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Ganglioglioma in the cerebellopontine angle in a child

Case report and review of the literature

Brian D. Milligan, Caterina Giannini and Michael J. Link

often not possible without significant neurological morbidity. Postoperative adjuvant therapy following subtotal resection of gangliogliomas is controversial regardless of the tumor's location. Among posterior fossa gangliogliomas, tumors located in the CPA are extremely rare, with only four previously reported cases. 1 , 13 , 16 We present a case of a CPA ganglioglioma and review the current literature on operative and adjuvant therapy. Case Report History and Presentation This 12-year-old boy from the Middle East presented with an 18-month history of

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Michael J. Link, Paul L. Cohen, John C. Breneman and John M. Tew Jr.

that of epidermoids. Treatment of such a malignancy can be problematic, particularly if there is intimate involvement of the brainstem. We report on the case of a woman with a CPA epidermoid tumor that subsequently degenerated into a squamous cell carcinoma. The neuroimaging identification, surgical management, subsequent adjuvant therapy, and follow-up care of this patient with this unusual pathological entity are discussed. Case Report History and Examination This 57-year-old woman initially presented in July 1996 with a 10-year history of left

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Michael J. Link, Thomas C. Schermerhorn, Jimmy R. Fulgham and Douglas A. Nichols

–40% of cases), focal neurological deficit and seizures (50–60% of cases), or diffuse encephalopathy (10–20% of cases). 2, 7–9 Intravenous or oral anticoagulant therapy may be combined with endovascular thrombolysis, symptomatic treatment of seizures or increased intracranial pressure, and the correction of any causal agent that may be present. The presence of both disorders in the same patient poses a treatment dilemma. We describe a patient who had a Spetzler—Martin Grade 5 AVM 33 and progressive intracranial venous thrombosis secondary to Leiden factor V

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Mark P. Piedra, Paul D. Brown, Paul C. Carpenter and Michael J. Link

ranges, indicating normal anterior pituitary function. The history and laboratory findings supported the diagnosis of DI. Magnetic resonance imaging of the head, including sequences obtained with Gd enhancement, demonstrated thickening and enlargement of the pituitary stalk, which was compatible with a solitary metastasis ( Fig. 1 ). The patient's polyuria and polydipsia were initially controlled with DDAVP (0.1 mg/day) therapy. Fig. 1. Pretreatment coronal unenhanced (A) and Gd-enhanced (B) T 1 -weighted MR images revealing enlargement of the pituitary stalk

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Kelly D. Flemming, Michael J. Link, Teresa J. H. Christianson and Robert D. Brown Jr.

 DVT/PE 2  headaches 2  unclear 6 * CAD = coronary artery disease; DVT/PE = deep venous thrombosis/pulmonary embolism. Of the 6 patients on a regimen anticoagulation therapy, one had initially presented with hemorrhage. During follow-up, 1 patient had an intraventricular hemorrhage of unclear but doubtful relationship to the cavernous malformation, and the remaining patients had no new symptoms. The patient with an intraventricular hemorrhage was known to have a tiny Type III ICM in the left cerebellum that was asymptomatic in 1991. The patient

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Brian D. Milligan, Bruce E. Pollock, Robert L. Foote and Michael J. Link

recorded the time-to-occurrence of specific postprocedural events including new persistent trigeminal neuropathy, temporary or permanent facial weakness of at least 1 HB grade, loss of serviceable hearing, new ataxia, vestibulopathy or imbalance, requirement for steroid therapy for radiation-induced edema, and radiographic or clinical GKS failure. We defined radiographic failure as an increase in the maximum tumor diameter by at least 2 mm on serial MR imaging examinations. Clinical failure was defined as the need for an additional VS-related intervention, such as

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Bruce E. Pollock, Michael J. Link and Robert L. Foote

radiosurgery. Radiographically demonstrated tumor control (absence of progressive growth) was 96% at 3 years and 94% at 7 years after radiosurgery. Twelve patients (4%) underwent tumor resection after failed radiosurgery, 1 patient had fractionated radiation therapy, and 2 patients are being monitored without additional treatment. Clinical tumor control (absence of further tumor-directed therapy) was 97% at 3 years and 94% at 7 years after radiosurgery. Tumor control was significantly better in patients treated before April 1997 (98% at 3 and 7 years after radiosurgery

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Michael J. Link, Robert J. Coffey, Douglas A. Nichols and Deborah A. Gorman

D ural arteriovenous fistulas (AVFs) are a unique set of acquired vascular malformations. 27, 32, 48, 62 They have been managed in a variety of ways including clinical observation, 1, 6, 12, 23, 30, 35, 36, 41, 49, 63, 66 manual vascular compression, 19, 20 endovascular therapy, 7, 10, 11, 14–16, 18–21, 24, 29, 31, 35, 37, 42, 44, 45, 47, 50, 51, 53, 54, 58, 60, 63–65 radiosurgery, 3, 8, 13, 25, 34, 39, 40, 55 and/or surgical resection. 2, 5, 17, 22, 28, 43, 56, 59 Curative treatment has been recommended for patients with neurological signs or symptoms

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Jean Régis, Christine Delsanti and Pierre-Hugues Roche

versus those remaining stable. The authors describe a threshold of annual growth of 2.5 mm; 97% of those with lower annual growth were afterward in the stable or decreasing group, and only 69% were in the group with a higher annual growth. It is of the utmost importance to note that in this study some patients were followed up for as little as 14 months, and among the patients in whom the selected treatment failed, some underwent salvage therapy as early as 2 years after radiosurgery! In 2002 we reported that a significant percentage of our patients demonstrated

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Vini G. Khurana, Michael J. Link, Colin L. W. Driscoll and Charles W. Beatty

. 2 ), was reported to be negative for intracranial pathological findings and a provisional diagnosis of Ménière disease was made. Three years later, the patient noted near-complete left-sided deafness and a sensation of fullness or pressure in her left ear. Hydrochlorothiazide therapy was initiated, which she thought relieved the sensation of fullness. Two years later the patient experienced episodes of nausea and unsteadiness, and 1 year after this she suffered her first episode of acute-onset, transient, severe vertigo. Results of repeated MR imaging performed at