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1.
Medicine (Baltimore) ; 99(33): e21628, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872023

RESUMO

RATIONABLE: Large cell neuroendocrine carcinoma of the lung is rare, especially in the area of the foramen magnum. No previous studies have reported metastatic large cell neuroendocrine lung cancer to the foramen magnum. This paper will be the first time to report this special case. PATIENT CONCERNS: A case of a 37-year-old woman presented with headache that had developed 20 days previously. Imaging examination revealed a circular abnormal signal at the posterior margin of the foramen magnum. DIAGNOSES: The patient we report was diagnosed with a metastatic intracranial tumor. INTERVENTIONS: The patient underwent occipital craniotomy. Pathological results showed metastatic neuroendocrine carcinoma of the brain. Whole body PET-CT examination showed that fusiform soft tissue shadows could be seen near the hilum of the lower lobe of the left lung. OUTCOMES: The final bronchoscopy pathological results showed the large cell neuroendocrine carcinoma of the lung. The patient underwent further chemotherapy and radiotherapy in the oncology department. LESSONS: Diagnosis and treatment of large cell neuroendocrine carcinoma of the lung are difficult. The prognosis is poorer, and effective treatment is urgently needed.


Assuntos
Neoplasias Encefálicas/secundário , Carcinoma Neuroendócrino/patologia , Forame Magno/patologia , Neoplasias Pulmonares/patologia , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/terapia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
2.
Cancer Radiother ; 24(6-7): 470-476, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32773281

RESUMO

Brain metastases are the most common intracranial tumors and are associated with a dismal prognosis. The management of patients with brain metastases has become more important because of the increased incidence of these tumours, the better treatment of the systemic disease and the improvement of surgical techniques. The treatment requires multidisciplinary approaches and become complex because of new emerging systemic therapy and advancements in neurosurgery and radiation oncology. The surgical treatment has an indispensable role to obtain a tissue diagnosis, in relieving intracranial effect mass and improving neurological status by improving induced encephalopathy. An understanding of the role and indications of the surgery in patients with metastatic brain lesions is essential for the effective management of this growing population.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Humanos
3.
Cancer Radiother ; 24(6-7): 477-481, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32828667

RESUMO

Metastases are the most common brain tumors. After surgery, stereotactic radiotherapy (SRT) of the resection cavity is the standard of care. Data from two randomized trials indicate that SRT to the surgical bed is an effective treatment in reducing local failure as compared with observation, while reducing the risk of cognitive deterioration and maintaining quality of life as compared with whole brain radiation therapy. Local control appears higher after hypofractionated SRT compared to single-fraction SRT. Several questions such as target volumes, the optimal regimen in particular for large tumor bed, strategies to reduce the risk of lepto-meningeal recurrence, and the treatment sequence still need to be answered.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Radiocirurgia , Neoplasias Encefálicas/cirurgia , Terapia Combinada , Humanos , Período Pós-Operatório , Radioterapia/métodos
4.
Artigo em Russo | MEDLINE | ID: mdl-32759923

RESUMO

Maximum resection and preservation of neurological function are main principles in surgery of brain tumors, especially glial neoplasms with diffuse growth. Therefore, exact localizing of eloquent brain areas is an important component in surgical planning ensuring optimal resection with minimal postoperative neurological deficit. Functional MRI is used to localize eloquent brain areas adjacent to the tumor. This paper is an initial stage in analysis of resting-state fMRI in assessment of functional changes of neuronal activity caused by brain gliomas of different localization. We report two patients with glial tumors localized within the precentral gyrus of the left hemisphere and near speech area. Considering data of task-based and resting-state fMRI, as well as direct cortical stimulation, we propose a methodology for assessing the overlap of activations obtained by these methods.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Mapeamento Encefálico , Lobo Frontal , Humanos , Imagem por Ressonância Magnética
5.
Artigo em Russo | MEDLINE | ID: mdl-32759924

