-
AJP Reports Jul 2020Cerebellar hemorrhage is rare in term newborns and is most often seen after traumatic birth. Lifelong sequelae include motor and cognitive impairment. We report the...
Cerebellar hemorrhage is rare in term newborns and is most often seen after traumatic birth. Lifelong sequelae include motor and cognitive impairment. We report the uncommon case of a late preterm infant born by spontaneous delivery who showed right peripheral facial palsy at 24 hours of life. Cranial ultrasound showed lateral ventricles dilatation and a diffuse hyperechoic round lesion in the right cerebellar hemisphere. The computed tomography scan confirmed a hemorrhagic lesion in the right cerebellar hemisphere and in the vermis with midline shift and intraventricular bleeding. Ommaya reservoir was inserted and used for a few days. The facial palsy gradually recovered to a complete remission after 6 weeks. Follow-up examinations at 12 and 18 months evidenced infant's delayed motor function, hyperreflexia, tremors, and speech delay.
PubMed: 33094015
DOI: 10.1055/s-0040-1715162 -
No Shinkei Geka. Neurological Surgery Oct 2020Intracranial teratoma is a rare disease that frequently occurs in children and young adults. It comprises of approximately 0.1% of the brain tumors. We report a case of...
Intracranial teratoma is a rare disease that frequently occurs in children and young adults. It comprises of approximately 0.1% of the brain tumors. We report a case of a large mature teratoma in the third ventricle with Holmes tremor. A 5-year-old boy presented with tremors 2 years ago. CT showed a 56×48 mm tumor in the third ventricle and hydrocephalus. The tumor was well demarcated from the surrounding brain tissue and contained calcification. MRI indicated a partially high-intensity signal on T1-weighted and T2-weighted images. The preoperative diagnosis was teratoma. Initially, the tumor was biopsied using neuroendoscopy and the Ommaya reservoir was set. The pathological results showed fat-like tissues and fibroblasts. Subsequently, the tumor was completely removed using the interhemispheric transcallosal transchoroidal approach. The tumor included fat and hair tissues. It also included calcification similar to that observed in a tooth. It was strongly adhered near the pineal gland. Pathologically, the diagnosis was a mature teratoma. Postoperatively, the tremor disappeared and the patient was discharged from the hospital without neurological deficits. We believe that compression of the Guillain-Mollaret triangle was relieved by removal of the tumor. Hence, the tremor disappeared after the operation.
Topics: Child; Child, Preschool; Dermoid Cyst; Humans; Magnetic Resonance Imaging; Male; Teratoma; Third Ventricle; Tremor; Young Adult
PubMed: 33071229
DOI: 10.11477/mf.1436204298 -
Journal of Neurology Feb 2021To evaluate the effect of intrathecally (IT) delivered rituximab as a therapeutic intervention for progressive multiple sclerosis (PMS) during a 3-year follow-up period. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the effect of intrathecally (IT) delivered rituximab as a therapeutic intervention for progressive multiple sclerosis (PMS) during a 3-year follow-up period.
METHODS
Participants of a 1-year open-label phase 1b study of IT delivered rituximab to patients with PMS were offered extended treatment with follow-up for an additional 2 years. During the extension phase, treatment with 25 mg rituximab was administered every 6 months via a subcutaneous Ommaya reservoir connected to the right frontal horn with a ventricular catheter.
RESULTS
Mild to moderate vertigo and nausea occurred in 4 out of 14 participants as temporary adverse events associated with IT rituximab infusion. During the entire 3-year period, two cases of low-virulent bacterial meningitis occurred, which were successfully treated. Walking speed deteriorated significantly during the study.
CONCLUSIONS
IT administration of rituximab via a ventricular catheter was well tolerated. Considering the meningitis cases, the risk of infection was not negligible. The continued loss of walking speed indicates that IT rituximab was not able to stop disease progression.
CLASSIFICATION OF EVIDENCE
This study provides class IV evidence that intraventricularly administered rituximab in progressive MS is associated with a risk for bacterial meningitis and does not halt disease progression.
EU CLINICAL TRIAL REGISTER
EudraCT; 2008-002626-11 and 2012-000721-53.
Topics: Disease Progression; Humans; Immunologic Factors; Multiple Sclerosis, Chronic Progressive; Rituximab
PubMed: 32901316
DOI: 10.1007/s00415-020-10210-0 -
The Journal of Craniofacial SurgerySpread of cerebral spinal fluid (CSF) into the brain parenchyma is a very rare complication of Ommaya reservoir placement and can take form of CSF edema or an...
Spread of cerebral spinal fluid (CSF) into the brain parenchyma is a very rare complication of Ommaya reservoir placement and can take form of CSF edema or an intraparenchymal pericatheter cyst. Herein, we described an extremely rare case of a progressive enlarging intraparenchymal pericatheter cyst and CSF edema in a patient with cerebral cysticercosis following Ommaya reservoir placement. A heightened index of suspicion of this rare complication is required to prevent misdiagnosis as a tumor or brain abscess that may lead to unnecessary surgical explorations.
