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2.
Br J Radiol ; 93(1105): 20190653, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31746635

RESUMO

OBJECTIVE: This study aims to assess the CT and MRI features of calvarium and skull base osteosarcoma (CSBO). METHODS: The CT and MRI features and pathological characteristics of 12 cases of pathologically confirmed CSBO were analyzed retrospectively. RESULTS: 12 patients (age range 9-67 years; 3 male, 9 female) were included in the study. Tumours occurred in skull base (7, 58.3%), temporal (4, 33.3%) and frontal (1, 8.3%). Among all, six patients received radiotherapy for nasopharyngeal carcinoma. According to pathology, 11 out of 12 tumours were high-grade (91.7%). On CT, all the tumours had soft tissue mass penetrated into cortical bone with invasion of surrounding soft tissue. Six tumours were shown to have lytic density and six were mixed density. Matrix mineralization was present in 10 cases (83.3%). On MRI, tumours presented as soft-tissue masses measuring 5.9 ± 2.4 (3.9-8.0) cm. Five tumours showed low signal intensities on T1 weighted imaging with seven having heterogeneous signal intensities. One showed low signal intensity on T2 weighted imaging, two showed high signal intensities and nine heterogeneous signal intensities. All the tumours showed low signal intensities on diffusion-weighted imaging. On contrast enhanced images, seven cases showed heterogeneous enhancement, three showed peripheral enhancementand and two showed homogeneous enhancement. Dural tail sign were detected in nine cases. CONCLUSION: CSBO is rare, and is commonly associated with previous radiation exposure. A presumptive diagnosis for osteosarcoma should be considered when calvarium and skull base tumours with osteoid matrix and duraltail sign are found. ADVANCES IN KNOWLEDGE: CT and MR features of CSBO have not been reported. The study helps to identify CSBO and other sarcomas.


Assuntos
Imagem por Ressonância Magnética/métodos , Osteossarcoma/diagnóstico por imagem , Neoplasias Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Criança , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Base do Crânio/diagnóstico por imagem
3.
Int J Radiat Oncol Biol Phys ; 106(1): 185-193, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31580928

RESUMO

PURPOSE: Recurrent or previously irradiated head and neck cancers (HNC) are therapeutically challenging and may benefit from high-dose, highly accurate radiation techniques, such as stereotactic ablative radiation therapy (SABR). Here, we compare set-up and positioning accuracy across HNC subsites to further optimize the treatment process and planning target volume (PTV) margin recommendations for head and neck SABR. METHODS AND MATERIALS: We prospectively collected data on 405 treatment fractions across 79 patients treated with SABR for recurrent/previously irradiated HNC. First, interfractional error was determined by comparing ExacTrac x-ray to the treatment plan. Patients were then shifted and residual error was measured with repeat x-ray. Next, cone beam computed tomography (CBCT) was compared with ExacTrac for positioning agreement, and final shifts were applied. Lastly, intrafractional error was measured with x-ray before each arc. Results were stratified by treatment site into skull base, neck/parotid, and mucosal. RESULTS: Most patients (66.7%) were treated to 45 Gy in 5 fractions (range, 21-47.5 Gy in 3-5 fractions). The initial mean ± standard deviation interfractional errors were -0.2 ± 1.4 mm (anteroposterior), 0.2 ± 1.8 mm (craniocaudal), and -0.1 ± 1.7 mm (left-right). Interfractional 3-dimensional vector error was 2.48 ± 1.44, with skull base significantly lower than other sites (2.22 vs 2.77; P = .0016). All interfractional errors were corrected to within 1.3 mm and 1.8°. CBCT agreed with ExacTrac to within 3.6 mm and 3.4°. CBCT disagreements and intrafractional errors of >1 mm or >1° occurred at significantly lower rates in skull base sites (CBCT: 16.4% vs 50.0% neck, 52.0% mucosal, P < .0001; intrafractional: 22.0% vs 48.7% all others, P < .0001). Final PTVs were 1.5 mm (skull base), 2.0 mm (neck/parotid), and 1.8 mm (mucosal). CONCLUSIONS: Head and neck SABR PTV margins should be optimized by target site. PTV margins of 1.5 to 2 mm may be sufficient in the skull base, whereas 2 to 2.5 mm may be necessary for neck and mucosal targets. When using ExacTrac, skull base sites show significantly fewer uncertainties throughout the treatment process, but neck/mucosal targets may require the addition of CBCT to account for positioning errors and internal organ motion.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Recidiva Local de Neoplasia/radioterapia , Radiocirurgia/métodos , Erros de Configuração em Radioterapia , Idoso , Tomografia Computadorizada de Feixe Cônico/métodos , Fracionamento da Dose de Radiação , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imobilização/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/radioterapia , Posicionamento do Paciente , Estudos Prospectivos , Melhoria de Qualidade , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Reirradiação/métodos , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/radioterapia
4.
Medicina (B Aires) ; 79(6): 453-460, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829947