RESUMO

OBJECTIVE: To develop a prognostic scale suitable for distinguishing a group of poor prognosis with low survival prior to deciding on the appropriateness of radiotherapy. MATERIAL AND METHODS: We analyzed only those patients with reliably known date of death after previous WBRT to determine objective criteria allowing WBRT abandonment. WBRT was carried out in 100 patients with non-small cell lung cancer (n=49) and breast cancer (n=51) and confirmed metastatic brain disease. All procedures have been conducted at the radiotherapy department of the Herzen Moscow Oncology Research Institute since January 2014. The prescribed dose of 3 Gy was ensured in all patients. Total focal dose of 30 Gy delivered in 10 fractions was achieved in 77 cases, 36 Gy delivered in 12 fractions - in 23 cases. RESULTS: Death date was recorded in all patients (n=100) by January 2020. In the electronic SPSS database, death information was digitized for each patient up to 2-24 months, respectively. We identified eight the most significant factors by using of correlation analysis: primary tumor (controlled (0), uncontrolled (1)), number of brain metastases (<17 (0), ≥17 (1)), volume of brain metastases (<48 cm3 (0) ≥48 cm3 (1)), extracranial control (no metastases (0), metastases with positive dynamics after chemotherapy (1), continued growth after chemotherapy (2)), metastatic lesion of liver and lungs, respectively (no (0), yes (1)), functional status (≥ 70% (0), ≤ 60% (1)), carcinomatosis of the meninges (no (0), yes (1)). A simple summation of digital variables for factors 1-8 in each patient resulted a prognostic scale. Low risk of early mortality after WBRT was determined by 0-3 scores, intermediate risk - 4-5 scores, high risk - 6-9 scores. According to univariate analysis (log-rank 0.000), median survival rate varied in these groups: low risk - 15.5 months (11.4-19.7), intermediate risk - 5.26 months (4.6-6.0), high risk - only 1.35 months (0.9-1.8). Only 1 out of 15 high-risk patients (6-9 scores) survived 3 months (3.25 months). Inclusion of all eight factors into multivariate analysis revealed significant impact of only risk group on short-term survival. A 3-month survival in the high-risk group was 20.6 times lower (p=0.002) compared to the low and intermediate risk groups. CONCLUSION: High significance of prognostic model and low informative value of each of the included factors emphasize the advisability of determining risk groups for short-term survival according to the suggested scale for each patient scheduled for WBRT. A simple assessment of separate predictors is pointless to decide whether WBRT is necessary.


Assuntos
Neoplasias Encefálicas/cirurgia , Neoplasias da Mama/terapia , Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares/terapia , Radiocirurgia , Humanos , Moscou , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
6.
Artigo em Russo | MEDLINE | ID: mdl-32759927

RESUMO

Spinal cord metastases of brain gliomas are rare. However, incidence of these tumors has been increasing recently. The vast majority of neurosurgeons and oncologists recognize spinal cord metastasis of malignant brain glioma followed by symptoms of transverse spinal cord lesion as non-curable terminal stage of malignant process. In this paper, we report a rare clinical case of metastatic spinal cord lesion in a patient after previous surgery for anaplastic oligodendroglioma of the right frontal lobe. There were no signs of local recurrence of the primary tumor. Active surgical strategy followed by radio- and chemotherapy significantly improved the patient's quality of life. Postoperative follow-up is 6 months by the moment of writing the manuscript, no clinical signs of progression are observed.


Assuntos
Astrocitoma , Neoplasias Encefálicas/cirurgia , Oligodendroglioma/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Humanos , Recidiva Local de Neoplasia , Qualidade de Vida
7.
BMJ Open ; 10(8): e040898, 2020 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-32801210

RESUMO

OBJECTIVES: Pressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making. DESIGN: A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020. SETTING: Regional neurosurgical units outside London (as the pandemic was more advanced at time of study). PARTICIPANTS: Representatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK. RESULTS: 18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed-the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%-28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected. CONCLUSION: COVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments-most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures. STUDY REGISTRATION: This study was registered with the Royal College of Surgeons of England's COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).


