RESUMO
BACKGROUND AND PURPOSE: Preoperative embolization expands the spectrum of meningioma that can be operated on safely. Our goal was to achieve the distalmost loading of the vascular bed and confluent tumor necrosis with a fibrin glue preparation in the preoperative embolization of meningiomas. METHODS: Between 1992 and 1997, 80 patients with a meningioma had diagnostic angiography with a standard transfemoral Seldinger technique, performed with a 6F guiding catheter and digital subtraction angiography. Preoperative embolization was carried out in the same session with an additional microcatheter system. Fibrin glue was the only component used. In all cases, CT was performed immediately after embolization; in nine patients, MR imaging was also performed. RESULTS: Angiography verified the elimination of tumor blush in all patients. The high-density areas seen on postembolization CT scans, caused by the fibrin glue dispersed in the embolized supply area, were found to be necrotic at surgery and were easily removed by suction. Two (2.5%) of the 80 patients had complications associated with embolization that resulted in neurologic deficits. CONCLUSION: The most effective preoperative embolization of tumors requires a distalmost loading of the vascular bed. Fibrin glue, which is easy to use and safe to handle, causes confluent tumor necrosis within the injected vascular territory.
Assuntos
Embolização Terapêutica , Adesivo Tecidual de Fibrina/administração & dosagem , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Terapia Neoadjuvante , Adulto , Idoso , Angiografia Cerebral , Criança , Terapia Combinada , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/irrigação sanguínea , Neoplasias Meníngeas/patologia , Meningioma/irrigação sanguínea , Meningioma/patologia , Pessoa de Meia-Idade , Necrose , Fluxo Sanguíneo Regional/fisiologia , Tomografia Computadorizada por Raios XRESUMO
Hemophagocytic lymphohistiocytosis (HLH) is a rare disease of infancy and young childhood. The clinical presentation includes recurrent unexplained fever with hepatosplenomegaly. Cytopenia, hypofibrinogenemia and/or hypertriglyceridemia and hemophagocytosis in bone marrow, spleen and lymphnode confirm the diagnosis. Hemophagocytosis may not be present at the beginning. In these cases, diagnosis is facilitated by a positive family history, a relapsing course of the disease, the frequent involvement of the central nervous system and positive findings on immunological work-up. Treatment by chemotherapy and immunosuppressants can achieve sustained remissions in most patients and reinduction of remission after relapse is possible. Most children however, eventually die from progressive disease. At present, allogeneic bone marrow transplantation is the only curative therapeutic option. Between August 1992 and May 1997 eleven consecutive patients with HLH received bone marrow from unrelated (n = 7) or matched sibling donors (n = 4). The conditioning regimen consisted of busulfan, VP-16 and cyclophosphamide. Patients engrafted after a median time of 16 days (13-43). Only one patient developed grade III acute GVHD, another patient, grade II acute GVHD. Although regimen-related toxicity was extensive, all patients have survived without signs of HLH after a median follow up of 20 months (8-63). One patient suffers from chronic GVHD, three patients reveal psychomotoric retardation and one patient has severe impairment with spastic tetraparesis, amaurosis and seizures. Our experience shows that HLH can be successfully treated by allogeneic BMT from unrelated donors.
Assuntos
Transplante de Medula Óssea , Histiocitose de Células não Langerhans/terapia , Medula Óssea/patologia , Transplante de Medula Óssea/patologia , Criança , Pré-Escolar , Seguimentos , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/patologia , Histiocitose de Células não Langerhans/diagnóstico , Histiocitose de Células não Langerhans/patologia , Humanos , Lactente , Resultado do TratamentoAssuntos
Fístula Arteriovenosa/congênito , Edema Encefálico/etiologia , Tronco Encefálico/irrigação sanguínea , Artéria Carótida Interna/anormalidades , Veias Cerebrais/anormalidades , Dura-Máter/irrigação sanguínea , Malformações Arteriovenosas Intracranianas/complicações , Adulto , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico , Neoplasias Encefálicas/diagnóstico , Angiografia Cerebral , Veias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Fossa Craniana Posterior , Diagnóstico Diferencial , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Imageamento por Ressonância MagnéticaRESUMO
The authors report a case of a congenital clivus chordoma that caused cranial nerve palsy and hydrocephalus within a few days after birth. The tumor was well demonstrated by sonography, CT, and MR; the preoperative diagnosis was histologically confirmed after subtotal resection.
Assuntos
Neoplasias Encefálicas/congênito , Cordoma/congênito , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/diagnóstico por imagem , Cordoma/diagnóstico , Cordoma/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
We report the first case of a congenital intracranial chordoma. Hydrocephalus, sixth and seventh cranial nerve palsy, and torticollis were observed shortly after birth. The tumour was delineated by sonography, CT scans and MRI and the diagnosis confirmed after subtotal resection at the end of the newborn period.