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1.
Arthropod Struct Dev ; 76: 101295, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37722770

RESUMO

Phoxichilidium femoratum is a common species of sea spiders - a small and unique group of chelicerates with unusual adult anatomy. In particular, substantial parts of the reproductive system in pycnogonids (unlike euchelicerates) are located in the appendages. Existing studies of pycnogonid gonads are often limited to light-microscopic level, cover a small range of species, and focus on the contents of the gonad diverticula. Ultrastructural data are rare and contradictory, and the organisation of the gonad wall and the gonoducts is unknown. Here we present a detailed light and transmission electron microscopy-based examination of the pedal portion of the adult female reproductive system in Phoxichilidium femoratum Rathke, 1799. We describe its gross anatomy and the ultrastructure of the gonad diverticulum, oviduct and gonopore, as well as development of the oocytes. Each gonad diverticulum is enclosed in the extracellular matrix of the horizontal septum and bears some internal cellular lining. However, neither the gonad lining, nor the septum sheath cells, ever form a continuous epithelial layer. Oocytes, which undergo maturation in the diverticulum, remain, until very late in the process, attached to the gonad wall though specialised stalk cells. Interestingly, stalk cells do not participate in egg envelope or yolk formation: both are synthesized endogenously in the oocytes. The oviduct is supplied with musculature, which assists in egg transport to the gonopore, whereas the gonopore itself is surrounded by specialised glands.


Assuntos
Artrópodes , Divertículo , Feminino , Animais , Ovário , Gônadas , