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1.
Wiad Lek ; 75(9 pt 2): 2299-2303, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36378712

RESUMO

The authors present a 3-year-old female with increasing proptosis and absent vision in the right eye. Chemotherapy had done for 3months. But her ailments lingered. The right eye exhibited severe proptosis and poor vision, whereas the left eye was normal with 20/20 vision. Preoperative MRI revealed a dumbbell-shaped tumor in the intra-orbital and intra-cranial section of the right optic nerve. A lateral supra-orbital approach was used to dissect the dumbbell-shaped tumor and the right optic nerve. No remnant of the tumor was discovered during a follow-up examination. The case study demonstrates how to identify and treat ONA surgically. However, we need further research on optic nerve PA to gain a better understanding of their behavior. While gross total resection (GTR) is usually curative, tumors in deep locations may be unresectable and require alternative therapeutic procedures. Additionally, the case study emphasizes the importance of additional research on early detection and prevention.


Assuntos
Astrocitoma , Exoftalmia , Humanos , Feminino , Pré-Escolar , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Nervo Óptico/patologia , Imageamento por Ressonância Magnética , Exoftalmia/etiologia , Exoftalmia/cirurgia , Exoftalmia/patologia , Astrocitoma/diagnóstico por imagem , Astrocitoma/cirurgia
2.
Neurosurg Rev ; 45(6): 3817-3827, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36352046

RESUMO

The deep location of the thalamus and the complex neural circuits in the surrounding area make surgery extremely challenging. Feasibility and advisability of using a supracerebellar infratentorial approach (SCITA) for endoscopic resection of thalamic lesions remains to be further evaluated. Fifteen patients who underwent endoscopic resection of thalamic via SCITA from 2014 to 2021 were retrospectively collected. We analyzed preoperative tumor-related variables and surgical procedures in detail, as well as postoperative outcomes. Lesions mainly located in the posterior and/or medial part of the thalamus, and some of them expanded downward, or backward. The mean size of them was 30 × 24 mm. Five of the nine patients with preoperative hydrocephalus underwent cerebrospinal fluid shunts to relieve increased intracranial pressure. Among the 15 patients, 4 were glioblastoma, 3 were pilocytic astrocytoma, and the rest included 1 case of anaplastic astrocytoma, melanoma, polymorphous low-grade neuroepithelial tumor of the young, rosette-forming glioneuronal tumor, inflammatory lesion, diffuse midline glioma, and cavernous hemangioma. The majority of patients (10/15) achieved gross total resection, which has become more pronounced since paramedian SCITA was used in place of the midline approach in 2020 (6/8). Three patients had unresolved or new onset of clinical symptoms after surgery, resulting in a decreased KPS score at discharge. Neuro-endoscopic techniques can ameliorate many of the shortcomings of the SCITA. With the accumulation of experience and technological progress, more deficiencies of this approach may be improved, enabling safe and effective resection of posterior and/or medial part thalamic lesions.


Assuntos
Astrocitoma , Glioblastoma , Glioma , Hemangioma Cavernoso , Humanos , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Astrocitoma/cirurgia , Astrocitoma/patologia , Hemangioma Cavernoso/cirurgia , Glioma/cirurgia , Glioblastoma/cirurgia
3.
Neurol India ; 70(Supplement): S206-S210, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412370

RESUMO

Purpose: Adult intramedullary pilocytic astrocytomas (PAs) are exceedingly rare. The aim of this study was to summarize our experiences in treating adult intramedullary PAs. Materials and Methods: We retrospectively reviewed the records of seven adult patients who underwent microsurgery for intramedullary PAs between 2010 and 2017. Magnetic resonance imaging was the standard radiological investigation. The diagnosis of PAs was based on pathology. All the follow-up data were obtained during office visits. Results: There were three males and four females with the mean age of 40.9 years. The tumors generally exhibited hypointensity on T1-weighted images (WI) and hyperintensity on T2WI. Contrast-enhanced T1WI showed heterogeneous enhancement. Gross total resection (GTR) of the tumor was achieved in four cases and subtotal resection (STR) was achieved in three cases. Two cases of STR received postoperative radiotherapy. One STR case had mildly residual tumor regrowth. At the last follow-up, neurological status was improved in six patients. Conclusion: The accurate diagnosis of adult intramedullary PAs depends on pathology. GTR is the best treatment and the outcome is favorable. STR increases the risk of tumor recurrence, and regular follow-up is necessary. Due to uncertain therapeutic efficacy, radiotherapy should be considered carefully for cases of STR.


