Introduction:Collision tumors are extremely rare in the sellar region, less than 1 to 2% of sellar masses. Intracranial dermoid cyst is a rare, benign, slow-growing lesion accounting for 0.04 to 0.7% of all intracranial tumors. Sellar dermoid cysts are extremely rare; from 1976 to 2024, there were only 59 records of sellar dermoid cyst published in the English language. Coexisting sellar dermoid cyst and pituitary adenoma have not been reported in the literature. Case Presentation:A 51-year-old man having medical history of left traumatic optic neuropathy and acute lymphoblastic leukemia posttreatment with complete remission in 2018 suffered from intermittent dizziness and occasional unsteady gait with deviation to the left side for more than 6 months prior to visiting our hospital. His brain magnetic resonance imaging disclosed a mass lesion in the sellar region with suprasellar extension, and his preoperative hormone study showed hypopituitarism. After a thorough preoperative evaluation, he underwent an endoscopic endonasal transsphenoidal approach with the removal of the lesion and skull base reconstruction. The lesion was pathologically diagnosed to be a dermoid cyst with coexisting pituitary adenoma/pituitary neuroendocrine tumor. Conclusion:To our best knowledge, this is probably the first report of sellar dermoid cyst with coexisting pituitary adenoma/pituitary neuroendocrine tumor.

[This corrects the article DOI: 10.1055/a-2816-7368.].

Introduction:Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2 to 1.1% of operative pituitary lesions. Preoperative diagnosis is difficult because it shares many similarities with other pituitary lesions in terms of signs and symptoms and radiographic findings. The author would like to share a case of primary pituitary abscess due to Cutibacterium acnes infection, which is probably the first case reported in an adult patient. Case Presentation:A 60-year-old woman with having medical history of diabetes mellitus who suffered from severe headache, fever, chillness, and vomiting in January 2024. She had been admitted to the Infectious Diseases Department; however, no definite infection source was found, but hypopituitarism was detected. Her brain magnetic resonance imaging (MRI) showed a rim-like enhanced sellar lesion with suprasellar extension. She underwent an endoscopic endonasal transsphenoidal approach with the removal of the lesion and skull base reconstruction. During the surgery, pus-like material and some solid tissue, which was yellowish white in color, were found. The culture of the pus revealed the growth of Cutibacterium acnes, and the histological report of the solid tissue proved nonneoplastic pituitary gland tissue, admixed with fibrous tissue and marked chronic inflammation. She recovered well after surgery and completed antibiotic treatment. Conclusion:Preoperative diagnosis of pituitary abscess is difficult. The majority of pituitary abscesses are diagnosed during the operation or postoperatively. Prompt diagnosis and treatment of pituitary abscess yield a favorable prognosis. The mainstay of treatment is transsphenoidal surgical resection in combination with antibiotic therapy.

Introduction Gliomas and meningiomas are two common primary brain tumors, but occurring simultaneously in the same patient is a rare entity. The authors would like to report a case of coexistence of a superior parietal lobule diffuse glioma, IDH-wild type, histologically CNS WHO grade 3 and a left posterior fossa transitional meningioma, WHO grade 1; both the tumors were successfully removed in one-stage operation. Case Presentation A 68-year-old female having hypertension, who presented to us with the chief complaints of involuntary shaking of her left lower limb associated with her left upper limb tingle, dizziness, and neck soreness. She was found to have a lesion in her right parietal region and a tumor in her left cerebellar region. After detailed discussion with the patient and thorough preoperative evaluation, the authors performed a right parietal craniotomy and a left retrosigmoid approach in one-stage operation to remove both the tumors, which were proven to be of two distinct histological identities. Conclusion The management for two tumors located far apart needs a case-by-case evaluation. An important aspect while dealing with such cases is to decide which tumor needs to be operated first or whether both lesions can be operated at the same time with one-stage operation.

Intracranial hypotension has variable clinical manifestations; subdural hematoma is one of the complications of intracranial hypotension with the reported incidence ranging from 16% to 57%. The author would like to share a case of subdural hematoma caused by recurrent intracranial hypotension with different cerebrospinal fluid (CSF) leakage site and to review a case series of intracranial hypotension treated in the author’s hospital (Kaohsiung Veterans General Hospital). A 44-year-old male having the past history of intracranial hypotension was treated in our Neurology division one month previous to this admission, who was sent to our emergency room (ER) due to severe orthostatic headache with nausea and vomiting. Computed tomography (CT) scan of brain at ER showed bilateral subdural hematoma, more on the left side with mass effect. Both surgical removal of the subdural hematoma and epidural blood patch were performed and he had a good outcome. Orthostatic headache is a specific symptom sign of intracranial hypotension. Epidural blood patch is effective to manage intracranial hypotension either the leakage site of CSF is detected or not. In case of non-traumatic subdural hematoma, intracranial hypotension should be kept in mind.

