Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 529
Filtrar
1.
World Neurosurg ; 136: 146-149, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954897

RESUMO

BACKGROUND: Intramedullary spinal cord cysts are benign, rare, fluid-filled lesions that can present anywhere along the craniospinal axis. However, when present at the level of the ventriculus terminalis, conus medullaris syndrome may occur. Radical resection of the cyst wall and evacuation of the cyst content are the 2 surgical procedures of choice. CASE DESCRIPTION: We present the case of a 54-year-old woman with a long-lasting history of left lower-extremity weakness and recent onset of bladder dysfunction. On further assessment, magnetic resonance imaging of the thoracic and lumbar spine showed a T10-L3 intramedullary cystic lesion. Surgical fenestration of the cyst was rendered, but no biopsy was taken due to the highly functional tissue along the full extension of lesion. CONCLUSIONS: Cystic lesions of the ventriculus terminalis are rare entities with a common presentation of severe, progressive neurologic impairment. Our case matches the classic presentation of conus medullaris syndrome. We describe and demonstrate through an operative video novel surgical techniques used to achieve successful fenestration of the cyst wall with remarkable neurologic symptom improvement. Moreover, the present case does not correlate with the classic radiographic characteristics available in current literature, such as involvement of 5 spinal segments.


Assuntos
Cistos do Sistema Nervoso Central/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/diagnóstico por imagem , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/cirurgia , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
2.
World Neurosurg ; 133: 80-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574329

RESUMO

BACKGROUND: Bobble-head doll syndrome is a rare neurological syndrome presenting with repetitive anteroposterior head movements. It is usually associated with expansile cystic lesions in the third ventricular region. CASE DESCRIPTION: An 8-year-old boy presented with involuntary bobbling head movements. Magnetic resonance imaging of the brain revealed an extensive suprasellar cyst resulting in obstructive hydrocephalus. Endoscopic ventriculo-cysto-cisternostomy resulted in improved clinical outcome. CONCLUSIONS: Endoscopic ventriculo-cysto-cisternostomy is an effective, less-invasive technique in the treatment of suprasellar cysts that results in resolution of the bobbling head movements.


Assuntos
Cistos Aracnóideos/etiologia , Cistos do Sistema Nervoso Central/complicações , Discinesias/etiologia , Hidrocefalia/etiologia , Terceiro Ventrículo/anormalidades , Ventriculostomia/métodos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/cirurgia , Criança , Discinesias/diagnóstico por imagem , Discinesias/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Masculino , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do Tratamento
3.
World Neurosurg ; 133: e218-e224, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493609

RESUMO

OBJECTIVE: Delayed postoperative hemorrhage (DPOH) was a severe postoperative complication after intracranial epidermoid cyst (EC) surgery. This study was designed to investigate possible clinical data and image features related to DPOH in patients with EC. METHODS: We retrospectively investigated 186 cases of EC, and 8 cases presented an appearance of DPOH. Preoperative magnetic resonance imaging (MRI) and clinical data (age, sex, chief surgeon, tumor size, tumor location, and degree of resection) were reviewed and analyzed. The Student t test and the χ2 test were used, and statistical significance was defined as P < 0.05. RESULTS: A total of 8 patients suffered from DPOH. Seven patients (87.5%) with DPOH showed atypical mixed signal intensity on preoperative T1 MRI compared with typical low intensity in another DPOH case. Only 1 case of mixed signal intensity on T1 MRI was found in 178 patients without DPOH. The mixed signal intensity on preoperative T1 MRI was highly related to DPOH and mortality (both P < 0.001). There was no significant difference in other relative clinical data between patients with or without DPOH. CONCLUSIONS: Mixed signal intensity on preoperative T1 MRI might be associated with DPOH in patients with EC. The surgeon should pay more attention to this rarely atypical imaging before surgery. Further observations are necessary to illustrate the relationship between mixed signal intensity and DPOH in EC and to guide reasonable therapy.


