A 34-year-old man who previously underwent a craniotomy due to oligodendroglioma was admitted with a diagnosis of recurrent brain tumor. An awake craniotomy was planned. Approximately 15 minutes after completing the scalp nerve block, his upper torso suddenly moved and trembled for 10 seconds, suggesting a generalized clonic seizure. He recovered gradually and fully in 55 minutes without any neurological sequelae. The emergency computed tomography scan revealed a localized fluid collection and small intracerebral hemorrhage nearby in the temporoparietal cortex beneath the skull defect. He underwent surgery under general anesthesia at 8 hours after the seizure and was discharged from the hospital after 10 days. This report documents the first case of generalized seizure that was caused by the accidental intracerebral injection of local anesthetics. Although the patient recovered completely, the clinical implications regarding the scalp infiltration technique in a patient with skull defects are discussed.
Adult ; Anesthesia, General ; Anesthetics, Local ; Brain Neoplasms ; Cerebral Hemorrhage ; Craniotomy* ; Diagnosis ; Emergencies ; Humans ; Nerve Block* ; Oligodendroglioma ; Scalp* ; Seizures* ; Skull ; Torso

Cranial Fossa, Posterior ; Cranial Nerve Neoplasms ; diagnosis ; pathology ; Ganglioneuroma ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Skull Base Neoplasms ; diagnosis ; pathology ; Trigeminal Ganglion

We report a case of breast cancer with osteolytic skull lesions which mimicked osteolytic lesions in multiple myeloma. A 60-year-old female was admitted to our hospital due to confused mentality. Laboratory tests showed the findings of an increased calcium level, kidney failure, and anemia. Multiple osteolytic lesions were detected in the ribs, spine, humerus, and pelvis on X-rays. The skull showed the punched out sign. Accordingly we initially suspected multiple myeloma; however, monoclonal protein was not detected in serum and urine and the number of plasma cells was not increased in bone marrow examination. In bone marrow examination, metastatic cancer was detected and biopsy revealed breast cancer. Finally, breast cancer with multiple metastases including those to bone, liver, and lung was diagnosed. Therefore, when a patient presents with multiple osteolytic lesions, we need to consider metastasis from solid cancer in the differential diagnosis as well as multiple myeloma.
Anemia ; Biopsy ; Bone Marrow Examination ; Bone Neoplasms ; Breast Neoplasms ; Breast ; Calcium ; Diagnosis, Differential ; Female ; Humans ; Humerus ; Liver ; Lung ; Middle Aged ; Multiple Myeloma ; Neoplasm Metastasis ; Osteolysis ; Pelvis ; Plasma Cells ; Renal Insufficiency ; Ribs ; Skull ; Spine

BACKGROUNDVarious surgical approaches for the removal of sellar region lesions have previously been described. This study aimed to evaluate the reliability and safety of the frontolateral approach (FLA) to remove sellar region lesions.

METHODSWe presented a retrospective study of 79 patients with sellar region lesions who were admitted and operated by the FLA approach from August 2011 to August 2015 in Department of Neurosurgery of Beijing Tian Tan Hospital. We classified FLA into three types, compared the FLA types to the areas of lesion invasion, and analyzed operation bleeding volume, gross total resection (GTR) rate, visual outcome, and mortality.

RESULTSSeventy-nine patients were followed up from 2.9 to 50.3 months with a mean follow-up of 20.5 months. There were 42 cases of meningiomas, 25 cases of craniopharyngiomas, and 12 cases of pituitary adenomas. The mean follow-up Karnofsky Performance Scale was 90.4. GTR was achieved in 75 patients (94.9%). Two patients (2.5%) had tumor recurrence. No patients died perioperatively or during short-term follow-up. Three patients (3.8%) with craniopharyngioma died 10, 12, and 23 months, respectively, after surgery. The operative bleeding volume of this study was no more than that of the other approaches in the sellar region (P = 0.783). In this study, 35 patients (44.3%) had visual improvement after surgery, 38 patients (48.1%) remained unchanged, and three patients' visual outcome (3.8%) worsened.