OBJECTIVE: Ependymomas are rare central nervous system tumors. The current treatment strategy is gross total tumor removal. Whether adjuvant therapy will be beneficial is controversial. We retrospectively analyzed 3 cases of World Health Organization (WHO) grade III posterior fossa anaplastic ependymomas treated with different treatment modalities. We aimed to identify possible treatment options for infratentorial WHO grade III anaplastic ependymoma in adults. METHODS: We performed a retrospective analysis of 3 patients diagnosed with infratentorial anaplastic ependymomas in our institution from 2016 to 2020. The demographic data were documented. This case series of 3 patients does not meet the Department of Health and Human Services definition of research and does not need Institutional Review Board approval. All patients' informed consents have been obtained. RESULTS: One patient underwent subtotal tumor resection combined with adjuvant radiotherapy and Gamma Knife radiosurgery while the other 2 patients -nderwent gross total tumor removal combined with Gamma Knife radiosurgery or adjuvant radiotherapy. Tumors recurred in the first patient 20 months later, while the other 2 patents did not develop recurrence. The modified Rankin scale scores of these patients were 1, 0, and 0. All patients are followed up with regular magnetic resonance imaging at our facility. CONCLUSIONS: The strategy for treating WHO grade III anaplastic ependymomas is controversial, but gross total tumor resection remains the key element. Adjuvant stereotactic radiosurgery after tumor removal might be considered if radiotherapy is not an option. The role of chemotherapy is unclear, and the use of chemotherapy should be tailored to individual patients.

INTRODUCTION:Gout is a metabolic disease secondary to an increased body pool of urate with hyperuricemia. Gout typically affects the peripheral joints and rarely involves the intra-spinal area.CASE PRESENTATION:A 43-year-old man, who had metabolic syndrome s/p bariatric surgery and gout suffered from severe left low back pain with radiation to the lateral side of his left thigh and anterior side of his left leg for more than 7 days. His L-spine MRI showed an abnormal posterior epidural space occupying lesion at L4-L5 level. For tissue diagnosis and neural structures decompression, he underwent surgical removal of the epidural mass lesion. The surgical specimen showed a picture of gout and he got a good recovery after operation.DISCUSSION:The differential diagnoses of an epidural mass includes synovial cysts, ligament cyst, cystic neuromas, tumors, hematomas and abscesses. Gout in the spinal canal is difficult to diagnosis before surgery because it is rare and its clinical presentation and radiologic findings mimic tumor, abscess, tuberculosis, and degenerative spinal diseases. Patients with spinal gout may present with axial pain and a variety of neurological symptoms.CONCLUSION:Spinal gouty tophus should be considered in the different diagnoses of spinal epidural masses especially in patients with systemic gout. Surgery is needed for final diagnosis. If spinal gouty tophus is highly suspected during the surgery, the specimen should not be preserved with Formalin because birefringent crystals under polarized light is a unique feature for gouty tophus but they dissolve in Formalin.

Background:Intracranial solitary fibrous tumor/hemangiopericytoma (HPC) is a rare and aggressive tumor. We conducted this retrospective study to investigate the outcome of patients after treatment, the efficacy of postoperative adjuvant radiotherapy, and the factors not conducive to total resection.Methods:We conducted a retrospective review of the medical records of patients harboring fresh intracranial solitary fibrous tumor/HPC treated from January 2009 to December 2019 in our hospital. We reviewed their clinical presentations, radiologic appearances, tumor size and location, extent of resection, estimate intraoperative blood loss, treatment modalities and results, and duration of follow-up.Results:There were seven consecutive patients (three males and four females). The ages of the patients at the time of diagnosis ranged from 35 to 77 years (mean: 52.86 years). Five patients (71.43%) got tumor bigger than 5 cm in dimension and only 1 patient (14.29%) underwent gross total tumor resection in the first operation without complication. Five patients (71.43%) underwent postoperative adjuvant radiotherapy. Follow-up period ranged from 4.24 to 123.55 months and the median follow-up period was 91.36 months. Three patients had favorable outcome with Glasgow Outcome Scale (GOS) equal to 4; four patients had unfavorable outcome with GOS equal to 2 or 3. No mortality was happened.Conclusion:Gross total tumor resection in the initial surgery is very important to achieve a better outcome. Massive intraoperative bleeding and venous sinus or major vessels adjoining are factors not conducive to total resection. Radiotherapy can be administered as adjuvant therapy for cases showing an aggressive phenotype or not treated with gross total resection.

