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1.
Am J Phys Med Rehabil ; 100(1): 100-104, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534219

RESUMO

ABSTRACT: The incidence of leptomeningeal disease (LMD) is believed to be increasing in part because of more effective chemotherapy treatments allowing cancer progression behind the blood-brain barrier. However, little has been published about the rehabilitation of this growing patient population. In this study, impairments and rehabilitation utilization by cytology-proven LMD patients receiving intrathecal chemotherapy at a cancer center are described. A total of 109 consecutive patients with pathology-confirmed LMD who received an intrathecal chemotherapy infusion from January 1, 2017, through October 31, 2017, were retrospectively reviewed. Of the 109 patients, 103 (95%) had impairments described in their medical record that could impact physical function, including 74 of 109 (68%) who had deconditioning or fatigue. Kaplan-Meier median survival from initial LMD diagnosis was 13.1 mos. The median number of hospital admissions and intrathecal chemotherapy administrations was both 8. Of the 109 patients, 43 (39%) had magnetic resonance imaging radiology interpreted LMD. Most LMD patients used rehabilitation services (95/109, 87%) and most were able to forego post-acute inpatient rehabilitation facilities (96/109, 88%). Additional research and education for rehabilitation professionals about this increasingly common syndrome are needed.


Assuntos
Neoplasias Encefálicas/reabilitação , Fadiga/reabilitação , Neoplasias Meníngeas/reabilitação , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/tratamento farmacológico , Fadiga/etiologia , Feminino , Humanos , Injeções Espinhais , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/tratamento farmacológico , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
2.
BMC Neurol ; 21(1): 25, 2021 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-33451289

RESUMO

BACKGROUND: Meningiomas are the most common benign intracranial tumors, and commonly comprise high-vascularizing but slow-growing tumors. On the other hand, meningiomas arising from the ventricular system are of rare occurrence, and spontaneous hemorrhage is an infrequent event. CASE PRESENTATION: We describe here the rare clinical manifestations of a 28-year-old female with acute intracranial hemorrhage located in the trigone of the lateral ventricle who was initially thought to have suffered an acute cerebrovascular accident, but was subsequently confirmed to have a benign intraventricular meningioma. To clarify the clinical features of such a rare course of meningioma, we also present a short literature review of acute intracranial hemorrhage caused by intraventricular meningioma. CONCLUSIONS: Ventricular meningioma presenting with hemorrhage such as acute stroke is a rare event, but recognition of such a pathogenesis is important. Although further accumulation of clinical data is needed, we suggest that early surgery should be undertaken in patients with lateral ventricular meningioma, even if it is not so large or asymptomatic.


Assuntos
Neoplasias do Ventrículo Cerebral/complicações , Hemorragias Intracranianas/etiologia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Adulto , Neoplasias do Ventrículo Cerebral/patologia , Feminino , Humanos , Ventrículos Laterais/patologia , Neoplasias Meníngeas/patologia , Meningioma/patologia
3.
Medicine (Baltimore) ; 99(50): e23504, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327290

RESUMO

RATIONALE: Solitary fibrous tumor is a rare mesenchymal tumor. This case report describes the diagnosis and treatment of this tumor. PATIENT CONCERNS: A 31-year-old patient presented with epileptic seizure and headache 1 day prior to the visit and showed transient right limb hemiplegia for 6 hours that was resolved after intravenous infusion of mannitol. DIAGNOSES: Based on imaging, the provisional diagnosis was meningioma. Postsurgical histopathological diagnosis confirmed solitary fibrous tumor. INTERVENTIONS: The lesion was totally excised. The patient improved remarkably after the operation, without any signs of associated limb movement disorder. No epileptic seizure was observed or reported after the operation. OUTCOMES: Postoperation computed tomography (CT) scans showed no obvious residual tumor. The patient was followed up every 3 months for a total of 1 year following the operation, during which time the patient did not complain of headache or seizure. LESSONS: The manifestation of solitary fibrous tumor (SFT) through imaging methods has certain specific findings,butimmunohistochemistry is still very important for confirming the diagnosis.


