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Erschienen in: Child's Nervous System 6/2009

01.06.2009 | Case Report

Pathophysiological mechanism of ipsilateral cerebral and brainstem hemiatrophy in basal ganglia germ cell tumors: case report

verfasst von: Sui-To Wong, Shing-Chau Yuen, Dawson Fong

Erschienen in: Child's Nervous System | Ausgabe 6/2009

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Abstract

Introduction

The basal ganglia is an uncommon location for germ cell tumors. It has been reported that basal ganglia germinomas and mixed germ cell tumors are associated with ipsilateral cerebral and brainstem hemiatrophy on presentation. Several pathophysiological mechanisms including autoimmune process and direct tumor infiltration of the thalamus or the internal capsule have been postulated to explain this association.

Case reports

The authors report two boys, aged 7 and 10, with basal ganglia germ cell tumors. Both of them presented with gradual onset of hemiparesis and had features of ipsilateral cerebral and brainstem hemiatrophy on imaging studies. They underwent chemotherapy followed by reduced dose radiotherapy with good response.

Discussion

Pathophysiological mechanisms of the associated ipsilateral cerebral and brainstem hemiatrophy are discussed. The authors postulate that the gradual obliteration of the perforating arteries to the diencephalon especially the lenticulostriate arteries of the prebifurcation middle cerebral artery may be the major mechanism of the associated hemiatrophy.
Literatur
1.
Zurück zum Zitat Donzelli R, Marinkovic S, Brigante L, de Divitiis O, Nikodijevic I, Schonauer C, Maiuri F (1998) Territories of the perforating (lenticulostriate) branches of the middle cerebral artery. Surg Radiol Anat 20:393–398PubMedCrossRef Donzelli R, Marinkovic S, Brigante L, de Divitiis O, Nikodijevic I, Schonauer C, Maiuri F (1998) Territories of the perforating (lenticulostriate) branches of the middle cerebral artery. Surg Radiol Anat 20:393–398PubMedCrossRef
2.
Zurück zum Zitat Echevarria ME, Fangusaro J, Goldman S (2008) Pediatric central nervous system germ cell tumors: a review. Oncologist 13:690–699PubMedCrossRef Echevarria ME, Fangusaro J, Goldman S (2008) Pediatric central nervous system germ cell tumors: a review. Oncologist 13:690–699PubMedCrossRef
3.
Zurück zum Zitat Hamada H, Awa H, Kadota K, Kobayashi E, Asakura T (1977) Ipsilateral cerebral hemiatrophy and precocious puberty produced by astrocytoma—a case report. No Shinkei Geka 5:1181–1187 JapanesePubMed Hamada H, Awa H, Kadota K, Kobayashi E, Asakura T (1977) Ipsilateral cerebral hemiatrophy and precocious puberty produced by astrocytoma—a case report. No Shinkei Geka 5:1181–1187 JapanesePubMed
4.
Zurück zum Zitat Higano S, Takahashi S, Ishii K, Matsumoto K, Ikeda H, Sakamoto K (1994) Germinoma originating in the basal ganglia and thalamus: MR and CT evaluation. Am J Neuroradiol 15:1435–1441PubMed Higano S, Takahashi S, Ishii K, Matsumoto K, Ikeda H, Sakamoto K (1994) Germinoma originating in the basal ganglia and thalamus: MR and CT evaluation. Am J Neuroradiol 15:1435–1441PubMed
5.
Zurück zum Zitat Jayakumar PN, Rao TV, Arya BY, Jain VK (1987) Hemiatrophy and glioblastoma. Surg Neurol 27:291–294PubMedCrossRef Jayakumar PN, Rao TV, Arya BY, Jain VK (1987) Hemiatrophy and glioblastoma. Surg Neurol 27:291–294PubMedCrossRef
6.
Zurück zum Zitat Kim CH, Paek SH, Park IA, Chi JG, Kim DG (2002) Cerebral germinomas with hemiatrophy of the brain: report of three cases. Acta Neurochir 144:145–150CrossRef Kim CH, Paek SH, Park IA, Chi JG, Kim DG (2002) Cerebral germinomas with hemiatrophy of the brain: report of three cases. Acta Neurochir 144:145–150CrossRef
