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

A Case of chordoma of the base of the skull is reported. It had been present with minimal symptoms for six years during which the clinical picture was limited to nasal obstruction and headache. Comparison of initial X-rays and the preoperative assessment revealed progressive destruction of the base of the skull which indicated the likelihood of considerable difficulties in excision. Surgical treatment posed the problem of the approach and emphasised the absence of encapsulation and the incomplete nature of the operation. The development of new symptoms (diplopia, dysphagia) resulted in complementary radiotherapy. The authors take the opportunity to point out the polymorphous clinical nature of these tumours in relation to their site and the criteria of the histological diagnosis. The possibilities of treatment are discussed. Abstention from treatment is formally rejected and, on the contrary, the emphasis is placed upon the need for early treatment. The consequences of excision should be limited by using a minimal surgical technique when possible. Complementary radiotherapy is necessary and may be repeated, up to certain limits, in the case of recurrence if the first irradiation is felt to be effective. There is no parallel between histological appearances and the response to treatment. The possibilities of chemotherapy would appear to be limited.
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PMID:[Chordoma of the base of the skull. Clinical and histological study. Therapeutic possibilities (author's transl)]. 52 48

The case of a 74-year-old woman with chondroid chordoma is presented. This tumor is an uncommon variant of typical chordoma and occurs in less than 1% of all intracranial tumors. The mean age of occurrence is approximately 36 years, 38 years younger than the woman in this study. Classical symptoms of intracranial chordoma were noted in this patient, including headaches, diplopia, third nerve palsy and sixth nerve palsy. Differentiation of this tumor from classic chordoma is important because chondroid chordoma has a substantially superior progress.
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PMID:Chondroid chordoma: case report and literature review. 199 98

Twenty cases of a rare tumor, chordoma involving the nasal cavity, paranasal sinuses, or nasopharynx, are reported. Patients most often had localized headache, nasal obstruction, decreased hearing, or symptoms related to cranial nerve involvement, especially diplopia. A mass bulging into the nasopharynx, posterior nasal cavity, or pharynx was found on physical examination in 13 of these 20 patients, and in another 6 patients on radiologic examination. Paralysis of one or more cranial nerves was identified in the majority of patients who had tumors involving the upper nasopharynx. On radiologic examination, bone destruction was frequently identified in the clivus and sphenoid areas, and less commonly in the cervical vertebrae. Each patient had biopsy-proven tumor in the nasopharynx or sphenoid areas. Patients usually were treated by combinations of surgery and radiotherapy, in some cases leading to prolonged periods of apparent tumor control. Radiotherapy frequently resulted in regression of symptoms, sometimes lasting many months or years. A few tumors that involved mainly the lower nasopharynx were more amenable to surgical resection, in one case leading to apparent tumor control. In those cases with adequate follow-up information, most patients had either died of their disease or were living with recurrent or persistent inoperable tumor. Some patients lived for many months or years between recurrences or with known tumor, indicating that chordomas often are slowly growing neoplasms. The histologic features of these chordomas are described and illustrated, and the histopathologic differential diagnosis is discussed.
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PMID:Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIV: Chordomas. 241 83

We are reporting a rare case of clivus chordoma with fatal hemorrhage in the posterior fossa. A 38-year-old woman afflicted with sudden onset of severe headache and vomiting. On neurological examination, she was mildly lethargic. She had slight dysarthria and nystagmus, but no cranial nerve abnormalities. Craniogram revealed erosive changes in the right petrous bone. CT scan showed a massive intracerebellar hemorrhage and isodense mass in the sphenoid sinus, which were not enhanced by contrast medium. She became comatose and died 3 days later. No operation was performed. Autopsy revealed massive hemorrhage in the posterior fossa and yellowish, gelatinous tumor extending from the right clivus to the sphenoid sinus. Histological examination showed a chordoma. This case demonstrates that the hemorrhage associated with brain tumor, especially in posterior fossa, produces a significant sudden elevation of intracranial pressure and leads clinically to a rapid loss of consciousness and death soon after the onset.
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PMID:[A case of clivus chordoma showing hemorrhage in the posterior fossa]. 306 8

A case of clival chordoma without bone destruction is reported. A 28-year-old man was admitted to Kagoshima University Hospital on April 8, 1983 with the complaints of headache, displopia and gait disturbance. Neurological examination revealed the right eighth, ninth, tenth nerve palsy and gait disturbance. Plain skull firms showed no abnormality and left vertebral arteriography revealed a displacement of basilar artery to the left side. The CT scanning showed a low density area at the retroclival region, and enhancement was acquired slightly. Metrizamide cisternography, CT cisternography showed retroclival round tumor and no destruction of the bone. The tumor which invaded intradurally was removed totally. Histological examination confilmed the chordoma. In this report, it will be stressed that when clival chordoma invades intradually, subtemporal approach will be most favorable, and metrizamide CT cisternography is one of the useful diagnostic procedures of retroclival mass.
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PMID:[A case of clival chordoma without bone destruction]. 371 80