Topics: Cysts; Edema; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 32833842
DOI: 10.1097/SCS.0000000000006869 -
Child's Nervous System : ChNS :... May 2021Labrune syndrome (LS) is a rare white matter disease characterized by leukoencephalopathy with intracranial calcification and cysts (LCC). While the intracranial cyst... (Review)
Review
PURPOSE
Labrune syndrome (LS) is a rare white matter disease characterized by leukoencephalopathy with intracranial calcification and cysts (LCC). While the intracranial cyst characteristics of LS are for the most part stable, some may require surgical intervention when they develop associated hemorrhage and/or mass effect. To date, no review of the surgical outcomes of cyst decompression in LS has been performed.
CASE PRESENTATION
We report the case of a 16-year-old girl with LS who presented with progressive right hemiparesis from an enlarging hemorrhagic left thalamic cyst. The patient underwent frameless stereotactic cyst aspiration and Ommaya reservoir placement and her hemiparesis subsequently improved. Serial monitoring demonstrated stable decompression of the cyst.
CONCLUSIONS
The pathophysiology of LS is thought to be diffuse cerebral microangiopathy and it is thought that these microhemorrhages contribute to the formation of intracranial cysts as well as diffuse calcifications. Indications for surgical intervention in LS are not well established and the heterogeneity of lesions compels them to be managed on a case-by-case basis. Based on our literature review, surgery is the standard treatment of choice for patients with progressive symptoms and growing lesions on imaging studies, with outcomes favoring less-invasive stereotactic approaches with contingencies of reservoir placement when cysts recur.
Topics: Adolescent; Calcinosis; Central Nervous System Cysts; Female; Humans; Leukoencephalopathies; Magnetic Resonance Imaging; Neoplasm Recurrence, Local
PubMed: 32789548
DOI: 10.1007/s00381-020-04861-7 -
Child's Nervous System : ChNS :... Feb 2021To report our experience and management strategies during 10 years for 137 childhood craniopharyngiomas treated at a single institution.
PURPOSE
To report our experience and management strategies during 10 years for 137 childhood craniopharyngiomas treated at a single institution.
METHODS
Medical records of children with craniopharyngioma treated at Children's Cancer Hospital Egypt (CCHE-57357) from July 2007 to December 2017 were retrospectively reviewed. Beta-catenin as an immunohistochemical marker was assessed also in available specimens.
RESULTS
Our registry included 137 patients. Headache (n = 122), visual failure (n = 118), and hypothyroidism(n = 78) were the most common findings on presentation. Three management protocols were identified; 65 patients were primarily followed up after surgery, 71 patients had radiotherapy after surgery, and one patient underwent surgery for Ommaya insertion with intracystic interferon injection. Overall, gross total resection/near total resection was achieved in 48 cases (35.04%), subtotal resection was achieved in 58 patients (42.33%), 29 (21.16%) had biopsy and Ommaya reservoir, and two patients with calcified lesions had no operations. Fifty-four patients showed recurrence/progression of their lesions. Allover, 5-year progression-free survival (PFS) was 52.3%, while it was 34.49% and 72.25% for the follow-up group and the radiotherapy group, respectively. Beta-catenin mutations were positive in 61/95 patients; 5-year PFS for beta-catenin negative and positive cases was 65.5% and 39.4% respectively (p = 0.087). Mortality was reported in eight patients. Intraoperative endoscopy-assisted assessment was the cornerstone of tailored decision-making.
CONCLUSION
The concepts of conservative surgery and multimodal management should be applied to reach the perfect balance between the quality of life and the best tumor control rates. Beta-catenin mutations more than 5% are associated with statistically trending aggressive clinical behavior. The CCHE-57357 algorithm of individualized management protocol was presented.
Topics: Child; Craniopharyngioma; Egypt; Humans; Neoplasm Recurrence, Local; Pituitary Neoplasms; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 32712862
DOI: 10.1007/s00381-020-04833-x -
Journal of Biomedical Research Aug 2019Intraventricular metastases are a rare occurrence, particularly from a primary colorectal malignancy. To our knowledge, this is the first report of intraventricular...
Intraventricular metastases are a rare occurrence, particularly from a primary colorectal malignancy. To our knowledge, this is the first report of intraventricular metastasis from rectal cancer. A 72-year-old male presented with a new diagnosis of multiple intraventricular lesions, an anterior mediastinal mass and a rectal mass. His workup revealed rectal adenocarcinoma with intraventricular metastases and an incidental thymoma. Ommaya reservoir placement was performed an awake procedure rather than under general anesthesia due to airway concerns. Cerebrospinal fluid (CSF) cytology was positive for malignancy and consistent with adenocarcinoma. Two weeks postoperatively, the patient underwent whole brain radiation. Although rare, this diagnosis should always be considered in the differential for solitary or multiple intraventricular lesions. CSF sampling is a useful alternative to intraventricular biopsy for diagnosis of intraventricular metastases. Awake placement of Ommaya reservoir is a safe option in the management of patients with intraventricular metastases, especially those who cannot undergo general anesthesia.