Assuntos
Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cisto Epidérmico/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Hemorragia Pós-Operatória/etiologia , Adolescente , Adulto , Idoso , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/cirurgia , Cisto Epidérmico/complicações , Cisto Epidérmico/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
World Neurosurg ; 133: e241-e251, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505289

RESUMO

BACKGROUND: Cystic sellar masses (CSMs) pose diagnostic and therapeutic challenges associated with subtotal cyst wall resection, cerebrospinal fluid (CSF) leak repair, and disease recurrence. Current magnetic resonance imaging (MRI) interpretation often cannot reliably differentiate CSMs, mandating adaptable intraoperative strategies. We reviewed our diagnostic and therapeutic experience after endoscopic endonasal approaches (EEAs) for CSMs. METHODS: A retrospective record review of patients with CSM managed via EEA at the University of Southern California from 2011 to 2018 was conducted. Patient demographics, preoperative characteristics, surgical details, pathologic findings, and postoperative outcomes were assessed. RESULTS: Analysis included 47 patients (mean age, 43.2 years); of these, 78.7% were women. Preoperative symptoms included headache (76.6%) and vision loss (42.6%). Histologically verified sellar pathology included 27 Rathke cleft cysts (RCCs) (57.4%), 17 cystic pituitary adenomas (CPAs) (36.2%), 2 arachnoid cysts (4.3%), and 1 xanthogranuloma (2.1%). Twelve patients (70.6%) with CPAs underwent complete resection and 5 (29.4%) underwent subtotal resection. All 27 patients with RCC and 2 patients with arachnoid cyst underwent complete fenestration and drainage. One xanthogranuloma was completely resected. There were 14 intraoperative (29.8%) and 4 postoperative CSF leaks (8.5%). Headaches, vision, and endocrinopathy improved in 69.2%, 80.0%, and 33.3% of patients with CPA and 73.9%, 71.4%, and 40.9% of patients with RCC, respectively. There were 2 RCC recurrences and 1 CPA recurrence over the follow-up period. CONCLUSIONS: Surgeons must prepare for versatile management strategies of CSMs based on pretest probability associated with MRI and intraoperative findings. Outcomes after EEA for CSMs show low complication profiles and excellent rates of headache and visual improvement, albeit lower rates of endocrine normalization.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroimagem/métodos , Sela Túrcica , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Drenagem , Fadiga/etiologia , Feminino , Cefaleia/etiologia , Humanos , Hipopituitarismo/etiologia , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/cirurgia , Transtornos da Visão/etiologia , Xantomatose/complicações , Xantomatose/diagnóstico , Xantomatose/diagnóstico por imagem , Xantomatose/cirurgia
5.
World Neurosurg ; 135: 228-232, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863895

RESUMO

BACKGROUND: Tension pneumoventricle is an extremely rare, but treatable, neurosurgical emergency. The prompt and accurate diagnosis of tension pneumoventricle requires vigilance for the detection of clinical signs, which should also be corroborated by the imaging findings. We have reported on the pathophysiology of tension pneumoventricle and its management. CASE DESCRIPTION: A 66-year-old woman had presented with a Rathke cleft cyst. The patient underwent transsphenoidal surgery (TSS), with no clinical cerebrospinal fluid leakage observed peri- or postoperatively. However, she developed an altered mental status 8 hours after surgery, and a computed tomography scan showed evidence of a tension pneumoventricle. The patient underwent emergent external ventricular drainage insertion and exploratory endoscopic TSS. A 1-way valve was observed during TSS, and the sella floor was packed with a fat graft for 1-way valve obliteration. The patient recovered well without neurologic deficits. No radiologic regrowth was noted at the 48-month follow-up examination. CONCLUSIONS: Tension pneumoventricle is an extremely rare, but life-threatening, complication of TSS. The development of tension pneumoventricle should be kept in mind even when the surgery has proceeded very smoothly. Sellar reconstruction will, theoretically, prevent this extremely rare complication but might increase the recurrence rate of Rathke cleft cysts. The related symptoms and signs should be recognized. Prompt recognition and treatment of this condition can be life-saving, and the long-term outcomes have generally been favorable if the condition has been recognized early.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Ventrículos Cerebrais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neuroendoscopia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/cirurgia , Sela Túrcica/cirurgia , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Imagem por Ressonância Magnética , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide , Tomografia Computadorizada por Raios X , Ventriculostomia
6.
World Neurosurg ; 132: e208-e216, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493602

