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

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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.

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References

  1. 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 20:393–398

    Article  PubMed  CAS  Google Scholar 

  2. Echevarria ME, Fangusaro J, Goldman S (2008) Pediatric central nervous system germ cell tumors: a review. Oncologist 13:690–699

    Article  PubMed  Google Scholar 

  3. 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 Japanese

    PubMed  CAS  Google Scholar 

  4. 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 15:1435–1441

    PubMed  CAS  Google Scholar 

  5. Jayakumar PN, Rao TV, Arya BY, Jain VK (1987) Hemiatrophy and glioblastoma. Surg Neurol 27:291–294

    Article  PubMed  CAS  Google Scholar 

  6. Kim CH, Paek SH, Park IA, Chi JG, Kim DG (2002) Cerebral germinomas with hemiatrophy of the brain: report of three cases. Acta Neurochir 144:145–150

    Article  CAS  Google Scholar 

  7. Kim DI, Yoon PH, Ryu YH, Jeon P, Hwang GJ (1998) MRI of germinomas arising from the basal ganglia and thalamus. Neuroradiology 40:507–511

    Article  PubMed  CAS  Google Scholar 

  8. 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 23:105–108

    Article  PubMed  CAS  Google Scholar 

  9. Kuhn MJ, Johnson KA, Davis KR (1988) Wallerian degeneration: evaluation with MR imaging. Radiology 168:199–202

    PubMed  CAS  Google Scholar 

  10. Kuhn MJ, Mikulis DJ, Ayoub DM, Kosofsky BE, Davis KR, Taveras JM (1989) Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging. Radiology 172:179–182

    PubMed  CAS  Google Scholar 

  11. 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 13:904–907

    Article  PubMed  CAS  Google Scholar 

  12. Kwak R, Saso SI, Suzuki J (1978) Ipsilateral cerebral atrophy with thalamic tumor of childhood. Case report. J Neurosurg 48:443–449

    PubMed  CAS  Google Scholar 

  13. Liu E, Robertson RL, du Plessis A, Pomeroy SL (1999) Basal ganglia germinoma with progressive cerebral hemiatrophy. Pediatr Neurol 20:312–314

    Article  PubMed  CAS  Google Scholar 

  14. Maehara T, Machida T, Tsuchiya K, Iio M (1983) Brain tumors with ipsilateral cerebral hemiatrophy. AJNR 4:478–480

    PubMed  CAS  Google Scholar 

  15. Marinkovic S, Gibo H, Milisavljevic M, Cetkovic M (2001) Anatomic and clinical correlations of the lenticulostriate arteries. Clin Anat 14:190–195

    Article  PubMed  CAS  Google Scholar 

  16. Marinkovic SV, Milisavljevic MM, Kovacevic MS, Stevic ZD (1985) Perforating branches of the middle cerebral artery. Microsurgical anatomy of their intracerebral segments. Stroke 16:1022–1029

    PubMed  CAS  Google Scholar 

  17. 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

    Google Scholar 

  18. Mutoh K, Okuno T, Ito M et al (1988) Ipsilateral atrophy in children with hemispheric cerebral tumors: CT findings. J Comput Assist Tomogr 12:740–743

    Article  PubMed  CAS  Google Scholar 

  19. 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 88:126–128

    PubMed  CAS  Google Scholar 

  20. Nakagawa Y, Hamajima I, Iwasaki Y, Yada K, Kunita H (1973) Ipsilateral cerebral atrophy caused by ectopic pinealoma. Brain Nerve 25:69–75

    Google Scholar 

  21. 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 62:803–808

    PubMed  CAS  Google Scholar 

  22. 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 44:389–394

    Article  PubMed  CAS  Google Scholar 

  23. 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 25:495–500

    Article  PubMed  CAS  Google Scholar 

  24. 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 83:71–79

    Article  PubMed  Google Scholar 

  25. 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 36:325–330

    Article  PubMed  Google Scholar 

  26. 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 French

    PubMed  CAS  Google Scholar 

  27. Rhoton AL (2002) The supratentorial arteries. Neurosurgery 51(Suppl 1):s98–s106

    Google Scholar 

  28. Rozental JM, Levine RL, Nickles RJ, Dobkin JA, Hanson JM (1990) Cerebral diaschisis in patients with malignant glioma. J Neurooncol 8:153–161

    Article  PubMed  CAS  Google Scholar 

  29. Sakai K, Shigeta H (1999) Serial MR and CT features of primary germinoma originating in the basal ganglia. J Clin Neurosci 6:162–164

    Article  PubMed  CAS  Google Scholar 

  30. 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 23:1341–1345

    Article  PubMed  CAS  Google Scholar 

  31. 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 24:1909–1911

    PubMed  Google Scholar 

  32. 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 40:306–311

    Article  PubMed  Google Scholar 

  33. 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 6:3–7

    Article  PubMed  CAS  Google Scholar 

  34. 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 24:303–306

    Article  PubMed  Google Scholar 

  35. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain: cerebral hemispheres. Neurology 50:1699–1708

    PubMed  CAS  Google Scholar 

  36. Ture U, Yasargil MG, Al-Mefty O, Yasargil DCH (2000) Arteries of the insula. J Neurosurg 92:676–687

    Article  PubMed  CAS  Google Scholar 

  37. Uchino A, Takase Y, Nomiyama K, Egashira R, Kudo S (2006) Brainstem and cerebellar changes after cerebrovascular accidents: magnetic resonance imaging. Eur Radiol 16:592–597

    Article  PubMed  CAS  Google Scholar 

  38. 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 38:100–104

    Article  PubMed  CAS  Google Scholar 

  39. Wong TT, Chen YW, Guo WY, Chang KP, Ho DM, Yen SH (2008) Germinoma involving the basal ganglia in children. Childs Nerv Syst 24:71–78

    Article  PubMed  CAS  Google Scholar 

  40. 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):2156–2167

    Article  PubMed  Google Scholar 

  41. 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

    Google Scholar 

  42. Yasargil MG (1998) Microneurosurgery. Vol. IVB. Microneurosurgery of CNS tumors. Thieme, Stuttgart, p 263

    Google Scholar 

  43. 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

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, China

    Sui-To Wong, Shing-Chau Yuen & Dawson Fong

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  1. Sui-To Wong
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  2. Shing-Chau Yuen
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  3. Dawson Fong
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Correspondence to Sui-To Wong.

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Wong, ST., Yuen, SC. & Fong, D. Pathophysiological mechanism of ipsilateral cerebral and brainstem hemiatrophy in basal ganglia germ cell tumors: case report. Childs Nerv Syst 25, 693–699 (2009). https://doi.org/10.1007/s00381-008-0787-1

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  • DOI: https://doi.org/10.1007/s00381-008-0787-1

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