Histopathological characterization of cerebral small vessel disease in epilepsy patients with temporal lobe epilepsy submitted to surgery: A case-control study.

BACKGROUND: Cerebrovascular disease (CVD) is a major contributor to epilepsy; however, patients with epilepsy also have a significantly increased risk of stroke. The way in which epilepsy contributes to the increased risk of stroke is still uncertain and is ill-characterized in neuropathological studies. A neuropathological characterization of cerebral small vessel disease (cSVD) in patients with chronic epilepsy was performed. METHODS: Thirty-three patients with refractory epilepsy and hippocampal sclerosis (HS) submitted to epilepsy surgery from a reference center were selected between 2010 and 2020 and compared with 19 autopsy controls. Five randomly selected arterioles from each patient were analyzed using a previously validated scale for cSVD. The presence of CVD disease imaging markers in pre-surgical brain magnetic resonance imaging (MRI) was studied. RESULTS: There were no differences in age (43.8 vs. 41.6 years; p = 0.547) or gender distribution (female gender 60.6% vs. male gender 52.6%; p = 0.575) between groups. Most CVD findings in brain MRI were mild. Patients had a mean time between the epilepsy onset and surgery of 26 ± 14.7 years and were medicated with a median number of three antiseizure medication (ASMs) [IQR 2-3]. Patients had higher median scores in arteriolosclerosis (3 vs. 1; p < 0.0001), microhemorrhages (4 vs. 1; p < 0.0001) and total score value (12 vs. 8.9; p = 0.031) in comparison with controls. No correlation was found between age, number of years until surgery, number of ASMs or cumulative defined daily dosage of ASM. CONCLUSION: The present study provides evidence supporting the increased burden of cSVD in the neuropathological samples of patients with chronic epilepsy.

Ageing affects the balance between central and peripheral mechanisms of cerebrovascular regulation with increasing influence of systolic blood pressure levels.

BACKGROUND: Arterial baroreflex (BR) and cerebral autoregulation (CA) are two major regulatory mechanisms that maintain constant cerebral perfusion. Little is known about the interplay between these mechanisms, particularly when considering the effects of ageing or sex. PURPOSE: We studied the relationship between dynamic CA and BR sensitivity (BRS) in healthy subjects by sex and in different age strata. METHODS: 95 healthy adults (52% female), 20-80 years-old, were recruited. Arterial blood pressure (Finometer), 3-lead electrocardiogram and cerebral blood flow velocity in middle cerebral arteries (transcranial Doppler) were monitored. We assessed CA by transfer function analysis and BRS in frequency and time domain. RESULTS: With increasing age, BRS diminished (ANCOVA R2 = 0.281, p < 0.001) but CA parameters did not change significantly (p > 0.05). Overall, there was an inverse relationship between the efficacy of BRS and CA low-frequency gain [multivariate linear regression ß = 0.41 (0.31; 0.61), p < 0.001]. However, this association suffers changes with ageing: in older subjects BRS and CA were not correlated [ß = 0.10 (- 0.41; 0.62), p = 0.369]. Instead, decreasing systolic blood pressure correlated with less efficient CA [lower CA low-frequency gain ß = - 0.02 (- 0.03; - 0.02), p = 0.003]. Sex did not affect BRS and CA relationship. CONCLUSIONS: Cerebral blood supply is governed by a tuned balance between BR and CA which is lost with age as BRS decreases dramatically. Low systolic blood pressure values might be harmful to older subjects as they might reduce the ability to keep cerebral blood flow tightly controlled.

Surf Session Events' Profiling Using Smartphones' Embedded Sensors.

The increasing popularity of water sports-surfing, in particular-has been raising attention to its yet immature technology market. While several available solutions aim to characterise surf session events, this can still be considered an open issue, due to the low performance, unavailability, obtrusiveness and/or lack of validation of existing systems. In this work, we propose a novel method for wave, paddle, sprint paddle, dive, lay, and sit events detection in the context of a surf session, which enables its entire profiling with 88.1% accuracy for the combined detection of all events. In particular, waves, the most important surf event, were detected with second precision with an accuracy of 90.3%. When measuring the number of missed and misdetected wave events, out of the entire universe of 327 annotated waves, wave detection performance achieved 97.5% precision and 94.2% recall. These findings verify the precision, validity and thoroughness of the proposed solution in constituting a complete surf session profiling system, suitable for real-time implementation and with market potential.