7.
Zurück zum Zitat Kim DI, Yoon PH, Ryu YH, Jeon P, Hwang GJ (1998) MRI of germinomas arising from the basal ganglia and thalamus. Neuroradiology 40:507–511PubMedCrossRef Kim DI, Yoon PH, Ryu YH, Jeon P, Hwang GJ (1998) MRI of germinomas arising from the basal ganglia and thalamus. Neuroradiology 40:507–511PubMedCrossRef
8.
Zurück zum Zitat Klein O, Voirin J, Civit T, Auque J, Marchal JC (2007) Germinoma located in the basal ganglia in an 8-year-old girl. Childs Nerv Syst 23:105–108PubMedCrossRef Klein O, Voirin J, Civit T, Auque J, Marchal JC (2007) Germinoma located in the basal ganglia in an 8-year-old girl. Childs Nerv Syst 23:105–108PubMedCrossRef
9.
Zurück zum Zitat Kuhn MJ, Johnson KA, Davis KR (1988) Wallerian degeneration: evaluation with MR imaging. Radiology 168:199–202PubMed Kuhn MJ, Johnson KA, Davis KR (1988) Wallerian degeneration: evaluation with MR imaging. Radiology 168:199–202PubMed
10.
Zurück zum Zitat Kuhn MJ, Mikulis DJ, Ayoub DM, Kosofsky BE, Davis KR, Taveras JM (1989) Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging. Radiology 172:179–182PubMed Kuhn MJ, Mikulis DJ, Ayoub DM, Kosofsky BE, Davis KR, Taveras JM (1989) Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging. Radiology 172:179–182PubMed
11.
Zurück zum Zitat Kumar N, Kotagal S, Parisi JE, Westmoreland BF (2006) Cerebral hemiatrophy with superficial siderosis and PLEDs due to a germ cell tumor of the basal ganglia. Eur J Neurol 13:904–907PubMedCrossRef Kumar N, Kotagal S, Parisi JE, Westmoreland BF (2006) Cerebral hemiatrophy with superficial siderosis and PLEDs due to a germ cell tumor of the basal ganglia. Eur J Neurol 13:904–907PubMedCrossRef
12.
Zurück zum Zitat Kwak R, Saso SI, Suzuki J (1978) Ipsilateral cerebral atrophy with thalamic tumor of childhood. Case report. J Neurosurg 48:443–449PubMed Kwak R, Saso SI, Suzuki J (1978) Ipsilateral cerebral atrophy with thalamic tumor of childhood. Case report. J Neurosurg 48:443–449PubMed
13.
Zurück zum Zitat Liu E, Robertson RL, du Plessis A, Pomeroy SL (1999) Basal ganglia germinoma with progressive cerebral hemiatrophy. Pediatr Neurol 20:312–314PubMedCrossRef Liu E, Robertson RL, du Plessis A, Pomeroy SL (1999) Basal ganglia germinoma with progressive cerebral hemiatrophy. Pediatr Neurol 20:312–314PubMedCrossRef
14.
Zurück zum Zitat Maehara T, Machida T, Tsuchiya K, Iio M (1983) Brain tumors with ipsilateral cerebral hemiatrophy. AJNR 4:478–480PubMed Maehara T, Machida T, Tsuchiya K, Iio M (1983) Brain tumors with ipsilateral cerebral hemiatrophy. AJNR 4:478–480PubMed
15.
Zurück zum Zitat Marinkovic S, Gibo H, Milisavljevic M, Cetkovic M (2001) Anatomic and clinical correlations of the lenticulostriate arteries. Clin Anat 14:190–195PubMedCrossRef Marinkovic S, Gibo H, Milisavljevic M, Cetkovic M (2001) Anatomic and clinical correlations of the lenticulostriate arteries. Clin Anat 14:190–195PubMedCrossRef
16.
Zurück zum Zitat Marinkovic SV, Milisavljevic MM, Kovacevic MS, Stevic ZD (1985) Perforating branches of the middle cerebral artery. Microsurgical anatomy of their intracerebral segments. Stroke 16:1022–1029PubMed Marinkovic SV, Milisavljevic MM, Kovacevic MS, Stevic ZD (1985) Perforating branches of the middle cerebral artery. Microsurgical anatomy of their intracerebral segments. Stroke 16:1022–1029PubMed
17.
Zurück zum Zitat Matula C (2005) Tumors of the pineal region. In: Rengachary SS, Ellenbogen RG (eds) Principles of neurosurgery, . nd edn. 2nd edn. Elsevier, Mosby, pp 509–511 Matula C (2005) Tumors of the pineal region. In: Rengachary SS, Ellenbogen RG (eds) Principles of neurosurgery, . nd edn. 2nd edn. Elsevier, Mosby, pp 509–511
18.
Zurück zum Zitat Mutoh K, Okuno T, Ito M et al (1988) Ipsilateral atrophy in children with hemispheric cerebral tumors: CT findings. J Comput Assist Tomogr 12:740–743PubMedCrossRef Mutoh K, Okuno T, Ito M et al (1988) Ipsilateral atrophy in children with hemispheric cerebral tumors: CT findings. J Comput Assist Tomogr 12:740–743PubMedCrossRef
19.
Zurück zum Zitat Nagata K, Nikaido Y, Yuasa T, Fujimoto K, Kim YJ, Inoue M (1998) Germinoma causing wallerian degeneration. Case report and review of literature. J Neurosurg 88:126–128PubMed Nagata K, Nikaido Y, Yuasa T, Fujimoto K, Kim YJ, Inoue M (1998) Germinoma causing wallerian degeneration. Case report and review of literature. J Neurosurg 88:126–128PubMed
20.
Zurück zum Zitat Nakagawa Y, Hamajima I, Iwasaki Y, Yada K, Kunita H (1973) Ipsilateral cerebral atrophy caused by ectopic pinealoma. Brain Nerve 25:69–75 Nakagawa Y, Hamajima I, Iwasaki Y, Yada K, Kunita H (1973) Ipsilateral cerebral atrophy caused by ectopic pinealoma. Brain Nerve 25:69–75
21.
Zurück zum Zitat Ogino H, Shibamoto Y, Takanaka T, Suzuki K, Ishihara S, Yamada T et al (2005) CNS germinoma with elevated serum human chorionic gonadotropin level: clinical characteristics and treatment outcome. Int J Radiat Oncol Biol Phys 62:803–808PubMed Ogino H, Shibamoto Y, Takanaka T, Suzuki K, Ishihara S, Yamada T et al (2005) CNS germinoma with elevated serum human chorionic gonadotropin level: clinical characteristics and treatment outcome. Int J Radiat Oncol Biol Phys 62:803–808PubMed
22.
Zurück zum Zitat Okamoto K, Ito J, Ishikawa K, Morii K, Yamada M, Takahashi N, Tokiguchi S, Furusawa T, Sakai K (2002) Atrophy of the basal ganglia as the initial diagnostic sign of germinoma in the basal ganglia. Neuroradiology 44:389–394PubMedCrossRef Okamoto K, Ito J, Ishikawa K, Morii K, Yamada M, Takahashi N, Tokiguchi S, Furusawa T, Sakai K (2002) Atrophy of the basal ganglia as the initial diagnostic sign of germinoma in the basal ganglia. Neuroradiology 44:389–394PubMedCrossRef
23.
Zurück zum Zitat Ono N, Inoue HK, Naganuma H, Misumi S, Tamura M (1986) Germ cell tumor in the basal ganglia: immunohistochemical demonstration of alpha-fetoprotein, human chorionic gonadotropin, and carcinoembryonic antigen. Surg Neurol 25:495–500PubMedCrossRef Ono N, Inoue HK, Naganuma H, Misumi S, Tamura M (1986) Germ cell tumor in the basal ganglia: immunohistochemical demonstration of alpha-fetoprotein, human chorionic gonadotropin, and carcinoembryonic antigen. Surg Neurol 25:495–500PubMedCrossRef
24.
Zurück zum Zitat Osuka S, Tsuboi K, Takano S, Ishikawa E, Matsushita A, Tokuuye K, Akine Y, Matsumura A (2007) Long-term outcome of patients with intracranial germinomas. J Neurooncol 83:71–79PubMedCrossRef Osuka S, Tsuboi K, Takano S, Ishikawa E, Matsushita A, Tokuuye K, Akine Y, Matsumura A (2007) Long-term outcome of patients with intracranial germinomas. J Neurooncol 83:71–79PubMedCrossRef
25.
Zurück zum Zitat Ozelame RV, Shroff M, Wood B, Bouffet E, Bartels U, Drake JM, Hawkins C, Blaser S (2006) Basal ganglia germinoma in children with associated ipsilateral cerebral and brain stem hemiatrophy. Pediatr Radiol 36:325–330PubMedCrossRef Ozelame RV, Shroff M, Wood B, Bouffet E, Bartels U, Drake JM, Hawkins C, Blaser S (2006) Basal ganglia germinoma in children with associated ipsilateral cerebral and brain stem hemiatrophy. Pediatr Radiol 36:325–330PubMedCrossRef
