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BACKGROUND: Stereotactic radiosurgery (SRS) is considered to be a relatively safe procedure in cerebral arteriovenous malformation management. There are very few reported cases of SRS-associated/induced malignancies. METHODS: We show the case of a 21-year-old female who presented with a 21-mm(3) ruptured AVM in the right mesial frontocallosal region. Embolization and/or radiosurgery was proposed. She preferred radiosurgery. The AVM was treated with CyberKnife(®) SRS. RESULTS: She presented behavior changes 6 years after SRS. MRI showed a right subcortical frontal lesion with increased perfusion, more consistent with high-grade glioma. The lesion's center was within the irradiated region of the previous SRS, having received an estimated radiation dose of 4 Gy. Pathological examination noted a hypercellular tumor showing astrocytic tumor cells with moderate pleomorphism in a fibrillary background, endothelial proliferation, and tumor necrosis surrounded by perinecrotic pseudopalisades. Numerous mitotic figures were seen. The appearances were those of glioblastoma, WHO grade IV, with neuronal differentiation. SRS-associated/-induced GBM after treatment of a large AM is exceptional. SRS-associated/-induced malignancies are mostly GBMs and occur on average after a latency of 9.4 years, within very low-dose peripheral regions as well as the full-dose regions; 33.3 % of patients were under 20 years at the time of SRS, and in 66 % the lesion treated was a vascular pathology. CONCLUSION: Although it is unlikely that the risk of radiation-induced cancer will change the current standard of practice, patients must be warned of this potential possibility before treatment.
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Malformações Arteriovenosas/cirurgia , Glioblastoma/etiologia , Neoplasias Induzidas por Radiação/etiologia , Radiocirurgia/efeitos adversos , Feminino , Seguimentos , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: To investigate the efficacy of platinum-based chemotherapy in patients with recurrent high-grade glioma (HGG) who had received previous alkylating line of chemotherapy. MATERIAL AND METHODS: Case notes of patients who had received chemotherapy with carboplatin or cysplatin for recurrent HGG between June 2006 and July 2012 were reviewed. Baseline characteristics and outcomes after treatment were recorded. RESULTS: Forty-eight patients received carboplatin/cysplatin as second line chemotherapy for recurrent HGG (grade III n = 6; grade IV n = 42). The median number of cycles completed was 4. Fifteen patients (28%) had at least minor response, 22 (49%) had stable disease and 11 (23%) had progressive disease. Six month progression-free survival was 30% (52% in patients with grade III glioma and 18% in patients with grade IV glioma). The median time to disease progression from the first treatment with platinum drug was 3.2 months. The median survival was 8 months (10 months for patients with grade III glioma and 7 months for patients with grade IV glioma). Among patients with either stable disease or a partial response, the median survival was 12 months compared with 3 months in patients with progressive disease. No survival or response rate differences were noted regarding the type of previous chemotherapy, nitrosoureas or temozolomide. CONCLUSIONS: Single-agent carboplatin/cysplatin has modest activity in patients with recurrent HGG previously treated with one line of chemotherapy, nitrosoureas or temozolomide. Despite the improvement of median survival of patients achieving stable disease or a partial response to treatment, more effective regimens are required for this patient population.
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Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Carboplatina/uso terapêutico , Cisplatino/uso terapêutico , Glioma/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Adulto , Idoso , Biópsia , Neoplasias Encefálicas/patologia , Progressão da Doença , Feminino , Glioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Giant ophthalmic artery (OphA) aneurysms remain surgically challenging despite the progress in endovascular treatments. This study describes the contralateral interoptic corridor in select patients based on imaging criteria suitable for clipping. The aim of this study was to show that despite the growing use of novel endovascular techniques, such as coil embolization and flow diversion, for the treatment of OphA aneurysms, microsurgical clipping may still be preferred for giant ones under certain conditions. OBSERVATIONS: The authors retrospectively reviewed the records of the microsurgical treatment of unruptured and ruptured giant OphA aneurysms at the University Hospital Center "Mother Teresa," Tirana, from 2007 to 2016. Four patients were selected for microsurgery and the contralateral approach using ophthalmic evaluations and coronal imaging on computed tomography, magnetic resonance imaging, and digital subtraction angiography that demonstrated aneurysms with a small neck and an orientation between 11 and 13 on the coronal clock face. A prefixed chiasm was a contraindication to this approach. LESSONS: Giant OphA aneurysms can be safely clipped through a contralateral interoptic corridor without creating new visual deficits or a residual aneurysm. https://thejns.org/doi/10.3171/CASE2473.