Demographic and Systemic Hemodynamic Influences in Mechanisms of Cerebrovascular Regulation in Healthy Adults.

OBJECTIVES: A competent cerebrovascular regulation maintains an adequate cerebral blood flow by 3 major mechanisms: cerebral autoregulation (CA), vasomotor reactivity (VMR), namely to CO2, and neurovascular coupling (NVC). However, most studies generalize their results based on a response to a single parameter. Using a full battery of neurovascular stress tests, our study aims to evaluate the relationships among grades of CA, VMR, and NVC, and how their interplay is influenced by demographic and systemic hemodynamic factors. METHODS: Fifty-eight healthy adults were recruited to fit each decade age stratum from 20 to 80 years old with similar sex ratio. Arterial blood pressure (Finometer), cerebral blood flow velocity in the middle cerebral arteries (transcranial Doppler), electrocardiogram, and end-tidal CO2 were monitored. We assessed CA by transfer function analysis, VMR at hypocapnia and hypercapnia (carbogen 5%), and NVC response during the N-Back Task. The Montreal Cognitive Assessment scores were recorded. RESULTS: Neurovascular stress tests were not affected by age or gender, and no correlation was found between their outputs (P > .05). Systemic hemodynamic parameters during tasks as well as cognitive scores had no correlation with cerebrovascular measurements (P > .05). CONCLUSIONS: Age and gender do not have major influence on the 3 major cerebrovascular regulation mechanisms. Our results also pinpoint the fact that neurovascular stress tests measure different aspects of cerebrovascular control, and that their outputs are uncorrelated and cannot be used interchangeability. Being independent of age and cognitive status, neurovascular stress tests seem adequate for studying several cerebrovascular conditions affecting the aging brain.

Nonclassic metallointercalators with dipyridophenazine: DNA interaction studies and leishmanicidal activity.

Complexes [Cu(CH3COO)(dppz)2]CH3COO (1) and [Zn(dppz)2](BF4)2 (2) with the intercalator dipyridophenazine (dppz) were prepared to obtain metallointercalators with increased geometrical flexibility compared to octahedral ones. Biophysical results (thermal denaturation, circular dichroism, rheometry, atomic force microscopy) indicate a strong interaction with DNA by intercalation and the existence of a positive cooperative effect with groove binding being preferred at low concentration of complexes. Induced circular dichroism (ICD) studies with DNA show that compounds 1 and 2 have a preferred orientation when binding to DNA. Since the compounds lack functional groups to permit hydrogen bonds, a combined intercalation/covalent binding mode is plausible. Further studies by QTof-ESI-MS and tandem experiments with GC oligonucleotides strongly support this dual-binding mode, since binding requires loss of one dppz unit with the copper center remaining attached to DNA even after another dppz loss. DNA saturation by the copper compound occurs at about one-half the concentration required for the zinc complex. Molecular modeling results suggest that it is caused by the increased ability of Cu(II) to distort to a more planar structure during interaction with DNA. Compounds 1 and 2 are active against a viscerotropic Leishmania infantum strain at submicromolar concentrations (IC50 = 0.57 and 0.46 µM, respectively), being more active than the reference drug miltefosine (M) (15.97 µM). They are also more cytotoxic than the control on human macrophages (MTD25 = 0.41 (1), 0.63 (2)). Besides miltefosine, the zinc compound is the only one with a MTD25/IC50 ratio above 1 on the promastigote phase (1.39) and was further studied on the amastigote form with a significant improvement in the therapeutic index (2.51). Combined analysis of DNA biophysical studies, parasite activity, and cytotoxicity measurements suggests that intercalation correlates with leishmanicidal activity, while cytotoxicity results are justified by a combination of DNA intercalation and possible radical formation in the case of Cu(II), most probably hydroxyl and/or singlet oxygen radicals.

Investigation of cobalt(III)-phenylalanine complexes for hypoxia-activated drug delivery.

