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1.
World Neurosurg ; 132: e124-e132, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518744

RESUMO

BACKGROUND: Posterior fossa tumors are rare in adults and pose a challenge to treat due to the bony contour of the posterior fossa, complex anatomical structures including deep venous sinuses, and the proximity of the fourth ventricle and brain stem. We describe our experience with laser interstitial thermal therapy (LITT) for the management of brain metastases and radiation necrosis of the posterior fossa. METHODS: We retrospectively analyzed 13 patients with metastases and radiation necrosis of the posterior fossa managed with LITT. RESULTS: Thirteen patients with histopathologically confirmed radiation necrosis (n = 5) and metastases (n = 8) of the posterior fossa underwent LITT. The median preoperative tumor was 4.66 cm3, and median postoperative ablation cavity volume was 6.29 cm3. The median volume of the ablation cavity was decreased to 2.90 cm3 at a 9-month follow-up. The median volume of peritumoral edema was 12.25 cm3, which fell to a median of 5.77 cm3 at 1-month follow-up. The median progression-free survival was 7 months (range, 3-14 months) and the mean overall survival was 40 months (range, 2-49 months) after LITT. There were no intraoperative complications. One patient experienced palsy of the seventh and eighth cranial nerves on follow-up, attributable to LITT. CONCLUSIONS: Lesions of the posterior fossa are challenging to treat given their proximity to the dura and venous sinuses. Our findings demonstrate that LITT ablation may be a safe and feasible option for metastases and radiation necrosis of the posterior fossa. Larger studies are needed to confirm the efficacy of this approach.


Assuntos
Fossa Craniana Posterior/cirurgia , Hipertermia Induzida/métodos , Neoplasias Infratentoriais/terapia , Terapia a Laser/métodos , Adulto , Idoso , Edema Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Fossa Craniana Posterior/patologia , Feminino , Seguimentos , Humanos , Neoplasias Infratentoriais/secundário , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico por imagem , Necrose/etiologia , Complicações Pós-Operatórias/epidemiologia , Intervalo Livre de Progressão , Radiocirurgia , Estudos Retrospectivos , Análise de Sobrevida
2.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 33(9): 840-844;847, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31446700

RESUMO

Summary Chiari malformation type Ⅰ(CMI) is a disorder characterized by tonsilla cerebelli herniating into an underdeveloped posterior cranial fossa, hearing loss is often covered by more striking neurological symptoms. Hearing loss in this syndrome is not specific in terms of gender side, degree, age of onset, and progression. The hearing improvement after posterior fossa decompression is controversial on the basis of literature, while satisfactory result was obtained after cochlear implantation in the patient reported here, who was diagnosed as CMI with hearing loss as the main symptom. Therefore, after ensuring the integrity of the auditory pathway, cochlear implantation may be considered in CMI patients with bilateral severe or profound without other severe neurological symptoms.


Assuntos
Malformação de Arnold-Chiari/complicações , Implante Coclear , Surdez/etiologia , Surdez/cirurgia , Fossa Craniana Posterior/patologia , Audição , Humanos , Resultado do Tratamento
3.
J Craniofac Surg ; 30(8): e755-e757, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449204

RESUMO

A 78-year-old woman with progressive worsening vertigo and new onset of diplopia. Neurological examination revealed bilateral abducens nerve paralysis and gait disturbance with truncal ataxia. Neuroimaging revealed a mass lesion within the clivus with brain stem compression. The patient was operated with provisional diagnosis of clivus chordoma by neuro-navigation-guided extended endoscopic endonasal approach. Subtotal resection of the tumor was achieved with no intra- or postoperative complications. Histopathologic examination revealed intraosseous meningioma (WHO grade I). To the authors' best knowledge this is the first case reporting clivus site of intraosseous meningioma.


