This document provides an overview of various cystic diseases of the central nervous system from a surgical perspective. It discusses the classification, epidemiology, diagnosis and management of different types of CNS cysts including arachnoid cysts, neurenteric cysts, colloid cysts, epidermoid cysts, pineal cysts, and cystic lesions caused by conditions like neurocysticercosis. The document emphasizes the importance of imaging and histopathology in diagnosing cystic diseases and outlines surgical and medical treatment approaches depending on the specific cyst and whether it is causing symptoms.
Three grades of tumours are recognized:
(1) pineocytoma, the most common of all pineal parenchymal tumors
(2) pineal parenchymal tumor of intermediate differentiation
(3) pineoblastoma, the rarest but most malignant parenchymal cell tumor
Mediastinal cystic masses are well-marginated, round, epithelium-lined lesions that contain fluid. They include a variety of entities with overlapping radiologic manifestations and variable prognoses. Cysts comprise 15%–20% of all mediastinal masses (,1) and occur in all compartments of the mediastinum.
Three grades of tumours are recognized:
(1) pineocytoma, the most common of all pineal parenchymal tumors
(2) pineal parenchymal tumor of intermediate differentiation
(3) pineoblastoma, the rarest but most malignant parenchymal cell tumor
Mediastinal cystic masses are well-marginated, round, epithelium-lined lesions that contain fluid. They include a variety of entities with overlapping radiologic manifestations and variable prognoses. Cysts comprise 15%–20% of all mediastinal masses (,1) and occur in all compartments of the mediastinum.
Abstract
Carotid body tumors are rare, slow-growing, hypervascular neuroendocrine tumors. Although these tumors are benign neoplasm, they also have a tendency to malignant transformation. Complete surgical excision is the gold standard therapeutic modality for the treatment of carotid body tumors. Early surgical removal is recommended to prevent the development of larger and more advanced tumors, which are associated with higher morbidity and mortality. In this report, we presented three cases of carotid body tumor which were successfully treated with complete surgical excision, and reviewed the current literature. Furthermore, it was emphasized the necessity of early surgical management regardless of patient age and tumor size.
General features & management of Common neck lumps are described in this presentation. which are important for Medical students and ENT doctors.
Topics discussed in this presentation are
Cystic hygroma
Hemangioma
Branchial cyst
Thyroglossal cyst
Lipoma
Sebaceous cyst
Cervical lymphadenopathy
Tuberculosis
Carotid body tumor
Preauricular Cyst/Sinus
Lymphoma
It is a complete presentation on carcinoma penis, covering all aspects starting from premalignant lesions to details of squamous cell carcinoma penis including recent NCCN guidelines and steps of penectomy and lymph node dissection
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
3. Introduction
• CNS cysts are spectrum of lesions that
occupies space in the CNS.
• Clinical presentation depends on the
location & size and mimic tumors.
• The age, site, cyst wall & cyst content
provides an insight to its origin.
• Clinical exam & imaging is important.
• Histopathology is the gold standard to its
dx.
311/26/2020
4. Epidemiology
• 76% are neoplastic while 24% are non
neoplastic.
• Most non neoplastic lesions are cysts.
• Metastasis & arachinoid cysts are the most
common neoplastic & non neoplastic ICSOL
respectively.
• Cysts of CNS are usually benign.
• Intracranial cysts > intra spinal cysts.
• Infectious CNS cysts are more common in
developing countries.
411/26/2020
6. Arachnoid cysts (leptomeningeal cysts)
• Congenital lesions that arise from splitting of arachnoid
membrane.
• Do not communicate with ventricles or subarachnoid
space.
• Almost all occur in relation to an arachnoid cistern
(exception: intrasellar, the only one that is extradural
• ≈ 1% of intracranial m asses.
• Bilateral arachnoid cysts m ay occur in Hurler
syndrome (a mucopolysaccharidosis).
611/26/2020
8. Clinical features
Most are asymptomatic (incidental finding)
except in the suprasellar region
811/26/2020
9. Diagnosis
• CSF density
Hyperdense, if intracyst hemorrhage (rare)
May expand, thin/remodel bone
• Doesn't enhance
CTA: Posterior displacement of MCA in MCF Acs
• CT: Cisternography may demonstrate
communication with subarachnoid space
911/26/2020
10. Mgt
• For asymptomtic: follow -up imaging every 6–
8 months regardless of their size and location.