Four cobalt(iii)-phenylalanine complexes, [Co(Phe)(py2en)](ClO4)2·H2O (1), [Co(Phe)(TPA)](ClO4)2·H2O (2), [Co(Phe)(py2enMe2)](ClO4)2·H2O (3) and [Co(bipy)2(Phe)](ClO4)2·H2O (4), were investigated as prototype models for hypoxia-activated delivery of melphalan - a phenylalanine derivative anticancer drug of the class of nitrogen mustards. Single crystal X-ray diffraction analysis provided the molecular structures of 1-4, as a single isomer/conformer. According with NMR and theoretical calculations, the solid-state structures of 2 and 4 are maintained in solutions. For complexes 1 and 3, though, a mixture of isomers was found in DMSO solutions: Λ-cisα(exo,exo) and Δ-cisß1(exo,exo) for 1 (3 : 2 ratio), and Λ-cisα(exo,exo) and Δ-cisα(exo,exo) for 3 (5 : 1 ratio). Theoretical calculations point to a re-equilibration reaction of the solid-state Λ-cisß1 isomer of 1 in solution. Electrochemical analysis revealed a correlation between the electron-donor capacity of the ancillary ligands and the redox potentials of the complexes. The potentials varied from +0.01 for 1 to +0.31 V vs. SHE for 4 in aqueous media and indicate that reduction should be achieved in biological media. The integrity of the complexes in pH 5.5 and 7.4 buffered solutions was confirmed by UV-Vis monitoring up to 24 h at 25 °C. Reduction by ascorbic acid (AA) shows an O2-dependent dissociation of the l-Phe for complexes 1-3, with higher conversion rates at pH 7.4. For complex 4, a fast dissociation of l-Phe was observed, with conversion rates unaffected by the pH and presence of O2.

Contributions for classification of platelet rich plasma - proposal of a new classification: MARSPILL.

Platelet-rich plasma (PRP) has emerged as a significant therapy used in medical conditions with heterogeneous results. There are some important classifications to try to standardize the PRP procedure. The aim of this report is to describe PRP contents studying celular and molecular components, and also propose a new classification for PRP. The main focus is on mononuclear cells, which comprise progenitor cells and monocytes. In addition, there are important variables related to PRP application incorporated in this study, which are the harvest method, activation, red blood cells, number of spins, image guidance, leukocytes number and light activation. The other focus is the discussion about progenitor cells presence on peripherial blood which are interesting due to neovasculogenesis and proliferation. The function of monocytes (in tissue-macrophages) are discussed here and also its plasticity, a potential property for regenerative medicine treatments.

[Olfactory groove schwannoma: case report]. / Schwannoma da goteira olfatória: relato de caso.

Intracranial schwannoma not related to cranial nerves are unusual and rarely found in the subfrontal region. We report a case of olfactory groove schwannoma in a 27-year-old male, who presented with anosmia and headache initiated one year ago. At admission, bilateral papilledema was noted with absense of motor deficits or cranial nerves abnormalities. Cranial computed tomography (CT) revealed a bifrontal multicystic isodense enhancing mass lesion causing a frontal ventricular horn compression. Radiological features resembled that of a cystic olfactory groove meningioma. Decompressive bifrontal craniotomy was done. One month later, CT demonstrated a homogeneously contrast-enhancing mass in the olfactory groove region who extended into the left nasal cavity. Magnetic resonance imaging did not add more informations. A second surgical procedure was done through a nasoethmoidal approach with incomplete resection of the lesion. The complete tumor resection was only possible in a third surgery through another bifrontal approach. The hystopathological diagnosis of schwannoma was performed by conventional methods and confirmed by immunohistoquemical staining for S-100 protein. The rarity of this tumor and his clinical, radiological and histological aspects justify this publication.

Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases.