Assuntos
Neoplasias Encefálicas/cirurgia , Tomada de Decisão Clínica , Infecções por Coronavirus/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Assistência à Saúde , Inglaterra/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Pandemias , Estudos Prospectivos
8.
Anticancer Res ; 40(8): 4801-4804, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727808

RESUMO

BACKGROUND/AIM: Recent advances in systemic chemotherapy, including molecularly targeted therapy, have dramatically improved survival for patients with advanced non-small cell lung cancer. We retrospectively analyzed the clinical outcomes of surgical resection for brain metastases of non-small cell lung cancer cases performed at the Department of Neurosurgery of Kindai University Hospital, Osaka, Japan. PATIENTS AND METHODS: Craniotomy and tumor resection were performed for 56 patients with brain metastases of non-small cell lung cancer. Adenocarcinoma was the most common histological type, appearing in 40 cases, of which 18 were positive for driver gene mutations. RESULTS: Median survival for all 56 patients was 14.5 months, and single brain metastasis and adenocarcinoma were identified as favorable prognostic factors. Analysis limited to the 40 cases of adenocarcinoma identified single brain metastasis as a favorable prognostic factor. Although no significant difference was found for systemic chemotherapy, patients who received molecularly targeted therapy showed a better prognosis than those who received cytotoxic chemotherapy. Analyses of both the entire group and of adenocarcinoma patients alone found that whole-brain radiotherapy showed no significant association with survival. CONCLUSION: Single brain metastasis and adenocarcinoma were identified as favorable prognostic factors, but did not confirm any benefit from whole-brain radiotherapy. These results suggest that multimodal treatment strategies utilizing various methods of treatment, including systemic chemotherapy, may help prolong patient survival in the future.


Assuntos
Neoplasias Encefálicas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
9.
J Cancer Res Clin Oncol ; 146(10): 2589-2594, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32700108

RESUMO

BACKGROUND: Primary pineal malignant melanoma (PPMM) is a rare entity of primary central nervous system melanomas, with only 26 cases reported in the literature to date. CASE PRESENTATION: We report the case of a 65-year-old male with a PPMM who has prolonged survival of more than 104 weeks after combined microsurgical and endoscopic total resection. This is the first report: combined microscope and endoscopy total resection; PPMM in China; PPMM with total resection alone. CONCLUSION: Combined microscope and endoscopy total resection is beneficial to prolong the survival of patients. But the best approach to treatment needs verification from more clinical cases in future.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Melanoma/patologia , Melanoma/cirurgia , Glândula Pineal/patologia , Glândula Pineal/cirurgia , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Endoscopia/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Melanoma/diagnóstico por imagem , Glândula Pineal/diagnóstico por imagem
10.
Recent Results Cancer Res ; 216: 813-841, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32594408

RESUMO

In neurosurgery, the extent of resection plays a critical role, especially in the management of malignant gliomas. These tumors are characterized through a diffuse infiltration into the surrounding brain parenchyma. Delineation between tumor and normal brain parenchyma can therefore often be challenging. During the recent years, several techniques, aiming at better intraoperative tumor visualization, have been developed and implemented in the field of brain tumor surgery. In this chapter, we discuss current strategies for intraoperative imaging in brain tumor surgery, comprising conventional techniques such as neuronavigation, techniques using fluorescence-guided surgery, and further highly precise developments such as targeted fluorescence spectroscopy or Raman spectroscopy.


Assuntos
Encéfalo/cirurgia , Neuronavegação , Cirurgia Assistida por Computador , Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Humanos
11.
World Neurosurg ; 142: e183-e194, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32599201

RESUMO

OBJECTIVE: In the present study, we quantified the effect of the coronavirus disease 2019 (COVID-19) on the volume of adult and pediatric neurosurgical procedures, inpatient consultations, and clinic visits at an academic medical center. METHODS: Neurosurgical procedures, inpatient consultations, and outpatient appointments at Vanderbilt University Medical Center were identified from March 23, 2020 through May 8, 2020 (during COVID-19) and March 25, 2019 through May 10, 2019 (before COVID-19). The neurosurgical volume was compared between the 2 periods. RESULTS: A 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median before, 75; interquartile range [IQR], 72-80; median during, 45; IQR, 43-47; P < 0.001). A 42% reduction occurred in weekly adult procedures (median before, 62; IQR, 54-70; median during, 36; IQR, 34-39; P < 0.001), and a 31% reduction occurred in weekly pediatric procedures (median before, 13; IQR, 12-14; median during, 9; IQR, 8-10; P = 0.004). Among adult procedures, the most significant decreases were seen for spine (P < 0.001) and endovascular (P < 0.001) procedures and cranioplasty (P < 0.001). A significant change was not found in the adult open vascular (P = 0.291), functional (P = 0.263), cranial tumor (P = 0.143), or hydrocephalus (P = 0.173) procedural volume. Weekly inpatient consultations to neurosurgery decreased by 24% (median before, 99; IQR, 94-114; median during, 75; IQR, 68-84; P = 0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (median before, 329; IQR, 326-374; median during, 29; IQR, 26-39; P < 0.001). In contrast, weekly telehealth encounters increased from a median of 0 (IQR, 0-0) before to a median of 151 (IQR, 126-156) during COVID-19 (P < 0.001). CONCLUSIONS: Significant reductions occurred in neurosurgical operations, clinic visits, and inpatient consultations during COVID-19. Telehealth was increasingly used for assessments. The long-term effects of the reduced neurosurgical volume and increased telehealth usage on patient outcomes should be explored.