• For mass effect or symptomatic : Surgery
Options:
drainage by needle aspiration
Cyst wall fenestration it into basal cisterns
shunting of cyst into peritoneum
cystectomy
percutaneous ventriculo-cystostomy
ventricular drainage is ineffective. why? 1011/26/2020
11. Spinal arachnoid cysts
• Almost always dorsal
• most common in thoracic spine.
• Most are extradural aka arachnoid diverticula
• congenital or may follow infection or trauma.
• Usually asymptomatic, even if large.
Treatment: When symptomatic
1. percutaneous procedures: under MRI1 or CT guidance.
a) needle aspiration
b) needle fenestration
2. open surgical resection or fenestration
1111/26/2020
13. Neurenteric (enterogenous) cyst (NEC)
• a result of Congenital persistence of the
neurenteric canal (temporary duct b/n notochord
& primitive gut).
• lined by endothelium primarily resembling that of
the GI tract, or less often, respiratory tract.
• Intraspinal > intracranial (most common at
thoracic).
• Intradural intramedullary & Ventral in location.
• Spinal NEC may be associated endodermal sinus
cysts: spinal meningitis
1311/26/2020
14. Intracranial neurenteric cysts
• Rare, most common in p-fossa.
• Locations:
1. posterior fossa
a) cerebellopontine angle (CPA): usually
intradural, extraaxial
b) in midline anterior to brainstem
c) cisterna magna
2. supratentorial: suprasellar (possible
confusion with Rathke’s cleft cyst).
1411/26/2020
15. Diagnosis
• A midline mass in front of the brain stem/
spinal cord that is slightly hyperdense/intense
to CSF is NEC.
• Morphology: Smooth, lobulated, well-
demarcated.
1511/26/2020
16. Treatment
Surgery: if symptomatic
Spinal NEC
• surgical removal usually reverses the symptom s.
• Recurrence is uncommon with complete removal.
Intracranial NEC
• complete resection or marsupialization if capsule
adherent to brainstem
Outcome : good but Incomplete removal has
recurrence & requires long-term follow-up.
1611/26/2020
17. Rathke’s cleft cyst (Cystic Pituitary
Adenoma) (RCC)
• are nonneoplastic lesions that are thought to
be remnants of Rathke’s pouch.
• primarily intrasellar with /without suprasellar
extension.
1711/26/2020
18. Diagnosis
• Rule of thumb: a lesion with a nodule in the
sella is usually a RCC.
1811/26/2020
20. Colloid cyst
• slow-growing benign tumor comprising < 1%
of intracranial tumors
• Usual age of diagnosis: 20–50 yrs.
• Cells of origin: unknown
• classically occurs in the anterior 3rd ventricle,
blocking foramina of Monro →obstructive
hydrocephalus involving only the lateral
ventricles (≈ pathognomonic)
• enhances minimally or not at all on CT/MRI
2011/26/2020
22. Natural history
• incidence of being symptomatic
at 5 & 10 yr follow up: 0% & 8% respectively.
• ≈90% unchanged cyst or ventricular size.
• risk of sudden death(due to cardiovascular
instability from hypothalamic compression)
:controversial
2211/26/2020
24. Cont’d
Surgical options
• Shunt vs surgical resection:
• Currently, direct surgical preferred
1. to prevent shunt dependency
2. to reduce the possibility of progression
3. to void sudden neurologic deterioration
• Approach: transcallosal,
transcortical/transventricular
(only if hydrocephalus), ventriculoscopic ,
stereotactic
2411/26/2020
25. Epidermoid and dermoid cysts
Etiology
Developmental : Sequestration of surface
ectoderm at lines of two fusing ectoderm.
Acquired: trauma, surgery, LP
• Linear growth rate: like skin unlike neoplasm.
• Dermoids are predominantly intraspinal in
contrast to epidermoid cysts.
2511/26/2020
26. Location & clinical feature
• intracranial:
a) suprasellar: bitemporal hemianopsia and optic
atrophy, rarely pituitary dysfunction
b) sylvian fissure: seizures
c) CPA: trigeminal neuralgia, especially in young
d) basilar-posterior fossa: lower cranial nerve,
cerebellar, and/or corticospinal tract abnormalities
e) within the ventricular system : more within the
4th ventricle
2611/26/2020
27. Cont’d
• within the spinal canal:
a) most from thoracic or upper lumbar spine
b) epidermoids of the lower lumbar spine
may occur iatrogenically following LP
c) dermoids of the spinal canal are usually
associated with a dermal sinus tract: recurrent
spinal meningitis.
