BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the...BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.展开更多
<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery </span><span style="font-family:Verdana;">that </span><span style="font-family:""><span style="font-family:Verdana;">can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. </span><b><span style="font-family:Verdana;">Physical Examination: </span></b><span style="font-family:Verdana;">Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago.</span><b><span style="font-family:Verdana;"> Head CT: </span></b><span style="font-family:Verdana;">Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. </span><b><span style="font-family:Verdana;">Diagnosis:</span></b><span style="font-family:Verdana;"> Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. </span><b><span style="font-family:Verdana;">Discussion: </span></b><span style="font-family:Verdana;">This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal</span><span style="background:yellow;"> </span><span style="font-family:Verdana;">arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.展开更多
Purpose: Meningiomas are the most frequently diagnosed neoplasms. Ocular symptoms vary depending on size and localisation of the tumor, which is capable of compressing critical anatomic structures. Patients and Method...Purpose: Meningiomas are the most frequently diagnosed neoplasms. Ocular symptoms vary depending on size and localisation of the tumor, which is capable of compressing critical anatomic structures. Patients and Methods: A 44-year-old immunocompetent male was admitted to our hospital for further investigation of his bilateral optic disc swelling. A complete ophthalmological examination was performed including visual field assessment (VF), visual evoked potentials (VEP), fluorescein angiography (FLA) and magnetic resonance imaging (MRI). The patient had experienced only minor visual disturbances. Serological testing was performed. Results: Serological testing showed positive IgM and IgGtiters for cytomegalovirus (CMV) and subsequent imaging (MRI) revealed a frontal falxcerebri meningioma. Conclusions: We present a case of falx meningioma with overlapping serologically active CMV in an otherwise healthy and immunocompetent individual. Detailed differential diagnostic workup in immunocompetent individuals presenting with clinically unremarkable bilateral disc swelling is recommended.展开更多
目的：探讨超声外科吸引器（cavitron ultrasonic surgical aspirator,CUSA）在矢状窦、大脑镰旁脑膜瘤切除术中的应用及临床意义。方法：回顾性分析51例矢状窦、大脑镰旁脑膜瘤病历资料,根据是否应用CUSA分成A、B两组,A组27例运用CUSA...目的：探讨超声外科吸引器（cavitron ultrasonic surgical aspirator,CUSA）在矢状窦、大脑镰旁脑膜瘤切除术中的应用及临床意义。方法：回顾性分析51例矢状窦、大脑镰旁脑膜瘤病历资料,根据是否应用CUSA分成A、B两组,A组27例运用CUSA结合双极电凝行矢状窦、大脑镰旁脑膜瘤切除,B组24例组织剪结合双极电凝常规肿瘤切除。比较两组肿瘤切除率、手术时间、术中出血量、术后颅内压（intracranial pressure,ICP）、住院时间、甘露醇剂量、迟发性脑出血例数的统计学差异,并评估分析。结果：Simpson切除标准Ⅰ、Ⅱ、Ⅲ级A组分别为23、3、1例,B组为15、5、4例,两组切除率无统计学差异（P=0.125）;A组平均住院时间（15.11±2.50）d,B组（19.71±4.79）d,组间有统计学意义（P=0.019）;在出血量、手术时间上,A组分别为（631.48±240.65）ml、（4.27±0.27）h,B组为（1050.00±521.70）ml、（4.86±0.54）h,差异均有统计学意义（P=0.006,P=0.029）;ICP方面,6 h内两组差异不明显（P=0.138）;6~72 h及72 h后A组分别为（11.30±3.81 mm Hg、12.59±5.52 mm Hg）,B组为（13.96±9.95 mm Hg、16.83±8.98 mm Hg）,具有统计学差异（P=0.011、P=0.031）。其中A组1例发生急性肾功能衰竭,无迟发性脑出血;B组4例发生急性肾功能衰竭,迟发性脑出血5例,3例行开颅血肿清除术。3个月随访,A组恢复良好24例,恢复较差3例,无病重及死亡病例,组间有统计学差异（P=0.022）。结论：在矢状窦、大脑镰旁脑膜瘤切除术中,虽不能提高肿瘤切除率,但CUSA仍是一种实用而且有效的技术,能缩短手术时间、降低术后并发症,提高手术疗效,预后更佳。展开更多
文摘BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery </span><span style="font-family:Verdana;">that </span><span style="font-family:""><span style="font-family:Verdana;">can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. </span><b><span style="font-family:Verdana;">Physical Examination: </span></b><span style="font-family:Verdana;">Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago.</span><b><span style="font-family:Verdana;"> Head CT: </span></b><span style="font-family:Verdana;">Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. </span><b><span style="font-family:Verdana;">Diagnosis:</span></b><span style="font-family:Verdana;"> Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. </span><b><span style="font-family:Verdana;">Discussion: </span></b><span style="font-family:Verdana;">This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal</span><span style="background:yellow;"> </span><span style="font-family:Verdana;">arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.