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Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Glioma/tratamento farmacológico , Lomustina/uso terapêutico , Adolescente , Adulto , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Intervalo Livre de Doença , Feminino , Glioma/mortalidade , Glioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Adulto JovemRESUMO
Thrombosis of a previously ruptured intracranial aneurysm is a frequent event and it most commonly occurs in large or giant aneurysms. We present a dynamic short-term follow-up and management of thrombosis in a ruptured small posterior inferior cerebellar artery aneurysm with concomitant vertebral artery dissection (VAD). Clinical and radiological follow-up findings and reviewed literature on thrombosis of small ruptured aneurysms are the focus of this presentation. Early reappearance of a disappeared ruptured small cerebral aneurysm with a concomitant VAD may be attributed to the controlled ovarian hyperstimulation phase of in vitro fertilization and prolonged use of oral contraceptive pills.
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Aneurisma Roto/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Dissecação da Artéria Vertebral/diagnóstico por imagem , Adulto , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Angiografia Digital , Cerebelo/irrigação sanguínea , Cerebelo/diagnóstico por imagem , Anticoncepcionais Orais Combinados/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/cirurgiaAssuntos
Ângulo Cerebelopontino/patologia , Hemossiderina/metabolismo , Imageamento por Ressonância Magnética , Melanoma/diagnóstico , Neoplasias Meníngeas/diagnóstico , Siderose/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Melanoma/patologia , Neoplasias Meníngeas/patologia , Pessoa de Meia-Idade , Siderose/metabolismo , Siderose/patologiaRESUMO
Cerebral proliferative angiopathy (CPA) is defined as a rare vascular disorder, characterized by diffuse arterial proliferation and distinctive angiogenetic features. Complication with hemorrhage is exceedingly rare, but once the bleeding occurs, the chance of re-bleeding is increased. Here we report a case of a patient with CPA complicated with bleeding and re-bleeding, and imaging findings mimicking a brain tumor, which has not been reported in the literature so far.
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Malformações Arteriovenosas/complicações , Neoplasias Encefálicas/fisiopatologia , Hemorragia Cerebral/etiologia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Adulto JovemAssuntos
Carcinoma Papilar/diagnóstico , Pinealoma/diagnóstico , Adulto , Carcinoma Papilar/fisiopatologia , Carcinoma Papilar/cirurgia , Humanos , Antígeno Ki-67/metabolismo , Imageamento por Ressonância Magnética/métodos , Masculino , Pinealoma/fisiopatologia , Pinealoma/cirurgia , Tomografia Computadorizada por Raios X/métodos , Derivação Ventriculoperitoneal/métodosRESUMO
Multiple saccular or giant aneurysms of azygos anterior cerebral artery (AACA) at the distal segments A2-A5 are very rarely reported. Distal anterior cerebral artery (DACA) aneurysms represent approximately 2%-7% of all cerebral aneurysms. We present the case of an Albanian 62-year-old male, admitted at our service after sudden onset of severe headache and vomiting. Computerized tomography (CT) of the head showed hemorrhage in the front of corpus callosum. CT angiography followed by digitally subtracted angiography (DSA) documented a large necked aneurysm with three lobes at the origin of calloso-marginal artery and a single DACA, also known as AACA. A frontal parasagittal craniotomy was performed. Obliteration of the aneurysm was done only by separate clipping of each three lobes at the respective neck. Postoperative DSA demonstrated complete exclusion of the aneurysm and a regular flow of AACA. The patient recovered uneventfully. Despite it is a rare occurrence, an aneurysm of distal segments of anterior cerebral artery A2-A5, concomitant to AACA should be studied with DSA. In the era of embolization, conserving good microsurgical skills is fundamental for dealing with multilobar cerebral aneurysms, associated with rare anatomical variations.
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The authors report a complication of catheter ablation that, to their knowledge, has never been previously reported. A 63-year-old man had undergone successful transvenous catheter thermoablation for atrial fibrillation. The patient remained well until 3 days prior to further admission when he noticed itching in the right frontal area of his scalp. On palpating his scalp, he discovered a metallic body projecting out of it and he proceeded to extract 20 cm of wire from his head. The following day a progressive left hemiplegia developed, and the patient experienced a deteriorating level of consciousness. A CT scan of the brain showed a right frontotemporal intraparenchymal hemorrhage and revealed a metallic structure in the middle of the hematoma. The hematoma was evacuated and a decompressive craniotomy was performed. The guidewire was identified, but it was only possible to extract part of it. It was covered by fibrous tissue, secondary to inflammatory reaction. To the authors' knowledge, this is the first report of guidewire-induced brain hemorrhage. The guidewire apparently had not been removed and had spontaneously migrated from the heart to the brain and beyond to the scalp where it then exited the patient's head. The patient had been well before he attempted to pull out the wire. Earlier identification of the iatrogenic complication of a retained guidewire might have prevented the fatal outcome in this case.
