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1.
Rev Med Suisse ; 16(680): 283-288, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022496

RESUMO

Intracranial meningiomas account for 30 to 40 % of the primary lesions of the central nervous system. In most of the cases, the diagnosis of an intracranial meningioma requires a neurosurgical management, in a multi-disciplinary perspective involving radiation therapists, pathologists and, in some cases, oncologists. The variety of clinical presentations and localizations, as well as the varying degrees of aggressiveness, make intracranial meningiomas a protean surgical entity, requiring a case-by-case management tailored to each patient.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia , Procedimentos Neurocirúrgicos , Humanos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(3): e18783, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011473

RESUMO

RATIONALE: Primary melanin-producing tumors are rare extra-axial neoplasms OPEN of the central nervous system. In the literature, few case reports have discussed neoplasms involving the cavernous sinus; of these, only 4 have reported on neoplasms originating in Meckel cave. The diagnostic approach, including clinical and radiological analysis, is challenging, and cytopathological assessment with a molecular basis is the best approach to discriminate between these lesions. Herein, we discuss the pathophysiology, diagnostic approach, intraoperative features, and postoperative management in a unique case of primary pigmented meningeal melanocytoma originating in Meckel cave in a patient who was diagnosed with Carney complex (CCx) and sickle cell disease (SCD). PATIENT CONCERNS: A 23-year-old man diagnosed with SCD had also been diagnosed previously with CCx, without any familial history or neurocutaneous melanosis. He had experienced headaches accompanied by left facial pain and paresthesia for 2 months. DIAGNOSIS: The initial computed tomography scan and magnetic resonance imaging (MRI) revealed a mass arising from the left Meckel cave. On MRI, it followed the signal intensity of melanin. He underwent subtotal resection of the mass. Considering the patient's history of CCx, melanocytic schwannoma was the most relevant diagnosis. A postoperative histopathological examination was suggestive of benign pigmented meningeal melanocytoma. INTERVENTIONS: The patient underwent an uneventful subtotal resection of the mass through a left temporal linear incision. OUTCOMES: The patient showed progressive improvement of neurologic deficits, and after 2 years of follow-up, he did not present with any new complaints. LESSONS: To the best of our knowledge, this is the first report of the unusual presentation of both SCD, as well as of primary pigmented meningeal melanocytoma in a patient with CCx. Complete surgical resection can be curative in most cases of melanocytoma. The presence of CCx with SCD suggests potential shared genetic contributions that will require further exploration.


Assuntos
Complexo de Carney/complicações , Melanoma/complicações , Melanoma/diagnóstico , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Anemia Falciforme/complicações , Diagnóstico Diferencial , Humanos , Masculino , Melanoma/patologia , Melanoma/cirurgia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Base do Crânio , Adulto Jovem
3.
Medicine (Baltimore) ; 99(8): e19178, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080099

RESUMO

RATIONALE: Primary melanocytic tumors of central nerve system (CNS) are rare, primary diffuse leptomeningeal melanomatosis (PDLM), a subtype of malignant melanomas of CNS, is extremely rare,especially in pediatrics. As the clinical manifestation of PDLM is not characteristic, It is often misdiagnosed as tubercular meningitis and hemorrhage. PATIENT CONCERNS: A 13-year-old boy was admitted to our department with symptoms of recurrent headache and vomiting twice. As the brain imaging revealed a lesion located in the left temporal lobe mimicked hemorrhage, so there was a misdiagnosis of hemorrhage in first hospitalization. He was admitted again for the recurrence of the headache and vomiting. Detailed physical examination showed multiple melanin changes in the skin of the whole body which were ignored in last hospitalization. Brain imaging showed the significantly enlarged lesion in the left temporal lobe and several smaller lesions in the left parietal lobe and cerebellum which indicated metastasis. DIAGNOSIS: According to the history,physical examination and the radiological finding, the patient was diagnosed with malignant melanoma of central never system possibly. INTERVENTIONS: The patient underwent left temporal and parietal lesions total resection with a craniotomy. OUTCOMES: The diagnosis of PDLM was established according to pathological characteristics and the negative finding of positron emission tomography (PET)-computed tomography (CT) outside CNS. The patient got no further treatment for economic reasons and experienced the progression and died 5 months after operation. LESSONS: PDLM is extremely rare in CNS, as the clinical manifestation, radiological changes are not special, early diagnosis is difficult. The confirmed diagnosis is established by leptomeningeal biospy or surgical tissue. PET-CT can help differential diagnosis with metastastic leptomeningeal melanomas. The prognosis is dismal due to the inefficiency of chemotherapy or radiotherapy.


