RESUMO
We report a case of a 63-year-old woman who was presented to the emergency department with an occipital haemorrhage secondary to a pancreatic cerebral metastasis. Pancreatic cancer is the ninth most common cancer in women in Australia, and distant disease is present in 70% of patients with pancreatic cancer at the time of diagnosis. However, metastases to the brain are rare, accounting for only 0.33%-0.57% cases antemortem. Herein, we discuss the management of this unusual case to highlight the importance of recognising unusual central nervous system involvement of cancers, a problem which may be increasing in prevalence.
Assuntos
Neoplasias Cerebelares/secundário , Hemorragia Cerebral/patologia , Irradiação Craniana , Lobo Occipital/patologia , Neoplasias Pancreáticas/patologia , Anorexia/etiologia , Neoplasias Cerebelares/complicações , Neoplasias Cerebelares/radioterapia , Hemorragia Cerebral/etiologia , Evolução Fatal , Feminino , Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Neoplasias Pancreáticas/terapia , Radioterapia Adjuvante , Tomografia Computadorizada por Raios X , Neoplasias PancreáticasRESUMO
BACKGROUND: The "floating anchored" craniotomy is a technique utilized at our tertiary neurosurgery institution in which a traditional decompressive craniectomy has been substituted for a floating craniotomy. The hypothesized advantages of this technique include adequate decompression, reduction in the intracranial pressure, obviating the need for a secondary cranioplasty, maintained bone protection, preventing the syndrome of the trephined, and a potential reduction in axonal stretching. METHODS: The bone plate is re-attached via multiple loosely affixed vicryl sutures, enabling decompression, but then ensuring the bone returns to its anatomical position once cerebral edema has subsided. RESULTS: From the analysis of 57 consecutive patients analyzed at our institution, we have found that the floating anchored craniotomy is comparable to decompressive craniectomy for intracranial pressure reduction and has some significant theoretical advantages. CONCLUSIONS: Despite the potential advantages of techniques that avoid the need for a second cranioplasty, they have not been widely adopted and have been omitted from trials examining the utility of decompressive surgery. This retrospective analysis of prospectively collected data suggests that the floating anchored craniotomy may be applicable instead of decompressive craniectomy.