Assuntos
Assistência Ambulatorial/tendências , Infecções por Coronavirus , Neurocirurgia , Procedimentos Neurocirúrgicos/tendências , Pandemias , Pneumonia Viral , Encaminhamento e Consulta/tendências , Telemedicina/tendências , Centros Médicos Acadêmicos , Adolescente , Idoso , Betacoronavirus , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Craniotomia/tendências , Remoção de Dispositivo , Procedimentos Endovasculares/tendências , Epilepsia/cirurgia , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/tendências , Doenças da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Tennessee , Procedimentos Cirúrgicos Vasculares/tendências
12.
Zhonghua Wai Ke Za Zhi ; 58(6): 469-474, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498488

RESUMO

Objective: To analyze the prognosis factors of cerebrospinal fluid (CSF) spread after surgery in glioblastoma (GBM) patients when tumors progressed and the effect factors on prognosis. Methods: A retrospective study was conducted on 124 patients who were pathologically diagnosed as glioblastoma after surgery, and found tumor progressed during regularly follow-up at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University between January 2009 and August 2017.There were 82 males and 42 females, aged 47.9 years(range: 19 to 75 years) .Patients were divided into local recurrence group(96 cases) and CSF spread group (28 cases) .Clinical data were recorded in detail and compared by independent sample t test or χ(2) test.Kaplan-Meier survival curves was used to demonstrated the distribution of progression free survival (PFS) overall survival (OS) and post progression survival (PPS), and differences between local recurrence and CSF spread groups were assessed by Log-rank test.Cox proportion hazard regression analysis was used to identify independent prognostic factors. Results: Logistics regression analysis showed ventricle entry was the only prognosis factor of CSF spread (OR=2.667, 95% CI: 1.128 to 6.304, P=0.025).No significant distinction was observed in PFS between CSF spread group and local recurrence group(7.0 months vs.9.3 months, P=0.066).However, OS and PPS were substantially shortened in CSF spread group (13.0 months vs.23.0 months, P=0.011; 6.0 months vs.11.0 months, P=0.022, respectively).Mutations of isocitrate dehydrogenase gene, distant spread, gross-total resection, Ki-67 index>30% were independent prognostic factors of GBM patients. Conclusions: Ventricle entry is a prognosis factor for CSF spread, after which the median OS and PPS are markedly diminished.However, ventricle entry is not independent prognosis factor shortening survival.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias do Ventrículo Cerebral/secundário , Ventrículos Cerebrais/patologia , Líquido Cefalorraquidiano , Glioblastoma/secundário , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Análise Fatorial , Feminino , Glioblastoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Adulto Jovem
13.
No Shinkei Geka ; 48(6): 541-546, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32572007

RESUMO

Radiation necrosis with massive hemorrhage is a rare complication of radiotherapy. We report the case of a male patient who had undergone radiotherapy therapy 18 years earlier and presently underwent gamma knife radiosurgery for a metastatic brain tumor in his right occipital lobe. The patient showed aberrant behavior with left homonymous hemianopsia and a gradual deterioration of cognitive function after radiotherapy. A CT scan showed the presence of an intracerebral hematoma over the right occipital lobe with mass effect, and small spotty enhancements on the lesion when enhanced on gadolinium contrast-enhanced MRI. Intraoperative findings revealed necrosis of the occipital surface and a hematoma in the occipital lobe. Pathological findings showed damage to the walls of the sinusoidal capillaries and vitreous degeneration of the inner membrane with a spongiform hemangioma. After surgery, the cerebral edema resolved, and the patient's clinical symptoms improved. The cause of the radiation necrosis and bleeding in this patient was assumed to be due to the breakdown of the congested walls of the sinusoidal capillary vessels.


