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1.
World Neurosurg ; 132: 7-11, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442659

RESUMO

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


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Glioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Neoplasias do Ventrículo Cerebral/complicações , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Glioma/complicações , Glioma/diagnóstico por imagem , Glioma/secundário , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Doenças Raras , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/secundário , Derivação Ventriculoperitoneal
3.
World Neurosurg ; 131: 87-89, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356970

RESUMO

BACKGROUND: Intraorbital and intracerebral cavernous malformation (CM) lesions are considered independent entities. Purely cerebral CMs have variable biology with recent evidence depicting inflammation as an important player and a risk factor for aggressiveness. We describe a case of concomitant left intraaxial and extraaxial CMs, linked by the ipsilateral basal vein, where the extraaxial component has developed an aggressive behavior. CASE DESCRIPTION: A 35-year-old female patient presented with a rapid and progressive exophthalmos and loss of vision on the left eye. Cranial magnetic resonance and angiography examinations demonstrated a left craniofacial CM and large intraorbital component. The lesion was connected through a large basal vein to a cerebral intraventricular CM. Transconjunctival resection showed typical findings of CM. A complete histopathology and immunostaining analysis was performed and revealed a clear acute lymphomononuclear reaction with a predominant immune cellular inflammation. CONCLUSIONS: A case of intraorbital and extracranial cavernomatous mass, connected to a cerebral intraventricular CM through a large basal vein, has presented with an aggressive course. A complete histopathologic and immunohistochemical analysis of the orbital mass has pictured a clear immune-cellular inflammatory reaction adding to the amounting evidence of association between inflammation and site aggressiveness in the setting of CMs.


Assuntos
Veias Cerebrais/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Orbitárias/diagnóstico por imagem , Adulto , Linfócitos B/imunologia , Linfócitos B/patologia , Angiografia Cerebral , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/imunologia , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Inflamação/imunologia , Inflamação/patologia , Macrófagos/imunologia , Macrófagos/patologia , Imagem por Ressonância Magnética , Neoplasias Primárias Múltiplas/imunologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Orbitárias/imunologia , Neoplasias Orbitárias/patologia , Neoplasias Orbitárias/cirurgia , Plasmócitos/imunologia , Plasmócitos/patologia
4.
World Neurosurg ; 129: e177-e190, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31121376

RESUMO

BACKGROUND: The aim of this study is to share our experiences on a series of 21 patients with intraventricular meningiomas (IVMs). Histopathologic examinations are reviewed in detail and the cell of origin of IVMs is discussed. METHODS: We retrospectively reviewed 1372 patients with intracranial meningioma who were surgically treated between September 1986 and July 2018. From this cohort, 21 patients with IVM were identified. The clinical, radiologic, surgical, and follow-up records were analyzed. The archival pathologic specimens were reviewed. Tissue microarray blocks were performed from the formalin-fixed, paraffin-embedded samples of all IVM cases, 2 choroid plexus tissue adjacent to the tumors, and 10 extraventricular fibrous meningioma cases selected as control randomly. Immunohistochemical staining with the antibodies S-100, SOX10, NGFR, and OTX2 was performed according to the protocols indicated by the manufacturers. RESULTS: Surgical complications included hemiparesis in 1 patient (5%), postoperative seizure in 1 patient (5%), sensorial aphasia in 1 patient (5%), and preexisting headache in 1 patient (5%). Seventeen (81%) of the IVMs had grade I pathology and 4 (19%) had grade II pathology. The immunoprofile of IVMs is identical to the immunoprofile of normal choroid plexus epithelium. CONCLUSIONS: Transcortical approaches using intraoperative ultrasonography and intraoperative monitoring with avoidance of eloquent cortical areas can achieve good outcomes. Resection of the choroidal attachments should be attempted. Our results indicate that IVMs do not show arachnoid cap cell phenotype and the findings support that IVMs originate from the choroid plexus epithelium or the progenitors of the choroid plexus epithelium.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Plexo Corióideo/patologia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Plexo Corióideo/diagnóstico por imagem , Feminino , Humanos , Masculino , Meningioma/diagnóstico por imagem , Meningioma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
5.
World Neurosurg ; 127: 139-145, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30974274