Assuntos
Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Adulto , Diagnóstico Diferencial , Cefaleia/etiologia , Hemiplegia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Lobo Parietal , Convulsões/etiologia , Tomografia Computadorizada por Raios X
4.
Medicine (Baltimore) ; 99(44): e23028, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126391

RESUMO

RATIONALE: Tumor-to-tumor metastasis is a rare clinical phenomenon. Although meningioma is the most common intracranial recipient of cancer metastasis, only a few cases have been reported. We present a case of metastasis of lung adenocarcinoma into intracranial meningioma and review the published literature. PATIENT CONCERNS: A 70-year-old woman was admitted to our hospital for a 1-month history of headache and pain in her lower extremities. DIAGNOSIS: Brain and lumbar vertebral magnetic resonance imaging showed an intracranial space-occupying lesion in the right occipital region and spinal canal stenosis. Pulmonary computed tomography showed an irregular mass in the right upper lobe of the lung. The postoperative histological examination demonstrated adenocarcinoma metastasis to meningioma. INTERVENTION: The patient underwent right occipital craniotomy for tumor removal and lumbar spinal canal decompression. OUTCOMES: There were no initial abnormal conditions after the operation. However, the patient died suddenly 7 days after surgery. LESSONS: Tumor-to-meningioma metastasis is a rare but important phenomenon. According to previous reports, it is associated with rapid onset of symptoms and a poor prognosis. Histological examination is of great importance in diagnosis. The history and process of malignant carcinoma should be closely monitored.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Idoso , Craniotomia , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/secundário , Meningioma/complicações , Meningioma/diagnóstico por imagem , Meningioma/secundário , Metástase Neoplásica , Lobo Occipital
7.
World Neurosurg ; 139: e761-e768, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360921

RESUMO

BACKGROUND: Symptomatic trigeminal neuralgia caused by small (<3 cm) skull base meningiomas is treated by radiosurgery or surgical resection. Although radiosurgery is less invasive, surgical resection provides more rapid resolution of symptoms. We reviewed a short series of patients who underwent an anterior transpetrosal approach for surgical resection of meningiomas causing trigeminal neuralgia. METHODS: A retrospective review of 5 consecutive patients with meningiomas causing trigeminal neuralgia of the senior author was included. Preoperative parameters (size, proximity to critical neurovascular structures, presence of brainstem compression), intraoperative parameters (Simpson grade of resection, loss of brainstem evoked potentials, surgical approach), and outcomes (symptom resolution, extent of resection, follow-up) were recorded. RESULTS: Patient median age was 67 years (range, 60-73 years). All patients had symptoms concerning trigeminal neuralgia with 2 having associated areas of facial numbness. The anterior transpetrosal approach was used to achieve complete resection (Simpson grade I). Postresection, the trigeminal nerve and brainstem were clearly visible to evaluate neurovascular structures and ensure decompression. No postoperative complications were reported, and all patients experienced sustained symptomatic relief 1 month postsurgery. CONCLUSIONS: With the advent of radiosurgery for skull base meningiomas, surgical resection is not always considered; however, such meningiomas causing trigeminal neuralgia can be resected safely using the anterior transpetrosal approach allowing rapid resolution of symptoms. This review of operative nuances provides a guide for neurosurgeons to provide safe surgical resection.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Neuralgia do Trigêmeo/etiologia , Idoso , Feminino , Humanos , Masculino , Neoplasias Meníngeas/complicações , Meningioma/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Base do Crânio/complicações
8.
World Neurosurg ; 139: 242-244, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32330619

RESUMO

BACKGROUND: Some petroclival meningiomas cause trigeminal nerve compression, leading to disabling trigeminal neuralgia (TN). Tumor resection and nerve decompression can offer pain relief but might not be feasible in all patients. Simultaneous stereotactic radiosurgery (SRS) to the tumor and nerve is another option. SRS is an effective means of treating meningiomas and TN separately, but data on the efficacy and outcomes of their concomitant treatment are limited. CASE DESCRIPTION: We report a series of 4 patients who presented with TN secondary to a petroclival mass causing compression of the trigeminal nerve. All patients underwent SRS to both the petroclival mass and trigeminal nerve in a single session. The average margin tumor dose was 12.25 Gy (range, 12-12.5 Gy), and the average maximum trigeminal nerve dose was 80 Gy (range, 75-85 Gy). In all patients, before intervention, the Barrow Neurologic Institute (BNI) pain intensity score was grade IV or V. At last follow-up (average, 29.8 months), all patients were pain-free (BNI I or IIIA). Two patients experienced reduced facial sensation in 1 or all 3 distributions. No brainstem edema was seen. CONCLUSIONS: This series highlights the benefits and safety of simultaneous treatment of petroclival tumors and the trigeminal nerve in a single session for patients affected by tumor-related TN.