Assuntos
Melanoma/diagnóstico , Melanoma/patologia , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Adolescente , Craniotomia , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
4.
No Shinkei Geka ; 48(1): 63-69, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31983690

RESUMO

Metastatic meningiomas are extremely rare, and generally have poor prognosis. We report a case of atypical meningioma with good clinical course despite metastasis 9 years after the initial surgery. CASE:A 58-year-old woman visited a nearby hospital with complaints of hemiplegia and aphasia. MRI showed a large left frontal meningioma;she was referred to our department where she underwent a tumor resection(Simpson Grade I). Histopathological finding revealed fibrous meningioma in the prominent part of the tumor. Additionally, a small lesion with high Ki-67 labeling index was identified;therefore, the final diagnosis was atypical meningioma. Nine years postoperatively, a hepatic mass found incidentally and was resected by digestive surgery;a histological diagnosis of metastatic atypical meningioma was established. Thirteen years after the first operation, routine MRI showed enlargement of the local recurrent lesions in the tumor resection cavity. She underwent a reoperation(Simpson Grade I)at our department, and subsequently, discharged without any neurological deficits. Findings were not suggestive of atypical meningioma. Studies report three good prognostic factors in patients with metastatic meningioma-histologically benign primary tumor, long interval between initial diagnosis and metastasis, and asymptomatic metastatic lesion.


Assuntos
Neoplasias Hepáticas , Neoplasias Meníngeas , Meningioma , Feminino , Humanos , Neoplasias Hepáticas/secundário , Imagem por Ressonância Magnética , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/secundário , Meningioma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Reoperação , Fatores de Tempo
5.
World Neurosurg ; 136: 263-269, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31899401

RESUMO

BACKGROUND: Meningioma is an intracranial tumor frequently encountered in the neurosurgical setting. Extracranial disease is a rare occurrence, with a reported incidence in 0.1% of cases. Metastasis is associated with previous craniotomy, venous sinus invasion, local recurrence, and World Health Organization (WHO) grade III tumor. Metastasis of a benign, grade I meningioma is extraordinarily rare. CASE DESCRIPTION: We report a case of a 41-year-old with a WHO grade I intracranial meningioma that had invaded and occluded the superior sagittal sinus. Chest computed tomography (CT) scan revealed pulmonary nodules, which were biopsied and confirmed benign meningioma. The metastatic meningiomas were found before resection of the primary tumor, suggesting direct seeding through the venous system versus iatrogenic seeding. Thirteen years later, an additional lung mass was found incidentally on abdominal CT scan for workup of a sarcoidosis. Biopsy and subsequent resection confirmed benign meningioma. A retrospective review of earlier chest CT scans revealed a small lesion that corresponded to the larger lesion found 13 years later. CONCLUSIONS: This a rare case of a WHO grade I meningioma involving the sagittal sinus with direct seeding of the pulmonary vascular bed leading to multiple meningioma metastases. The report highlights an increased risk of distant metastases for a benign meningioma with invasion of dural sinuses.


