV-1 Outbreak in the United States Caused by a New H752 Genotype

Pathogens ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 747
Author(s):  
Nicola Pusterla ◽  
Samantha Barnum ◽  
Julia Miller ◽  
Sarah Varnell ◽  
Barbara Dallap-Schaer ◽  
...  
Keyword(s):  
Early Stage ◽  
Clinical Signs ◽  
Amino Acid Position ◽  
High Viral Load ◽  
The United States ◽  
Neurological Deficits ◽  
Diagnostic Challenge ◽  
Genotype I ◽  
Flunixin Meglumine ◽  
Nasal Secretions

Here we report on an EHV-1 outbreak investigation caused by a novel genotype H752 (histidine in amino acid position 752 of the ORF 30 gene). The outbreak involved 31 performance horses. Horses were monitored over a period of 35 days for clinical signs, therapeutic outcome and qPCR results of EHV-1 in blood and nasal secretions. The morbidity of the EHV-1 outbreak was 84% with 26 clinically infected horses displaying fever and less frequently anorexia and distal limb edema. Four horses showed mild transient neurological deficits. Clinically diseased horses experienced high viral load of EHV-1 in blood and/or nasal secretions via qPCR, while subclinically infected horses had detectable EHV-1 mainly in nasal secretions. The majority of infected horses showed a rise in antibody titers to EHV-1 during the outbreak. All 31 horses were treated with valacyclovir, while clinically infected horses further received flunixin meglumine and sodium heparin. This investigation highlights various relevant aspects of an EHV-1 outbreak caused by a new H752 genotype: (i) importance of early detection of EHV-1 infection; (ii) diagnostic challenge to assess H752 genotype; (iii) apparent benefit of valacyclovir use in the early stage of the outbreak; and (iv) weekly testing of blood and nasal secretions by qPCR in order to monitor individual infection status and lift quarantine.

scholarly journals Stereotactic radiosurgery for treating meningiomas eligible for complete resection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maximilian I. Ruge ◽  
Juman Tutunji ◽  
Daniel Rueß ◽  
Eren Celik ◽  
Christian Baues ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stereotactic Radiosurgery ◽  
Medical Condition ◽  
Local Tumor Control ◽  
Complete Resection ◽  
Neurological Deficits ◽  
Tumor Control ◽  
Recurrence Rates ◽  
Treatment Volume

Abstract Background For meningiomas, complete resection is recommended as first-line treatment while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable. If the patient´s medical condition or preference excludes surgery, SRS remains a treatment option. We evaluated the efficacy and safety of SRS in a cohort comprising these cases. Methods In this retrospective single-centre analysis we included patients receiving single fraction SRS either by modified LINAC or robotic guidance by Cyberknife for potentially resectable intracranial meningiomas. Treatment-related adverse events as well as local and regional control rates were determined from follow-up imaging and estimated by the Kaplan–Meier method. Results We analyzed 188 patients with 218 meningiomas. The median radiological, and clinical follow-up periods were 51.4 (6.2–289.6) and 55.8 (6.2–300.9) months. The median tumor volume was 4.2 ml (0.1–22), and the mean marginal radiation dose was 13.0 ± 3.1 Gy, with reference to the 80.0 ± 11.2% isodose level. Local recurrence was observed in one case (0.5%) after 239 months. The estimated 2-, 5-, 10- and 15-year regional recurrence rates were 1.5%, 3.0%, 6.6% and 6.6%, respectively. Early adverse events (≤ 6 months after SRS) occurred in 11.2% (CTCEA grade 1–2) and resolved during follow-up in 7.4% of patients, while late adverse events were documented in 14.4% (grade 1–2; one case grade 3). Adverse effects (early and late) were associated with the presence of symptoms or neurological deficits prior to SRS (p < 0.03) and correlated with the treatment volume (p < 0.02). Conclusion In this analysis SRS appears to be an effective treatment for patients with meningiomas eligible for complete resection and provides reliable long-term local tumor control with low rates of mild morbidity.

Advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma

2021 ◽  
pp. 32-42
Author(s):  
Igor Aleksandrovich Medyanik ◽  
Simon Quarteng Badu
Keyword(s):  
Neurological Disorders ◽  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Complete Resection ◽  
Anaplastic Glioma ◽  
Neurological Deficits ◽  
Neural Pathways ◽  
Histological Subtype ◽  
Group A ◽  
Group B

The possibility of using only tractography as a preoperative diagnosis of anaplastic glioma is limited due to its inability to show the exact functional location of the tumor; therefore, the combination of tractography and fMRI seems to be a more promising complex diagnostic method. In neurooncology, complete resection without or with minimal neurological deficit is the goal of surgical intervention. The aim of the study was to investigate the advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma compared to standard CT or MRI. The study involved 48 patients who were divided into two groups based on the use of fMRI and tractography: group A (24 patients) and without it — group B (24 patients). The groups were compared in terms of age, sex, histological subtype of anaplastic glioma, degree of resection, postoperative complications, and dynamics of neurological disorders. The combination of fMRI and tractography is the best preoperative diagnosis, it is safe and allows localizing neural pathways, preserve them during surgery, and reduce postoperative neurological deficits.

scholarly journals Cerebellar peduncle abscess secondary to disseminated strangles in a six-week-old miniature foal

2011 ◽  
Vol 1 (1) ◽  
pp. 12
Author(s):  
Brianne Henderson
Keyword(s):  
Animal Health ◽  
Clinical Signs ◽  
Acute Onset ◽  
Abscess Formation ◽  
Neurological Deficits ◽  
Post Mortem ◽  
Streptococcus Equi ◽  
The Central Nervous System ◽  
Cerebellar Peduncle ◽  
The Right

During a strangles outbreak within a herd of minature horses, a six week old foal developed acute onset clinical signs of sepsis and neurological deficits. The foal was euthanized and submitted for post-mortem at the Animal Health Laboratories, Guelph Ontario. Gross <em>post-mortem</em> examination noted severe bronchopneumonia, hypopyon of the right eye and a singular cerebellar peduncle abscess. Culture of the lungs and cerebellum produced a pure growth of <em>Streptococcus equi</em> ssp. <em>equi</em>. <em>Streptococcus equi</em> ssp. <em>equi</em>, the causative agent of equine strangles, produces an acute pyrexia, purulent lymphadenopathy of submandibular and retropharyngeal lymph nodes. Commonly, lymph node abscesses rupture and resolve without complication. Rarely, complications may include: dissemination of the bacteria with diffuse abscess formation, immune mediated disease (purpura haemorrhagica), rarely abscess formation within the central nervous system (CNS) can occur. These can be managed medically with appropriate antibiotics and drugs to reduce intra-cranial pressure, however surgical drainage and debulking of the abscess has been attempted successfully in a few cases.

scholarly journals Ischemic myelopathy caused by fibrocartilaginous embolism in a horse

2018 ◽  
Vol 48 (2) ◽  
Author(s):  
Welden Panziera ◽  
Ronaldo Michel Bianchi ◽  
Paula Reis Pereira ◽  
Mariana Martins Flores ◽  
Monique Togni ◽  
...  
Keyword(s):  
Cross Sections ◽  
Clinical Course ◽  
Clinical Signs ◽  
Histological Findings ◽  
Hind Limbs ◽  
Fibrocartilaginous Embolism ◽  
Mixed Breed ◽  
Liquefactive Necrosis ◽  
Gross Lesions ◽  
Multiple Blood

ABSTRACT: This report described clinical, epidemiological, and pathological aspects of ischemic myelopathy caused by fibrocartilaginous embolism (FCE) in a 10-year-old, mixed breed gelding. Clinically, the horse presented acute hind limbs paralysis, with a clinical course of approximately 24 hours. At necropsy, no gross lesions were observed. Cross-sections of the spinal cord revealed focally extensive areas of malacia from the T10 to L4 segments. Focally extensive areas of liquefactive necrosis involving the gray matter and adjacent white matter were observed on histologic sections. The lumen of multiple blood vessels in the periphery of the necrotic areas was occluded by fibrocartilaginous emboli that strongly stained with alcian blue. Clinical signs, gross necropsy, and histological findings observed in this case were identical to those described in the literature for ischemic myelopathy caused by FCE in the horse and other species.

