A variety of neoplasms can develop in each tetal organ. Most fetal neoplasms can be detected by careful prenatal ultrasonographic examination. Some neoplosms show specific ultrasonographic findings suggesting the differential diagnosis, but others do not. Knowledge of the presence of a neoplasm in the fetus may alter the prenatal management of a pregnancy and the mode of delivery, and facilitates immediate postnatal treatment. During the last five years, we experienced 32 cases of fetal neoplasms in a variety of organs. We describe their typical ultrasonographic findings with correlating postnatal CT, MRI, and pathologic findings.
Brain Neoplasms/ultrasonography ; Female ; Fetal Diseases/*ultrasonography ; Human ; Lymphangioma/ultrasonography ; Lymphangioma, Cystic/ultrasonography ; Neoplasms/*ultrasonography ; Pregnancy ; Teratoma/ultrasonography ; *Ultrasonography, Prenatal

We report a case of fetal pericallosal lipoma occurring at the anterior interhemispheric fissure and associated with agenesis of the corpus callosum. During targeted prenatal ultrasonography at 26 weeks' gestation, the lesion was seen as a highly echogenic mass. MR imaging performed at 35 weeks' gestation and during the postnatal period revealed a pericallosal fatty mass and agenesis of the corpus callosum.
Adult ; Brain Neoplasms/*diagnosis/ultrasonography ; Corpus Callosum/*abnormalities ; Female ; Fetal Diseases/*diagnosis/ultrasonography ; Gestational Age ; Human ; Infant, Newborn ; Lipoma/*diagnosis/ultrasonography ; *Magnetic Resonance Imaging ; Pregnancy ; *Ultrasonography, Prenatal

OBJECTIVE: We wanted to evaluate the clinical value of intraoperative ultrasonography for real-time guidance when performing microneurosurgical resection of small subcortical lesions. MATERIALS AND METHODS: Fifty-two patients with small subcortical lesions were involved in this study. The pathological diagnoses were cavernous hemangioma in 25 cases, cerebral glioma in eight cases, abscess in eight cases, small inflammatory lesion in five cases, brain parasite infection in four cases and the presence of an intracranial foreign body in two cases. An ultrasonic probe was sterilized and lightly placed on the surface of the brain during the operation. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation. RESULTS: All the lesions were located in the cortex and their mean size was 1.3 +/- 0.2 cm. Intraoperative ultrasonography accurately located all the small subcortical lesions, and so the neurosurgeon could provide appropriate treatment. Different lesion pathologies presented with different ultrasonic appearances. Cavernous hemangioma exhibited irregular shapes with distinct margins and it was mildly hyperechoic or hyperechoic. The majority of the cerebral gliomas displayed irregular shapes with indistinct margins, and they often showed cystic and solid mixed echoes. Postoperative imaging identified that the lesions had completely disappeared, and the original symptoms of all the patients were significantly alleviated. CONCLUSION: Intraoperative ultrasonography can help accurately locate small subcortical lesions and it is helpful for selecting the proper approach and guiding thorough resection of these lesions.
Adolescent ; Adult ; Aged ; Brain Diseases/*surgery/ultrasonography ; Brain Neoplasms/surgery/ultrasonography ; Female ; Glioma/surgery/ultrasonography ; Hemangioma, Cavernous, Central Nervous System/surgery/ultrasonography ; Humans ; Male ; *Microsurgery ; Middle Aged ; *Ultrasonography, Interventional ; Young Adult

BACKGROUNDThe goal of surgery in the treatment of intrinsic cerebral tumors is to resect the maximum tumor volume, and to spare the eloquent areas. However, it is difficult to discover the eloquent areas intraoperatively due to individual anatomo-functional variability both for sensori-motor and language functions. Consequently, the surgery of intrinsic cerebral tumors frequently results in poor extent of resection or permanent postoperative deficits, or both, and remains a difficult problem for neurosurgeons.

METHODSFrom January 2003 to January 2010, 112 patients with neuroepithelial tumors in/close to the eloquent areas were operated on under awake anesthesia with the intraoperative direct electrical stimulation for functional mapping of the eloquent areas. The extent of the tumors was verified by intraoperative ultrasonography. The maximal resection of the tumors and minimal damage of the eloquent areas were the surgical goal of all patients.

RESULTSTotally 356 cortical sites in 99 patients were detected for motor response by intraoperative direct electrical stimulation, 50 sites in 16 patients for sensory, 72 sites in 48 patients for language. Sixty-six patients (58.9%) achieved total resection, 34 (30.4%) subtotal and 12 (10.7%) partial. Fifty-eight patients (51.8%) had no postoperative deficit, while 37 patients (33.0%) had transitory postoperative paralysis, 26 patients (23.2%) with transitory postoperative language disturbance and 3 patients (2.7%) with permanent neurological deficits. No patient complained of pain recollection following operation.

