Ventricle Involvement Research Articles

Value of the Electrocardiogram as a Predictor of Right Ventricular Dysfunction in Patients With Chronic Right Ventricular Volume Overload

Introduction and objectivesPulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or congenital pulmonary stenosis. Electrocardiographic variables have been correlated with parameters used to evaluate right ventricular function. We aimed to analyze the diagnostic value of the width and fragmentation of the electrocardiogram in the identification of patients with right ventricular dysfunction and/or dilation. MethodsWe selected 107 consecutive patients diagnosed with severe pulmonary insufficiency after repair of pulmonary stenosis or tetralogy of Fallot. The tests included electrocardiography, echocardiography, and magnetic resonance. Each electrocardiogram was analyzed manually to measure QRS duration. We defined QRS fragmentation as the presence of low-voltage waves in the terminal portion of the QRS complex in at least 2 contiguous leads. ResultsWe found a significant negative correlation between QRS width and right ventricular function, as well as a positive correlation with right ventricular volume. The receiver operating characteristic curve indicated a cut-off point for QRS width of 140ms, which showed good sensitivity for a diagnosis of right ventricular dilation (> 80%) and dysfunction (> 95%). In logistic regression models, a QRS duration > 140ms was found to be the only independent predictor of right ventricular dilation and dysfunction. ConclusionsElectrocardiography is a rapid, widely available, and reproducible tool. QRS width constitutes an independent predictor of the presence of right ventricular dilation and dysfunction. This study is the first to provide a cutoff value for QRS width to screen for right ventricle involvement.

Transsellar Transsphenoidal Meningoencephalocele; an Alternative Approach for Repair

Objective: To introduce an alternative surgical approach for repair of the transsellar transsphenoidal meningoencephaloceles (TTSME), which are extremely rare CNS defects and a challenge in surgical management because of the vicinity and even involvement of vital structures of midline diencephalon. Study Design: A case report introducing an alternative approach. Material and Methods: A 36-year-old woman with pituitary dwarfism presented complaining of nasal obstruction. CT scan showed a bony defect in the sellar floor and sphenoid sinus with huge nasopharyngeal mass. In MRI, a true TTSME with third ventricle involvement was detected. Endoscopic endonasal approach was used for repair. The sac was partially removed after close inspection of its contents, and the defect was reconstructed with fat and facial graft, and buttressed with titanium mesh and septal flap. Results: Visual field improvement noticed postoperatively. No complication including postoperative cerebrospinal fluid (CSF) leak or relapse was encountered in 18 months follow-up. Conclusion: Endoscopic endonasal approach was successfully used for repair of a true TTSME. As the case had a huge sac, partial resection of the sac was adopted instead of reduction to not put the optic chiasma in jeopardy.

Isolated right ventricular non-compaction: A rare form of dilated cardiomyopathy

Noncompaction of the ventricular myocardium is a cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium. This abnormality is often associated with other congenital cardiac defects but it is also seen in the absence of other cardiac anomalies. Isolated ventricular non-compaction is a morphological abnormality of excessive (atleast four) trabeculation and deep inter-trabecular spaces communicating with the ventricular cavity, with typical bilaminar structure of compacted and noncompacted segment of ventricle. It is often complicated by ventricular dysfunction, arrhythmias and cardioembolism. Although the usual site of involvement is the left ventricle, the right ventricle (RV) can rarely be affected. Isolated right ventricle involvement is very rare and to the best of our knowledge only few cases of isolated RV noncompaction are reported. Thus herein we report a case of 40-year-old male patient who presented with features of right sided heart faiure, atrial fibrillation and history of syncope. ECG showed RBBB with junctional rhythm. Echocardiography showed enlarged right atrium and right ventricle showed double layered structure with prominent trabecula and deep intertrabecular recesses. Left ventricle was normal. Cardiac MRI further confirmed the diagnosis of isolated right ventricle noncompaction. Thus clinician should keenly look for this rare cardiomyopathy as an important differential diagnosis of patient presenting with right sided heart failure.