Assuntos
Cordoma/cirurgia , Fossa Craniana Posterior/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias da Base do Crânio/cirurgia , Idoso , Cordoma/complicações , Cordoma/diagnóstico , Fossa Craniana Posterior/patologia , Diplopia/complicações , Feminino , Neoplasias de Cabeça e Pescoço , Humanos , Neuroimagem , Complicações Pós-Operatórias , Neoplasias da Base do Crânio/complicações , Neoplasias da Base do Crânio/diagnóstico
4.
J Med Case Rep ; 13(1): 222, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31325957

RESUMO

BACKGROUND: Management of the disproportionately large communicating fourth ventricle is still problematic. CASE PRESENTATION: Two cases of disproportionately large communicating fourth ventricle were treated successfully. One was a case of a 51-year-old Han Chinese woman with a complaint of headache and dizziness of 1 year's duration. Magnetic resonance imaging (MRI) demonstrated hydrocephalus with a disproportionately large fourth ventricle. She underwent a ventriculo-peritoneal shunt of the right lateral ventricle. Her symptoms were relieved totally. Five years later, magnetic resonance imaging showed she had a normal ventricular system. The other case was a 24-year-old Han Chinese man with a 2-month history of headache and dizziness accompanied by progressive loss of bilateral vision. Magnetic resonance imaging revealed hydrocephalus with a disproportionately large fourth ventricle, crowded posterior cranial fossa, and syringomyelia extending from C1 to C5. He underwent suboccipital and C1 decompression and duraplasty. Shortly after the surgery, his symptoms were relieved completely, the syringomyelia completely disappeared, and the fourth ventricle became significantly smaller. CONCLUSIONS: The management of the disproportionately large communicating fourth ventricle should be individualized. If it coexists with crowded posterior cranial fossa or syringomyelia, posterior fossa decompression could be an option for initial management. If there is no sign of crowded posterior cranial fossa or syringomyelia, shunt of the lateral ventricles might be the first choice.


Assuntos
Quarto Ventrículo/patologia , Hidrocefalia/etiologia , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Tontura/etiologia , Feminino , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Cefaleia/etiologia , Humanos , Hidrocefalia/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Siringomielia/patologia , Resultado do Tratamento , Derivação Ventriculoperitoneal , Adulto Jovem
5.
J Pediatr Endocrinol Metab ; 32(8): 797-802, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31323007

RESUMO

PHACE syndrome is an uncommon disorder of posterior fossa anomalies, cervicofacial infantile hemangiomas, arterial anomalies, cardiac defects, eye anomalies, and midline/ventral defects. Endocrine abnormalities including hypopituitarism and ectopic thyroid were rarely described. In this article we review occurrence, onset, presenting symptoms, hormonal treatments and outcomes of all endocrine abnormalities in PHACE syndrome. Eleven of 20 (55%) had hypothalamic-pituitary dysfunction and 10 of 20 (50%) had thyroid dysgenesis. A thorough understanding of the endocrine manifestations is important for clinicians to early identify endocrine involvement in PHACE and develop plans for monitoring and treatment of its complications.


Assuntos
Anormalidades Múltiplas/etiologia , Coartação Aórtica/etiologia , Doenças do Sistema Endócrino/complicações , Anormalidades do Olho/etiologia , Síndromes Neurocutâneas/etiologia , Anormalidades Múltiplas/patologia , Coartação Aórtica/patologia , Fossa Craniana Posterior/patologia , Anormalidades do Olho/patologia , Neoplasias Faciais/etiologia , Neoplasias Faciais/patologia , Cardiopatias Congênitas/etiologia , Cardiopatias Congênitas/patologia , Hemangioma/etiologia , Hemangioma/patologia , Humanos , Síndromes Neurocutâneas/patologia , Síndrome
6.
World Neurosurg ; 130: 512-515, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279922

