Role of 18 F-FDG PET/CT differentiating olfactory neuroblastoma from sinonasal undifferentiated carcinoma.

OBJECTIVES: The purpose of this study is to demonstrate the potential contribution of positron emission tomography (PET)/computed tomography (CT) to help differentiate olfactory neuroblastoma (ONB) from sinonasal undifferentiated carcinoma (SNUC). METHODS: Following approval by the institutional review board at the Wexner Medical Center at the Ohio State University, Columbus, Ohio, a pilot study with retrospective review of patients with biopsy-proven diagnosis of ONB s and SNUC s was conducted. Staging PET/CT scans were reviewed to document the maximum standardized uptake value (SUVmax). A statistical comparison of SUVmax was performed. RESULTS: We identified 13 patients (7 with ONBs and 6 with SNUCs) with mean age 60.2 years who had undergone staging F-18 fluorodeoxyglucose (18 F-FDG) PET/CT of the primary tumor at the time of their diagnosis. Mean SUVmax was found to be five-fold higher in SNUC patients (35.63, range 10.8-77.9) than in ONB patients (7.24, range 4.6-10.7) (P ≤ 0.00169). CONCLUSION: Maximum standardized uptake value of 18 F-FDG PET/CT can be used to initially discriminate between ONB and SNUC. This finding may prove helpful to guide diagnostic and treatment planning when the histopathologic diagnosis is inconclusive. LEVEL OF EVIDENCE: 4. Laryngoscope, 2016 127:321-324, 2017.

Anatomical study of critical features on the posterior wall of the maxillary sinus: clinical implications.

OBJECTIVES/HYPOTHESIS: Endonasal approaches to the pterygopalatine fossa for epistaxis or as part of a transpterygoid approach have been popularized somewhat by the ability to control the terminal branches of the maxillary artery (MA). Surgical landmarks are useful to identify these arteries. Therefore, identification of surface features on the posterior wall of the antrum that reflect the position of deeper structures within the pterygopalatine fossa would help predict anatomical position and orientation. STUDY DESIGN: Describe the incidence of identifiable markings on the posterior wall of the maxillary sinus and ascertain their nature. METHODS: An anatomical study of 18 cadaveric specimens noting and recording the presence, location, and number of prominences on the posterior wall of the antrum. After removing the bony wall, structure in the pterygopalatine fossa corresponding to the surface markings was noted. RESULTS: Two prominences were identified. Prominence (P)1 extended from the upper part of the posterior wall of the maxillary sinus to the inferior orbit and corresponded to the infraorbital nerve. P2 was located at the middle part of the posterior wall, below P1, and corresponded to the MA. P2 was located medial to a vertical "drop line" where P1 connected to the posterior wall. P1 and P2 were found in 41.7% and 22.2%, respectively, of the specimens. CONCLUSIONS: This study defines features on the maxillary sinus posterior wall from an endoscopic perspective. These landmarks may be useful to identify the MA and its branches during surgery within the pterygopalatine fossa. LEVEL OF EVIDENCE: N/A.

Endoscopic anatomy of the middle ethmoidal artery.

BACKGROUND: The purpose of this study was to describe the incidence of the middle ethmoidal artery and its anatomical nuances via an endoscopic endonasal approach. METHODS: A cadaveric study was performed on 22 adult specimens. First, a frontal sinusotomy and ethmoidectomy were performed via an endoscopic endonasal approach in order to fully expose the anterior skull base. Subsequently, the lamina papyracea and the bone of the canals covering the ethmoidal neurovascular bundles were removed to identify the anterior, middle, and posterior ethmoidal arteries. Presence, laterality, and location of the middle ethmoidal artery were recorded. RESULTS: A total of 14 middle ethmoidal arteries were identified (10 right and 4 left), among 44 sides (22 specimens), accounting for an incidence of 31.8%. Bilateral middle ethmoidal arteries were found in 3 of 22 specimens (14%). Endonasal endoscopy features of the middle ethmoidal artery were noted. CONCLUSION: This is the first study assessing the anatomical features of the middle ethmoidal arteries from an endonasal endoscopic perspective. The findings of this research have clinical significance in guiding surgeries that involve the medial orbital wall, intractable epistaxis, and anterior skull base pathologies, as well as endoscopic endonasal surgeries.

Cerebral metastasis of cervical uterine cancer: report of three cases.

Cervical uterine cancer (CUC) spreads locally (pelvis and paraortic lymphnodes) or distantly (lungs, liver and bones). Metastasis to central nervous system (CNS) are rare. There are about 80 cases reported in the literature. Outcome is poor and survival varies from 3 to 6 months. Three cases of CNS metastasis from CUC are reported, one infratentorial and two supratentorials in location. In one patient, the initial manifestation was due to the cerebral lesion, a feature reported for the first time. All cases were treated by surgery, radiotherapy and/or chemotherapy. Clinical findings and treatment options of these rare lesions are reviewed.

Cerebral metastasis of cervical uterine cancer: report of three cases

Tumores do cólo uterino se disseminam por contigüidade ou via hematogênica (pulmão, fígado e ossos). Metástases para sistema nervoso central são incomuns. Apenas cerca de 80 casos são citados na literatura. Manifestações clínicas são devidas à hipertensão intracraniana e a déficits focais. A sobrevida varia de 3 a 6 meses. Três casos são relatados sendo um infratentorial e dois supratentoriais. No primeiro, o diagnóstico da metástase antecedeu o da lesão uterina. No segundo, houve 5 anos sem recidiva após a cirurgia, fato este inédito. O tratamento foi cirurgia, radioterapia e/ou quimioterapia. A discussão enfatiza manejo multidisciplinar destas raras lesões.

Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations.

We present the case of a 47 years old woman submitted to an endovascular trapping of a left cavernous internal carotid artery aneurysm, in which the distal balloon was inflated, as usually done, within the cavernous segment of the internal carotid artery, different from the proximal one which was inflated inside the carotid canal due to technical problems. Consequently, a clinical picture of Raeder's paratrigeminal neuralgia took place. This is the first case report in the literature with theses characteristics. A review of the anatomic pathways and further considerations about the possible pathophysiological mechanisms involved are presented.

Granular cell tumor of the neurohypophysis: report of a case with unusual age presentation.

Granular cell tumor (GCT) usually occurs as a solitary, small, nodular tumor and rarely grows to a sufficient size to present symptoms. The tumor is more prevalent in female adults. The authors report a case of an 8-year-old boy with GCT of the neurohypophysis presenting with central precocious puberty. Few cases of symptomatic GCT have been reported in the literature, none of them in a patient in the first decade of life. Clinical picture, histopathological features, and histogenesis of GCT of neurohypophysis are discussed.

Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations

Apresentamos o caso de uma mulher de 47 anos submetida a obliteração endovascular de um aneurisma gigante de carótida interna cavernosa à esquerda, no qual o balão distal foi inflado, tal como usual, dentro do segmento cavernoso da artéria carótida interna, diferente do proximal, o qual foi inflado dentro do canal carotídeo devido a problemas técnicos. Conseqüentemente, um quadro clínico de neuralgia paratrigeminal de Raeder se instalou. Este é o primeiro relato na literatura com estas características. Uma revisão das vias anatômicas e maiores considerações a respeito de possíveis mecanismos fisiopatológicos envolvidos são apresentados.

Management of primary spinal chondrosarcoma: report of two cases causing cord compression.

Chondrosarcomas are malignant tumors that rarely grow inside the spinal canal. Prognosis depends on histological features, patient's age and surgical margins free from tumor. Response to radio and chemotherapy is poor. Ideal treatment consists of total "en-block" resection, not always achievable due to limitation of location, compromise of stability and risk of inducing neurological deficits. Two cases of spinal chondrosarcoma causing cord compression are reported, located in the cervical and thoracic spine. Microsurgical technique consisted of initial debulking followed by removal of margins until limits free from tumor were obtained. Total resection was accomplished and neurological function improved in both cases. Follow-up has been seven and one year respectively, with no evidence of recurrence and preserved neurological functions. Association between chondrosarcoma and estrogen-dependent tumor has been confirmed in this report. Although "en-block" resection of a chondrosarcoma should be tried whenever possible, tumor fragmentation should be considered in difficult cases, as in the present report, in which a long period free from recurrence with good quality of life can be obtained.

Management of primary spinal chondrosarcoma: report of two cases causing cord compression

Os condrosarcomas são tumores malignos, raramente localizados no interior do canal espinhal, com prognóstico dependente do grau histológico do tumor, idade do paciente e margens cirúrgicas livres. Esses tumores apresentam pouca resposta à radio e quimioterapia. O tratamento ideal consiste em ressecção tumoral em bloco, condição particularmente difícil em se tratando de tumores causando compressão medular, devido à localização da lesão, comprometimento da estabilidade axial e necessidade da manutenção ou recuperação da integridade da função neurológica do paciente. Relatamos dois casos de condrossarcomas causando compressão medular, um na coluna cervical e outro na torácica, submetidos a cirurgia com esvaziamento tumoral seguido de remoção das margens, atingindo-se ressecção total e melhora das funções neurológicas em ambos os casos. Um paciente se encontra há 7 anos e outro há 1 ano livre de recorrências, ambos com funções neurológicas preservadas. Associação entre condrosarcoma e tumor dependente de estrógeno é confirmada clinicamente pelo presente estudo. Embora uma ressecção em bloco dos condrossarcomas deva ser tentada quando possível, deve-se considerar uma ressecção com fragmentação tumoral em casos específicos, podendo-se atingir, como demonstrado nos presentes casos, períodos livres de recorrência e longo tempo de sobrevida.

[Prognostic factors in the treatment of the intradural extramedullary tumors: a study of 44 cases]. / Fatores prognósticos no tratamento dos tumores intradurais extramedulares: estudo de 44 casos.

Between 1993 and 1999, 44 patients submitted to resection of an expansible intradural extramedullary lesion who filled protocol requirements of appropriate follow up were studied. Patients were constituted by 43.2% female and 56.8% male. The mean age was 32.9 years old. Lesion most common location was at the thoracic spine, with 45.5% of the cases, followed by the lumbar level with 18.2%. Tumor extension varied from 1 to 7 vertebral segments, with an average of 2.5 levels. Schwannoma, with 65,9% of the cases, was the most frequent lesion, followed by meningioma with 20.5%. There were 2 cases of neurofibroma and 1 case of paraganglioma, neuroenteric cyst, metastasis and malignant schwannoma. The evolution was of improvement in 56.8%, stability in 31.8% and of worsening in 11.4%. There was no mortality related to the surgical procedure. All cases of worsening had total resection and they had lesions located in the thoracic segment. Total resection is the ideal modality of surgical treatment. However, at the thoracic level, where the peculiarities of spine irrigation prevail, surgical morbidade may be higher (p=0.014).

Fatores prognósticos no tratamento dos tumores intradurais extramedulares: estudo de 44 casos / Prognostic factors in the treatment of the intradural extramedullary tumors: a study of 44 cases

Entre 1993 e 1999 foram estudados 44 pacientes que preencheram requisitos protocolares de seguimento adequado e que foram submetidos a ressecção de processo expansivo extramedular intradural. Os pacientes eram constituídos por 43,2 por cento de mulheres e por 56,8 por cento de homens. A média da idade foi 32,9 anos. A localização da lesão foi mais comum na região torácica, com 45,5 por cento dos casos, seguida da lombar com 18,2 por cento. A extensão tumoral variou de 1 a 7 segmentos vertebrais, com uma média de 2,5 níveis. O schwanoma foi o tipo histológico mais comum com 65,9 por cento, seguido dos meningiomas com 20,5 por cento. Houve 2 casos de neurofibroma e 1 caso de paraganglioma, cisto neuroentorico, metástase e schwanoma maligno. A evolução foi de melhora em 56,8 por cento, estabilidade em 31,8 por cento e de piora em 11,4 por cento. Não houve mortalidade relacionada ao procedimento cirúrgico. Todos os casos de piora tiveram ressecção total e eram localizados no segmento torácico. A ressecção total é a modalidade ideal de tratamento cirúrgico. No entanto, no nível toracico, onde predominam as peculiaridades de irrigação da medula, a morbidade cirúrgica pode ser mais elevada (p=0,014)

[Prognostic factors in the treatment of intramedullary spinal cord tumors]. / Fatores prognósticos no tratamento dos tumores intramedulares.