Assuntos
Astrocitoma , Adulto , Feminino , Humanos , Masculino , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Astrocitoma/radioterapia , Astrocitoma/cirurgia , Microcirurgia , Recidiva Local de Neoplasia , Neoplasia Residual/etiologia , Neoplasia Residual/radioterapia , Estudos Retrospectivos , Imageamento por Ressonância Magnética
4.
Cancer Biol Med ; 19(10)2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36350001

RESUMO

OBJECTIVE: IDH-mutant lower-grade gliomas (LGGs, grade 2 or 3) eventually transform into secondary grade 4 astrocytomas (sAIDHmut/G4). Here, we sought to describe the transformation time, risk factors, and outcomes in malignant transformation of IDH-mutant LGGs. METHODS: We screened data for 108 patients with sAIDHmut/G4 in the Chinese Glioma Genome Atlas who had initial IDH-mutant LGGs and underwent reoperation during 2005-2021. We evaluated the transformation time from IDH-mutant LGGs to sAIDHmut/G4, and associated risk factors and outcomes. Malignant transformation was defined as pathological confirmation of grade 4 astrocytoma. RESULTS: The median age of the 108 patients with IDH-mutant LGGs was 35 years (range, 19-54); the median age at transformation was 40 years (range, 25-62); and the median follow-up time for all patients was 146 months (range, 121-171). The average transformation time was 58.8 months for all patients with LGGs (range, 5.9-208.1); 63.5 and 51.9 months for grade 2 and 3 gliomas, respectively; and 58.4 and 78.1 months for IDH-mutant/1p/19q-non-codeleted astrocytomas and IDH-mutant/1p/19q-codeleted oligodendrogliomas, respectively. Univariate and multivariate analysis indicated that radiotherapy [hazard ratio (HR), 0.29; 95% confidence interval (CI), 0.137-0.595; P = 0.001] and non-A blood type (HR, 0.37; 95% CI, 0.203-0.680; P = 0.001) were protective factors against delayed malignant transformation. Radiotherapy was associated with improved survival after transformation (HR, 0.44; 95% CI, 0.241-0.803; P = 0.008), overall survival (HR, 0.50; 95% CI, 0.265-0.972; P = 0.041), and progression-free survival (HR, 0.25; 95% CI, 0.133-0.479; P < 0.0001) in patients with IDH-mutant gliomas. CONCLUSIONS: Radiotherapy is associated with delayed malignant transformation and improved survival in patients with IDH-mutant gliomas.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Glioblastoma , Glioma , Oligodendroglioma , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Isocitrato Desidrogenase/genética , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/patologia , Glioma/genética , Glioma/radioterapia , Glioma/patologia , Astrocitoma/genética , Astrocitoma/radioterapia , Astrocitoma/cirurgia , Transformação Celular Neoplásica/genética
6.
J Neurooncol ; 160(2): 403-411, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36258151

RESUMO

PURPOSE: Most patients with Lower Grade Gliomas (LGG) present with epileptic seizures. Since the advent of molecular diagnostics, more homogenous sub-entities have emerged, including the isocitrate dehydrogenase-mutated (IDH-mutated) astrocytomas and 1p19q-codeleted oligodendrogliomas. We aimed to describe the occurrence of seizures in patients with molecularly defined LGG pre- and postoperatively and to analyze factors affecting seizure status postoperatively. METHODS: A population-based cohort of 130 adult patients with IDH-mutated WHO grade 2 or 3 astrocytomas and oligodendrogliomas was assessed pertaining to seizure burden before and after surgery. RESULTS: Fifty-four (79.4%) patients with astrocytoma and 45 (72.6%) patients with oligodendroglioma had a history of seizures before surgery. At 12 months postoperatively, 51/67 (76.1%) patients with astrocytoma and 47/62 (75.8%) patients with oligodendrogliomas were seizure free. In a multivariable logistic regression analysis, lower extent of resection (EOR) (OR 0.98; 95% CI 0.97-1.00, p = 0.01) and insular tumor location (OR 5.02; 95% CI 1.01-24.87, p = 0.048) were associated with presence of seizures within 1 year postoperatively in the entire LGG cohort. In sub-entities, EOR was in a similar manner associated with seizures postoperatively in astrocytomas (OR 0.98; 95% CI 0.96-0.99, p < 0.01) but not in oligodendrogliomas (p = 0.34). CONCLUSION: Our results are well in line with data published for non-molecularly defined LGG with a large proportion of patients being seizure free at 1 year postoperative. Better seizure outcome was observed with increased EOR in astrocytomas, but this association was absent in oligodendrogliomas.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Glioma , Oligodendroglioma , Adulto , Humanos , Isocitrato Desidrogenase/genética , Oligodendroglioma/complicações , Oligodendroglioma/genética , Oligodendroglioma/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/cirurgia , Glioma/complicações , Glioma/genética , Glioma/cirurgia , Astrocitoma/complicações , Astrocitoma/genética , Astrocitoma/cirurgia , Convulsões/genética , Mutação
7.
Medicina (B Aires) ; 82 Suppl 3: 71-75, 2022 Aug 30.
Artigo em Espanhol | MEDLINE | ID: mdl-36054862