RESUMO

OBJECTIVE: To investigate the clinical effect and surgical techniques of fourth ventricle astrocytoma resection through the median suboccipital keyhole approach. METHODS: Twelve patients received tumor resection through the median suboccipital keyhole approach in our department. A 4-cm median suboccipital excision starting 1 cm under the foramen magnum region and directed vertically upward was applied. The fourth ventricle was exposed through a cerebellomedullary fissure approach within a bone hole ≈2.5 cm in diameter. All clinical data (including preoperative/postoperative symptoms, magnetic resonance imaging scan, intraoperative findings, tumor resection rate, and surgical complications) were collected and analyzed. RESULTS: In our treatment group, the mean maximum tumor diameter was 3.48 ± 1.3 cm and the mean tumor volume was 34.79 ± 20.70 cm3. The complete resection rate was 92%. The average operative blood loss was 127.0 ± 24.6 mL; the mean craniotomy time was 26.4 ± 6.0 minutes; the mean tumor resection time was 190.3 ± 31.2 minutes; the mean cranial closure time was 42.3 ± 6.1 minutes; and the average hospitalization time was 13.6 ± 2.4 days. The mean Glasgow Outcome Scale score before discharge was 4.92. CONCLUSIONS: If appropriate microneurosurgical techniques are used via the median suboccipital keyhole approach, the fourth ventricle astrocytoma may be accessed and resected safely with shorter surgery time, reduced hemorrhage during operation, low incidence of postoperative complications, good recovery, and shorter hospitalization time.


Assuntos
Astrocitoma/cirurgia , Neoplasias do Ventrículo Cerebral/cirurgia , Gerenciamento Clínico , Quarto Ventrículo/cirurgia , Microcirurgia/métodos , Osso Occipital/cirurgia , Adulto , Astrocitoma/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Craniotomia/métodos , Feminino , Quarto Ventrículo/diagnóstico por imagem , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Osso Occipital/diagnóstico por imagem
6.
World Neurosurg ; 125: 253-256, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30790744

RESUMO

BACKGROUND: Rosette-forming glioneuronal tumour [RGNT] is a relatively rare entity first identified as a separate entity in 2002. We are reporting the second case of RGNT in the opticochiasmatic region. CASE DESCRIPTION: We report a case report and literature review of RGNT with syndromic association. CONCLUSIONS: Although initial reports were predominantly in the fourth ventricle, many recent reports have identified the possibility of its occurrence outside fourth ventricle in pineal gland, spinal cord, septum pellucidum, lateral ventricle, and suprasellar region. To date, only 1 case of RGNT involving the opticochiasmatic region has been reported in a patient with neurofibromatosis type 1. Genetic analysis of this rare tumor identified 3 hotspots involving somatic mutations of FGFR-1 and PIK3CA and a germline mutation involving PTPN11, which can be targets for therapeutic intervention in cases where complete resection is not possible. To the best of our knowledge, we report the first case of RGNT involving the opticochiasmatic region without any syndromic association. Other cases of RGNT with syndromic associations provide us with insight into possible therapeutic interventions.


Assuntos
Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Quarto Ventrículo/diagnóstico por imagem , Ganglioglioma/diagnóstico por imagem , Quiasma Óptico/diagnóstico por imagem , Formação de Roseta , Adolescente , Neoplasias do Ventrículo Cerebral/cirurgia , Seguimentos , Quarto Ventrículo/cirurgia , Ganglioglioma/cirurgia , Humanos , Masculino , Neuroglia/patologia , Neurônios/patologia , Quiasma Óptico/cirurgia
7.
Turk Neurosurg ; 29(4): 497-505, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30649815

RESUMO

AIM: To describe our institution’s experience with the telovelar approach as well as factors governing radicality and outcome for pediatric fourth ventricle tumors. MATERIAL AND METHODS: During March 2015â€"January 2017, 44 children with fourth ventricular tumors were operated using the telovelar approach. Radicality, neurological outcome, complications, and survival rates were evaluated. Statistical analysis was performed to determine factors associated with radicality and neurological outcome. RESULTS: Gross tumor removal was achieved in 37 patients (84.1%). All patients required cerebrospinal fluid (CSF) diversion through a ventriculoperitoneal shunt. Six patients (13.6%) developed cerebellar mutism, 4 patients (9.1%) developed bulbar paralysis (lower cranial nerve palsy), and 13 patients (30.2%) had tumor recurrence. Medulloblastoma was associated with the highest risk of cerebellar mutism (p=0.040). A poor prognosis (according to overall and progression-free survival rates) was associated with subtotal resection (p=0.020), large cell/anaplastic medulloblastoma and anaplastic ependymoma (p=0.038), highrisk medulloblastoma (p=0.005), and CSF seeding (p < 0.001). CONCLUSION: The telovelar approach provides an adequate anatomical exposure of the fourth ventricle and allows early visualization and protection of its floor (brainstem). It facilitates adequate radicality and is associated with a lower incidence of cerebellar mutism and other approach-related complications. The working angle, particularly to the rostral part of the fourth ventricle, can be increased by removing the posterior arch of the atlas.


Assuntos
Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/cirurgia , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
8.
World Neurosurg ; 122: e427-e435, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30342263

RESUMO

OBJECTIVE: To assess usefulness and limitations of flexible fiber carbon dioxide (CO2) laser in the microsurgical treatment of intraventricular tumors. METHODS: We reviewed a series of 9 patients treated with microsurgical resection of intraventricular tumors using a flexible fiber CO2 laser. The lesions involved the third ventricle (8) and the frontal horn of the right lateral ventricle (1). Histology revealed 6 craniopharyngiomas, 1 pituitary macroadenoma, 1 subependymoma, and 1 neurocytoma. In all cases, an interhemispheric transcallosal approach was performed. The laser was used during callosotomy, fornix column sectioning, tumor debulking, and to facilitate tumor dissection. We used a 5-tiered score system to assess laser's efficacy in each surgical step (approach, dissection, debulking): grade 1: laser was not at all helpful, grade 5: laser was extremely helpful. Limits of the instrument also are discussed. RESULTS: Gross total resection was achieved in 6 cases and subtotal resection in the remaining 3. Three patients had pulmonary complications treated without clinical sequelae. No laser-related complication was described. Mean utility score observed was 4.2 (range 3-5) during approach, 2.8 (range 2-4) during tumor dissection; and 3.3 (range 2-5) during tumor debulking. Main limits were low hemostatic effect and inefficiency versus calcified and highly vascularized tumors. CONCLUSIONS: The CO2 laser proved to be a useful and safe tool that could be used for intraventricular pathology; its design is suitable for narrow surgical corridors like interhemispheric fissure and foramen of Monro; its main utility is the ability to create precise and relatively bloodless cut (callosotomy, tumor debulking); low hemostatic effect is its main limit.


Assuntos
Adenoma/cirurgia , Neoplasias do Ventrículo Cerebral/cirurgia , Craniofaringioma/cirurgia , Glioma Subependimal/cirurgia , Lasers de Gás/uso terapêutico , Microcirurgia/métodos , Neurocitoma/cirurgia , Adenoma/diagnóstico por imagem , Adulto , Idoso , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Craniofaringioma/diagnóstico por imagem , Feminino , Glioma Subependimal/diagnóstico por imagem , Humanos , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Masculino , Pessoa de Meia-Idade , Neurocitoma/diagnóstico por imagem , Estudos Retrospectivos , Terceiro Ventrículo/diagnóstico por imagem
9.
World Neurosurg ; 122: e176-e185, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30292657

