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1.
World Neurosurg ; 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32565373

RESUMO

OBJECTIVE: To study the surgical anatomy of the labyrinthine artery (LA) and the subarcuate artery (SA), their anatomic relationships, and clinical implications, as injury of the LA can result in hearing loss. METHODS: Ten formalin-fixed, latex-colored specimens were studied (20 sides). After retrosigmoid craniotomy and neurovascular dissection under microscopic magnification, 4-mm 0° and 30° endoscopic lenses were used to improve visualization. Results were statistically analyzed. RESULTS: The LA was a constant artery that followed the vestibulocochlear nerve into the internal auditory canal. The SA was an inconstant artery that ended in the dura mater around the subarcuate fossa in 35% of cases. The LA originated from the anterior inferior cerebellar artery in 89.3% of specimens and from the basilar artery in 10.7% of specimens. The SA branched off from the anterior inferior cerebellar artery when present. The origin of the LA was inferomedial to the vestibulocochlear nerve in most cases (71.4%), whereas the SA was usually lateral (70%). The distal portion of the LA was inferomedial to the vestibulocochlear nerve in 71.4% of cases. The distal portion of the SA was superolateral to the nerve in all cases (P < 0.00001). CONCLUSIONS: Knowledge of the different trajectory and anatomic relationship of the LA and the SA with the vestibulocochlear nerve is of paramount importance to differentiate them during surgery. The LA is usually inferomedial to the vestibulocochlear nerve at its distal and proximal aspects, whereas the SA usually originates lateral and ends superolateral to the nerve.

2.
J Neurosurg ; : 1-5, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31518983

RESUMO

Benign notochordal cell tumors (BNCTs) are considered to be benign intraosseous lesions of notochord origin; however, recent spine studies have suggested the possibility that some chordomas arise from BNCTs. Here, the authors describe two cases demonstrating histological features of BNCT and concomitant chordoma involving the clivus, which, to the best of the authors' knowledge, have not been previously documented at this anatomical site.An 18-year-old female presented with an incidentally discovered clival mass. Magnetic resonance imaging revealed a 2.8-cm nonenhancing lesion in the upper clivus that was T2 hyperintense and T1 hypointense. She underwent an uneventful endoscopic transsphenoidal resection. Histologically, the tumor demonstrated areas of classic chordoma and a distinct intraosseous BNCT component. The patient completed adjuvant radiation therapy. Follow-up showed no recurrence at 18 months.A 39-year-old male presented with an incidentally discovered 2.8-cm clival lesion. The nonenhancing mass was T2 hyperintense and T1 hypointense. Surgical removal of the lesion was performed through an endoscopic transsphenoidal approach. Histological analysis revealed areas of BNCT with typical features of chordoma. Follow-up did not demonstrate recurrence at 4 years.These cases document histologically concomitant BNCT and chordoma involving the clivus, suggesting that the BNCT component may be a precursor of chordoma.

3.
World Neurosurg ; 126: e758-e764, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30853518

RESUMO

OBJECTIVE: After a craniotomy procedure to access the brain, neurosurgeons have several options to fix the bone flap to the skull. The aim of this study was to assess if a polymeric clamplike fixation system (Cranial LOOP) is a safe and reliable system that maintains over time an appropriate alignment of the bone flap. METHODS: This is an observational, retrospective, case series study of 60 patients who underwent a craniotomy and were subject to cranial bone flap fixation with the Cranial LOOP fixation system. Baseline clinical parameters, surgical variables, medical records, and all postoperative medical images available were reviewed to assess the bone flap alignment and potential adverse events. RESULTS: A total of 182 Cranial LOOPs were implanted in the 60 patients (56.01 ± 20.21 years, 55% women) included in the study. The cranial fixation system maintained a good bone flap alignment in 95% of the patients studied immediately after surgery and in up to 96.7% of them at the end of follow-up. No intraoperative complications were reported. An ulcer potentially related to a device was detected, which was solved without the need for device removal. No artifacts were observed in any of the 219 medical images analyzed. CONCLUSIONS: Cranial LOOP is a safe and reliable postoperative long-term cranial bone flap fixation system. This device can fix the bone flap after a wide range of craniotomy procedures, performed in multiple locations, and provides good bone flap alignment. Cranial LOOP does not interfere in patient follow-up through medical imaging.


