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Jasmit Singh, Hrushikesh Kharosekar, Vernon Velho Department of Neurosurgery, Sir JJ Group of Hospitals and Grant Medical College , Mumbai, Maharashtra, India E-mail: [email protected]
References 1. 2.
3. 4. 5.
Baskin HJ Jr. The pathogenesis and imaging of the tuberous sclerosis complex. Pediatr Radiol 2008;38:936-52. Jóźwiak S, Nabbout R, Curatolo P. Participants of the TSC Consensus Meeting for SEGA and Epilepsy Management. Management of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC): Clinical recommendations. Eur J Paediatr Neurol 2013;17:348-52. Bollo RJ, Berliner JL. Extraventricular subependymal giant cell astrocytoma in a child with tuberous sclerosis complex. J Neurosurg Pediatr 2009;4:85-90. Oikawa S, Sakamoto K, Kobayashi N. A neonatal huge subependymal giant cell astrocytoma: Case report. Neurosurgery 1994;35:748-50. Medhkour A, Traul D, Husain M. Neonatal subependymal giant cell astrocytoma. Pediatr Neurosurg 2002;36:271-4. Access this article online Quick Response Code:
encased the cavernous portion of the internal carotid artery. The left temporal lobe was also compressed. The lesion appeared iso-intense to gray matter on T1-weighted image [Figure 1a] and hyper-intense on T2-weighted images (T2WI) [Figure 1b and c] and enhanced homogenously with gadolinium injection [Figure 1d-f]. Patient was operated by an endoscopic endonasal transsphenoidal approach. At operation, the sellar lesion was dark red in color, firm and highly vascular. There was profuse bleeding during the surgical procedure. Pathological examination revealed that the lesion consisting of multiple vessels, filled with red cells, with large lumen and thin wall and some of the vessels were filled with organized thrombi [Figure 1g]. Extra-cerebral CMs account for 5-13% of intracranial vascular malformations.[1,2] Grossly the CMs are purple or dark red lesions with or without pseudocapsule and the microscopic findings consist of dense and dilated blood vessels lined by a single layer of endothelial cells and no elastic fibers and smooth muscle.[3] The lumen
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128351
Received: 06-01-2014 Review completed: 07-01-2014 Accepted: 02-02-2014
Intrasellar cavernous hemangioma Sir, Intrasellar cavernous malformation (CM) is a rare vascular malformation of the sellar region and only seven cases of intrasellar CM have previously been reported, five with imaging data. Because of such rarity this case report. This patient presented with blurred vision of 3 years duration and also decreased libido and bilateral temporal headache. Blood biochemistry and hormone profile were normal. Brain magnetic resonance imaging (MRI) showed an enlarged pituitary fossa and an irregular solid tumor (35 mm × 18 mm × 27 mm) in the sella turcica and suprasellar region. Pituitary stalk was not visible and the optic chiasm was elevated. The tumor invaded the left cavernous sinus, compressed and Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Figure 1a: Coronal plain T2-weighted image showing the iso-intense lesion
b
c
Figure 1b and c: Axial and coronal T2-weighted image showing the lesion with homogeneous and bright signal. The cavernous portion of the left internal carotid artery was shifted laterally and surrounded and the optic chiasm was elevated. No normal pituitary signal was found
95
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and a progressive enhancement.[10] Contrast fills the peripheral part of the lesion in the early stage of dynamic contrast-enhanced scanning and then slowly fills the entire lesion.[10] This pattern of progressive enhancement is very similar to the extra-cranial CM, e.g. the hepatic CM. d
e
f
L. C. Ma, W. Y. Li, W. Q. Chen, Y. K. Wu
Figure 1d-f: Axial, sagittal and coronal T1-weighted image with gadolinium diethylenetriaminepentaacetic acid showing the mass enhanced significantly
Medical Imaging Centre, Nanfang Hospital, Southern Medical University, Guangzhou, China E-mail: [email protected]
References 1.
