Central lobe tumor

Central lobe tumor

Akeret et al., reviewed prospectively collected clinical and imaging data of all patients operated on a supratentorial intraparenchymaprimary brain tumor at the Neuroscience Center Zurichbetween January 2009 and December 2016. The effect of tumor histology, anatomical location and white matter infiltration on seizure prevalence and semiology were assessed using uni- and multivariate analyses.

Of 678 included patients, 311 (45.9%) presented with epileptic seizures. Tumor location within the central lobe was associated with higher seizure prevalence (OR 4.67, 95% CI: 1.90-13.3, p = .002), especially within the precentral gyrus or paracentral lobule (100%). Bilateral extension, location within subcortical structures and invasion of deeper white matter sectors were associated with a lower risk (OR 0.45, 95% CI: 0.25-0.78; OR 0.10, 95% CI: 0.04-0.21 and OR 0.39, 95% CI: 0.14-0.96, respectively). Multivariate analysis revealed the impact of a locationwithin the central lobe on seizure risk to be highly significant and more relevant than histopathology (OR: 4.79, 95% CI: 1.82-14.52, p = .003). Seizures due to tumors within the central lobe differed from those of other locations by lower risk of secondary generalization (p < .001).

Topographical lobar and gyral location, as well as extent of white matter infiltration impact seizure risk and semiology. This finding may have a high therapeutic potential, for example regarding the use of prophylactic antiepileptic therapy1).


Brain mapping with direct electrical stimulation is usefull when the tumor is located near or has infiltrated the central lobe.

To analyze the surgical findings with direct electrical stimulation of the cortex and white matter under general anesthesia during surgery for brain tumors related to the central lobe.

We studied 42 patients operated on from June 2000 to June 2003. We analyzed surgical findings and details of brain mapping.

The mean value of the intensity of the stimulus was greater among those who presented motor deficit prior to surgery (p = 0.0425) and edema on MRI (p = 0.0468) or during anesthesia with continuous propofol (p = 0.001).

The functional mapping of the central lobe may be influenced by severe motor deficit, edema on MRI and propofol’s anesthesia 2).

1)

Akeret K, Serra C, Rafi O, Staartjes VE, Fierstra J, Bellut D, Maldaner N, Imbach LL, Wolpert F, Poryazova R, Regli L, Krayenbühl N. Anatomical features of primary brain tumors affect seizure risk and semiology. Neuroimage Clin. 2019 Jan 25;22:101688. doi: 10.1016/j.nicl.2019.101688. [Epub ahead of print] PubMed PMID: 30710869.
2)

Brainer-Lima PT, Brainer-Lima AM, Brandt CT, Carneiro GS, Azevedo HC. [Intraoperative mapping of motor areas during brain tumor surgery: electrical stimulation patterns]. Arq Neuropsiquiatr. 2005 Mar;63(1):55-60. Portuguese. PubMed PMID: 15830066.

Peripontomedullary hydatid cyst

Peripontomedullary hydatid cyst

Even when Hydatid cyst is found in the brain it presents usually in the supratentorial compartment. However this case was unique in having the Hydatid cyst within the infratentorial fossa. With multiple small cysts, causing mass effect and challenging for surgical resection.

A 44 years female presented with headachediplopia and bulbar symptoms, followed by ataxia. Full examination, proper investigations showed the peripontomedullary hydatid cysts. Surgical management is illustrated.

It is still challenging for the neurosurgeons to operate on these lesions in spite of modern technologies and fancy approaches due to its delicate nature, associated risk of allergic reaction, cyst’s material dissemination and irreversible injury of multiple neurological structure due to prolonged compression of cranial nerves crossing the cerebellopontine angle.

In this case report Alkhotani et al., from the King Faisal Specialist Hospital and Research Center, present a rare case of Multiple Hydatid cysts involving a rare location in the brain; peripontomedullary area and extending all the way down to the foramen magnum. Supported with a literature review in relation to disease etiologyepidemiology, clinical presentation and management 1).

1)

Alkhotani A, Butt B, Khalid M, Binmahfoodh M. Peripontomedullary hydatid cyst: Case report and literature review. Int J Surg Case Rep. 2019 Jan 18;55:23-27. doi: 10.1016/j.ijscr.2019.01.003. [Epub ahead of print] PubMed PMID: 30710875.
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