A 49 year old man had had headache and some cranial nerve paralyses for about three years. A tentative diagnosis of meningioma of the skull base or chordoma was made before his death. In the postmortem examination, a large tumor lying on the skull base was found. The sella turcica, a part of the basilar bone were destroyed. The neoplasm had invaded the adjacent cerebrum, cranial nerves and extra-cranial tissues. Histopathologically, the lesion showed a typical poorly-differentiated plasmacytoma. Both clinic and pathologic characteristics of this tumor are discussed and the literature on solitary intracranial plasmacytoma is reviewed.
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PMID:[Solitary intracranial plasmacytoma--a case report and review of the literature]. 376 46

The clinical presentation and the results of operative and radiation therapy in a series of 26 patients with cranial chordomas seen at the University of California, San Francisco, between 1940 and 1984 are reviewed. There were 14 men and 12 women, with a mean age of 39.6 years. Six patients had chondroid chordomas. The most common presenting symptoms were headache and diplopia, and the most common presenting sign was extraocular palsy. Fifty-three operations directed at removal of the tumor were performed. Twenty-three patients received various forms of radiation therapy postoperatively, including conventional external beam therapy, heavy charged particles, and interstitial implants. The average length of follow-up is 5.6 years. Eleven of 26 patients have died; the mean duration of survival in this group, excluding 1 perioperative death, was 4 years and 2 months. Although the average survival time of 6 years and 4 months was the same in patients with typical chordomas (excluding the perioperative death and 1 patient lost to follow-up) and in those with the chondroid variant, all of the latter are still alive, whereas more than half of the patients with typical chordoma have died.
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PMID:Cranial chordomas: clinical presentation and results of operative and radiation therapy in twenty-six patients. 406 25

The presentation and results of treatment are reviewed for 38 patients with skull base chordoma treated at the National Hospital for Neurology and Neurosurgery between 1958 and 1988. With few exceptions, previous studies have combined results for clival and sacral chordomas, or for chordomas and other similar tumours such as chondrosarcoma, and thus it is difficult to be specific about effects of therapy. This study included histological review using immunohistochemistry to confirm diagnosis. Analysis of the survival data for our patients suggests that there are two subgroups with distinct survival patterns: one group with high mortality within the first 5 years, and a second group with an indolent disease process and near normal life expectancy. The age of the patients at presentation ranged from 7 to 78 years, with a mean of 44.3 years. Male: female distribution was 6:5. The commonest presentation was with cranial nerve palsy (94%) or with headache (60%). The most frequently involved cranial nerve was the VIth (60%), followed by the IXth and Xth (40% each). Comparing our results with those of 50 years ago, there was little improvement in the outlook for these patients, despite improvements in surgical approaches and the use of radiotherapy. The promising results in skull base tumours using proton therapy must be treated with caution until definite criteria for diagnosis and outcome have been established. There is a case for a multicentre prospective study of this disease.
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PMID:Skull base chordomas: a review of 38 patients, 1958-88. 833 44

Review of the clinical features of 48 patients with chordoma and 49 patients with low-grade chondrosarcoma of the skull base disclosed overlapping clinical profiles but distinctive features. Both tumors occurred at all ages but chondrosarcoma tended to occur in the third and fourth decades. Twenty-five (52%) of the patients with chordoma and 24 (49%) of the patients with chondrosarcoma had ocular symptoms (diplopia or visual impairment) as the initial manifestation of the disease. Of the 59 patients (both groups) with diplopia, the diplopia was initially intermittent in 25 (42%). Headache and diplopia from an insidious abducens nerve palsy was most common in both groups. Abducens nerve palsy occurred in 22 (46%) of the patients with chordoma and 23 (47%) of the patients with chondrosarcoma. Normal examination results were more common in patients with chordoma, whereas visual loss, facial numbness, and multiple cranial neuropathies were more common in patients with chondrosarcoma. The similarities in the clinical features of these tumors reflect their common origin at the central skull base and the vulnerability of the abducens nerves at that site. The differences reflect the tendency of chordomas to originate from the clivus and chondrosarcomas to originate from the temporal bone.
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PMID:Neuro-ophthalmologic findings in chordoma and chondrosarcoma of the skull base. 842 Mar 85

A 29-year-old man presented with headache, confusion, word-finding difficulty, and a visual field deficit 16 months after complete removal of a sacrococcygeal chordoma. Magnetic resonance imaging of the head demonstrated two discrete enhancing left occipital lesions with associated cerebral edema. Both masses were surgically excised and their histological appearance was consistent with chordoma. Chordoma from the sacral region is known to metastasize to the lungs and the vertebral bodies but has rarely been shown to spread to the brain. Dissemination to the brain in this case may be related to the extent of the metastatic pulmonary disease and the anaplastic appearance of the primary tumor.
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PMID:Sacrococcygeal chordoma metastatic to the brain with review of the literature. 854 71


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