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1.
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
2.
World Neurosurg ; 135: 297-300, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899391

RESUMO

BACKGROUND: Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a recent addition to the World Health Organization classification schema of brain tumors, under the heading of neuronal and mixed neuronal-glial tumors. DLGNTs have a classic imaging appearance. However, it has often been misdiagnosed owing to its rarity, its resemblance to granulomatous/leptomeningeal etiologies, and the clinical presentation. CASE DESCRIPTION: We have described the case of a 3-year-old girl who had presented with complaints of nonprojectile vomiting and altered sensorium that had been initially diagnosed and treated as a case of tubercular meningitis at a peripheral health facility. However, the nonresponse to antitubercular medication necessitated a repeat magnetic resonance imaging evaluation at our institute, which had revealed the classic imaging appearance of DLGNT. The diagnosis was further established by meningeal biopsy and the histopathological evaluation findings. CONCLUSION: We have described the classic imaging appearance of this rare brain tumor. Radiologists and clinicians should be aware of this entity to avoid misdiagnosis and a delay in management.


Assuntos
Glioma/patologia , Neoplasias Meníngeas/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Pré-Escolar , Feminino , Glioma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Neurocitoma/diagnóstico por imagem , Neurocitoma/patologia , Oligodendroglioma/diagnóstico por imagem , Oligodendroglioma/patologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Tomografia Computadorizada por Raios X
3.
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
4.
World Neurosurg ; 133: 69-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550540

RESUMO

BACKGROUND: Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare non-Langerhans cell reactive histiocytic disorder that rarely occurs in the central nervous system (CNS). Extranodal RDD most frequently involves the skin, upper respiratory tract, soft tissue, gastrointestinal tracts, bones, breast, and CNS. CASE DESCRIPTION: RDD of the CNS infiltrates most commonly the dura of the sella, cavernous sinus, and the periclival regions. It is usually clinically and radiologically mistaken for meningioma because of its focal dural-based aspect. RDD is confirmed histologically by lymphoplasmacytic cells and histiocytes of varying size showing emperipolesis (lymphocytophagocytosis). To date, only 4 cases of RDD displaying spinal cord compression secondary to craniocervical junction involvement have been reported. CONCLUSION: We report the case of a patient diagnosed with RDD localized at the foramen magnum extending to the base of the odontoid process and involving the V4 segment vertebral artery.


Assuntos
Histiocitose Sinusal/cirurgia , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Artéria Vertebral/cirurgia , Diagnóstico Diferencial , Histiocitose Sinusal/diagnóstico por imagem , Histiocitose Sinusal/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia
5.
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
6.
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
7.
J Clin Ultrasound ; 48(1): 52-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31120556

RESUMO

Meningiomas are extra-axial tumors with a long-standing indolent clinical course. Sphenoid wing meningiomas may slowly grow, spreading toward the orbitofrontal and temporal regions as well as encasing the middle cerebral artery (MCA). Herein, we report the incidental finding of a sphenoid wing meningioma compressing the MCA in a patient who undergone a transcranial sonography study for recurrent speech disorders. We illustrate the associated sonographic "red flags" which should prompt to suspect an underlying compressive space-occupying lesion.


Assuntos
Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Humanos , Masculino , Pessoa de Meia-Idade
9.
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
10.
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
11.
J Craniofac Surg ; 30(8): e799-e802, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633669

RESUMO

OBJECTIVES: The aim of the study was to investigate the association between meningioma volume and the occurrence of clinic-radiologic signs of tumor aggressiveness. For volumetric approximation, the authors evaluated the method of semiautomatic image segmentation at hand of high-resolution MRI-image sequences. METHODS: ITK-SNAP was utilized for semiautomatic image segmentation of 58 gadolinium-contrast enhanced T1-weighted thin-slice MRI datasets for volumetric analysis. Furthermore, multimodal imaging datasets (including T2, FLAIR, T1) were evaluated for radiological biomarkers of aggressiveness and growth potential. Thereby generated data was checked for association with retrospectively collected data points. RESULTS: Location (P = 0.001), clinical disease manifestation (P = 0.033), peritumoral edema (P = 0.038), tumor intrinsic cystic degeneration (P = 0.007), three-dimensional complexity (P = 0.022), and the presence of meningioma mass effect (P = 0.001) were statistically associated with higher tumor volumes. There was no association between higher tumor volumes and histopathological tumor grade. CONCLUSION: The size of a meningioma does not seem to reliably predict tumor grade. Growth potential seems to be influenced by tumor location. Higher tumor volumes were significantly associated with the occurrence of clinical symptoms.