RESUMO

BACKGROUND: Endoscopic resection of colloid cysts is a widely accepted treatment option instead of microsurgery. However, there is still a debate about a potentially higher rate of incomplete resections and recurrence. OBJECTIVE: The aim of this retrospective study was to evaluate long-term results after endoscopic removal of colloid cysts. METHODS: Twenty patients underwent endoscopic treatment in our department. Eighteen patients agreed to follow-up examinations. In 17 patients, magnetic resonance images were obtained. RESULTS: Total cyst resection was achieved in 16 procedures. In 1 patient, only plexus coagulation and widening of the ipsilateral foramen of Monro were performed. In 3 patients, small remnants of the cyst membrane were left behind. Conversion to microsurgery became necessary in 1 patient. Mild temporary complications occurred in 6 patients. Preoperative symptoms were completely relieved in 16 patients and improved in 2 patients. The average follow-up period was 188 months. In the patient with plexus coagulation, the cyst did not change. Recurrence occurred in 2 of 3 patients with cyst remnants. To date, no cyst remnant or recurrence has caused any symptoms or required surgical treatment. CONCLUSIONS: Our results indicate that endoscopic treatment of colloid cysts is a safe and effective treatment option that provides excellent long-term results. However, we determined that a significant risk for recurrence exists when even small parts of the cyst capsule were left behind. Therefore, we advocate an attempt at total endoscopic cyst resection.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Cistos Coloides/cirurgia , Neuroendoscopia , Adolescente , Adulto , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Cistos Coloides/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Neuronavegação , Complicações Pós-Operatórias , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Terceiro Ventrículo , Resultado do Tratamento , Adulto Jovem
10.
World Neurosurg ; 131: e1-e11, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30500581

RESUMO

OBJECTIVE: Lateral intraventricular anaplastic meningiomas (LIAMs) are rare lesions. The aim of this study is to clarify clinical and radiologic characteristics and the optimal treatment strategies of LIAMs with long-term follow-up. METHODS: From September 2008 to September 2017, 5 patients with LIAM were enrolled in our study. The clinical profiles, radiologic features, treatment strategies, and outcomes were retrospectively analyzed. RESULTS: Five patients (all female; mean age, 48.8 years; range, 33-61 years) were included in this study. The most frequent symptoms were those related to increased intracranial pressure. Mean duration of symptoms was 6.7 months (range, 2 weeks-2 years). The average tumor size was 4.98 cm at the maximal diameter (range, 3.0-6.2 cm). All were confirmed with a diagnosis of anaplastic meningioma. Gross total resection was achieved in all 5 patients. All patients experienced improvement of symptoms. Recurrence and progression were identified in only 2 patients. At the last follow-up, the mean recurrence-free survival was 13 months (range, 7-21 months) and the mean overall survival was 16.25 months (range, 8-21 months). One patient was lost to follow-up. CONCLUSIONS: Female and right trigone area predominance were found in our case series. Shorter duration of symptoms, irregular tumor shape, peritumoral edema, and heterogeneous enhancement may indicate an aggressive feature. Maximal safe resection followed by radiation therapy may be the best strategy for patients with LIAM. Long-term clinical follow-up and serial imaging are recommended.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Ventrículos Laterais/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adulto , Anaplasia , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Intervalo Livre de Doença , Feminino , Humanos , Ventrículos Laterais/diagnóstico por imagem , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Meningioma/diagnóstico por imagem , Meningioma/patologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Radioterapia Adjuvante , Fatores de Tempo , Carga Tumoral
12.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 29(5): 255-259, sept.-oct. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-180319

RESUMO

El tumor glioneuronal formador de rosetas del IV ventrículo es un tumor primario del sistema nervioso central introducido en el grupo de tumores glioneuronales en la clasificación de la OMS de 2007. Inicialmente se describió alrededor del IV ventrículo, pero recientemente se han publicados casos en distintas localizaciones. Presentamos 2casos de este raro tumor, ambos tratados quirúrgicamente. El primero en un varón de 41 años de edad, con síntomas típicos de lesión de fosa posterior; el segundo, en una mujer de 18 años de edad, con hallazgo incidental de lesión en fosa posterior que también fue tratada quirúrgicamente. Presentamos imágenes de resonancia magnética pre- y posquirúrgicas, aportamos imágenes histológicas de este tumor y realizamos una revisión de la literatura


Rosette-forming glioneuronal tumor of the fourth ventricle is a primary central nervous system tumor introduced in the group of glioneuronal tumors in the WHO classification of 2007. Initially it was described around the fourth ventricle, but recently have been published cases in different locations. We present 2cases of this rare tumor, both surgically treated. The first in a 41 year old man with typical symptoms of posterior fossa injury. The second in an 18 year old woman, with incidental finding of posterior fossa injury that was also surgically treated. We present pre- and post-surgical magnetic resonance images, histological pictures of this tumor and we make a review of the literature