Assuntos
Neoplasias Pulmonares/secundário , Neoplasias Meníngeas/patologia , Meningioma/patologia , Adulto , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Seio Sagital Superior
6.
World Neurosurg ; 135: e748-e753, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31901496

RESUMO

OBJECTIVE: Cervical meningiomas are uncommon intradural-extramedullary tumors that have a tendency to be situated anterior to the spinal cord. The optimal surgical corridor to reach purely ventral cervical meningiomas has not been established. This article presents a series of patients with ventral cervical meningiomas treated via 1 of 2 microneurosurgical approaches: the anterior approach with corpectomy and fusion or the posterolateral approach. METHODS: Eight patients who underwent surgical resection of solitary, histopathologically confirmed, intradural-extramedullary cervical meningiomas of purely ventral location were retrospectively examined. Preoperative and postoperative Nurick scores quantified the degree of ambulatory function. Patients were followed for an average of 2.1 years after surgery. Postoperative imaging was performed to determine the extent of resection and to assess for tumor recurrence. RESULTS: Two patients with lower cervical meningiomas underwent resection via an anterior approach with single-level corpectomy and fusion. Six patients were treated via a posterolateral approach including ipsilateral hemilaminectomy and partial facetectomy without fusion. No intraoperative or postoperative complications were observed. Gross total resection was achieved in 8 of 8 patients, although 1 patient exhibited tumor recurrence. Improvement in ambulatory function was observed in all patients. CONCLUSIONS: Purely ventral cervical meningiomas are uncommon and pose unique technical challenges for neurosurgeons. We document favorable outcomes from 2 cases of lower cervical meningioma treated via an anterior approach and 6 cases of upper cervical tumors treated via a posterolateral approach. This series demonstrates operative considerations for effectively managing ventral cervical meningiomas.


Assuntos
Vértebras Cervicais/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/métodos , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
World Neurosurg ; 133: 216-220, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31610245

RESUMO

BACKGROUND: Meningiomas are common central nervous system tumors with a wide range of morphologic variants, the pathogenesis being their complex embryogenesis. Intracranial meningiomas with heterogenous histopathology in the same lesion are common in low-grade meningiomas but less frequent in recurrent and high-grade variants. CASE DESCRIPTION: A 75-year-old male presented elsewhere a year ago with complaints of slurred speech. Magnetic resonance imaging revealed a left frontotemporal, dural-based, extraaxial, solid cystic lesion with doubtful infiltration into the adjacent brain parenchyma. A subtotal excision was done. A diagnosis of meningioma with an aggressive biological behavior was rendered on histology, but the grade was deferred, in view of a single focus of small cell formation and no adjacent brain parenchyma to comment on invasion. The patient presented here with recurrence of his original symptoms. Magnetic resonance imaging of the brain with contrast revealed 2 dural-based, solid cystic enhancing lesions of sizes 29 mm × 25 mm × 24 mm and 25 mm × 16 mm seen at the left frontal region, indenting the adjacent brain parenchyma with diffuse meningeal thickening in the postoperative bed. Microscopy revealed a hypercellular meningeal neoplasm with increased mitosis and a pseudopapillary pattern with lipomatous changes. CONCLUSIONS: To date there are no case reports in current literature with such rare combinations in a recurrent meningioma. This highlights the multipotency of phenotypic transformation of primary meningothelial cells. The presence of papillary features, even if focal, should be quantified in the diagnosis. This is of importance because the most current literature suggests that meningioma harboring a papillary component has an increased risk of recurrence and progression to aggressive behavior.


Assuntos
Neoplasias Meníngeas/patologia , Meningioma/patologia , Recidiva Local de Neoplasia/patologia , Idoso , Progressão da Doença , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia
8.
World Neurosurg ; 133: e804-e812, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605839