RESUMO

BACKGROUND: The purpose of this study was to evaluate the preoperative clinical data and postoperative endocrinologic improvement, recurrence, and complications of Rathke's cleft cysts (RCCs) in a large series of endoscopic transsphenoidal surgery patients, operated in a single center. METHODS: Between 1997 and April 2018, 84 patients underwent endoscopic transsphenoidal surgery for RCCs. The presentation symptoms, endocrinologic results by localization and content of the cysts, surgical resections, postoperative complications, and recurrences were evaluated retrospectively. RESULTS: Chronic headache was reported in 66.6% (56/84), visual field defects were present in 20.2% (17/84), and 23.8% (20/84) of the cases had pituitary dysfunction. Among the endocrinopathies, 17 of 17 patients had hyperprolactinemia, 2 of 7 patients had cortisol deficiency, and 2 of 13 had hypogonadism, which resolved after surgery. Preoperative pituitary hormone deficiency was associated with gelatinous tumor content (P = 0.044). However, there was no significant relationship between tumor localization and preoperative hormone insufficiency. Postoperative hypocortisolemia was seen more frequently in intrasellar RCCs (P = 0.048). Three new pituitary hormonal deficiencies were identified in postoperative patients (1 hypocortisolism, 1 diabetes insipidus, 1 hypogonadism). Gross total resection was achieved in 20 cases (23.8%), 9 of which were performed using an extended approach. Postoperative complications included 3 cerebrospinal fluid leakages and 1 epistaxis. Two patients presented with cyst recurrence at follow-up at 12 and 26 months. CONCLUSIONS: Preoperative hormone deficiency was found to be associated with tumor content, independent of size or localization. The surgical aim for symptomatic RCCs should be decompression and this is effective for endocrinologic improvement. An extended endoscopic approach was adequate for total cyst wall removal in suprasellar cysts. Endoscopic transsphenoidal surgery was successful, with low complication rates, for decompression of intrasellar and suprasellar cysts in both complete cyst wall resection and cyst fenestration.


Assuntos
Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Neuroendoscopia/métodos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
World Neurosurg ; 132: e654-e664, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442641

RESUMO

OBJECTIVE: Posterior fossa cystic malformations are diversely classified with considerable overlap without therapeutic relevance. These cysts posterior to the cerebellum, presenting in children younger than 5 years, are labeled developmental retrocerebellar cysts (DRCCs) under a new classification in relation to neuroendoscopy. METHODS: DRCC was categorized as type 0 for asymptomatic enlarged cistern magna and was not treated. Among symptomatic cases, cysts with a compressed fourth ventricle were labeled type 1, whereas cysts in continuity with the fourth ventricle were termed type 2. They were further categorized as subtype B if hydrocephalus was greater relative to the cyst, or otherwise as subtype A. The literature was reviewed according to PRISMA guidelines. RESULTS: There were 13 children aged 3-48 months. Type 1A DRCC was noted in 5 patients, with onset before 6 months, 4 of whom (80%) had intracranial hypertension. All underwent suboccipital endoscopic deroofing and cisternostomy (SEDC), a new technique. Type 1B DRCC was seen in 2 patients, with onset at 8-9 months, who underwent endoscopic third ventriculostomy (ETV) + endoscopic ventriculocystostomy (EVC). Type 2A DRCC was observed in 4 patients, with onset at 5-47 months, who underwent SEDC. Type 2B DRCC was noted in 2 patients, with onset 6-8 months, who underwent ETV. With a mean follow-up of 32 months, all showed clinicoradiologic improvement. The application of our classification to other studies showed ETV/EVC to be successful in only 67% of type 1A DRCC and 72% of type 2A DRCC, compared with 100% efficacy of SEDC in our series. CONCLUSIONS: This is probably the first ever endoscopic classification of pediatric posterior fossa cyts, elucidating pathophysiology, presentation, and treatment. Patients with type 1 DRCC present early because of extraneous compression. Among patients with type 2 DRCC, posterior fossa compliance determines the degree of hydrocephalus. The newly described SEDC seems more appropriate for types 1A and 2A DRCC. ETV is adequate in type 2B DRCC and effective with EVC in type 1B.


Assuntos
Cistos do Sistema Nervoso Central/classificação , Malformações do Sistema Nervoso/classificação , Cistos do Sistema Nervoso Central/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Malformações do Sistema Nervoso/cirurgia , Neuroendoscopia
8.
J Clin Neurosci ; 67: 226-230, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31281086

RESUMO

Benign intracranial cystic lesions of the thalamus are an uncommon clinical entity rarely requiring operative decompression. In combination with cyst fenestration, cerebrospinal fluid (CSF) flow diversion or fenestrated stent placement may be performed at the time of surgery. We describe a method of treatment of these cysts using endoscopic cyst fenestration with fenestrated transventricular stent placement. Three patients with benign cystic lesions were treated with stereotactic-guided, endoscopic fenestration and fenestrated stent placement. All 3 had radiographic and clinical improvement. There were no complications. Endoscopic fenestration and transventricular fenestrated stent placement is a minimally invasive, effective, and safe method to decompress benign, symptomatic cystic lesions of the thalamus.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Neuroendoscopia/métodos , Técnicas Estereotáxicas , Tálamo/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
9.
BMJ Case Rep ; 12(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31320371