文摘Purpose: Meningiomas are the most frequently diagnosed neoplasms. Ocular symptoms vary depending on size and localisation of the tumor, which is capable of compressing critical anatomic structures. Patients and Methods: A 44-year-old immunocompetent male was admitted to our hospital for further investigation of his bilateral optic disc swelling. A complete ophthalmological examination was performed including visual field assessment (VF), visual evoked potentials (VEP), fluorescein angiography (FLA) and magnetic resonance imaging (MRI). The patient had experienced only minor visual disturbances. Serological testing was performed. Results: Serological testing showed positive IgM and IgGtiters for cytomegalovirus (CMV) and subsequent imaging (MRI) revealed a frontal falxcerebri meningioma. Conclusions: We present a case of falx meningioma with overlapping serologically active CMV in an otherwise healthy and immunocompetent individual. Detailed differential diagnostic workup in immunocompetent individuals presenting with clinically unremarkable bilateral disc swelling is recommended.
文摘目的：探讨超声外科吸引器（cavitron ultrasonic surgical aspirator,CUSA）在矢状窦、大脑镰旁脑膜瘤切除术中的应用及临床意义。方法：回顾性分析51例矢状窦、大脑镰旁脑膜瘤病历资料,根据是否应用CUSA分成A、B两组,A组27例运用CUSA结合双极电凝行矢状窦、大脑镰旁脑膜瘤切除,B组24例组织剪结合双极电凝常规肿瘤切除。比较两组肿瘤切除率、手术时间、术中出血量、术后颅内压（intracranial pressure,ICP）、住院时间、甘露醇剂量、迟发性脑出血例数的统计学差异,并评估分析。结果：Simpson切除标准Ⅰ、Ⅱ、Ⅲ级A组分别为23、3、1例,B组为15、5、4例,两组切除率无统计学差异（P=0.125）;A组平均住院时间（15.11±2.50）d,B组（19.71±4.79）d,组间有统计学意义（P=0.019）;在出血量、手术时间上,A组分别为（631.48±240.65）ml、（4.27±0.27）h,B组为（1050.00±521.70）ml、（4.86±0.54）h,差异均有统计学意义（P=0.006,P=0.029）;ICP方面,6 h内两组差异不明显（P=0.138）;6~72 h及72 h后A组分别为（11.30±3.81 mm Hg、12.59±5.52 mm Hg）,B组为（13.96±9.95 mm Hg、16.83±8.98 mm Hg）,具有统计学差异（P=0.011、P=0.031）。其中A组1例发生急性肾功能衰竭,无迟发性脑出血;B组4例发生急性肾功能衰竭,迟发性脑出血5例,3例行开颅血肿清除术。3个月随访,A组恢复良好24例,恢复较差3例,无病重及死亡病例,组间有统计学差异（P=0.022）。结论：在矢状窦、大脑镰旁脑膜瘤切除术中,虽不能提高肿瘤切除率,但CUSA仍是一种实用而且有效的技术,能缩短手术时间、降低术后并发症,提高手术疗效,预后更佳。
