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1.
J Clin Neurosci ; 89: 165-170, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119263

RESUMO

Knowledge on high-grade meningiomas in octogenarian and elderly patients is limited. We aimed to analyze the outcomes and identify factors that influence overall survival (OS) in this population, using data from the Surveillance, Epidemiology, and End Results (SEER) database.Patients (≥80 years old) diagnosed with high-grade meningiomas between 1990 and 2016 were retrieved from the SEER database. According to treatments received, patients were classified into three groups: observation, radiation only, and surgery (with or without radiation). A Cox proportional hazards regression model was used for univariate and multivariate analyses. Based on the inclusion criteria, 678 patients with high-grade meningiomas were included.Surgery was the most common treatment modality. The median OS was 32 months for patients who received surgery, compared with 20 months for observation (p = 0.001).The factors significantly associated with OS on multivariate analysis included increasing age (hazard ratio [HR] 1.353, p < 0.001), diagnosis after 2008 (HR 0.693, p = 0.022), and surgical treatment (HR 0.807, p = 0.028). Further analysis revealed increasing age (HR 1.451, p = 0.003), and subtotal resection (HR 1.275, p = 0.043) were significantly associated with worse OS following surgery. This is the largest clinical study of high-grade meningiomas in octogenarian and elderly patients conducted thus far. Age, treatment modality, and year of diagnosis were associated with OS in octogenarian and elderly patients with high-grade meningiomas. Patients who received subtotal resection had a worse prognosis than gross total resection.


Assuntos
Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico , Meningioma/cirurgia , Vigilância da População , Programa de SEER/tendências , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais/tendências , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Análise Multivariada , Vigilância da População/métodos , Modelos de Riscos Proporcionais , Estudos Retrospectivos
2.
J Clin Neurosci ; 88: 268-270, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992195

RESUMO

Sclerosing extramedullary hematopoietic tumour is a rare tumour which can occur in certain myeloproliferative diseases, typically myelofibrosis. Typically these tumours present as a discrete retroperitoneal mass or masses, however they can occur in other sites within the body. In this case report we describe a 61-year old woman who underwent stealth guided bi-temporal craniotomy for resection of what was expected to be a large falx meningioma, however histopathology revealed the lesion to be a sclerosing extramedullary hematopoietic tumour. Following surgery, the patients post-operative recovery was complicated by intracerebral haemorrhage which required emergency evacuation and the patient remained in intensive care on a ventilator for 3 weeks. At one year follow up the patient reports her presenting symptoms of headaches, nausea, and vertigo had resolved.


Assuntos
Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/patologia , Hematopoese Extramedular , Mielofibrose Primária/complicações , Carcinoma de Células Renais/patologia , Diagnóstico Diferencial , Feminino , Neoplasias Hematológicas/diagnóstico , Humanos , Neoplasias Renais/patologia , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Mielofibrose Primária/patologia
3.
Obstet Gynecol ; 137(4): 682-686, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33706360

RESUMO

BACKGROUND: We summarize a case of transient oculomotor nerve palsy in a pregnant woman with a cavernous sinus meningioma. When pregnant women present with acute ophthalmic signs and symptoms, meningioma should be considered during diagnostic workup given the common proximity of growing meningiomas to visual pathways and ocular motor nerves within the parasellar region. CASE: A 32-year-old woman, gravida 2 para 1, at 37 weeks of gestation, presented with 2 weeks of diplopia, left-sided ptosis, and left periocular headache. There were no signs of preeclampsia. Examination revealed a left mydriatic pupil, complete left-sided ptosis, and motility deficits consistent with a left pupil-involving oculomotor nerve palsy. Magnetic resonance imaging of the brain revealed a cavernous sinus meningioma. Five days after cesarean birth, the ptosis significantly improved; 2 weeks later, the diplopia resolved. CONCLUSION: Pregnancy is associated with increased likelihood of intracranial meningioma growth, particularly in the parasellar region. We highlight a rare case of a transient cranial nerve III palsy in a pregnant patient due to cavernous sinus meningioma and review prior published reports.