Figure 1g: Histopathology showing the lesions consisting of multiple vessels, filled with red cells, with large lumen and thin wall, (H and E, ×50)
diameters vary in size and the blood flow is slow. The vascular spaces are separated by a matrix of fibrous collagenous tissue without glial.[4,5] Extra-cerebral CMs are mainly located in the middle cranial fossa, more so in the parasellar region and occasional at the clivus. Literature review showed report of seven cases of intrasellar CMs and five cases with imaging findings.[6-9] The clinical presenting features of intrasellar CMs is similar to pituitary adenomas.[8] Parasellar CMs with intrasellar extension are different from intrasellar CMs with cavernous sinus extension and this can be determined by measuring the major portion of the tumor mass. In this case, the major part of the tumor was located in the sellar fossa with left and upward extension. Intracranial CMs can be divided into two types: avascular and highly vascular, the former accounting for about 80%.[9] The highly vascular type of CM on angiography demonstrates rich blood supply, which appears clump-shaped staining shadow in the stage of capillaries and sinus. MRI has been reported to be more specific and sensitive than cerebral angiography and computed tomography in the diagnosis of CMs.[9,10] On MRI, CMs have the following characteristics: well-defined borders; brightly hyperintense on T2WI images and two patterns enhancement - a rapid homogeneous enhancement 96
Cobbs CS, Wilson CB. Intrasellar cavernous hemangioma. Case report. J Neurosurg 2001;94:520-2. 2. Jeon SC, Yi JS, Yang JH, Lee IW. Intrasellar cavernous hemangioma. J Korean Neurosurg Soc 2004;36:163-5. 3. Lombardi D, Giovanelli M, de Tribolet N. Sellar and parasellar extra-axial cavernous hemangiomas. Acta Neurochir (Wien) 1994;130:47-54. 4. Gould TJ, Johnson LN, Colapinto EV, Spollen LE, Rodriguez FJ. Intrasellar vascular malformation mimicking a pituitary macroadenoma. J Neuroophthalmol 1996;16:199-203. 5. Buonaguidi R, Canapicci R, Mimassi N, Ferdeghini M. Intrasellar cavernous hemangioma. Neurosurgery 1984;14:732-4. 6. Chuang CC, Jung SM, Yang JT, Chang CN, Pai PC. Intrasellar cavernous hemangioma. J Clin Neurosci 2006;13:672-5. 7. Chhang WH, Khosla VK, Radotra BD, Kak VK. Large cavernous haemangioma of the pituitary fossa: A case report. Br J Neurosurg 1991;5:627-9. 8. Sohn CH, Kim SP, Kim IM, Lee JH, Lee HK. Characteristic MR imaging findings of cavernous hemangiomas in the cavernous sinus. AJNR Am J Neuroradiol 2003;24:1148-51. 9. Sansone ME, Liwnicz BH, Mandybur TI. Giant pituitary cavernous hemangioma: Case report. J Neurosurg 1980;53:124-6. 10. Mitsuhashi T, Hashimoto R, Nagahama S, Nagata Y. Intrasellar cavernous angioma in neurofibromatosis. Hum Pathol 1991;22:623-4.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128352
Received: O7-O1-2014 Review completed: 07-01-2014 Accepted: 02-02-2014
Schwannoma of supraorbital nerve presenting as a subfrontal tumor Sir, Schwannomas in the naso-ethmoidal region are uncommon and approximately 40 cases are reported Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Jasmit Singh, Hrushikesh Kharosekar, Vernon Velho Department of Neurosurgery, Sir JJ Group of Hospitals and Grant Medical College , Mumbai, Maharashtra, India E-mail: [email protected]
References 1. 2.
3. 4. 5.
Baskin HJ Jr. The pathogenesis and imaging of the tuberous sclerosis complex. Pediatr Radiol 2008;38:936-52. Jóźwiak S, Nabbout R, Curatolo P. Participants of the TSC Consensus Meeting for SEGA and Epilepsy Management. Management of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC): Clinical recommendations. Eur J Paediatr Neurol 2013;17:348-52. Bollo RJ, Berliner JL. Extraventricular subependymal giant cell astrocytoma in a child with tuberous sclerosis complex. J Neurosurg Pediatr 2009;4:85-90. Oikawa S, Sakamoto K, Kobayashi N. A neonatal huge subependymal giant cell astrocytoma: Case report. Neurosurgery 1994;35:748-50. Medhkour A, Traul D, Husain M. Neonatal subependymal giant cell astrocytoma. Pediatr Neurosurg 2002;36:271-4. Access this article online Quick Response Code:
encased the cavernous portion of the internal carotid artery. The left temporal lobe was also compressed. The lesion appeared iso-intense to gray matter on T1-weighted image [Figure 1a] and hyper-intense on T2-weighted images (T2WI) [Figure 1b and c] and enhanced homogenously with gadolinium injection [Figure 1d-f]. Patient was operated by an endoscopic endonasal transsphenoidal approach. At operation, the sellar lesion was dark red in color, firm and highly vascular. There was profuse bleeding during the surgical procedure. Pathological examination revealed that the lesion consisting of multiple vessels, filled with red cells, with large lumen and thin wall and some of the vessels were filled with organized thrombi [Figure 1g]. Extra-cerebral CMs account for 5-13% of intracranial vascular malformations.[1,2] Grossly the CMs are purple or dark red lesions with or without pseudocapsule and the microscopic findings consist of dense and dilated blood vessels lined by a single layer of endothelial cells and no elastic fibers and smooth muscle.[3] The lumen
