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1.
No Shinkei Geka ; 50(6): 1301-1313, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36426530

RESUMO

Posterior fossa tumors tend to entail obstructive hydrocephalus, and urges initiating prompt treatment. Prevalent pathologies include medulloblastoma, ependymoma, pilocytic astrocytoma, and atypical teratoid/rhabdoid tumor(AT/RT). In most cases, maximal safe resection is related to better prognosis. In some cases of ependymoma and AT/RT with high vascularity, second-look surgery with neoadjuvant chemotherapy is effective. The treatment strategy should be tailored according to each tumor.


Assuntos
Neoplasias do Sistema Nervoso Central , Neoplasias Cerebelares , Ependimoma , Neoplasias Infratentoriais , Tumor Rabdoide , Criança , Humanos , Neoplasias Infratentoriais/diagnóstico , Neoplasias Infratentoriais/cirurgia , Ependimoma/diagnóstico , Ependimoma/cirurgia
2.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-36252199

RESUMO

The authors report a patient with spinomedullary tumor who underwent resection with subsequent histological examination. However, the authors encountered difficulties in determining the exact histological type of neoplasm. Microscopic and immunohistochemical examination of spinomedullary neoplasm revealed two types of tumor: ependymoma and hemangioblastoma. However, analysis of literature data indicated that the identified tumor could be attributed to a certain cellular type of hemangioblastoma.


Assuntos
Ependimoma , Hemangioblastoma , Ependimoma/cirurgia , Hemangioblastoma/diagnóstico por imagem , Hemangioblastoma/cirurgia , Humanos
3.
Neurosurg Rev ; 45(6): 3771-3778, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36284077

RESUMO

Supratentorial extraventricular ependymoma (STEE) and supratentorial intraventricular ependymoma (STIE) are two subsets of supratentorial ependymoma (SE). These two subsets have similar gene features and only differ in original sites: STEE occurs in the brain parenchyma, and STIE is located in ventricles and surrounded by cerebral spinal fluid. The present study aims to depict the diversities of these two subsets and elucidate the potential effects of the anatomic site on the tumor with the same type, grade, and molecular features. Sixty-six consecutive adult SE patients from 2008 to 2021 were enrolled in our study. Clinical data, pathological features, and long-term outcomes were analyzed retrospectively. Results demonstrated that adult STEE presented with a higher proportion of WHO grade 3 (P = .028) and higher Ki-67 index (≥10%) (P = .019) compared to adult STIE. Survival analysis demonstrated that patients of grade 3 STEE exhibited a significantly longer overall survival (OS) than patients of grade 3 STIE (median OS, 24.4 months vs. 13.0 months; P = .004). Grade 2 (hazard ratio (HR) = 0.217; P < .001) and gross total resection (GTR) (HR = 0.156; P < .001) were identified as favorable prognostic factors for all adult SE. The STEE was also associated with a lesser hazard of death for patients of grade 3 on multivariate analysis (HR = 0.263; P = .047). These findings suggested that the extraventricular site was an indicator for higher grade and better prognosis in adult supratentorial ependymoma.


Assuntos
Ependimoma , Neoplasias Supratentoriais , Adulto , Humanos , Estudos Retrospectivos , Ependimoma/diagnóstico , Ependimoma/cirurgia , Neoplasias Supratentoriais/diagnóstico , Neoplasias Supratentoriais/cirurgia , Prognóstico
4.
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
5.
J Med Case Rep ; 16(1): 312, 2022 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-35986385

RESUMO

BACKGROUND: Dura-attached supratentorial extra-axial ependymoma is a very rare type of tumor, with only nine reported cases. Preoperative diagnosis of dura-attached supratentorial extra-axial ependymoma is difficult and often radiologically misdiagnosed as a meningioma. We report a case of dura-attached supratentorial extra-axial ependymoma that was misdiagnosed using intraoperative histological and cytological examinations. CASE PRESENTATION: A 26-year-old Japanese man with headache and nausea was referred to our medical facility. Magnetic resonance imaging revealed a cystic mass of 70 × 53 × 57 mm in the left temporoparietal lobe. A peritumoral band with hyperintensity on T2-weighted imaging was observed at the periphery of the lesion, suggesting an extra-axial lesion with no apparent connection to the ventricle. A dural tail sign was also noted on the gadolinium-enhanced T1-weighted image. Preoperative clinical diagnosis was meningioma. Proliferated tumor cells in sheets with intermingled branching vessels were observed in the frozen tissue. Perivascular rosettes were inconspicuous, and the tumor cells had rhabdoid cytoplasm. The tumor was intraoperatively diagnosed as a meningioma, suspected to be a rhabdoid meningioma. Perivascular rosettes were evident in the formalin-fixed paraffin-embedded tissues, suggesting ependymoma. The tumor cells had eosinophilic cytoplasm without a rhabdoid appearance. Anaplastic features, such as high tumor cellularity, increased mitotic activity, microvascular proliferation, and necrosis, were observed. Ependymal differentiation was confirmed on the basis of ultrastructural analysis. Molecular analysis detected C11orf95-RELA fusion gene. The final diagnosis was RELA fusion-positive ependymoma, World Health Organization grade III. CONCLUSION: Owing to its unusual location, dura-attached supratentorial extra-axial ependymomas are frequently misdiagnosed as meningiomas. Neuropathologists should take great precaution in intraoperatively diagnosing this rare subtype of ependymoma to avoid misdiagnosis of the lesion as other common dura-attached tumors.


