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1.
BMJ Case Rep ; 12(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31272995

RESUMO

Frequent falls and dizziness are common complaints in children. These symptoms can be caused by wide range of underlying pathologies including peripheral vestibular deficits, cardiac disease, central lesions, motor skills delay and psychogenic disorders. We report three paediatric cases who presented with complaints of repeated falls and imbalance. MRI scan revealed underlying brain lesions (frontal lobe arteriovenous malformation, exophytic brain stem glioma and cerebellomedullary angle arachnoid cyst with cerebellar tonsillar ectopia). By reporting these cases, we would like to emphasise the importance of a thorough assessment of children with similar symptoms by detailed clinical history, physical examination and maintaining low threshold for investigations, including radiological imaging. Taking in consideration, the wide range of differential diagnosis, the challenge of obtaining detailed history and difficulty of performing reliable physical examination in this age group. Management of underlying disorders can be medical, surgical or just observational.


Assuntos
Cistos Aracnóideos/diagnóstico por imagem , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Tontura/diagnóstico por imagem , Glioma/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Acidentes por Quedas , Adolescente , Cistos Aracnóideos/complicações , Neoplasias do Tronco Encefálico/complicações , Criança , Pré-Escolar , Diagnóstico Diferencial , Tontura/etiologia , Feminino , Glioma/complicações , Humanos , Malformações Arteriovenosas Intracranianas/complicações
2.
World Neurosurg ; 130: 499-505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295597

RESUMO

BACKGROUND: Syringobulbia is an uncommon lesion that occurs in the central nervous system; it is often defined as a pathologic cavitation in the brainstem. The cases with partial blockage of the cerebrospinal fluid pathways at the level of the foramen magnum are more common and the most important group. The most common treatment of syringobulbia is craniovertebral decompression. CASE DESCRIPTION: This paper reports a case of a symptomatic syringobulbia in which an urgent endoscopic endonasal approach to the craniovertebral junction (CVJ) was done to limit bulbo-medullary compression and rapid neurologic deterioration. A 69-year-old man was admitted to the hospital because of acute onset of dysphonia, dysphagia, imbalance, and vomiting. Magnetic resonance imaging revealed a cystic lesion in the brainstem, suggestive of a syringobulbia in Klippel Feil syndrome with CVJ stenosis. CONCLUSIONS: This case report details the successful use of endoscopic endonasal anterior decompression to treat syringobulbia, and adds to the growing literature in support of the endonasal endoscopic approach as a safe and feasible means for decompressing the craniocervical junction, even in the setting of urgency. However, prudent patient selection, combined with sound clinical judgment, access to instrumentation, and intraoperative imaging cannot be overemphasized.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Compressão da Medula Espinal/cirurgia , Idoso , Neoplasias do Tronco Encefálico/complicações , Humanos , Síndrome de Klippel-Feil/complicações , Síndrome de Klippel-Feil/cirurgia , Masculino , Nariz/cirurgia , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(6): e14322, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732152

RESUMO

RATIONALE: Endodermal cysts are rare benign lesions in the central nervous system. Their common symptoms include headache and neck pain caused by mass effect or inflammatory reaction. We report the case of an elderly woman with intracranial endodermal cyst who presented with nonobstructive hydrocephalus. PATIENT CONCERNS: A 78-year-old woman presented with acute deterioration of consciousness caused by acute hydrocephalus. She subsequently underwent ventriculoperitoneal shunt placement. Eighteen months after this operation, she developed numbness of extremities and gait and progressive cognitive disturbances. DIAGNOSIS: Initially, the endodermal cyst could not be recognized, but it became clinically evident in the craniocervical junction after ventriculoperitoneal shunt placement. MRI revealed multiple cystic lesions in the pontomedullary cistern. Postoperative pathology confirmed the diagnosis of endodermal cyst. INTERVENTIONS: Subtotal resection of the cystic lesion was performed. Intra-operatively, multiple cysts containing a milky white fluid were noted and the medullary surface including the median and lateral apertures of the fourth ventricle were covered by thick, cloudy arachnoid membrane. OUTCOMES: Although the numbness of extremities improved after the surgery, she remained bedridden due to deterioration in cognitive function and generalized muscle weakness. The patient developed recurrence 2 months after the surgery; however, no additional surgery was performed owing to her poor general condition. LESSONS: Endodermal cysts rarely present with nonobstructive hydrocephalus caused by recurrent meningitis. In such cases, the lesions are often invisible on initial diagnostic imaging, and complete resection of the lesions is typically difficult because of strong adhesion between the cyst walls and contiguous vital structures.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/diagnóstico , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico , Hidrocefalia/etiologia , Idoso , Neoplasias do Tronco Encefálico/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/terapia
6.
Pediatr Blood Cancer ; 66(3): e27561, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30484948