RESUMO

Tuberous sclerosis complex is an autosomal dominant genetic multisystemic disorder caused primarily by mutations in one of the two tumor suppressor genes TSC1 or TSC2, resulting in increased activation of the mTOR pathway. Regarding clinical manifestations, a wide range of phenotypic variability exists, with symptoms constellations that may differ in affected organs (brain, skin, heart, eyes, kidneys, lungs), age of presentation and severity, but usually with great impact in biopsychosocial aspects of health and in quality of life. Main clinical neurological features are epilepsy (frequently, antiepileptic drug-resistant epilepsy), neuropsychiatric disorders, and subependymal giant cell astrocytomas. Recently, many therapeutic strategies have developed, including preventive treatment of epilepsy, new options for treatment of epilepsy as cannabidiol, mTOR inhibitors, ketogenic diet, and a more precise epilepsy surgery. Subependymal giant cell astrocytomas may require surgical procedures or mTOR inhibitors treatment. mTOR inhibitors may also be useful for other comorbidities. To improve quality of life of patients with tuberous sclerosis complex, it is essential to be able to deliver an integrated approach by specialized multidisciplinary teams, coordinated with primary care physicians and health professionals, that include access to treatments, attention of psychosocial aspects, and an adequate health care transition from pediatric to adult care.


El complejo de esclerosis tuberosa es un trastorno genético autosómico dominante multisistémico, causado primariamente por mutaciones en uno de los genes supresores de tumores TSC1 o TSC2, que generan una sobre-activación de la vía mTOR. En relación a las manifestaciones clínicas, existe una gran variabilidad fenotípica, con constelaciones de síntomas que pueden diferir tanto en los órganos afectados (encéfalo, piel, corazón, ojos, riñones, pulmones), como en la edad de presentación y la gravedad, pero que generalmente impactan fuertemente en los aspectos biopsicosociales y en la calidad de vida. Las principales manifestaciones clínicas neurológicas incluyen la epilepsia (con frecuencia, fármaco-resistente), los trastornos neuropsiquiátricos y los síntomas relacionados a los astrocitomas de células gigantes. En los últimos años han surgido nuevos abordajes terapéuticos, incluyendo el tratamiento preventivo de la epilepsia, nuevas opciones de tratamiento para la epilepsia como el uso de cannabidiol, de inhibidores de mTOR, la terapia cetogénica y cirugía de epilepsia. Los astrocitomas de células gigantes pueden requerir tratamientos quirúrgicos o con inhibidores de mTOR. Estos últimos también pueden utilizarse para el tratamiento de otras comorbilidades. Para mejorar la calidad de atención de los pacientes con esclerosis tuberosa, el desafío es poder brindar un abordaje integral por equipos interdisciplinarios especializados, en coordinación con sus médicos de cabecera y los equipos de salud del primer nivel de atención, que incluya el acceso a los tratamientos, la atención de los aspectos psicosociales, y una adecuada transición desde la atención pediátrica a la de adultos.


Assuntos
Astrocitoma , Epilepsia , Transição para Assistência do Adulto , Esclerose Tuberosa , Adulto , Astrocitoma/tratamento farmacológico , Astrocitoma/genética , Astrocitoma/cirurgia , Criança , Epilepsia/tratamento farmacológico , Humanos , Qualidade de Vida , Esclerose Tuberosa/diagnóstico , Esclerose Tuberosa/genética , Esclerose Tuberosa/terapia
8.
Medicine (Baltimore) ; 101(36): e30492, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36086683

RESUMO

INTRODUCTION: Dandy-Walker complex and pleomorphic xanthoastrocytomas are both rare disease entities that typically manifest early in life and are associated with congenital etiological factors. Dandy-Walker complex is a cerebellar malformation associated with a series of anatomical changes. The disease onset is usually at birth or during infancy. Late onset in adulthood is uncommon. Pleomorphic xanthoastrocytoma is a rare WHO grade II astrocytic tumor affecting mainly young adults. Concomitant occurrence of Dandy-Walker complex and pleomorphic xanthoastrocytoma has not been previously reported. PATIENT CONCERNS AND DIAGNOSIS: A 30-year-old woman with a previous history of unconfirmed resected lateral ventricle meningioma presented with severe headache for 1 day. Imaging examination revealed a mass in the right lateral ventricle with heterogeneous signal patterns, changes in the posterior fossa corresponding to a Dandy-Walker variant, and mild hydrocephalus. INTERVENTIONS AND OUTCOMES: Surgical complete resection of the mass was achieved. postoperative histopathological examination confirmed WHO grade II pleomorphic xanthoastrocytoma. Three years postsurgery, ventriculoperitoneal shunt was performed due to worsening of hydrocephalus. The patient has since remained symptom-free. CONCLUSION: This is the first report of concomitant occurrence of Dandy-Walker complex and pleomorphic xanthoastrocytoma. The association of neurological congenital malformation with intracranial neoplasms may be multifactorial, with underlying role of genetic mutations or chromosome alterations.