Assuntos
Ependimoma , Neoplasias Meníngeas , Meningioma , Neoplasias Supratentoriais , Adulto , Erros de Diagnóstico , Ependimoma/diagnóstico , Ependimoma/patologia , Ependimoma/cirurgia , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico , Meningioma/cirurgia , Neoplasias Supratentoriais/diagnóstico , Neoplasias Supratentoriais/patologia , Neoplasias Supratentoriais/cirurgia , Fator de Transcrição RelA/genética
6.
Indian J Pathol Microbiol ; 65(3): 668-670, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35900497

RESUMO

Introduction: Ependymomas are more common in the pediatric population, in whom they are commonly infratentorial. Extra axial location of a supratentorial ependymoma is extremely rare. Diagnosis: Radiologically these tumors are often misdiagnosed as meningioma or other extra axial lesions owing to their unusual location and lack of any pathognomonic features. Hence, histopathological examination becomes imperative for proper evaluation and an adequate diagnosis. Case: Herein we report a case of a supratentorial extra axial anaplastic ependymoma misdiagnosed as a metastatic tumor on radiological examination and mimicking meningioma intra operatively, located in the frontal and temporal region in a 20 year old man.


Assuntos
Ependimoma , Neoplasias Meníngeas , Meningioma , Neoplasias Supratentoriais , Adulto , Criança , Ependimoma/diagnóstico , Ependimoma/cirurgia , Humanos , Masculino , Neoplasias Supratentoriais/diagnóstico , Neoplasias Supratentoriais/patologia , Neoplasias Supratentoriais/cirurgia , Adulto Jovem
7.
Neurol Res ; 44(9): 774-785, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35793265

RESUMO

BACKGROUND: Myxopapillary ependymomas (MPEs) possess leptomeningeal, neural axis dissemination, seeding metastases, and extra-neural spread which are malignant characteristics, even they classified low-grade lesions as WHO grade II. Managing such lesions remains an arguable neurosurgical challenge. The study aimed to discuss the management of MPEs by evaluating the long-term surgical outcomes of consecutively treated MPEs in different 3 neurosurgical centers. METHODS: Medical records of all diagnosed patients with spinal tumors at our institutions were reviewed retrospectively. This study included all consecutive MPE who underwent surgical intervention in our institutions in different periods between February 2004 and December 2020. RESULTS: A total of 44 patients with MPE were treated surgically in three institutions. 28 (63.6%) patients were males. Six patients were pediatric patients (≤18 years). The mean age was 36.2 years. The preoperative course was 19.2 months. The most common symptom was leg pain, observed in 35 (79.5%) patients. Gross-total resection was performed in 35 (79.5%) patients. 39 (88.7%) patients had good functional outcomes with an average follow-up period of 106.2 months. The progression was observed in 5 (11.4%) patients. Extending >2 segments, unclear boundaries, bone-erosions were associated with poor prognosis and progression. Laminectomy and surgical complications were associated with poor functional outcomes. En bloc resection without violation of lesions' integrities reduced the progression. CONCLUSIONS: Radiological, intraoperative, and surgical factors can affect the functional outcomes and the progression of MPEs. Some precautions in the surgical interventions particularly in MPEs with defined radiological features can improve functional outcomes and reduce the progression risk.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Adulto , Ependimoma/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
8.
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
10.
Clin Neurol Neurosurg ; 218: 107303, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35605508

RESUMO

Tanycytic ependymomas are a rare spinal cord tumour arising from tanycyte cells lining the ventricle or spinal central canal. This is the first report of familial spinal tanycytic ependymoma occurring in two first degree relatives. Both patients underwent surgical resection of the intra-medullary tumours with good overall recovery. Genetic analysis identified that the brothers shared a previously unreported mutation in the NF-2 gene. NF-2 mutations in spinal tanycytic ependymomas may be more common than initially thought and consideration should be given to screening the neural axis for other tumours and genetic counselling.