“All roads lead to Rome” ventricular tachycardia due to right ventricle involvement in autoimmune and non-autoimmune disease

The right ventricle (RV) is involved in numerous heart diseases, even if the primary diagnosis is attributed to the left ventricle (LV) [1]. RV pathology has been well documented as a causative factor of ventricular tachycardia with left bundle branch morphology (LBBBVT) in non-autoimmune disease [2–4]; however, data about autoimmune disease with LBBBVT is still scarce.

Biohumoral markers as predictor of right ventricular dysfunction in AL Amyloidosis

Aim: In AL amyloidosis, the importance of right ventricle (RV) involvement has recently been underlined and its role in predicting prognosis has been emphasized. Little is known about the relationship between RV involvement, N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin levels. Aim of our study was to clarify the relationship between NT-proBNP and troponin and RV involvement and analyze their independent value as predictors of RV dysfunction.Methods and Results: We examined 76 consecutive patients with biopsy-proven AL amyloidosis. Each patient received complete clinical evaluation, troponin I, NT-proBNP assay and comprehensive echocardiographic evaluation. Considering a tricuspidal annulus plane systolic excursion (TAPSE) value <16 mm, 23 patients (30%) presented RV systolic dysfunction, whereas 53 (70%) did not. Patient with reduced TAPSE had thicker left ventricle (LV) walls and RV free walls, reduced LV fractional shortening, impaired LV diastolic function and worse LV and RV myocardial performance index. For RV dysfunction the best predictive value for NT-proBNP was identified as 2977 ng/l with sensitivity and specificity of 87% and 84%, respectively; best cut-off for troponin I was identified as 0.085 ng/l, with sensitivity and specificity of 85% and 90% respectively.At multivariable logistic regression analysis, both NT-proBNP and troponin I emerged as independent predictors of RV dysfunction presence but troponin appears to have a higher predictive power.Conclusion: Our study demonstrated that cut-off values of 2977 ng/ml for NT-proBNP and 0.085 ng/l for troponin were able to identify a subgroup of AL patients with RV dysfunction. Troponin I is more accurate and seems to be the best biohumoral marker of RV dysfunction.

Quantification of Myocardial Extracellular Volume Fraction with Cardiac MR Imaging for Early Detection of Left Ventricle Involvement in Systemic Sclerosis

To determine whether extracellular volume fraction (ECV) quantification at cardiac magnetic resonance (MR) imaging can demonstrate subclinical left ventricle (LV) abnormalities in a cohort of consecutive systemic sclerosis (SS) patients, and to investigate the relationship between ECV and diastolic and systolic LV function. All subjects gave their written informed consent. The protocol was approved by the ethics committee. ECV quantification with cardiac MR imaging was prospectively performed in 33 consecutive SS patients with normal echocardiography results and no late gadolinium chelate enhancement at MR imaging. Left ventricular and atrial volumes and peak circumferential strain were measured at cardiac MR imaging. Diastolic function was assessed at echocardiography. The results were compared with those of 16 age-matched healthy control subjects by using Mann-Whitney and Kruskal-Wallis tests. SS patients had significantly higher global ECV (P < .001) and higher local ECV for all basal and midventricular LV segments. Global ECV significantly correlated with left atrial volume (P = .002) and with the grade of diastolic dysfunction (P = .016). The majority of SS patients (63%; 21 of 33 patients) had a high global ECV and a low global systolic circumferential strain. ECV quantification can identify LV abnormalities at an early stage in SS patients. These abnormalities may reflect increase in diffuse myocardial fibrosis and are associated with diastolic LV dysfunction.

Clinical and echocardiographic predictors of mortality in chagasic cardiomyopathy--systematic review.

Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed), LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease.

Right ventricular dysfunction in Chagas' Cardiomyopathy. Primary involvement or a resonant manifestation of Left ventricular dysfunction?