RESUMO

BACKGROUND: The mean overall survival rate of children with diffuse intrinsic pontine glioma (DIPG) is 9-11 months, with current standard treatment with fractionated radiotherapy and adjuvant chemotherapy. So far, novel therapeutic strategies have not yet resulted in significantly better survival. The main source of energy for glioblastoma cells is glucose. Therefore, metabolic alterations induced by the use of the extremely carbohydrate-restricted ketogenic diet (KD) as adjuvant therapy are subject of interest in cancer research. PROCEDURE: This study explores the safety and feasibility of the KD in children with recurrent DIPG and no remaining treatment options. Safety was defined as the number of adverse effects. Feasibility was defined as the number of patients who were able to use the KD for three months. Coping of patients and parents was measured with questionnaires. RESULTS: Three of 14 children referred to our hospital between 2010 and 2015 were included. Two patients completed the study, and one died before the end of the study. Hospitalizations were needed for placing a nasogastric tube (n = 1) and epileptic seizures (n = 1). Adverse effects related to the diet were mild and transient. Parents were highly motivated during the study. CONCLUSION: Use of KD is safe and feasible, but the effect on survival has to be proven in a larger cohort of children who start the KD earlier after diagnosis, preferably as adjuvant therapy to fractionated radiotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Tronco Encefálico/terapia , Quimiorradioterapia , Dieta Cetogênica/métodos , Glioma/terapia , Recidiva Local de Neoplasia/dietoterapia , Radioterapia , Adolescente , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/patologia , Quimioterapia Adjuvante , Criança , Pré-Escolar , Estudos de Viabilidade , Seguimentos , Glioma/complicações , Glioma/patologia , Humanos , Incidência , Masculino , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Países Baixos/epidemiologia , Prognóstico , Estudos Prospectivos , Segurança , Taxa de Sobrevida
7.
World Neurosurg ; 123: 464-468.e1, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30496930

RESUMO

BACKGROUND: Hypertrophic olivary degeneration (HOD) is a rare neurological condition of trans-synaptic degeneration caused by disruption of the dentatorubro-olivary pathway. We present new radiologic findings of HOD in 2 cases of brainstem lymphoma. CASE DESCRIPTION: A 35-year-old woman (Case 1) and a 69-year-old man (Case 2) presented with remarkably similar clinical courses. The primary lesion was located at the dorsal pons extending to the midbrain. Pathologic diagnosis of diffuse large B-cell lymphoma was obtained after surgical resection. Complete remission of the primary lesion was achieved by treatment with 3 courses of high-dose methotrexate and radiotherapy. Arterial spin-labeling and T2-weighted imagings showed high signal intensity in the inferior olive (IO) at some time after the operation. Slight contrast enhancement in the IO was also found in Case 1. These radiologic findings nearly misled us into a diagnosis of recurrence of lymphoma. Signal intensity in the IO on arterial spin-labeling imaging changed with time. Normalized regional cerebral blood flow (rCBF) in the IO was defined as a percentage of rCBF to the global cerebral blood flow calculated using automated software. Chronologic change in normalized rCBF in the IO revealed a large peak in Case 1, but only a mild increase in Case 2. Neurological findings demonstrated severe oculopalatal tremor in Case 1 and mild palatal tremor in Case 2. CONCLUSIONS: Hyperperfusion and contrast enhancement in the IO were found in 2 patients with HOD. These findings may be confused with recurrence of malignant tumor.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Linfoma/complicações , Núcleo Olivar/patologia , Atrofias Olivopontocerebelares/diagnóstico por imagem , Atrofias Olivopontocerebelares/etiologia , Adulto , Idoso , Feminino , Humanos , Imagem Tridimensional , Imagem por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons , Marcadores de Spin
8.
J Clin Neurosci ; 60: 151-153, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30366780