Assuntos
Craniotomia/métodos , Polímeros , Crânio/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Craniotomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
World Neurosurg ; 122: e262-e269, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30315985

RESUMO

BACKGROUND: In the literature, there are only short series of radiofrequency of the sphenopalatine ganglion (SPG) to treat chronic refractory cluster headache (CCHr) with variable results. Furthermore, there is no consensus on which methodology to use: radiofrequency ablation (RFA) or pulsed radiofrequency (PRF). METHODS: We conducted a prospective analysis of 37 patients with CCHr who underwent RFA or PRF of the SPG in our center between 2004 and 2015. RESULTS: The mean age of the patients was 40 years (range, 26-59 years). PRF was performed in 24 patients, and RFA was performed in 13 patients. A total of 5 patients (13.5%) experienced complete clinical relief of both pain and parasympathetic symptoms, 21 patients (56.8%) had partial and transient relief, and 11 patients (29.7%) did not improve. There was no evidence of significant superiority of one radiofrequency modality over the other (P = 0.48). There were no complications associated with the technique. The passage of time tended to decrease the efficacy of both techniques (P < 0.001). The mean follow-up was 68.1 months (range, 15-148 months). To our knowledge, this is the series with the largest number of patients and the longest follow-up period published in the literature. CONCLUSIONS: Radiofrequency of the SPG is a safe, fast, and partially effective method for the treatment of CCHr. Given its low rate of complications and its low economic cost, we think it should be one of the first invasive treatment options, prior to techniques with greater morbidity and mortality, such as neuromodulation.


Assuntos
Cefaleia Histamínica/terapia , Tratamento por Radiofrequência Pulsada , Ablação por Radiofrequência , Adulto , Feminino , Seguimentos , Gânglios Autônomos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento , Adulto Jovem
5.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 29(5): 2225-232, sept.-oct. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180314

RESUMO

Antecedentes y objetivo: La clinoidectomía anterior extradural (CaE) es una técnica microquirúrgica clave que facilita la resección de tumores localizados en la región paraselar. Actualmente, no existe consenso de la ejecución vía extradural o intradural, o evidencia científica que apoye su uso de manera rutinaria. El propósito de este artículo es exponer nuestra experiencia en la realización de la CaE como parte del manejo de los meningiomas paraselares. Materiales y métodos: Se realizó un análisis retrospectivo de las CaE empleadas en las resecciones de meningiomas paraselares realizadas en nuestro centro entre los años 2003 y 2015. Se registraron un total de 53 pacientes. Realizamos un análisis de nuestra serie de casos, enfocándonos en los resultados visuales, las tasas de resección y las complicaciones postoperatorias. A través de una revisión bibliográfica, se discuten las ventajas e inconvenientes de la CaE, consideraciones técnicas, comparación con la clinoidectomía anterior intradural e impacto visual. Resultados: El tipo de tumor más frecuente fueron los meningiomas de clinoides anterior (33,9%). Los síntomas iniciales más frecuentes fueron la disminución de la agudeza visual (45,3%) y la cefalea (22,6%). La resección tumoral total se consiguió en el 67,9% de los casos, siendo subtotal en el restante 32,1%. Con respecto a los déficits visuales, el 67,9% de los pacientes presentaron estabilidad clínica, el 22,6% mejoraron y el 9,4% experimentaron empeoramiento. El grado de resección tumoral no influyó de manera significativa en los resultados visuales posquirúrgicos, ni en la agudeza visual (p=0,71) ni en los déficits campimétricos (p=0,53). El 24,5% de los pacientes experimentaron paresia del iiipar transitoria y el 1,9%, permanente. La tasa de fístula de líquido cefalorraquídeo postoperatoria fue del 3,8%. La mortalidad fue del 0%. El periodo medio de seguimiento fue de 82,3 meses. Conclusiones: En nuestra experiencia, la CaE es una técnica segura que facilita la resección de los meningiomas localizados en la región paraselar, favorece la desvascularización temprana del tumor, reduce la necesidad de retracción del parénquima cerebral y podría ejercer un papel positivo en la preservación de la función visual y en la aparición de recidivas tumorales en la apófisis clinoides anterior (ACa)


