RESUMEN
Adenoid cystic carcinoma (ACC) of the lacrimal gland is a rare tumor. In addition, considering the lack of data on large groups of patients there is no standard of care to treat patients with multiple meningeal metastases of ACC. A two-year analysis of the course of the disease in a patient with synchronous oligometastatic ACC of the lacrimal gland that was treated with stereotactic radiosurgery (SRS) is presented. The aim of the present case report was to evaluate the effect of SRS in the treatment of a patient with ACC. Preliminary results confirmed that this method was highly effective in this patient. The patient is currently living with a good quality of life, normal vision and with no evidence of disease or complications. SRS exhibited reliable local tumor control and insignificant radiation-related complications, rendering it an encouraging treatment option for patients with recurrent or metastatic ACC.
RESUMEN
BACKGROUND: The aim of this study was to evaluate the efficacy of interposed saphenous vein graft (SVG) usage during extracranial-intracranial (EC-IC) bypass surgery in patients with cerebral ischemia and appropriate donor artery absence. METHODS: Since October 2010 till January 2014, 62 EC-IC bypass surgeries were applied in 60 patients. In nineteen patients SVG was used to create low-flow bypasses between superficial temporal artery trunk and cortical segment of middle cerebral artery. SVG was used due to inappropriate diameter of scalp artery in 12 cases, inadequate flow in intended donor artery in 5 patients and in 2 cases for other reasons. Indications for revascularization were based on clinical symptoms of cerebral hemodynamics impairment, confirmed with transcranial duplex ultrasonography (DUS) and brain perfusion computed tomography (CT). RESULTS: Early bypass patency was confirmed with DUS up to 9 postoperative day in 16 patients. In 3 (15.8%) patients blood flow was not visualized. Bypass patency in these patients was confirmed with repeated DUS up to 42 months period. At mean clinical follow-up of 22.3 months 14 patients (73.7%) reported an improvement of their condition, 4 patients (21%) didn't observe any changes in well-being and 1 patient (5.3%) got worse. Late bypass patency assessment was available and confirmed in 16 patients at mean follow-up of 15.6 months postoperation. Repeated brain perfusion CT was performed in 10 patients at mean follow-up of 5.2 months. Average growth of regional cerebral blood flow was 24.1%. CONCLUSIONS: The use of interposed SVG bypass for EC-IC revascularization is an effective method, that could be applied in patients with cerebral ischemia caused by internal carotid artery occlusive disease and absence of appropriate donor artery.