Background: Meningiomas are the most common intracranial tumours; they accountfor 13%–26% of all the primary intracranial tumours. Skull base meningiomas make up 25% of allmeningiomas and are one of the most difficult intracranial tumours to be managed surgically. Thisis due to the fact that it is difficult to approach the lesions which are also close to vital structuressuch as cranial nerves and major blood vessels. Despite the abundance of these cases in Malaysia,local data on meningiomas is scarce.Methods: This is a retrospective study consisting of 199 patients with meningiomaswho have been operated at the Kuala Lumpur General Hospital from January 2010–December2014. They were categorised into skull base and non-skull base groups. Demography, tumourcharacteristics, and patient outcomes were analysed. Kaplan-Meier survival curves as well asCox hazard univariable and multivariable regressions for the possible predictors of survival wereanalysed.Results: 97.5% of the patients (n = 194) had WHO grade I meningioma and only fivepatients had WHO grade II meningioma. There was a female predominance (n = 134; 67.3%), witha male-to-female ratio of 1:2. Some 27.1 % patients had skull base meningiomas. Patients with skullbase meningiomas had poorer outcomes and discharge conditions (n = 23; 42.6% P < 0.01), inaddition to higher risk of incomplete resections (n = 34; 63% P < 0.01). Multivariate cox hazardregressions showed that the skull base meningioma group had four times the risk of death of thenon-skull base group.Conclusions: Symptomatic meningiomas can be curative if the tumour is completelyremoved. Our study has revealed that skull base meningiomas which were operated locallyhad higher rates of incomplete resection and poorer surgical outcomes as compared to the nonskullbase group. Patients with skull base meningiomas had four times the risk of death vis-à-visnon-skull base ones. More local studies are needed to look into skull base meningiomas for theimprovement of its surgical outcomes.

This report describes a 26-year-old man of Takayasu's arteritis complicated with acute myocardial infarction due to the occlusion of proximal left anterior descending artery and renovascular hypertension which was improved spontaneously without obstruction of stenotic renal artery. Coronary artery involvement and myocardial ischemic symptom in Takayasu's arteritis is uncommon and only about 10 case of acute myocardial infarction were reported. But most cases were diagnosed by autopsy after death. In this case, acute myocardial infarction developed during follow up after diagnosis of Takayasu's aortitis and coronary artery involvement was confirmed by coronary angingraphy. Hypertension is found in 40-70% of the cases. In our case hypertension was complicated and thought to be renovascular origin. It was refractory to medication including captopril. During follow up blood pressure was normalized spontaneously after wide fluctuations for 3 times. Now he is normotensive without medication. It is thought to give a new insight to the mechanism and treatment of renovascular hypertension.
Adult ; Aortitis ; Arteries ; Autopsy ; Blood Pressure ; Captopril ; Coronary Vessels ; Diagnosis ; Follow-Up Studies ; Humans ; Hypertension ; Hypertension, Renovascular* ; Myocardial Infarction* ; Renal Artery ; Takayasu Arteritis*

The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness. Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good long-term outcome.

INTRODUCTION: In Europe and North America, the majority of children with high-risk neuroblastoma survive the disease. Elsewhere, the treatment outcomes are poor. METHODS: A retrospective review of children treated for high-risk neuroblastoma in a single institution in Singapore from 2007 to 2019 was carried out. Treatment consisted of intensive chemotherapy, surgery aimed at gross total resection of residual disease after chemotherapy, consolidation with high-dose therapy followed by autologous stem cell rescue, and radiotherapy to the primary and metastatic sites followed by maintenance treatment with either cis-retinoic acid or anti-disialoganglioside monoclonal antibody therapy. Survival data were examined on certain clinical and laboratory factors. RESULTS: There were 57 children (32 male) treated for high-risk neuroblastoma. Their mean age was 3.9 (range 0.7-14.9) years. The median follow-up time was 5.5 (range 1.8-13.0) years for the surviving patients. There were 31 survivors, with 27 patients surviving in first remission, and the five-year overall survival and event-free survival rates were 52.5% and 47.4%, respectively. On log-rank testing, only the group of 17 patients who were exclusively treated at our centre had a survival advantage. Their five-year overall survival rate compared to patients whose initial chemotherapy was done elsewhere was 81.6% versus 41.1% (P = 0.011), and that of event-free survival was 69.7% versus 36.1% (P = 0.032). Published treatment results were obtained from four countries in Southeast Asia with five-year overall survival rates from 13.5% to 28.2%. CONCLUSION Intensified medical and surgical treatment for high-risk neuroblastoma proved to be effective, with superior survival rates compared to previous data from Southeast Asia.
Child ; Humans ; Male ; Infant ; Child, Preschool ; Adolescent ; Disease-Free Survival ; Neuroblastoma/pathology* ; Hematopoietic Stem Cell Transplantation/methods* ; Treatment Outcome ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Asia, Southeastern/epidemiology* ; Combined Modality Therapy