RESUMO

BACKGROUND: Histopathological grading of meningiomas is insufficient for optimal risk stratification. The purpose of the present study was to determine the prognostic value of atypical histopathological features across all nonmalignant meningiomas (World Health Organization [WHO] grade I-II). METHODS: The data from 334 patients with WHO grade I (n = 275) and grade II (n = 59) meningiomas who had undergone surgical resection from 2001 to 2015 at 2 academic centers were pooled. Progression/recurrence (P/R) was determined radiographically and measured from the date of surgery. RESULTS: The median follow-up was 52 months. The patients were stratified by the number of atypical features: 0 (n = 151), 1 (n = 71), 2 (n = 66), 3 (n = 22), and 4 or 5 (n = 24). The risk of P/R increased with an increasing number of atypical features (log-rank test, P = 0.001). The 5-year actuarial rates of P/R stratified by the number of atypical features were as follows: 0, 16.3% (95% confidence interval [CI], 10.7-24.4); 1, 21.7% (95% CI, 12.8-35.2); 2, 28.2% (95% CI, 18.4-41.7); 3, 30.4% (95% CI, 13.8-58.7); and 4 or 5, 51.4% (95% CI, 31.7-74.5). On univariate analysis, the presence of high nuclear/cytoplasmic ratio (P = 0.007), prominent nucleoli (P = 0.007), and necrosis (P < 0.00005) were associated with an increased risk of P/R. On multivariate analysis, the number of atypical features (hazard ratio [HR], 1.30; 95% CI, 1.03-1.63; P = 0.03), ≥4 mitoses per high-power fields (HR, 2.45; 95% CI, 1.17-5.15; P = 0.02), subtotal resection (HR, 3.9; 95% CI, 2.5-6.3; P < 0.0005), and the lack of adjuvant radiotherapy (HR, 2.40; 95% CI, 1.19-4.80; P = 0.01) were associated with an increased risk of P/R. CONCLUSIONS: An increased number of atypical features, ≥4 mitoses per 10 high-power fields, subtotal resection, and the lack of adjuvant radiotherapy were independently associated with P/R of WHO grade I-II meningiomas. Patients with these features might benefit from intensified therapy.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Progressão da Doença , Feminino , Humanos , Masculino , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/radioterapia , Meningioma/patologia , Meningioma/radioterapia , Gradação de Tumores , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
9.
World Neurosurg ; 133: 324-330, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605858

RESUMO

BACKGROUND: Gorlin-Goltz syndrome is a rare hereditary disease affecting multiple organ systems. Medulloblastoma is the most common intracranial malignancy in these patients, radiotherapy makes them more susceptible to intracranial meningioma. Here we report an intracranial meningioma without radiation exposure. CASE DESCRIPTION: We present a case of intracranial meningioma in a young woman who was postoperatively diagnosed to have Gorlin-Goltz syndrome based on presence of calcification of bilateral tent and falx. Further clinical and radiological assessment helped us identify many other syndromic features and patient was promptly advised multispecialty consultations to screen for other malignancies and counselled regarding risk factors. CONCLUSIONS: Early identification of the syndrome is important for prevention of secondary radiation-induced malignancies, both intracranial and extracranial. Patients need multidisciplinary approach for management.


Assuntos
Síndrome do Nevo Basocelular/complicações , Neoplasias Meníngeas/complicações , Meningioma/complicações , Adulto , Síndrome do Nevo Basocelular/diagnóstico por imagem , Síndrome do Nevo Basocelular/cirurgia , Craniotomia , Feminino , Humanos , Imagem por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Resultado do Tratamento
10.
World Neurosurg ; 133: e529-e534, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562964