RESUMO

We report the first clinical case on the successful use of proton beam therapy in the management of malignant transformation of intracranial epidermoid cyst. A 43-year-old man was initially diagnosed as this disease with left facial paresis, hypesthesia and hypoalgesia in the territories of the trigeminal nerve. After failure of surgical interventions, he was referred to our radiation centre. We performed a postoperative proton beam therapy for treatment. We delivered a total dose of 57 GyE in 31 fractions. He tolerated the treatment well with mild acute toxicities and remained healthy and functional by 2-year follow-up postradiotherapy. No evidence of delayed radiation-induced neurotoxicity was observed.


Assuntos
Cistos do Sistema Nervoso Central/radioterapia , Neoplasias Cerebelares/radioterapia , Cisto Epidérmico/radioterapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Adulto , Transformação Celular Neoplásica , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos , Terapia com Prótons , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
10.
World Neurosurg ; 129: e530-e537, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154104

RESUMO

BACKGROUND: Surgical indications for patients with pineal cysts are controversial. There are absolute indications such as hydrocephalus or tectal compression; otherwise, it is difficult to decide whether surgery would be beneficial when symptoms are not distinct. OBJECTIVE: We tried to clarify the indications and clinical course of patients after resection of pineal cysts without ventriculomegaly. METHODS: We reviewed our database for all patients operated on for pineal cyst without ventriculomegaly from 2003 to 2018. We studied the presenting symptoms, cyst size, surgical approach, extent of resection, and clinical and radiologic follow-up. Follow-up ranged from 3 months to 14 years (mean 3.74 years). RESULTS: Forty-three patients underwent surgery for pineal cyst in absence of ventriculomegaly; 36 female patients, 7 male patients, mean age 25.63 years (±10.62 years, range 4-52 years). Presenting symptoms included headache (41/43), nausea and vomiting (31/43), dizziness (19/43), visual disturbances (10/43), and sleep disturbances (8/43). Mean cyst size was 15.7 mm (±4.9 mm, range 9-27 mm). In total, 41 of 43 patients reported a good outcome, represented by a Chicago Chiari Outcome Scale score of 11 or greater and only 2 of 43 patients reported a bad outcome, defined by Chicago Chiari Outcome Scale score of 10 or less. CONCLUSIONS: We suggest that pineal cysts without ventriculomegaly are an indication for surgery when patients present with headache and/or visual disturbances and other causes have been excluded. Resolution of symptoms and quality of life in our cohort may denote a good indication for resection. However, we must admit that there is still no evidence to recommend this technique as a treatment of headache in these patients.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Glândula Pineal/cirurgia , Adolescente , Adulto , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Criança , Pré-Escolar , Tontura/diagnóstico por imagem , Tontura/etiologia , Tontura/cirurgia , Feminino , Cefaleia/diagnóstico por imagem , Cefaleia/etiologia , Cefaleia/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Pineal/diagnóstico por imagem , Período Pós-Operatório , Resultado do Tratamento , Adulto Jovem
11.
World Neurosurg ; 129: 359-362, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254712

RESUMO

BACKGROUND: Intraspinal degenerative cysts in the cervical region are rare disorders that may cause myelopathy or radiculopathy. Most of the intraspinal degenerative cysts reported are extradural cysts. This case report includes the neuroimaging, intraoperative, pathologic, and postoperative findings obtained in a patient with a degenerative intradural cyst at the craniovertebral (CV) junction. CASE DESCRIPTION: We report a patient presenting with progressive spastic quadriparesis resulting from compressive myelopathy due to intradural degenerative cyst at the CV junction. Preoperative magnetic resonance imaging showed the intradural cyst at the cervicomedullary junction with degenerative changes causing myelopathy. We performed decompression of the CV junction, and histopathology of the cyst revealed degenerative cyst. Postoperatively the symptoms were relieved with no apparent complication. Intraspinal degenerative cysts causing compressive myelopathy are rare. To the best of our knowledge, this is the first case of intradural degenerative cyst at the CV junction. CONCLUSIONS: In this case report, we demonstrated the clinical, imaging, intraoperative, and pathologic features of a degenerative intraspinal cyst at the CV junction that was intradural in location. Compression of the spinal cord resulted in a gradually progressive myelopathy that showed remarkable improvement immediately after decompression by cystectomy.