Assuntos
Astrocitoma , Síndrome de Dandy-Walker , Hidrocefalia , Adulto , Astrocitoma/complicações , Astrocitoma/cirurgia , Síndrome de Dandy-Walker/complicações , Síndrome de Dandy-Walker/diagnóstico , Síndrome de Dandy-Walker/cirurgia , Feminino , Humanos , Hidrocefalia/etiologia , Recém-Nascido , Ventrículos Laterais/patologia , Derivação Ventriculoperitoneal/efeitos adversos
9.
Neurol India ; 70(4): 1468-1474, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36076645

RESUMO

Background: Intraventricular pilocytic astrocytomas are a rare occurrence, accounting for approximately 4% -15.6% of all pilocytic astrocytomas .The aim of the study was to describe the radiology, surgical management and outcome in 15 patients with histopathologically proven intraventricular pilocytic astrocytoma(IVPA). Objective: To study the clinical presentation radiology and operative challenges in rare intra ventricular pilocytic astrocytomas. Materials and Methods: Between January 2010 and August 2018, 15 patients with histopathologically proven IVPA were identified. The radiological images were obtained from PACS. Patient and surgical details were obtained from the computerized discharge summary, OT records and operative notes, whereas follow up was obtained from the record section. Results: Headache with progressive loss of vision was the most common presentation. Duration of symptoms varied from 4 months to 2 years (mean 9. 88 months). Except one patient, all patients with preoperative CT scan revealed calcifications in the lesion, with extensive calcification in 3 patients. All the tumors were predominantly hypointense on T1WI and iso to hyperintense on T2WI. Lesion in all patients showed heterogenous contrast enhancement on post gadolinium images. Mean blood loss in the series was 1969 ml (range 250 ml- 4500 ml).There was one death in this series due to meningitis and septic shock. Conclusion: IVPAs are rare tumors and are difficult to diagnose in the preoperative period based on the radiologic profile alone. These tumors can be extremely vascular with potential for massive blood loss. These tumors can be associated with extensive calcification and the calcified tumors have less bleeding as expected.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Calcinose , Astrocitoma/diagnóstico por imagem , Astrocitoma/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Gadolínio , Humanos , Tomografia Computadorizada por Raios X
10.
Acta Neurochir (Wien) ; 164(11): 3047-3056, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36166105

RESUMO

BACKGROUND: Intramedullary spinal cord tumours are rare and account for about 2-4% of primary CNS tumours. Ependymomas and astrocytomas are most frequent. The aim of this study was to evaluate the long-term neurological outcome, quality of life (QoL), survival, need for additional treatment and frequency of neuropathic pain in a patient group treated at a tertiary university hospital. METHOD: Retrospective descriptive study of 52 long-term survivors with intramedullary or filum tumours consenting to participate in this study. Fifty-six operations were performed in 48 patients. Clinical and radiological follow-up period was 113 and 117 months, respectively. RESULTS: Good neurological outcome (ASIA score D or E, modified McCormick grade 1 or 2) was achieved in 88%. We found two negative prognostic factors in regards of severe disability which were large craniocaudal tumour size (p = 0.004) and histologic verified astrocytomas (p = 0.002). SF-36 results showed significantly lower results on all five subdomains concerning physical function, whereas scores for mental health and role emotional showed no significant differences compared to Norwegian norms. Ten patients including all astrocytoma patients, one primitive neuroectodermal tumour and three recurrent tumours of filum terminale had adjuvant therapy. None of the patients with intramedullary ependymoma had adjuvant therapy. Neuropathic pain was present in 54% of patients at the last follow-up. CONCLUSION: This series shows that good results can be obtained with surgery for intramedullary tumours, even without perioperative neurophysiological monitoring. Multicentre studies are needed for further evaluation of negative and positive prognostic factors to further improve outcome.