Assuntos
Neoplasias Meníngeas/diagnóstico , Doenças do Nervo Oculomotor/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Adulto , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Doenças do Nervo Oculomotor/complicações , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem
4.
J Med Life ; 14(1): 2-6, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33767778

RESUMO

Meningiomas are common primary tumors of the central nervous system. The incidence at the age of fertility is low, although there are some hormonal mechanisms involved. Growth in size was observed during the luteal phase of the menstrual cycle, which could lead to developing new symptoms during pregnancy or worsening of the already existing ones. Visual impairment is the chief complaint, followed by headache, nausea, vomiting, and seizures. Diagnosis is based on neurological examination, ophthalmoscopy, imaging techniques like gadolinium-enhanced magnetic resonance imaging (MRI), and contrast-enhanced computed tomography (CT) scans, bearing in mind the patient's irradiation and prejudice on the fetus together with the histopathological examination. The objective of the review is to determine the influence of meningioma on pregnancy and vice-versa and provide a strategy of follow-up for maternal-fetal specialists and not only. We performed a systematic review by searching relevant information in PubMed and Wiley databases using keywords as meningioma, pregnancy, progesterone receptors. The results showed that besides a similar incidence of meningioma in pregnant and non-pregnant women, symptoms might flare during pregnancy due to water retention, engorgement of vessels, and the presence of sex hormone receptors on tumor cells. Meningioma may impact the route of pregnancy with adverse effects on the fetus. Thus, fetal monitoring by biophysical profile and cardiotocography (CTG) is needed. The preferred treatment option is surgery, but gestational age and the woman's status must be taken into consideration.


Assuntos
Neoplasias Meníngeas/terapia , Meningioma/terapia , Gestantes , Feminino , Monitorização Fetal , Seguimentos , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/patologia , Meningioma/cirurgia , Gravidez
6.
J Vis Exp ; (167)2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33586709

RESUMO

Leptomeningeal disease (LMD) is an uncommon type of central nervous system (CNS) metastasis to the cerebral spinal fluid (CSF). The most common cancers that cause LMD are breast and lung cancers and melanoma. Patients diagnosed with LMD have a very poor prognosis and generally survive for only a few weeks or months. One possible reason for the lack of efficacy of systemic therapy against LMD is the failure to achieve therapeutically effective concentrations of drug in the CSF because of an intact and relatively impermeable blood-brain barrier (BBB) or blood-CSF barrier across the choroid plexus. Therefore, directly administering drugs intrathecally or intraventricularly may overcome these barriers. This group has developed a model that allows for the effective delivery of therapeutics (i.e., drugs, antibodies, and cellular therapies) chronically and the repeated sampling of CSF to determine drug concentrations and target modulation in the CSF (when the tumor microenvironment is targeted in mice). The model is the murine equivalent of a magnetic resonance imaging-compatible Ommaya reservoir, which is used clinically. This model, which is affixed to the skull, has been designated as the "Murine Ommaya." As a therapeutic proof of concept, human epidermal growth factor receptor 2 antibodies (clone 7.16.4) were delivered into the CSF via the Murine Ommaya to treat mice with LMD from human epidermal growth factor receptor 2-positive breast cancer. The Murine Ommaya increases the efficiency of drug delivery using a miniature access port and prevents the wastage of excess drug; it does not interfere with CSF sampling for molecular and immunological studies. The Murine Ommaya is useful for testing novel therapeutics in experimental models of LMD.


Assuntos
Doenças do Sistema Nervoso Central/terapia , Sistemas de Liberação de Medicamentos , Xenoenxertos/fisiologia , Modelos Biológicos , Animais , Neoplasias da Mama/patologia , Feminino , Injeções Intraventriculares , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/tratamento farmacológico , Neoplasias Meníngeas/patologia , Camundongos , Metástase Neoplásica , Células Neoplásicas Circulantes/patologia , Prognóstico
7.
Neurosurgery ; 88(4): 828-837, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475718

