Enfermedad de Rosai-Dorfman intracraneal: un infrecuente diagnóstico diferencial del meningioma. Reporte de un caso ilustrativo

La Enfermedad de Rosai-Dorfman es un trastorno infrecuente y de etiología desconocida. La presentación intracraneal es aún más rara y suele imitar la apariencia de un meningioma en las imágenes del encéfalo. Se presenta el caso de un paciente varón de 38 años que ingresa por una tumoración intracraneal, extra-axial y supratentorial asociada a déficit neurológico leve; con diagnóstico presuntivo de meningioma de la convexidad. Después de la intervención quirúrgica, el diagnóstico histológico definitivo fue de Enfermedad de Rosai-Dorfman intracraneal. Se debe considerar la Enfermedad de Rosai-Dorfman intracraneal dentro del diagnóstico diferencial de una lesión intracraneal extra-axial sugestiva de un meningioma debido a la similitud en las neuroimágenes y la presentación clínica entre ambas patologías.

Rosai-Dorfman disease is an infrequent condition with no known etiology. The intracranial presentation is even rarer, and it resembles the appearance of a meningioma in image studies. We present the case of a 38-year-old male patient who was admitted because of an extra-axial supratentorial cranial tumor, associated to mild neurological deficit. The presumptive diagnosis was convexity meningioma. After surgery, the definitive histologic diagnosis was intracranial Rosai-Dorfman disease. This condition should be considered in the differential diagnosis of an extra-axial intracranial lesion suggesting meningioma, because of similar neuroimaging results and the similar clinical picture.

Seis casos consecutivos de sarcoma intracraneal primario en niños en dos instituciones privadas de Lima durante la pandemia del COVID-19 / Six consecutive cases of primary intracranial sarcoma in children in two private institutions from Lima during COVID-19 pandemic

Objetivo: El presente artículo describe las características clínicas e imagenológicas de seis pacientes en edad pediátrica con diagnóstico de tumor cerebral atendidos en dos instituciones privadas de Lima durante la pandemia del COVID-19. Material y métodos: Estudio descriptivo de casos de tumor cerebral en pacientes menores de 18 años, atendidos en dos clínicas privadas de Lima, desde marzo 2020 a diciembre 2021. Resultados: Seis casos consecutivos de tumores intracraneales fueron detectados durante la mayor parte del primer año de la pandemia COVID-19 (periodo de octubre del 2020 a marzo del 2021), todos ellos con el diagnóstico de sarcoma intracraneal primario. Antes de la pandemia, el último sarcoma intracraneal primario en niños operado en las instituciones mencionadas ocurrió en junio del 2018 y fue el único caso de este tipo de tumor en el año. Conclusiones: Durante la pandemia de COVID-19, se encontró una inusual frecuencia de sarcoma intracraneal primario en niños en dos instituciones privadas de Lima.

SUMMARY Objective: The article describes the clinical and neuroimaging characteristics of six children with the diagnosis of brain tumor attended in two private institutions from Lima, during the COVID-19 pandemic. Material and methods: Descriptive study of cases of brain tumor in patients aged 18 and younger, followed at two private institutions in in Lima, from March 2020 to December 2021. Results: Six consecutive cases of intracranial tumors were detected during a large part of the COVID-19 pandemic's first year (October 2020 to March 2021), all of them with diagnosis of primary intracranial sarcoma. Before the pandemic, the last primary intracranial sarcoma in children, operated in the mentioned institutions, occurred in June 2018 and was the only case that year. Conclusions: During the COVID-19 pandemic, an unusual frequency of primary intracranial sarcoma in children was found in two private institutions from Lima.

Insurance status influences the rates of reportable quality metrics in brain tumor patients: a nationwide inpatient sample study.

BACKGROUND: In 2010, the Patient Protection and Affordable Care Act was passed to expand health insurance, narrow health care disparities, and improve health care quality in the United States. As part of this initiative, the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services are now tracking quality metrics. OBJECTIVE: To analyze the effects of insurance on the incidence of patient safety indicators (PSIs) and hospital-acquired conditions (HACs) using the Nationwide Inpatient Sample for patients who have brain tumors. METHODS: The Nationwide Inpatient Sample was queried for all hospitalizations between 2002 and 2011 involving patients with brain tumors. Because of the confounding age restriction with Medicare, comparisons were made between Medicaid/self-pay and private insurance. To determine which factors contributed to HACs and PSIs, odds ratios were calculated for each risk factor. Logistic regression models were used to assess the effect of payer status on individual PSIs, HACs, and patient outcomes. RESULTS: Medicaid/self-pay patients had a higher PSI and HAC incidence compared with private insurance patients. The greater incidence of PSIs and HACs correlated with increased length of stay, worse discharge outcomes, and increased in-hospital mortality. CONCLUSION: Variability exists in the incidence of PSIs and HACs in patients with brain tumors based on insurance status. Controlling for both patient and hospital factors can explain these differences. The cause of these disparities should be studied prospectively to begin the process of improving quality metrics in vulnerable patient populations.