Between 1993 and 1999, in the Divisions of Neurosurgery of the Hospital Nossa Senhora das Graças and the Hospital de Clínicas in Curitiba, Paraná, Brazil, 35 patients harboring intramedullary spinal cord tumors who were submitted to microsurgery were analyzed. There were 24 males (68.6%) and average age was 32.9 years. The main location, with 40% of cases, was the thoracic level, followed by cervical and cervico-thoracic levels with 25.7%. Neurological exam, carried out between 6 and 12 months after surgery, showed that 42.9% of patients improved, 34.3% were stable and 22.9% presented neurological worsening. Total resection was obtained in 57.2% of cases and subtotal in 37.1%. In 5.7% of patients a biopsy was the accomplished procedure. Total resection was more often obtained among patients with ependymomas (13 out of 17) than with astrocytomas (5 out of 12). However, degree of resection and tumor histology did not interfere in postoperative morbidity. Factors as sex, age and tumor's size also did not demonstrate significance in predicting prognostic after surgery, whereas tumor in a thoracic level was associated with higher morbidity (p=0.021).

[Central nervous system granulocytic sarcoma after bone marrow transplant: case report]. / Sarcoma granulocítico de sistema nervoso central pós transplante de medula óssea: relato de caso.

Granulocytic sarcoma is a solid tumor, composed by granulocytic precursor cells at various levels of differentiation, located at an extra-medullary site. It is associated with acute myeloid leukemia, and its presence reveals a bad prognostic factor. The treatment usually consists of radiotherapy and chemotherapy. A case of an intracranial granulocytic sarcoma occurring six months after a bone marrow transplant in a patient with acute myeloid leukemia is reported. The patient presented with headache and left hemiplegia caused by a large fronto-parietal lesion with significant mass effect. After a complete surgical resection there was a full recovery of the deficit. The patient completed radiotherapy and chemotherapy with no evidence of disease after three months of follow-up. Surgery is indicated in the presence of progressive neurological deficit. Surgical decompression may provide rapid improvement and therefore, affect quality of survival.

Fatores prognósticos no tratamento dos tumores intramedulares / Prognostic factors in the treatment of intramedullary spinal cord tumors

Entre 1993 e 1999, foram analisados 35 pacientes submetidos a microcirurgia para remoçäo de tumor intramedular nos Serviços de Neurocirurgia do Hospital Nossa Senhora das Graças e do Hospital de Clínicas de Curitiba - PR. A populaçäo foi composta por 68,6 por cento de pacientes do sexo masculino; a média de idade era de 32,9 anos. A localizaçäo tumoral mais frequente foi torácica em 40 por cento dos casos, seguida pela regiäo cervical e cervicotorácica em 25,7 por cento. Ao exame neurológico realizado entre 6 a 12 meses do pós-operatório, 42,9 por cento dos pacientes demonstraram melhora, 34,3 por cento permaneceram estáveis e 22,9 por cento dos casos apresentaram piora. A ressecçäo foi total em 57,2 por cento dos casos e subtotal em 37,1 por cento. Em 5,7 por cento dos pacientes, foi realizada apenas biópsia para diagnóstico. O grau de ressecçäo completa foi maior nos ependimomas (13 de 17 casos) e menor nos astrocitomas (5 de 12 casos). Entretanto, o grau de ressecçäo e o tipo histológico näo interferiram na morbidade pós-operatória. Fatores como sexo, idade e tamanho do tumor também näo demonstraram importância na evoluçäo após a cirurgia. A localizaçäo torácica do tumor foi associada a maior morbidade cirúrgica (p=0,021)

Sarcoma granulocítico de sistema nervoso central pós transplante de medula óssea: relato de caso / Central nervous system granulocytic sarcoma after bone marrow transplant: case report

