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  • ISSN: 2373-9479
    Volume 3, Issue 1
    Case Report
    Feyza Karagoz Guzey*, Yucel Hitay, Cihan Isler, Abdurrahim Tas, Ozgur Aktas, Azmi Tufan, Mustafa Vatansever, and Asli Kahraman Akkalp
    Background: Primary spinal intramedullary lymphoma is a very rare lesion. It has not specific laboratory or radiologic findings. Therefore false and late diagnosis is frequent.
    Case Report and Literature Review: A 55 year-old lady with multifocal primary spinal intramedullary B-cell non-Hodgkin's lymphoma was reported. Review of literature yielded 45 cases with primary spinal intramedullary lymphoma and clinical and radiological characteristics of these 46 cases were evaluated.
    Results: Male/female ratio was 24/22. Median age of the patients was 51.5 years for all cases except a series consisting 14 cases to be reported in an article in which detailed data case by case was not given. Median age of those 14 cases was 62.5. Most of the cases were localized in the cervical and then thoracic segments. Multifocal spinal tumors were found in 12 patients. Most of the patients were admitted with rapidly progressing myelopathy symptoms and signs. Most frequently seen magnetic resonance appearance was T2 hyperintensity and dense and homogeneous contrast enhancement with spinal cord enlargement. Misdiagnosis was frequent (23 cases) and certain diagnosis could be provided with autopsy in 5 cases. Tissue sampling was performed mostly with spinal cord biopsy (27) and brain biopsy (10 cases). Most of the cases had B-cell lymphoma (26 cases). Patients were treated with various types of chemotherapy, radiotherapy or combination of them. Twenty-six cases were died during follow-up median 16.5 months (for 10 cases of the largest series consisting 14 cases) and 10 months (for other cases) after onset of symptoms and signs.
    Survival time was significantly different between neither cell types (B cell and other lymphomas) nor initial treatment modalities (chemotherapy, radiotherapy or combined of them).
    Conclusions: Primary spinal intramedullary lymphoma diagnosis is difficult, and misdiagnosis is frequent. It must be kept in mind for differential diagnosis especially in middle aged patients with rapidly progressing myelopathy findings. Prognosis is poor despite aggressive treatment.
    Cheng Peng, Hongyang Zhao, Yuechen Zheng, and Yingchun Zhou*
    Abstract: Invasive intracranial aspergillosis is a rare disease with high morbidity and mortality that occurs most commonly in immunosuppressed patients. However, intracranial Aspergillus infections have also been reported in immunocompetent hosts after brain trauma or neurosurgery. Neurosurgical intervention combined with aggressive anti-fungal treatment is effective in treating cerebral aspergillus granuloma or abscess, and recurrent abscess in situ is the most frequently reported complication after surgical debridement. Here, we describe a 39-year-old male who developed an intracranial aspergillus abscess after a posterior fossa craniectomy following brain trauma. Aspergillus infection disseminated intraventricularly after surgical debridement. Ventriculoperitoneal (VP) shunting surgery in conjunction with anti-fungal medications was used to successfully treat the ventriculitis.
    Ahmad Faried*, Muhammad Z. Arifin, Roland Sidabutar and Bethy S. Hernowo
    Abstract: Tuberculum Sellae Meningioma (TSM) is one of the most challenging operations among neurosurgeons. Many approaches have been proposed in the attempt of total removal of the tumor. Rhabdoid meningioma is a rare subtype of meningiomas accounting for 2-3% of all intra-cranial meningiomas, an aggressive tumor classified as World Health Organization (WHO) grade III; it occurs mainly in the early childhood, but also rarely in teenagers and adults. It is an aggressive tumor and needs to be treated using both surgery and radiotherapy. We describe the case of a 16-year-old girl with bilateral progressive visual loss. Imaging studies show a tumor mass in the sellae region. Surgery using an anterior interhemispheric approach was performed, and gross total removal was achieved. Histopathological findings established a diagnosis of rhabdoid meningioma. The visual function was improved postoperatively within a week. Rhabdoid tuberculum sellae meningioma, a rare clinical entity in teenagers and adults, had been treated with excellent clinical outcome. This case report supports the suitability of the anterior interhemispheric approach for resection of rhabdoid TSM, followed by radiation therapy.
    Muhammad Z. Arifin, Roland Sidabutar, Rachmanda H. Wibisono, and Ahmad Faried*
    Abstract: A rare morphological variant of meningioma, known as microcystic meningioma, was originally described as "humid" or vacuolated meningioma. It is difficult to distinguish this clinical entity through computed tomographic scans or magnetic resonance images, as they appear similar to glial or metastatic tumor with cystic or necrotic areas. Their similar imaging characteristics make it difficult to differentiate microcystic meningiomas from these more common pathologies. We describe the case of a 33 years old female who presented with generalized seizures, and was found to have a mass of the left parieto occipital region. Preoperative diagnosis based on imaging studies was pilocytic astrocytoma. A craniotomy tumor removal was performed, and tumor was excised. Microscopic and histopathological results established a diagnosis of microcystic meningioma. Cystic meningiomas are difficult to diagnose accurately using pre-operative imaging. Our case is unique because it presented as a rare morphological variant of meningioma that is extremely rare in our institution. Its unusual imaging might lead to confusion between extra- and intra-axial tumors. In our case, a definitive diagnosis was only possible using a histopathological examination.
    Research Article
    Sakellaridis N*, Burtzinos G, Petsanas D, Spyridakis PH, Iatrelli I, Sakellaridi L, Melidonis A, and Grivas TH
    Abstract: Our purpose is to offer treating physicians guidelines, which can be proposed to their patients post-op, so that recurrent lumbar disc disease can be prevented. We have reviewed Medline and other possible resources. We have collected 714 relevant articles, which have been studied. The surgeon can try to close the annular defect or to keep it small, but the current relevant materials have not yet withstand the probation of time. Patients after lumbar discectomy or other similar techniques should be careful of trauma and other violent forces, avoid lifting weights for a few months post-op, try to lose weight if overweight, stop smoking, control diabetes mellitus, hypertension and increased cholesterol levels and discuss problems and treat psychological diseases and symptoms as necessary.
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