Spindle cell oncocytoma is a rare nonfunctioning neoplasm of the adenohypophysis, and was first described in 2002 by Roncaroli et al. In 2007, spindle cell oncocytoma has been categorized as a separate entity by the World Health Organization (WHO) and is classified as a Grade 1 tumor of the central nervous system. Spindle cell oncocytoma of pituitary gland usually occurs in adults and accounts for 0.1-0.4% of all sellar region tumors. Clinically and radiologically, they are indistinguishable from nonfunctioning pituitary adenomas. From 2002 to 2018, approximately 46 cases of spindle cell oncocytoma of pituitary gland had been reported in the English literature and we would like to report a case of 28-year-old woman presented with pituitary apoplexy proved to be a case of spindle cell oncocytoma of pituitary gland which probably will be the 47th reported case.

Intracranial solitary fibrous tumors are rare mesenchymal neoplasms originating in the meninges and constitute a heterogeneous group of rare spindle cell tumors that include benign and malignant neoplasms of which hemangiopericytoma is nowadays considered a cellular phenotypic variant. From literatures, the incidence of coexistence of brain tumors and intracranial aneurysms is 0.7-5.4%. Meningioma is the most frequent tumor coexisted with intracranial aneurysms, followed by pituitary adenoma, neuroepithelial tumor, and metastatic tumor. We would like to report a case of 74-year-old man harboring a rare intracranial solitary fibrous tumor/hemangiopericytoma and an unruptured aneurysm of the right middle cerebral artery which probably the first report of these combinations in the English literature. Both lesions were treated surgically in one session with favorable outcome. Magnetic resonance angiography should be performed in patients with brain tumor preoperatively not only to visualize neoplastic vascularization but also to pick up incidental aneurysm.

Introduction. Glioblastoma multiforme (GBM), the most common primary malignant brain tumor in adults, is characterized by extensive heterogeneity in its clinicopathological presentation. A primary brain tumor with both astrocytic differentiation and neuronal immunophenotype features is rare. Here, we report a long-term survival patient who presented this rare form of GBM in the disease course. Presentation of Case. A 23-year-old woman, presenting with rapidly progressive headache and right-side weakness, was diagnosed with brain tumor over the left basal ganglion. She underwent the first craniectomy for tumor removal, and histopathology revealed classic GBM. Tumor recurrence occurred 8 years later. Another gross total resection was performed and pathology revealed GBM with the oligodendroglioma component (GBM-O). Due to disease progression, she received debulking surgery the following year. The third pathology revealed glioblastoma with primitive neuroectodermal tumor-like component (GBM-PNET). Discussion. GBM-PNETs are collision tumors with both neuronal and glial components. They are rare, and a few case reports have suggested that these tumors are associated with favorable outcomes but a higher risk of cerebrospinal fluid dissemination. Conclusion. We report a patient who developed the distinct pathologic variants of classic GBM, GBM-O, and GBM-PNET, throughout the disease course. Young age, aggressive surgical resection, and pathologic and genetic features may have contributed to the long-term survival of the patient.

BACKGROUND:Giant cell tumor of bone originating from the connective tissue within the bone marrow is benign but locally aggressive lesion. In all, 90% of the cases involve the epiphysis of long bones and less than 2% involve the skull. Giant cell tumors of the skull occur most frequently in the sphenoid and temporal bones, and very rarely in the ethmoid, frontal, parietal, and occipital bones. We would like to share a case of giant cell tumor of bone arising from the left orbital roof with involving ethmoid sinus, which was diagnosed to be a meningioma before surgery.CASE DESCRIPTION:A 32-year-old lady presented to us with the chief complain of left proptosis, diplopia, and left eye soreness without decline of visual acuity for about 2 months. Her orbital magnetic resonance imaging (MRI) disclosed a mass lesion located in the left frontal base, orbital roof, and upper medial orbital region with adjacent dural-tail sign favoring meningioma. She underwent a left supraorbital pterional craniotomy with the gross total removal of tumor and dura reconstruction. Histology examination of the tumor showed a picture of giant cell tumor of bone. Considering giant cell tumor of bone is locally aggressive, postoperative adjuvant therapy with Denosumab was introduced after full explanation.CONCLUSION:Standard treatments of skull-base giant cell tumors have yet to be established due to small number of cases reported in the literature. The standard treatment of giant cell tumor of bone is complete resection of the tumor.

