Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0017638 (glioma)
 30,880 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

10 patients in whom an early post operative alteration of the level of consciousness or of the neurological status could be related to a tension pneumocephalus are reviewed. Four underwent a surgical procedure in the sitting position. Among these, 2 had been previously shunted for hydrocephalus. A 5th patient underwent a IIId ventriculocisternostomy for tumorous occlusion of the aqueduct. The other five patients were involved with supra-tentorial conditions (hemispheric glioma: 1 case, meningioma: 1 case, chronic subdural hematoma: 3 cases). The post-operative deterioration clinically suggested a post operative hematoma. CT showed a very low density effusion either located in the operative area or in the subdural space or both, with significant mass effect. 9 patients steadily improved after conservative therapy. In 1 case, reoperation was required. Pathogenesis of symptomatic pneumocephalus remains controversial. The role of the sitting position and of CSF drainage seem likely. Spontaneous or nitrous oxide induced expansion of post-operative residual intra cranial air plays a debatable role. It is postulated that tension pneumocephalus may result from a discrepancy between spontaneous reexpansion of the cerebral mass and a residual air collection. Such complications are regarded as serious enough to justify several preventive measures.
 ...
PMID:[Intracranial pneumocephalus under pressure. A possible cause of postoperative deterioration in neurosurgery. 10 cases]. 361 96

We present the case history of a 23-year-old man who underwent frontal craniotomy followed by radiotherapy for a Grade III anaplastic glioma. Magnetic resonance imaging (MRI) at the 3-month follow-up showed significant tumour response. He became unwell some weeks after the MRI with an upper respiratory tract infection, severe headache and mild right-sided weakness. A computed tomographic (CT) scan showed a very large volume of intracranial gas, thought to have entered via a defect in the frontal air sinus after craniotomy and brought to light by blowing his nose. Intracranial air is frequently present after craniotomy, but it is normally absorbed within 34 weeks. The presence of pneumocephalus on a delayed postoperative CT scan should raise the possibility of a cerebrospinal fluid (CSF) fistula, or infection with a gas-forming organism. Many CSF fistulae require surgical closure in order to prevent potentially life-threatening central nervous system infection and tension pneumocephalitis. Immediate neurosurgical review is advisable.
 ...
PMID:Gas in the cranium: an unusual case of delayed pneumocephalus following craniotomy. 1085 52

The mitogen-activated protein kinase (MAPK) pathway consists of the Ras/Raf/MEK/ERK signaling cascade, and its upregulation plays a major role in the pathogenesis of pediatric astrocytomas and molecular inhibitors of this pathway including trametinib and dabrafenib have been tested in early-phase clinical trials and used by pediatric oncologists in children with BRAF-mutated gliomas. We report a clinical case where a child with progressive BRAF-mutated glioma developed an uncommon and difficult to manage complication - pneumocephalus from intracranial air entry and trapping through dehisced surgical wounds and preexisting skull burr holes. The patient's wound breakdown coincided with skin toxicity from MEK inhibitor therapy. With increasing use of targeted molecular inhibitors in pediatric neuro-oncology, this case illustrates the potentially complicated course of MEK inhibitor therapy in patients with scalp surgical wounds and burr holes that were placed within few weeks from initiation of drug therapy, especially if patients have additional factors that can contribute to poor wound healing such as use of steroids and malnutrition.
 ...
PMID:Pneumocephalus in a Pediatric Patient with Glioma Receiving Trametinib. 3166 99