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Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/instrumentação , Hemorragia Cerebral/etiologia , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/etiologia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Evolução Fatal , Migração de Corpo Estranho/terapia , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECT: The aim of this study was to evaluate the impact of CCNU chemotherapy alone on low-grade glioma (LGG) growth dynamics. METHODS: The authors measured the evolution of the mean tumor diameter (MTD) in adult patients with LGG before (n=28 patients) and after (n=38 patients) CCNU administration. RESULTS: Natural (spontaneous) growth of LGG in the present study was 4.3 mm/year (range 2.1-6.6 mm/year). The median MTD decrease after CCNU was 5.1 mm/year (range 1-8.9 mm/year). MTD decrease was noted in 30 patients (late decrease in 4 patients, and ongoing decrease in 24 patients with oligodendroglial tumors and 2 with astrocytic tumors). The median duration it took for the MTD to decrease after initiation of CCNU treatment was 619 days (1038 days for oligodendroglial tumors vs 377 days for astrocytic tumors; p=0.003). CONCLUSIONS: These results show that CCNU as a single agent has a significant impact on LGG tumor growth. The impact of CCNU seems to be comparable to the previously reported impact of temozolomide therapy and of combined procarbazine, CCNU, and vincristine chemotherapy.
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Antineoplásicos Alquilantes/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Glioma/tratamento farmacológico , Lomustina/uso terapêutico , Adolescente , Adulto , Animais , Astrocitoma/tratamento farmacológico , Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Progressão da Doença , Feminino , Glioma/patologia , Humanos , Cinética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Oligodendroglioma/tratamento farmacológico , Oligodendroglioma/patologia , Coelhos , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Bathing epilepsy is a specific type of reflex epilepsy triggered by domestic bathing in water. It is a geographically specific epilepsy syndrome that is more prevalent in India Cases in Caucasian population are very rarely reported. These cases share many similar clinical features and a similar prognosis to the Indian cases. CASE REPORT: We describe three cases of bathing epilepsy in Albanian population; two cases with well controlled seizures and one with drug-resistant seizures.
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AIMS AND BACKGROUND: Carboplatin (CBDCA) and bevacizumab (BEV) are active in glioblastoma (GBM) with different profiles of toxicity. To date, no study has compared the value of the addition of BEV to historical or traditional cytotoxic chemotherapy. We sought to determine the relative value of BEV in combination with CBDCA versus CBDCA alone in patients with recurrent GBM. METHODS AND STUDY DESIGN: Eligible patients with progressive GBM following surgery, radiotherapy and temozolomide received CBDCA either alone (group 1, n = 25) or in combination with BEV (group 2, n = 23) at 5 mg/kg once every 3 weeks between June 2010 and December 2013. Baseline characteristics and outcomes after treatment were recorded. The primary end points of this retrospective analysis were progression-free survival (PFS) and objective response rate. Secondary end points included safety and overall survival (OS). RESULTS: Forty-eight patients were enrolled. The median number of cycles was 4 in group 1 and 6 in group 2. No toxicities or intracerebral bleeding were observed. The objective response rate was higher in group 2 than group 1, 66% vs 24% (p = 0.003). The estimated median PFS and OS were 3.1 vs 6.7 months (p<0.0001) and 6.1 vs 8.6 months (p = 0.09) in group 1 vs group 2, respectively. CONCLUSIONS: The combination of BEV and CBDCA is associated with improved response rates and survival compared with CBDCA alone. These results highlight the value of BEV in recurrent GBM. However, the clinical benefit of this interesting approach needs validation in a larger patient cohort.
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Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Carboplatina/uso terapêutico , Glioblastoma/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Carboplatina/administração & dosagem , Carboplatina/efeitos adversos , Progressão da Doença , Intervalo Livre de Doença , Esquema de Medicação , Feminino , Glioblastoma/patologia , Glioblastoma/radioterapia , Glioblastoma/cirurgia , Humanos , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia de Salvação/métodosRESUMO
Study Design Case study. Objectives We report the case of a 58-year-old Caucasian man, who presented with a 4-month history of increasing low back pain and gait difficulty. Objective neurologic examination revealed a severe paraparetic symptomatology without any sphincter involvement. Methods Spinal magnetic resonance imaging (MRI) showed an extradural mass formation situated dorsally at the level of thoracic vertebrae T2 to T4. Results A laminectomy was performed with total removal of the mass; histology suggested a highly vascularized lesion with lobular architecture, which seems a very rare case, compatible with a capillary hemangioma. Conclusions A careful follow-up for the next 4 years, including control MRIs every postoperative year, showed a very good neurologic condition of the patient and no recurrence on imaging findings.
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Spinal metastasis, a devastating neurologic complication of intracranial glioblastomas is not as uncommon as initially thought. It varies from 25% in supratentorial glioblastomas to 60% in infratentorial glioblastomas. The underlying pathogenesis spinal spread of high-grade gliomas is still unclear. To date, no causal responsibility of Bevacizumab (BEV) was noted. Here, we report for the first time, a case of thoracic intramedullary metastases from a cerebral glioblastoma pre-treated with BEV. A critical and exhaustive review is provided.
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OBJECTIVE: Visual and auditory hallucinations in relation to a cerebellar tumor are rarely reported in children. Primary origin of extraventricular neurocytoma (EVN) in the cerebellum is very rare. CLINICAL PRESENTATION: We report on a case of a cerebellar EVN in a 13-year-old girl with the initial symptoms of psychiatric manifestations for more than 2 months. Magnetic resonance imaging of the brain revealed a patchy enhanced tumor in the paramedian left cerebellar region. No obstructive hydrocephalus was noted. INTERVENTION: Total surgical removal of the tumor was performed. The tumor was initially diagnosed as an oligodendroglioma. After special immunohistochemical studies, the final definitive diagnosis was an EVN without isocitrate dehydrogenase mutation. CONCLUSION: EVNs located in the cerebellum are extremely rare. We discuss the clinical symptoms and histological-immunohistochemical features of this rare tumor in that rare location.
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Neoplasias Cerebelares/complicações , Alucinações/etiologia , Neurocitoma/complicações , Adolescente , Neoplasias Cerebelares/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Neurocitoma/diagnósticoRESUMO
Teratomas are embryonal neoplasms that arise when totipotential germ cells escape the developmental control of primary organizers and give rise to tumors containing tissue derived from all three blastodermic layers. Teratomas have been reported to occur in various sites and organs. Teratoma of the cervical neck are relatively rare in adulthood. It usually extends from the neck to the thoracic cavity causing local mass effect. In most of the cases intrauterine diagnosis is possible by ultrasound. Because of dyspnea due to mass effect, this condition is treated promptly after birth. However cases of teratoma in adulthood with supraclavicular localization have been reported rarely in the literature. The presented case is of a 25-year-old female with a cervical mass. Histological examination revealed a benign mature teratoma. The patient has been disease free for more than nine years after surgical removal of a neck teratoma.
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Infratentorial empyema is a life threatening condition and constitutes a neurosurgical emergency. Purulent mastoiditis and medial otitis is the most common origin and a thorough eradication of the purulent foci is mandatory. Decompression craniectomy has been primarily advised in the literature as the gold standard of the surgical treatment but burr hole evacuation when there the lack of cerebellar edema is less invasive and deemed equally efficient in the few reported cases. This is the report of a seventeen year old female who presented in a comatose state due to infratentorial empyema with acute hydrocephalus and who improved immediately after burr hole evacuation. Details of the surgical procedures are given. Mastoidectomy was completed, with the patient under combined antibiotherapy. She leads a normal life now, more than six years after surgery.
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The use of bevacizumab is increasingly reported in neuro-oncology. The most common schedule is 10 mg/kg every 2 weeks. We retrospectively investigated the efficacy of a 3-week schedule of 5 mg/kg bevacizumab in patients with recurrent glioblastomas. Fourteen patients (median age, 46 years) were included in the study. The median number of bevacizumab cycles was 4 (range, 2-8). Five patients (36%) had a partial response, 7 (50%) had stable disease, and 2 (14%) had progressive disease. No grade III-IV toxicities were observed. The median progression-free and overall survival were 3.6 months and 6.4 months, respectively. Every-3-week low-dose single-agent bevacizumab showed substantial activity and a safe profile in patients with recurrent glioblastoma.