RESUMO

OBJECTIVE: Gamma Knife radiosurgery (GKRS) outcomes for anterior clinoid process (ACP) meningiomas have not been specifically reported within any meningioma series. We present the initial and largest series in the literature that describes the presenting features, radiosurgery parameters, and radiologic and long-term clinical outcomes for 61 patients with ACP meningiomas treated with GKRS. METHODS: Medical records were reviewed for 61 consecutive patients at a single center who underwent GKRS for ACP meningioma between 2008 and 2016. RESULTS: Of 61 patients with ACP meningiomas, 49 (80%) were treated with GKRS as primary treatment, and 12 (20%) were treated with GKRS as an adjuvant therapy. Before GKRS, 29 patients presented with visual impairment and 50 patients presented with headache. Median patient age was 54.9 years. Median tumor volume was 3.2 cm3, and median margin dose was 12.0 Gy. The median radiologic follow-up time after GKRS was 75 months. During follow-up, tumor volume regressed in 37 cases (61%) and remained unchanged in 24 cases (39%). None of the patients experienced tumor volume progression. Tumor volume <3 cm3 was an independent predictor of tumor volume regression after GKRS (univariate analysis, P = 0.047; multivariate analysis, P = 0.049). Of 29 patients who presented with visual impairment, 16 (55%) improved after GKRS. None of the 61 patients developed new neurologic deficits after GKRS. CONCLUSIONS: GKRS provides a high rate of tumor volume control for ACP meningiomas as well as a low complication rate. Excellent tumor volume control was associated with smaller tumor size only.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Radiocirurgia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Osso Esfenoide , Resultado do Tratamento
11.
World Neurosurg ; 133: e97-e104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505279

RESUMO

BACKGROUND: Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. METHODS: A series of consecutive cases operated between 2016 and October 2018 were analyzed retrospectively. The database included age, sex, clinical presentation, intraspinal location (intra/extradural), number of laminotomies, grade of resection, surgical time, bleeding, and follow-up. The initial and follow-up clinical condition was analyzed using the Frankel scale. RESULTS: A total of 13 patients underwent surgery: 3 intraspinal/extradural (23%), 8 intradural/extramedullary (61.5%), and 2 intramedullary tumors (15.3%); these were classified as 5 meningiomas (38.4%), 4 neurofibromas (30.7%), 2 schwannomas (15.3%), 1 hemangioblastoma (7.6%), and 1 astrocytoma (7.6%). Eleven (84.61%) patients had complete motor improvement, 1 patient had partial improvement, and 1 patient had no improvement (7.6% each). An 18-mm working channel tube was used for extramedullary lesions and 20-mm tubes for intramedullary injuries. Total tumor resection was achieved in 11 patients (84.6%) and subtotal in 2 patients (15.38%) corresponding to intramedullary tumors. CONCLUSIONS: Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.


Assuntos
Descompressão Cirúrgica/métodos , Fixadores Internos , Microcirurgia/métodos , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/instrumentação , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neurofibroma/diagnóstico por imagem , Neurofibroma/cirurgia , Estudos Retrospectivos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto Jovem
12.
World Neurosurg ; 133: 381-391.e2, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476461

RESUMO

BACKGROUND: Data on the endonasal endoscopic approach (EEA) to treat sellar/parasellar synchronous tumors remain sparse. This work aims to describe a minimally invasive approach with intraoperative magnetic resonance imaging (MRI) to remove a large sellar/parasellar synchronous tumor, and presents a systematic literature review. METHODS: The preoperative MRI of a 54-year-old woman revealed a sellar lesion (28 × 19 × 16 mm), presumably a pituitary macroadenoma, and a second extra-axial lesion (22 × 36 × 20 mm) expanding from the tuberculum sellae to the planum sphenoidale with encasement of the anterior communicating complex, presumably a meningioma. We used intraoperative MRI to assess the extent of the resection before reconstructing the large skull base defect. Furthermore, we systematically reviewed pertinent articles retrieved by a PubMed/Embase database search between 1961 and December 2018. RESULTS: Out of 63 patients with synchronous tumors reported in 43 publications, we found 3 patients in which the tumor was removed by EEA. In these 3 patients and the presented case, the resection of both lesions was successful, without major approach-related morbidity or mortality. More extensive removal of endonasal structures to gain an adequate tumor exposure was not necessary. We did not find any previous reports describing the benefits of intraoperative MRI in the presented setting. CONCLUSIONS: In the rare case of a synchronous meningioma and pituitary adenoma of the sellar region, intraoperative MRI might be beneficial in confirming residual disease before skull base reconstruction, and therefore radiologic follow-up.