RESUMO

BACKGROUND: Stereotactic radiosurgery (SRS) is increasingly used for management of perioptic meningiomas. OBJECTIVE: To study the safety and effectiveness of SRS for perioptic meningiomas. METHODS: From 12 institutions participating in the International Radiosurgery Research Foundation (IRRF), we retrospectively assessed treatment parameters and outcomes following SRS for meningiomas located within 3 mm of the optic apparatus. RESULTS: A total of 438 patients (median age 51 yr) underwent SRS for histologically confirmed (29%) or radiologically suspected (71%) perioptic meningiomas. Median treatment volume was 8.01 cm3. Median prescription dose was 12 Gy, and median dose to the optic apparatus was 8.50 Gy. A total of 405 patients (93%) underwent single-fraction SRS and 33 patients (7%) underwent hypofractionated SRS. During median imaging follow-up of 55.6 mo (range: 3.15-239 mo), 33 (8%) patients experienced tumor progression. Actuarial 5-yr and 10-yr progression-free survival was 96% and 89%, respectively. Prescription dose of ≥12 Gy (HR: 0.310; 95% CI [0.141-0.679], P = .003) and single-fraction SRS (HR: 0.078; 95% CI [0.016-0.395], P = .002) were associated with improved tumor control. A total of 31 (10%) patients experienced visual decline, with actuarial 5-yr and 10-yr post-SRS visual decline rates of 9% and 21%, respectively. Maximum dose to the optic apparatus ≥10 Gy (HR = 2.370; 95% CI [1.086-5.172], P = .03) and tumor progression (HR = 4.340; 95% CI [2.070-9.097], P < .001) were independent predictors of post-SRS visual decline. CONCLUSION: SRS provides durable tumor control and quite acceptable rates of vision preservation in perioptic meningiomas. Margin dose of ≥12 Gy is associated with improved tumor control, while a dose to the optic apparatus of ≥10 Gy and tumor progression are associated with post-SRS visual decline.


Assuntos
Internacionalidade , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Radiocirurgia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Nervo Óptico/cirurgia , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Neurosurgery ; 88(4): 838-845, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33483747

RESUMO

BACKGROUND: Machine learning (ML)-based predictive models are increasingly common in neurosurgery, but typically require large databases of discrete variables for training. Natural language processing (NLP) can extract meaningful data from unstructured text. OBJECTIVE: To present an NLP model that predicts nonhome discharge and a point-of-care implementation. METHODS: We retrospectively collected age, preoperative notes, and radiology reports from 595 adults who underwent meningioma resection in an academic center from 1995 to 2015. A total of 32 algorithms were trained with the data; the 3 best performing algorithms were combined to form an ensemble. Predictive ability, assessed by area under the receiver operating characteristic curve (AUC) and calibration, was compared to a previously published model utilizing 52 neurosurgeon-selected variables. We then built a multi-institutional model by incorporating notes from 693 patients at another center into algorithm training. Permutation importance was used to analyze the relative importance of each input to model performance. Word clouds and non-negative matrix factorization were used to analyze predictive features of text. RESULTS: The single-institution NLP model predicted nonhome discharge with AUC of 0.80 (95% CI = 0.74-0.86) on internal and 0.76 on holdout validation compared to AUC of 0.77 (95% CI = 0.73-0.81) and 0.74 for the 52-variable ensemble. The multi-institutional model performed similarly well with AUC = 0.78 (95% CI = 0.74-0.81) on internal and 0.76 on holdout validation. Preoperative notes most influenced predictions. The model is available at http://nlp-home.insds.org. CONCLUSION: ML and NLP are underutilized in neurosurgery. Here, we construct a multi-institutional NLP model that predicts nonhome discharge.


