RESUMO
PURPOSE: Symptomatic Chiari type 1 malformation (CIM) patients may elect to be treated; however, choosing the optimum surgical method remains problematic: posterior fossa decompression with duraplasty (PFDD) or without duraplasty (PFD). Many studies have compared these surgical methods from several perspectives. We looked at soft tissue density (STD) at the foramen magnum to add another perspective to the comparison of PFD with PFDD. MATERIALS AND METHODS: Eighty-six patients who underwent surgery in our clinic were included in the study. We examined preoperative and postoperative MR images taken in the 1st year. We obtained the foramen magnum area (FMA) and soft tissue at the level of the foramen magnum. The STD within the foramen magnum was calculated as the percentage ratio of soft tissue area (STA) to FMA. Anteroposterior diameters of the syrinx cavities in sagittal T2 sections were measured preoperatively and at 1-year postoperatively. Measurements were double-blind and were performed by the neurosurgeon and by the neuroradiologist. RESULTS: There was no statistically significant difference between the postoperative FMA increases, STA changes, STD changes in patients who underwent PFD and PFDD. In this study, there was no statistically significant difference between PFD and PFDD in terms of syrinx changes. CONCLUSIONS: The medium-term anatomical outcome following craniovertebral decompression for CIM, is no different whether performed PFD or PFDD.
Assuntos
Malformação de Arnold-Chiari , Descompressão Cirúrgica , Humanos , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Descompressão Cirúrgica/métodos , Método Duplo-Cego , Dura-Máter/cirurgia , Forame Magno/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: Arachnoid cysts are usually asymptomatic lesions. However, they can sometimes cause intracranial hypertension, headache, seizures, focal neurological deficits, and bleeding. The most commonly used surgical techniques are microsurgical cyst fenestration/excision/drainage, cyst shunting, and endoscopic procedures. We aimed to investigate the success of different surgical techniques. METHODS: Between 2000 and 2021, patients with Sylvan fissure arachnoid cysts who received treatment via an endoscopic approach chosen as the first-line treatment in three centers were enrolled. All case notes and radiological studies were evaluated retrospectively. RESULTS: The study included 131 (female, n = 28; male, n = 103) patients with a mean age of 87.04 ± 66.76 (range, 0-216) months. Of the patients, 25 had Galassi type II left-sided arachnoid cysts, 33 had Galassi type II right-sided arachnoid cysts, 40 had Galassi type III left-sided arachnoid cysts, and 32 had Galassi type III right-sided arachnoid cysts. No difference was found between patients who underwent single and multiple fenestrations in terms of Galassi type, side, clinical outcome, and cyst size (p > 0.05). On the contrary, the rate of additional surgical intervention was lower in patients with multiple fenestrations than in those with single fenestration (36.10% vs. 5.30%; p < 0.001). CONCLUSION: Endoscopic fenestration of Sylvian fissure arachnoid cysts is a good alternative to open surgery or cystoperitoneal shunting, and the number of fenestrations made during this surgery decreases the need for a second surgical procedure.
Assuntos
Cistos Aracnóideos , Humanos , Masculino , Feminino , Cistos Aracnóideos/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Neurocirúrgicos/métodos , EndoscopiaRESUMO
AIM: To explore the ability of dynamic susceptibility contrast perfusion imaging (DSC-PI) to detect isocitrate dehydrogenase (IDH) gene mutation in gliomas. MATERIAL AND METHODS: Preoperative DSC-PI data on histopathologically proven gliomas obtained between January 2015 and December 2019 were reviewed retrospectively. All magnetic resonance imaging (MRI) examinations were performed using a 1.5-T scanner. The maximum relative cerebral blood volume (rCBVmax), percentage signal recovery (PSR), and normalized PSR of tumor cores were calculated. Differences in these values between IDH-mutant and wild-type gliomas were compared, and receiver operating characteristic curves were generated. RESULTS: The patients (32 females, 47 males) were aged 21-76 years (mean 50.7 ± 15 years). The rCBVmax and all PSR values differed significantly between patients with IDH-mutant and those with wild-type tumors (p < 0.01 for all comparisons). CONCLUSION: The rCBVmax and PSR values obtained by DSC-PI may facilitate noninvasive detection of the IDH mutation status of gliomas. PSR provided more reliable values for differentiation of IDH-mutant gliomas from wild-type gliomas.