2711/26/2020
31. Treatment
Goal of surgery:
• Cautious Complete microsurgical excision to px
chemical (Mollaret’s) meningitis & post-op
communicating HCP.
• Peri-operative IV steroids and copious saline
irrigation during surgery.
• leave capsule if adherent to critical structures
(brainstem & vessels).
• Residual capsule: lead to recurrence
• XRT: no role & doesn’t prevent recurrence.
3111/26/2020
32. Pineal cyst
• 1-4% prevalence at imaging
• Etiopathogenesis: 3 major theories
Enlargement of embryonic pineal cavity
Ischemic glial degeneration +/- hemorrhagic
expansion
Small pre-existing cysts enlarge with
hormonal influences
3211/26/2020
33. Diagnosis
• Sharply-demarcated, smooth cyst behind 3rd
ventricle ,above tectum, below internal
cerebral veins.
• May flatten tectum, occasionally compress
aqueduct.
variable HCP (enlarged 3rd, lateral ventricles;
normal 4th V) with large cysts.
3311/26/2020
34. Natural History & Prognosis
• Size generally remains unchanged in males
• Cystic expansion of pineal in some females
begins in adolescence, decreases with aging
• Rare: Sudden expansion, hemorrhage ("pineal
apoplexy")
Treatment
• Usually none
• Atypical/symptomatic lesions may require
stereotactic aspiration or biopsy/resection
• Preferred approach: infra tentorial supra
cerebellar
3411/26/2020
35. Neuroglial cyst
Etiology
i. Intraparenchymal
• sequestration of lining embryonic neural tube
(neuroectoderm) within developing WM
ii. Subarachnoid space
• Leptomeningeal neuroglial heterotopia
3511/26/2020
36. Diagnosis
• Nonenhancing CSF-like parenchymal
cyst with minimal/no surrounding signal
abnormality.
• Location: anywhere, Frontal lobe most
common site
• Morphology: Smooth, rounded, unilocular
benign-appearing
cyst
3611/26/2020
37. Choroid plexus cyst
Etiology
• Lipid from desquamating, degenerating choroid epithelium accumulates
in choroid plexus
• Lipid provokes xanthomatous response
• commonest neuroepithelial cyst
• Prevalence increases with age
• Adult CPC: obstructive HCP (rare)
Diagnosis
• Older patient with "bright" choroid plexi on MRI
Location
• Atria of lateral ventricles most common site
• Attached to or within choroid plexus
• Usually bilateral:cystic mass(es) in choroid plexus glomi
3711/26/2020
38. Diagnosis
• Morphology: Cystic or nodular/partially cystic
mass(es) in choroid plexus glomi
• Natural History & Prognosis: Usually
asymptomatic & nonprogressive
• Treatment:none, Shunt for obstructive HCP
(rarely)
3811/26/2020
39. Choroid Fissure Neuroepithelial Cysts
Well-demarcated cysts along the choroid
fissure dorsal to the hippocampus.
On axial images, typically seen alongside
midbrain.
Exhibit CSF signal characteristics.
11/26/2020 39
40. Hippocampal sulcal remnant cysts
• extremely common and benign findings
• do not indicate hippocampal atrophy or d/se.
• often bilaterally and are located along the
length of the hippocampal body
• not associated with Alzheimer disease
11/26/2020 40
41. Ependymal cyst
• Arise from sequestration of developing neuroectoderm
• Typically young adults, less than 40 years
• Diagnostic clue: Non-enhancing thin-walled cyst with
CSF density/intensity
Location
• Intraventricular common, typically lateral ventricle
• central WM of temporoparietal and frontal lobes
Morphology: Smooth, thin-walled cyst
4111/26/2020
42. Cont’d
Natural History &Treatment
• Conservative management
if asymptomatic
• surgical excision or
decompression If
symptomatic.
• outcome: Rapid resolution
of symptoms after surgery
4211/26/2020
44. Porencephaly
• a cystic lesion lined by gliotic white matter of
cerebral hemisphere that usually communicate
with the ventricles.
Etiology
congenital: In utero vascular events / infection
(CMV)
Acquired: TBI, vascular occlusion, repeated
ventricular punctures or infection .
Location: Usually corresponds to cerebral arteries
territories
4411/26/2020
46. Treatment
• Usually no treatment is required
• Indications for surgery: Mass effect
(hemimacrocephaly, midline displacement),
localized/generalized symptoms, intractable seizures
Options:
• Cystoperitoneal shunt (preferred)
• If no communication with ventricular system:
Fenestration or partial resection of cyst wall
Children with intractable seizures and
porencephaly benefit from uncapping and cyst
fenestration to lateral ventricle
4611/26/2020
47. Schizencephaly
• is a neuronal migration anomaly characterized
by a cleft lined by heterotopic gray matter
that extends from the ependyma of the
lateral ventricles to the pial surface of the
cerebral cortex.