Background Chagas’ Cardiomyopathy (CC) is an important cause of heart failure and sudden cardiac death (SCD) in Latin America. Migratory movements have spread carriers throughout the world, especially in USA and Europe. Left Ventricle (LV) involvement is a landmark and apical aneurysm a pathognomical sign. Nevertheless, early involvement of the right ventricle (RV) and RV systolic dysfunction in presence of normal left ventricular systolic function in CC has been a subject of controversy in the literature. Therefore, we analyzed a cohort of patients with CC in order to explore the presence of RV dysfunction. Methods 125 patients with CC were submitted to cardiac magnetic resonance during an investigational protocol for primary prevention of SCD. SSFP short-axis cines were used to establish RV and LV volumes, mass and function. Late Gadolinium Enhanced (LGE) short axis sequences were visually analyzed to establish the presence of a LV scar. RV and LV systolic dysfunction were established using most recent recommendations of the European Society of Cardiology. Parametric tests and Chi-square tests were used as appropriate and P < 0.05 was established as significant.

Investigation of recurrence risk in laryngeal cancer following laser surgery

The general prognostic factors in larynx tumors are believed to be tumor stage, anatomical location, histological differentiation and the presence of neck metastasis. Effects of tumor invasion to sub-regions of larynx (anterior commissure, ventricle, subglottic space) and over-expression of p53, c-erb-B2 and Ki67 detected immunohistochemically on development of recurrence in patients were investigated in this study. Twenty patients (Group 1) in whom recurrence had developed and 20 others (Group 2) without recurrence during follow-up were included in this study. Both the anterior commissure and ventricle involvements were found to be more frequent in patients with recurrence. But statistically significant difference was detected with only ventricular involvement (p=0.025). After Immunohistochemical evaluation none of the 3 immunohistochemical parameters were found to be higher in the recurrence group and not any of them showed a statistically significant difference between two groups. Only ventricle involvement may be a predictor factor for recurrence.

Utility of cardiac magnetic resonance (CMR) in the evaluation of right ventricular (RV) involvement in patients with myocardial infarction (MI)

The aim of this work was to compare the prevalence of right ventricle involvement in a population of patients with myocardial infarction as detected by cardiac magnetic resonance (CMR), clinical presentation, electrocardiographic (ECG) and echocardiographic criteria. A total of 97 consecutive patients, admitted to our institution for acute myocardial infarction, underwent a standard CMR examination within 5days after the event. The presence of myocardial oedema and late enhancement of the right ventricle were compared to infarct location (anterior vs. inferior), clinical data, ECG, echocardiography results and other CMR findings. The results were analysed statistically using the Student's t test for independent samples and the K statistic. Among the 97 patients included in the study, a diagnosis of right ventricular infarction was established in 12, 14 and 24 cases on the basis of the clinical data, the ECG and echocardiography, respectively. CMR demonstrated myocardial oedema and late enhancement of the right ventricle in 48 and 32 cases, respectively. The right ventricle was involved in 46% of patients with inferior myocardial infarction (15/32) and in 30% with anterior myocardial infarction (17/56), correlating to a worsening of both right and left ventricular performance (p=0.001-0.05). The right ventricle is frequently involved in myocardial infarction, correlating to a worse functional impairment of both ventricles and a worse prognosis. This finding, which is often underestimated by traditional cardiological tests, is well revealed by CMR, with potential clinical and therapeutic impact.

Quantification of myocardial extracellular volume fraction by cardiac magnetic resonance for early detection of the left ventricle involvement in systemic sclerosis

Cardiologia CROATICA Background: Early identification of myocardial dysfunction is challenging for many cardiovascular diseases and systemic sclerosis (SSc) is an unique model of progressive myocardial fibrosis. Cardiac magnetic resonance with late gadolinium enhancement (LGE) can detect fibrosis in advanced stages of SSc, but is limited in the early stage due to the diffuse nature of fibrotic changes. T1 mapping is able to quantify myocardial fibrosis and can be used to quantify myocardial extracellular volume fraction (EVF), which changes when collagen content increases. We aimed to determine whether EVF quantification could detect subclinical left ventricular (LV) abnormalities and to investigate the relationship between EVF and subtle diastolic and systolic dysfunction. Materials and Methods: T1 mapping and EVF quantification were prospectively performed in 33 consecutive SSc patients with normal echocardiography, no severe diastolic dysfunction, no pulmonary hypertension at rest and no LGE, as well as in 16 healthy controls. The study was approved by the local ethics committee and all subjects gave written informed consent. Results: SSc patients had significantly higher global EVF (P<0.0001) and higher local EVF for all basal and mid-ventricular LV segments (P<0.01). Global EVF significantly correlated with left atrial volume (P<0.0001) and with the grade of diastolic dysfunction (P=0.016). Majority of SSc patients (63%) had both a high global EVF and low global systolic circumferential strain. Conclusions: EVF quantification can identify LV abnormalities at an early stage in SSc patients. These abnormalities may reflect increase in diffuse myocardial fibrosis and are associated with subtle diastolic and systolic LV dysfunction.