PubMed: 32701070
DOI: 10.7555/JBR.33.20180133 -
British Journal of Neurosurgery Apr 2021To investigate whether the Ommaya reservoir can be used to treat multiple drug-resistant Acinetobacter baumannii (MDR-AB) infections in the central nervous system (CNS).
AIM
To investigate whether the Ommaya reservoir can be used to treat multiple drug-resistant Acinetobacter baumannii (MDR-AB) infections in the central nervous system (CNS).
METHODS
Retrospectively analyzed the clinical records and data of 15 MDR-AB CNS infection patients who were treated in our neuro-ICU. Four patients with MDR-AB CNS infection were involved in this study.
RESULTS
We report the successful treatment of MDR-AB CNS infection by Ommaya reservoirs and intraventricular antibiotic (IVA) administration. Ommaya reservoirs allow serial CSF sampling and IVA injection. Furthermore, debridement can be performed during the operation to insert the Ommaya.
CONCLUSION
Ommaya reservoirs can be used as an effective treatment approach of MDR-AB or other multidrug-resistant Gram-negative bacteria CNS infections.
Topics: Acinetobacter Infections; Acinetobacter baumannii; Anti-Bacterial Agents; Central Nervous System Infections; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Retrospective Studies
PubMed: 32657168
DOI: 10.1080/02688697.2020.1777255 -
Annals of Palliative Medicine Jul 2020Leptomeningeal metastasis (LM) is one of the most severe complications of non-small cell lung cancer (NSCLC), and it lacks standard treatment guidelines and is always...
Treatment response to intrathecal chemotherapy with pemetrexed via an Ommaya reservoir in EGFR-mutated leptomeningeal metastases from non-small cell lung cancer: a case report.
Leptomeningeal metastasis (LM) is one of the most severe complications of non-small cell lung cancer (NSCLC), and it lacks standard treatment guidelines and is always accompanied by poor prognosis. We report a patient who was definitively diagnosed as LM from NSCLC with a targeted mutation of epidermal growth factor receptor (EGFR) via magnetic resonance imaging (MRI) and positive cerebrospinal fluid (CSF) cytology. Tyrosine kinase inhibitors (TKIs) were implemented but ineffective. Then the patient received the installation of an intraventricular Ommaya reservoir. Thirty mg of pemetrexed and other adjuvant treatments were implemented on days 1 and 8 every 3 weeks via the Ommaya reservoir. This treatment regimen resulted in the alleviation of the neurological symptoms, the clearing of CSF cytology and a reduced lesion of LM without notable side effects. At recent follow-ups, MRI examinations revealed the sustained stable LM lesion. We report the first successful example of administering intrathecal chemotherapy with pemetrexed via an Ommaya reservoir, providing a new therapeutic approach against LM from NSCLC.
Topics: Carcinoma, Non-Small-Cell Lung; ErbB Receptors; Humans; Lung Neoplasms; Meningeal Carcinomatosis; Pemetrexed
PubMed: 32648459
DOI: 10.21037/apm-19-521 -
Neuro-oncology Advances 2019Glioblastoma (GBM) is the most common primary brain neoplasm with median overall survival (OS) around 15 months. There is a dearth of effective monitoring strategies for... (Review)
Review
Glioblastoma (GBM) is the most common primary brain neoplasm with median overall survival (OS) around 15 months. There is a dearth of effective monitoring strategies for patients with high-grade gliomas. Relying on magnetic resonance images of brain has its challenges, and repeated brain biopsies add significant morbidity. Hence, it is imperative to establish a less invasive way to diagnose, monitor, and guide management of patients with high-grade gliomas. Currently, multiple biomarkers are in various phases of development and include tissue, serum, cerebrospinal fluid (CSF), and imaging biomarkers. Here we review and summarize the potential biomarkers found in blood and CSF, including extracellular macromolecules, extracellular vesicles, circulating tumor cells, immune cells, endothelial cells, and endothelial progenitor cells. The ability to detect tumor-specific biomarkers in blood and CSF will potentially not only reduce the need for repeated brain biopsies but also provide valuable information about the heterogeneity of tumor, response to current treatment, and identify disease resistance. This review also details the status and potential scope of brain tumor-related cranial devices and implants including Ommaya reservoir, microelectromechanical systems-based depot device, Alzet mini-osmotic pump, Metronomic Biofeedback Pump (MBP), ipsum G1 implant, ultra-thin needle implant, and putative devices. An ideal smart cranial implant will overcome the blood-brain barrier, deliver various drugs, provide access to brain tissue, and potentially measure and monitor levels of various biomarkers.
PubMed: 32642651
DOI: 10.1093/noajnl/vdz013