Sobrevida asociada a la resección quirúrgica de los gliomas de alto grado operados en el Departamento de Neurocirugía del Hospital Edgardo Rebagliati Martins en el periodo 2011-2012 / Survivorship associated with surgical resection of high-grade gliomas operated in the Department of Neurosurgery at the Hospital Edgardo Rebagliati Martins in the period 2011-2012

Introducción: Los gliomas de alto grado constituyen la causa más frecuente de tumores cerebrales malignos primarios, que afectan dramáticamente la esperanza de vida de los pacientes que lo padecen. El tratamiento es multidisciplinario que incluye cirugía, quimioterapia y radioterapia. A pesar de los avances en el tratamiento la sobrevida media es de 14 meses. En el Perú no existen datos sobre la sobrevida de los pacientes con glioma de alto grado asociada a la resección quirúrgica que se realiza en nuestro medio. Objetivo: Determinar la sobrevida asociada a la resección quirúrgica de los pacientes con gliomas de alto grado operados en el Departamento de Neurocirugía del Hospital Edgardo Rebagliati Martins en el periodo 2011-2012. Diseño: Diseño analítico retrospectivo. Lugar: Departamento de Neurocirugía del Hospital Edgardo Rebagliati Martins. Participantes: pacientes operados de glioma de alto grado en el Departamento de Neurocirugía del Hospital Edgardo Rebagliati Martins en el periodo 2011-2012. Intervenciones: No. Principales medidas de resultados: Gráficas, tablas y curvas de sobrevida de Kaplan-Meier. Resultados: De un total de 60 pacientes, 54 por ciento fueron varones, grupo etario más afectado fue por encima de los 50 años, glioblastoma multiforme fue el glioma de alto grado más frecuente. La media de sobrevida fue de 11.8 meses. La resección total, bajo los criterios del estudio, se logra en un 38 por ciento. No hubo diferencias en la sobrevida con respecto al grado de resección quirúrgica realizada. Conclusiones: El grado de resección quirúrgica no influye en la sobrevida de los pacientes operados de glioma de alto grado en el Departamento de Neurocirugía del Hospital Edgardo Rebagliati Martins en el periodo enero 2011-mayo 2012. No recibir tratamiento adyuvante (radioterapia-quimioterapia) es el principal factor que influye negativamente en la sobrevida de los pacientes.

Introduction: High-grade gliomas constitute the leading cause of primary malignant brain tumors that affect dramatically the life expectancy of patients. In spite of current advances in therapeutics, the mean survival is 14 months. In Peru, there is not available data regarding the survival of patients with high-grade glioma associated with the degree of surgical resection. Aim: Determine the survival associated with the surgical resection in patients with high-grade glioma that underwent surgery in the Department of Neurosurgery at Hospital Edgardo Rebagliati Martins for the period 2011-2012. Study Design: Retrospective analytic design. Location: Hospital Edgardo Rebagliati Martins-Department of Neurosurgery. Study population: Patients with high-grade glioma that underwent surgery in the Department of Neurosurgery at Hospital Edgardo Rebagliati Martins for the period 2011-2012. Interventions: No. Main result measurements: Graphics, tables and Kaplan-Meier Survival Curves. Results: The total number of patients was 60.54 per cent were male; the age group more than 50 years old was the most affected. Glioblastoma Multiforme was the most common diagnosis. Mean survival was 11.8 months. The rate of gross total resection was 38 per cent. No difference in survival was found regarding the degree of surgical resection. Conclusions: The degree of surgical resection did not affect the survival of patients with high-grade glioma that underwent surgery in the Department of Neurosurgery at Hospital Edgardo Rebagliati Martins for the period 2011-2012. The main factor that affected the survival of patients was not to receive the adjuvant therapy (chemotherapy, radiotherapy).

Revascularización cerebral en el tratamiento de aneurismas cerebrales complejos / Cerebral revascularization for the treatment of complex intracranial aneurysms

Los procedimientos de revascularización cerebral se utilizan en el manejo quirúrgico de aneurismas en los que hay gran riesgo de generar isquemia al intentar el tratamiento quirúrgico o endovascular. Además se usan en el tratamiento de tumores de base craneal que engloban e infiltran la pared de la arteria carótida interna o sus ramas principales, en la enfermedad oclusiva vascular con riesgo de producir infarto de tipo hemodinámico y en la enfermedad de moyamoya.

Cerebral revascularization procedures are used in the surgical management of cerebral aneurysms in which there is agreat risk of generating ischemia, in the attempt for surgical or endovascular treatment. Besides this, these procedures are utilized en the treatment of cranial base tumors that encase and infiltrate the trunk of the internal carotid artery orits main branches, in the vascular occlusive disease with risk of producing hemodynamic type stroke and, in the moyamoya disease. These techniques have the aim of restoring the blood supply of the brain and with it, the nutrient loading in order to avoid ischemia in territories already affected or in risk. To obtain an effective revascularization, with good clinical outcome , the patient should be chosen adequately with cerebral blood flow studies and vascular reserve, to perform a meticulous technique and the correct graft should be elected.

Aneurisma cerebral en el interior de glioblastoma multiforme: reporte del caso / Cerebral aneurysm inside glioblastoma multiforme. Case report

A 30-yr-old woman was admitted with acute headache, right hypesthesia and hemiparesis, right quadrantanoptic defect and neck stiffness. CT imaging study revealed left temporal hematoma and angio CT and cerebral digital angiography revealed and aneurysm of the left posterior cerebral artery. The patient was treated surgically. Surprisingly the clot was very firm and consistent with a mixture of tumor tissue and blood debris and in the pathological examination turned to be a glioblastoma multiforme. The aneurysm was clipped. The partner gradually improved and was treated with linear accelerator radiotherapy. This rare case is consistent with the association of malignant tumor with an aneurysm of neoplasm type.