Assuntos
Neoplasias Meníngeas/complicações , Meningioma/complicações , Radiocirurgia/métodos , Nervo Trigêmeo/efeitos da radiação , Neuralgia do Trigêmeo/radioterapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/radioterapia , Manejo da Dor/métodos , Neuralgia do Trigêmeo/etiologia
9.
World Neurosurg ; 139: 588-591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32344145

RESUMO

BACKGROUND: Orbital compartment syndrome (OCS) is a rare post operative complication of Neurosurgery. It presents typically acutely with loss of vision, loss of pupillary reaction, and limitation of extraocular movement. The etiology of OCS is most typically associated with increased pressure from a mass lesion in the orbit compromising the blood supply of orbital structures. Emergent bedside decompression of the orbit by lateral canthotomy is indicated to quickly treat OCS in an attempt to save visual acuity and extraocular function. CASE DESCRIPTION: We report a 76-year-old male patient whose magnetic resonance imaging of the brain demonstrated an anterior right frontal broad dural-based homogenously enhancing mass measuring 6.0 × 3.1 × 6.3 cm after he presented with 1-year of progressive cognitive dysfunction. A right-sided pterional craniotomy and resection of mass was performed under general anesthesia, with an uncomplicated intraoperative course. Postoperatively, the right eye was noted to have an afferent pupillary defect, complete ophthalmoplegia, ptosis, and significant resistance to retropulsion. Emergent ophthalmologic consultation confirmed the ocular examination, and the diagnosis of right OCS was suspected. A right lateral canthotomy and cantholysis was performed by the ophthalmologist at the bedside. The fundoscopic retinal evaluation was normal. Noncontrast computed tomography of the head demonstrated expected postoperative changes and mild edema of the right frontal lobe without evidence of acute hemorrhage. There was no retro-orbital hematoma, but the right extra-ocular muscles appeared edematous compared to the left. No light perception and ophthalmoplegia continued in the right eye. CONCLUSIONS: This case demonstrates that although very rare, OCS can occur without compression of the eye or an intra-orbital mass. Visual loss is a devastating complication. Constant vigilance to ensure adequate arterial and venous supply to the orbit, with great care to prevent external compression on the eye, hopefully, will continue to make this complication rare.


Assuntos
Neoplasias Encefálicas/cirurgia , Síndromes Compartimentais/cirurgia , Craniotomia/métodos , Lobo Frontal/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Órbita/cirurgia , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/etiologia , Descompressão Cirúrgica/métodos , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/complicações , Meningioma/diagnóstico por imagem , Órbita/diagnóstico por imagem
10.
Wiad Lek ; 73(3): 541-545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32285830

RESUMO

OBJECTIVE: The aim: To study the effect of epileptic seizures in patients with supratentorial brain meningiomas on the clinical course of meningiomas in the early and late postoperative period. PATIENTS AND METHODS: Materials and methods: A retrospective analysis of the course of the disease was performed in 242 patients with total removed supratentorial meningioma of the brain (general group). Long-term outcome of the disease was estimated in 176 people (a catamnesis group). RESULTS: Results: The occurrence of a new neurological deficit was observed in 18 (18.0±3.8 %) patients out of 100 among patients with epileptic seizures before surgery and in 19 (13.4±2.9 %) out of 142 among those who had no seizures. The mortality rate was 1 (1.0±1.0 %) in the group of patients with seizures and 3 (2.8±1.4 %) in the group of patients without seizures before surgery. The prevalence of new neurological deficits in the catamnesis group is 14 (19.2±4.6 %) of 73 patients with epileptic seizures before surgery and 17 (16.5±3.7 %) of 103 patients without seizures. Mortality was 3 cases (4.1±2.3 %) in patients with seizures and 9 cases (8.7±2.8 %) among patients without seizures. CONCLUSION: Conclusions: No data have been obtained that the presence of epileptic seizures affects the incidence of new neurological deficits, complications and mortality after surgical treatment of meningiomas in the early and late postoperative period.