RESUMO

BACKGROUND: Hemangiomas are benign blood vessels tumors that represent less than 1% of all the bone neoplasms. Calvarial hemangiomas are mainly solitary lesions commonly located in the frontal and parietal bone; however, they may occur in any skull region. These tumors increase in size over a period of months to years before they start showing their first symptoms such as headache, bone deformity, and pathological fractures. Differential diagnosis with osteosarcoma should be considered. Surgical resection with a safety margin is a standard treatment of the cranial hemangioma. Furthermore, radiotherapy has proven to stop the tumor's growth but not its size. CASE DESCRIPTION: We treated an 11-year-old male who had a rare case of a capillary hemangioma located in the clivus bone. The patient underwent 2 endoscopic endonasal resection because of tumor recurrence. Surgical safety margins are highly recommended, but this procedure could not be performed because of the tumor's location. After the second relapse, the oncology team decided to initiate radiotherapy. At 6-month follow-up, the tumor reduced its size and remained unchanged. CONCLUSIONS: Surgical safety margins are highly important to prevent recurrence in this type of bone tumors. Skull base hemangiomas are a big challenge when you want to achieve these safety margins. We believe that a combined treatment of surgery and radiotherapy should be considered as the main treatment.


Assuntos
Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Hemangioma/diagnóstico , Hemangioma/patologia , Neoplasias da Base do Crânio/diagnóstico , Neoplasias da Base do Crânio/patologia , Criança , Fossa Craniana Posterior/irrigação sanguínea , Diagnóstico Diferencial , Humanos , Masculino , Osteossarcoma/diagnóstico , Osteossarcoma/patologia , Neoplasias da Base do Crânio/irrigação sanguínea
7.
World Neurosurg ; 130: e620-e626, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31265927

RESUMO

OBJECTIVE: The aim of this study was to discuss the relationship between Ki-67 values and the degree to which chordoma invade the clivus and to certify that the prognosis of chordoma is worse when it invades the middle and lower clivus than when it does not. METHODS: We collected 56 cases of first-time chordoma illness in which patients received no treatment before surgery. Patients underwent craniocerebral magnetic resonance imaging and skull-base 3-dimensional computed tomography scans before the operation. We divided patients into 2 groups depending on the extent to which the middle and lower clivus were invaded. We classified patients with chordoma that did not significantly invade the middle and lower clivuses into a "noninvasive" group and the others into an "invasive" group. Ki-67 values were extracted from the pathological report after surgery. We use an independent χ2 test to indicate that Ki-67 values for the invasive group were higher than those for the noninvasive group. RESULTS: We grouped the data and did a statistical analysis. We found that the Ki-67 values are >5% for most patients in whom chordoma have eroded the middle-lower clivus, whereas it is ≤5% for patients in whom the middle-lower clivus region has not been invaded. Therefore, there is a correlation between Ki-67 value and the region of chordoma invading the clivus. CONCLUSIONS: Statistical analysis revealed that Ki-67 values when the chordoma invaded the middle and lower clivus were significantly higher than when it did not. Thus, we can conclude that the prognosis is worse when chordoma invade the middle and lower clivus.


Assuntos
Cordoma/patologia , Fossa Craniana Posterior/patologia , Invasividade Neoplásica/patologia , Neoplasias da Base do Crânio/patologia , Adolescente , Adulto , Idoso , Biomarcadores Tumorais/análise , Cordoma/diagnóstico por imagem , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Humanos , Antígeno Ki-67/análise , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Prognóstico , Neoplasias da Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Medicine (Baltimore) ; 98(23): e15980, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169734

RESUMO

Owing to the special growth pattern of chordomas and the limited treatment options currently available, the treatment of chordoma still remains difficult. In this study, we hope to further clarify the relationship between surgical treatment and radiotherapy of chordoma and disease progression.All patients with a primary histopathological diagnosis of clival or spinal chordomas recorded in our institution between 1976 and 2017 were examined.A total of 60 patients (location: skull base/clival, n = 24; vertebral column, n = 5; sacrum, n = 31) had a mean follow-up time of 7.7 years (range 12 months-35 years). Compared with patients who received subtotal resection (n = 5, 5-year and 10-year survival = 61% and 39%, respectively), the annual survival rate of patients who received total resection (n = 55, 5-year and 10-year survival = 67%, respectively) was significantly higher. The overall 10-year survival rate (58%) of patients treated with surgery alone was significantly different from those treated with a combination of surgery and radiation (73%). The long-term prognosis of sacral chordoma was the worst (10-year survival rate = 48%).The best treatment strategy for improved long-term survival in chordoma was a combination of surgical resection and radiation therapy. Adjuvant radiotherapy for chordoma significantly improves disease-free survival, although the long-term survival benefit remains to be determined. A worse prognosis and poor long-term survival are seen in sacral chordomas.


