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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The available data in the literature (177 cases), two current clinical patients, and cases which occurred in The Netherlands (13) were reviewed concerning the clinical presentation, pathological features, radiological data, and treatment options of chondrosarcoma of the cranial base. The mean age of patients was 37 years, the male/female ratio 1:1.1. The most frequent complaints were diplopia with oculomotor disorders (51%), headache (31%), and decreased hearing, dizziness, and tinnitus with statoacusticus dysfunction (21%). The mean duration of symptoms before diagnosis was 27 months. The chondrosarcomas were located in the petrosal bone in 37% (47 cases), in the occipital bone and clivus in 23% (30 cases), in the sphenoid bone in 20% (25 cases) and to a lesser extent in frontal, ethmoidal, and parietal bones (14%). In 6% (eight cases) the primary location was in dural tissue. Radiological examinations showed bone destruction and variable calcification (CT), involvement of neuronal and vascular structures (MRI), and mostly hypovascularity on angiography. On histological examination 51% of tumours were classified as grade I, 11% grade II, 30% mesenchymal, and 8% myxoid. The mesenchymal type was the most malignant as illustrated by a strong tendency to intradural and cerebral growth and possibly occurrence in younger age groups. The treatment of choice until recently was surgery because of the critical location and local aggressive nature. Regrowth of tumour after surgery occurred in 53% of the patients (average after 32 months). Charged particle irradiation gave a five year survival of 83-94% and a local control rate of 78%-91%. Both in surgery and radiotherapy there is treatment related morbidity and mortality that should be considered when offering these therapies. Recent promising results imply that charged particle radiotherapy, in combination with surgery, may be the therapeutical choice of the future.
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PMID:Intracranial chondrosarcoma: review of the literature and report of 15 cases. 966 67

Intracranial chondrosarcoma (Ch-S) is a slow-growing, locally recurrent, malignant cartilaginous tumour of the skull base. Intracranial mesenchymal chondrosarcoma (MsCh-S) is a rarer, more malignant variant associated with the supratentorial meninges. Only seven cases of Ch-S, and six of MsCh-S, that were primarily intraparenchymal in origin have been reported. Moreover, no case of intracranial Ch-S or MsCh-S has been reported in which rhabdomyosarcomatous differentiation was prominent. A 17-year-old Asian girl presented with a 4-week history of occipital headache, vomiting and paraesthesia in the left hand. She was drowsy with a left hemiparesis and had a dilated right pupil with bilateral papilloedema. CT demonstrated a large, partly calcified, contrast-enhancing mass in the right temporo-parietal region with oedema and midline shift. Through a large craniotomy, a tense brain was encountered with no apparent cortical abnormality. Despite a radical tumour excision, with excellent initial clinical recovery, a local recurrence rapidly occurred within weeks prior to the administration of any radiotherapy. Initial histopathological examination revealed a primary MsCh-S with osseous and rhabdomyosarcomatous differentiation, with an indistinct margin. After a second radical excision, a second recurrence rapidly occurred; however, this proved excessively vascular and inoperable. Radiotherapy was declined and death followed within 3 weeks. This is the seventh case of primary intracerebral MsCh-S to be reported and the first to demonstrate rhabdomyosarcomatous differentiation. It was characterized clinically by rapid, local recurrence with increased vascularity.
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PMID:Primary intracerebral mesenchymal chondrosarcoma with rhabdomyosarcomatous differentiation: case report and literature review. 1170 46

A 28-year-old woman presented with left-sided frontotemporal headache lasting 6 wk. Head CT and MR imaging revealed a clival mass, which was interpreted as a chondrosarcoma. The lesion was removed at endoscopic endonasal surgery; histologic and immunohistochemical findings proved it to be neurenteric cyst. On CT scans, the lesion was lytic, with an intact cortex; it was uniformly hyperintense relative to gray matter on T1-weighted MR images and iso- to hypointense relative to CSF on T2-weighted MR images.
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PMID:Neuroradiologic-pathologic correlation in a neurenteric cyst of the clivus. 1190 Oct 22