Assuntos
Neoplasias Meníngeas , Meningioma , Convulsões/etiologia , Encéfalo , Humanos , Neoplasias Meníngeas/complicações , Meningioma/complicações , Complicações Pós-Operatórias , Estudos Retrospectivos
13.
World Neurosurg ; 137: 337, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32081824

RESUMO

A 66-year-old woman presented with a 4.5- × 4-cm left posterior parafalcine meningioma and visual loss in her left eye (Video 1). Prior to meningioma embolization, angiography confirmed an incidental high-risk falcotentorial dural arteriovenous fistula (DAVF) with pial tectal arteriovenous malformation (AVM) and flow-related aneurysms of the superior cerebellar artery (SCA) and posterior cerebral artery (PCA). Arterial supply to the AVM/DAVF consisted of branches of the middle meningeal artery, tentorial branches of the internal carotid arteries, and the PCA and SCA. Drainage into the vein of Galen (VG) and venous reflux into the precentral cerebellar vein (PCCV) were identified. The patient underwent transarterial embolization of the DAVF via the left middle meningeal artery using Onyx with a significant decrease of arterial venous shunting. A semi-sitting supracerebellar approach was performed. The subarachnoid space of the tentorium, cerebellar hemispheres, vermis, quadrigeminal, and ambient cisterns was dissected to reveal the boundaries of the lesion. Indocyanine green video angiography was done before and after in situ occlusion to identify the arterial supply and early venous drainage. The vascular lesion was disconnected circumferentially around the edges of the pial portion of the AVM, and the feeders were carefully cauterized and cut. The vessels on the surface of the brainstem were occluded in situ to prevent any parenchymal transgression. Finally, the drainage into the VG and the venous reflux to the PCCV were ligated. Postoperative angiography showed no residual DAVF or AVM and regression of aneurysms. The patient was discharged with no added deficits, and the meningioma was totally resected several months later.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Aneurisma Intracraniano/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Idoso , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Veias Cerebrais , Embolização Terapêutica , Feminino , Humanos , Achados Incidentais , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Artérias Meníngeas , Neoplasias Meníngeas/complicações , Meningioma/complicações , Teto do Mesencéfalo
14.
Cancer Imaging ; 20(1): 15, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024553

RESUMO

BACKGROUND: Mature cystic teratoma (MCT) with meningioma of the ovary is a very rare benign tumor. There is only 3 reports of this disease until June 2019. The aim of the present study was to describe a ovarian mature cystic teratoma containing meningioma and nests of neuroblasts in a 15-year-old girl. METHODS: The method used in the present study consists of description of the clinical history, image lab features, and pathological result. RESULTS: The patient complained of a 2-month history of irregular vaginal bleeding. Abdominal computed tomography (CT) showed a large oval cystic-solid mass with septations and fat density shadow, in abdomen pelvic cavity. The cystic part was the main component in the mass. The tumoral solid parts and its internal division could be seen intensified from slight to moderate on contrast-enhanced CT images compared with those on precontrast images, and the solid parts showed heterogeneous enhancement. Neighbouring intestinal tract and the uterus displaced by compression. The pathological examination confirmed the diagnosis. CONCLUSIONS: The clinical feature of ovarian mature cystic teratoma with meningioma includes a lack of specificity. Only meticulous recording of the gross features, histopathological examination including immunohistochemistry and supportive clinical and radiological findings to arrive at a correct diagnosis in case of unconventional tumours. If necessary, preoperative puncture can be performed.