Assuntos
Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Período Intraoperatório , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Imagem Multimodal , Gradação de Tumores , Estudos Retrospectivos , Carga Tumoral
12.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532104

RESUMO

BACKGROUND: The Cavernous Angioma in Posterior Sagittal Sinus is exceedingly rare. METHODS: We report for the case of a 10-year-old male patient who was diagnosed with Cavernous Angioma in Posterior Sagittal Sinus. RESULTS: Our case is the second reported case of Cavernous Angioma in Posterior Sagittal Sinus in the world. CONCLUSIONS: It is very rare for the cavernous hemangioma to occur in the sinus, preoperative conventional MR scan lacks specificity and easily leads to misdiagnosis. Head MR enhancement, MRBTI, and SWI can provide more useful diagnostic information. The final diagnosis depends on the pathology examination.


Assuntos
Seio Cavernoso/patologia , Dura-Máter/irrigação sanguínea , Hemangioma Cavernoso/diagnóstico , Neoplasias Meníngeas/diagnóstico , Seio Cavernoso/diagnóstico por imagem , Criança , Dura-Máter/diagnóstico por imagem , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
13.
Clin Nucl Med ; 44(12): 987-988, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31524680

RESUMO

A 59-year-old man had developed within a few months walking disorders and rigidity of the left upper limb. I-FP-CIT SPECT/CT was performed in response to the suspicion of atypical parkinsonian syndrome. It showed an anomaly in presynaptic dopaminergic transmission on the right striatum and a voluminous expansive process on CT. MRI revealed an atypical meningioma. The patient had surgery for tumor removal. Later I-FP-CIT SPECT/CT showed normalization of presynaptic dopaminergic transmission on the right striatum.


Assuntos
Erros de Diagnóstico , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Meningioma/complicações , Meningioma/diagnóstico , Transtornos Parkinsonianos/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Neostriado/diagnóstico por imagem , Neostriado/metabolismo , Transtornos Parkinsonianos/metabolismo , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
14.
World Neurosurg ; 132: e366-e390, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476455

RESUMO

OBJECTIVE: Meningioma grading is relevant to therapy decisions in complete or partial resection, observation, and radiotherapy because higher grades are associated with tumor growth and recurrence. The differentiation of low and intermediate grades is particularly challenging. This study attempts to apply radiomics-based shape and texture analysis on routine multiparametric magnetic resonance imaging (MRI) from different scanners and institutions for grading. METHODS: We used MRI data (T1-weighted/T2-weighted, T1-weighted-contrast-enhanced [T1CE], fluid-attenuated inversion recovery [FLAIR], diffusion-weighted imaging [DWI], apparent diffusion coefficient [ADC]) of grade I (n = 46) and grade II (n = 25) nontreated meningiomas with histologic workup. Two experienced radiologists performed manual tumor segmentations on FLAIR, T1CE, and ADC images in consensus. The MRI data were preprocessed through T1CE and T1-subtraction, coregistration, resampling, and normalization. A PyRadiomics package was used to generate 990 shape/texture features. Stepwise dimension reduction and robust radiomics feature selection were performed. Biopsy results were used as standard of reference. RESULTS: Four statistically independent radiomics features were identified as showing the strongest predictive values for higher tumor grades: roundness-of-FLAIR-shape (area under curve [AUC], 0.80), cluster-shades-of-FLAIR/T1CE-gray-level (AUC, 0.80), DWI/ADC-gray-level-variability (AUC, 0.72), and FLAIR/T1CE-gray-level-energy (AUC, 0.76). In a multivariate logistic regression model, the combination of the features led to an AUC of 0.91 for the differentiation of grade I and grade II meningiomas. CONCLUSIONS: Our results indicate that radiomics-based feature analysis applied on routine MRI is viable for meningioma grading, and a multivariate logistic regression model yielded strong classification performances. More advanced tumor stages are identifiable through certain shape parameters of the lesion, textural patterns in morphologic MRI sequences, and DWI/ADC variability.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Gradação de Tumores/métodos , Neuroimagem/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
J Nippon Med Sch ; 86(4): 248-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484881