CONCLUSIONSAwake anesthesia, intraoperative direct electrical stimulation and ultrasonography are three core techniques for the resection of intrinsic cerebral tumors near the eloquent areas. This new concept allows an improvement in the quality of surgery for neuroepithelial tumors in/adjacent to eloquent areas.

Adolescent ; Adult ; Aged ; Anesthesia ; methods ; Brain Mapping ; methods ; Brain Neoplasms ; diagnostic imaging ; surgery ; Deep Brain Stimulation ; methods ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Neuroepithelial ; diagnostic imaging ; surgery ; Ultrasonography

Desmoplastic cerebral glioblastoma has been described recently and is a very rare histologic variant of glioblastoma. We report a case of congenital cerebral glioblastoma associated with intense desmoplastic stromal reaction. A male infant was born at 36 gestational weeks by Cesarian section. He had a brain tumor, which was detected by fetal ultrasonography. The tumor was partially resected 2 months after the day of the boy's birth and totally resected when he was one year old. The microscopic features of the tumor were those of glioblastoma, including high cellularity, frequent mitotic figures, vascular endothelial proliferation, and geographic palisading necrosis. The tumor showed an area of intense desmoplasia where tumor cells were surrounded by dense reticulin fibers. The desmoplastic cerebral tumors in children may be a distinct group of brain tumor, and it is important to understand the entity of these tumors which generally seem to be associated with more favorable prognosis compared to other high grade brain tumors.
Brain Neoplasms ; Child ; Glioblastoma* ; Humans ; Infant ; Male ; Necrosis ; Parturition ; Prognosis ; Reticulin ; Ultrasonography, Prenatal

Perinatal cardiac tumors are rare and the vast majority are histologically benign. Clinical manifestations depend on their size and location. Most of them are clinically unimportant but an arrhythmia or a cardiac failure may present as a feature of obstruction of the outflow tract. Cardiac rhabdomyoma is the most common type of the cardiac tumor and associated with the tuberous sclerosis, and may be the only sign of the tuberous sclerosis, especially, in fetus. We report a case of a cardiac tumor detected during routine prenatal ultrasonographic evaluation, which demonstrated features of rhabdomyoma. After birth, the newborn was diagnosed as tuberous sclerosis with brain MRI scanning.
Arrhythmias, Cardiac ; Brain ; Fetus ; Heart Failure ; Heart Neoplasms* ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Parturition ; Rhabdomyoma ; Tuberous Sclerosis ; Ultrasonography*

The concept of focused ultrasound (FUS) and its application in the field of medicine have been suggested since the mid-20th century. However, the clinical applications of this technique in central nervous system (CNS) diseases have been extremely limited because the skull inhibits efficient energy transmission. Therefore, early application of FUS treatment was only performed in patients who had already undergone invasive procedures including craniectomy and burr hole trephination. In the 1990s, the phased array technique was developed and this enabled the focus of ultrasonic energy through the skull, and in conjunction with another technique, magnetic resonance thermal monitoring, the possibility of applying FUS in the CNS was further strengthened. The first clinical trial using FUS treatment for CNS diseases was performed in the early 21(st) century in patients with glioblastoma, which consists of highly malignant primary brain tumors. However, this trial resulted in a failure to make lesions in the tumors. Various causes were suggested for this outcome including different acoustic impedances across heterogeneous intracranial tissue (not only brain tissue, but also fibrous or tumor tissue). To avoid the influence of this factor, the targets for FUS treatment were shifted to functional diseases such as essential tremor, Parkinson's disease, and psychiatric disease, which usually occur in normal brain structures. The first trial for functional diseases was started in 2010, and the results were successful as accurate lesions were made in the target area. Nowadays, the indication of FUS treatment for functional CNS diseases is gradually widening, and many trials using the FUS technique are reporting good results. In addition to the lesioning technique using high intensity FUS treatment, the possibility of clinical application of low intensity FUS to CNS disease treatment has been investigated at a preclinical level, and it is expected that FUS treatment will become one of the most important novel techniques for the treatment of CNS diseases in the near future.
Acoustics ; Brain ; Brain Neoplasms ; Central Nervous System Diseases ; Central Nervous System* ; Essential Tremor ; Glioblastoma ; Humans ; Parkinson Disease ; Skull ; Trephining ; Ultrasonics ; Ultrasonography*

