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1.
Br J Neurosurg ; 37(5): 1223-1227, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33095079

RESUMO

Meningiomas have a 5 year recurrence rate of 8%. Histological grade and extent of resection are the two main prognostic factors. Cystic meningiomas represent between 2 and 4% of meningiomas, and the complete resection rate in these cases is 62.7%. 5-ALA has been shown to be useful in detecting tumour remnants that could go unnoticed by the conventional microsurgical technique, thereby achieving more complete resections. We present the case of a 66-year-old patient with a frontal convexity meningioma, presenting with a cystic component and bone invasion, who was treated using 5-ALA fluorescence-guided surgery. Fluorescence emission from the tumour tissue allowed the areas of bone invasion and the cystic wall to be identified, achieving complete resection.


Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Idoso , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Meningioma/patologia , Ácido Aminolevulínico , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Neoplasias Meníngeas/patologia , Fluorescência
2.
Neurocirugia (Astur : Engl Ed) ; 31(4): 184-194, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31836283

RESUMO

INTRODUCTION: New intraoperative imaging techniques, which aim to improve tumour resection, have been implemented in recent years in brain tumour surgery, although they lead to an increase in resources. In order to carry out an update on this topic, this manuscript has been drafted by a group from the Sociedad Española de Neurocirugía (Spanish Society of Neurosurgery). MATERIAL AND METHODS: Experts in the use of each one of the most-used intraoperative techniques in brain tumour surgery were presented with a description of the technique and a brief review of the literature. Indications for use, their advantages and disadvantages based on clinical experience and on what is published in the literature will be described. RESULTS: The most robust intraoperative imaging technique appears to be low- and high-field magnetic resonance imaging, but this is the technique which results in the greatest expenditure. Intraoperative ultrasound navigation is portable and less expensive, but it provides poorer differentiation of high-grade tumours and is observer-dependent. The most-used fluorescence techniques are 5-aminolevulinic acid for high-grade gliomas and fluorescein, useful in lesions which rupture the blood-brain barrier. Last of all, intraoperative CT is more versatile in the neurosurgery operating theatre, but it has fewer indications in neuro-oncology surgery. CONCLUSIONS: Intraoperative imaging techniques are used with increasingly greater frequency in brain tumour surgery, and the neurosurgeon should assess their possible use depending on their resources and the needs of each patient.


Assuntos
Neoplasias Encefálicas , Glioma , Neurocirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Glioma/diagnóstico por imagem , Glioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Neuronavegação , Procedimentos Neurocirúrgicos
3.
J Neurosurg Spine ; 7(2): 254-8, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17688069

RESUMO

Hemangioblastomas are low-grade, highly vascular tumors commonly associated with von Hippel-Lindau (VHL) syndrome and most often appearing in the cerebellum. They very rarely occur in the spinal nerve roots, and an origin in the filum terminale is exceptional with no instances of multiple hemangioblastomas of the filum terminale reported in the literature. Because of their vascular nature, these lesions can enlarge and become symptomatic in the context of the changes that take place during pregnancy, as has been noted with cerebellar hemangioblastomas. In any case, the evolution of spinal hemangioblastomas during pregnancy is not well known given its rarity. The conjunction of both processes--that is, multiple hemangioblastomas arising in the filum terminale and pregnancy--is unique. The authors describe the case of a 41-year-old woman with multiple hemangioblastomas of the filum terminale and no other evidence of VHL syndrome, in whom pregnancy precipitated symptoms. The interruption of gestation led to a remission of the symptoms. The literature concerning filum terminale hemangioblastomas and pregnancy is also reviewed.


Assuntos
Cauda Equina , Hemangioblastoma/fisiopatologia , Segunda Neoplasia Primária/fisiopatologia , Neoplasias do Sistema Nervoso Periférico/fisiopatologia , Complicações Neoplásicas na Gravidez/fisiopatologia , Aborto Induzido , Adulto , Angiografia , Cauda Equina/patologia , Feminino , Hemangioblastoma/irrigação sanguínea , Hemangioblastoma/diagnóstico , Hemangioblastoma/cirurgia , Humanos , Laminectomia , Região Lombossacral , Imageamento por Ressonância Magnética , Segunda Neoplasia Primária/irrigação sanguínea , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/cirurgia , Dor/fisiopatologia , Neoplasias do Sistema Nervoso Periférico/irrigação sanguínea , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Neoplasias do Sistema Nervoso Periférico/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Reflexo Anormal
5.
Clin Nucl Med ; 33(12): 838-40, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19033782

RESUMO

RATIONALE: Malignant astrocytomas show thallium uptake with a high target-to-background ratio, allowing the use of radioguided surgery. METHOD: We report on 6 patients (3 men) diagnosed with malignant astrocytoma. All patients signed informed consent documents. Previous thallium-201 SPECT was performed, showing uptake in tumors. In the operating room we injected 37 MBq (1 mCi) of thallium-201 at the same time the craniotomy was performed. With the gamma probe we confirmed the tumor uptake, and a biopsy sample was taken. After conventional tumor resection, we scanned the surgical bed with the gamma probe. All areas of abnormal uptake were evaluated by the surgeon and, if possible, removed. RESULTS: In all patients the biopsy confirmed a high-grade astrocytoma. In all cases we found residual uptake in the surgical bed that was confirmed as residual tumor by pathologic examination. In 3 cases it was not possible to remove all the sites of pathologic uptake because critical areas were involved. In the other 3 patients, only background activity was found after the procedure. CONCLUSION: Radioguided surgery in brain tumors with thallium-201 is a complex technique and expertise in radioguided surgery and neuroimaging is needed, but we think that it is promising.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios
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