Background and aim: The extradural anterior clinoidectomy (EAC) is a key microsurgical technique that facilitates the resection of tumors located in the parasellar region. There is currently no consensus regarding the execution of the procedure via extradural or intradural nor scientific evidence that supports its routine use. The purpose of this article is to expose our experience in performing EAC as part of the management of the parasellar meningiomas. Materials and methods: A retrospective analysis of the EAC for parasellar meningioma resection performed in our center between 2003 and 2015 was done. A total of 53 patients were recorded. We analized our series focusing on visual outcomes, resection rates and complications. Through an extensive bibliographic research, we discussed the advantages and disadvantages of the EAC, technical considerations, comparison with the intradural clinoidectomy and its visual impact. Results: The most frequent tumors were anterior clinoidal meningiomas (33.9%). The most common initial symptoms were decreased visual acuity (45.3%) and headache (22.6%). A gross total resection was achieved in 67.9%, being subtotal in the remaining 32.1%. Regarding the visual deficits 67.9% of the patients presented clinical stability, 22.6% improvement and 9.4% worsening. The degree of tumor resection did not significantly influence post-surgical visual outcomes, either visual acuity (P=.71) or campimetric alterations (P=.53). 24.5% of the patients experienced iiinerve transient paresis and 1.9% permanent. The postoperative cerebrospinal fluid leak rate was 3.8%. Mortality rate was 0%. The mean follow-up was 82.3 months. Conclusions: In our experience, EAC is a safe technique that facilitates the resection of the meningiomas located in the parasellar area, helps to achieve early tumor devascularization, reduces the need for retraction of the cerebral parenchyma and could play a positive role in the preservation of visual function and the appearance of tumor recurrences in the anterior clinoid process (ACP)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Meningioma/cirurgia , Meningioma/diagnóstico por imagem , Aneurisma/psicologia , Aneurisma/cirurgia , Procedimentos Neurocirúrgicos , Microcirurgia , Estudos Retrospectivos , Acuidade Visual , Cefaleia , Liberação de Cirurgia , Seio Cavernoso , Paresia/complicações
6.
Neurocirugia (Astur) ; 29(5): 225-232, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29753644

RESUMO

BACKGROUND AND AIM: The extradural anterior clinoidectomy (EAC) is a key microsurgical technique that facilitates the resection of tumors located in the parasellar region. There is currently no consensus regarding the execution of the procedure via extradural or intradural nor scientific evidence that supports its routine use. The purpose of this article is to expose our experience in performing EAC as part of the management of the parasellar meningiomas. MATERIALS AND METHODS: A retrospective analysis of the EAC for parasellar meningioma resection performed in our center between 2003 and 2015 was done. A total of 53 patients were recorded. We analized our series focusing on visual outcomes, resection rates and complications. Through an extensive bibliographic research, we discussed the advantages and disadvantages of the EAC, technical considerations, comparison with the intradural clinoidectomy and its visual impact. RESULTS: The most frequent tumors were anterior clinoidal meningiomas (33.9%). The most common initial symptoms were decreased visual acuity (45.3%) and headache (22.6%). A gross total resection was achieved in 67.9%, being subtotal in the remaining 32.1%. Regarding the visual deficits 67.9% of the patients presented clinical stability, 22.6% improvement and 9.4% worsening. The degree of tumor resection did not significantly influence post-surgical visual outcomes, either visual acuity (P=.71) or campimetric alterations (P=.53). 24.5% of the patients experienced iiinerve transient paresis and 1.9% permanent. The postoperative cerebrospinal fluid leak rate was 3.8%. Mortality rate was 0%. The mean follow-up was 82.3 months. CONCLUSIONS: In our experience, EAC is a safe technique that facilitates the resection of the meningiomas located in the parasellar area, helps to achieve early tumor devascularization, reduces the need for retraction of the cerebral parenchyma and could play a positive role in the preservation of visual function and the appearance of tumor recurrences in the anterior clinoid process (ACP).