Assuntos
Astrocitoma , Ependimoma , Neuralgia , Neoplasias da Medula Espinal , Humanos , Qualidade de Vida , Estudos Retrospectivos , Seguimentos , Recidiva Local de Neoplasia , Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/patologia , Astrocitoma/diagnóstico por imagem , Astrocitoma/cirurgia , Medula Espinal/patologia , Resultado do Tratamento
11.
Oper Neurosurg (Hagerstown) ; 23(3): 182-187, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35972079

RESUMO

BACKGROUND: Minimally invasive surgery (MIS) for intracranial pathology minimizes surgical morbidity but can come at the cost of operator ergonomics and technical surgical success. Here, the authors present a case series to report the first use of a novel 15-mm tubular retraction system with integrated lighting and visualization capabilities for MIS access to intracranial lesions. OBJECTIVE: To demonstrate feasibility and effectiveness of the 15-mm Aurora Surgiscope (Integra Lifesciences) for intracranial MIS approaches. METHODS: The 15-mm Aurora Surgiscope facilitated MIS approach to gain access to intraparenchymal pathologies. The device consists of a tubular access system with integrated light source and a reusable control unit that modifies video parameters. The port was inserted along a preplanned trajectory through a mini-craniotomy. Bimanual access allowed the surgeon to comfortably dissect/resect lesional tissue using high-quality video. RESULTS: Four patients are presented. In cases 1 and 2, the authors evacuated acute intracerebral hemorrhages. Both had <15 cc hemorrhage with improved or stable neurological examination. In case 3, the authors performed gross total resection of a cerebellar pilocytic astrocytoma. In case 4, the authors resected a mesial posterior temporal cavernoma. No perioperative/technical complications were noted. CONCLUSION: The Aurora Surgiscope system is a novel integrated tubular retraction, lighting, and visualization system that allows access to a wide variety of pathologies using a MIS approach. The Surgiscope allows the surgeon to use bimanual dexterity through a small access port while limiting the need for additional equipment such as microscope, exoscope, or endoscope.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Astrocitoma/diagnóstico por imagem , Astrocitoma/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Craniotomia , Humanos , Microcirurgia , Procedimentos Neurocirúrgicos
12.
J Neurooncol ; 160(1): 107-114, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35997920

RESUMO

PURPOSE: Diffuse intrinsic pontine gliomas (DIPGs) are prone to high surgical risks, and they could even lead to death due to their specific sites. To determine the value of frameless robot-assisted stereotactic biopsies of DIPGs, when compared it with microsurgical biopsies. METHODS: We conducted a retrospective study of 71 pediatric patients who underwent biopsies from January 2016 to January 2021. (i) group 1: microsurgical biopsies, and (ii) group 2: frameless robot-assisted stereotactic biopsies. Demographic information, neuroimaging characteristics, pathological diagnoses, operation time, postoperative intensive care unit (ICU) stay time, postoperative hospitalization time, complications, cost, and perioperative mortality rate (POMR) were collected for analyses. RESULTS: 32 Cases underwent microsurgical biopsies (group 1) and 39 cases underwent frameless robot-assisted stereotactic biopsies (group 2). All cases were accurately diagnosed after surgery. There was no significant difference in gender, age, symptom times and tumor volumes between the two groups (p > 0.05); operation time, postoperative ICU, stay time and postoperative hospitalization time were longer in group 1 than in group 2 (p < 0.001); the intraoperative bleeding volumes and cost were higher in group 1 than in group 2 (p < 0.001). Group 1 patients required more perioperative blood transfusion than group 2 (p = 0.001), and the new neurological impairments were more frequent in group 1 than in group 2 (p = 0.003). The POMR was 9.38% (3/32) in group 1 and 0 in group 2 (p = 0.087). CONCLUSIONS: Frameless robot-assisted stereotactic biopsy was an effective and minimally invasive technique for pediatric DIPGs.


Assuntos
Astrocitoma , Neoplasias do Tronco Encefálico , Glioma Pontino Intrínseco Difuso , Robótica , Humanos , Criança , Técnicas Estereotáxicas , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Neoplasias do Tronco Encefálico/cirurgia , Astrocitoma/cirurgia , Biópsia
13.
Clin Neurol Neurosurg ; 221: 107379, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35932588