26.
Zurück zum Zitat Pistorius MA, Enginger V, Mussini JM, Planchon B (1994) Cerebral atrophy of vascular origin in the course of neurofibromatosis. J Mal Vasc 19:315–319 FrenchPubMed Pistorius MA, Enginger V, Mussini JM, Planchon B (1994) Cerebral atrophy of vascular origin in the course of neurofibromatosis. J Mal Vasc 19:315–319 FrenchPubMed
27.
Zurück zum Zitat Rhoton AL (2002) The supratentorial arteries. Neurosurgery 51(Suppl 1):s98–s106 Rhoton AL (2002) The supratentorial arteries. Neurosurgery 51(Suppl 1):s98–s106
28.
Zurück zum Zitat Rozental JM, Levine RL, Nickles RJ, Dobkin JA, Hanson JM (1990) Cerebral diaschisis in patients with malignant glioma. J Neurooncol 8:153–161PubMedCrossRef Rozental JM, Levine RL, Nickles RJ, Dobkin JA, Hanson JM (1990) Cerebral diaschisis in patients with malignant glioma. J Neurooncol 8:153–161PubMedCrossRef
29.
Zurück zum Zitat Sakai K, Shigeta H (1999) Serial MR and CT features of primary germinoma originating in the basal ganglia. J Clin Neurosci 6:162–164PubMedCrossRef Sakai K, Shigeta H (1999) Serial MR and CT features of primary germinoma originating in the basal ganglia. J Clin Neurosci 6:162–164PubMedCrossRef
30.
Zurück zum Zitat Sartori S, Laverda AM, Calderone M, Carollo C, Viscardi E, Faggin R, Perilongo G (2007) Germinoma with synchronous involvement of midline and off-midline structures associated with progressive hemiparesis and hemiatrophy in a young adult. Childs Nerv Syst 23:1341–1345PubMedCrossRef Sartori S, Laverda AM, Calderone M, Carollo C, Viscardi E, Faggin R, Perilongo G (2007) Germinoma with synchronous involvement of midline and off-midline structures associated with progressive hemiparesis and hemiatrophy in a young adult. Childs Nerv Syst 23:1341–1345PubMedCrossRef
31.
Zurück zum Zitat Sudo A, Shiga T, Okajiama M, Takano K, Terae S, Sawamura Y, Ohnishi A, Nagashima K, Saitoh S (2003) High uptake on 11Cmethionine positron emission tomographic scan of basal ganglia germinoma with cerebral hemiatrophy. Am J Neuroradiol 24:1909–1911PubMed Sudo A, Shiga T, Okajiama M, Takano K, Terae S, Sawamura Y, Ohnishi A, Nagashima K, Saitoh S (2003) High uptake on 11Cmethionine positron emission tomographic scan of basal ganglia germinoma with cerebral hemiatrophy. Am J Neuroradiol 24:1909–1911PubMed
32.
Zurück zum Zitat Takeda N, Fujita K, Katayama S, Uchihash Y, Okamura Y, Nigami H, Hashimoto K, Kohmura E (2004) Germinoma of the basal ganglia: an 8-year asymptomatic history after detection of abnormality on CT. Pediatr Neurosurg 40:306–311PubMedCrossRef Takeda N, Fujita K, Katayama S, Uchihash Y, Okamura Y, Nigami H, Hashimoto K, Kohmura E (2004) Germinoma of the basal ganglia: an 8-year asymptomatic history after detection of abnormality on CT. Pediatr Neurosurg 40:306–311PubMedCrossRef
33.
Zurück zum Zitat Tamaki N, Lin T, Shirataki K, Hosoda K, Kurata H, Matsumoto S, Ito H (1990) Germ cell tumors of the thalamus and the basal ganglia. Childs Nerv Syst 6:3–7PubMedCrossRef Tamaki N, Lin T, Shirataki K, Hosoda K, Kurata H, Matsumoto S, Ito H (1990) Germ cell tumors of the thalamus and the basal ganglia. Childs Nerv Syst 6:3–7PubMedCrossRef
34.
Zurück zum Zitat Tang J, Ma Z, Luo S, Zhang Y, Jia G, Zhang J (2008) The germinomas arising from the basal ganglia and thalamus. Childs Nerv Syst 24:303–306PubMedCrossRef Tang J, Ma Z, Luo S, Zhang Y, Jia G, Zhang J (2008) The germinomas arising from the basal ganglia and thalamus. Childs Nerv Syst 24:303–306PubMedCrossRef
35.