A 63-year-old man was admitted to our hospital because of a large, firm tumor in the upper region of the anterior chest wall. The tumor measured 8 x 10 cm in diameter. A diagnosis of chondrosarcoma of the sternum was made cytologically from a percutaneous fine needle aspiration biopsy. The primary tumor was completely resected, but the sternum, ribs and clavicles were only partially resected. Another tumor was detected five months after resection and metastasis to the brain was recognized in December 2000. The patient, now suffering headaches and vomiting due to the intracranial hemorrhage around the metastatic lesion in the brain, was readmitted. Although temporary improvement of his general condition was achieved by conservative treatment, he suddenly died of respiratory failure because of multiple tumor emboli in the pulmonary artery. This was a very interesting case in that the chondrosarcoma was of sternal origin and was complicated by tumor emboli in the pulmonary artery.
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PMID:[A case of sternal chondrosarcoma with multiple pulmonary embolisms]. 1197 74

We present the case of a 13-year-old girl with a huge intracranial mesenchymal chondrosarcoma. She had suffered from severe headache, diplopia, intermittent nausea and vomiting for 1 month. Neurologic examination revealed bilateral blurred optic disc margins and abducens paresis. Magnetic resonance imaging demonstrated a giant, heterogeneous, intensely enhancing mass of 7 x 8 x 6 cm, occupying the bilateral frontal and left high parietal regions and based on the anterior cerebral falx. A presumptive diagnosis of aggressive meningioma was made. The patient underwent bicoronal craniotomy and gross total resection of the tumor. Pathologic examination revealed an extraskeletal mesenchymal chondrosarcoma. She was under regular follow-up and remained free of recurrence after surgery. In addition to the current case, we review previously reported cases of extraskeletal intracranial mesenchymal chondrosarcoma and discuss treatment strategies and outcomes.
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PMID:Extraskeletal intracranial mesenchymal chondrosarcoma: case report and literature review. 1523 36

Intracranial Mesenchymal Chondrosarcoma is a very rare and uncommon entity that affects young adults. We came across one such patient who presented with severe headache and intermittent nausea and vomiting. The clinical, radiological preoperative diagnosis was a meningioma, on histological examination it turned out to be mesenchymal chondrosarcoma of tentorial region in posterior fossa, uncommon site for this entity.
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PMID:Intracranial extra-skeletal mesenchymal chondrosarcoma. 1697 25

A 22-year-old, otherwise healthy, female Jehovah's Witness underwent resection of a midline skull base chondrosarcoma which had been detected after a work-up for headache and diplopia. After bilateral maxillectomies, ethmoidectomies, and a sphenoidectomy, the patient's chondrosarcoma was resected. Despite proper anesthetic management and meticulous hemostasis, significant intraoperative blood loss occurred. The initial postoperative hemoglobin level was 2.3 gm/dL. The clinical concerns pertaining to the perioperative management of the Jehovah's Witness are discussed along with the patient's course and management.
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PMID:Perioperative Management of a Jehovah's Witness Presenting for Skull Base Surgery. 1717 Sep 89

We report a 27-year-old male who presented with paroxysmal headache, stuffy nose, epistaxis and impairment of vision in each eye. A huge chondrosarcoma, arising from the skull base with extension into the middle cranial fossa and nasal cavity was suspected. The patient underwent craniotomy and endoscope-assisted transnasal resection and a satisfactory removal was achieved. Postoperative immunohistochemical examination confirmed the diagnosis of myxoma rather than chondrosarcoma. The patient remained neurologically intact except for poor vision in the left eye at six-month follow-up. The relevant literature was reviewed and discussed. The main treatment of myxomas of cranial base is by surgery.
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PMID:Huge primary myxoma of skull base: a report of an uncommon case. 1755 55