Displacement of mammillary bodies by craniopharyngiomas involving the third ventricle: surgical-MRI correlation and use in topographical diagnosis

Accurate diagnosis of the topographical relationships of craniopharyngiomas (CPs) involving the third ventricle and/or hypothalamus remains a challenging issue that critically influences the prediction of risks associated with their radical surgical removal. This study evaluates the diagnostic accuracy of MRI to define the precise topographical relationships between intraventricular CPs, the third ventricle, and the hypothalamus. An extensive retrospective review of well-described CPs reported in the MRI era between 1990 and 2009 yielded 875 lesions largely or wholly involving the third ventricle. Craniopharyngiomas with midsagittal and coronal preoperative and postoperative MRI studies, in addition to detailed descriptions of clinical and surgical findings, were selected from this database (n = 130). The position of the CP and the morphological distortions caused by the tumor on the sella turcica, suprasellar cistern, optic chiasm, pituitary stalk, and third ventricle floor, including the infundibulum, tuber cinereum, and mammillary bodies (MBs), were analyzed on both preoperative and postoperative MRI studies. These changes were correlated with the definitive CP topography and type of third ventricle involvement by the lesion, as confirmed surgically. The mammillary body angle (MBA) is the angle formed by the intersection of a plane tangential to the base of the MBs and a plane parallel to the floor of the fourth ventricle in midsagittal MRI studies. Measurement of the MBA represented a reliable neuroradiological sign that could be used to discriminate the type of intraventricular involvement by the CP in 83% of cases in this series (n = 109). An acute MBA (< 60°) was indicative of a primary tuberal-intraventricular topography, whereas an obtuse MBA (> 90°) denoted a primary suprasellar CP position, causing either an invagination of the third ventricle (pseudointraventricular lesion) or its invasion (secondarily intraventricular lesion; p < 0.01). A multivariate model including a combination of 5 variables (the MBA, position of the hypothalamus, presence of hydrocephalus, psychiatric symptoms, and patient age) allowed an accurate definition of the CP topography preoperatively in 74%-90% of lesions, depending on the specific type of relationship between the tumor and third ventricle. The type of mammillary body displacement caused by CPs represents a valuable clue for ascertaining the topographical relationships between these lesions and the third ventricle on preoperative MRI studies. The MBA provides a useful sign to preoperatively differentiate a primary intraventricular CP originating at the infundibulotuberal area from a primary suprasellar CP, which either invaginated or secondarily invaded the third ventricle.

Multiple Thrombosis Caused by Arrhythmogenic Right Ventricular Cardiomyopathy

A 68-year-old man was transferred emergently to our department because of multichamber intracardiac thrombosis. Enhanced computed tomography revealed multichamber thrombosis in the right atrial appendage, right ventricular outlet tract. and left atrial appendage, with localized aneurysm of a much enlarged right ventricle. He underwent thrombectomy and valve repair. Here we report a rare case of arrhythmogenic right ventricular cardiomyopathy with multichamber intracardiac thrombosis.