Tuberous sclerosis(TS), a type of neurocutaneous syndrome, is inherited in an autosomal dominant manner. Approximately 60% of children with TS have rhabdomyomas of the heart, and 40% of fetuses in whom rhabdomyomas are detected by a prenatal ultrasonography eventually end up with TS. Therefore, when multiple cardiac rhabdomyomas are detected by a fetal ultrasonography, TS should be suspected and further examination should be considered after birth. Infantile spasms is a common type of seizure among young children with TS. We describe a patient with TS who showed cardiac tumors on a fetal ultrasound. Also, hypomelanotic macules, retinal tumors, brain cortical tubers, nodules in subependymal regions, and infantile spasms was detected after birth.
Brain ; Child ; Fetus ; Heart ; Heart Neoplasms ; Humans ; Infant ; Infant, Newborn ; Neurocutaneous Syndromes ; Parturition ; Retinal Neoplasms ; Rhabdomyoma ; Seizures ; Spasms, Infantile ; Tuberous Sclerosis ; Ultrasonography, Prenatal

Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging new technology with considerable potential to treat various neurological diseases. With refinement of ultrasound transducer technology and integration with magnetic resonance imaging guidance, transcranial sonication of precise cerebral targets has become a therapeutic option. Intensity is a key determinant of ultrasound effects. High-intensity focused ultrasound can produce targeted lesions via thermal ablation of tissue. MRgFUS-mediated stereotactic ablation is non-invasive, incision-free, and confers immediate therapeutic effects. Since the US Food and Drug Administration approval of MRgFUS in 2016 for unilateral thalamotomy in medication-refractory essential tremor, studies on novel indications such as Parkinson's disease, psychiatric disease, and brain tumors are underway. MRgFUS is also used in the context of blood-brain barrier (BBB) opening at low intensities, in combination with intravenously-administered microbubbles. Preclinical studies show that MRgFUS-mediated BBB opening safely enhances the delivery of targeted chemotherapeutic agents to the brain and improves tumor control as well as survival. In addition, BBB opening has been shown to activate the innate immune system in animal models of Alzheimer’s disease. Amyloid plaque clearance and promotion of neurogenesis in these studies suggest that MRgFUS-mediated BBB opening may be a new paradigm for neurodegenerative disease treatment in the future. Here, we review the current status of preclinical and clinical trials of MRgFUS-mediated thermal ablation and BBB opening, described their mechanisms of action, and discuss future prospects.
Alzheimer Disease ; Blood-Brain Barrier ; Brain ; Brain Neoplasms ; Essential Tremor ; High-Intensity Focused Ultrasound Ablation ; Immune System ; Magnetic Resonance Imaging ; Microbubbles ; Models, Animal ; Neurodegenerative Diseases ; Neurogenesis ; Parkinson Disease ; Plaque, Amyloid ; Sonication ; Therapeutic Uses ; Transducers ; Ultrasonography ; United States Food and Drug Administration

The incidence of acute urinary retention in females is very low but the causes are diverse. So, it is important to verify the causative diseases trough history taking, physical examination including neurologic tests and it is essential to find adequate therapeutic modalities. MATERIALS AND METHODS: We experienced 45 female patients who visited under the chief complaint of acute urinary retention and reviewed, evaluated retrospectively or prospectively during 4 years. The patients are divided 1) transient causes: immobilization after surgery, constipation, medications, herpes zoster, psychogenic causes 2) neurologic causes: cerebral concussion, peripheral neuropathy, brain tumor, herniated nucleus pulposus, spinal cord injury, previously undiagnosed diabetes 3) pelvic causes: difficult labor, uterine prolapse,, pelvic bone tumor, vaginal invasion of rectal cancer, imperforate hymen. RESULTS: Screening test were done through physical examination, history taking, routine urinalysis. Most patients recovered voiding after correction of underlying diseases. CONCLUSIONS: The patients who showed persistent retention were further evaluated through neurologic tests, urodynamics, pelvic ultrasonography and serious diseases as blain tumor, polyneuritis, metastaic pelvic bone tumor were diagnosed.
Brain Concussion ; Brain Neoplasms ; Constipation ; Female* ; Herpes Zoster ; Humans ; Hymen ; Immobilization ; Incidence ; Mass Screening ; Neuritis ; Pelvic Bones ; Peripheral Nervous System Diseases ; Physical Examination ; Prospective Studies ; Rectal Neoplasms ; Retrospective Studies ; Spinal Cord Injuries ; Ultrasonography ; Urinalysis ; Urinary Retention* ; Urodynamics ; Uterine Prolapse