Assuntos
Articulação Atlantoccipital/patologia , Cistos do Sistema Nervoso Central/patologia , Compressão da Medula Espinal/etiologia , Idoso , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/cirurgia , Humanos , Masculino , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/patologia
12.
No Shinkei Geka ; 47(6): 637-645, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31235666

RESUMO

PURPOSE: We describe a surgical case of aseptic meningitis and secondary hypophysitis due to rupture of a Rathke's cleft cyst(RCC)and report on literature considerations. CASE: A 36-year-old woman with a past history of menstrual irregularity who had been taking a low-dose contraceptive for five years visited our hospital. She had discomfort in her right eye four years earlier. A waxy nodule observed on MRI was diagnosed to be an asymptomatic RCC. She experienced periodic headaches and retrobulbar pain without any prior history. MRI showed dural thickening on gadolinium-T1-weighted(GdT1)imaging, disappearance of the waxy nodule on T1/T2-weighted imaging, signal change of the cyst contents, and suspected cerebrospinal fluid in the pre-pontine cistern. Aseptic meningitis or hemorrhagic adenoma due to RCC rupture was suspected, and endoscopic transsphenoidal surgery was performed on day 26. The pathological results indicated that the ruptured RCC had resulted in aseptic meningitis and secondary hypophysitis. CONCLUSION: If the rupture of an RCC is suspected and subsequent secondary hypophysitis and optic neuritis are observed, early diagnosis and surgery with informed consent are essential. This is because of the high risk for panhypopituitarism with vision loss and visual field disturbance.


Assuntos
Cistos do Sistema Nervoso Central , Hipofisite , Hipopituitarismo , Meningite Asséptica , Adulto , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/cirurgia , Feminino , Humanos , Hipofisite/etiologia , Hipopituitarismo/etiologia , Imagem por Ressonância Magnética , Meningite Asséptica/etiologia , Ruptura Espontânea
13.
World Neurosurg ; 128: 501-505, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077896

RESUMO

BACKGROUND: Chiari malformation results from a bony structural anomaly of the skull base. The structural defect causes downward displacement of the cerebellar tonsils through the foramen magnum. The herniated tonsils block the normal flow of cerebrospinal fluid, which causes a wide spectrum of clinical symptoms. CASE REPORT: In May 2015, a 16-year-old girl was referred to our center because of a 1-year history of occipital headache, most often triggered by exercise and physical activity at school. She had experienced new-onset numbness in both hands, more severe on the right side, associated with some degrees of weakness. Eventually, an evaluation of her condition included magnetic resonance imaging in T1 and T2 sequences, which revealed a 20-mm downward migration of the cerebellar tonsils, associated with a cervical cord syrinx at the level of the fourth and fifth cervical vertebrae. The patient underwent posterior fossa decompression and C1 and partial C2 laminectomies. Postoperatively there were no complications, and the patient was discharged on day 3. Postoperatively, she experienced some improvement in her symptoms. After 2 months of routine outpatient follow-up, she was better, the headaches had subsided, she could resume some activities, and there was no paresis in her limbs. CONCLUSIONS: In cases of progressive symptoms of Chiari malformation, surgical decompression is important and should be considered after shunt insertion to the hindbrain.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Cerebelo/cirurgia , Complicações Pós-Operatórias/cirurgia , Adolescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Siringomielia/complicações , Siringomielia/diagnóstico por imagem
14.
World Neurosurg ; 128: 514-526, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31121364

RESUMO

BACKGROUND: Suprasellar epidermoid cysts (SECs) constitute a large portion of so-called pearly tumors. Despite their insidious development and infiltration into vital neurovascular structures, they have a friable consistency, which particularly facilitates their resection; the only alternative to surgery is wait-and-see policy. We present a case of SEC in a patient with bitemporal hemianopia and no other significant symptoms and results of analysis of data on surgical treatment of 71 similar cases reported in the last 4 decades. CASE DESCRIPTION: A 29-year-old man presented with 1 year blurred vision. Bitemporal hemianopia was detected by perimetry. The patient was otherwise fit and well, with no significant past medical history. Magnetic resonance imaging showed an extra-axial suprasellar lesion with expansion toward the prepontine cistern, which showed restricted diffusion. The patient was operated on via a binostril endoscopic transtuberculum-transplanum endonasal approach. Pathologic examination confirmed the diagnosis of epidermoid cyst. The postoperative course was complicated by third cranial nerve palsy, rhinorrhea, which required reoperation, and diabetes insipidus. Otherwise, the patient made a good recovery and reported subjective improvement of visual acuity. Gradually, the left third cranial nerve function improved and there was neither any long-term complication nor recurrence on 6 months follow-up study. CONCLUSIONS: A suprasellar location frequently impedes the gross total resection of epidermoid cysts. Endoscopic endonasal approaches might be more effective in resection of lesions that do not extend laterally beyond the cranial nerves. The introduction of magnetic resonance imaging and surgical endoscopy were fundamental achievements in SEC management. There is a constant need for quality case reports on the management of these intracranial tumors.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Cisto Epidérmico/cirurgia , Neuroendoscopia/métodos , Adulto , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Rinorreia de Líquido Cefalorraquidiano , Diabetes Insípido , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Hemianopsia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Cirurgia Endoscópica por Orifício Natural , Doenças do Nervo Oculomotor , Complicações Pós-Operatórias , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/cirurgia
15.
Laryngoscope ; 129(10): 2258-2261, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31038765