Assuntos
Aprendizado de Máquina/tendências , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Processamento de Linguagem Natural , Alta do Paciente/tendências , Adulto , Idoso , Algoritmos , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
9.
Virchows Arch ; 478(4): 747-756, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33305338

RESUMO

Limited studies on whole slide imaging (WSI) in surgical neuropathology reported a perceived limitation in the recognition of mitoses. This study analyzed and compared the inter- and intra-observer concordance for atypical meningioma, using glass slides and WSI. Two neuropathologists and two residents assessed the histopathological features of 35 meningiomas-originally diagnosed as atypical-in a representative glass slide and corresponding WSI. For each histological parameter and final diagnosis, we calculated the inter- and intra-observer concordance in the two viewing modes and the predictive accuracy on recurrence. The concordance rates for atypical meningioma on glass slides and on WSI were 54% and 60% among four observers and 63% and 74% between two neuropathologists. The inter-observer agreement was higher using WSI than with glass slides for all parameters, with the exception of high mitotic index. For all histological features, we found median intra-observer concordance of ≥ 79% and similar predictive accuracy for recurrence between the two viewing modes. The higher concordance for atypical meningioma using WSI than with glass slides and the similar predictive accuracy for recurrence in the two modalities suggest that atypical meningioma may be safely diagnosed using WSI.


Assuntos
Neoplasias Meníngeas/patologia , Meningioma/patologia , Humanos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Gradação de Tumores , Variações Dependentes do Observador , Reprodutibilidade dos Testes
10.
Ophthalmic Plast Reconstr Surg ; 37(2): e66-e68, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32732542

RESUMO

A woman in her early 50s previously treated 7 years prior with iodine-125 plaque brachytherapy without a biopsy for gene expression profiling for uveal melanoma in the left eye presented with a 3-week history of intermittent diplopia and headache. Ophthalmic examination was significant for limitation in left eye upward gaze; otherwise, examination revealed a stable, regressed tumor in the left eye, and normal vision, pressure, and pupils in both eyes. Neuroimaging showed a left cavernous sinus lesion, suggestive of a meningioma. Excisional biopsy revealed metastatic melanoma. The patient was treated with radiotherapy, and her diplopia resolved. Slight enlargement of the lesion was noted on neuroimaging 20 months later, and was treated with stereotactic radiosurgery. Serial neuroimaging in the following 6 months did not reveal any recurrences or new metastases. This case demonstrates the importance of investigating persistent diplopia in a patient with a history of uveal melanoma, and the possibility of metastases occurring in organs besides the liver or lung.


Assuntos
Braquiterapia , Seio Cavernoso , Melanoma , Neoplasias Meníngeas , Neoplasias Uveais , Feminino , Humanos , Melanoma/diagnóstico , Neoplasias Meníngeas/diagnóstico , Recidiva Local de Neoplasia , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/radioterapia
12.
J Neuroimaging ; 31(2): 324-333, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33332686

RESUMO

BACKGROUND AND PURPOSE: Leptomeningeal metastases (LMs) carry a poor prognosis. Existing LM scoring systems show limited reproducibility. We assessed the contribution of education level on the reproducibility of LM scoring using structured planning and implementation of new experiments (SPINE), a novel web-based platform. METHODS: Stringent radiological definitions of LM and a customized interactive scoring system were implemented in SPINE. Five patients with brain LM and 3 patients with spine, but no brain LM, were selected. Each patient's baseline post-contrast T1-weighted brain MRI was analyzed by three attending neuroradiologists, two neuroradiology fellows, and two radiology residents. Raters identified and characterized all LMs based on: (1) location (cerebrum, cerebellum, brainstem, ventricle, and/or cranial nerves); (2) shape (nodular and/or linear/curvilinear); (3) size (≥ or <5mm in two orthogonal diameters); (4) spatial extension (focal or diffuse). Inter-rater agreement and association of LM with patient survival were investigated. RESULTS: On average, 6.5 LMs per case were detected. Forty-nine percent of LMs were cerebral, 77.7% were nodular, 86.6% were focal, and 66% were <5 × 5 mm. Agreement on the total number of LMs and the above-mentioned common LM characteristics was higher between attendings (intra-class correlation [ICC] = 0.8-0.94) than fellows (ICC = 0.6-0.82) or residents (ICC = 0.43-0.73). Agreement on ventricular, cranial nerve, and nodular + linear LM was low even between attendings. The number of brainstem LMs showed significant correlation with survival. CONCLUSION: Structured education using SPINE may improve consistency in LM reporting. Future work should address the impact of the presented approach on the reproducibility of longitudinal analyses directly relevant to the assessment of treatment-response.