Diagnostic Values of Clinical and Magnetic Resonance Findings in Presumptive Trigeminal Neuropathy: 49 Dogs

2020 ◽  
Vol 56 (2) ◽  
pp. 106-113 ◽  
Author(s):  
Clément Musso ◽  
Kevin Le Boedec ◽  
Eymeric Gomes ◽  
Laurent Cauzinille
Keyword(s):  
Clinical Signs ◽  
Cross Sectional Study ◽  
Neurological Deficits ◽  
Sensory Impairment ◽  
Mri Findings ◽  
Trigeminal Neuropathy ◽  
Cross Sectional ◽  
Predicted Probability ◽  
Diagnostic Values ◽  
Ear Effusion

ABSTRACT The goal of this retrospective, cross-sectional study was to describe the different etiologies of trigeminal neuropathy based on clinical and MRI findings and to evaluate the significance of associated concomitant disorders. MRI studies of 49 dogs with trigeminal neuropathy were blindly reviewed and were classified into the following three groups: neoplasia, neuritis, or idiopathic trigeminal neuropathy (ITN). Thirty-one percent were suspected to have neoplasia (all unilateral), 16% to have neuritis (1 bilateral and 7 unilateral), and 53% to have ITN (4 unilateral and 22 bilateral). Dogs with clinical bilateral trigeminal dysfunction were most likely to have a diagnosis of ITN (predicted probability 95.7%). Unilateral clinical signs were significantly associated with neoplasia or neuritis compared with ITN (P &lt; .001 and P = .002, respectively). Even with marked brainstem neoplastic involvement, central neurological deficits may be absent. Sensory impairment was significantly associated with either neoplasia or neuritis compared with ITN (P = .007 and P = .03, respectively). Ipsilateral noninfectious middle ear effusion was only seen in dogs with neoplasia (33%). Horner’s syndrome was present in 12% of all dogs (2 dogs in each group). Dogs with neoplasia were significantly older than dogs with neuritis (P = .02) and ITN (P = .002). JAAHA-MS-6997

scholarly journals Multifocal granulocytic sarcoma of the spine mimicking neurofibromatosis Type 2: case report

2016 ◽  
Vol 25 (4) ◽  
pp. 523-527
Author(s):  
Gregory P. Lekovic ◽  
Marc S. Schwartz ◽  
John L. Go
Keyword(s):  
Granulocytic Sarcoma ◽  
Neurofibromatosis Type ◽  
Rapid Onset ◽  
Neurofibromatosis Type 2 ◽  
Neurological Deficits ◽  
Lumbosacral Spine ◽  
Imaging Features ◽  
History Of ◽  
Patient’S History

In this report the authors report on a patient with a very indolent course of granulocytic sarcoma, characterized by steroid-induced remission of spinal and cranial tumors and recurrence over a period of several years. This 24-year-old man with history of leukemia presented with rapid-onset quadriparesis secondary to multiple extraaxial masses of the cervicothoracic spine, from C-5 to T-3, and lumbosacral spine, from L-5 to the coccyx. Although the imaging features were highly suggestive of neurofibromatosis Type 2, the patient's history and clinical course were consistent with granulocytic sarcoma; repeat imaging and, later, needle biopsy definitively established the diagnosis of granulocytic sarcoma. Laminectomy and surgical decompression of the spine were not required and, arguably, could have posed unnecessary risk to the patient. This case illustrates that the successful management of a patient presenting with profound neurological deficits due to intradural spinal cord tumors may sometimes be nonsurgical.

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