RESUMO

OBJECTIVES: Rathke cleft cysts (RCCs) are rare, benign lesions formed from remnants of Rathke pouch during embryologic development. However, following marsupialization, maintaining tract patency remains a challenge. Several techniques for decreasing stenosis have been described, including free mucosal grafting, silastic spacing, and using steroid-eluting stents. Nasoseptal flaps (NSFs) have a reliable vascular supply and are widely utilized in skull base reconstruction. We present a novel technique to maintain patency of the marsupialized RCC cavity by lining it with an NSF to promote long-term drainage and re-epithelialization of the RCC cavity. METHODS: Retrospective chart review of all patients who underwent surgery for symptomatic RCCs. These patients underwent endoscopic endonasal surgery between February 3, 2016, and June 12, 2018, with marsupialization followed by circumferential NSF lining. Primary outcomes include symptomatic control, surgical complications, and RCC cavity patency. RESULTS: Seven patients underwent RCC marsupialization with no intraoperative cerebrospinal fluid leak, followed by circumferential lining of the marsupialized cavity with an NSF. In each case, no cyst re-accumulation or recurrent symptoms were noted, and the NSF lining provided long-term patency of the tract in all cases to a mean of 6.7 ± 10.1 months of follow-up, including one patient with sustained patency at 29 months follow-up. CONCLUSION: Utilization of the NSF to "stent open" the RCC cavity following marsupialization is a safe and effective means to prevent restenosis. Advantages include sustained patency of RCC cavity for complete drainage and a dependable vascular supply. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2258-2261, 2019.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Septo Nasal/transplante , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Retalhos Cirúrgicos/transplante , Adolescente , Adulto , Idoso , Cistos do Sistema Nervoso Central/patologia , Constrição Patológica/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Neoplasias da Base do Crânio/patologia , Resultado do Tratamento , Adulto Jovem
16.
World Neurosurg ; 128: 408-414, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31108250

RESUMO

BACKGROUND: The benefit of prophylactic antibiotic use in endoscopic endonasal transsphenoidal surgery (EETS) for pituitary lesions is controversial. Many surgeons administer antibiotics perioperatively not based on clear guidelines but to be safe. The purpose of this study was to determine if antibiotic prophylaxis use reduces the risk of infection (e.g., meningitis, sinusitis) within 30 days after the surgery in adult patients with pituitary lesions undergoing EETS. METHODS: A systematic review was performed to assess the effectiveness of perioperative antibiotic use in preventing infectious complications in patients undergoing EETS. Data sources included Ovid Databases, Scopus, PubMed, Cochrane Library, and Grey Literature. The inclusion criteria were randomized controlled trials, systematic reviews, observational studies, and case series of prophylactic antibiotic perioperative use for EETS. The study end points were the rates of meningitis and sinusitis as infectious complications after EETS. RESULTS: A total of 282 articles were identified by the initial literature search. Four studies met the inclusion criteria: 3 retrospective cohort and 1 prospective case series studies. All patients included in each study received different antibiotic regimens perioperatively. The quality of studies did not permit performance of a meta-analysis. CONCLUSIONS: Even though there are no clear practice guidelines regarding the antibiotic prophylaxis need in EETS, various antibiotic regimens have been used by surgeons. Our systematic review identified a limited number of published studies assessing this question, all observational. Randomized controlled trials are needed to evaluate the effectiveness of prophylactic antibiotic use in patients with pituitary lesions undergoing EETS.