Assuntos
Internet , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/secundário , Adulto , Humanos , Colaboração Intersetorial , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Reprodutibilidade dos Testes
13.
J Clin Neurosci ; 83: 43-48, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33342627

RESUMO

Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.


Assuntos
Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Meningioma/diagnóstico , Meningioma/patologia , Adulto , Idoso , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Radiografia , Radiologia , Estudos Retrospectivos
14.
Neurol India ; 68(6): 1385-1388, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33342873

RESUMO

Introduction: Cavitron Ultrasonic Surgical Aspirator (CUSA) is a technique used for the surgical treatment of tumors that aids the surgeon in highly selective tumor sampling with minimal injury to surrounding tissues. The utility of the tissue obtained from CUSA for histopathological diagnosis of central nervous system tumors is not as well-known as its surgical benefits. Even though a few studies have evaluated the diagnostic accuracy of CUSA specimen, these have dealt with very few cases. Methodology: In this study, we nil analysed 73 cases of CNS tumors (glial and non-glial) where CUSA specimen was available for histopathological examination and compared with findings on conventional samples as gold standard. Results: Most frequent types of artefacts induced by CUSA included tissue breakdown resembling necrosis, empty spaces in tissues, and crush artefacts particularly in cellular tumors, that interfered with interpretation. CUSA samples were found optimal for diagnosis of non-glial tumors (45/73), (mainly mesenchymal), wherein the diagnostic utility was comparable to the conventional samples. Difficulties were encountered in glial neoplasms, medulloblastomas and meningiomas. In glial neoplasms (28/73), accurate grading was not possible (9/28, 32%) utilising CUSA samples alone as necrosis and mitosis were not represented. Similarly in meningiomas, mitosis and brain invasion, essential for grading, was not recognizable in CUSA samples. In medulloblastomas, extensive crush artefacts interfered with diagnosis and histological subtyping making it mandatory to examine conventional tissue samples and CUSA. Immunohistochemistry results were optimal with CUSA tissue, wherever performed. Conclusion: The greatest benefits of CUSA, is its ability to sample multiple areas enhancing the yield in heterogenous tumors like gliosarcomas and its utility in tumors at surgically inaccessible sites. As a policy, we recommend that it is beneficial that all surgically excised tissues including those from the CUSA bottle and suction be sent for histopathological analysis for optimising diagnostic accuracy.


Assuntos
Neoplasias Meníngeas , Meningioma , Sistema Nervoso Central , Humanos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Sucção , Ultrassom
15.
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 , Imageamento 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
16.
J Clin Neurosci ; 82(Pt A): 36-42, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317736

RESUMO

Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningiomas that originates within bone. We aimed to characterize the clinical, radiographic, and pathologic features of PIM and the resulting outcomes following resection. Herein we examined a retrospective case series of all patients with a pathologically confirmed WHO grade I PIM that were managed at one of three tertiary care centers. Patients with tumors that demonstrated extraosseous extension or involvement of the dura mater were excluded. The main outcomes included surgical safety and duration of local tumor control. Nine patients were identified with benign PIMs, presenting with headaches or painless enlarging subcutaneous masses if involving the calvarium or with neurologic deficits if involving the skull base, or otherwise incidentally identified. Surgery was pursued for symptomatic relief and/or tissue diagnosis. Lesions were evaluated by radiographic imaging - including sensitive detection by plain X-ray films - and definitive diagnosis ascertained by histopathological examination. Maximal resection of both calvarial and skull base lesions was safely tolerated. PIM represents a rare benign skull lesion, whose identification depends on the integration of radiographic findings with intraoperative findings and histopathological confirmation; it should be considered in the differential for slow-growing expansile intraosseous lesions of the skull.


Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias Cranianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cranianas/diagnóstico , Neoplasias Cranianas/patologia , Neoplasias Cranianas/cirurgia , Resultado do Tratamento
17.
J Clin Neurosci ; 81: 1-5, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33222894

RESUMO

Intracranial schwannomas not originating from cranial nerves are rare. In this paper, we report a case of a 50-year-old male who presented with worsening headaches, diplopia and nausea over two years. Radiological imaging revealed a large tumour arising from the olfactory groove region with a preoperative diagnosis of olfactory groove meningioma (OGM). Intraoperatively, the tumour originated from the region of the attachment of the falx to the crista galli. The patient recovered without complication and histopathology reported an unexpected diagnosis of WHO Grade 1 schwannoma. However, as olfactory groove schwannomas (OGSs) cannot be distinguished from olfactory ensheathing cell tumours (OECTs), it is possible that the tumour could have been either an OGS or an OECT. Distinguishing between OGSs, OECTs and OGMs preoperatively is difficult. OGMs exhibit distinct histopathological features from OGSs/OECTs, however, OGSs and OECTs currently cannot be distinguished from each other. Here, we review the literature to discuss the differentiating features and cellular origins of these three tumours.


Assuntos
Fossa Craniana Anterior/patologia , Neurilemoma/diagnóstico , Neoplasias da Base do Crânio/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Neoplasias da Base do Crânio/cirurgia
18.
J Clin Neurosci ; 81: 265-269, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33222927

RESUMO

BACKGROUND: Acute postoperative pulmonary embolism (PE) is a dreaded complication with severe mortality rates. Brain tumor patients are at the highest risk for postoperative PE. The juxtaposition of low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) in the treatment of postoperative PE in meningioma patients is largely unexplored. PATIENTS/METHODS: This is a single center observational analysis of meningioma patients who underwent neurosurgical resection with a thoracic CT scan confirmation of postoperative PE. The treatment modality, clinical course and outcome were investigated. RESULTS: Of 538 meningioma patients operated, 30 (6%) developed acute postoperative PE. After diagnosis, these patients received different long-term anticoagulation regimes. No significant difference in postoperative hemorrhage (p < 0.56), re-operation rate (p < 0.70) or Karnofsky performance scale (KPS) at 3 (p < 0.34) and 12 months (p = 1) were identified, when compared according to the different anticoagulation regimes. CONCLUSION: DOACs were not associated with elevated risk for hemorrhage, recurrent thrombosis or poor outcome when compared with traditional anticoagulation regimes. Prospective randomized trials are necessary to verify the non-inferiority of DOACs for long-term anticoagulation in postoperative pulmonary embolism after meningioma resection.


Assuntos
Anticoagulantes/administração & dosagem , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Adulto , Coagulação Sanguínea/efeitos dos fármacos , Coagulação Sanguínea/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Estudos Retrospectivos
19.
Clin Neurol Neurosurg ; 199: 106175, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33027728

RESUMO

OBJECTIVE: To review the data published on the subject to create a more comprehensive natural history of the haemorrhagic onset of meningiomas (IVMs). PATIENTS AND METHODS: A Medline search up to June 2020, using the search term "bleeding meningioma," returned 136 papers. As a first selection step, we adopted the following inclusion criteria: series and case reports about bleeding meningioma. Papers written in other languages but with abstracts written in English were also evaluated. RESULTS: A total of 190 tumours were evaluated, specifically 109 tumours from female patients and 81 tumours from male patients with a ratio of 1.34 female to 1.0 male (mean age of 54.86 ± 16.1years old). The majority were located in the convexity (129-67.9 %). Among the 190 tumours evaluated, 171 patients (90 %) presented with GI tumours, with a predominance of the meningothelial subtype (32.6 %). Nine patients (4.7 %) presented with grade GII tumours, and 10 (5.3 %) presented with GIII tumours. The most prevalent type was intracerebral haemorrhage (ICH) at 50 %, followed by subdural at 27.36 %; the mortality rate was 13.1 % (25 deaths), the distribution of both location (prevalence of convexity: 18-72 %) and histopathology (grade 1: 22-88 %). CONCLUSION: These tumours follow the histopathological distribution of meningiomas, in general. The age distribution shows prevalence among the adult population but with a greater proportion in the elderly. The fact that the overwhelming majority of cases involve meningiomas with a benign histological subtype is noteworthy. Another relevant factor observed is that most reports are from Asian origin.


Assuntos
Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Meningioma/complicações , Meningioma/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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