RESUMO

Stereotactic radiosurgery has shown effectiveness in the multimodal treatment of skull base tumors, however it is suggested that in radiobiologically sensitive areas (eg. optic nerves and brainstem) the radiation dose should be reduced due to radiotoxic effects. To avoid the consequent therapeutic ineffectiveness, a recently implemented alternative is multisession radiosurgery (RCH). We retrospectively analyzed a series of patients with skull base tumors, in order to evaluate the treatment with RCH through tumor control in the post-treatment images. Age, sex, tumor histology, tumor volume, radiation protocol, pre-treatment Karnofsky performance status (KPS) previous neurosurgery and radiant treatment were also evaluated. Eighty-four patients were treated between January 2009 and January 2017. The median age was 51.5 years; females: 53.6%. There was a 92.7% non-progression after treatment, with a median follow-up time of 36 months. Treated tumors were mainly pituitary adenomas, acoustic schwannomas, and skull base meningiomas. Most of the patients received a 5-day fractionated treatment scheme, with a total dose of 25 Gy. No clinically manifest late radiotoxicity was observed. In the multivariate analysis, a high pre-treatment KPS was significantly associated with tumor non-progression. In our series, the high incidence of tumor non-progression would indicate that treatment with RCH could be a therapeutic option in some cases of skull-base tumors, mainly recurrences or tumor residuals of pituitary adenomas, neurinomas and meningiomas.


Assuntos
Radiocirurgia/métodos , Neoplasias da Base do Crânio/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doses de Radiação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/patologia , Fatores de Tempo , Carga Tumoral
5.
Pan Afr Med J ; 33: 268, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692804

RESUMO

Occipital condyle syndrome is a rare clinical disorder, clinically defined by the association of intense occipital headaches and paralysis of the twelfth paired cranial nerve. Its etiology is dominated by metastatic tumor. Imaging is the gold standard for diagnosis allowing to highlight occipital condyle lesion as weel as to find out primary tumor. Treatment is based on pain relief using analgesics, corticosteroids and very often, external radiotherapy. On the other hand, treatment of metastatic tumor is based on cytotoxic chemotherapy, targeted therapies or immunotherapy depending on the molecular profile of the primary tumor.


Assuntos
Cefaleia/etiologia , Osso Occipital/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Idoso , Humanos , Masculino , Síndrome
6.
Radiologe ; 59(12): 1071-1079, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31642936

RESUMO

A variety of tumors, tumor-like non-neoplastic and inflammatory lesions occur in the skull base. A wide variety of diseases and lesions complicate the process of radiological diagnosis. The main task of imaging consists of the recognition and characterization of skull base lesions with detailed description of the extent of infiltration of adjacent structures, which is important for preoperative planning. Computed tomography (CT) and magnetic resonance imaging (MRI) are the preferred modalities for evaluating cranial base lesions. Above all, they depict more accurately the involvement of bones, vascular and nerve structures. MRI, especially T1-weighted sequences, provide superior contrast to CT soft tissue, which is useful for detecting lesions surrounded by high-fat bone marrow. T2-weighted MRI imaging is useful for characterizing watery tumor tissue/edema or cystic portions of the lesions. CT outperforms MRI in assessing the presence of calcification and osseous destruction. Knowledge of the clinical symptoms, as well as the overview of possible variants of the skull base lesions, aid in the diagnosis. The aim of this review is to present the most important benign and inflammatory lesions of the skull base as well as to investigate typical imaging phenomena of the most common lesions, and to provide insights into the most important anatomical landmarks of the skull base.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias da Base do Crânio , Base do Crânio , Tomografia Computadorizada por Raios X/métodos , Humanos , Neoplasias da Base do Crânio/diagnóstico por imagem
7.
Radiologe ; 59(12): 1080-1087, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31628501