Introduction: Vertebral artery injury associated with blunt cervical trauma has been infrequently reported. The prevalence of traumatic vertebral artery injury is approximately 0.5-2.0% to overall trauma patients, usually occurs in the setting of high-energy trauma. The most common mechanism of injury was high-speed motor vehicle collisions and pedestrian-versus-automobile collision. Here, we would like to report a case of cervical spine fracture with cord injury and left vertebral artery transection after a slipping down event that was successfully managed by endovascular intervention with favourable outcome. Case report: A 42-year-old man having medical history of alcoholic liver disease and hepatitis C was sent to our ER in December 2016 in a conscious disturbance and hypotension state after suffering a slipping down event at a slope in a market after drinking. After resuscitation, a series of trauma imaging survey was arranged. Results: His CT scan of brain showed essentially negative finding; his CT scan of C-spine demonstrated fracture of right transverse process and transverse foramen of C3, avulsion fracture of left transverse process of C4; his MRI of C-spine disclosed a large hematoma at pre-vertebral space, cord contusion and hemorrhage at C3/C4 without significant compressive lesion and loss of flow void at left upper vertebral artery at the level of C3-C4. Angiography was arranged to identify his vascular injury and it showed the interruption of left vertebral artery at C4 with formation of arteriovenous fistula draining into adjacent venous plexus. After evaluating his vital signs, liver function, and family discussion, endovascular intervention was preferred to manage his left vertebral artery injury. After the detachable coils were approved, successful trapping of the left vertebral artery was done by endovascular embolization. The angiography performed just before coiling showed the newly development of pseudoaneurysm closed to the injured site. 27 days after admission, he was discharged with stable vital signs, clear consciousness, but the muscle power of his right upper limb was grade 2/5 while the muscle power of his other extremities was grade 4/5 and he had no sphincter problem. Conclusion: There is a particularly high risk for vertebral artery injury in the setting of cervical spine fractures with subluxation, and/or extension to the foramen transversarium. Under such circumstances, the vascular injury most likely occurs when tensile or shear strain exceeds the mechanical limits of arterial tissue during hyperflexion, hyperextension, anteroposterior translation, and/or forcible rotation. Displaced bone fragments can injure the artery directly especially when the foramen transversarium is disrupted. The clinician must be aware of the presence of vertebral artery injury in cases of cervical spine trauma.

Background: Atypical meningiomas fall into a category World Health Organization Grade II, which have higher local recurrence rates and lower survival rates than their benign counterparts. The aim of this study is to review the outcome of newly diagnosed patients with atypical meningioma after therapy. Methods: We conducted a retrospective review of the medical records of patients having atypical meningiomas who were treated in our hospital between January 2005 and December 2014. Their age, sex, initial presentation, tumor location, tumor size, extent of resection, tumor recurrence or tumor progression, duration of follow-up, adjuvant therapy, and outcome were reviewed. Results: There were 27 consecutive patients (15 male and 12 female) having fresh intracranial atypical meningiomas treated in our hospital between January 2005 and December 2014. Their mean age at diagnosis was 60.81 years. Twenty-three patients (85.19%) underwent total resection of the tumor, whereas 4 patients (14.81%) had partial resection of their tumors during their first time of surgery. Fifteen patients (55.56%) had finished adjuvant radiotherapy. Nine patients (33.33%) had tumor progression or recurrence during follow-up, and 4 of them were proved to have malignant transformation to anaplastic meningiomas in the following operations. The mean time to tumor progression or recurrence of these nine patients was 17.67 months. Nineteen patients (70.37%) had a favorable outcome, 7 patients (25.93%) had an unfavorable outcome, and we lost 1 patient (3.7%) due to disease progression. Conclusions: Surgery remains the standard treatment to atypical meningioma, and postoperative adjuvant radiotherapy is still controversial especially to those who undergo total surgical resection of the tumors. Our study reveals that early postoperative adjuvant radiotherapy seems to play a role in local control. Atypical meningioma can have malignant transformation to anaplastic meningioma, so aggressive treatment and follow-up are essential to manage this particular tumor.

Rathke cleft cyst is thought to arise from incomplete obliteration of the lumen of Rathke pouch. The cells of the anterior pituitary lobe, from which pituitary adenomas develop, are also derived from the cells of Rathke pouch. Although Rathke cleft cyst and pituitary adenoma have a shared ancestry, they rarely occur coincidentally. Rathke cleft cysts have been found incidentally in 11% - 33% of post-mortem examinations, and were associated with 1.7% - 2.1% of the pituitary adenoma cases. These coexisting lesions are difficult to diagnose pre-operatively due to the variable signal intensity and position of the Rathke cleft cysts. Treatment of these lesions involves surgical resection to decrease mass effect and medical management to normalize hormonal imbalances. To our best knowledge, only 42 cases of Rathke cleft cyst with a coexisting pituitary adenoma have been reported in the English or Japanese literatures, but none of the coexisting pituitary adenoma is gonadotropin producing. We would like to report a case of Rathke cleft cyst with a coexisting gonadotropin producing adenoma that was successfully treated by endoscopic endonasal transsphenoidal approach with the removal of the sellar lesion and temporary hormone replacement.