RESUMO

BACKGROUND: Pleomorphic xanthoastrocytoma (PXA), anaplastic pleomorphic xanthoastrocytoma (A-PXA), and epithelioid glioblastoma (E-GBM) show overlapping features. However, little is known about their clinical characteristics, molecular features and relationship with progression. METHODS: Fourteen patients diagnosed at Nanfang Hospital from 2016 to 2019 were enroled, including eleven PXA patients, two A-PXA patients, and one E-GBM patient. All tumour tissue samples of the fourteen patients were examined by immunohistochemical staining (MGMT, VEGF, BRAF-V600E, etc.). RESULTS: The mean age of 13 patients with PXA or A-PXA was 25.4 years; twelve of these patients had tumours at supratentorial regions. VEGF positivity was detected in the tumour samples of 13 patients, MGMT positivity in 10 patients, and BRAF-V600E positivity in 7 patients. The recurrent tumour tissue of the patient with E-GBM arising from A-PXA was screened to detect 11 glioma markers (MGMT, BRAF-V600E, etc.) and chromosome 1p/19q by next-generation sequencing (NGS). For the tumour sample of the E-GBM patient who survived for up to 11 years after the fourth resection, BRAF V600E was wild type in the sample obtained from the first surgery, while it was mutant in the second, third, and fourth surgeries. In contrast, the promoter status of MGMT in the four surgeries was unmethylated. The NGS results showed that the mutation frequencies of BRAF V600E in the second, third and fourth surgeries were 14.06%, 9.13% and 48.29%, respectively. CONCLUSIONS: Collectively, the results suggest that patients with A-PXA may relapse multiple times and eventually progress to E-GBM with the BRAF-V600E mutation.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Glioblastoma , Adolescente , Astrocitoma/genética , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Glioblastoma/genética , Glioblastoma/patologia , Glioblastoma/cirurgia , Humanos , Mutação , Recidiva Local de Neoplasia/genética , Proteínas Proto-Oncogênicas B-raf/genética , Fator A de Crescimento do Endotélio Vascular
14.
Pediatr Neurosurg ; 57(5): 358-364, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35988537

RESUMO

INTRODUCTION: Intradiploic pseudomeningoceles, also called intradiploic cerebrospinal fluid (CSF) fistulas, are abnormal CSF collections between the two bony tables of the calvaria resulting from postsurgical CSF leakage. To date, only six cases of intradiploic pseudomeningocele have been reported, all occurring in the occipital area. In this paper, we report the seventh case of late-onset occipital intradiploic pseudomeningocele (OIP) occurring in a young female patient who underwent surgery for the removal of a cerebellar pilocytic astrocytoma. In this regard, we also review the literature on the few recognized cases of OIP. CASE PRESENTATION: The case of an 18-year-old female patient known to our institute for an operation 12 years earlier to remove a pilocytic astrocytoma is illustrated. At admission, the patient complained only of occasional orthostatic headache. Brain imaging demonstrated a pseudomeningocele extended intradiploically from the occipital squama to the condylar and clivus regions, thinning both occipital bone tables and dilating the CSF-filled diploe. Watertight duroplasty and cranioplasty were effectively performed. CONCLUSION: Pediatric patients undergoing posterior cranial fossa craniotomy/craniectomy may postoperatively develop OIP. In this setting, treatment of any dural CSF fistula should be considered because of the risk of progressive extension and bone erosion.


Assuntos
Astrocitoma , Fossa Craniana Posterior , Humanos , Feminino , Criança , Adolescente , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologia , Osso Occipital/diagnóstico por imagem , Osso Occipital/cirurgia , Craniotomia/efeitos adversos , Craniotomia/métodos , Astrocitoma/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
15.
Turk Neurosurg ; 32(5): 872-876, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35929036

RESUMO

AIM: To improve the extent and safety of resecting these deep-seated tumors, we report a novel procedure of minimally invasive endoscopic resection of deep-seated pilocytic astrocytomas under the guidance of 5-aminolevulinic acid (5-ALA) fluorescence undescribed until now. CASE DESCRIPTION: A 53-year-old male presented with a gradually progressing mild right hemiparesis. Imaging studies showed a solid tumor with degenerative cystic formation in the left basal ganglia. The tumor was removed endoscopically via right frontal small craniotomy. The tumor was positive for 5-ALA fluorescence and allowed better detection of the dissection margin of the solid tumor from the surrounding brain tissue. The histopathological diagnosis was pilocytic astrocytoma. No recurrence was observed on follow-up magnetic resonance imaging (MRI) 2 years after surgery, and the patient was fully independent after rehabilitation. CONCLUSION: This minimally invasive technique, enhanced by intraoperative fluorescence, might be a safe and feasible alternative to open surgery in the removal of deeply located gliomas.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Ácido Aminolevulínico , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Fluorescência , Humanos , Ácidos Levulínicos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes
16.
Cir Cir ; 90(4): 433-438, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35944421

RESUMO

AIM: Describe our stereotactic brain biopsy (SBB) technique for intra-axial lesions of the posterior fossa, evaluate its effectiveness and safety, and compare them with other series. MATERIAL AND METHODS: Retrospective study in ten consecutive patients, whose variables were age, gender, location of the lesions, clinical, radiological, and histopathological diagnoses, complications, and mortality, for analysis using descriptive statistics and tests of concordance and diagnostic validity. RESULTS: Lesions were pontine in seven cases, and pontomedullary in three occasions, with histopathological diagnoses of four Grade II astrocytomas, two Grade IV astrocytomas, two infectious process, one neuroblastic tumor, and one cavernous malformation, whose frequency differs from the previous reports (χ2 = 0.07). The clinical-radiological concordance was poor (κ = 0.20). The validity of the clinical diagnosis had intermediate values (Sn = 66.7%, Sp = 75%), while radiological studies were more sensitive (Sn = 100%, Sp = 25%). A definitive diagnosis was obtained in all procedures, with no permanent morbidity or mortality because of the surgery. CONCLUSION: The SBB technique for posterior fossa implemented in our hospital shows high diagnostic yield, as well as absolute safety for the patient.