Assuntos
Cordoma/mortalidade , Neoplasias da Base do Crânio/mortalidade , Neoplasias da Coluna Vertebral/mortalidade , Adulto , Cordoma/terapia , Fossa Craniana Posterior/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radioterapia Adjuvante , Sacro/patologia , Base do Crânio/patologia , Neoplasias da Base do Crânio/terapia , Neoplasias da Coluna Vertebral/terapia , Taxa de Sobrevida , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(19): e15533, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083202

RESUMO

Posterior fossa decompression (PFD) is the standard procedure for the treatment of Chiari malformation type I (CMI). Although most patients have satisfactory surgical outcomes, some show no improvement or even a worsening of symptoms. Patient selection is thought to account for these different surgical outcomes. Our aim was to evaluate the predictive value of the preoperative posterior cranial fossa (PCF) morphology on the efficacy of PFD.Data from 39 CMI patients with CMI-related symptoms who underwent occipital foramen enlargement + C-1 laminectomy + enlarged duraplasty were retrospectively collected from January 2011 to May 2018. The patients were divided into improved and unimproved groups according to the modified Chicago Chiari Outcome Scale. Demographic information and clinical history, including preoperative comorbidities and clinical manifestations, were recorded for the 2 groups and compared. PCF morphology was assessed based on 13 linear, 8 angular, 4 areal parameters and 4 ratios related to these liner and areal parameters. The data were then analyzed statistically.Of the 39 patients with CMI, 24 showed improvement after PFD (61.5%), whereas the remaining 15 patients showed no improvement (38.5%). The preoperative symptoms lasted 1 to 240 months, with a median of 24 months. The follow-up period ranged from 2 to 82 months, with a median of 27 months. The improved and unimproved groups differed significantly with regard to upper limb numbness (OR = 10, P = .02) and upper limb weakness (OR = 4.86, P = .02). The 2 groups did not differ significantly with regard to any morphological parameters such as tonsillar descent, syrinx size.Preoperative upper limb numbness and upper limb weakness are unfavorable factors that influence the outcome of PFD in patients with CMI. However, the morphology of PCF cannot predict the response to PFD in patients with CMI.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Fossa Craniana Posterior/patologia , Adulto , Idoso , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/patologia , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Neuropsychology ; 33(5): 725-738, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31094552

RESUMO

BACKGROUND: Idiopathic descent of cerebellar tonsils into the cervical spine in Chiari malformation Type I (CMI) is typically associated with occipital headache. Accumulating evidence from experimental studies suggests cognitive effects of CMI. The aim of the current study was to examine the relationship between cognition and CMI using a battery of standardized neuropsychological and symptom inventory instruments. METHOD: Eighteen untreated adults with CMI, and 18 gender, age, and education matched healthy controls completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and standardized measures of pain, mood, and disability. Morphometric measurements of key neural and osseous elements were also obtained from structural brain magnetic resonance images, for correlation with symptom outcomes. RESULTS: CMI patients exhibited deficits in RBANS attention, immediate memory, delayed memory, and total score. After controlling for pain and associated affective disturbance, the significant group effect for RBANS attention remained. CMI patients also presented seven morphometric differences comprising the cerebellum and posterior cranial fossa compartment that differed from healthy controls, some of which were associated with self-reported pain and disability. Notably, group differences in tonsillar position were associated with self-reported pain, disability, and delayed memory. CONCLUSION: Adult CMI is associated with domain-specific cognitive change, detectable using a standard clinical instrument. The extent of cognitive impairment is independent of pain or affective symptomatology and may be related to the key pathognomonic feature of the condition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/patologia , Cerebelo/patologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Fossa Craniana Posterior/patologia , Adolescente , Adulto , Cerebelo/diagnóstico por imagem , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Adulto Jovem
11.
Neurochirurgie ; 65(2-3): 55-62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31104846

RESUMO

BACKGROUND: Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. METHODS: A multicenter study of patients with PCMs larger than 2.5cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients' medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. RESULTS: There were 154 patients. The follow-up was 76.8 months on average (range 8-380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. CONCLUSIONS: Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity.


