-
Anticancer Research Jun 2022Extraventricular supratentorial ependymomas are rare entities. Most ependymomas are located at the infratentorial and intraventricular level, and only in a small group...
BACKGROUND/AIM
Extraventricular supratentorial ependymomas are rare entities. Most ependymomas are located at the infratentorial and intraventricular level, and only in a small group of cases they do not present continuity with the ventricular system. This is a case report of a patient with an atypical location of a cerebral ependymoma, which required the implementation of a complex and infrequent approach for its complete microsurgical removal.
CASE REPORT
A 16-year-old male patient was referred at our department with a diagnosis of a 40 mm × 50 mm × 60 mm solid-cystic space-occupying lesion, sited between the left superior frontal-cingulate gyri. A contralateral transfalcine interhemispheric approach was selected, which achieved total resection of the tumor. The histopathological diagnosis of Grade II ependymoma was obtained according to WHO classification.
CONCLUSION
The contralateral transfalcine interhemispheric approach represents a favorable surgical corridor to achieve a total resection of the tumor lesion and is favored by an adequate working angle and reduced brain manipulation.
Topics: Adolescent; Ependymoma; Humans; Male; Neurosurgical Procedures; Referral and Consultation; Supratentorial Neoplasms
PubMed: 35641289
DOI: 10.21873/anticanres.15810 -
Pediatric Neurosurgery 2007To study the outcome and recurrence in supratentorial anaplastic ependymoma.
AIM
To study the outcome and recurrence in supratentorial anaplastic ependymoma.
METHODS
Sixteen cases of supratentorial anaplastic ependymoma were reviewed. The average age of presentation was 8.2 years ranging from 1 to 16 years of age. The mean duration between the onset of first symptoms to time of presentation was 4.2 months. Follow-up ranged from 5 to 58 months with a mean of 16.8 months.
RESULTS
Gross total excision of tumor was achieved in 14 cases, as judged on the basis of intraoperative impression and confirmed with postoperative contrast MR or CT scan. There were 2 unfortunate deaths in the series, one as result of disseminated intravascular coagulation in view of massive blood loss and the other child had evidence of central transtentorial herniation preoperatively which failed to recover. Postoperative cranial radiotherapy was offered to all the 14 remaining cases. Twelve of 14 cases showed evidence of recurrence at follow-up. Recurrence occurred as early at 6 months and as late as 58 months. Only 2 children were recurrence free at follow-up of 6 months and 14 months, respectively. Two operated and irradiated cases of differentiated ependymomas (grade II) developed anaplastic recurrence at follow-up of 5 years and 9 years, respectively, suggesting a malignant transformation of tumor at follow-up. Four out of 12 cases were reoperated for their recurrence in view of localized nature of recurrence and good Karnofsky's performance status.
CONCLUSION
It is obvious that anaplastic ependymomas of the supratentorial compartment are aggressive tumors with high rates of recurrence even after gross total excision and irradiation. Gross total excision and postoperative irradiation are not effective in preventing early recurrence in anaplastic ependymomas, and other factors affecting the outcome need to be analyzed.
Topics: Adolescent; Child; Child, Preschool; Ependymoma; Female; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local; Retrospective Studies; Supratentorial Neoplasms
PubMed: 17786000
DOI: 10.1159/000106384 -
Neurosurgery Clinics of North America Jan 1990Low-grade gliomas (grades I and II) are infiltrative lesions. Patients harboring these tumors follow extremely variable clinical courses. Review of current data suggests... (Review)
Review
Low-grade gliomas (grades I and II) are infiltrative lesions. Patients harboring these tumors follow extremely variable clinical courses. Review of current data suggests that in patients with large tumors, complete excision affords long-term survival, with or without radiation therapy. Partial excision should be followed by radiation therapy. The management of very small tumors in patients who are neurologically normal is controversial. Stereotactic technique is particularly useful in diagnosis, and often in tumor resection, in this group of patients.
Topics: Combined Modality Therapy; Craniotomy; Glioma; Humans; Supratentorial Neoplasms
PubMed: 2135972
DOI: No ID Found -
Indian Journal of Pathology &... 2022Ependymomas are more common in the pediatric population, in whom they are commonly infratentorial. Extra axial location of a supratentorial ependymoma is extremely rare.
INTRODUCTION
Ependymomas are more common in the pediatric population, in whom they are commonly infratentorial. Extra axial location of a supratentorial ependymoma is extremely rare.
DIAGNOSIS
Radiologically these tumors are often misdiagnosed as meningioma or other extra axial lesions owing to their unusual location and lack of any pathognomonic features. Hence, histopathological examination becomes imperative for proper evaluation and an adequate diagnosis.
CASE
Herein we report a case of a supratentorial extra axial anaplastic ependymoma misdiagnosed as a metastatic tumor on radiological examination and mimicking meningioma intra operatively, located in the frontal and temporal region in a 20 year old man.