Surgical management of craniopharyngioma with third ventricle involvement

Craniopharyngiomas are notorious for their ability to invade the hypothalamus and third ventricle. Although several transcranial approaches have been proposed for their treatment, the endonasal route provides direct access to the tumor with no need for cerebral retraction or manipulation of the optic apparatus. After the lesion is debulked, the unique angle of approach achieved with this technique enables the surgeon to perform an extra-capsular dissection and visualize the walls of the third ventricle, the foramina of Monro, and the anterior comissure. Moreover, the enhanced magnification and lighting afforded by the endoscope facilitate safe tumor removal, particularly in areas where there is loss of clear lesion delimitation and greater infiltration of the surrounding structures. Herein we present the case of a 68-year-old female patient with a 3-month history of visual deterioration accompanied by worsening headaches. Investigation with magnetic resonance imaging revealed a heterogeneous mass in the suprasellar region, extending into the third ventricle and displacing the pituitary gland and stalk inferiorly. Hormonal profile was within expected range for her age. An endonasal, fully endoscopic, transplanum transtuberculum approach was performed. Gross-total removal was achieved and pathology confirmed the diagnosis of craniopharyngioma. Postoperative recovery was marked by transient diabetes insipidus. Closure was achieved with a pedicled nasoseptal flap; despite exploration of the third ventricle, there was no cerebrospinal fluid leakage. Pituitary function was preserved. Visual function has fully recovered and the patient has been uneventfully followed since surgery. The video can be found here: http://youtu.be/it5mpofZl0Q. (http://thejns.org/doi/abs/10.3171/2013.V1.FOCUS12330)

Atypical Clinical Presentation of Arrhythmogenic Biventricular Cardiomyopathy

. However, the clinical manifestations and prognosis of biventricular arrhythmogenic cardiomyopathy not yet been established. We present a case of ARVC with left ventricle (LV) involvement, with no typical symptoms and no relevant medical history.

Primary Central Nervous System Lymphoma with Lateral Ventricle Involvement

A 77-year-old woman presented with worsening cognitive impairment, nausea and vomiting. Computed tomography (CT) of the head revealed a high-density mass that symmetrically filled both lateral ventricles. Magnetic resonance imaging (MRI) showed an enhanced mass with T1 and T2 prolongation and restricted diffusion on diffusion weighted imaging (DWI). Diagnosis was delayed until a post-mortem examination, which revealed the mass as a primary central nervous system lymphoma (PCNSL). A high-intensity tumor on DWI with lateral ventricle involvement should raise the possibility of PCNSL.

Risk factors analysis of outcomes for patients with primary pontine hemorrhage

To evaluate the risk factors of prognosis in patients with primary pontine hemorrhage. A retrospective analysis was conducted using data from 60 patients admitted with a diagnosis of primary pontine hemorrhage to the Department of Neurology of Nanfang Hospital in Guangzhou City. Patients were classified as survivors (n=34) and non-survivors (n=26) according to their outcomes on 30 days from the onset of symptoms. Univariate analysis and multivariate logistic regression analysis were performed on clinical data and imaging features of patients. Receiver operating characteristic curve (ROC curve) analysis was used on continuous parameters verified by multivariate logistic regression analysis to determine their cut-off value. The 30-day mortality was 43.3% for 60 patients with primary pontine hemorrhage. Univariate analysis showed Glasgow coma scale (GCS) at admission, temperature, heart rate, hemorrhage volume, mechanical ventilation, involvement of ventricles and location of hematoma were statistically related to 30-day mortality in patients with primary pontine hemorrhage. Multivariate logistic regression analysis demonstrated that the GCS at admission [odds ratio (OR)=0.745, 95% confidence interval (95%CI) 0.585 to 0.949], hemorrhage volume (OR=1.438, 95%CI 1.077 to 1.919) and location of hematoma (basal-tegmental hemorrhage, OR=0.120, 95%CI 0.016 to 0.904) were independent risk factors of poor prognosis in patients with primary pontine hemorrhage (all P<0.05). ROC curve analysis showed the cut-off value for GCS score at admission and hemorrhage volume was 7.5 and 5.5 ml, respectively. Patients suffering from primary pontine hemorrhage in the basal-tegmental region, GCS<7.5 at admission and hemorrhage volume≥5.5 ml would lead to a poor outcome in 30 days.