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/cirurgia , Formação de Roseta , Sistema Nervoso Central/diagnóstico por imagem , Sistema Nervoso Central/patologia , Neuroimagem/métodos
13.
Neuroradiol J ; 31(6): 554-564, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30230411

RESUMO

PURPOSE: We applied voxelwise apparent diffusion coefficient (ADC) histogram analysis in addition to structural magnetic resonance imaging (MRI) findings and patients' age for differentiation of intraaxial posterior fossa tumors involving the fourth ventricle. PARTICIPANTS AND METHODS: Pretreatment MRIs of 74 patients with intraaxial brain neoplasm involving the fourth ventricle, from January 1, 2004 to December 31, 2015, were reviewed. The tumor solid components were segmented and voxelwise ADC histogram variables were determined. Histogram-driven variables, structural MRI findings, and patient age were combined to devise a differential diagnosis algorithm. RESULTS: The most common neoplasms were ependymomas ( n = 21), medulloblastoma ( n = 17), and pilocytic astrocytomas ( n = 13). Medulloblastomas followed by atypical teratoid/rhabdoid tumors had the lowest ADC histogram percentile values; whereas pilocytic astrocytomas and choroid plexus papillomas had the highest ADC histogram percentile values. In a multivariable multinominal regression analysis, the ADC 10th percentile value from voxelwise histogram was the only independent predictor of tumor type ( p < 0.001). In separate binary logistic regression analyses, the 10th percentile ADC value, tumor morphology, enhancement pattern, extension into Luschka/Magendie foramina, and patient age were predictors of different tumor types. Combining these variables, we devised a stepwise diagnostic model yielding 71% to 82% sensitivity, 91% to 95% specificity, 75% to 78% positive predictive value, and 89% to 95% negative predictive value for differentiation of ependymoma, medulloblastoma, and pilocytic astrocytoma. CONCLUSION: We have shown how the addition of quantitative voxelwise ADC histogram analysis of the tumor solid component to structural findings and patient age can help with accurate differentiation of intraaxial posterior fossa neoplasms involving the fourth ventricle based on pretreatment MRI.


Assuntos
Astrocitoma/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Quarto Ventrículo/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Meduloblastoma/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Difusão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
15.
World Neurosurg ; 120: 372-381, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30144612

RESUMO

BACKGROUND: Primary intracranial squamous cell carcinoma (PISCC) is extremely rare, and most cases are caused by malignant changes in an epidermoid cyst or a dermoid cyst. We report a case of intracranial squamous cell carcinoma (SCC) that arose without a preexisting tumor. In addition, the literature on PISCC is reviewed. CASE DESCRIPTION: A 20-year-old man presented with a 4-day history of headache. Magnetic resonance imaging of the brain showed a heterogeneous and irregularly marginated solid-cystic lesion in the left lateral ventricle, which enhanced dramatically. The patient underwent removal of the lesion, and a postoperative histologic examination showed SCC. The patient did not undergo postoperative radiotherapy and was admitted to the hospital again 40 days later because of dizziness, right lower extremity pain, and difficulty in bending. Computed tomography showed hydrocephalus. The cerebrospinal fluid examination confirmed an intracranial infection. The patient was discharged after treatment. The patient survived for 9 months from the onset of the disease. CONCLUSIONS: Most cases of PISCC arise from the malignant transformation of epidermoid cysts. However, SCC arising de novo is even less common. Although rare, the malignant transformation of intracranial epithelial cysts has a poor prognosis. Future prospective trials are necessary to evaluate the optimal treatment modality for patients with PISCC.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias do Ventrículo Cerebral/cirurgia , Ventrículos Laterais/cirurgia , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Craniotomia , Humanos , Imuno-Histoquímica , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/patologia , Imagem por Ressonância Magnética , Masculino , Adulto Jovem
16.
BMJ Case Rep ; 20182018 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-30150329

RESUMO

A 37-year-old Hispanic man with a right atrial intracardiac mass diagnosed as diffuse large B-cell lymphoma (DLBCL) was successfully treated with surgery and chemotherapy. During 4 years, several total-body positron emission tomography and MRI scans showed no extracardiac lymphoma. On year 5 after the cardiac surgery, patient presented with sleepiness, hyperphagia, memory loss, confabulation, dementia and diabetes insipidus. Brain MRI showed a single hypothalamic recurrence of the original lymphoma that responded to high-dose methotrexate treatment. Correction of diabetes insipidus improved alertness but amnesia and cognitive deficits persisted, including incapacity to read and write. This case illustrates two unusual locations of DLBCL: primary cardiac lymphoma and hypothalamus. We emphasise the importance of third ventricle tumours as causing amnesia, confabulation, behavioural changes, alexia-agraphia, endocrine disorders and alterations of the circadian rhythm of wakefulness-sleep secondary to lesions of specific hypothalamic nuclei and disruption of hypothalamic-thalamic circuits.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias do Ventrículo Cerebral/complicações , Neoplasias Cardíacas/terapia , Linfoma Difuso de Grandes Células B/terapia , Metotrexato/uso terapêutico , Recidiva Local de Neoplasia/diagnóstico por imagem , Terceiro Ventrículo/patologia , Adulto , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/fisiopatologia , Neoplasias do Ventrículo Cerebral/secundário , Diabetes Insípido/etiologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Hiperfagia/etiologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Imagem por Ressonância Magnética , Masculino , Transtornos da Memória/etiologia , Recidiva Local de Neoplasia/fisiopatologia , Recidiva Local de Neoplasia/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Terceiro Ventrículo/diagnóstico por imagem , Resultado do Tratamento
17.
Clin Imaging ; 52: 226-239, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30138862

RESUMO

The MRI appearance of intraventricular neoplasms is often nonspecific, however knowledge of patient age and tumor location facilitates the formulation of a differential diagnosis. Imaging and pertinent clinical features of the following intraventricular neoplasms are reviewed: ependymoma, subependymoma, central neurocytoma, subependymal giant cell tumor, choroid plexus tumors, medulloblastoma, meningioma, chordoid glioma, rosette-forming glioneuronal tumor, central nervous system lymphoma, and metastasis.


Assuntos
Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Glioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Diagnóstico Diferencial , Ependimoma , Glioma/patologia , Humanos , Neoplasias Meníngeas/patologia , Meningioma/patologia
18.
World Neurosurg ; 117: 190-194, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29933085

RESUMO

BACKGROUND: Gastroparesis following resection of a fourth ventricle tumor has never been reported in the literature. We report a unique case of gastroparesis following resection of a fourth-ventricle ependymoma in a child. CASE DESCRIPTION: A 14-year-old boy had a 12-day history of headache, nausea, and vomiting. Magnetic resonance imaging revealed a tumor in the fourth ventricle. He underwent a posterior median craniotomy, and total removal was achieved. Histologic analysis revealed an anaplastic ependymoma (World Health Organization grade III). Three days after surgery, the patient complained of upper abdominal pain, nausea, and vomiting. Computed tomography of the abdomen showed dilatation of the stomach. Gastroscopy revealed moderate gastritis without gastric outlet obstruction. Nine days after surgery, a jejunal feeding tube (J-tube) was placed for nutritional support. Once the patient improved his oral intake and demonstrated that he could keep up with his nutritional requirements, the J-tube was discontinued 19 days after surgery. The patient had no neurologic or gastrointestinal complaints at the 2-month follow up. CONCLUSIONS: We report, to our knowledge, the first case of gastroparesis following resection of a fourth-ventricle ependymoma in a child. Gastroparesis can recover spontaneously, which we suspect may be due to reversible injury of the dorsal motor nucleus of the vagus.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Ependimoma/cirurgia , Gastroparesia/etiologia , Complicações Pós-Operatórias , Adolescente , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Ependimoma/diagnóstico por imagem , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Gastroparesia/diagnóstico por imagem , Gastroparesia/terapia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia
19.
Rofo ; 190(10): 955-966, 2018 10.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-29913520

RESUMO

PURPOSE: Intracranial subependymomas are rare, mostly asymptomatic tumours, which are often found incidentally and therefore did not receive much attention in previous literature. By being classified as benign grade I in the WHO classification of tumours of the central nervous system, they are given a special status compared to the other ependymal tumours. Tumor recurrences are a rarity, spinal "drop metastases" do not occur. While etiological, pathological and therapeutic characteristics have been subject of several publications over the last few decades and have meanwhile been well studied, the imaging characteristics are much less well received. MATERIAL AND METHOD: Retrospective analysis of our relatively large group of 33 patients with subependymoma, including 4 patients with a mixture of subependymomas with ependymal cell fractions in terms of imaging and clinical aspects and with reference to a current literature review. RESULTS: Subependymomas have typical image morphologic characteristics that differentiate them from tumors of other entities, however, the rare subgroup of histopathological mixtures of subependymomas with ependymal cell fractions has no distinctly different imaging properties. CONCLUSIONS: Knowing the imaging characteristics of subpendymoma and their differential diagnoses is of particular importance in order to be able to decide between the necessity of follow-up controls, an early invasive diagnosis or, depending on the entity, tumor resection. KEY POINTS: · Subependymomas have typical imaging characteristics that are clearly distinguishable from other entities.. · Increased incidence in middle/ older aged men, most frequent localization: 4th ventricle.. · Symptomatic subependymomas, often located in lateral ventricles, are usually characterized by hydrocephalus.. · Radiological identification of mixed subependymoma with ependymal cell fractions is not possible.. · Image based differentiation from other entities is important for the procedure.. CITATION FORMAT: · Kammerer S, Mueller-Eschner M, Lauer A et al. Subependymomas - Characteristics of a "Leave me Alone" Lesion. Fortschr Röntgenstr 2018; 190: 955 - 966.


Assuntos
Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Glioma Subependimal/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Ventrículo Cerebral/patologia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Meios de Contraste/administração & dosagem , Ependimoma/diagnóstico por imagem , Ependimoma/patologia , Feminino , Seguimentos , Glioma Subependimal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tumor Misto Maligno/diagnóstico por imagem , Tumor Misto Maligno/patologia , Compostos Organometálicos , Estudos Retrospectivos , Carga Tumoral
20.
Eur Radiol ; 28(10): 4306-4313, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29713774

RESUMO

OBJECTIVES: To increase our understanding of the imaging features of central neurocytoma (CN) and improve the preoperative MRI diagnosis accuracy. METHODS: Preoperative MR images of 30 CNs and another 68 intraventricular non-CN tumours were analysed by one experienced neuroradiologist retrospectively to identify previously reported features and new features of CN. Six blinded radiologists independently reviewed all these MRI images, and scored all characteristic features on a five-point scale. Diagnostic value was assessed by the area under the receiver operating characteristic curve (AUC); sensitivity, specificity and accuracy were also calculated. RESULTS: In addition to the 'scalloping' sign, 'broad-based attachment' sign and 'soap-bubble' sign, three new MRI features of CN were identified, including the 'peripheral cysts' sign, 'fluid-fluid level' sign and the 'gemstone' sign. The scalloping sign showed the highest AUC value (0.82), followed by the peripheral cysts sign (0.75) and broad-based attachment sign (0.75). The scalloping sign exhibited the highest specificity (82%), followed by the fluid-fluid level sign (79%) and gemstone (78%) sign. The broad-based attachment sign (85%) was the most sensitive feature, followed by the soap-bubble sign (84%) and peripheral cysts sign (77%). CONCLUSION: There are six characteristic MRI features that help to improve the preoperative diagnostic accuracy of CN. KEY POINTS: • This study is the largest magnetic resonance imaging (MRI) cohort on central neurocytoma (CN). • Three new features helpful for the diagnosis of CN were reported. • Diagnostic value of six MRI features of CN was preliminarily determined.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neurocitoma/diagnóstico por imagem , Adulto , Neoplasias Encefálicas/patologia , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurocitoma/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
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