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128351
Received: 06-01-2014 Review completed: 07-01-2014 Accepted: 02-02-2014
Intrasellar cavernous hemangioma Sir, Intrasellar cavernous malformation (CM) is a rare vascular malformation of the sellar region and only seven cases of intrasellar CM have previously been reported, five with imaging data. Because of such rarity this case report. This patient presented with blurred vision of 3 years duration and also decreased libido and bilateral temporal headache. Blood biochemistry and hormone profile were normal. Brain magnetic resonance imaging (MRI) showed an enlarged pituitary fossa and an irregular solid tumor (35 mm × 18 mm × 27 mm) in the sella turcica and suprasellar region. Pituitary stalk was not visible and the optic chiasm was elevated. The tumor invaded the left cavernous sinus, compressed and Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Figure 1a: Coronal plain T2-weighted image showing the iso-intense lesion
b
c
Figure 1b and c: Axial and coronal T2-weighted image showing the lesion with homogeneous and bright signal. The cavernous portion of the left internal carotid artery was shifted laterally and surrounded and the optic chiasm was elevated. No normal pituitary signal was found
95
[Downloaded free from http://www.neurologyindia.com on Thursday, March 13, 2014, IP: 202.177.173.189] || Click here to download free Android application for this journal Letters to Editor
and a progressive enhancement.[10] Contrast fills the peripheral part of the lesion in the early stage of dynamic contrast-enhanced scanning and then slowly fills the entire lesion.[10] This pattern of progressive enhancement is very similar to the extra-cranial CM, e.g. the hepatic CM. d
e
f
L. C. Ma, W. Y. Li, W. Q. Chen, Y. K. Wu
Figure 1d-f: Axial, sagittal and coronal T1-weighted image with gadolinium diethylenetriaminepentaacetic acid showing the mass enhanced significantly
Medical Imaging Centre, Nanfang Hospital, Southern Medical University, Guangzhou, China E-mail: [email protected]
References 1.
Figure 1g: Histopathology showing the lesions consisting of multiple vessels, filled with red cells, with large lumen and thin wall, (H and E, ×50)
diameters vary in size and the blood flow is slow. The vascular spaces are separated by a matrix of fibrous collagenous tissue without glial.[4,5] Extra-cerebral CMs are mainly located in the middle cranial fossa, more so in the parasellar region and occasional at the clivus. Literature review showed report of seven cases of intrasellar CMs and five cases with imaging findings.[6-9] The clinical presenting features of intrasellar CMs is similar to pituitary adenomas.[8] Parasellar CMs with intrasellar extension are different from intrasellar CMs with cavernous sinus extension and this can be determined by measuring the major portion of the tumor mass. In this case, the major part of the tumor was located in the sellar fossa with left and upward extension. Intracranial CMs can be divided into two types: avascular and highly vascular, the former accounting for about 80%.[9] The highly vascular type of CM on angiography demonstrates rich blood supply, which appears clump-shaped staining shadow in the stage of capillaries and sinus. MRI has been reported to be more specific and sensitive than cerebral angiography and computed tomography in the diagnosis of CMs.[9,10] On MRI, CMs have the following characteristics: well-defined borders; brightly hyperintense on T2WI images and two patterns enhancement - a rapid homogeneous enhancement 96
Cobbs CS, Wilson CB. Intrasellar cavernous hemangioma. Case report. J Neurosurg 2001;94:520-2. 2. Jeon SC, Yi JS, Yang JH, Lee IW. Intrasellar cavernous hemangioma. J Korean Neurosurg Soc 2004;36:163-5. 3. Lombardi D, Giovanelli M, de Tribolet N. Sellar and parasellar extra-axial cavernous hemangiomas. Acta Neurochir (Wien) 1994;130:47-54. 4. Gould TJ, Johnson LN, Colapinto EV, Spollen LE, Rodriguez FJ. Intrasellar vascular malformation mimicking a pituitary macroadenoma. J Neuroophthalmol 1996;16:199-203. 5. Buonaguidi R, Canapicci R, Mimassi N, Ferdeghini M. Intrasellar cavernous hemangioma. Neurosurgery 1984;14:732-4. 6. Chuang CC, Jung SM, Yang JT, Chang CN, Pai PC. Intrasellar cavernous hemangioma. J Clin Neurosci 2006;13:672-5. 7. Chhang WH, Khosla VK, Radotra BD, Kak VK. Large cavernous haemangioma of the pituitary fossa: A case report. Br J Neurosurg 1991;5:627-9. 8. Sohn CH, Kim SP, Kim IM, Lee JH, Lee HK. Characteristic MR imaging findings of cavernous hemangiomas in the cavernous sinus. AJNR Am J Neuroradiol 2003;24:1148-51. 9. Sansone ME, Liwnicz BH, Mandybur TI. Giant pituitary cavernous hemangioma: Case report. J Neurosurg 1980;53:124-6. 10. Mitsuhashi T, Hashimoto R, Nagahama S, Nagata Y. Intrasellar cavernous angioma in neurofibromatosis. Hum Pathol 1991;22:623-4.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128352
Received: O7-O1-2014 Review completed: 07-01-2014 Accepted: 02-02-2014
Schwannoma of supraorbital nerve presenting as a subfrontal tumor Sir, Schwannomas in the naso-ethmoidal region are uncommon and approximately 40 cases are reported Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