OBJECTIVES: To determine the clinical presentation and treatment outcome of pediatric intracranial cavernous malformation (CM) in a single-centered institution. METHODS: Clinical data review of 30 patients under 18 years-old who had undergone surgery for cavernous malformation from January 1993 to December 2011. RESULTS: The Study Group included 18 males and 12 females (mean age: 8.7 years-old). Symptoms at presentation were seizures (16/30, 53.3%), headache (15/30, 50.0%), and focal neurological deficits (11/30, 36.6%). Multiple cavernous malformations were found in 5/30 (16.6%). According to location, patients were classified in groups: (G1) brain-steam in 5/30 (16.6%), (G2) cerebellum in 2/30 (6.6%), (G3) supratentorial associated with seizures in 16/30 (53.3%), and (G4) supratentorial without seizures in 7/30 (23.3%). Surgical resection was performed in 26 out of 30 (86.6%) patients. The mean follow-up period was 4.1 years. Of 15 children followed-up with preoperative seizures, all were rendered seizure-free after surgery. CONCLUSIONS: For symptomatic solitary cavernous malformation, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. For multiple cavernous malformation or asymptomatic patients, the treatment modalities must be cautiously considered.

FLOATING ELBOW IN CHILDREN: A DESCRIPTIVE STUDY OF 31 CASES ATTENDED IN A REFERENCE CENTER FOR PEDIATRIC TRAUMA.

OBJECTIVE: To conduct a descriptive analysis on 31 cases of children with floating elbow who were attended at our clinic between 1994 and 2009, and to review the literature relating to this topic. METHODS: Data were obtained through examining the medical records. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications. RESULTS: Twenty-four patients (77.4%) were male and seven (22.6%) were female. The mean age was 8.5 (± 3.2) years, ranging from one to 14 years. The left side was predominantly affected (67.7%). The commonest injury mechanism was a fall from a height (74.2%). All the supracondylar fractures were Gartland type III. Distal radius fractures alone, of Salter-Harris type II, were diagnosed in 22 patients (71%). Open fractures occurred in 22 cases (71%). Closed reduction and application of a plaster cast for a closed fracture of the distal radius was performed in two patients (6.45%). Simultaneous conservative treatment for two fractures was not used. Sixteen supracondylar fractures (54.8%) were fixed using crossed wires, at 90° to each other, and in 14 cases (45.16%), an intramedullary wire was used together with another wire introduced through the lateral epicondyle at 45°. The following complications were observed: deformed consolidation (10%), nerve injuries (6%), compartment syndrome (3%) and pin path infection (16%). CONCLUSIONS: This is an uncommon injury that in most cases results from high-energy trauma. Surgical treatment for both fractures is recommended by most authors. Ulnar nerve injuries were correlated with the fixation method, but no neurological injuries were triggered by the initial trauma.

Non-operative management of right side thoracoabdominal penetrating injuries--the value of testing chest tube effluent for bile.

INTRODUCTION: While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients' chest tube effluent. PATIENTS AND METHODS: We managed non-operatively all stable patients with a single RST penetrating injury. Chest tube effluent samples were obtained six times within (4-8 h; 12-16 h; 20-24 h; 28-32 h; 36-40 h; 48 h and 72 h) of admission for bilirubin measurement and blood for complete blood count, bilirubin, alanine (ALT) and aspartate aminotransferases (AST) assays. For comparison we studied patients with single left thoracic penetrating injury. RESULTS: Forty-two patients with RST injuries were included. All had liver and lung injuries confirmed by CT scans. Only one patient failed non-operative management. Chest tube bilirubin peaked at 48 h post-trauma (mean 3.3+/-4.1 mg/dL) and was always higher than both serum bilirubin (p<0.05) and chest tube effluent from control group (27 patients with left side thoracic trauma). Serum ALT and AST were higher in RST injury patients (p<0.05). One RST injury patient died of line sepsis. CONCLUSION: Non-operative management of RST penetrating trauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.

Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases / Angiomas cavernosos intracranianos em crianças: experiência de um único centro em 30 casos consecutivos

Objectives: To determine the clinical presentation and treatment outcome of pediatric intracranial cavernous malformation (CM) in a single-centered institution. Methods: Clinical data review of 30 patients under 18 years-old who had undergone surgery for cavernous malformation from January 1993 to December 2011. Results: The Study Group included 18 males and 12 females (mean age: 8.7 years-old). Symptoms at presentation were seizures (16/30, 53.3%), headache (15/30, 50.0%), and focal neurological deficits (11/30, 36.6%). Multiple cavernous malformations were found in 5/30 (16.6%). According to location, patients were classified in groups: (G1) brain-steam in 5/30 (16.6%), (G2) cerebellum in 2/30 (6.6%), (G3) supratentorial associated with seizures in 16/30 (53.3%), and (G4) supratentorial without seizures in 7/30 (23.3%). Surgical resection was performed in 26 out of 30 (86.6%) patients. The mean follow-up period was 4.1 years. Of 15 children followed-up with preoperative seizures, all were rendered seizure-free after surgery. Conclusions: For symptomatic solitary cavernous malformation, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. For multiple cavernous malformation or asymptomatic patients, the treatment modalities must be cautiously considered. .