RESUMO

A previously well man presented with several months' history of neurological symptoms including diplopia and balance difficulties. Examination revealed fluctuating neurological deficits, fatigable weakness and slowed saccades. Extensive testing revealed mildly elevated cerebrospinal fluid protein, strongly positive single fiber electromyography and a dorsal pontine lesion at the floor of the 4th ventricle. An autoimmune process was felt to best account for the myasthenic presentation while the differential diagnoses for the brainstem lesion included glioma. Aggressive immunotherapy failed to halt clinical deterioration; over months he developed generalized weakness, aspiration pneumonia and died. Post-mortem analysis revealed glioneuronal tumor infiltration throughout the brainstem, cerebellum and along the meningeal surface. This is an unusual case of an infiltrative brainstem lesion, with the presentation suggesting a primary diagnosis of myasthenia gravis. The progressive nature of the illness, despite aggressive immune therapy, together with slow saccades, underscored a more sinister process. Cerebral imaging should be performed in patients with fluctuating neurological symptoms, progressive deterioration, and ocular, bulbar, respiratory, or pyramidal pattern deficits, and differentials for contrast-enhancing brain lesions should include primary brain tumors. In such cases, biopsy must proceed if the disease is of relatively recent onset, to facilitate diagnosis and maximize treatment opportunities.


Assuntos
Neoplasias do Tronco Encefálico/diagnóstico , Glioma/diagnóstico , Neoplasias do Tronco Encefálico/complicações , Diagnóstico Diferencial , Diplopia/etiologia , Eletromiografia , Evolução Fatal , Glioma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Miastenia Gravis/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/etiologia
10.
World Neurosurg ; 118: 212-218, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30031191

RESUMO

BACKGROUND: Brainstem cavernous malformations represent around 8%-22% of all intracranial cavernous malformations but exhibit a higher annual incidence of hemorrhage (2%-3%) compared with other cavernous angiomas and tend to be more symptomatic given their proximity to critical nuclei and fiber tracts. Recently, endoscopic endonasal techniques have been used for the removal of ventral skull base lesions, with significant improvement in operative morbidity and mortality compared with open approaches. Here we demonstrate the utility and feasibility of the endoscopic transclival approach for ventrally located pontine cavernomas in carefully selected patients. CASE DESCRIPTION: Consent was provided by the patient before the writing of this report. Institutional review board approval was not necessary because there was no other patient data accessed. A 21-year-old man presented to the emergency department with right-sided hemiparesis. Magnetic resonance imaging demonstrated evidence of hemorrhage from a ventrally located pontine cavernoma. Given the ventral location of the lesion and the desire for early control of an associated developmental venous anomaly (DVA), an endoscopic endonasal transclival approach was chosen. Gross total resection was achieved, and the patient did well postoperatively with no new neurologic deficits or cerebrospinal fluid leak. He is currently routinely followed and is neurologically well. CONCLUSIONS: This approach provided direct visualization of the lesion and the associated DVA allowing for a gross total resection without injury to the DVA. The transclival approach may be considered as an alternative to open lateral and dorsolateral neurosurgical approaches for ventral brainstem cavernomas in carefully selected patients.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Fossa Craniana Posterior/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Cavidade Nasal/cirurgia , Neuroendoscopia/métodos , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Fossa Craniana Posterior/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Masculino , Cavidade Nasal/diagnóstico por imagem , Adulto Jovem
11.
Acta Neuropathol Commun ; 6(1): 51, 2018 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-29954445

RESUMO

Diffuse intrinsic pontine glioma (DIPG) is a universally fatal malignancy of the childhood central nervous system, with a median overall survival of 9-11 months. We have previously shown that primary DIPG tissue contains numerous tumor-associated macrophages, and substantial work has demonstrated a significant pathological role for adult glioma-associated macrophages. However, work over the past decade has highlighted many molecular and genomic differences between pediatric and adult high-grade gliomas. Thus, we directly compared inflammatory characteristics of DIPG and adult glioblastoma (GBM). We found that the leukocyte (CD45+) compartment in primary DIPG tissue samples is predominantly composed of CD11b + macrophages, with very few CD3+ T-lymphocytes. In contrast, T-lymphocytes are more abundant in adult GBM tissue samples. RNA sequencing of macrophages isolated from primary tumor samples revealed that DIPG- and adult GBM-associated macrophages both express gene programs related to ECM remodeling and angiogenesis, but DIPG-associated macrophages express substantially fewer inflammatory factors than their adult GBM counterparts. Examining the secretome of glioma cells, we found that patient-derived DIPG cell cultures secrete markedly fewer cytokines and chemokines than patient-derived adult GBM cultures. Concordantly, bulk and single-cell RNA sequencing data indicates low to absent expression of chemokines and cytokines in DIPG. Together, these observations suggest that the inflammatory milieu of the DIPG tumor microenvironment is fundamentally different than adult GBM. The low intrinsic inflammatory signature of DIPG cells may contribute to the lack of lymphocytes and non-inflammatory phenotype of DIPG-associated microglia/macrophages. Understanding the glioma subtype-specific inflammatory milieu may inform the design and application of immunotherapy-based treatments.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Citocinas/metabolismo , Regulação Neoplásica da Expressão Gênica/fisiologia , Glioma/patologia , Microambiente Tumoral , Adolescente , Autopsia , Neoplasias do Tronco Encefálico/complicações , Proteínas de Ligação ao Cálcio , Adesão Celular/genética , Criança , Pré-Escolar , Citocinas/genética , Proteínas de Ligação a DNA/metabolismo , Encefalite/etiologia , Feminino , Glioma/química , Glioma/complicações , Humanos , Linfócitos/patologia , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Proteínas dos Microfilamentos , Microglia/metabolismo , Microglia/patologia , Pessoa de Meia-Idade , Neovascularização Patológica/etiologia , Neovascularização Patológica/genética , Transcriptoma
12.
J Clin Sleep Med ; 14(6): 1071-1074, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29852906

