Anaplastic transformation of an atypical intraventricular meningioma with metastases to the liver: case report.

OBJECTIVE: Malignant intraventricular meningiomas are very rare. To the best of our knowledge, only eleven cases have been reported thus far. Seven of them developed cerebrospinal fluid (CSF) metastases. We present herein the first case of a malignant intraventricular meningioma with extraneural metastases. CLINICAL PRESENTATION: We report a 44 year-old-man with a history of progressive headache and disorientation. Magnetic resonance imaging (MRI) revealed a 5-cm homogeneously-enhancing mass in the right trigone. INTERVENTION: The lesion was totally resected via a parietooccipital transcortical approach. Histological examination demonstrated an atypical meningioma. Thereafter, the tumor recurred twice. At first recurrence, the tumor was completely removed again and external radiotherapy was administered. At surgery at second recurrence, the tumor was more aggressive, invading the brain parenchyma. Histological examination showed anaplastic meningioma. The patient was readmitted to hospital with fever and pain in right hypochondrium. Abdominal ultrasound examination disclosed multiple hypoechoic liver lesions. Biopsy was consistent with liver metastases of a malignant meningioma. The patient died of acute liver failure seven months after initial diagnosis. CONCLUSION: Malignant intraventricular meningiomas are prone to recur and develop metastases, mainly through the CSF. Nevertheless, our case shows that extraneural metastases are also possible. Therefore, when systemic deterioration occurs in a patient with a malignant intraventricular meningioma, metastases to extraneural organs such as the liver must be ruled out.

Anaplastic transformation of an atypical intraventricular meningioma withmetastases to the liver: case report

Objective. Malignant intraventricular meningiomasare very rare. To the best of our knowledge, only elevencases have been reported thus far. Seven of them developedcerebrospinal fluid (CSF) metastases. We presentherein the first case of a malignant intraventricularmeningioma with extraneural metastases.Clinical presentation. We report a 44 year-old-manwith a history of progressive headache and disorientation.Magnetic resonance imaging (MRI) revealed a5-cm homogeneously-enhancing mass in the right trigone.Intervention. The lesion was totally resected via aparietooccipital transcortical approach. Histologicalexamination demonstrated an atypical meningioma.Thereafter, the tumor recurred twice. At first recurrence,the tumor was completely removed again andexternal radiotherapy was administered. At surgeryat second recurrence, the tumor was more aggressive,invading the brain parenchyma. Histological examinationshowed anaplastic meningioma. The patientwas readmitted to hospital with fever and pain in righthypochondrium. Abdominal ultrasound examinationdisclosed multiple hypoechoic liver lesions. Biopsywas consistent with liver metastases of a malignantmeningioma. The patient died of acute liver failureseven months after initial diagnosis.Conclusion. Malignant intraventricular meningiomasare prone to recur and develop metastases, mainlythrough the CSF. Nevertheless, our case shows thatextraneural metastases are also possible. Therefore,when systemic deterioration occurs in a patient with amalignant intraventricular meningioma, metastases toextraneural organs such as the liver must be ruled out (AU)

Objetivos. Los meningiomas malignos intraventricularesson muy infrecuentes. En la bibliografía existentesólo se han descrito once casos hasta ahora. Sietede ellos desarrollaron metástasis a través del líquidocefalorraquídeo (LCR). Presentamos el primer caso deun meningioma maligno intraventricular con metástasisextraneurales.Caso clínico. Paciente varón de 44 años de edad conuna clínica de cefalea progresiva y desorientación. Laresonancia magnética mostraba un proceso expansivointracraneal en el trígono derecho con captación decontraste de forma homogénea.Intervención. Se practicó una resección total de lalesión a través de un acceso transcortical. El análisishistológico mostró un meningioma atípico. A pesarde la resección total, el tumor recidivó otras dosveces. Después de la primera recidiva, el tumor fueextirpado nuevamente y el paciente recibió radioterapiaexterna. En la segunda recidiva, el tumorse comportó de forma más agresiva, invadiendo elparénquima cerebral. El análisis histológico mostrabaun meningioma anaplásico. El paciente fueingresado nuevamente por fiebre y dolor en el hipocondrioderecho. Una ecografía abdominal mostrómúltiples lesiones hipoecogénicas hepáticas. La biopsiade dichas lesiones fue compatible con metástasisdel meningioma maligno. El paciente falleció debidoa una insuficiencia hepática aguda siete meses despuésdel diagnóstico inicial.Conclusiones. Los meningiomas malignos intraventricularestienden a recurrir y producir metástasis,principalmente a través del LCR. Sin embargo,nuestro caso muestra que los meningioma malignosintraventriculares también pueden metastatizar fueradel sistema nervioso central, siendo el primer caso descrito. Por lo tanto, cuando un deterioro sistémicoocurra en un paciente con un meningioma malignointraventricular debería descartarse la posibilidad demetástasis extraneurales como sucedió en este caso (AU)

[Intraoperative neurophysiological monitoring of the spinal cord: our experience]. / Monitorización neurofisiológica intraoperatoria de la médula espinal: nuestra experiencia.