Assuntos
Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Adolescente , Feminino , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Meningioma/complicações , Meningioma/patologia , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Teratoma/complicações , Teratoma/patologia , Tomografia Computadorizada por Raios X
15.
World Neurosurg ; 139: e1-e12, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32001400

RESUMO

OBJECTIVE: Sphenoid wing meningiomas (SWMs) can be treated with complete surgical resection and the recently introduced endoscopic transorbital approach (ETOA) offers a minimally invasive alternative. In this study, the surgical outcome of ETOA and the extended mini-pterional approach (eMPTA) for SWMs with osseous involvement is compared. METHODS: From October 2015 to May 2019, 24 patients underwent surgery for SWMs with osseous involvement. Among them, tumor resection was performed by ETOA for 11 patients (45.8%) and eMPTA for 13 patients (54.2%). The tumor characteristics, surgical outcome and morbidity, and approach-related aesthetic outcome were analyzed and compared retrospectively between ETOA and eMPTA based on SWM classification. RESULTS: The location of SWMs was mostly the middle sphenoid ridge (group III) (45.8%), followed by the greater sphenoid wing (group IV) (29.2%). Simpson resection grades I/II were achieved in 9 of 11 patients (81.8%) with ETOA and 11 of 13 patients (84.6%) with eMPTA. There were no differences in tumor characteristics between the 2 approaches. Surgery time, surgical bleeding, and hospital length of stay were significantly shorter with ETOA. Three patients had transient surgical morbidities such as diplopia (n = 1), ptosis (n = 1), and cerebrospinal fluid leak (n = 1) after ETOA. No differences could be seen in surgical morbidities between ETOA and eMPTA. CONCLUSIONS: ETOA can provide direct access to the sphenoid bone and resectability with a more rapid and minimally invasive exposure than does eMPTA. Maximal subtotal resection with extensive sphenoid bone decompression for tumors with cavernous sinus infiltration is the key to a good clinical outcome, regardless of the surgical approach.


Assuntos
Hiperostose/cirurgia , Tempo de Internação/estatística & dados numéricos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neuroendoscopia/métodos , Duração da Cirurgia , Osso Esfenoide , Adulto , Idoso , Blefaroptose/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Fossa Craniana Média , Diplopia/epidemiologia , Feminino , Humanos , Hiperostose/complicações , Hiperostose/diagnóstico por imagem , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Meningioma/complicações , Meningioma/diagnóstico por imagem , Meningioma/patologia , Pessoa de Meia-Idade , Órbita , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
World Neurosurg ; 136: 311-314, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32004738

RESUMO

BACKGROUND: Primary meningeal melanomatosis is a rare leptomeningeal tumor, and the diagnosis is challenging due to nonspecific clinical symptoms and radiologic findings. CASE DESCRIPTION: A 21-year-old man presented with recurrent seizure and impaired memory. Cranial magnetic resonance imaging showed obvious brain atrophy with bilateral extensive meningeal enhancement in the supratentorial region. Diffusion-weighted imaging and fluid-attenuated inversion recovery showed slightly hyperintensive signals in the cortex. Microscopic examination revealed invasion of pigment into the Virchow-Robin space and cortex. Immunohistochemical examination of biopsy samples showed that cells were immunopositive for HMB45 and S-100 and immunonegative for melan-A with a Ki-67-positive percentage of 3%. No obvious atypia or nuclear mitosis was observed. Pathohistologic results of biopsied meninges confirmed the diagnosis of diffuse meningeal melanomatosis. The disease was aggravated with the occurrence of brain atrophy, recurrent seizure, and declined higher cortical function. CONCLUSIONS: This case report illustrates that brain atrophy in meningeal melanomatosis is associated with a progressive decline of higher cortical function.


Assuntos
Encéfalo/patologia , Melanoma/patologia , Neoplasias Meníngeas/patologia , Neoplasias Supratentoriais/patologia , Atrofia/etiologia , Biópsia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Demência/etiologia , Imagem de Difusão por Ressonância Magnética , Progressão da Doença , Humanos , Masculino , Melanoma/complicações , Neoplasias Meníngeas/complicações , Convulsões/etiologia , Neoplasias Supratentoriais/complicações , Adulto Jovem
17.
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
18.
J Neurooncol ; 147(1): 15-24, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31981014