RESUMO

CLINICAL ISSUE: Knowledge of skull base anatomy is essential for recognizing the pathological conditions affecting the skull base structures (including cranial nerves and cerebral vasculature), for correct interpretation of their presentation on imaging studies, and finally for proper planning of surgical skull base approaches. PURPOSE OF THE ARTICLE: The main goal of the following work is to present a brief recapitulation of the regular skull base anatomy (with a focus on the bony structures) and based on this, to provide an overview of the most commonly used neurosurgical skull base approaches (illustrated using radiological case presentations). DIAGNOSTIC WORK-UP: Already at the step of the preoperative workup, the suitable radiological technique and proper choice of technical parameters for image acquisition lays the foundation for a successful surgical procedure and for the reliable assessment of operative results. CONCLUSION: Each radiologist should be familiar with basic principles of neurosurgical approaches and operative techniques used in skull base surgery and with their appearance in postoperative images.


Assuntos
Imagem por Ressonância Magnética , Neoplasias da Base do Crânio , Base do Crânio/anatomia & histologia , Nervos Cranianos , Humanos , Procedimentos Neurocirúrgicos , Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia
8.
Radiologe ; 59(12): 1064-1070, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31602499

RESUMO

Malignant skull base tumors consist of a heterogeneous group of malignancies that can be divided into primary and secondary (metastatic) skull base tumors. In addition, according their anatomical location, they can be further divided into tumors of the anterior, middle, or posterior cranial fossa. Although malignant skull base tumors do not rigorously respect anatomical borders, their anatomical occurrence can potentially be helpful for possible differential diagnosis. This article is focused on the most common malignant tumors of the skull base and their imaging and clinical presentations.


Assuntos
Neoplasias da Base do Crânio , Base do Crânio , Fossa Craniana Posterior , Diagnóstico Diferencial , Humanos , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/patologia
9.
Br J Radiol ; 92(1104): 20190513, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31529977

RESUMO

MRI is an invaluable diagnostic tool in the investigation and management of patients with pathology of the head and neck. However, numerous technical challenges exist, owing to a combination of fine anatomical detail, complex geometry (that is subject to frequent motion) and susceptibility effects from both endogenous structures and exogenous implants. Over recent years, there have been rapid developments in several aspects of head and neck imaging including higher resolution, isotropic 3D sequences, diffusion-weighted and diffusion-tensor imaging as well as permeability and perfusion imaging. These have led to improvements in anatomic, dynamic and functional imaging. Further developments using contrast-enhanced 3D FLAIR for the delineation of endolymphatic structures and black bone imaging for osseous structures are opening new diagnostic avenues. Furthermore, technical advances in compressed sensing and metal artefact reduction have the capacity to improve imaging speed and quality, respectively. This review explores novel and evolving MRI sequences that can be employed to evaluate diseases of the head and neck, including the skull base.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Base do Crânio/diagnóstico por imagem , Artefatos , Osso e Ossos/diagnóstico por imagem , Tecido Conjuntivo/diagnóstico por imagem , Meios de Contraste , Imagem de Difusão por Ressonância Magnética , Hidropisia Endolinfática/diagnóstico por imagem , Gadolínio , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Súbita/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética/tendências
10.
World Neurosurg ; 132: 363-367, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541760

RESUMO

BACKGROUND: The flexion of the skull base (basal angle [BA]) is the inclination between the anterior fossae and the basilar ramp of the occipital and sphenoid bones. An increased BA, termed platybasia, is usually associated with basilar invagination. BA reference values in the magnetic resonance imaging (MRI) era and the diagnosis of platybasia are of clinical importance. The transnasal approach has been the surgical technique of choice to remove the odontoid process in cases of ventral brainstem compression in patients with platybasia. The knowledge of normal BA values has been influenced by technological image acquisitions. The aim of this study was to determine the normal BA values in normal subjects in the MRI era. METHODS: For the determination of normal BA values, the literature reporting these values in normal individuals was reviewed and a meta-analysis of pertinent studies was performed. RESULTS: A total of 8 articles were included in this study, evaluating a total of 667 individuals. A summary measure of the results was obtained. The data obtained in this analysis provided a final basal angle value of 116.5 degrees (95% confidence interval, 104.39-128.7). The normal basal angle ranges between 104 and 129 degrees. CONCLUSION: Platybasia can be defined as a value >129 from the basal angle.