Sarcoma granulocítico é tumor sólido, constituído por células precursoras de granulócitos, localizado em sítio extra medular. Geralmente surge precedendo uma leucemia mielóide aguda ou concomitantemente a ela, sendo considerado fator de mau prognóstico. Tem como principais modalidades terapêuticas a radioterapia e a quimioterapia. Um caso de sarcoma granulocítico intracraniano ocorrido seis meses após transplante de medula óssea por leucemia mielóide aguda é relatado. A paciente apresentava cefaléia e hemiplegia esquerda, causada por extensa lesäo fronto-parietal direita. Após a ressecçäo completa do tumor, houve total recuperaçäo do déficit neurológico. A paciente completou o tratamento radio e quimioterápico, estando livre de doença após três meses de acompanhamento. O manejo cirúrgico do sarcoma granulocítico é modalidade adjuvante, indicada quando o efeito compressivo tumoral determina déficit neurológico. É o meio mais rápido de descompressäo do tecido nervoso, possibilitando a chance de recuperaçäo funcional, melhorando a qualidade de vida do paciente

Neurocitoma central com apresentaçäo incomum por hemorragia intraventricular: relato de caso / Central neurocytoma presented by intraventricular hemorrhage: case report

O neurocitoma central foi descrito pela primeira vez na literatura em 1982 por Hassoun e colaboradores como tumor bem diferenciado de origem neuronal. O tumor geralmente localiza-se no sistema ventricular, afetando adultos jovens e geralmente cursando com hipertensão intracraniana secundária à hidrocefalia obstrutiva. O diagnóstico diferencial com outros processos intraventriculares como oligodendroglioma é realizado através de métodos imuno-histoquímicos. Raros casos de neurocitoma central associados com hemorragia têm sido descritos na literatura. Descrevemos um caso de neurocitoma central de uma paciente de 35 anos com apresentação atípica. A paciente havia procurado o hospital com quadro súbito de cefaléia, vômitos e rigidez de nuca, sugerindo a presença de hemorragia subaracnóidea. A ressonância magnética demonstrou volumosa massa no ventrículo lateral direito cujos perfis histológico e imuno-histoquímico eram condizentes com neurocitoma central, a ressecção cirúrgica foi realizada com sucesso, embora a paciente tenha evoluído para um quadro de ventriculite no pós-operatório. Salientamos a importância do estabelecimento do neurocitoma central como diagnóstico diferencial de pacientes com hemorragia intraventricular e discutimos as opções de tratamento para este tumor incomum.

Aspectos clínicos e cirúrgicos dos pacientes operados por neurocisticercose / Clinical and surgical aspects of the patients submitted to surgical treatment for neurocysticercosis

Os autores realizam estudo retrospectivo de 68 pacientes, portadores de neurocisticercose, operados no Hospital de Clínicas da Universidade Federal do Paraná, entre Abril/78 e Julho/95. Sao analisados os aspectos epidemiológicos, laboratoriais, radiológicos, clínicos e cirúrgicos relevantes. É proposta uma classificaçao dos pacientes de acordo com a sua evoluçao.

Astrocitoma de células gigantes: estudo clínico, histológico e imuno-histológico e imuno-histoquímico / Giant cell astrocytoma: clinical, histological and immuno-histochemical study

O astrocitoma de células gigantes é uma variante rara das neoplasias gliais, oscilando ao redor de 2 por cento dos tumores astrocitários e frequentemente associado à esclerose tuberosa, doença hamartomatosa de caráter genético autossômico dominante. Afeta ambos os sexos de maneira semelhante, sendo mais encontrado na primeira e na segunda décadas de vida, principalmente nos ventrículos laterias e por vezes ocluindo o forame de Monro. É um tumor de crescimento lento e sobrevida longa após ressecção cirúrgica. Microscopicamente, mostrou-se composto por células grandes, globóides, de citoplasma amplo com núcleos vesiculosos e arranjo perivascular. Os autores relatam seis casos de pacientes portadores de astrocitoma de células gigantes, sendo quatro pacientes portadores de astrocitoma de células gigantes, sendo quatro pacientes portadores de esclerose tuberosa diagnosticados e registrados no Banco de Patologia Tumoral do Sistema Nervoso Central de Curitiba. Os casos estudados correspondem aos dados da literatura, auxiliando na compreesão do comportamento biológico e na correlação clínica desta neoplasia.