RESUMO

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adulto , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Reoperação , Neoplasias da Base do Crânio/diagnóstico por imagem , Resultado do Tratamento
16.
World Neurosurg ; 131: e155-e169, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376550

RESUMO

OBJECTIVE: To integrate 3-dimensional (3D) intraoperative ultrasound (iUS) data in spinal navigation. METHODS: In 11 patients with intradural spinal tumors, 3D-iUS was performed before and after tumor resection. Intraoperative computed tomography (iCT) was used for automatic patient registration for spinal navigation; fiducial-based registration was performed in 1 case. The outlines of the vertebra were defined in preoperative image data by automatic mapping; risk and target structures were segmented manually; all these data were rigidly and if necessary non-rigidly registered with iCT. For 3D-iUS acquisition, tracked convex-shaped transducers (contact surface: 29 x 10 mm; scanning frequency: 10-3.8 MHz or 13-5 MHz) were used. RESULTS: Navigated 3D-iUS was successfully implemented in all cases; 3D-iUS datasets were acquired and could be used as 3D image data for further navigation after iUS scanning. The 3D objects defined in preoperative image data, outlining the vertebra, target and risk structures, could be visualized in the 3D-iUS data. Navigated 3D-iUS allowed to reliably evaluate the extent of resection in all cases and updating of navigation, ensuring high navigational accuracy. The target registration error applying iCT-based automatic registration was 0.78 ± 0.23 mm. The effective dose for iCT was 0.11 ± 0.077 mSv for cervical and 1.75 ± 0.72 mSv for thoracic scans. CONCLUSIONS: Using 3D-iUS can be successfully integrated in spinal navigation. Automatic registration applying low-dose iCT and non-linear image registration offers displaying preoperative images in the same orientation as the 3D-iUS scan, as well as visualizing segmented structures in the navigated 3D-iUS data. This greatly facilitates image interpretation. Navigated 3D-iUS provides a possibility for navigation updating and immediate online quality control.


Assuntos
Imagem Tridimensional/métodos , Neoplasias Meníngeas/cirurgia , Neuronavegação/métodos , Neoplasias da Medula Espinal/cirurgia , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Feminino , Glioma/diagnóstico por imagem , Glioma/cirurgia , Hemangioblastoma/diagnóstico por imagem , Hemangioblastoma/cirurgia , Humanos , Cuidados Intraoperatórios , Neoplasias Pulmonares/patologia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/secundário , Adulto Jovem
17.
World Neurosurg ; 132: e577-e584, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442639

RESUMO

OBJECTIVE: The surgery of parasellar meningiomas is crucial. There are only a few reports of the use of intraoperative magnetic resonance imaging (iMRI) for resection of these lesions. We discuss the safety and usefulness of this technique in achieving the planned surgical goal and analyze patients' outcomes. METHODS: Nineteen cases of parasellar meningioma were treated in our institution using iMRI. We classified the tumors according to their primary location: tuberculum sellae, clinoidal, and cavernous sinus meningiomas. We evaluated the history of previous surgery, outcome, residual (if present) tumor volume, degree of resection, achievement of the surgical goal, and number of iMRI scans. RESULTS: The preoperative surgical goal was achieved in all patients. In 7 of 19 patients, (37%) further tumor resection was performed after the first iMRI scan. Regarding the cavernous sinus group, the surgical resection was continued after the first iMRI in 56% of patients, obtaining substantial additional volume reduction. No complications were found related to the use of iMRI scan. CONCLUSIONS: iMRI has been effective in safely increasing the extent of parasellar meningioma resection mainly for recurrent and invasive tumors. Its usefulness has been seen mostly in cavernous sinus lesions, in which it allowed the further safe resection in 56% of cases. Moreover, this tool was particularly useful in recurrent or residual meningiomas with extension in extracranial compartments.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neuroimagem/métodos , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Período Intraoperatório , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Sela Túrcica/patologia
18.
World Neurosurg ; 132: 7-11, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442659