• absence of septum pellucidum in 80–90%
• presentation m ay range from seizures to
hemiparesis depending on size and location
4711/26/2020
48. Periventricular Leukomalacia
• white matter necrosis.
• most frequently occurs in premature infants of less
than 32 weeks gestation due to the unique anatomic
features of the brain at this age.
• The white matter of these infants is poorly
vascularized and contains oligodendrocyte
progenitors, which are sensitive to the effects of
ischemia and infection .
• The cortex is usually spared.why?
• Bilateral parieto-occipital location and larger than 10
mm are highly predictive of the development of
cerebral palsy.
4811/26/2020
53. Treatment
Medical rx : main stay of rx
• Antiparasitic therapy — Oral albendazole for
14 dys (reduces parasitic burden, seizures)
• Steroids should be used for 28 days.
• Antiseizure drug therapy
Antiparasitic rx C/I in patients with
encephalitic cysticercosis & ICP: use steroid
Surgical:
• obstructive vs communictive HCP: shunt
• intraventricular cysts causing obstruction:
Endoscopic resection
5311/26/2020
54. Hydatid cyst
• 2% in CNS (less in spinal cord)
• Parietal lobe commonest; MCA territory
Diagnosis :
• Serology
• CT & mri Findings
Large unilocular cyst mostly
with +/-detached germinal
membrane & daughter cysts.
isodense /isotense/ to CSF
No perilesional edema
No enhancement
11/26/2020 54
55. Treatment
• Surgery (cyst excision) remains the main
treatment .
• Albendazole10 to 15 mg/kg/day administered
continuously without interruptions can be
beneficial for inoperable patients & with
multiple cysts.
• optimal dosage and optimal duration of rx:
unknown.
5511/26/2020
59. Craniopharyngioma (CP)
• Develop from residual cells of rathke’s pouch.
• At anterior superior margin of the pituitary.
• Not malignant but behaves malignant
• Bimodal: 5-15 yr (50%) vs >50 yr.
• Almost all have solid and cystic components.
• Variable fluid in the cysts, cholesterol (usual).
• Calcification: 85% in childhood, 40% in adults.
5911/26/2020
63. Pilocytic astrocytoma (PCA)
• 5-10% of all gliomas
• Peak incidence: 5-15 years of age (>80%).
• WHO grade I
• causes obstructive hydrocephalus
• Associated with NF l
15% of NF l patients develop PCAs, mostly in optic
pathway
PCAs arising in the optic nerve are called optic
gliomas.
6311/26/2020
64. Location
• Cerebellum (60%) > optic nerve path
(25-30%) > adjacent to 3rd ventricle>
brainstem
• Size: Larger in cerebellum than optic nerve
6411/26/2020
67. Pleomorphic Xanthoastrocytoma
• < 1% of all astrocytomas
• Important cause of temporal lobe epilepsy
• WHO grade II
• Tumor of children/young adults
• Peripherally located mass, involves cortex and
meninges
• Site: Temporal >frontoparietal> occipital lobes
• 98% supratentorial
6711/26/2020
69. Treatment
• Surgical resection is treatment of choice
• Repeat resection for recurrent tumors
• Chemo radiation: show no significant
role.
6911/26/2020
70. Ganglioglioma
• Well differentiated, slowly growing neoplasm
of ganglion and glial cells
• Tumor of children, young adults ( 80% in <
30yr)
• occur anywhere in superficial hemispheres,
temporal lobe (commonest).
7011/26/2020
71. Morphology
• Three patterns.
Most common: Circumscribed cyst + mural
nodule
Solid tumor (often thickens, expands gyri)
Calcification is common
In younger pts <10 yr, larger & more cystic
7111/26/2020
75. Hemangioblstoma
• Benign vascular tumor of unknown origin
• Sporadic HGBL: Peak 40-60 y
• Familial: VHL-associated HGBLs occur at younger
age but are rare < 15Yr
• Location –95% posterior fossa (80% cerebellar
hemispheres)
• WHO grade I (No malignant change)
7511/26/2020
76. Imaging
• Best diagnostic clue – adult with intra-axial
posterior fossa cystic mass with enhancing
mural nodule abuttin pia.