Assuntos
Imagem por Ressonância Magnética/métodos , Procedimentos Neurocirúrgicos/métodos , Platibasia/diagnóstico por imagem , Platibasia/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Humanos , Valores de Referência
11.
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
12.
Int J Mol Sci ; 20(18)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31514293

RESUMO

BACKGROUND: Skull base chordomas are rare tumors arising from notochord. Sphingolipids analysis is a promising approach in molecular oncology, and it has never been applied in chordomas. Our aim is to investigate chordoma behavior and the role of ceramides. METHODS: Ceramides were extracted and evaluated by liquid chromatography and mass spectrometry in a cohort of patients with a skull base chordoma. Clinical data were also collected and correlated with ceramide levels. Linear regression and correlation analyses were conducted. RESULTS: Analyzing the association between ceramides level and MIB-1, total ceramides and dihydroceramides showed a strong association (r = 0.7257 and r = 0.6733, respectively) with MIB-1 staining (p = 0.0033 and p = 0.0083, respectively). Among the single ceramide species, Cer C24:1 (r = 0.8814, p ≤ 0.0001), DHCer C24:1 (r = 0.8429, p = 0.0002) and DHCer C18:0 (r = 0.9426, p ≤ 0.0001) showed a significant correlation with MIB-1. CONCLUSION: Our lipid analysis showed ceramides to be promising tumoral biomarkers in skull base chordomas. Long- and very-long-chain ceramides, such as Cer C24:1 and DHCer C24:1, may be related to a prolonged tumor survival and aggressiveness, and the understanding of their effective biological role will hopefully shed light on the mechanisms of chordoma radio-resistance, tendency to recur, and use of agents targeting ceramide metabolism.


Assuntos
Agressão , Ceramidas/metabolismo , Cordoma/metabolismo , Neoplasias da Base do Crânio/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Proliferação de Células , Cordoma/diagnóstico por imagem , Feminino , Humanos , Modelos Lineares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Base do Crânio/diagnóstico por imagem , Esfingolipídeos/metabolismo
13.
J Med Case Rep ; 13(1): 273, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31466520

RESUMO

BACKGROUND: With increasing treatment options available, neuroendocrine tumor has become a chronic disease and may present later on with atypical manifestation of disease spread once resistant to treatment. CASE PRESENTATION: A 74-year-old white British woman undergoing treatment for metastatic well-differentiated neuroendocrine tumor for the past 9 years presented with a brief history of mild frontal headache, and progressive left ptosis and ocular palsy. She had no visual loss, and had neither speech nor motor deficit. At the outset, it was crucial to exclude acute or missed stroke. An urgent magnetic resonance imaging of her head revealed an unusual skull base metastasis extending into the cavernous sinus, with no peritumoral edema. Following discussion at a specialist neuro-oncology meeting and a neuroendocrine tumor multidisciplinary team meeting, she proceeded to have conventional fractionated radiotherapy followed by subsequent palliative chemotherapy. CONCLUSIONS: Intracranial metastasis is rare in patients with neuroendocrine tumor, particularly in those with well-differentiated histology; skull base metastasis is even more uncommon. Management of intracranial metastasis from a rare tumor should always be discussed in a specialist multidisciplinary meeting. Surgery or radiotherapy, including stereotactic radiosurgery, should be considered in skull base metastases. Hormonal abnormalities may occur following radiotherapy to skull base metastases and should be monitored closely in the first few months post treatment.