Assuntos
Neoplasias Encefálicas/cirurgia , Radiocirurgia , Hemorragia Cerebral , Humanos , Imagem por Ressonância Magnética , Masculino , Lobo Occipital
14.
Anesthesiology ; 133(2): 304-317, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32482999

RESUMO

BACKGROUND: Studies in anesthetized patients suggest that phenylephrine reduces regional cerebral oxygen saturation compared with ephedrine. The present study aimed to quantify the effects of phenylephrine and ephedrine on cerebral blood flow and cerebral metabolic rate of oxygen in brain tumor patients. The authors hypothesized that phenylephrine reduces cerebral metabolic rate of oxygen in selected brain regions compared with ephedrine. METHODS: In this double-blinded, randomized clinical trial, 24 anesthetized patients with brain tumors were randomly assigned to ephedrine or phenylephrine treatment. Positron emission tomography measurements of cerebral blood flow and cerebral metabolic rate of oxygen in peritumoral and normal contralateral regions were performed before and during vasopressor infusion. The primary endpoint was between-group difference in cerebral metabolic rate of oxygen. Secondary endpoints included changes in cerebral blood flow, oxygen extraction fraction, and regional cerebral oxygen saturation. RESULTS: Peritumoral mean ± SD cerebral metabolic rate of oxygen values before and after vasopressor (ephedrine, 67.0 ± 11.3 and 67.8 ± 25.7 µmol · 100 g · min; phenylephrine, 68.2 ± 15.2 and 67.6 ± 18.0 µmol · 100 g · min) showed no intergroup difference (difference [95% CI], 1.5 [-13.3 to 16.3] µmol · 100 g · min [P = 0.839]). Corresponding contralateral hemisphere cerebral metabolic rate of oxygen values (ephedrine, 90.8 ± 15.9 and 94.6 ± 16.9 µmol · 100 g · min; phenylephrine, 100.8 ± 20.7 and 96.4 ± 17.7 µmol · 100 g · min) showed no intergroup difference (difference [95% CI], 8.2 [-2.0 to 18.5] µmol · 100 g · min [P = 0.118]). Ephedrine significantly increased cerebral blood flow (difference [95% CI], 3.9 [0.7 to 7.0] ml · 100 g · min [P = 0.019]) and regional cerebral oxygen saturation (difference [95% CI], 4 [1 to 8]% [P = 0.024]) in the contralateral hemisphere compared to phenylephrine. The change in oxygen extraction fraction in both regions (peritumoral difference [95% CI], -0.6 [-14.7 to 13.6]% [P = 0.934]; contralateral hemisphere difference [95% CI], -0.1 [- 12.1 to 12.0]% [P = 0.989]) were comparable between groups. CONCLUSIONS: The cerebral metabolic rate of oxygen changes in peritumoral and normal contralateral regions were similar between ephedrine- and phenylephrine-treated patients. In the normal contralateral region, ephedrine was associated with an increase in cerebral blood flow and regional cerebral oxygen saturation compared with phenylephrine.


Assuntos
Anestesia/tendências , Neoplasias Encefálicas/tratamento farmacológico , Circulação Cerebrovascular/efeitos dos fármacos , Efedrina/uso terapêutico , Consumo de Oxigênio/efeitos dos fármacos , Fenilefrina/uso terapêutico , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Circulação Cerebrovascular/fisiologia , Método Duplo-Cego , Efedrina/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Fenilefrina/farmacologia , Estudos Prospectivos , Resultado do Tratamento , Vasoconstritores/farmacologia , Vasoconstritores/uso terapêutico
15.
World Neurosurg ; 141: 157-161, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32526365