Introduction: chordomas are slow-growing, low-grade malignant but locally invasive tumors which originate from embryonic remnants of the primitive notochord. chordomas are principally midline tumors. In the neuraxis, chordomas are most commonly located in the sacrococcygeal region (50–55%), followed by the cranio-occipital region (25–30%). case report: A 71-year-old male has a left paraspinal tumor extending from c2 to c6 with bone erosion and left vertebral artery encasement. the tentative diagnosis before surgery was lymphoma or metastatic tumor. He underwent posterior cervical decompression with surgical debulking of the tumor to release the cord compression and posterior lamina screw fixation from c2 to c7 with allograft fusion and pathology confirmed the tumor to be chordoma. conclusion: Due to the rare occurrence of chordomas extra-axially, these lesions have not earned a great deal of consideration in the clinical and radiographic differential diagnoses

Background: Intraspinal tumors are rare central nervous system neoplasms. The reported clinical features of intraspinal tumors have varied in previous studies. We present here the cases of 184 patients with intraspinal tumors treated surgically in our hospital and a review of the literature. Methods: We conducted a retrospective review of 184 patients with intraspinal tumors who underwent surgical treatment in our institution between 2002 and 2013. Their age, sex, initial presentation, tumor location, level of affected vertebral column, histological diagnosis, and primary origin of the metastatic tumor were reviewed and analyzed.Results: Of these 184 patients, 97 (52.7%) were men and 87 (47.3%) were women. The mean age was 56.3 years (range 7-83 years). A total of 102 (55.4%) had primary tumors, while 82 (44.6%) patients had developed metastatic tumors. The histological diagnosis of the primary tumors included 55 (53.9%) schwannomas, 16(15.7%) meningiomas, six (5.9%) ependymomas, five (4.9%) neurofibromas, three (2.9%) hemangiomas, two (2.0%) hemagioblastomas, and 15 (14.7%) other tumor types. The most common primary sites of the metastatic tumors were the lung and breast.Conclusion: Primary tumors were more numerous than metastastic tumors in our series of patients. For the primary tumors, our study showed a higher proportion of nerve sheath cell tumors (schwannomas and neurofibromas) and fewer meningiomas and neuroepithelial tumors compared with reports from non-Asian countries. In addition, the lung was the most common origin of the metastatic tumors and more than half of these tumors were located at the thoracic spine. Back pain and radicular pain were the most common presentations in patients with intraspinal tumors. Copyright (C) 2014 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.

Background: The medulla oblongata is the lower half of the brainstem. It contains the cardiac, respiratory, vomiting, and vasomotor centers and deals with autonomic functions such as breathing, heartbeat, and blood pressure. Primary medulla oblongata germinoma is very rare and less than 20 cases have been reported in the English literature. Case Description: A 22-year-old female without any particular past medical history presented to us in October 2012 with the chief complaint of dyspnea and frequent choking for 1 month. Neurological examination revealed lower cranial nerve palsies and nystagmus. Her brain computed tomography (CT) and brain magnetic resonance imaging (MRI) demonstrated a mass lesion at the dorsal surface of medulla oblongata with extension into the inferior fourth ventricle and foramen magnum. She underwent bilateral suboccipital craniotomy and C1 laminoplasty with the grossly total resection of the tumor. The histological examination of the tumor proved germinoma. Postoperative adjuvant radiotherapy was arranged. The latest brain MRI and whole spine MRI done 1 year after surgery showed neither residual nor recurrent tumor in the whole axis. She is regularly followed-up at our outpatient department and is doing well except having left vocal cord palsy, which occurred before surgery. Conclusion: Medulloblastoma, ependymoma, glioma, hemangioblastoma, and cavernous angioma are common intraaxial tumors in the medulla oblongata and fourth ventricle. Intracranial germ cell tumors originate from extragonadal seminal cells and have been found in 0.4-3.4% of patients with primary central nervous system (CNS) tumors in Western countries, while the incidence is reported to be 5-8 times greater in Japan and the Far East. Although germinoma of medulla oblongata is rare and difficult to diagnose preoperatively, it should be included in the differential diagnosis of medulla masses with fourth ventricle extension, especially in Asian population.