OBJETIVO: Describir nuestra técnica de biopsia cerebral estereotáctica (SBB) para lesiones intraaxiales de fosa posterior, evaluar su eficacia y seguridad y compararlas con otras series. MATERIAL Y MÉTODOS: Estudio retrospectivo en 10 pacientes consecutivos, cuyas variables fueron edad, sexo, localización de las lesiones, diagnósticos clínicos, radiológicos e histopatológicos, complicaciones y mortalidad, para análisis mediante estadística descriptiva y pruebas de concordancia y validez diagnóstica. RESULTADOS: Las lesiones fueron pontinas en 7 casos y pontomedulares en 3 ocasiones, con diagnósticos histopatológicos de 4 astrocitomas grado II, 2 astrocitomas grado IV, 2 procesos infecciosos, 1 tumor neuroblástico y 1 malformación cavernosa, cuya frecuencia difiere de reportes previos (χ2 = 0.07). La concordancia clínico-radiológica fue mala (κ = 0.20). La validez del diagnóstico clínico tuvo valores intermedios (Sn = 66.7%, Sp = 75%), mientras que los estudios radiológicos fueron más sensibles (Sn = 100%, Sp = 25%). Se obtuvo un diagnóstico definitivo en todos los procedimientos, sin morbimortalidad permanente por la cirugía. CONCLUSIÓN: La técnica SBB para fosa posterior implementada en nuestro hospital muestra un alto rendimiento diagnóstico, así como una seguridad absoluta para el paciente.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Astrocitoma/diagnóstico por imagem , Astrocitoma/cirurgia , Biópsia/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Hospitais , Humanos , Estudos Retrospectivos , Técnicas Estereotáxicas
17.
Neurochirurgie ; 68(6): 627-636, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35907444

RESUMO

INTRODUCTION: Surgical removal has been the historical treatment for subependymal giant-cell astrocytoma (SEGA) in tuberous sclerosis complex (TSC) patients. In the past decade, mTOR inhibitors have shown efficacy in the treatment of SEGA, significantly reducing tumor size. The aim of this study was to assess the safety and efficacy of surgical treatment at a time when mTOR inhibitors have changed standard treatment. MATERIAL AND METHODS: We conducted a single-center retrospective study including all patients treated by surgery for SEGA from October 2003 to September 2019, with a review of all SEGA surgical case series, following PRISMA guidelines. Research focused on demographics, surgical indications, surgical approach, use of CSF shunt, morbidity and mortality, resection quality, recurrence rate and treatment of recurrence, follow-up and long-term clinical status. RESULTS: Eleven patients were included, with a median age at surgery of 16.0 years. Gross total resection was achieved in 8 patients (72%), with no permanent morbidity. One patient needed further surgery for tumor recurrence. Eighteen studies were reviewed, totaling 263 TSC patients affected by SEGA and 286 surgical procedures. Gross total resection was achieved in 81.1% of cases, mortality was 4.9% and permanent morbidity 6.1%. Tumor recurrence occurred in 11.5% of cases, and was secondary to partial tumor resection at first surgery in the majority of cases. CONCLUSION: Surgical treatment of SEGA is still a valid and effective option. Morbidity is low and complete disappearance of SEGA can be achieved in selected cases.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Inibidores MTOR , Esclerose Tuberosa , Adolescente , Humanos , Astrocitoma/tratamento farmacológico , Astrocitoma/cirurgia , Astrocitoma/patologia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/patologia , Recidiva Local de Neoplasia/cirurgia , Recidiva Local de Neoplasia/tratamento farmacológico , Estudos Retrospectivos , Serina-Treonina Quinases TOR , Esclerose Tuberosa/complicações , Esclerose Tuberosa/cirurgia , Esclerose Tuberosa/tratamento farmacológico
18.
Acta Neurochir (Wien) ; 164(10): 2605-2622, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35829775