Topics: Adult; Child; Ependymoma; Humans; Male; Meningeal Neoplasms; Meningioma; Supratentorial Neoplasms; Young Adult
PubMed: 35900497
DOI: 10.4103/ijpm.ijpm_372_21 -
Neurosurgical Review Jun 2023We assessed the feasibility of Carmustine wafer implantation in "extreme" conditions (i.e. patients > 80 years and Karnofsky Performance Status score < 50) and...
We assessed the feasibility of Carmustine wafer implantation in "extreme" conditions (i.e. patients > 80 years and Karnofsky Performance Status score < 50) and of implantation ≥ 12 Carmustine wafers in adult patients harbouring a newly diagnosed supratentorial glioblastoma, IDH-wildtype. We performed an observational, retrospective single-centre cohort study at a tertiary surgical neuro-oncological centre between January 2006 and December 2021. Four hundred eighty patients who benefited from a surgical resection at first-line treatment were included. We showed that Carmustine wafer implantation in patients > 80 years, in patients with a Karnofsky performance status score < 50, and that implantation ≥ 12 Carmustine wafers (1) did not increase overall postoperative complication rates, (2) did not affect the completion of standard radiochemotherapy protocol, (3) did not worsen the postoperative Karnofsky Performance Status scores, and (4) did not significantly affect the time to oncological treatment. We showed that the implantation of ≥ 12 Carmustine wafers improved progression-free survival (31.0 versus 10.0 months, p = 0.025) and overall survival (39.0 versus 16.5 months, p = 0.041) without increasing postoperative complication rates. Carmustine wafer implantation during the surgical resection of a newly diagnosed supratentorial glioblastoma, IDH-wildtype is safe and efficient in patients > 80 years and in patients with preoperative Karnofsky Performance Status score < 50. The number of Carmustine wafers should be adapted (up to 16 in our experience) to the resection cavity to improve survival without increasing postoperative overall complication rates.
Topics: Humans; Antineoplastic Agents, Alkylating; Brain Neoplasms; Carmustine; Cohort Studies; Combined Modality Therapy; Glioblastoma; Postoperative Complications; Retrospective Studies; Supratentorial Neoplasms; Aged, 80 and over
PubMed: 37329341
DOI: 10.1007/s10143-023-02052-x -
Child's Nervous System : ChNS :... Apr 1994Three hundred and ninety-six paediatric (below 15 years of age) patients with brain tumours were treated at our institute in the last 4 years. Eighty-two of the tumours...
Three hundred and ninety-six paediatric (below 15 years of age) patients with brain tumours were treated at our institute in the last 4 years. Eighty-two of the tumours were located supratentorially. These 82 patients included 14 infants (below 1 year of age), who made up 3.5% of all paediatric patients with brain tumours and 17% and those with brain tumours in a supratentorial location. There was a male preponderance, and two-thirds of the 14 patients were within their first 6 months of life. Increasing head size, vomiting and failure to thrive were the common presenting features. One infant presented with asymmetric skull growth. The tumours tended to be large, occupying almost the entire affected cerebral hemisphere; histological types included astrocytomas, malignant astrocytomas, glioblastoma multiforme, primitive neuroectodermal tumours, malignant choroid plexus papillomas and malignant teratomas. Two children had congenital tumours and another two tumours, in children with associated lobar agenesis, were thought to be congenital in origin. Associated hydrocephalus was present in seven patients, but precraniotomy shunt was required in only two patients. The perioperative (within 1 month) mortality was 57%. Only 30% of the patients survived for more than 1 year after surgery and chemotherapy. The longest survival was 20 months. Delay in diagnosis, poor general condition prior to surgery, and the high vascularity and malignant nature of these tumours accounted for the poor results.
Topics: Astrocytoma; Brain; Female; Humans; India; Infant; Infant, Newborn; Male; Sex Factors; Supratentorial Neoplasms; Tomography, X-Ray Computed
PubMed: 8044813
DOI: 10.1007/BF00301085 -
Journal of Neuro-oncology Jan 2008Supratentorial primitive neuroectodermal tumors (sPNET) occurring in adults are rare. Only 56 such cases have been previously reported. This report documents a... (Review)
Review
Supratentorial primitive neuroectodermal tumors (sPNET) occurring in adults are rare. Only 56 such cases have been previously reported. This report documents a 56-year-old male who presented with the chief complaint of right facial palsy. Magnetic resonance imaging (MRI) revealed left frontal and bilateral periventricular lesions. Surgery was performed for the frontal mass, which was histologically diagnosed to be sPNET. An immunohistochemistry assay for CD99, and a fluorescence in situ hybridization (FISH) assay for t(11;22) translocation revealed this PNET to be a central PNET. This case was the first case to detect a central PNET using both immunohistochemistry and the FISH assay in adult sPNET. Though radiation therapy was performed, an MRI performed 2.5 months after the surgery revealed a regrowth of the tumor. The patient died 5 months after surgery. This case report is accompanied by a review of 57 cases of adult sPNET.