Assuntos
Meningioma/cirurgia , Neoplasias da Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Criança , Fossa Craniana Posterior/patologia , Fossa Craniana Posterior/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Meningioma/patologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Exame Neurológico , Procedimentos Neurocirúrgicos , Osso Petroso/patologia , Osso Petroso/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Neoplasias da Base do Crânio/patologia , Resultado do Tratamento , Adulto Jovem
12.
World Neurosurg ; 129: e171-e176, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31121374

RESUMO

BACKGROUND: Cerebrospinal fluid (CSF) leak remains a significant complication of posterior fossa tumor surgery. The goal of this study was to evaluate the wound CSF leakage rate in pediatric patients who underwent fourth ventricle tumor resection in a single-site setting and to explore the association of CSF leakage with the length of stay in the intensive care unit (ICU) and with dural sealant application. METHODS: Two hundred and eleven patients who underwent fourth ventricle tumor surgery between 2008 and 2016 were included in this study. Patient data were evaluated retrospectively. RESULTS: Postoperative wound CSF leakage was observed in 6 patients (2.8%). One hundred and seventy-six patients (83.4%) stayed in the ICU for ≤1 day, and CSF leakage developed in 4 of these patients (2.3%). Thirty-five patients (16.6%) stayed in the ICU for >1 day, and CSF leakage was observed in 2 of these patients (5.7%). The observed difference was not statistically significant (P = 0.260). There were no statistically significant differences in the CSF leakage rates in groups with and without dural sealing before (n = 2 [3%] and n = 4 [2.8%], respectively; P = 0.99) and after (n = 2 [3.0%] and n = 4 [6.0%], respectively; P = 0.68) application of the propensity score matching algorithm. CONCLUSIONS: The low CSF leakage rate (2.8%) identified in this study was associated with a certain algorithm of patient management. There was no strong evidence that the CSF leakage rate was associated with the length of stay in the ICU or with dural sealant application.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologia , Fossa Craniana Posterior/cirurgia , Quarto Ventrículo/cirurgia , Glioma/cirurgia , Neoplasias Infratentoriais/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Adolescente , Neoplasias do Ventrículo Cerebral/patologia , Criança , Pré-Escolar , Fossa Craniana Posterior/patologia , Craniotomia/efeitos adversos , Feminino , Quarto Ventrículo/patologia , Glioma/patologia , Humanos , Lactente , Recém-Nascido , Neoplasias Infratentoriais/patologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
13.
Cerebellum ; 18(4): 673-675, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31028519

RESUMO

Separating the etiologies of an acute vestibular syndrome (AVS) of central origin is a clinical challenge; the common causes include (1) stroke of the brainstem/cerebellum and (2) demyelinating disorders such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Overshadowed by the vascular etiologies, the literature describing AVS due to demyelinating disorders has been growing through the last decade. The discovery of IgG-NMO, a specific pathogenic antibody directed against the astrocytic water channel aquaporin-4 (AQP4), has improved the differential diagnoses between MS and NMOSD. AQP4 is particularly expressed in ependymal/subependymal astrocytes and glia limitans astrocyte processes, including around the fourth ventricle. Adding a clinical biomarker to distinguish MS and NMOSD in AVS patients, as reported in this issue, will be of great clinical value.


Assuntos
Fossa Craniana Posterior/patologia , Doenças Desmielinizantes/diagnóstico , Doenças Vestibulares/diagnóstico , Biomarcadores , Doenças Desmielinizantes/patologia , Movimentos Oculares , Humanos , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/patologia , Doenças Vestibulares/patologia
14.
J Korean Med Sci ; 34(13): e107, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30950252

RESUMO

BACKGROUND: Chordomas are aggressive bone tumors that have a predilection for the axial skeleton including the skull base and spinal/sacral bones. However, the histopathological and clinical differences between skull base chordoma (SBC) and sacral/spinal chordoma (SC) are unclear as previous studies have been focused on patient prognosis and treatment outcome. This study aimed to evaluate the clinicopathologic features and prognosis of chordoma according to its location. METHODS: Patients with chordomas were enrolled, and the histopathologic features were compared according to the tumor location. RESULTS: A total of 52 patients were enrolled. SBCs had more abundant chondroid matrix and diffuse growth pattern, while SCs had non-chondroid, myxoid matrix and a lobulating pattern, typical of chordoma. Old age and residual tumors were risk factors for shorter overall survival in SBCs. The chondroid matrix was an independent risk factor for shorter disease-free survival in the overall population. CONCLUSION: Chordomas have different histopathologic features depending on the anatomical location.


Assuntos
Cordoma/patologia , Neoplasias da Base do Crânio/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cordoma/mortalidade , Fossa Craniana Posterior/patologia , Intervalo Livre de Doença , Feminino , Humanos , Antígeno Ki-67/metabolismo , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Sacro/patologia , Neoplasias da Base do Crânio/mortalidade , Taxa de Sobrevida , Adulto Jovem
15.
Ear Nose Throat J ; 98(5): E24-E26, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30961387

RESUMO

Primary spontaneous cerebrospinal fluid (CSF) rhinorrhea is an unusual phenomenon that may occur anywhere along the skull base. However, CSF leaks originating from clival defects are rarely reported in the literature. The majority of reported cases were managed with microscopic techniques, using free grafts. The present study discusses a case of spontaneous CSF rhinorrhea from a clival defect closed with our transnasal operative approach using endoscopic techniques. The skull base defect was successfully managed with an endoscopic binostril approach to create a nasal septal flap pedicled at the sphenopalatine artery, while also preserving the integrity of the nasal septum.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Fossa Craniana Posterior , Imagem Tridimensional/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tomografia Computadorizada por Raios X/métodos , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Fossa Craniana Posterior/cirurgia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Septo Nasal/cirurgia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
16.
J Int Adv Otol ; 15(1): 12-17, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924775

RESUMO

OBJECTIVES: Different types of chronic otitis media are distinguished based on the observed lesions in the middle ear mucous. Hearing improvement is a measurable effect of the surgical treatment of patients with chronic otitis media. Chronic cholesteatoma otitis media and chronic otitis media with inflammatory granulation have a tendency to damage the bone tissue, leading to the development of intratemporal and intracranial complications. MATERIALS AND METHODS: A prospective analysis of patients who underwent surgery for the first time due to chronic otitis media from 2009 to 2012 was performed. Patients were divided into groups according to the abnormalities of the middle ear mucous observed during otosurgery. Special attention was given to patients diagnosed with chronic otitis media with inflammatory granulation and chronic cholesteatoma otitis media, which are characterized by a tendency to damage the bone tissue. RESULTS: A total of 293 individuals met the criteria for inclusion in the study. The analysis showed that chronic otitis media with inflammatory granulation had an unfavorable effect on hearing improvement prognosticated postoperatively. Defects in the middle cranial fossa were observed to occur five times more often than defects in the posterior cranial fossa. These defects were usually observed with granulation tissue and rarely with the concurrence of cholesteatoma and granulation tissue. CONCLUSION: The presence of granulation tissue is an unfavorable prognostic factor for improvement in air and bone conduction. The probability of exposing the dura mater of the brain is higher in cases with granulation tissue than in cases with cholesteatoma.


Assuntos
Condução Óssea/fisiologia , Tecido de Granulação/patologia , Audição/fisiologia , Otite Média/cirurgia , Adulto , Idoso , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Fossa Craniana Posterior/patologia , Feminino , Testes Auditivos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Otite Média/diagnóstico , Otite Média/patologia , Complicações Pós-Operatórias , Prognóstico , Estudos Prospectivos
17.
World Neurosurg ; 126: 310-313, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30885870

RESUMO

BACKGROUND: Stiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation. CASE DESCRIPTION: We report a recent experience on this association. CONCLUSIONS: In the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.


Assuntos
Cistos Aracnóideos/complicações , Hérnia/complicações , Rigidez Muscular/complicações , Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Fossa Craniana Média/patologia , Fossa Craniana Posterior/patologia , Hérnia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Temporal/patologia , Resultado do Tratamento
18.
World Neurosurg ; 126: 413, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30902767

RESUMO

Dural arteriovenous fistulas (DAVFs) represent 10%-15% of all intracranial arteriovenous malformations.1 DAVFs located in the posterior cranial fossa are rare and often present with intracranial hemorrhage and myelopathy.2 Arterial supply could be provided by the meningeal branches of the vertebral artery and external and internal carotid arteries.3 A 68-year-old man presented with progressive lower-extremity weakness (Video 1). Magnetic resonance imaging revealed a patchy longitudinal cord signal abnormality extending from the cervicomedullary junction to C7. A tentorial DAVF supplied by the right posterior meningeal artery with drainage via dorsal and ventral perimedullary veins was identified on angiography. According to the Cognard classification, the patient's DAVF was determined to be high risk as a type V lesion with spinal venous drainage and progressive myelopathy.4 The fistula was embolized with 50% ethanol resulting in near-complete occlusion. However, follow-up angiography revealed a persistent arteriovenous shunt and slightly worsening symptoms for the patient. He underwent a sitting supracerebellar approach with a torcular craniotomy for successful clip ligation of the dural arteriovenous fistula. The patient was discharged with improvements in lower-extremity strength and no residual arteriovenous shunting in postoperative imaging.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Fossa Craniana Posterior/cirurgia , Procedimentos Neurocirúrgicos/métodos , Idoso , Malformações Vasculares do Sistema Nervoso Central/complicações , Fossa Craniana Posterior/patologia , Humanos , Masculino , Procedimentos Neurocirúrgicos/educação , Doenças da Medula Espinal/complicações , Instrumentos Cirúrgicos , Resultado do Tratamento
19.
Neurol India ; 67(1): 155-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860115

RESUMO

Objective: The conventional midline suboccipital craniectomy, the standard approach for posterior fossa lesions, involves ligation of the occipital sinus. Postoperative sequelae that could occur from ligation of the occipital sinus include hydrocephalus, cerebrospinal fluid (CSF) leak, and pseudomeningiocoele formation. The standard of practice of venous pathway preservation, as practiced elsewhere in the cranium, should also be attempted in the posterior fossa. In the current study, we compared postsurgical complications between conventional "Y" durotomy with the proposed crescent durotomy in patients with posterior fossa lesions who underwent midline suboccipital craniectomy. Materials and Methods: The prospective data of 104 patients who underwent a midline suboccipital craniotomy for posterior fossa tumors between January 2011 and December 2015 was performed. Comparison of study variables was done between the durotomy techniques used. Results: Of the 104 patients who formed the study population, 39 (37.5%) were women. While 75 patients underwent crescent durotomy, the remaining underwent the conventional "Y" durotomy. Among the postsurgical complications, there were no differences between groups in terms of their surgical site hematoma (2.7% vs 3.4%; P = 1.000) and edema (1.3% vs 0.0%; P = 1.000). The groups were also similar in terms of the incidence of postsurgical CSF leak (1.3% vs 6.9%; P = 0.187) and cranial nerve deficits (4.0% vs 6.9%; P = 0.617). However, more number of patients who underwent the "Y" durotomy had postoperative pseudomeningiocoele (2.7% vs 17.2%; P = 0.017). Conclusion: The "crescent" durotomy is a novel dural opening technique which attempts to preserve the normal venous flow physiology. The crescent durotomy reduces the need for a duroplasty, facilitates a comfortable primary closure, thus reducing the risk of developing a postoperative pseudomeningiocoele.


Assuntos
Fossa Craniana Posterior/cirurgia , Dura-Máter/cirurgia , Neoplasias Infratentoriais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Craniotomia/métodos , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Neoplasias Infratentoriais/diagnóstico por imagem , Neoplasias Infratentoriais/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/patologia , Resultado do Tratamento , Adulto Jovem
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