RESUMO

PURPOSE: Intramedullary spinal cord tumours (IMSCTs) are comparatively rare neoplasms. We present a single-centre clinical case series of adult patients with surgically managed IMSCTs. METHODS: We performed a retrospective analysis of electronic patient records in the time period spanning July 2010 to July 2021. All adult patients that had undergone surgical management for IMSCTs were eligible for inclusion. Baseline and post-operative clinical and radiological characteristics, along with follow-up data, were assessed. We also performed a literature review with a focus on surgical outcomes for IMSCTs. RESULTS: Sixty-six patients matched our selection criteria, with a median age of 42 years (range 23-85). Thirty-four ependymomas, 17 haemangioblastomas, 12 astrocytomas, 2 lymphomas and 1 teratoma were included. Statistical analysis yielded several significant findings: IMSCTs spanning a greater number of vertebral levels are significantly associated with poor McCormick outcomes (p = 0.03), presence of gait disturbance before surgery is significantly associated with poor outcome for both post-operative McCormick and Nurick scores (p = 0.007), and radicular pain present pre-operatively is significantly associated with a good post-operative McCormick score (p = 0.045). Haemangioblastomas are significantly more likely to have a clear intra-operative dissection plane compared to ependymomas and astrocytomas (p = 0.009). However, astrocytomas have a significantly higher prevalence of good McCormick outcomes compared to ependymomas and haemangioblastomas (p = 0.03). CONCLUSION: Histological diagnosis, cranio-caudal extent of the tumour and the presence or absence of baseline deficits-such as gait impairment and radicular pain-are significant in determining neurological outcomes after surgery for IMSCTs.


Assuntos
Astrocitoma , Ependimoma , Hemangioblastoma , Neoplasias da Medula Espinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Astrocitoma/cirurgia , Ependimoma/cirurgia , Hemangioblastoma/complicações , Hemangioblastoma/diagnóstico por imagem , Hemangioblastoma/cirurgia , Humanos , Pessoa de Meia-Idade , Dor , Prognóstico , Estudos Retrospectivos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento , Adulto Jovem
19.
Neurosurg Rev ; 45(5): 3109-3118, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35896917

RESUMO

The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) increased the treatment spectrum of neuroendoscopy. This review aimed to present a systematic overview of the extent of resection, lesion characteristics, technical aspects, complications, and clinical outcomes related to using the NUA. Articles were identified by searching the PubMed/Medline, Embase, and Web of Science database through June 2022 with restriction to the last 20 years. We included case series, case reports, clinical trials, controlled clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews written in English. Studies reporting on endonasal approach or hematoma evacuation using the NUA were excluded. The references of the identified studies were reviewed as well. Nine full-text articles were included in the analysis, with a total of 40 patients who underwent surgery for a brain tumor using NUA. The most common underlying pathology treated by NUA was colloid cyst (17.5%), pilocytic astrocytoma (12.5%), subependymal giant cell astrocytoma (7.5%), subependymoma (7.5%), and craniopharyngioma (7.5%). Complete or near-total resection was achieved in 62.5%. The most frequently reported postoperative complication was secondary hydrocephalus (10%), meningitis/-encephalitis (7.5%), cognitive impairment (7.5%), and subdural hygroma (7.5%). In one case (2.5%), surgery-related death occurred due to a severe course of meningoencephalitis. According to the preliminary data, NUA seems to be a safe and efficient minimally invasive alternative to conventional microscopic resection of brain tumors. Further studies to investigate advantages and disadvantages of using the NUA are needed.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Cistos Coloides , Neuroendoscopia , Neoplasias Hipofisárias , Astrocitoma/cirurgia , Encéfalo , Neoplasias Encefálicas/cirurgia , Cistos Coloides/cirurgia , Humanos , Neoplasias Hipofisárias/cirurgia , Ultrassom
20.
World Neurosurg ; 165: 18-19, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35718276

RESUMO

A 25-year-old male presented with headaches 3 weeks after a car accident. His magnetic resonance imaging images showed a hemorrhagic vermis mass with fourth ventricle effacement. One month later, he underwent suboccipital craniotomy for removal of a pilocytic astrocytoma. A 3-month postoperative scan demonstrated a new area of medullary hyperintensity in the inferior olive, which was also present 7 months postoperatively consistent with hypertrophic olivary degeneration. This condition is caused by disruption to the dento-rubro-olivary pathway with magnetic resonance imaging enlargement of the inferior olivary nucleus and increased T2 signal. Hypertrophic olivary degeneration should be considered after cerebellar surgery and should not be mistaken for tumor recurrence.


Assuntos
Astrocitoma , Recidiva Local de Neoplasia , Adulto , Astrocitoma/complicações , Astrocitoma/diagnóstico por imagem , Astrocitoma/cirurgia , Núcleos Cerebelares/patologia , Humanos , Hipertrofia/etiologia , Hipertrofia/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Recidiva Local de Neoplasia/patologia , Núcleo Olivar/diagnóstico por imagem , Núcleo Olivar/patologia
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