Objetivos: Determinar a apresentação clínica e o acompanhamento do tratamento em crianças com angioma cavernoso intracraniano numa única instituição. Métodos: Revisão de dados clínicos de 30 pacientes menores de 18 anos com que passaram por uma cirurgia de angioma cavernoso intracraniano entre janeiro de 1993 a dezembro de 2011. Resultados: O grupo de estudo incluiu 18 sujeitos masculinos e 12 femininos (idade média: 8,7 anos). Os sintomas iniciais eram convulsões (16/30, 53,3%), cefaleia (15/30, 50,0%) e déficits neurológicos focais (11/30, 36,6%). Havia angiomas cavernosos intracranianos múltiplos em 5 de 30 (16.6%). A classificação foi feita em grupos de acordo com a localização: (G1) tronco cerebral em 5/30 (16,6%); (G2) cerebelo em 2/30 (6,6%); (G3) supratentoriais associados a convulsões em 16/30 (53,3%) e (G4) supratentoriais sem convulsões em 7/30 (23,3%). Ressecção cirúrgica foi realizada em 26 de 30 (86,6%) pacientes, com seguimento médio de 4,1 anos. De 15 crianças com convulsões pré-operatórias, todas ficaram livres das crises após a cirurgia. Conclusões: Para angioma cavernoso intracraniano solitário e sintomático, o tratamento de escolha é excisão microcirúrgica total precedida de avaliação funcional e anatômica meticulosa. Para angiomas cavernosos intracranianos múltiplos ou pacientes assintomáticos, as modalidades terapêuticas devem ser consideradas cautelosamente. .

Brain abscess in a neonate: an unusual presentation.

BACKGROUND: Neonatal brain abscesses are very rare and their clinical presentation is specific for this age group. They usually occur as a complication of bacterial meningitis or septicemia. They are most often caused by gram-negative organisms, and mortality and morbidity are still significant in this particular group of patients in spite of antibiotics and modern radiological tools. METHODS: We report an unusual case of a multiloculated brain abscess in a term neonate caused by Staphylococcus aureus. The abscess developed in the absence of trauma, prior surgery, cyanotic heart disease, mother's disease, or immune defect. The onset of infection in this case was not clear and image features mimicked a brain tumor in the initial evaluation. The infant was successfully treated by primary surgical excision of the lesion and a 6-week total course of intravenous antibiotics. CONCLUSION: The interest of this case lies in the rarity of the causative organism and the atypical features of clinical and neurological images in a term neonate.

Reconstruction of a large complex skull defect in a child: a case report and literature review.

BACKGROUND: Major skull defects, especially in the anterior region, can present as a most disturbing deformity. Reconstructive cranioplasty can restore cerebral protection and improve craniofacial aesthetics. Complex and large skull defects in children often present reconstructive difficulties. MATERIALS AND METHODS: In this paper, an unusual case of a very large post-traumatic defect (318 cm(2)) in a child managed by a multidisciplinary team is described. The literature is reviewed. CONCLUSION: The management of a large complex skull defect in children is still controversial. Each case should be extensively debated in craniofacial units. In our case, bioceramics proved to be an effective and good alternative for final skull reconstruction.

Ru(II) electron transfer systems containing S-donor ligands.