Assuntos
Neoplasias Intestinais/patologia , Tumores Neuroendócrinos/patologia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/secundário , Idoso , Blefaroptose/etiologia , Evolução Fatal , Feminino , Cefaleia/etiologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Imagem por Ressonância Magnética , Doenças do Nervo Oculomotor/etiologia , Tomografia por Emissão de Pósitrons
14.
J Laryngol Otol ; 133(6): 501-507, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31271349

RESUMO

OBJECTIVE: Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken. METHODS: Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance. RESULTS: Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa-Hunt syndrome cases. CONCLUSION: A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem Tridimensional , Órbita/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Adulto , Fatores Etários , Idoso , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Órbita/diagnóstico por imagem , Órbita/patologia , Medição da Dor , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Radiologe ; 59(11): 982-991, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31321467

RESUMO

BACKGROUND: In this article, the most common pituitary gland tumors and the various differential diagnoses with focus on (neuro-)radiological diagnostic criteria are presented. MATERIALS AND METHODS: An intensive, selective search of the literature in PubMed was carried out. RESULTS: Pituitary adenomas account for approximately 10-15% of all intracranial brain tumors and are the most common tumors of the sellar region. Beyond a size of 10 mm they are called macroadenomas, under 10 mm microadenomas. They can be distinguished into hormone-active and non-active adenomas. Most of the hormone-active adenomas secrete prolactin (50%), more rarely somatotropin (10%) or corticotropin (5%). Tumors in the sellar region can arise from various tissues. Due to the anatomically complex location, local adjacent structures can be affected or compressed by the tumors. Particularly in case of suprasellar extension, visual impairment due to pressure on the optic chiasm is common. Important differential diagnoses for sellar tumors include craniopharyngiomas, meningiomas, metastases, aneurysms and Rathke cleft cysts. The task of image diagnostics is the early detection of the lesions as well as the proliferation pattern into perifocal structures. Gold standard is the thin-section, contrast-enhanced MRI examination. Dynamic contrast administration is crucial for the diagnosis of the microadenoma and the specific enhancement characteristic of some other tumors. CONCLUSION: A highly focused imaging protocol is important for the diagnosis of sellar lesions such as pituitary tumors. The current favored modality is contrast-enhanced MRI, preferably with dynamic contrast-enhanced T1-weighted sequences. Early detection of the lesions and identification of the precise anatomical location are of great importance for diagnosis and therapy.


Assuntos
Adenoma , Neoplasias Encefálicas , Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias , Neoplasias da Base do Crânio , Adenoma/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Hipófise/diagnóstico por imagem , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica , Neoplasias da Base do Crânio/diagnóstico por imagem
17.
World Neurosurg ; 130: e620-e626, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31265927

RESUMO

OBJECTIVE: The aim of this study was to discuss the relationship between Ki-67 values and the degree to which chordoma invade the clivus and to certify that the prognosis of chordoma is worse when it invades the middle and lower clivus than when it does not. METHODS: We collected 56 cases of first-time chordoma illness in which patients received no treatment before surgery. Patients underwent craniocerebral magnetic resonance imaging and skull-base 3-dimensional computed tomography scans before the operation. We divided patients into 2 groups depending on the extent to which the middle and lower clivus were invaded. We classified patients with chordoma that did not significantly invade the middle and lower clivuses into a "noninvasive" group and the others into an "invasive" group. Ki-67 values were extracted from the pathological report after surgery. We use an independent χ2 test to indicate that Ki-67 values for the invasive group were higher than those for the noninvasive group. RESULTS: We grouped the data and did a statistical analysis. We found that the Ki-67 values are >5% for most patients in whom chordoma have eroded the middle-lower clivus, whereas it is ≤5% for patients in whom the middle-lower clivus region has not been invaded. Therefore, there is a correlation between Ki-67 value and the region of chordoma invading the clivus. CONCLUSIONS: Statistical analysis revealed that Ki-67 values when the chordoma invaded the middle and lower clivus were significantly higher than when it did not. Thus, we can conclude that the prognosis is worse when chordoma invade the middle and lower clivus.


Assuntos
Cordoma/patologia , Fossa Craniana Posterior/patologia , Invasividade Neoplásica/patologia , Neoplasias da Base do Crânio/patologia , Adolescente , Adulto , Idoso , Biomarcadores Tumorais/análise , Cordoma/diagnóstico por imagem , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Humanos , Antígeno Ki-67/análise , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Prognóstico , Neoplasias da Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
Clin Nucl Med ; 44(9): 750-751, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31283610

RESUMO

We present a case of a right skull base paraganglioma detected using F-choline PET/CT in a 63-year-old man. The F-choline PET/CT scan was performed to assess a known prostate cancer. In addition, the scan demonstrated a mildly choline-avid (SUVmax, 3.8) tumor within the carotid sheath of the right skull base, extending through the jugular foramen to the cerebellomedullary and cerebellopontine angles. F-choline may provide a superior alternative to FDG in imaging paragangliomas of the skull base because, unlike FDG, there is no significant F-choline uptake in the adjacent brain.