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/etiologia , Doenças dos Nervos Cranianos/etiologia , Feminino , Cefaleia/etiologia , Humanos , Masculino , Neoplasias Meníngeas/complicações , Meningioma/complicações , Microcirurgia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/etiologia
7.
Rev. neurol. (Ed. impr.) ; 66(10): 340-343, 16 mayo, 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-173460

RESUMO

Introducción. La panarteritis nodosa es una vasculitis necrotizante que afecta de manera predominante a arterias de pequeño y mediano calibre de la piel y los órganos internos. La afectación neurológica sucede en un 25% de casos: los ictus isquémicos son relativamente frecuentes, pero las lesiones hemorrágicas resultan extremadamente raras. La hemorragia subaracnoidea es una expresión poco común de la enfermedad, asociada la inmensa mayoría de las veces a patología aneurismática. En nuestro conocimiento, sólo existe otro caso descrito de panarteritis nodosa con hemorragia subaracnoidea en la edad pediátrica sin patología aneurismática subyacente. Caso clínico. Niña de 7 años que presentó una hemorragia subaracnoidea no aneurismática con extensión intraparenquimatosa a los ganglios basales izquierdos. Previamente se había diagnosticado panarteritis nodosa y enfermedad protrombótica, en tratamiento con fármacos inmunodepresores y antiagregantes en ese momento. Conclusiones. Las características clínicas de la panarteritis nodosa, junto con el tratamiento antiagregante para prevenir la enfermedad tromboembólica en nuestra paciente, podrían haber predispuesto al evento hemorrágico en el proceso de la vasculitis cerebral. El manejo estándar de la hemorragia subaracnoidea es necesario en estos casos debido a que los aneurismas cerebrales son la causa más común de hemorragia subaracnoidea en un contexto de panarteritis nodosa


Introduction. Polyarteritis nodosa is a necrotizing vasculitis that mainly affects small and medium-sized arteries in skin and internal organs. Neurological involvement is reported in around 25% of cases: ischemic stroke is relatively common, but haemorrhagic lesions are extremely rare. Subarachnoid haemorrhage in polyarteritis nodosa is an uncommon expression of this disease, mostly associated with aneurism rupture. To the best of the authors’ knowledge, there is just one published case in pediatric age with polyarteritis nodosa and subarachnoid haemorrhage with no underlying aneurismal disease. Case report. A 7-year-old girl, who presented a non-aneurismal subarachnoid haemorrhage with intraparenchymal extension in the left basal ganglia. She was previously diagnosed with polyarteritis nodosa and prothrombotic condition, being under immunosuppressive and anti-platelet treatment at that moment. Conclusions. The clinical features of polyarteritis nodosa together with continued anti-platelet therapy to prevent thromboembolic disease in this patient could have predisposed to the haemorrhagic event in the process of cerebral vasculitis. Standard subarachnoid haemorrhage management is initially required in such cases as cerebral aneurysms are the most common cause of haemorrhage in the context of polyarteritis nodosa disease


Assuntos
Humanos , Feminino , Criança , Hemorragia Subaracnóidea/diagnóstico por imagem , Vasculite/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Vasculite/complicações , Transtornos da Consciência/complicações , Hidrocefalia/terapia , Angiografia , Hemorragia Subaracnóidea/terapia , Lesões Encefálicas/complicações , Lesões Encefálicas/terapia
9.
Neurocir.-Soc. Luso-Esp. Neurocir ; 26(6): 276-283, nov.-dic. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-144952

RESUMO

Objetivo: La respuesta al tratamiento y el pronóstico de los glioblastomas multiformes (GBM) puede ser distinta entre diferentes individuos. Este hecho está haciendo que cada vez estén cobrando más importancia los biomarcadores genéticos para intentar diferenciar distintos subtipos de GBM. Uno de los que está adquiriendo más importancia es la isocitrato deshidrogenasa (IDH1). El objetivo del trabajo es analizar la diferencias tanto clínicas como pronósticas de los GBM con y sin mutación de la IDH1. Materiales y método: Estudio retrospectivo de pacientes con GBM intervenidos entre los años 2007 y 2012. Los criterios de inclusión fueron: pacientes entre 18-85 años, sometidos por primera vez a cirugía, resección macroscópicamente completa, tratamiento coadyuvante con quimioterapia y radioterapia y Karnofsky status > 70. Resultados: N = 61 pacientes (36 varones/25 mujeres). Edad media de 62,3 años. En 14 pacientes (23%) se encontró la IDH1 mutada. La supervivencia media de los pacientes con mutación de la IDH1 (IDH1-m) fue de 23,6 meses respecto a los 11,9 meses que presentaban los de la IDH1 en estado natural (IDH1-wt) (p = 0,028). Existió una tendencia en los pacientes con IDH1-m a presentar la enfermedad en edades más tempranas 58,7 vs. 63,4 años, pero estas diferencias no fueron significativas. Conclusiones: Se deberían considerar los GBM con IDH1-m como una entidad distinta a los IDH1-wt. Se trata de dos subtipos de GBM con una historia natural y un pronóstico totalmente distinto por lo que se deberían clasificar en un futuro en función de la presencia de la mutación de la IDH1