Assuntos
Adenoma/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade
13.
World Neurosurg ; 135: 234-240, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863889

RESUMO

BACKGROUND: In our series, the gravity-assisted ipsilateral paramedian approach was shown to be safe and advantageous for the resection of parafalcine meningioma, because it does not result in contralateral brain impingement and does not require brain retraction. We have reported the technical details of this method and the outcomes of our patients. METHODS: From September 2018 to September 2019, 10 consecutive patients with parafalcine meningioma underwent microsurgery using the gravity-assisted ipsilateral paramedian approach. The clinical data, radiological images, and surgical outcomes were collected and analyzed. RESULTS: All 10 patients (5 men and 5 women, mean age, 55.8 ± 12.5 years) underwent safe tumor resection. Of the 10 tumors, 6 were located in the frontal area, 2 in the parietal area, and 2 in frontal and parietal area. The superior sagittal sinus wall had been affected in 6 patients. Obvious perilesional edema was observed in 60% of the patients. During surgery, bridging veins were encountered in 8 patients and were preserved, except for a small branch. Brain retraction or transgression was not required, and gross total resection was achieved in all 10 patients. No major postoperative complications occurred, except for an unexpected subacute subdural hematoma 1 month postoperatively. All 10 patients had achieved a favorable outcome (Glasgow outcome scale, ≥ 4) at discharge, which remained the same after a mean follow-up of 5.8 ± 3.7 months. CONCLUSIONS: The results from the present case series have demonstrated the safety of the gravity-assisted ipsilateral paramedian approach for parafalcine meningioma resection. The approach provides good tumor exposure and clear identification and preservation of bridging veins, does not result in contralateral brain impingement, and does not require excessive brain retraction.


Assuntos
Gravitação , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Posicionamento do Paciente/métodos , Adulto , Idoso , Dura-Máter , Feminino , Escala de Resultado de Glasgow , Hematoma Subdural/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
14.
World Neurosurg ; 135: e452-e458, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843725

RESUMO

OBJECTIVE: Many neurosurgeons prefer conservative treatments in the elderly because of higher rates of mortality and morbidity after surgery. We aim to evaluate safety and efficacy of surgery in elderly patients with frontobasal and suprasellar meningiomas with a simple operative procedure, the frontolateral approach. METHODS: Retrospective analysis was made in consecutive patients with meningiomas operated via frontolateral approach. They were divided into 2 groups: elderly group (age ≥ 65 years) and young group (age < 65 years). Multivariate logistic regression analysis was performed for postoperative complications and Karnofsky Performance Scale score (KPS). RESULTS: The study comprises 128 patients operated over a 19-year period, of which 35 patients were in the elderly group and 93 patients were in the young group. More elderly patients presented with American Society of Anesthesiology (ASA) class II and III (57.1% vs. 43%). Gross resection was achieved in 31 cases in the elderly and 85 cases in young group (88.6% vs. 90.3%, P = 0.17). Postoperative KPS in both groups was improved (85.7% vs. 91.4%, P = 0.18). One death occurred in elderly group (2.9%, P = 0.27). Approach-related and medical morbidity in the elderly group was slightly higher than in the young group without significant difference (respectively, 11.4% and 14.3% vs. 9.7% and 8.6%, P = 0.18). Multivariate logistic regression showed increasing age was not associated with approach-related morbidity (odds ratio [OR]: 1.39, P = 0.53), medical morbidity (OR: 1.94, P = 0.88), and improvement of KPS (OR: 0.32, P = 0.25). CONCLUSIONS: Frontobasal and suprasellar meningiomas in elderly patients can be treated surgically with acceptably low morbidity and mortality rates via the frontolateral approach. Preoperative KPS score ≤60 and ASA classification ≥III predict an unfavorable postoperative outcome.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Adulto Jovem
15.
Pan Afr Med J ; 34: 5, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762874