Assuntos
Colina/análogos & derivados , Paraganglioma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias da Base do Crânio/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade
19.
World Neurosurg ; 131: e12-e22, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31226453

RESUMO

BACKGROUND: Parasellar meningiomas involving the cavernous sinus and Meckel's cave pose a management challenge because of invasion around neurovascular structures and the pituitary gland. The management options range from aggressive resection to focused radiotherapy alone. We present a strategy for these tumors that includes endonasal bony decompression, partial tumor removal, and stereotactic radiotherapy (SRT) in select cases. METHODS: The tumor location, previous treatments, cranial neuropathies, pituitary dysfunction, tumor control rates, use of stereotactic radiosurgery, SRT, and complications were retrospectively evaluated. RESULTS: Twenty patients (age range, 43-81 years; 65% women; 90% with World Health Organization grade I; median follow-up, 57 months; 14 without previous debulking and RT; 6 with previous debulking and RT) underwent endonasal bony decompression and partial tumor removal. The most common tumor locations were cavernous sinus (95%), Meckel's cave (95%), sella (75%), petroclival (60%), and optic canal/orbit (30%). Three patients with large meningiomas underwent staged transcranial and endonasal debulking. Of the 14 patients without previous debulking and RT, 11 had undergone postoperative SRT, with tumor shrinkage in 3 (27%). At the last follow-up examination, for these 14 patients and the 6 patients who had undergone previous surgery and RT, tumor control was 100% and 33% (P < 0.001) and the cranial neuropathies had improved in 57% and 33%, respectively. Major complications occurred in 2 patients: a permanent sixth cranial nerve palsy and cerebrospinal fluid leakage requiring reoperation. CONCLUSIONS: Endonasal bony decompression and selective tumor removal, followed by SRT, appears to be a reasonable treatment option for most previously untreated parasellar meningiomas. For patients who have undergone previous debulking and RT, new targeted treatment strategies are needed.


Assuntos
Seio Cavernoso/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Descompressão Cirúrgica/métodos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neuroendoscopia/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Seio Cavernoso/diagnóstico por imagem , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/radioterapia , Meningioma/complicações , Meningioma/diagnóstico por imagem , Meningioma/radioterapia , Pessoa de Meia-Idade , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Doenças da Hipófise/etiologia , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia , Estudos Retrospectivos , Neoplasias da Base do Crânio/complicações , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/radioterapia
20.
J Pak Med Assoc ; 69(6): 896-898, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201400

RESUMO

To report a case of chondrosarcoma of right big toe with left orbital and left infra temporal metastases. Chondrosarcoma is the second most frequent primary malignant tumour of the bone. A 56 year old man had history of trauma on his right big toe, which was amputated and the biopsy in 2011 at Sindh Institute of Urology and Transplantation (SIUT) revealed chondrosarcoma with clear margins. Eventually the patient was presented with swelling of the left eye, pain and gradual loss of vision of that eye. Later a CT scan of his chest, brain and orbit showed pulmonary and pleural based nodule, with mediastinal and hilar lymphadenopathy representing metastatic deposit in left orbit, extending to left infra temporal region. A treatment of palliative chemotherapy was started with doxorubicin and ifosfamide, after which he was referred for radiotherapy. At that time he had loss of vision, pain and exopthalamus, and palliative radiotherapy was delivered to the left orbit with the prescribed dose of30 Gy/300cGy×10 fraction. Thereafter his case will be followed up at the oncology OPD after a 03 month interval.


Assuntos
Neoplasias Ósseas/patologia , Condrossarcoma/secundário , Neoplasias Pulmonares/secundário , Neoplasias Orbitárias/secundário , Neoplasias da Base do Crânio/secundário , Falanges dos Dedos do Pé/patologia , Condrossarcoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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