CONCLUSIONSFLA was an effective approach in the treatment of sellar region lesions with good preservation of visual function. FLA classification enabled tailored craniotomies for each patient according to the anatomic site of tumor invasion. This study found that FLA had similar outcomes to other surgical approaches of sellar region lesions.

Adult ; Craniopharyngioma ; diagnosis ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma ; diagnosis ; surgery ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; surgery ; Retrospective Studies ; Skull Base ; pathology

To date, there are still very few reports on benign-tumor cases based on East Asian skeletal series, even though other regions and continents have been well represented. In our study on the Joseon Human Skeletal Series, we identified benign bone tumors in two skeletons (cases Nos. 75 and 96). Our radiological analyses showed both cases to be homogeneous sclerotic bone masses aligned with the cranial vault suture. In a subsequent series of differential diagnoses, we determined both cases to be osteoma, the most common bone-tumor type reported for archaeological samples. Our study is the osteoarchaeological basis for this, the first-ever report on benign bone neoplasm in a pre-modern East Asian population.
Asian Continental Ancestry Group ; Bone Neoplasms ; Diagnosis, Differential ; Humans* ; Korea ; Osteoma ; Paleopathology ; Skeleton ; Skull* ; Sutures

Endoscopy ; Humans ; Myosarcoma ; diagnosis ; surgery ; Nasal Cavity ; Nose Neoplasms ; diagnosis ; surgery ; Paranasal Sinuses ; Skull Base ; Skull Base Neoplasms ; diagnosis ; surgery

OBJECTIVETo analyze the clinical features and treatment of skull base osteosarcoma.

METHODSThe clinical data of 18 patients with skull base osteosarcoma, who were admitted to the CAMS Cancer Hospital from January 2005 to November 2013, were retrospectively analyzed. The patients were followed up by telephone, outpatient review and other means. Fifteen patients were followed up, 4 cases received surgery only, and 11 cases received surgery with adjuvant chemotherapy and/or radiotherapy. Kaplan-Meier survival curve analysis was used to analyze the clinical data and Log rank method was used for verification.

RESULTSNine patients died among the 15 patients who were followed up for 3-103 months (mean 25.0 months): seven patients died of local recurrence, and two patients died of distant metastasis, and six patients were still alive. Four patients received surgery only, with a median survival time of 25.0 months, and 11 patients received comprehensive treatment, with a median survival time of 47.0 months (P = 0.02). Five patients received sub-total resection, with a mean survival time of 47.0 months, and 10 patients received total resection, with a mean survival time of 45.0 months (P = 0.37). The 1- and 2-year recurrence rates were 46.6% and 68.9%, respectively. The overall 1-, 2-, 3- and 5-year survival rates were 82.4%, 61.8%, 36.0% and 36.0%, respectively, with a median survival time of 30.0 months.

CONCLUSIONSTo compare the long bone and head and neck osteosarcoma with skull base osteosarcoma, the skull base osteosarcoma has a lower total resection rate, a higher recurrence rate, and a poorer prognosis. Radical surgery and comprehensive treatment are appropriate for skull base osteosarcoma.

Bone Neoplasms ; diagnosis ; pathology ; therapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Humans ; Kaplan-Meier Estimate ; Neoplasm Recurrence, Local ; Osteosarcoma ; diagnosis ; pathology ; therapy ; Retrospective Studies ; Skull Base ; pathology ; Survival Rate

OBJECTIVETo analyze the factors affecting prognosis of the carcinoma arising from nasal and sinonasal inverted papilloma.

METHODSThe clinicopathological data of sixty-two patients treated in our hospital from January 1974 to February 2012 were retrospectively analyzed. Of the 62 cases, 10 were at stage I or II, 24 at stage III, and 28 at stage IV. Twenty-six patients were treated with surgery alone, and 36 with surgery combined with radiation therapy. Kaplan-Meier method and log-rank test were used for the survival analysis.

