Acute Hemifacial And Hemiparesis Caused By Hemorrhagic Vestibular Schwannoma; A Case Report

Vestibular schwannoma is a benign and common slow-growing tumor that develops on the vestibular divisions of cranial nerve VIII. Some risk factors may enhance intratumoral hemorrhage risk which leads to tumor management to early surgical procedures. Hence, we describe a 57-year-old man presented with hearing loss and a 5*8 mm vestibular schwannoma. Eight months later, the patient was referred with headache, nausea and vomiting, right hemifacial paresis, and hemiparesis. Magnetic resonance imaging (MRI) revealed a 45*35 mm hemorrhagic vestibular schwannoma. Surgical pathology reported hemorrhagic vestibular schwannoma. This was a rare case of hemorrhagic vestibular schwannoma with none of the established risk factors for the intratumoral hemorrhage and presented with Wallenberg-like syndrome. Many risk factors can cause hemorrhagic vestibular schwannoma. We present one case of small vestibular schwannoma without any predisposing of hemorrhage and acute onset of same side hemifacial paresis and hemiparesis

Cervicomedullary Ganglioglioma in a Child – A Case Report

Ganglioglioma is a benign slow-growing neoplasm that most frequently occurs at the supratentorial region. Nevertheless, there are occasional reports of ganglioglioma occurring in the brainstem and spinal cord. Here we report a rare case of the craniocervical ganglioglioma. A 3.5-year-old male, presented with severe progressive quadriparesis, gait disturbance, and sphincter deficit. Physical examination demonstrated the quadriparesis, associated with positive Hoffman, Babinski, and clonus signs, and increased respond of deep tendon reflexes. Magnetic resonance imaging (MRI) demonstrated an ill-defined mass within medulla and upper cervical spinal cord, which was hypo to iso signal on T1, heterogeneous iso to hypersignal on T2 and demonstrated marked bright enhancement on T1 with gadolinium (Gad) injection. On surgery, the mass had a soft texture, ill-defined border, and grey to brown appearance. According to the frozen section report, and due to the absence of the tumour-neural parenchymal interference, only decompression of the tumour and expansile duraplasty were performed. The histopathology revealed ganglioglioma. On last follow-up 14 months after surgery, the patient was asymptomatic and neurological status was improved. The craniocervical MRI demonstrated the tumour that did not grow. Although it is rare, the ganglioglioma should be in the differentiated diagnoses of tumours with compatible clinical and radiologic features even in the unusual locations, especially in the pediatric and young patients. Safety surgical resection should be considered in these patients, whenever possible. In the case of partial resection, that is common in the tumours located within functionally critical structures, long close follow-up rather than radiation therapy is required

Flow diverter-coil technique for endovascular treatment of complex wide neck brain aneurysms, Technical point

Background: Treatment of complex wide neck brain aneurysms is a challenging era in neurosurgery. Both surgical and endovascular therapies are considered for treatment of them. In endovascular, there are different ways such as trapping, coiling, stent and balloon assisted coiling. In this study, we use flow-diverter devices to create new vascular lumen and then coiling the aneurysm sac for three patients. Methods: We describe three cases with complex cerebral aneurysm who were treated successfully by flow diverter-coil technique and point to technical nuances. Results: In our patients, wide neck aneurysms, two in distal part of ICA (internal carotid artery) and other in basilar tip. We use flow-diverter-coil technique successfully. On the follow-up, aneurysms are treated completely without any complications. Conclusion: We think flow diverter devices adjunct to coiling is a useful way for the treatment of complex wide neck cerebral aneurysms

Histiocytic Sarcoma Involving Cervical Vertebra: A Case Report and Review of the Literature

Histiocytic sarcoma (HS) is a rare neoplasm composed of cells with immunohistochemical characteristics of mature histiocytes. It can be disseminated or localized and usually involves the skin, spleen, and gastrointestinal tract. Primary involvement of the vertebral column is extremely rare. We report a 29-year-old female who presented with neck pain and had a destructive 35*43*48 mm lesion in C2 with a paravertebral extension. The initial biopsy did not lead to the correct diagnosis. She later developed dysphagia, and the anterior approach was used for tumor decompression. The diagnosis of cervical histiocytic sarcoma was made, and she underwent radiotherapy. The follow-up MRI showed a marked response to radiotherapy. Here, we report the first case of cervical HS, review all cases of vertebral HS, compare patients’ characteristics and clinical courses, and discuss diagnostic nuances and treatment options

Meningeal Melanomas Associated With Transforming Ota Nevus to Malignant Melanoma: A Case Report

Intracranial invasion of cellular blue nevus (CBN) from the skin is extremely rare and such a condition with malignant transformation is even rarer.A case of meningeal melanoma with malignant transformation which was derived from an Ota   nevus is presented in this report.   A21-year-old man with a neurocutaneous syndrome since childhood was referred with headache and mild left hemiparesia. CT scan and MRI demonstrated intracranial lesions and conjunctival biopsy leads to the pathologic diagnosis of blue nevus.Thereafter his parietal lesion was operated by craniotomy with total gross excision.On histopathological examination, diagnosis of malignant melanoma was confirmed.Approximately 2 months after radiotherapy and chemotherapy, he afflicted to diplopia and blurred vision on the leftside due to enlargement of orbital and cavernous sinus lesion. Following one year follow-up,he was survived and thrived with diffuse leptomeningeal nodular enhancement in favor of melanoma dissemination.Primary intracranial melanomas are though rare, but it should be suspected especially in the presence of periorbital blue nevus or nevus of Ota. Moreover, although CBN is considered benign, scalp or periorbital CBN has the potential for intracranial invasion and malignant ransformation

The Real Story of the Fifth Nerve Neurinoma: A Review of Our Learning Curve about Surgical Approaches and Associated Shortcomings

Background and Importance: Our learning curve during two decades of neurosurgical practice has been changed from an abstractive to a more meaningful and conductive state. In cases of fifth nerve neurinoma, pre-operative anatomopathologic diagnosis could lead us to a pre-planned program during and after the surgery to get the safe surgical result. Case Presentation: Representation of two complex fifth nerve neurinoma cases, untoward happenings and the way to manage patient safety. Review of literature to find a wise approach for maximum benefit is included here. Conclusion: Both of our patients have developed iatrogenic unilateral corneal anesthesia, one of them warned of it and the second one not. We have had more problems in the way of preservation of the cornea in the warned case. We have reviewed the factors influencing safe corneal preservation after the operation of fifth nerve neurinoma which are included following items: surgical approach, Anatomopathologic location of the tumor (pre-ganglionic, ganglionic or post-ganglionic), simultaneous damage of V and VII nerve including vidian nerve, preserved corneal sensation, any combination of injury to physiologic and mechanical protectors. The cornerstones to have a safe cornea following such surgeries are pre-operative exam of fifth and 7th nerve in all aspects and also early post-operative evaluation of them including the state of the tear secretion. We encounter corneal anesthesia and epithelial defect. Iatrogenic damage of vidian nerve depending to approach selected seems to be considerable. Simultaneous damage of V and VII nerve during the surgery of large neurinoma are expected and noteworthy