Assuntos
Neoplasias do Tronco Encefálico , Ependimoma , Neurofibromatose 2 , Neoplasias da Medula Espinal , Ependimoma/diagnóstico , Ependimoma/genética , Ependimoma/cirurgia , Humanos , Masculino , Mutação/genética , Neurofibromatose 2/complicações , Neurofibromatose 2/genética , Irmãos , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/genética , Neoplasias da Medula Espinal/cirurgia
11.
Anticancer Res ; 42(6): 3203-3207, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35641289

RESUMO

BACKGROUND/AIM: Extraventricular supratentorial ependymomas are rare entities. Most ependymomas are located at the infratentorial and intraventricular level, and only in a small group of cases they do not present continuity with the ventricular system. This is a case report of a patient with an atypical location of a cerebral ependymoma, which required the implementation of a complex and infrequent approach for its complete microsurgical removal. CASE REPORT: A 16-year-old male patient was referred at our department with a diagnosis of a 40 mm × 50 mm × 60 mm solid-cystic space-occupying lesion, sited between the left superior frontal-cingulate gyri. A contralateral transfalcine interhemispheric approach was selected, which achieved total resection of the tumor. The histopathological diagnosis of Grade II ependymoma was obtained according to WHO classification. CONCLUSION: The contralateral transfalcine interhemispheric approach represents a favorable surgical corridor to achieve a total resection of the tumor lesion and is favored by an adequate working angle and reduced brain manipulation.


Assuntos
Ependimoma , Neoplasias Supratentoriais , Adolescente , Ependimoma/cirurgia , Humanos , Masculino , Procedimentos Neurocirúrgicos , Encaminhamento e Consulta , Neoplasias Supratentoriais/patologia , Neoplasias Supratentoriais/cirurgia
13.
Spinal Cord Ser Cases ; 8(1): 43, 2022 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459220

RESUMO

INTRODUCTION: Spinal myxopapillary ependymomas (SME) are rare WHO grade II neoplasms of the spinal cord. Despite their good prognosis, they have a high propensity for metastasis and recurrence, although the presentation of SME as multifocal is uncommon. CASE PRESENTATION: Here we describe a rare case of a 34-year-old man who presented with painful bilateral radiculopathy with sexual dysfunction and altered sensation with defecation. The patient also reported worsening weakness of bilateral lower extremities when climbing stairs. Biopsy results revealed multifocal SME in the lumbar and sacral spine that was treated with staged surgical resection and post-operative focal radiation therapy. DISCUSSION: We discuss and evaluate surgical resection and the role of postoperative radiotherapy for SME. We also review the literature surrounding multifocal SME presenting in adults.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Adulto , Ependimoma/diagnóstico , Ependimoma/patologia , Ependimoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
14.
World Neurosurg ; 163: 38, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35413470

RESUMO

Ependymomas are rare primary tumors of the brain and spinal cord that arises from the ependymal cell layer. Cranial ependymomas commonly occur in the posterior fossa; however, approximately 30% of all tumors can be found in the supratentorial region. Supratentorial ependymomas have a shorter progression-free and overall survival than their infratentorial counterparts. We present the case of a 47-year-old man who presented with mild left-sided hemiparesis and confusion secondary to a right-sided 8.5 × 6.0 × 6.0 cm frontotemporal neoplasm encasing the ipsilateral internal and middle cerebral arteries. The patient had undergone a suboccipital craniectomy for resection of a posterior fossa ependymoma at 6 years of age (41 years ago). After multidisciplinary discussion, we performed a right frontotemporal craniotomy for tumor resection (Video) using intraoperative navigation, ultrasound, and intraoperative neurophysiological monitoring. While skeletonizing branches of the middle cerebral artery, an M3 branch was injured inadvertently and repaired immediately. Histopathologic specimens were consistent with ependymoma (World Health Organization grade II). A near-total resection was achieved. The patient developed a transient left-sided hemiparesis but improved to full strength on discharge from the hospital.