RESULTSThe overall 5-years survival rate was 39.6%. The 5-years survival rate was 67.5% in the stage I or II patients,51.3% in the stage III patients, and 18.3% in the stage IV patients (P<0.05). The 5-years survival rate was 65.7% in patients who had no surgical history, and 29.9% in patients who had surgery (P<0.05). The 5-year survival rate was 17.6% in the group who relapsed after the treatment, and 49.6% in the non-relapsed patients (P<0.05). The 5-year survival rate was 23.4% in the patients who had involvement of cranial base and (or) orbit, and 47.6% in the patients whose cranial base and (or) orbit were clean (P<0.05). Of the patients at the same stage (III-IV), the 5-year survival rate of patients treated with surgery alone was 32.4%, and those treated with combination therapy was 36.2%(P=0.89). The univariate analysis showed that clinical stage, surgical history before malignization, involvement of the cranial base and (or) orbit organs, and post-operative relapse are significantly correlated to prognosis of the patients (P<0.05 for all). Multivariate analysis showed that age, clinical stage, and previous history of surgery were independent factors affecting the prognosis of the patients. Distant metastasis was the major cause of death, mostly lung metastases.

CONCLUSIONSAge, clinical stage and surgical history are the main factors affecting the prognosis of the patients. The history of recurrence and involvement of cranial base or orbit also play an important role for the prognosis. Distant metastasis is the main cause of death in the patients with carcinoma arising from nasal and sinonasal inverted papilloma.

Carcinoma ; diagnosis ; therapy ; Combined Modality Therapy ; Head and Neck Neoplasms ; Humans ; Lung Neoplasms ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; diagnosis ; therapy ; Papillomavirus Infections ; Prognosis ; Retrospective Studies ; Skull Base ; Survival Rate

Intracranial chondroma is a rare benign tumor. Here, we present the case of a 29-year-old female who was afflicted with left eye blindness and ptosis. Brain computerized tomography and magnetic resonance imaging revealed the presence of a giant calcified mass accompanied by a solid mass in the middle and posterior fossa. A differential diagnosis regarding chordoma, chondrosarcoma, and other chondroid tumors based on radiologic information was inconclusive. The lesion was resected completely under a microscope using a combined pterional and subtemporal approach. The pathologic report confirmed the diagnosis of chondroma. No evidence of neurological worsening was observed. The tumor had a calcified mass with mature hyaline cartilage surrounded by a thick fibrous capsule. We dissected the periphery of the tumor mass and removed it via aspiration. It was readily distinguished from normal brain parenchymal tissue. The large calcified mass at the center of the tumor had relatively high vascularity, and a high-speed drill and various rongeurs were used to remove the tumor.
Adult ; Blindness ; Brain ; Chondroma* ; Chondrosarcoma ; Chordoma ; Cranial Fossa, Posterior ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Hyaline Cartilage ; Magnetic Resonance Imaging ; Skull Base Neoplasms ; Skull Base*

An osteolytic lesion with a small central area of mineralization and sclerotic borders was discovered incidentally in the clivus on the cone-beam computed tomography (CBCT) of a 27-year-old male patient. This benign appearance indicated a primary differential diagnosis of non-aggressive lesions such as fibro-osseous lesions and arrested pneumatization. Further, on magnetic resonance imaging (MRI), the lesion showed a homogenously low T1 signal intensity with mild internal enhancement after post-gadolinium and a heterogeneous T2 signal intensity. These signal characteristics might be attributed to the fibrous tissues, chondroid matrix, calcific material, or cystic component of the lesion; thus, chondroblastoma and chondromyxoid fibroma were added to the differential diagnosis. Although this report was limited by the lack of final diagnosis and the patient lost to follow-up, the incidental skull base finding would be important for interpreting the entire volume of CBCT by a qualified oral and maxillofacial radiologist.
Adult ; Chondroblastoma ; Cone-Beam Computed Tomography* ; Cranial Fossa, Posterior ; Diagnosis ; Diagnosis, Differential ; Fibroma ; Humans ; Incidental Findings ; Lost to Follow-Up ; Magnetic Resonance Imaging ; Male ; Skull Base ; Skull Base Neoplasms