INTRODUCTION: The main objective of intraoperative monitoring of the spinal cord is to detect any neurological damage that may occur (and which would otherwise go unnoticed) while it is still reversible. AIM: To retrospectively evaluate the effectiveness of neurophysiological monitoring in spine and spinal cord surgery since the time such procedures were first implemented within our centre. PATIENTS AND METHODS: The patients were divided into three groups, according to their pathologies. They were clinically evaluated with the McCormick scale before surgery, on discharge from hospital and at six months after the operation. Neurophysiological monitoring was performed with motor evoked potentials, somatosensory potentials and screw stimulation, when appropriate. RESULTS: The sample finally consisted of 49 subjects, with a mean age of 51 +/- 19.4 years. Distribution by groups was 53.1% spinal cord tumours, 22.4% traumatic injuries to the spinal cord and 24.5% bone/disc pathologies. During surgery potentials improved in 4.08% of patients, in 63.26% they remained intact, 20.41% were alerted by the neurophysiologist with intact potentials, 10.2% suffered a transitory decline and in one case there was permanent loss. All the patients who were submitted to a follow-up at six months displayed a clinical status that was the same or better than the one before their operation. CONCLUSIONS: Neurophysiological monitoring is a valuable tool that prevented, in 30.61% of our patients, damage that could otherwise have occurred. From the clinical point of view, its high predictive value is also worth highlighting.

Monitorización neurofisiológica intraoperatoria de la médula espinal: nuestra experiencia / Intraoperative neurophysiological monitoring of the spinal cord: Our experience

Introducción. El principal objetivo de la monitorización intraoperatoria de la médula espinal es la detección decualquier daño neurológico, que de otro modo pudiese pasar inadvertido, durante el período en el que éste es reversible. Objetivo. Evaluar retrospectivamente la efectividad de la monitorización neurofisiológica en la cirugía vertebral y de médula espinal desde su implantación en nuestro centro. Pacientes y métodos. Los pacientes se dividieron en tres grupos según patologías. Se evaluaron clínicamente antes, en el momento del alta y a los seis meses de la cirugía con la escala de McCormick. La monitorización neurofisiológica se realizó con potenciales evocados motores, potenciales somatosensoriales y estimulaciónde tornillos donde procedía. Resultados. El tamaño de la muestra fue de 49 sujetos, con una media de edad de 51 ± 19,4 años. La distribución por grupos fue de un 53,1% de tumores medulares, un 22,4% de traumatismo medular y un 24,5% de patologíaosteodiscal. Durante la cirugía, el 4,08% de los pacientes presentó una mejoría de sus potenciales, el 63,26% los mantuvo intactos, el 20,41% sufrió una alerta por parte del neurofisiólogo con unos potenciales intactos, el 10,2% sufrió una caída transitoria, y en un caso hubo una pérdida permanente. Todos los pacientes seguidos a los seis meses presentaron un estadoclínico igual o mejor al prequirúrgico. Conclusiones. La monitorización neurofisiológica constituye una herramienta de gran valor que evitó, en el 30,61% de nuestros pacientes, daños que de otro modo podrían haberse producido. Debe reseñarse tambiénsu importante valor predictivo desde el punto de vista clínico

Introduction. The main objective of intraoperative monitoring of the spinal cord is to detect any neurological damage that may occur (and which would otherwise go unnoticed) while it is still reversible. Aim. To retrospectively evaluate the effectiveness of neurophysiological monitoring in spine and spinal cord surgery since the time such procedures were firstimplemented within our centre. Patients and methods. The patients were divided into three groups, according to their pathologies. They were clinically evaluated with the McCormick scale before surgery, on discharge from hospital and at sixmonths after the operation. Neurophysiological monitoring was performed with motor evoked potentials, somatosensory potentials and screw stimulation, when appropriate. Results. The sample finally consisted of 49 subjects, with a mean age of 51 ± 19.4 years. Distribution by groups was 53.1% spinal cord tumours, 22.4% traumatic injuries to the spinal cord and 24.5% bone/disc pathologies. During surgery potentials improved in 4.08% of patients, in 63.26% they remained intact, 20.41% were alerted by the neurophysiologist with intact potentials, 10.2% suffered a transitory decline and in one case there was permanent loss. All the patients who were submitted to a follow-up at six months displayed a clinical status that was the same or better than the one before their operation. Conclusions. Neurophysiological monitoring is a valuable tool that prevented, in 30.61% of our patients, damage that could otherwise have occurred. From the clinical point of view, its high predictive value is also worth highlighting

Hipertensión intracraneal y muerte encefálica / Intracranial hypertension and brain death

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