Assuntos
Ependimoma , Neoplasias Supratentoriais , Adulto , Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Paresia/etiologia , Paresia/cirurgia , Neoplasias Supratentoriais/diagnóstico por imagem , Neoplasias Supratentoriais/cirurgia
15.
Oper Neurosurg (Hagerstown) ; 22(5): e189-e197, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35426878

RESUMO

BACKGROUND: Despite the importance of complete, gross total resection (GTR) of fourth ventricular ependymomas, significant morbidity and/or subtotal resections are reported, particularly when the ventricular floor is infiltrated. Step-by-step technique descriptions are lacking in the literature. OBJECTIVE: To describe monitoring and stimulation mapping techniques and surgical nuances in the challenging subgroup of infiltrating fourth ventricular ependymomas by a highly illustrated, step-by-step description. Superimposed outlines of cranial nerve nuclei on the surgical field demonstrate critical anatomy and facilitate understanding in a way not previously presented. METHODS: We reviewed the microanatomical and neurophysiological prerequisites of resecting a diffusively infiltrating fourth ventricular ependymoma. RESULTS: We achieved GTR with the use of reproducible stimulating mapping and accurate cranial nerve nuclei identification. CONCLUSION: Enhanced microanatomical understanding, reproducible stimulation mapping, and meticulous resection techniques can result in GTR, even in diffusively infiltrating ependymomas.


Assuntos
Ependimoma , Procedimentos Neurocirúrgicos , Nervos Cranianos , Ependimoma/cirurgia , Quarto Ventrículo/cirurgia , Humanos , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento
16.
Neurol Med Chir (Tokyo) ; 62(6): 300-305, 2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35387944

RESUMO

Spinal intramedullary tumors such as ependymoma or vascular lesions such as cavernous malformation are often at risk of intramedullary hemorrhage. Surgical procedures involving the high cervical spinal cord are often challenging. This technical note included four patients who presented with acute, subacute, or gradual onset of spinal cord dysfunction associated with intramedullary hemorrhage at the C1 or C1/2 level of the high cervical spine. The mean age was 46.3 years (16-74 years). All patients underwent posterior spinal cord myelotomy of the posterior median sulcus or posterolateral sulcus. It was not to exceed the caudal opening of the fourth ventricle (foramen of Magendie) and was assumed to be as high as the caudal medulla oblongata. Total removal of the intramedullary ependymoma or cavernous malformation occurred in three of four cases, and the remaining case had subtotal removal of the ependymoma. None of the patients showed postoperative deterioration of the neurological condition. Pathological examination of all cases revealed intramedullary hemorrhage was associated with ependymoma or cavernous malformation. Posterior spinal myelotomy should be limited to the caudal opening of the fourth ventricle (foramen of Magendie), that is the caudal medulla oblongata, to avoid the significant deterioration after surgery.


Assuntos
Neoplasias do Sistema Nervoso Central , Ependimoma , Neoplasias da Medula Espinal , Doenças Vasculares da Medula Espinal , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Ependimoma/complicações , Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Hemorragia , Humanos , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia
17.
World Neurosurg ; 164: e82-e90, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35378317

RESUMO

BACKGROUND: Supratentorial ependymomas (STEs) are an aggressive group of ependymomas, topographically distinct from their posterior fossa and spinal counterparts. Zinc finger translocation associated (ZFTA) fusion-positive cases have been reported to account for the majority of STEs, although data on its association with poorer outcomes are inconsistent. MATERIALS AND METHODS: We assessed the prevalence of the ZFTA fusion by reverse-transcription polymerase chain reaction and fluorescence in situ hybridization in a cohort of 61 patients (68 samples) with STE. Our primary outcome was to determine the role of the ZFTA fusion on progression-free and overall survival of patients with STE. Our secondary objectives were to assess the impact of ZFTA fusion on nuclear factor (NF)-kB pathway signaling via surrogate markers of this pathway, namely COX-2, CCND1, and L1 cell adhesion molecule. RESULTS: ZFTA fusion was noted in 21.3% of STEs in our cohort. The presence of this rearrangement did not significantly impact the progression-free or overall survival of patients with STEs and was not associated with upregulation of markers of the NF-kB pathway. Only gross total resection was significantly associated with better progression-free survival. CONCLUSIONS: In contradiction to previous reports from across the world, the ZFTA fusion is far less prevalent among our population. It does not appear to drive NF-kB signaling or significantly affect outcomes. Gross total resection must be attempted in all cases of STE and adjuvant radiation and/or chemotherapy employed when gross total resection is not achieved.