Assuntos
Antibioticoprofilaxia/métodos , Neuroendoscopia/métodos , Doenças da Hipófise/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Adenoma/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Humanos , Meningite/prevenção & controle , Cirurgia Endoscópica por Orifício Natural , Neoplasias Hipofisárias/cirurgia , Sinusite/prevenção & controle
17.
Pituitary ; 22(4): 362-371, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31016554

RESUMO

BACKGROUND: Rathke's cleft cysts (RCCs) are common sellar lesions. Their management remains controversial, particularly when small or asymptomatic. Herein we review a consecutive series of RCC patients managed with surgery or observation. METHODS: All patients with a new diagnosis of presumed RCC, based on MRI, from February 2012-March 2018 were retrospectively divided into observational and surgical cohorts based on an intent-to-treat model. The cohorts were compared for clinical presentation, and cyst volume. The observational cohort was followed for change in cyst size. The surgical cohort was followed for changes in endocrinopathy, visual symptoms, headache and recurrence. RESULTS: Of 90 patients (mean age 36.7 ± 19.4 years; 68% female), 60% (n = 54) were in the observational cohort and 40% (n = 36) in the surgical cohort. Average follow-up was 13 ± 23 months in the observational cohort and 24 ± 19 months in the surgical group. In comparing the cohorts, mean ages were similar with more women in the surgical group (81% vs. 56%, p = 0.04). Most patients in the observational cohort had incidentally-discovered RCCs (n = 50, 88%) as opposed to the surgical cohort (n = 6, 17%). The surgical cohort had higher rates of headache (89% vs 26%, p < 0.001), endocrinopathy (36% vs 0%, p < 0.001), and visual dysfunction (19% vs 0%, p = 0.001). Mean cyst volume and maximal cyst dimensions were greater in the surgical cohort (0.94 ± 0.77 cm3 and 14.2 ± 4.1 mm), compared to the observational cohort (0.1 ± 0.14 cm3 and 6.4 ± 3 mm), (p < 0.001). Among the 53% (n = 30/54) of patients in the observational group with follow-up, 3 (10%) had spontaneous RCC shrinkage, 1 (3%) had modest asymptomatic growth (at 10 months from initial MRI), and 87% had stable cyst size. Of the 36 patients recommended to have surgery, 89% (n = 32) did so. Post-operatively, complete or partial resolution of headache, endocrinopathy and visual dysfunction were documented in 90% (n = 28/30), 75% (n = 10/12), and 100% (n = 7/7), respectively. On follow-up MRI, 8 (22%) patients had some cyst reaccumulation, of whom 3 (8%) were symptomatic and underwent uneventful reoperation. No major complications such as hematoma, CSF leak, new endocrinopathy or visual deficits occurred. CONCLUSION: From this consecutive series, a majority (60%) of RCCs do not appear to warrant surgical intervention and have a low risk of cyst progression. However, surgical cyst removal appears to be indicated and safe for patients with larger, symptomatic RCCs. Simple cyst drainage has a high rate of improvement in pituitary gland function, visual function and headache resolution with low complication rates and symptomatic recurrence risk. These findings stress the importance of careful case selection and potential utility of volumetric assessment for patients with RCCs.


Assuntos
Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Adulto , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/fisiologia , Estudos Retrospectivos , Adulto Jovem
18.
World Neurosurg ; 126: e921-e929, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30872194

RESUMO

BACKGROUND: Rathke cleft cysts (RCCs) arise from the remnant of Rathke pouch and are usually found in the intermediate lobe. In most cases, RCCs remain intrasellar and extend into the suprasellar region. Rarely, they emerge entirely into the suprasellar cistern-entirely suprasellar Rathke cleft cyst (ESSRCC). METHODS: We retrospectively reviewed medical records of 7 patients (5.5%) with ESSRCC among 128 patients with a diagnosis of RCC from January 1994 to September 2018. Of RCC cases, 70 were treated surgically. Patient age and sex, symptoms, magnetic resonance imaging findings, cyst diameter, presence of preoperative or postoperative hypopituitarism, operative procedures and complications, and functional outcomes at the final follow-up were investigated. RESULTS: All patients with ESSRCC were women with mean age 45.7 years (range, 29-69 years) at diagnosis. All patients experienced headache, mainly in the retro-orbital region. Mean ESSRCC diameter was 9.9 mm (range, 6-14 mm). Most cases exhibited hyperintensity on both T1-weighted and T2-weighted imaging. The endoscopic endonasal transtuberculum sellae approach relieved headache effectively and safely in 5 patients. Postoperative endocrinologic functions were almost entirely preserved. No patient experienced recurrence during the follow-up period. CONCLUSIONS: RCCs should be considered in the differential diagnosis of suprasellar cysts. The endoscopic endonasal transtuberculum sellae approach has an advantage in visualizing these lesions owing to the direction of light from the endoscope. Headache could be treated effectively with the endoscopic endonasal transtuberculum sellae approach without recurrence of cysts or pituitary dysfunction.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Hipopituitarismo/cirurgia , Neuroendoscopia/métodos , Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Adulto , Idoso , Cistos do Sistema Nervoso Central/complicações , Feminino , Humanos , Hipopituitarismo/etiologia , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Estudos Retrospectivos , Resultado do Tratamento
19.
World Neurosurg ; 126: 570-575, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30862574