RESUMO

ABSTRACT: A medullary tumor is a relatively rare disease that causes severe and complicated respiratory disorders, including sleep-related breathing disorders, due to dysregulation of respiratory control. A severely obese 12-year-old male was admitted to our hospital for worsening dyspnea and received a diagnosis of type II respiratory failure. Although obstructive sleep apnea (OSA) and/or obesity hypoventilation syndrome were suspected, a polysomnogram obtained during a nap (nap study) revealed central sleep apnea (CSA) and sleep-related hypoventilation disorder (SRHD) in addition to OSA. Brain magnetic resonance imaging showed a mass in the medulla oblongata. The patient received a diagnosis of CSA/SRHD caused by a medullary tumor, and with OSA. A partial brainstem tumor resection was performed. Noninvasive positive airway pressure therapy was initiated, and was continued after surgery. However, the patient died unexpectedly, 20 months after surgery. When children with sleep problems caused by OSA present with atypical symptoms of OSA, a neurological examination and polysomnography should be conducted to detect CSA and SRHD.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Hipoventilação/etiologia , Obesidade Pediátrica/complicações , Apneia do Sono Tipo Central/complicações , Apneia Obstrutiva do Sono/etiologia , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Tronco Encefálico/cirurgia , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/cirurgia , Criança , Evolução Fatal , Humanos , Hipoventilação/terapia , Imagem por Ressonância Magnética , Masculino , Polissonografia , Apneia do Sono Tipo Central/terapia , Apneia Obstrutiva do Sono/terapia
14.
World Neurosurg ; 113: 312-315, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29524720

RESUMO

The radiological signs of intracranial dural arteriovenous fistulas (ICDAVFs) are heterogenous. While it is commonly accepted that hyper intense T2 wedge magnetic resonance imaging of the brainstem and cervical cord mainly concern gliomas, it is so far uncommon and probably unknown that ICDAVFs can imitate similar radiological pattern, especially with gadolinium contrast enhancement and cord enlargement. Thus the angiography is poorly documented in the diagnostic workup. We report the unusual history of ICDAVFs, revealed by clinical and radiological features that mimicked a medulla or cervical spinal cord glioma. This observation provides information on the management of atypical lesions mimicking medulla or cervical cord glioma and arguments for a careful radiological study. Looking for dilated veins around the brainstem and the cord is mandatory in the workup of a supposed infiltrating brainstem or spinal cord lesion, in order to rule out an ICDAVF. Even if the hyperintense T2 images associated with contrast enhancement is in favor of a brainstem or spinal cord glioma, additional cerebral angiography should be mandatory. Moreover, this clinical case highlights the need for a multidisciplinary approach including neuroradiologist, oncologist and neurosurgeon.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Medula Cervical/cirurgia , Glioma/cirurgia , Bulbo/cirurgia , Neoplasias da Medula Espinal/cirurgia , Idoso , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Medula Cervical/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Glioma/complicações , Glioma/diagnóstico por imagem , Humanos , Bulbo/diagnóstico por imagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem
15.
BMJ Case Rep ; 20182018 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-29348287