Topics: 12E7 Antigen; Antigens, CD; Cell Adhesion Molecules; Fatal Outcome; Humans; Immunochemistry; In Situ Hybridization, Fluorescence; Male; Middle Aged; Neuroectodermal Tumors, Primitive; Supratentorial Neoplasms; Translocation, Genetic
PubMed: 17713720
DOI: 10.1007/s11060-007-9466-4 -
Child's Nervous System : ChNS :... Feb 2012Intracranial dermoid cysts are rare space-occupying lesions in paediatric patients. Supratentorial or lateralized localisations are described even less frequently.... (Review)
Review
BACKGROUND
Intracranial dermoid cysts are rare space-occupying lesions in paediatric patients. Supratentorial or lateralized localisations are described even less frequently. Diagnosis may be hard to obtain using standard imaging. Surgical removal provides cure for these benign, but growing lesions.
METHODS
We describe the cases of two paediatric patients in which supratentorially located (one lateralized) dermoid cysts were diagnosed and operated on. Due to unusual presenting symptoms, diagnosis was not straightforward in these cases. Complete resection could be achieved in both patients without any neurological sequelae. We reviewed the current literature available on dermoid cysts in paediatric patients which comprises mainly case reports and only two series. We could identify a total of 61 patients harbouring dermoid cysts. Only ten of these were located supratentorially, and only one was lateralized.
DISCUSSION
Most of the midline dermoids were associated with a dermal sinus. Complete surgical removal was discussed as the only treatment option in all cases. Difficulties in diagnosis were reported frequently. Despite good availability of routine MR imaging, the diagnosis of a dermoid cysts, probably due to the low incidence, still remains a challenge. These lesions represent benign intracranial masses. Yet non-neoplastic, they can lead to neurological deficits due to their space-occupying effect.
CONCLUSIONS
Radical surgical resection, if feasible without major risk for the patient, remains the only option of cure. Due to their unusual position and their unique symptomatology, our cases add favourably to the current literature, showing, once more, the multiple facets of this disease.
Topics: Adolescent; Child; Dermoid Cyst; Female; Humans; Male; Neurosurgical Procedures; Supratentorial Neoplasms
PubMed: 22160478
DOI: 10.1007/s00381-011-1646-z -
Journal of Neuroradiology = Journal de... 1991The topographic analysis of supratentorial brain tumors must answer the following questions: location of the tumor, its extension, its being infiltrative or well... (Review)
Review
The topographic analysis of supratentorial brain tumors must answer the following questions: location of the tumor, its extension, its being infiltrative or well localized and especially the relationships with the main functional areas such as the speech areas, the sensori-motor area, and the visuel areas. Also the topographic analysis may help to approach the diagnosis of nature. The neuroradiological procedures include the CT, the angiography and especially the MRI in sagittal and coronal sections, with gadolinium enhancement. The anatomical accuracy is obtained using the bicommissural plane and superimposition techniques according to the Talairach's Atlas and anatomical sections and MRI superimposition with angiography. 3D volumic reconstruction is of considerable contribution for the topographic analysis of a cerebral tumor.
Topics: Angiography; Humans; Magnetic Resonance Imaging; Supratentorial Neoplasms; Tomography, X-Ray Computed
PubMed: 1919679
DOI: No ID Found -
Neurology Dec 2009Low-grade gliomas (LGG) are thought to be very rare in elderly patients (>60 years) and have not been thoroughly studied. (Comparative Study)
Comparative Study
BACKGROUND
Low-grade gliomas (LGG) are thought to be very rare in elderly patients (>60 years) and have not been thoroughly studied.
METHODS
A series of 62 elderly (>or=60 years of age) LGG patients were identified in a department database collecting information on pathologically identified adult supratentorial LGG. The clinical, radiologic, pathologic, and therapeutic data of these patients were analyzed and compared to those of 704 younger LGG patients (<60 years).
RESULTS
Comparisons between older and younger groups showed that elderly patients more often presented with a clinical deficit (p < 0.0001), a lower Karnofsky performance status (p = 0.0002), a larger tumor on MRI (p = 0.03), and a lower rate of tumor resection (p < 0.0001). Chemotherapy was more often used as first line treatment (p = 0.001). Among the patients who died of progressive disease, 55% of the elderly patients had not received radiotherapy compared to 11% in the younger group (p < 0.0001). Survival was shorter in older patients (p < 0.0001), with a 5-year survival rate of 40%. An astrocytic phenotype (p = 0.0097), increasing age (p = 0.0049), and a tumor crossing the midline (p = 0.028) were negative prognostic factors in the older group.
CONCLUSION
We found that 8% of low-grade gliomas (LGG) occur in older patients (>or=60 years of age). The clinical-radiologic picture of LGG in the elderly population differs from younger patients. Although long-term survival occurs, the course is generally more severe because elderly patients accumulate negative prognostic factors and because they are probably undertreated.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Disease-Free Survival; Drug Therapy; Female; Glioma; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Prognosis; Radiotherapy; Severity of Illness Index; Supratentorial Neoplasms; Survival Rate; Young Adult
PubMed: 19907009
DOI: 10.1212/WNL.0b013e3181c6781e