The synthesis and properties of 3 new ligand-bridged bimetallic complexes, 1(2+), 2(2+), and 3(2+), containing [RuCl([9]aneS(3))](+) metal centers are reported. Each complex was bridged by a different ditopic ligand. 1(2+) is bridged by 3,6-bis(2-pyridyl)-1,2,4,5-tetrazine (bptz), while 2(2+) and 3(2+) are bridged by 2,3-bis(2-pyridyl)pyrazine (dpp) and 2,2'-bipyrimidine (bpym), respectively. The Ru([II]) isovalent states of these complexes have been investigated using a variety of techniques. In the case of 3(2+), X-ray crystallography studies show preferential crystallization of an anti form with respect to coordinated chloride ligands (crystal data for [3][Cl(2)].4H(2)O: C(20)H(38)Cl(4)N(4)O(4)Ru(2)S(6), monoclinic, space group P2(1)/a, a = 10.929(14), b = 13.514(17), c = 11.299(16) A, beta = 90.52(1), V = 1669 A(3), Z = 2). UV/vis spectroscopy shows that spectra of these complexes are dominated by intraligand (pi-->pi) and metal-to-ligand Ru(d)-->L(pi) charge transfer transitions. Electrochemical studies reveal that metal-metal interactions are sufficiently intense to generate the Ru(III)/Ru(II) mixed valence [[RuCl([9]aneS(3))(2)](L-L)](3+) state, where L-L = individual bridging ligands. Although the 1(3+), 2(3+), and 3(3+) mixed valence states were EPR silent at room temperature and 77 K, isotropic solution spectra were observed for the electrochemically generated radical cations 1(+), 2(+), and 3(+), with 1(+) displaying well-resolved hyperfine coupling to bridging ligand nitrogens. Using UV/vis/NIR spectroelectrochemistry, we investigated optical properties of the mixed valence complexes. All three showed intervalence charge transfer (IVCT) bands that are much more intense than electrochemical data indicate. Indeed, a comparison of IVCT data for 1(3+) with an analogous structure containing [(NH3)(3)Ru](2+) metal centers shows that the IVCT in the new complex is an order of magnitude more intense. It is concluded that although the new complexes show relatively weak electrostatic interactions, they possess large resonance energies.

Schwannoma da goteira olfatória. Relato de caso / Olfactory groove schwannoma: case report

Schwannomas intracranianos näo associados a nervos cranianos säo incomuns e raramente encontrados na regiäo subfrontal. Apresentamos raro caso de schwannoma da goteira olfatória, acometendo paciente de 27 anos, masculino, com quadro iniciado há 1 ano com perda da olfaçäo e cefaléia. Ao exame de admissäo, apresentava papiledema bilateral e anosmia. Tomografia computadorizada de Cranio (TC) revelou processo expansivo bifrontal hipodenso ao parênquima, com aspecto multicístico, sem captaçäo do contraste iodado, promovendo compressäo dos cornos ventriculares frontais. Os achados radiológicos sugeriam meningeoma cístico da goteira olfatória. Foi submetido a craniotomia frontal para descompressäo. Um mês após, TC de controle revelou processo expansivo da regiäo da goteira olfatória homogeneamente captante do contraste iodado, que se estendia para o interior da cavidade nasal esquerda. RM näo adicionou novas informações. Foi realizado segundo procedimento cirúrgico por via naso-etmoidal, com ressecçäo incompleta da lesäo. A ressecçäo completa foi possível através de re-operaçäo por craniotomia bifrontobasal. O diagnóstico histopatológico de schwannoma foi realizado através de microscopia óptica convencional e confirmado por técnica de imuno-histoquímica, utilizando o anticorpo para proteína S-100. A raridade deste tumor, seus aspectos clínicos, radiológicos e histológicos justificam esta publicaçäo

Metástase de meningeoma para linfonodos cervicais / Metastatic meningioma to cervical lymph nodes

Os autores relatam um caso de menongeoma atípico da goteira olfatória, acometendo um paciente de 74 anos, do sexo masculino, apresentado-se com quadro de hipertensão intracraniana e confusão mental. Após exérese cirúrgica, hove recidiva local precoce e matástase ganglionar cervical. As metástases extracranianas de meningeomas intracarnianos já foram bem documentadas, mas são raramente encontradas. Ocorre em menos de 0,1 por cento desses tumores. Os locais mais comuns dessas metástases são os pulmöes (60 por cento), o fígado (34 por cento), os linfonodos cervicais (18 por cento), os ossos longos, a pélvis e o crânio (11 por cento).