RESUMO

While occasional hiccups are normal, their persistent recurrence is distressing and may have an underlying aetiology. Patients with recurrent hiccups may undergo a long journey and see many physicians before the diagnosis is finally made. The purpose of this report is to increase awareness of central nervous system lesions as a possible cause for recurrent hiccups and provide an illustrative case of an otherwise fit man presenting with ongoing hiccups caused by a medullary haemangioblastoma.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Hemangioblastoma/complicações , Soluço/etiologia , Idoso , Humanos , Masculino , Recidiva
16.
World Neurosurg ; 110: 294-300, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29061458

RESUMO

BACKGROUND: Hypertrophic olivary degeneration (HOD) is a rare phenomenon in the dento-rubro-olivary pathway caused by lesion or disruption of the fibers of the Guillain-Mollaret triangle. Hemorrhage of pontine and midbrain cavernous angiomas can rarely lead to HOD portending neurologic deterioration and possible concomitant life-threatening complications; for this reason, it may define a poignant consideration in planning intervention. CASE DESCRIPTION: The patient was a 57-year-old woman with known midbrain-pontine cavernous angioma. For several years, the lesion had been stable, as shown by imaging follow-up, until 10 months before the patient presented with falls, dysarthria, and headache. Imaging showed some decrease in size as well as blood product around the cavernous angioma, suggesting interim period hemorrhage and interval development of HOD. CONCLUSIONS: The literature regarding imaging recommendations for stable cavernous angioma in the midbrain-pontine junction is reviewed. The implication of HOD for patient outcome is discussed and a comment is made on how the development of HOD may affect management of the cavernous angioma.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Hemangioma Cavernoso/complicações , Atrofias Olivopontocerebelares/etiologia , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Feminino , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Hipertrofia/complicações , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Degeneração Neural , Atrofias Olivopontocerebelares/diagnóstico por imagem , Atrofias Olivopontocerebelares/cirurgia , Tomografia Computadorizada por Raios X
17.
Br J Neurosurg ; 32(3): 295-296, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29191062

RESUMO

We present the case of a 15 year old boy who developed transient lower motor neuron facial weakness on two separate occasions shortly after ventriculoperitoneal shunt insertion. Both episodes, each of which occurred on the ipsilateral side to shunt insertion, were transient, self-limiting and were managed medically with a course of oral steroids. We believe this is the first reported case of Bell's palsy after this type of surgery in a child. Potential pathophysiological mechanisms are discussed.


Assuntos
Paralisia de Bell/etiologia , Neoplasias do Tronco Encefálico/cirurgia , Glioma/cirurgia , Hidrocefalia/cirurgia , Complicações Pós-Operatórias/etiologia , Teto do Mesencéfalo/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Adolescente , Paralisia de Bell/tratamento farmacológico , Paralisia de Bell/fisiopatologia , Neoplasias do Tronco Encefálico/complicações , Criança , Falha de Equipamento , Glioma/complicações , Humanos , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/fisiopatologia , Prednisolona/uso terapêutico , Recidiva , Reoperação , Esteroides
18.
J Neurosurg ; 128(5): 1289-1296, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28686112

RESUMO

Brainstem cavernous malformations (CMs) pose significant challenges to neurosurgeons because of their deep locations and high surgical risks. Most patients with brainstem CMs present with sudden-onset cranial nerve deficits or ataxia, but uncommonly patients can present in extremis from an acute hemorrhage, requiring surgical intervention. However, the timing of surgery for brainstem CMs has been a controversial topic. Although many authors propose delaying surgery into the subacute phase, some patients may not tolerate waiting until surgery. To the best of the authors' knowledge, emergency surgery after a brainstem CM hemorrhage has not been described. In cases of rapidly progressive neurological deterioration, emergency resection may often be the only option. In this retrospectively reviewed small series of patients, the authors report favorable outcomes after emergency surgery for resection of brainstem CMs.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Tratamento de Emergência , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Procedimentos Neurocirúrgicos , Adulto , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Pré-Escolar , Tratamento de Emergência/métodos , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Tempo para o Tratamento , Adulto Jovem
19.
Br J Neurosurg ; 31(5): 601-602, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28574289

RESUMO

Intermittent change in ventricular size in patients with ventriculo-peritoneal shunts is a recognised complication but definitive imaging evidence is rare. We report a 3 years old boy with a medullary astrocytoma and ventriculo-peritoneal shunt placement who demonstrated intermittent ventriculomegaly during a single MRI scan.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Astrocitoma/complicações , Astrocitoma/diagnóstico por imagem , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Pré-Escolar , Falha de Equipamento , Humanos , Hidrocefalia/cirurgia , Masculino , Resultado do Tratamento
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