Zurück zum Zitat Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain: cerebral hemispheres. Neurology 50:1699–1708PubMed Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain: cerebral hemispheres. Neurology 50:1699–1708PubMed
36.
Zurück zum Zitat Ture U, Yasargil MG, Al-Mefty O, Yasargil DCH (2000) Arteries of the insula. J Neurosurg 92:676–687PubMedCrossRef Ture U, Yasargil MG, Al-Mefty O, Yasargil DCH (2000) Arteries of the insula. J Neurosurg 92:676–687PubMedCrossRef
37.
Zurück zum Zitat Uchino A, Takase Y, Nomiyama K, Egashira R, Kudo S (2006) Brainstem and cerebellar changes after cerebrovascular accidents: magnetic resonance imaging. Eur Radiol 16:592–597PubMedCrossRef Uchino A, Takase Y, Nomiyama K, Egashira R, Kudo S (2006) Brainstem and cerebellar changes after cerebrovascular accidents: magnetic resonance imaging. Eur Radiol 16:592–597PubMedCrossRef
38.
Zurück zum Zitat Wintermark P, Meagher-Villemure K, Villemure JG, Maeder-Ingvar M, Maeder P, Ghariani S, Roulet-Perez E (2007) Progressive unilateral hemispheric atrophy in an infant with neurofibromatosis. Neuropediatrics 38:100–104PubMedCrossRef Wintermark P, Meagher-Villemure K, Villemure JG, Maeder-Ingvar M, Maeder P, Ghariani S, Roulet-Perez E (2007) Progressive unilateral hemispheric atrophy in an infant with neurofibromatosis. Neuropediatrics 38:100–104PubMedCrossRef
39.
Zurück zum Zitat Wong TT, Chen YW, Guo WY, Chang KP, Ho DM, Yen SH (2008) Germinoma involving the basal ganglia in children. Childs Nerv Syst 24:71–78PubMedCrossRef Wong TT, Chen YW, Guo WY, Chang KP, Ho DM, Yen SH (2008) Germinoma involving the basal ganglia in children. Childs Nerv Syst 24:71–78PubMedCrossRef
40.
Zurück zum Zitat Wong TT, Ho DM, Chang KP, Yen SH, Guo WY, Chang FC, Liang ML, Pan HC, Chung WY (2005) Primary pediatric brain tumors: statistics of Taipei VGH, Taiwan (1975–2004). Cancer 104(10):2156–2167PubMedCrossRef Wong TT, Ho DM, Chang KP, Yen SH, Guo WY, Chang FC, Liang ML, Pan HC, Chung WY (2005) Primary pediatric brain tumors: statistics of Taipei VGH, Taiwan (1975–2004). Cancer 104(10):2156–2167PubMedCrossRef
41.
Zurück zum Zitat Yasargil MG (1984) Microneurosurgery, vol. I. Microsurgical anatomy of the basal cisterns and vessels of the brain, diagnostic studies, general operative techniques and pathological considerations of the intracranial aneurysms. Thieme, Stuttgart, pp 144–150 Yasargil MG (1984) Microneurosurgery, vol. I. Microsurgical anatomy of the basal cisterns and vessels of the brain, diagnostic studies, general operative techniques and pathological considerations of the intracranial aneurysms. Thieme, Stuttgart, pp 144–150
42.
Zurück zum Zitat Yasargil MG (1998) Microneurosurgery. Vol. IVB. Microneurosurgery of CNS tumors. Thieme, Stuttgart, p 263 Yasargil MG (1998) Microneurosurgery. Vol. IVB. Microneurosurgery of CNS tumors. Thieme, Stuttgart, p 263
43.
Zurück zum Zitat Yasargil MG, Krisht AF, Ture U, Al-Mefty O, Yasargil DCH (2002) Microsurgery of insular gliomas part I: surgical anatomy of the sylvian cistern. Contemp Neurosurg 24(11):1–8 Yasargil MG, Krisht AF, Ture U, Al-Mefty O, Yasargil DCH (2002) Microsurgery of insular gliomas part I: surgical anatomy of the sylvian cistern. Contemp Neurosurg 24(11):1–8
Metadaten
Titel
Pathophysiological mechanism of ipsilateral cerebral and brainstem hemiatrophy in basal ganglia germ cell tumors: case report
verfasst von
Sui-To Wong
Shing-Chau Yuen
Dawson Fong
Publikationsdatum
01.06.2009
Verlag
Springer-Verlag
Erschienen in
Child's Nervous System / Ausgabe 6/2009
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-008-0787-1

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