RESUMO

PURPOSE: Although intracranial meningiomas are the most common primary brain tumor in adults, treatment options are few and have traditionally been limited to surgical resection and radiotherapy. Additional targeted therapies and biomarkers are needed, especially as complete surgical resection is frequently not feasible in many patients. METHODS: Non-pathologic brain tissue from 3 patients undergoing routine autopsies and tumor specimens from 16 patients requiring surgical resection for meningioma were collected. EMP2 protein expression was evaluated by immunohistochemistry and western blot analysis. EMP2 mRNA expression was also investigated using surgical specimens and validated by analysis of several independent NCBI GEO databases. RESULTS: EMP2 mRNA expression levels were found to be higher in meningioma relative to non-pathologic meninges (P = 0.0013) and brain (P = 0.0011). Concordantly, strong EMP2 protein expression was demonstrated in 100% of meningioma specimens from all 16 patients, with no observable protein expression in normal brain tissue samples from 3 subjects (P < 0.001). EMP2 expression was confirmed by western blot analysis in five samples, with EMP2 protein intensity positively correlating with histologic staining score (R2 = 0.780; P = 0.047). No association was found between EMP2 mRNA or protein levels and WHO grade or markers of proliferation. However, EMP2 expression was positively associated with an angiomatous pattern on histologic evaluation (P = 0.0597), VEGF-A mRNA expression (P < 0.001), and clinical markers of tumor vascularity such as operative blood loss (P = 0.037). CONCLUSIONS: EMP2 is not found in normal brain tissue, yet has shown consistently high mRNA and protein expression in meningiomas, and may serve as a useful molecular marker for these tumors.


Assuntos
Regulação Neoplásica da Expressão Gênica , Glicoproteínas de Membrana/metabolismo , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/patologia , Meningioma/metabolismo , Meningioma/patologia , Neovascularização Patológica/metabolismo , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Masculino , Glicoproteínas de Membrana/genética , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/genética , Meningioma/complicações , Meningioma/genética , Pessoa de Meia-Idade , Neovascularização Patológica/complicações , Neovascularização Patológica/genética , RNA Mensageiro/metabolismo
19.
World Neurosurg ; 134: 577-579, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790839

RESUMO

BACKGROUND: Spontaneous downbeat nystagmus is a finding that raises suspicions of a central nervous system disorder. Vermis and lower brainstem lesions are considered to be responsible, but the exact mechanism is still controversial. We observed a rare case of spontaneous downbeat nystagmus caused by an infratentorial meningioma. CASE DESCRIPTION: A 50-year-old woman was incidentally diagnosed with infratentorial tumor. Later, she suffered from oscillopsia and the symptom disturbed her daily life especially while driving. Magnetic resonance imaging showed a tumor of approximately 30 mm in diameter at the dorsal midline of the posterior fossa. The tumor was compressing the cerebellar vermis and was apparently responsible for the symptoms that affected her daily life; therefore, we decided to perform tumor removal. The postoperative course was uneventful, and the spontaneous downbeat nystagmus completely disappeared. CONCLUSIONS: Vertical nystagmus is a finding that raises suspicion of a central nervous system disorder, and requires detailed examination. In addition, in case of vertical nystagmus because of tumor compression of the vermis, removal of the tumor can be an effective treatment.


Assuntos
Neoplasias Infratentoriais/cirurgia , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/cirurgia , Nistagmo Patológico/etiologia , Encéfalo/patologia , Feminino , Humanos , Neoplasias Infratentoriais/complicações , Neoplasias Infratentoriais/diagnóstico , Imagem por Ressonância Magnética/efeitos adversos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/cirurgia , Resultado do Tratamento
20.
J Clin Neurosci ; 71: 281-283, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31843434

RESUMO

We report the case of a falcotentorial meningioma presenting only with binocular, horizontal diplopia in an otherwise healthy sixty-two-year old male. Review of the established literature highlights a lack of consensus regarding management of this extremely rare pineal region tumor. Complete surgical resection ultimately remains the ideal therapeutic option but surgical excision continues to bear serious risk of neurologic and ophthalmic morbidity, including hemianopia and cortical visual impairment. We advocate that a multidisciplinary approach focusing on patient values is critical in treatment of these uncommon lesions. Cerebrospinal fluid diversion in this patient achieved successful resolution of symptoms secondary to intracranial hypertension whilst facilitating close surveillance.


Assuntos
Diplopia/etiologia , Hidrocefalia/cirurgia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Derivação Ventriculoperitoneal/métodos , Humanos , Hidrocefalia/etiologia , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Pessoa de Meia-Idade
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