RESUMO

Introduction: We aimed to discuss surgical approaches and results that we applied foramen magnum meningiomas. Methods: We retrospectively investigated 11 foramen magnum meningioma cases, who had been operated between the dates of February 2012 and March 2017. Results: Eight of the patients were females and 3 of the patients were males, the age range was 32-75 and the age average was 60.8. 5 of the tumors were anatomically localized as posterolateral, 2 of them were localized as anterolateral, 2 of them were localized as lateral and 2 of them were localized as anterior according to the brain stem or spinal cord. Posterior far lateral (4 patients) approach including C1 laminoplasty (7 patients) and 1/3 condyle resection was surgically applied to the patients with median suboccipital craniotomy. Gross total excision was applied to 82% of the patients (9 patients) and subtotal mass excision was applied to 18% (2 patients) of the patients. The most frequent post-operative complications were temporary lower cranial nerve (CN IX and X ) palsy in our 2 anterior localized cases (18%) and also cerebrospinal fluid (CSF) fistula in our 1 anterior localized case with difficulty in swallowing (dysphagia). Karnofsky scores of the patients, who were followed for 18 months in post-operative 12 and 48 months of average, in the last follow-up were 80 and no post-operative mortality occurred. Conclusion: Posterior midline suboccipital and far lateral approaches that we apply in our own series were appropriate approaches for foramen magnum meningiomas.


Assuntos
Forame Magno/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Forame Magno/patologia , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 98(47): e18076, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764840

RESUMO

RATIONALE: Hemangioblastoma (HB) is a benign tumor that is typically located in the subtentorial region of the brain. HB that originates from dura mater is extremely rare. PATIENT CONCERNS: Herein, we reported a single case of a patient who presented with dizziness and headache lasting for 1 year that progressively aggravated within 1 month. DIAGNOSIS: After admission, the patient underwent head magnetic resonance (MR); a nodular long T1-T2 signal was found on the right side of parietal falx cerebri; the lesion appeared with high intensity on FLAIR and DWI, and with isointensity on ADC map. In addition, significant homogeneous enhancements were observed on the enhanced scan. According to clinical and imaging features, the lesion was diagnosed as meningioma. However, after performing tumor resection by craniotomy, the diagnosis of HB is clear. Additional pathological examination data were found: Ki-67(+1%), NSE(-), CD31(+), CD34(+), CD56(+), S-100(-), α-inhibin(+), Vimentin(-), EGFR-), GFAP(-), CK-pan(-), EMA(-), PR(-). INTERVENTIONS: The mass with abundant blood supply was removed. OUTCOMES: Ten days after operation, the patient was discharged from hospital and no signs of recurrence were observed three months later. LESSONS: To sum up, obvious high signal intensity in T2WI sequence and homogeneous enhancement are main characteristics that differentiate dural hemangioblastoma from meningioma lesion.


Assuntos
Dura-Máter , Hemangioblastoma , Neoplasias Meníngeas , Idoso , Feminino , Hemangioblastoma/diagnóstico , Hemangioblastoma/cirurgia , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirurgia
17.
Anticancer Res ; 39(11): 6299-6305, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704860

RESUMO

BACKGROUND/AIM: A minority of grade I meningiomas (MG1s) recur after surgical resection and their progression is associated with high grade transformation (HGT). This study aimed to characterize the clinicoradiological features of recurrent MGs (RMG) with HGT. PATIENTS AND METHODS: We identified 17 patients diagnosed with MG1 who then underwent surgery for RMG. Patients were categorized into HGT group vs. non-HGT (nHGT) group based on RMG histological grade and clinicoradiological features were comparatively analyzed. RESULTS: HGT was observed in 41.4% of RMGs. Original tumor size was larger in the HGT group and recurrence time interval was shorter. Following recurrence, 57.1% in the HGT group experienced further disease progression, compared to 22.2% in the nHGT group. CONCLUSION: A considerable HGT rate in RMGs developed after MG1 was observed. Although HGT was not distinguished from nHGT by radiological features, HGT in RMG was associated with larger initial tumor size and shorter recurrence time interval.