RESUMO

BACKGROUND: The rosette-forming glioneuronal tumor (RGNT) is a rare World Health Organization grade I tumor, most often originating in the fourth ventricle and characterized by a predominant glial component, as well as a neurocytic component. Despite its benign grading, there are a few documented cases of RGNT displaying more aggressive behavior with malignant characteristics. CASE DESCRIPTION: Herein, we describe a uniquely aggressive presentation of RGNT in a 49-year-old man initially presenting with obstructive hydrocephalus with lesions in the right frontal lobe, fourth ventricle, and left lateral ventricle. The patient was found to have 2 distinct intracranial entities: a right frontal meningioma and disseminated intraventricular RGNT. He underwent an anatomically limited resection of the fourth ventricular lesion with fourth ventricle-to-subarachnoid space shunting. His disease progressed thereafter, with diffuse intracranial dissemination and drop metastases in the lumbar spine. He was treated with craniospinal radiation and remains on palliative care 5 months after completion of radiotherapy. CONCLUSIONS: This case supplements and complements the handful of published cases available documenting the evolution of a particularly aggressive case of disseminated RGNT.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Glioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Neoplasias do Ventrículo Cerebral/complicações , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Glioma/complicações , Glioma/diagnóstico por imagem , Glioma/secundário , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Doenças Raras , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/secundário , Derivação Ventriculoperitoneal
19.
Zhongguo Fei Ai Za Zhi ; 22(8): 546-550, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31451148

RESUMO

Leptomeningeal metastasis (LM) is one of the most severe complications of non-small-cell lung cancer (NSCLC), and its incidence is increasing gradually with the progress of targeted therapies. There are currently no standard guidelines for the therapy of LM. Intrathecal chemotherapy is the mainstay of treatment for NSCLC patients with LM, but the optimal drug, administration route and mode, and dosage remain unclear. We report a case of LM from NSCLC, who received the intrathecal chemotherapy with pemetrexed by Ommaya reservoir after prior targeted therapies. This local treatment improved the quality of life, and obtained the clearing of CSF cytology and stable lesions of LM without any notable side effects. After confirmation of LM, the patient has survived 17 months until now. Here we report the first case to demonstrate the potential effectiveness of intrathecal pemetrexed by Ommaya reservoir for the treatment of LM of NSCLC, summarize the safety and effectiveness of intrathecal chemotherapy in combination with related literatures, and provide a new strategy for local treatment of LM in clinical.
.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Neoplasias Meníngeas/tratamento farmacológico , Pemetrexede/administração & dosagem , Líquido Cefalorraquidiano/efeitos dos fármacos , Feminino , Humanos , Infusões Intraventriculares , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/secundário , Pessoa de Meia-Idade , Metástase Neoplásica
20.
World Neurosurg ; 132: e434-e442, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470161

RESUMO

BACKGROUND: Venous collaterals form because of occlusion of the superior sagittal sinus (SSS), thus preserving venous drainage. Previous studies have focused on the evaluation and protection of sinuses and cortical veins and have neglected the collaterals between the SSS and deep venous system, which are important for surgical planning. We aimed to study the venous compensatory patterns inside and on both sides of the cerebral falx (parafalx) in patients with meningioma invading the SSS. METHODS: Conventional magnetic resonance imaging, magnetic resonance venography, and a three-dimensional reconstructed venous model of 45 patients were analyzed. The venous collateral pattern of the parafalx was divided into 4 types: A), with cerebral medial cortical vein displacement or hyperplasia; B), collaterals connect the 2 ends of the occluded segment of the SSS; C), collaterals connect the occluded segment of the SSS with the deep cerebral venous system; and D), recanalization or secondary formation of a falcine sinus. The incidence of each type in different occlusion grades and positions of the SSS was analyzed. RESULTS: The 4 types of venous collaterals were ranked according to their prevalence: A, 46.7%; C, 15.6%; D, 8.9%; and B, 4.4%. The collaterals of types B, C, and D were found only in patients with severe SSS occlusion, and both types C and D were found only in middle and posterior occlusions of the SSS. CONCLUSIONS: In meningiomas invading the SSS, especially with complete posterior SSS occlusion, the parafalcine collateral veins and falcine sinus should be evaluated preoperatively to avoid iatrogenic injury.


Assuntos
Circulação Colateral , Neoplasias Meníngeas/patologia , Meningioma/patologia , Seio Sagital Superior/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem Tridimensional/métodos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neuroimagem/métodos , Flebografia , Estudos Retrospectivos , Seio Sagital Superior/cirurgia
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