AN UNCOMMON CASE OF FILUM TERMINALE HEMANGIOBLASTOMA NON-ASSOCIATED WITH VON HIPPEL – LINDAU DISEASE

A 55-year-old man presented with low backache, paraesthesia, and spasticity of both lower limbs. He had urinary retention and constipation. Investigations revealed a vascular intradural cauda equina tumor. MRI scan demonstrated an enhancing mass at the third and fourth lumbar vertebral levels. There were multiple dilated and tortuous veins draining from both poles of the tumor. At surgery, we found a well-defined tumor with an orange hue and fleshy consistency was encountered arising from the filum terminale, comprising a few adjacent nerve roots. The tumor was excised en bloc. The filum terminale was also been resected. A sporadic hemangioblastoma arising from the filum terminale should be considered as a rare cause of back pain and sciatica. Total excision of the tumor offers a cure

Postoperative Cerebellar Mutism Syndrome in an Adult Patient

Postoperative cerebellar mutism syndrome is a common complication occurring after surgical treatment of medulloblastoma in children. The clinical course of this syndrome is characterized by delayed onset after the surgical intervention, loss of speech, emotional lability, hypotonia, and oropharyngeal dysfunction. This syndrome is rarely seen in adults. We report here a case of postoperative cerebellar mutism in a 25-year-old female patient, who underwent a surgical intervention due to medulloblastoma of the forth ventricle. There are very few reported cases in literature of this syndrome. In the discussion we discuss the likely reasons for the syndrome to develop in adult patients

How Effective is Superolateral Orbital Decompression in Cases of Drug-Resistant Graves' Ophthalmopathy

Introduction: Graves’ ophthalmopathy (GO) is the most common and difficult-to-treat extrathyroidal symptom of Graves’ disease. Though retraction of the upper eyelid is the most common clinical feature of GO, it can have a much more severe clinical manifesta-tion with symptoms such as conjunctival chemosis, keratopathy, extraocular muscle dysfunction, proptosis of the bulb and dysthyroid optic neuropathy. Treatment methods include control of the thyroid function, corticosteroid and immunosuppressive therapy as well as radiotherapy. These approaches are ineffective in one-third of cases, with patients being refractory to all aforementioned therapeutic modalities. In these cases, surgical decompression of the orbit is in order.The spectrum of surgical techniques is wide and varies from decompression of the lateral wall of the orbit to decompression via removal of all four orbital walls. The aim of the current study was to evaluate the results of superolateral orbital decompression.Patients and methods: The study is retrospective and covers the period from January 2009 to January 2019. During that period eight patients with Graves’ ophthalmopathy underwent surgery and were followed up in the Department of Neurosurgery in the Mili-tary Medical Academy, Sofia. The mean age of the patients was 57 years, with the youngest being 30 years old and the oldest – 74 years old. The gender distribution was 1.6/1 with predominance in females (5 women and 3 men). The surgical approach we used is a com-bination of lateral and upper orbitotomy and was described in detail by Al-Mefty. All of patients underwent ophthalmic examinations in the pre- and postoperative period, with special attention to their visual acuity, the condition of the eyelid and the width of the ocular slit. Exophthalmometry was obtained via Hertel’s method. The participants in this study are followed for a period of six months after the operation.Results: All eight patients underwent superolateral orbitotomy. There were a total of ten orbital decompressions. Improvement of visual acuity and reduction of the proptosis were reported in all other surgically treated patients. The mean reported improvement of visual acuity (measured via Snellen’s method) was 0.27±0.17. The mean reported a reduction of proptosis was 7.53±2.58 mm.Conclusions: Although the surgical techniques for orbital decompression we used have significant disadvantages, they remain the only alternative in order to avoid the complication of severe GO

Postoperative Cerebellar Mutism Syndrome in an Adult Patient

Postoperative cerebellar mutism syndrome is a common complication occurring after surgical treatment of medulloblastoma in children. The clinical course of this syndrome is characterized by delayed onset after the surgical intervention, loss of speech, emotional lability, hypotonia, and oropharyngeal dysfunction. This syndrome is rarely seen in adults. We report here a case of postoperative cerebellar mutism in a 25-year-old female patient, who underwent a surgical intervention due to medulloblastoma of the forth ventricle. There are very few reported cases in literature of this syndrome. In the discussion we discuss the likely reasons for the syndrome to develop in adult patients

L3 rootlet recurrent melanocytic schwannoma – case report and literature review

First described by Miller in 1932, melanocytic schwannoma (MS) (melanotic schwannoma, pigmented schwannoma) is a rare variation of peripheral nerve sheet tumours with ectodermal origin occurring predominantly in somatic, but also in the autonomic peripheral system with around two hundred cases in the literature. Predominantly benign tumours, MS are still imaging and pathological challenge and can be easily misdiagnosed with more aggressive peripheral nerve tumours.We report a case of melanocytic schwannoma on L3 sensory rootlet with systematic literature review of nearly 200 cases presented in intracranial, paraspinal region, thoracic, abdominal or pelvic cavities and skin. Two-thirds of cases are part of Carney complex.We present a case of a 61-year-old male with a 3-month history of low back pain, progressive numbness and stiffness in the right thigh, shin and knee, tibial and peroneal paresis causing gait disturbance and neurological claudication. MRI findings present “sand clock” type intradural extramedullary tumour formation with extension to the L3 rootlet through right L3-L4 foramen, hypointense on T2 and hyperintense on T1. Pathological diagnosis of sporadic type melanocytic schwannoma was made via immunohistological and ultrastructural analysis. Thirteen months after total resection there was clinical and MRI evidence of recurrence of the tumour. Total resection and radiosurgery was performed with a recurrence free period of 14 months.A gold standard for melanocytic schwannoma treatment is gross total surgical resection. Despite being considered benign tumours, MS have a local or metastatic recurrence of around 13%. MRI imaging in most of the cases is insufficient and only exhaustive pathological and immunohistological examination is the key to diagnosis. Need of postoperative radiation therapy is still controversial. For the first time, a criterion for postoperative adjuvant therapy was established