Assuntos
Neoplasias Encefálicas , Glioma , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Feminino , Glioma/diagnóstico por imagem , Glioma/genética , Humanos , Isocitrato Desidrogenase/genética , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mutação , Imagem de Perfusão , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Galantamine is well-known for its neuroprotective effects and is currently used in the treatment of individuals with Alzheimer's disease. In this study, we induced experimental sciatic nerve injury (SCI) in rats to test the beneficial effects of galantamine. METHODS: Thirty male Wistar albino rats were divided into three groups, as follows: sham, SCI + saline, and SCI + galantamine. After the administration of an intraperitoneal ketamine and xylazine mixture, which was used for anesthesia, SCI was induced by sur-gical clip compression at the midthigh region of the rats. After surgery, a single daily intraperitoneal dose of galantamine was adminis-tered for 7 days, and nerve tissue sections were obtained 1 week after injury. Histopathology studies were performed to assess neural thickness and apoptotic cell counts, and light microscopic morphological examination was used to determine a potential beneficial effect of galantamine on peripheral nerve degeneration. RESULTS: We observed a markedly increased microvasculature, increased nerve fiber thickness, and a statistically significant increase in apoptotic cell counts distal to the level of injury in the saline group compared with the sham group. However, the increases in nerve fiber thickness and apoptotic cell counts were less in the galantamine group compared with the saline group. CONCLUSION: In our experimental model, pharmacological intervention with galantamine demonstrated a protective effect on degeneration after peripheral nerve injury.
Assuntos
Lesões por Esmagamento , Tecido Nervoso , Traumatismos dos Nervos Periféricos , Animais , Galantamina/farmacologia , Masculino , Degeneração Neural , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Ratos , Ratos Wistar , Nervo Isquiático/lesõesRESUMO
BACKGROUND: In humans, coronavirus disease 2019 (COVID-19) has a variable presentation ranging from mild self-limiting respiratory tract infections to severe acute respiratory distress syndrome. Methods: We present the case of a patient who developed acute epiglottitis after surgery for an intracranial tumour and was subsequently diagnosed with COVID-19. RESULTS: A 58-year-old female patient developed acute-onset respiratory distress on day 6 after intracranial surgery. Neck computed tomography revealed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis. The patient's SARS-CoV-2 polymerase chain reaction test was positive. Viral respiratory tract panel and sputum and blood cultures were negative. She completed the antiviral and antibacterial treatment regimens recommended by the chest disease department. CONCLUSIONS: We conclude that epiglottitis can be an unusual manifestation of COVID-19.
Assuntos
COVID-19 , Epiglotite , Síndrome do Desconforto Respiratório , Doença Aguda , Epiglotite/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
ABSTRACT: Very few studies have focused exclusively on pediatric calvarial tumors. These studies have primarily addressed the similarities of the cases with those reported in the literature, as opposed to their distinctive features. In contrast, the present study is the most detailed study conducted in the last 10 years that includes only pediatric calvarial tumors and highlights their differences according to the literature. A total of 31 patients with pediatric calvarial tumor surgically treated in our center between 2010 and 2020 were included in the study. The patients' files were analyzed retrospectively and 17 different preoperative, intraoperative, and postoperative parameters were determined and compared with previous studies. Except for the tumors causing lytic or sclerotic lesions, there was at least one distinguishing aspect of our series in all parameters. Despite the many distinctive features, the consensus in the treatment of calvarial tumors is to perform complete resection of the tumor and, if possible, remove some of the adjacent healthy bone. Considering the age factor, however, closure of the resulting bone defects with cranioplasty to address issues of cosmesis and intracranial pressure is yet another aspect of pediatric calvarial tumors, because pediatric cranioplasty has its own specific complications. Using intraoperative neuronavigation and performing tumor resection alone without additional craniectomy are also methods the authors use to prevent major bone defects.
Assuntos
Neoplasias , Crânio , Criança , Craniotomia , Humanos , Neuronavegação , Estudos Retrospectivos , Crânio/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Meningiomas and schwannomas are common extra-axial brain tumors. Discrimination is challenging in some locations when characteristic imaging features are absent. This study investigated the accuracy of percentage signal recoveries obtained from dynamic susceptibility contrast perfusion imaging (DSC-PI) in discriminating meningiomas and schwannomas. MATERIAL AND METHODS: Retrospective database research was conducted. Sixty nine meningioma and 15 schwannoma having DSC-PI between January 2016 and February 2020 were included. Time to signal intensity curves (TSIC) were analyzed and grouped as T1-dominant leakage, T2*-dominant leakage and return to baseline. Relative cerebral blood volume (rCBV), relative mean transit time (rMTT), percentage signal recovery 1 (PSR 1) and PSR 2 values were calculated. The differences between the groups were investigated. Receiver operating characteristic curves were operated. RESULTS: rCBV, rMTT, PSR 1 and PSR 2 values were statistically different between meningiomas and schwannomas. PSR 2 provided the best discrimination. With the cut off value of 1.08 for PSR 2, meningiomas and schwannomas were differentiated with 95.7% sensitivity and 93.3% specificity. TSICs were also different between two groups. Most of meningiomas showed T2*-dominant leakage (78.2%), whereas most of shwannomas showed T1-dominant leakage (93.3%). CONCLUSION: DSC-PI is a useful imaging tool for non-invasive discrimination of meningiomas and schwannomas. Particularly, percentage signal recoveries discriminates meningiomas and schwannomas with high sensitivity and specificity.
Assuntos
Neoplasias Meníngeas , Meningioma , Neurilemoma , Humanos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Imagem de Perfusão , Estudos RetrospectivosRESUMO
AIM: To define the natural course of kyphosis, and to evaluate the efficiency of a new technique in surgical correction of kyphosis seen in myelomeningocele(MM) patients. MATERIAL AND METHODS: We retrospectively reviewed our patients with MM. The rate of kyphosis, mean angle of progression and mean angle of surgical correction were evaluated. Surgical correction was achieved with the same technique in all patients; kyphectomy, short segment instrumentation with plate system and long segment instrumentation with screw-rod system. RESULTS: A total of 14 patients were treated surgically and the mean age at the surgery was 39 months. The incidence of kyphosis rate was %21 in this study. The mean angle of kyphosis was 85.8°. Average angle of progression was 15.7° whereas it was 6.3° degree in patients whose kyphosis angle ?90 and > 90 degree, respectively, at birth. 14 patients were treated surgically and the mean age at the surgery was 39 months. The mean angle of correction of kyphosis was 86 degree. The most common complications were wound dehiscence and cerebro-spinal fluid leak. One patient died 3 months after surgery, and one patient was reoperated due to pull-out of screws. CONCLUSION: Effective surgical correction of kyphosis in MM patients can be achieved with the described surgical technique even in younger ages. Prospective studies in larger study population are necessary for more accurate definition of natural history of kyphosis in MM patients.
Assuntos
Cifose/diagnóstico por imagem , Cifose/cirurgia , Meningomielocele/diagnóstico por imagem , Meningomielocele/cirurgia , Fusão Vertebral/métodos , Parafusos Ósseos/tendências , Pré-Escolar , Feminino , Humanos , Lactente , Cifose/etiologia , Masculino , Meningomielocele/complicações , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Reoperação/métodos , Reoperação/tendências , Estudos Retrospectivos , Fusão Vertebral/tendências , Resultado do TratamentoRESUMO
AIM: To determine the clinical and radiographical aspects of six patients diagnosed with pericallosal lipomas (PCL). MATERIAL AND METHODS: A retrospective analysis of patients who presented to the neurosurgery outpatient clinics of Selcuk Faculty of Medicine between 2009 and 2019, revealed that six patients were diagnosed with PCL. The clinical and magnetic resonance imaging (MRI) data were obtained by reviewing patients? records. RESULTS: A total of six patients (two girls and four boys), with a mean age of 53.8 months (38?72 months), were included in this study. They were followed up for a mean period of 36.5 months (32?41 months). PCL were detected on MRIs, which were obtained to investigate headache in two patients, epilepsy in one patient, frontal dermal sinus tract and left frontal epidermoid tumor in one patient, and subcutaneous lipoma associated with PCL in one patient. Five patients displayed tubulonodular lipomas and one patient displayed curvilinear lipomas. Agenesis or dysgenesis of the corpus callosum (CC) was observed in four (66%) patients. Two patients received surgical treatment for cosmetic skin problem. CONCLUSION: Because of the benign course of PCL, i.e. no growth or very slow growth, and close proximity to the surrounding neurovascular structures, surgical removal should be considered only in symptomatic PCL. Furthermore, other malformations and anomalies may accompany PCL.
Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Corpo Caloso/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Corpo Caloso/cirurgia , Feminino , Cefaleia/diagnóstico por imagem , Cefaleia/cirurgia , Humanos , Lipoma/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
AIM: To investigate the immunogenetic properties of glial tumors according to the World Health Organization 2016 glial tumor classification and develop an accurate diagnosis and treatment strategy by comparing preoperative advanced magnetic resonance (aMRI) technique findings of these results. MATERIAL AND METHODS: This study was conducted at the Department of Neurosurgery at the Medical Faculty Hospital of Selcuk University between January 1, 2010 and January 4, 2017 and included 50 patients. MR spectroscopy (MRS), MR perfusion (PWI), and MR diffusion (DWI) were performed in 50 patients preoperatively. Patient data were obtained from the hospitalâ™s information system. Pathological diagnosis of all patients was taken from the department of pathology at the same medical faculty. RESULTS: Among the patients included in the study, 11 were grade II (22%), 7 were grade III (14%), and 32 were grade IV (64%). All patients were IDH1 stained: 22 were IDH mutant (44%) and 28 were IDH wild-type (56%). A statistically significant difference in the survival time was observed between IDH mutant and wild-type. IDH-mutant tumors were commonly located in the frontal lobe and IDH wild-type tumors in the parietal and temporal lobes. A significant difference in PWI relative cerebral blood volume (rCBV) and DWI apparent diffusion coefficients (ADC) was noted among grade II, III, and IV tumor groups. The PWI rCBV cut-off value for grade IV tumors was 2.05 (90% sensitivity, 78% specificity). No difference in the Cho/Cr ratio among grade II, III, and IV tumor groups was noted. A significant difference was noted between the IDH mutant and wild type in terms of PWI rCBV. The PWI rCBV cut-off value of IDH mutantâ"wild type was 2.15. No difference in the Cho/Cr, Cho/NAA, and DWI apparent diffusion coefficients (p > 0.05) was noted between the IDH mutant and wild type. CONCLUSION: PWI rCBV is the most important prognostic value of aMRI used in tumor grading. PWI rCBV values could be significant in distinguishing IDH wild and mutant.
Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Neuroimagem/métodos , Adulto , Idoso , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Feminino , Glioma/genética , Glioma/patologia , Humanos , Isocitrato Desidrogenase/genética , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Microcystic meningiomas are extra axial masses that are extremely rare in the pediatric population. Intraventricular meningiomas are also rarely seen. CASE PRESENTATION: This case reports an 18-year-old boy who had an intraventricular mass on magnetic resonance imaging at the age of 12 years and had shown growth at a 6-year follow-up after subtotal resection. The mass was removed by total resection and pathological examination indicated microcystic meningioma. CONCLUSION: The present case is the first pediatric intraventricular microcystic meningioma in the literature. We believe that this unique case presented with its radiological, pathological and clinical features will contribute to the literature.
Assuntos
Neoplasias Meníngeas , Meningioma , Adolescente , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , RadiografiaRESUMO
BACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months. CONCLUSIONS: Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.
Assuntos
Discotomia/efeitos adversos , Artéria Ilíaca/lesões , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Perda Sanguínea Cirúrgica , Angiografia por Tomografia Computadorizada , Diagnóstico Precoce , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Imagem Multimodal , Stents , Ativador de Plasminogênio Tecidual/administração & dosagem , Ultrassonografia , Lesões do Sistema Vascular/diagnóstico por imagemRESUMO
AIM: To assess the feasibility of the vasoactive-inotropic score (VIS) in determining the amount of vasoactive support and its relationship with the mortality rate and characteristics of the patients with traumatic brain injury (TBI). MATERIAL AND METHODS: This study was conducted with a retrospective design involving the years 2013-2018 in a university hospital which provides tertiary intensive care service. A total of 102 patients who were admitted in the ICU with the diagnosis of severe TBI, and also were followed by neurosurgery service and who received vasoactive and inotropic support were analyzed concerning VIS value. RESULTS: The median age of the patients was 34 years, and 69.6% of the patients were male. Mortality rate was 43.1%. In the group with mean VISâA10, the admission duration in the ICU and hospital were shorter (p < 0.0001) whereas mortality rates were higher (81.1% vs 21.5% and p < 0.0001). Besides, the number of patients with a VIS score of âA10, âA15 and âA20 were higher in the group of patients who died (p < 0.0001). The results of the multivariate analysis such as VISâA10 were significant. CONCLUSION: We can conclude that VIS, which is used to determine the amount of vasoactive and inotropic medicines during cardiac surgery and in sepsis patients, may be useful in predicting mortality in TBI patients.
Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Cardiotônicos/uso terapêutico , Índice de Gravidade de Doença , Vasoconstritores/uso terapêutico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
AIM: In the present study, we evaluated the association of the Glasgow Coma Scale (GCS) score and amount of blood loss with mortality in patients presenting with traumatic acute subdural hematoma (ASDH). MATERIAL AND METHODS: This retrospective study was performed on 99 patients who were operated for traumatic acute subdural hematoma (ASDH) without any systemic association at a single center. Epidural hematoma was reported to be the most common additional pathology. Age, sex, mechanism of trauma, time interval between onset of trauma and admission to the emergency ward, associated problems, thickness of hematoma and Glasgow Coma Scale (GCS) score at the time of admission and on discharge were all studied. RESULTS: The GCS score was inversely proportional to the thickness of hematoma and interval between onset of trauma and surgery (p < 0.05). Although the mortality rate was reported to be high in traffic accidents, the rate was low in patients with head trauma only (p < 0.05). The mortality rate was high in patients with associated pathologies (p < 0.05). Lost patients were reported to be older patients with more extensive ASDH or those who presented earlier with a low GCS (p < 0.05). CONCLUSION: ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.
Assuntos
Hematoma Subdural Agudo/mortalidade , Hematoma Subdural/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/cirurgia , Feminino , Escala de Coma de Glasgow , Hematoma Epidural Craniano/complicações , Hematoma Subdural/complicações , Hematoma Subdural/cirurgia , Hematoma Subdural Agudo/complicações , Hematoma Subdural Agudo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Nonfunctioning pituitary adenomas are the most common pituitary adenomas in adults and cause significant morbidity unless adequately treated. METHODS: This study retrospectively assessed the medical records of 160 patients operated via pure endonasal endoscopy. The presenting symptoms, results of neurologic and visual examinations, levels of pituitary hormones, results of radiologic examinations, size of the adenoma, rates of resection, results of postoperative visual examination, and pituitary hormone levels at follow-up were recorded to establish the appropriate approach, operative criteria, and outcomes of patients with nonfunctioning pituitary adenoma. RESULTS: Headache was the presenting symptom in 87.5% of the patients. Thirty-three percent had visual loss, and visual examinations on the whole study population revealed a visual field defect in 47.5% of the patients. Only 16.25% of the patients presented with endocrinological symptoms; 52.5% had abnormal anterior pituitary hormone levels. Regarding adenoma size, 56 patients had macroadenoma (35%), 84 (52.5%) had mesoadenoma, and 20 patients had giant adenoma. Gross total resection was achieved in 90% of the patients; subtotal resection was achieved in the remainder. The rate of total resection was lower for giant adenomas and recurrences. Visual symptoms and anterior pituitary hormone levels improved in 27 and 42 patients, respectively, after the operation. CONCLUSIONS: Nonfunctioning pituitary adenomas present frequently as mesoademonas and giant adenomas. Patients with these tumors may have subclinical visual or hormonal deficits at the time of diagnosis. Early and effective surgical treatment is essential for rapid recovery of visual and/or hormonal deficits, particularly in symptomatic cases.
Assuntos
Adenoma/metabolismo , Adenoma/cirurgia , Endoscopia/métodos , Hormônios Ectópicos/metabolismo , Hipofisectomia/métodos , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/cirurgia , Adenoma/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto JovemRESUMO
AIM: Acromegaly is a chronic disorder characterized by enhanced growth hormone (GH) secretion and elevated insulin-like growth factor-I (IGF-I) levels, usually caused by pituitary adenomas. In this retrospective study, we reviewed our experience with endoscopic endonasal transsphenoidal surgery (EETS) with in remission rates using the 2010 consensus criteria, predictors of remission and associated complications. MATERIAL AND METHODS: The authors retrospectively analyzed data from 56 acromegalic patients who underwent pure EETS. Tumors were classified according to size and suprasellar/parasellar extension. The criteria of remission were GH levels < 1 ng/mL randomly, < 0.4 ng/mL after oral glucose tolerance test and normal IGF-I levels for age and sex within the first 3 and 6 months after surgery. RESULTS: Biochemical remission was achieved in 4 of 5 microadenomas (80%) and in 33 of 51 macroadenomas (64.7%). The total remission rate was 66.1% (37 of 56 adenomas). Age, gender and suprasellar extension did not affect the remission rate. However, cavernous sinus invasion, sphenoid sinus invasion and history of prior surgery were associated with lower rates of disease control. CONCLUSION: EETS represents an effective and safe option for the treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique.
Assuntos
Acromegalia/cirurgia , Adenoma/cirurgia , Consenso , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Guias de Prática Clínica como Assunto , Adenoma/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
AIM: The aim of the present study was to analyze our experience with a new liquid embolic agent, Squid, for the treatment of cerebral vascular lesions. MATERIAL AND METHODS: We present 28 patients who were treated with two formulations of Squid (Squid 18 and Squid 12). The lesions included 16 arteriovenous malformation (AVM)s (Spetzler-Martin grade 2 in 8, 3 in 6 and 4 in 2), 9 arteriovenous (AV) fistulas, 2 tumors (glomus tumor and angiofibroma) and 1 AICA aneurysm. Of the 9 patients presenting with hemorrhage, 6 were AVM, 2 were AVF and 1 was aneurysm. RESULTS: The total obliteration rate of the AVMs was 37.5%. Fistulas were closed completely after combined treatment with surgery in 6 out of 9 patients, and one was sent to radiotherapy. There was no mortality. Two reported hemorrhages and thromboembolic complications resulted in permanent deficits in 3 patients. Pathologic examination revealed mild inflammatory reaction with infiltration of polymorphonuclear cells in 5 patients in whom surgery was performed immediately after embolization. Technical problems such as rupture, inability to remove or premature occlusion of the microcatheter related to the embolic agent were not recorded. CONCLUSION: Squid is a safe and effective embolic agent for treatment of cerebral AVMs, AV fistulas, tumors and aneurysms with satisfactory obliteration rate.
Assuntos
Fístula Arteriovenosa/terapia , Neoplasias Encefálicas/terapia , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Adolescente , Adulto , Idoso , Angiofibroma/cirurgia , Fístula Arteriovenosa/patologia , Neoplasias Encefálicas/patologia , Feminino , Tumor Glômico/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/patologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
AIM: To assess the incidence, hormonal activity and postoperative follow up of the cases that are histopathologically diagnosed as atypical pituitary adenoma (APA) in our series. MATERIAL AND METHODS: In this study, 13 atypical pituitary adenoma cases, by the WHO 2004 criteria, among the 146 pituitary adenoma patients operated on in our clinic between January 2009 and May 2012 by endoscopic endonasal transsphenoidal approach were included. RESULTS: In histological studies, 133 cases were diagnosed as typical pituitary adenoma (91.1%) and 13 cases were APAs (8.9%) of which 10 were male (76.9%) and 3 were female (23.1%), ranged between 27 and 80 (mean 52.7) ages. Histopathological distribution of APAs was 9 nonsecretory adenomas (69.3%), 3 prolactinomas (23.1%) and 1 somatostatinoma (7.6%). Asymptomatic pituitary apoplexy was diagnosed in 4 cases (30.7%). Eleven cases of typical pituitary adenomas (8.2%) and 5 cases of the atypical pituitary adenomas (38.4%) were re-operated due to tumor recurrences. CONCLUSION: Accurate histopathological examination shows that atypical pituitary adenoma is not a rare disease. Although it is not the only determinant, APAs are more prone to recurrence than typical adenomas. In our opinion, if total resection is not possible for the patients with APA, close postoperative follow up and additional curative therapy modalities are needed.