Arrhythmogenic Cardiomyopathy. Patterns of Ventricular Involvement Using Cardiac Magnetic Resonance

Introduction and objectives Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms had recently been included in the spectrum of arrhythmogenic cardiomyopathy. The aim of the study was to describe, using cardiovascular magnetic resonance, the patterns of ventricular involvement as well as late gadolinium enhancement in these conditions. Methods Medical databases and records from the cardiology units of 3 hospitals were reviewed to obtain data from patients with arrhythmogenic cardiomyopathy. Results Twenty-six consecutive patients were included (40 [16] years, 16 males). Right ventricle involvement was present in 19 patients (73%). Among them, 13 patients (50%) had volumes over the upper limit of normality, 11 (42%) patients had late gadolinium enhancement in right ventricle and 6 patients (23%) had just mild involvement with wall motion abnormalities or microaneurysms. Left ventricle involvement was present in 24 patients (92%), all of them with late gadolinium enhancement. In 15 patients (57%) left ventricular systolic dysfunction was observed, and dilatation in 3 patients (11%). Late gadolinium enhancement was more frequent in the inferior, lateral, and inferolateral walls (65%, 57%, and 61% of patients, respectively) while septum was seldom affected (26% of cases). The pattern of late gadolinium enhancement was mainly subepicardial (46% of patients) or transmural (19%), and was intramyocardial in only 12% of the cases. Conclusions In this sample, left ventricle involvement is very common. The most frequent finding was late gadolinium enhancement, while the least frequent was dilatation. The pattern of late gadolinium enhancement was more frequently subepicardial and located in the inferior and inferolateral walls.

Resonancia magnética cardiaca en miocardiopatía arritmogénica. Tipos de afección y patrones de realce tardío de gadolinio

Introduction and objectives Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms had recently been included in the spectrum of arrhythmogenic cardiomyopathy. The aim of the study was to describe, using cardiovascular magnetic resonance, the patterns of ventricular involvement as well as late gadolinium enhancement in these conditions. Methods Medical databases and records from the cardiology units of 3 hospitals were reviewed to obtain data from patients with arrhythmogenic cardiomyopathy. Results Twenty-six consecutive patients were included (40 [16] years, 16 males). Right ventricle involvement was present in 19 patients (73%). Among them, 13 patients (50%) had volumes over the upper limit of normality, 11 (42%) patients had late gadolinium enhancement in right ventricle and 6 patients (23%) had just mild involvement with wall motion abnormalities or microaneurysms. Left ventricle involvement was present in 24 patients (92%), all of them with late gadolinium enhancement. In 15 patients (57%) left ventricular systolic dysfunction was observed, and dilatation in 3 patients (11%). Late gadolinium enhancement was more frequent in the inferior, lateral, and inferolateral walls (65%, 57%, and 61% of patients, respectively) while septum was seldom affected (26% of cases). The pattern of late gadolinium enhancement was mainly subepicardial (46% of patients) or transmural (19%), and was intramyocardial in only 12% of the cases. Conclusions In this sample, left ventricle involvement is very common. The most frequent finding was left ventricular late gadolinium enhancement, while the least frequent was dilatation. The pattern of late gadolinium enhancement was more frequently subepicardial and located in the inferior and inferolateral walls. Full English text available from: www.revespcardiol.org

Rosette-forming glioneuronal tumors of the posterior fossa

Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a rare, recently described WHO Grade I neoplasm. The authors report 6 examples of RGNT arising primarily from the cerebellar vermis. All the patients were female, and the mean age of presentation was 24.8 years. The original diagnoses included pilocytic astrocytoma, ependymoma, cerebellar dysembryoplastic neuroepithelial tumor (DNT), and oligodendroglioma. The cases showed classic pathological characteristics, although in 2 cases the lesions included DNT-like "floating neurons" involving Purkinje cells, a feature which has not been previously reported to the authors' knowledge. The clinical outcome was excellent with no recurrences after complete resection. These cases expand the known clinical and histological spectrum of this rare tumor type. Given the lack of fourth ventricle involvement in most of these cases, the authors suggest revising the name to RGNT of the posterior fossa.