Assuntos
Transformação Celular Neoplásica/patologia , Neoplasias Meníngeas/patologia , Meningioma/patologia , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
18.
Zh Vopr Neirokhir Im N N Burdenko ; 83(4): 121-125, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31577278

RESUMO

For many years, radical surgery was considered the only effective method for treating meningiomas, including parasagittal meningiomas (PSM). However, accumulated experience makes it evident that extensive resections in the parasagittal region lead to impaired venous outflow and involve high rates of disability and mortality. In recent decades, stereotactic radiotherapy has been developed and widely implemented in practical neurosurgery, its role in the treatment of PSM patients is discussed in this work. MATERIAL AND METHODS: A sample of publications in the PubMed search system was taken using the following keywords: meningioma, parasagittal, superior sagittal sinus, stereotactic radiosurgery, stereotactic radiation therapy. No publications of evidence levels 1 and 2 have been found. Out of 123 works, 32 most relevant were selected. RESULTS AND DISCUSSION: Currently, both neurosurgeons and radiologists are involved in the treatment of PSM. An analytical review of the literature on the treatment of PSM is presented. Both surgical treatment and radiation therapy have their pros and cons. No general approach to the treatment of these tumours has been developed to date. A comprehensive treatment is considered to be effective - the maximum possible removal of the tumor without damaging functionally significant structures, including venous outflow pathways, followed by radiotherapy for tumor residues. CONCLUSION: In the existing literature, it was not possible to identify a single decision-making algorithm for the tactics of multimodality therapy for PSM patients, including the one for manipulations on the superior sagittal sinus and with regard to the role of ir irradiation radiation methods.


Assuntos
Neoplasias Meníngeas , Meningioma , Radiocirurgia , Humanos , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Meningioma/radioterapia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos , Seio Sagital Superior
19.
Cancer Invest ; 37(9): 501-505, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583922

RESUMO

Leptomeningeal metastasis (LM) in solid tumors are rare, even more in renal cell carcinoma (RCC). To date there is a lack of consensual treatment modalities of leptomeningeal metastasis. Furthermore, with the improvement of outcomes and more effective systemic targeted therapies, the management of leptomeningeal metastasis becomes a real challenge. We here report two cases of RCC with leptomeningeal metastasis at initial diagnosis. Both patients had concurrent adjacent skull bone metastasis. Therapeutic management of both patients consisted in surgical resection, followed by radiotherapy in one case. Systemic treatment was delayed according to current recommendations for the management of metastatic RCC. The aim of this work is to report the therapeutic approach and related outcomes and also provide a review of the currently available literature on leptomeningeal disease in renal cell carcinoma. Indeed, local treatment with curative outcome of meningeal location in RCC should be performed specially in LM at initial diagnosis.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Neoplasias Meníngeas/secundário , Neoplasias Cranianas/secundário , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/radioterapia , Terapia Combinada , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/radioterapia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Neoplasias Cranianas/radioterapia , Neoplasias Cranianas/cirurgia , Sunitinibe/uso terapêutico , Resultado do Tratamento
20.
Klin Monbl Augenheilkd ; 236(11): 1312-1317, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31509885

RESUMO

Meningiomas are slow growing tumours, usually becoming symptomatic with visual loss or diplopia, or they are found incidentally. Not all meningiomas need to be treated. Treatment consists of neuro-surgical removal or radiotherapy if surgery is not possible. Whether a meningioma of the anterior visual pathways needs to be treated is mainly determined by the ophthalmological state. This must also include assessment of the prognosis by evaluation of the clinical findings and OCT scanning. This contribution is intended as an overview of all relevant factors with meningiomas of the anterior visual pathways. It is mainly based on the authors' own experiences.


Assuntos
Neoplasias Meníngeas , Meningioma , Transtornos da Visão , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/cirurgia , Prognóstico , Transtornos da Visão/etiologia , Vias Visuais
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