Assuntos
Ependimoma , Neoplasias Supratentoriais , Ependimoma/genética , Ependimoma/metabolismo , Ependimoma/cirurgia , Humanos , Hibridização in Situ Fluorescente , NF-kappa B/metabolismo , Prevalência , Neoplasias Supratentoriais/genética , Neoplasias Supratentoriais/metabolismo , Neoplasias Supratentoriais/cirurgia , Fator de Transcrição RelA/genética , Fator de Transcrição RelA/metabolismo , Translocação Genética/genética , Dedos de Zinco
18.
J Int Med Res ; 50(3): 3000605221082889, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35313772

RESUMO

BACKGROUND: Spinal ependymoma is the most common intramedullary tumor in adults. This study was performed to evaluate whether intraoperative yellow fluorescence use enhances our ability to identify the tumor margin and residual tumor tissue in intramedullary spinal cord ependymoma resection. We also evaluated patients' clinical conditions at a 3-month follow-up. METHODS: We retrospectively evaluated 56 patients with intramedullary ependymoma. Thirty minutes before anesthesia, the patients received intravenous sodium fluorescein injections. Tumor resection was performed under two illumination modes, traditional white light and yellow fluorescence, and the residual tumor tissue was detected. Magnetic resonance imaging was performed 3 months postoperatively to observe the tumor resection outcome and residual tumor tissue. The McCormick spinal cord function grade was evaluated preoperatively and 3 months postoperatively. RESULTS: The total resection rate was 100.0% in all patients. Nine patients had no significant fluorescence imaging. After 3 months, patients with a spinal function grade of I to IV showed significant spinal function improvement. Magnetic resonance imaging showed no residual tumor tissue or recurrence. CONCLUSION: Sodium fluorescein aids in total excision of intramedullary spinal cord ependymoma and intraoperative residual tumor tissue identification. At the 3-month follow-up, the patients' functional outcome in the fluorescein group was good.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Adulto , Ependimoma/diagnóstico por imagem , Ependimoma/patologia , Ependimoma/cirurgia , Humanos , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Canal Medular , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
19.
Neurol Sci ; 43(8): 5075-5082, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35334013

RESUMO

PURPOSE: The aim of this study is to compare the use of 5-aminolevulinic acid (5-ALA) and sodium fluorescein (SF) in IV ventricular ependymoma (IVEP) surgical resection. METHODS: In this retrospective study, six patients with IVEP were enrolled. Gender ratio 2:1 male to female, with mean age 38.9 years old. A 5-ALA oral dose of 20 mg/kg and a SF intravenous dose of 2 mg/kg were administered. Telo-velar approach, operative microscope, and intraoperative monitoring were used in all the operations. We retrospectively compared the two fluorescence techniques at four steps during the surgical procedure: step 1: exposure of the tumor; step 2: dissection of the lesion from the cerebellum; step 3: assessment of the tumor borders and differentiation from normal tissue at the base of implants; and step 4: evaluation of possible residual tissue in the surgical cavity. RESULTS: At the first step, the ependymomas resulted well delineated by both fluorescent agents. In this step, 5-ALA was particularly helpful in the case of recurrent ependymoma. At step 2, 5-ALA provided a better identification of the ependymoma boundaries and distinction from cerebellum hemispheres than SF. In steps 3 and 4, SF was really helpful to detect tumor tissue. CONCLUSION: According to our experience, fluorescence-guided surgery of IVEP with 5-ALA and SF is useful to maximize surgical resection with less risk of brainstem injury. Both fluorescence techniques are helpful in different steps of IVEP resection. However, further studies are needed to confirm our preliminary data.


Assuntos
Neoplasias Encefálicas , Ependimoma , Adulto , Ácido Aminolevulínico , Neoplasias Encefálicas/patologia , Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Feminino , Fluoresceína , Humanos , Masculino , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos
20.
Sci Rep ; 12(1): 4926, 2022 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-35322104

RESUMO

Adult spinal ependymoma presents a rare low-grade tumor entity. Due to its incidence peak in the fourth decade of life, it mostly affects patients during a professionally and physically active time of life. We performed a retrospective monocentric study, including all patients operated upon for spinal ependymoma between 2009 and 2020. We prospectively collected data on professional reintegration, physical activities and quality-of-life parameters using EQ-5D and SF-36. Issues encountered were assessed using existing spinal-cord-specific questionnaires and free-text questions. In total, 65 of 114 patients agreed to participate. Most patients suffered from only mild pre- and postoperative impairment on the modified McCormick scale, but 67% confirmed difficulties performing physical activities in which they previously engaged due to pain, coordination problems and fear of injuries after a median follow-up of 5.4 years. We observed a shift from full- to part-time employment and patients unable to work, independently from tumor dignity, age and neurological function. Despite its benign nature and occurrence of formal only mild neurological deficits, patients described severe difficulties returning to their preoperative physical activity and profession. Clinical scores such as the McCormick grade and muscle strength may not reflect the entire self-perceived impairment appropriately.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Adulto , Ependimoma/patologia , Ependimoma/cirurgia , Humanos , Procedimentos Neurocirúrgicos , Qualidade de Vida , Estudos Retrospectivos , Retorno ao Trabalho , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
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