RESUMO

BACKGROUND: When Belgium's coronavirus disease 2019 (COVID-19) outbreak began in March 2020, our neurosurgical department followed the protocol of most surgical departments in the world and postponed elective surgery. However, patients with tumor-like brain lesions requiring urgent surgery still received treatment as usual, in order to ensure ongoing neurooncologic care. From a series of 31 patients admitted for brain surgery, 3 were confirmed as infected by the novel severe acute respiratory syndrome coronavirus 2. CASE DESCRIPTION: We present the clinical outcomes of these 3 COVID-19 patients, who underwent an intracerebral biopsy in our department during April 2020. All suffered from a diffuse intraparenchymal hemorrhage postoperatively. Unfortunately, we were not able to identify a clear etiology of these postoperative complications. It could be hypothesized that an active COVID-19 infection status may be related to a higher bleeding risk. The remaining 28 neurooncologic non-COVID-19 patients underwent uneventful surgery during the same period. CONCLUSIONS: This case series reports the previously unreported and unexpected outcomes of COVID-19 patients suffering from acute hemorrhage after intracerebral biopsy procedures. Although no direct relation can yet be established, we recommend the neurosurgical community be cautious in such cases.


Assuntos
Biópsia/efeitos adversos , Infecções por Coronavirus/complicações , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/terapia , Pneumonia Viral/complicações , Idoso , Neoplasias Encefálicas/cirurgia , Epilepsia/cirurgia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pandemias , Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/terapia , Resultado do Tratamento
19.
Int J Clin Oncol ; 25(8): 1475-1482, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32358736

RESUMO

INTRODUCTION: Management of patients with intracranial metastases from an unknown primary tumor (CUP) varies compared to those with metastases of known primary tumor origin (CKP). The National Institute for Health and Care Excellence (NICE) recognizes the current lack of research to support the management of CUP patients with brain metastases. The primary aim was to compare survival outcomes of CKP and CUP patients undergoing early resection of intracranial metastases to understand the efficacy of surgery for patients with CUP. METHODS: A retrospective study was performed, wherein patients were identified using a pathology database. Data was collected from patient notes and trust information services. Surgically managed patients during a 10-year period aged over 18 years, with a histological diagnosis of intracranial metastasis, were included. RESULTS: 298 patients were identified, including 243 (82.0%) CKP patients and 55 (18.0%) CUP patients. Median survival for CKP patients was 9 months (95%CI 7.475-10.525); and 6 months for CUP patients (95%CI 4.263-7.737, p = 0.113). Cox regression analyses suggest absence of other metastases (p = 0.016), age (p = 0.005), and performance status (p = 0.001) were positive prognostic factors for improved survival in cases of CUP. The eventual determination of the primary malignancy did not affect overall survival for CUP patients. CONCLUSIONS: There was no significant difference in overall survival between the two groups. Surgical management of patients with CUP brain metastases is an appropriate treatment option. Current diagnostic pathways specifying a thorough search for the primary tumor pre-operatively may not improve patient outcomes.


Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Neoplasias Primárias Desconhecidas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/cirurgia , Craniotomia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
20.
Crit Rev Oncol Hematol ; 150: 102946, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353705

RESUMO

The presence of brain metastases (BMs) from germ cell tumor (GCT) remains a rare situation. BMs predominantly occur among patients with testis primary tumor site, and are almost exclusively associated with non-seminomatous (NS) histologies. Two situations must be distinguished, which differ in terms of clinical presentation, overall prognostic and management. At diagnosis, BMs are almost systematically associated with extra-cerebral metastases and the cornerstone of treatment is chemotherapy, while the role of local treatment remains controversial. In the metachronous setting, BMs more frequently constitute an isolated site of relapse, the outcome is poorer, and the role of local treatment is more consensual. However, all these data widely come from old reports, with outdated radiation techniques. The recent advances in radiation oncology, especially the rising use of stereotactic radiotherapy, could lead to the reconsideration of ancient dogmas regarding the "radiosensitivity" of (NS)GCT and the role of radiotherapy among patients with BMs.


Assuntos
Neoplasias Encefálicas/cirurgia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Radiocirurgia , Neoplasias Testiculares/cirurgia , Neoplasias Encefálicas/patologia , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Embrionárias de Células Germinativas/patologia , Estudos Retrospectivos , Neoplasias Testiculares/patologia , Resultado do Tratamento
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