Meningioma como causa poco común de hiposmia. A propósito de un caso / Meningioma as an infrequent cause of hyposmia. Case report

Resumen La afectación del sentido del olfato puede pasar desapercibida en gran parte de los pacientes, siendo únicamente valorada cuando la alteración es importante. Sin embargo, la hiposmia es un síntoma asociado a numerosas patologías, de menor a mayor gravedad. Este sentido está relacionado con nuestros recuerdos y puede alertarnos de potenciales amenazas. Como médicos especialistas en Otorrinolaringología debemos estar alerta ante determinados síntomas que orienten a posible etiología central. Presentamos el caso de una mujer de 39 años que acudió al Servicio de Otorrinolaringología del Hospital General Universitario Morales Meseguer derivada por hiposmia de un año de evolución con cervicalgia y cefalea occipital progresiva, sin otra sintomatología asociada. La exploración otorrinolaringológica resultó normal. Debido a la persistencia sintomática se solicitó una tomografía computarizada de senos paranasales con hallazgos de masa intracraneal extraaxial compatible con meningioma de fosa craneal anterior.

Abstract The affectation of smell can go unnoticed in a great part of the patients, being only valued when the alteration is important. However, this sense is related to our memories and can alert us to potential threats. As otolaryngologists we must be alert to certain symptoms that may lead to a possible central aetiology. We present the case of a 39-year-old woman who went to the otolaryngology service at Morales Meseguer General University Hospital due to one-year evolution of hyposmia with cervicalgia and progressive occipital headache, with no other symptoms associated. The otolaryngology examination was anodyne. In view of symptomatic persistence, a paranasal sinus computed tomography scan was requested with findings of extra-axial intracranial mass compatible with anterior cranial fossa meningioma.

Microsurgical Resection of Petroclival Meningioma via the Posterior Petrosal Approach: Three-Dimensional Operative Video.

Petroclival meningiomas are complex, deep-seated lesions related to many critical neurovascular structures. We present the case of a 44-year-old woman who had presented with a history of severe facial pain, hearing loss, and tinnitus on the left side, associated with left facial hypoesthesia (Video 1). Preoperative magnetic resonance imaging demonstrated a mass highly suggestive of a left petroclival meningioma. Considering the worsening symptoms and important mass effect, microsurgical resection using the posterior petrosal approach was performed. Mastoidectomy was performed first, followed by craniotomy encompassing both posterior and middle cranial fossae. The posterior fossa and middle fossa dural incisions were connected, coagulating and sectioning the superior petrosal sinus. Next, the tentorium was cut all the way toward the incisura, with care to preserve the fourth nerve in the last cut. After completion of the tentorium incision, the presigmoid space increased. The lesion was totally resected using microsurgical techniques, with the aid of an ultrasonic aspirator to debulk the mass and allow for its circumferential dissection. Postoperative magnetic resonance imaging demonstrated complete tumor resection. The patient presented with improvement of symptoms and no new neurological deficit during follow-up. Skull base approaches, such as the posterior petrosal approach, are useful for successfully treating challenging lesions such as the one presented, with low morbidity. Laboratory training is essential to be familiarized with the complex intraoperative neuroanatomical nuances. The patient provided written informed consent for the report of her case and operative video. The anatomical images were provided courtesy of the Rhoton Collection, American Association of Neurological Surgeons/Neurosurgical Research and Education Foundation.

Cavernous sinus syndrome: need for early diagnosis.

Cavernous sinus syndrome (CSS) is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and Horner's syndrome. These signs and symptoms result from the involvement of the cranial nerves passing through the cavernous sinus. We report the case of a 53-year-old man with a history of daily stabbing headache associated with dizziness, progressive blurred vision, right ocular pain, ptosis and ophthalmoplegia. After working up the patient, a meningioma was identified as the cause of the CSS. Despite advances in neuroimaging techniques, in some cases, the aetiology of CSS remains difficult to determine. We highlight the clinical and radiological features of a meningioma, one of the causes of CSS. Early diagnosis and treatment of CSS play a key role in a better prognosis.

Neurofibromatosis type 2: molecular and clinical analyses in Argentine sporadic and familial cases.

Neurofibromatosis 2 is a familial syndrome characterized by the development of schwannomas, meningiomas and ependymomas. Most of them are benign however, their location in the nervous system has harmful effects on important cranial and spinal structures. These tumors are developed as the outcome of NF2 gene (22q12) inactivation. The NF2 protein, merlin or schwannomin belongs to the Ezrin, Radixin, Moesin (ERM) family involved in the cytoskeletal network and has a tumor suppressor function. Inactivating mutations occur as "de novo" (more frequently) or as inherited, and most of them are frameshift or nonsense. Our aim is to study NF2 gene alterations in Argentine patients and relate them to clinical features. 10 families and 29 single patients were analyzed for: 1) at-risk haplotype by STR-segregation analysis and 2) NF2 gene mutations by SSCP/heteroduplex/sequencing. The at-risk haplotype was uncovered in 8 families and mutations were identified in 5 patients. The molecular data are in full agreement with the clinical features supporting previous reports. The obtained results were important for the detection of mutation-carrying relatives and exclusion of other individuals from risk.

Meningeal melanocytoma of the posterior fossa: case report and literature review.

BACKGROUND: Meningeal melanocytomas are rare primary melanotic tumors of the leptomeninges. According to our review of the literature, just 22 cases of meningeal melanocytoma (MM) of the posterior fossa have been previously reported. Some aspects related to diagnosis, radiological appearance, histopathologic features, and management are discussed in this paper. CASE DESCRIPTION: We describe the case of a 42-year-old female presenting with severe headache, nausea, and vomiting. Computed tomography and magnetic resonance imaging demonstrated a posterior fossa lesion that was surgically treated. Histopathologic examination showed a highly cellular melanocytic neoplasm with numerous dark pigments in the cytoplasm. Immunoperoxidase staining S-100 protein and HMB 45 demonstrated immunoreactivity for both, confirming the diagnosis of MM. CONCLUSIONS: In conclusion, MMs are rare histologically benign tumors that can be cured by complete surgical resection alone, which should be the goal of the treatment. These lesions, although rare, should be considered in the differential diagnosis of tumors of the posterior fossa.

Meningeoma cístico. Análise de 5 casos e revisäo da literatura / Intracranial cystic menigeoma. Report of 5 cases and literature review

Os autores relatam 5 casos de meningeoma cístico operados. Discutem os aspectos fisiopatológicos da formaçäo do cisto tumoral e sua classificaçäo com base na literatura revista. A histopatologia é avaliada, bem como a imunohistoquímica referente à proliferaçäo celular através da técnica do MIB1. Aspectos referentes à técnica operatória e conduta terapêutica säo analisados. Com este relato, as publicaçöes na literatura brasileira totalizam 14 meningeomas císticos.