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Giant Olfactory Groove Meningioma

This 74 year old lady presented with progressive depression. She had been treated medically for months but her symptoms did not improve. She then developed headaches and cognitive deficits such as poor short term memory became increasingly obvious. An MRI scan of the brain was eventually done, revealing a very large lesion of the anterior cranial fossa. Fig 1. Preoperative MRI T1+GAD. A. Axial, B. Sagittal, C. Coronal Surgery proceeded […]

Neck pains and occipital headaches – a rare pathology

A 69 year old male presented to his GP with a slowly progressive, 6 month history of left sided neck pains and occipital headaches. Examination was unremarkable and in particular, strengths and reflexes in all 4 limbs were normal. CT scan revealed some degenerative changes low down in the cervical facet joints and a referral was made to an orthopaedic spinal specialist, and from here facet joint injections were undertaken. […]

Occipital Neuralgia

Occipital neuralgia is a painful condition characterised by pain originating in the upper neck and back of the head. It radiates from the sub-occipital region over the top or side of the head and behind the eyes. Pain is described as paroxysmal shooting or stabbing in the dermatomes corresponding to the lesser and greater occipital nerves. Hypo- or dysaesthesia in the affected area can accompany the pain. The main symptom […]

Haemangioblastoma

This 43 male presented with progressive headaches and neck pain over many months. He also described some visual obscuration over that time. He had a CT scan without contrast and was referred for assessment. An MRI scan was performed, showing a large, highly vascular left sided posterior fossa tumour, with obstructive hydrocephalus (figs 1 and 2). Urgent treatment of the hydrocephalus was needed so he proceeded to an endoscopic 3rd […]

Chiari Malformations: A Curious Pathology

Chiari malformation (CIM) presents an interesting pathology, affecting both children and adults. It is described as a downward displacement of the cerebellar tonsils through the foramen magnum (Fig 1). This downward displacement of the cerebellar tonsils (more than 5-7mm below the foramen magnum) is the primary cause of signs and symptoms observed. This herniation can be a result of congenital or acquired malformations. There are several theories yet to be […]

Pineal Cysts

One of the most common referrals to Neurosurgeons is for evaluation of pineal cysts. The advent of widely available imaging such as MRI and CT scans has lead to a dramatic increase in findings such as this in patients who have presented often with very vague symptoms. As such they can be a diagnostic problem. By definition a pineal cyst is a benign fluid containing cyst within the tissue of the […]

Management of Brain Metastasis

Metastatic tumors are the most common neoplasm in the brain, occurring in 24-45% of all cancer patients and accounting for 20% of cancer deaths annually.  These rates are on the increase due to a boost in survival of patients with cancer because of modern therapies along with increased availability of advanced imaging techniques for early detection. Newer therapies such as immunotherapy prolong overall survival in some cancers such as Melanoma […]

Treatment of Spinal Metastases

Significant advances have been made in the  treatment of spinal metastases in recent years. Options have evolved from simple decompression surgery or conventional external bean radiotherapy (cEBRT) to complex multi-disciplinary treatments incorporating stereotactic radio surgery (SRS) and minimally invasive surgical techniques (MIS). This is important as 60% of all patients with cancer will develop spinal metastases and 5-10% will develop spinal cord compression. The aims of therapy for these patients […]

Trigeminal Neuralgia: Current Treatment Strategies

Trigeminal neuralgia (aka tic douloureux or Fothergill disease) can be extremely difficult to manage and can cause significant distress for patients with craniofacial pain. In this article, we will explore current treatment strategies to assist in treating patients with severe trigeminal neuralgia (TN). TN is characterised by paroxysmal excruciating, electric like pain lasting a few seconds to minutes. It is often triggered by sensory stimulus: shaving, talking, eating, drinking, washing, […]

The Role of Surgery for Malignant Glioma – Is it all good?

Surgery has an important role in the diagnosis and treatment of patients with most brain tumours, including glioma patients with a suspected brain tumour are usually referred straight to a neurosurgeon for that reason. Traditionally, brain tumour surgery has been a core activity and skill for neurosurgeons, but better outcomes for almost all patients with brain tumours (especially gliomas/GBM/malignant glioma) are achieved when the patient is managed by a neurosurgeon […]

Why doesn’t the immune system work against Brain Cancer?