• Morphology –60% with cyst + mural nodule.
7611/26/2020
77. Natural History
• Usually benign tumor with slow growth pattern
• Symptoms usually associated with cyst expansion
Treatment
• En bloc surgical resection (piecemeal resection
result in catastrophic hemorrhage)
• Surgery curative in cases of sporadic HGB, not in
VHL.
• Pre-operative embolization: reduce vascularity.
7711/26/2020
79. Cystic metastasis
• Squamous cell ca lung
• Adenocarcinoma lung
• Carcinoma thyroid
• Multiple
• Typically at gray-white matter junction
• Disproportionate edema
• Generally, metastatic lesions show no
restricted diffusion.
• After contrast injection, enhancement is variable in
morphology and frequently ringlike due to the presence of
central necrosis.
7911/26/2020
80. Cystic glioblastoma
CT
• well-defined intra-axial cystic lesion with peripheral ring enhancement
• usually presents with mass effect
• mild perifocal edema
• enhancing margin and soft tissue component
• MRI
• T1: homogeneously hypointense
• T1 C+ (Gd): enhancing margin and soft tissue component
• T2: hyperintense
• FLAIR: cystic areas show hyperintensity relative to CSF due to higher
protein contents
DWI/ADC: no restriction for the cystic component; the solid component may
show restriction according to the grade
cerebral glioblastoma containing a large cyst survive longer and have a
longer period before recurrence than those who lack such a cyst 1,2.
8011/26/2020
82. Dandy-Walker malformation and
variants
• Best diagnostic clue
Large PF +
big cerebrospinal fluid (CSF) cyst +
normal 4th ventricle (V) absent
Location: Posterior fossa
• Classic" DWM:
Small hypoplastic vermis - superiorly
rotated by cyst
torcular arrested in fetal position
(cyst mechanically hinders caudal
migration)
Ddx:
persistent Blake’s pouch cyst Mega
Cisterna Magna, archinoid cyst
Rx: shunt/ETV
8211/26/2020
83. Cavum Septum Pellucidum: bordered by the corpus callosum and the column
and body of the fornix
Cavum Vergae:
• Anterior border: posterior to the columns of the fornix.
• lateral borders:crus of the fornix,
• inferior border is the hippocampal commissure,
• roof and posterior wall : posterior body and the splenium of the corpus
callosum, respectively.
causes downward fornix displacement
Cavum septum interpositum: between the crus of the fornix and the
hippocampal commissure.
Causes caudal displacement of the internal
cerebral veins and anterior and superior displacement of the fornix
11/26/2020 83
84. Normal Variants of septum pelucidum
The septum pellucidum consists of two thin
laminae of white matter surrounded by gray matter
with a potential intervening space are separated in
utero but fuse from back to front
as the fetus approaches term or in the first few
weeks after birth.
The septum pellucidum is part of
the limbic system; although its exact function is
not completely understood, it seems to moderate
behaviors such as rage and arousal.
85.
86. Cavum Septi Pellucidum
• The cavum septi pellucidi persists when the
two leaves of septum pellucidum fail to fuse
• It is considered a normal variant due to its frequent
appearance and because a specific clinical syndrome
has not yet been identified with its occurrence.
• Recently, an enlarged cavum septi pellucidi serves as a
significant marker of cerebral dysfunction (4,5) and has
been described in various neuropsychiatric and
posttraumatic conditions (6).
• 5th ventrice? Not b/c no choroidal plexus &
ependymal lining.
87. Cavum Vergae
• a fluid-filled space between the two leaves of septum pellucidum
located posterior to an arbitrary vertical plane formed by the
columns of the fornix
• The cavum septi pellucidi and the cavum vergae usually
communicate with each other and obliterate from posterior to
anterior, the posterior cavum vergae obliterating first and then
usually the anterior cavum septi pellucidi.
• Thus a cavum vergae without a cavum septi pellucidi would be
unexpected.
• The cavum veli interpositi is separated from the cavum vergae by
the crura of the fornices (9).
• 6th ventrice? Not b/c no choroidal plexus & ependymal lining.
88. Cavum Veli Interpositi
• Development of the cavum veli interpositi is
independent of the septum pellucidum, and it is believed
to be the result of abnormal separation of the crura of the
fornices.
• The cavum veli interpositi is an anatomic
variation that may appear as a cyst in the pineal
region.
• It is a potential space above the tela choroidea of the third
ventricle and below the columns of the fornices. The
internal cerebral veins run inferiorly (9).