The region of the foramen magnum (FM) presents an especially difficult area for therapeutic intervention. Indeed, this location is challenging to access surgically, particularly in the case of intramedullary and anterior lesions. Therefore, the potential for morbidity associated with therapy to the foramen magnum, most frequently in the form of lower cranial nerve deficits, has encouraged the search for methods that can effectively treat lesions of this region while sparing the important neighboring structures. We report our experience in the use of Cyberknife radiosurgery as a treatment option for these lesions. Thirty-five patients (17 men, 18 women; mean age, 51 yr; range, 18-83) with 35 lesions either spanning or approximating the foramen magnum were treated with the CyberKnife radiosurgical system. Histologies were determined either by prior surgery or radiographic criteria and included 25 benign tumors (nine meningiomas, five schwannomas, four neurofibromas, three hemangioblastomas, two ependymomas, one chordomas, and one pilocytic astrocytoma) along with 10 malignant growths (nine metastases and one chondrosarcoma). Twenty-seven (77%) patients presented with at least one sign and/or symptom, while eight (23%) patients were completely asymptomatic. The most common symptoms were headache, limb numbness, and limb/truncal ataxia, all of which were reported by ten (29%) patients. Among cranial neuropathies, CN XII dysfunction was evident in four (11%) patients. The specific fractionation schedule (mean of 1.8 sessions; range, 1-5) was based on the size of the treated lesion. The mean dose utilized was 19 Gy. Radiographic follow-up was obtained for twenty-three (66%) patients. Nine of the twenty-three (39%) were stable in size, ten lesions decreased in size (43%), and four lesions increased in size (17%). In terms of symptom relief, follow-up was collected for twenty-four (69%) patients. Eleven (46%) of these patients experienced no change in their signs or symptoms, while seven (29%) patients experienced improvement. Six (25%) patients witnessed deterioration in their signs and symptoms. Overall, eighteen (75%) patients had their signs and symptoms either stabilize or improve. There were eleven (31%) deaths in our series, eight of which were related to the disease (though not directly related to CyberKnife treatment) and three of which were from unrelated causes. Complications directly related to CyberKnife radiosurgery were noted in four (11%) of the thirty-five patients. These included one case of temporary emesis immediately following treatment, one case of cystic enlargement two months out, and two cases of radiation necrosis (occurring 1.5 yrs and 2.5 yrs out from treatment). Cyberknife radiosurgery can be an effective treatment for many foramen magnum lesions.
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PMID:CyberKnife radiosurgery for lesions of the foramen magnum. 1766 41

Primary cranial chondrosarcoma in an uncommon cartilaginous tumours of which the myxoid variant is the least reported in the literature. This tumour accounts for 0.15% of all primary intracranial lesions and 6% of all skull base tumours. Chondrosarcomas are frequently misdiagnosed as chordomas, which have a different prognosis. Differential diagnosis is very important because, when treated with similar aggressive treatment strategies, chondrosarcoma has a much better prognosis than chordoma. We describe a 54-year-old female with a 9-month history of left ophtalmoplegia and increasing headache. MR imaging of the head showed a sellar and left parasellar mass. We performed a gross total removal of the mass via a left pterional approach. The histopathologic diagnosis was of a myxoid chondrosarcoma. A post-operative contrast-enhanced computed tomography (CT) scan of the head showed a total removal of the neoplasm. After surgery, the patient showed a transitory dysphasia with right hemiparesis, but they both considerably improved before discharge. Review of the literature was identified using the Medline database: only 10 cases in the worldwide literature were identified to report on this kind of tumour. We present a case report of myxoid chondrosarcoma, a rare variant of chondrosarcoma, with sellar and left parasellar localization. This histopathological type is a low-grade variant and its total removal is effective.
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PMID:Parasellar myxoid chondrosarcoma: a rare variant of cranial chondrosarcoma. 2219 91


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