That is a VERY good question. Why would the body allow tumour cells to grow and destroy the normal brain? Isn’t the immune system supposed to rid us of foreign and destructive material? The immune system certainly is supposed to do this. It a highly evolved and finely tuned system that in general works extremely well. There are checks and balances built into this system which can go wrong – […]

CMV and brain tumours

Cytomegalovirus (CMV) is a common virus in our community. Most adults will show serological evidence of of previous exposure. CMV can cause severe disease, but generally this is only in newborns or in immunosuppressed patients, such as those people having had a transplant. In the last few years, it has become clear that CMV can be identified in brain tumour tissue – both in primary gliomas (glioblastoma, astrocytoma, GBM) and […]

Tumour Treating Fields – A new treatment for Glioblastoma

Malignant gliomas (glioblastoma, GBM) are difficult to treat. Our current methods of treatment –  surgery, radiotherapy and chemotherapy – all help but are ultimately not curative. New treatments are desperately needed. In recent years, a new form of treatment has been developed which may have a role in the future – Tumour Treating Fields (TTFields). TTFields are low intensity, intermediate frequency electric fields that slow cell division therefore inhibit tumour […]

Dexamethasone – the potential downside

Brain tumours often cause swelling in the brain and this swelling makes the pressure effect of the brain tumour worse. Symptoms therefore can be exacerbated – headaches may be worse, or patients can be drowsy or the neurological deficits such as arm and leg weakness are exaggerated. For many years, corticosteroids (typically dexamethasone) have been used to reduce the swelling around brain tumours. Starting dexamethasone can be very effective in controlling […]

Spinal Case – Keyhole lumbar laminectomy

Patients with spinal stenosis usually present with symptoms of neurogenic cluadication, with bilateral leg pain with walking and standing. A CT or MRI will often make the diagnosis. Surgery is the appropriate treatment and the traditional operation is a decompressive lumbar laminectomy at the affected levels. The commonest level to be affected is at L4/5, and a normal surgical approach would usually require a midline incision of 10-15 centimetres. Patients would […]

Tumour of the brainstem

Ms Ip was a 66 year old lady in good health. She had an MRI brain scan for investigation of dizziness in 2012 and an enhancing lesion on the dorsal aspect of the medulla was observed. It was consistent with a haemangioblastoma, and thought to be incidental to the mild clinical symptoms. Observation was recommended (see figures 1 and 2). She remained stable but a repeat MRI scan in mid-2015 […]

DBS for Parkinsons: Current scientific and clinical status

Abstract There is currently no cure for Parkinson disease (PD). Disease management is directed primarily at motor symptom relief, but the impact of non-motor symptoms associated with PD should not be underestimated. Medical and surgical treatment options aim to increase functional independence and quality of life. Deep brain stimulation (DBS) has proven to be a safe, effective and cost-efficient surgical treatment option. In 2009, the Australian referral guidelines, developed to […]

Progressive dysembryoplastic neuroepithelial tumour

An interesting article in the Journal of Clinical Neuroscience lead by Dr Hamish Alexander and co-authored by Dr Anthony Tannenburg, Dr David Walker and Dr Terry Coyne. Click here to read the full journal article Abstract: Dysembryoplastic neuroepithelial tumour (DNET) is a benign tumour characterised by cortical location and presentation with drug resistant partial seizures in children. Recently the potential for malignant transformation has been reported, however progression without malignant […]

Ependymomas

A 75 year old female presented to her local hospital with pains in the chest and was admitted under a Respiratory Physician with (incidental) rib fractures, that in retrospect were old.  Clinical suspicion lead to further investigation and the diagnosis of an intradural mass at the level of T6 and T7 vertebrae.  An MRI suggested showed the mass with significant spinal cord compression, but despite these rather dramatic findings on […]

Meningiomas – Not always benign and/or curable

Recently we treated 3 adult male patients on the same day, all with meningiomas. Together they illustrate the fact that meningiomas are not always benign and slow growing, and when they occur in difficult positions it can make surgical treatment complex and risky. The first patient (65 year old male) originally presented 5 years previously with left sided weakness. At that time a right parafalcine frontoparietal meningioma was diagnosed and resected. […]

Falls off ladders – just don’t do it

Falls off ladders are a surprisingly common injury in our community, and whilst most amount to nothing more than dented pride when they occur, some are considerably more serious – just ask Mr Ian (Molly) Meldrum. Recently we had cause to treat yet another considerably more serious “ladder injury”.  A 56 year old man had been painting his ceilings at home when he fell off his ladder.  Whilst this may […]

Breakthrough Glioma Surgery

ABC TV News National, Tuesday 20 September, 2011 There has been an exciting breakthrough in brain surgery for sufferers of Glioma, with Australia’s first Gliolan-fluorescence guided surgery being performed by Dr David Walker of BrizBrain & Spine at the Wesley Hospital in September 2011. The surgery was overseen by Professor Walter Stummer, a leading German neurosurgeon, who is training neurosurgeons in this new technology. The successful operation introduced a new […]

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