Objective: Treatment response and prognosis in glioblastoma (GBM) tumours can differ among patients, highlighting the growing relevance of genetic biomarkers to differentiate glioblastoma sub-types. The biomarker isocitrate dehydrogenase (IDH1) is currently receiving considerable attention. The objective of this work was to analyse the clinical and prognostic differences between glioblastomas with and without the IDH1 mutation. Methods: A retrospective study was performed on patients with GBM who underwent surgery between 2007 and 2012. The inclusion criteria were: patient age between 18-85 years who underwent surgery for the first time with complete macroscopic resection, complete adjuvant treatment with chemotherapy and radiotherapy, and a Karnofsky performance score > 70. Results: A total of 61 patients (36 males/25 famales) were included and with a mean age of 62.3 years. An IDH1mutation was found in 14 patients (23%). Median survival in patients with the IDH1 mutation (IDH1-m)was 23.6 months compared with 11.9 months in those with the wild type IDH1 (IDH1-wt) (P = .028). Disease onset in IDH1-m patients tended to be at a younger age, 58.7 vs. 63.4 years, but this difference was not statistically significant. Conclusion: Glioblastomas with IDH1-m should be considered a different entity from the IDH1-wt, as their natural history and prognosis differ. In the near future we should be classified glioblastomas based on the presence of the IDH1 mutation


Assuntos
Adulto , Idoso de 80 Anos ou mais , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Isocitrato Desidrogenase/análise , Isocitrato Desidrogenase , Isocitrato Desidrogenase/genética , Glioblastoma/diagnóstico , Glioblastoma/genética , Mutação , Prognóstico , Glioma/diagnóstico , Glioma/genética , Glioblastoma/cirurgia , Estudos Retrospectivos , Glioblastoma/tratamento farmacológico , Glioblastoma/radioterapia , Glioma/tratamento farmacológico , Glioma/radioterapia , Glioma/cirurgia , Sobrevivência , Análise Espectral
10.
Neurocirugia (Astur) ; 26(6): 276-83, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-26194445

RESUMO

OBJECTIVE: Treatment response and prognosis in glioblastoma (GBM) tumours can differ among patients, highlighting the growing relevance of genetic biomarkers to differentiate glioblastoma sub-types. The biomarker isocitrate dehydrogenase (IDH1) is currently receiving considerable attention. The objective of this work was to analyse the clinical and prognostic differences between glioblastomas with and without the IDH1 mutation. METHODS: A retrospective study was performed on patients with GBM who underwent surgery between 2007 and 2012. The inclusion criteria were: patient age between 18-85 years who underwent surgery for the first time with complete macroscopic resection, complete adjuvant treatment with chemotherapy and radiotherapy, and a Karnofsky performance score>70. RESULTS: A total of 61 patients (36 males/25 famales) were included and with a mean age of 62.3 years. An IDH1mutation was found in 14 patients (23%). Median survival in patients with the IDH1 mutation (IDH1-m) was 23.6 months compared with 11.9 months in those with the wild type IDH1 (IDH1-wt) (P=.028). Disease onset in IDH1-m patients tended to be at a younger age, 58.7 vs. 63.4 years, but this difference was not statistically significant. CONCLUSION: Glioblastomas with IDH1-m should be considered a different entity from the IDH1-wt, as their natural history and prognosis differ. In the near future we should be classified glioblastomas based on the presence of the IDH1 mutation.


Assuntos
Neoplasias Encefálicas/genética , Glioblastoma/genética , Isocitrato Desidrogenase/genética , Mutação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
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