RESUMO

BACKGROUND: Acromegaly caused by Rathke cleft cyst (RCC) mimicking a plurihormonal pituitary adenoma (PA) is rare. CASE DESCRIPTION: We report a 71-year-old woman who presented with hyperhidrosis in 2013. Magnetic resonance imaging performed in April 2018 revealed that the patient had a pituitary tumor, and she was referred to our hospital. She presented with an acromegaly-like appearance with mild hypertrophy at her limb extremities. Preoperative blood tests, magnetic resonance imaging, and an endocrine tolerance test indicated that the patient's symptoms satisfied the diagnostic criteria for acromegaly, with a suspected diagnosis of an RCC and growth hormone (GH)-producing PA. Endoscopic transsphenoidal surgery (eTSS) was performed. Permanent pathologic diagnosis showed an RCC mimicking a plurihormonal PA, which was confirmed via immunohistochemistry. Blood sampling 2 months post surgery showed reduced GH (0.41 ng/mL) and increased insulin-like growth factor-1 (IGF-1) (356 ng/mL) levels. In addition, a postoperative endocrine tolerance test revealed a parasitic reaction of GH and secondary adrenocortical hypofunction. No RCC recurrence was found, and the GH (0.32 ng/mL) and previously increased IGF-1 (169 ng/mL) levels were normalized 12 months after eTSS. CONCLUSIONS: We reported a rare case of acromegaly caused by RCC mimicking a plurihormonal PA. This case suggests that inflammation associated with RCC might be involved in the development of adenomatous cells. Postoperative clinical symptoms and elevated fibrinogen and IGF-1 levels later improved. This outcome suggested that the transient increase in IGF-1 2 months after surgery might reflect RCC-induced inflammation.


Assuntos
Acromegalia/etiologia , Cistos do Sistema Nervoso Central/complicações , Hormônios Hipofisários/sangue , Neoplasias Hipofisárias/diagnóstico , Acromegalia/sangue , Adenoma/diagnóstico , Idoso , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Técnicas de Diagnóstico Endócrino , Feminino , Fibrinogênio/análise , Humanos , Hiperidrose/etiologia , Hipofisectomia/métodos , Inflamação , Imagem por Ressonância Magnética , Neuroimagem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Tomografia Computadorizada por Raios X
20.
World Neurosurg ; 126: 484-490, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30922906

RESUMO

BACKGROUND: von Hippel-Lindau disease-related hemangioblastoma is likely to occur in the cerebellum and accompany a cyst. As multiple hemangioblastomas commonly occur in von Hippel-Lindau disease, and multiple surgeries may thus be necessary, a minimally invasive surgical strategy is of great importance. METHODS: We present 2 patients with von Hippel-Lindau disease-related hemangioblastomas successfully treated by a fully endoscopic transcranial approach via a short skin incision and a 2 cm × 2 cm small bony window. Before surgery, a three-dimensional virtual reality model was created to determine the ideal trajectory. RESULTS: Patient 1 had 2 serial large cystic tumors that equally contributed to obstructive hydrocephalus and were resected sequentially via a single endoscopic trajectory. Patient 2 had a progressive large cystic tumor that was resected endoscopically. Complete resection of the tumors was achieved without any complications in either patient. CONCLUSIONS: Small nodular tumors accompanying a large cyst are plausible candidates for endoscopic transcranial surgery. The spatial relationship of nodules, cyst, and cerebellar parenchyma is important to determine the applicability of the present technique. Preoperative three-dimensional virtual reality simulation helps assess the feasibility of this approach.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Neoplasias Cerebelares/cirurgia , Endoscopia/métodos , Hemangioblastoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doença de von Hippel-Lindau/complicações , Adulto , Cistos do Sistema Nervoso Central/complicações , Neoplasias Cerebelares/complicações , Hemangioblastoma/complicações , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA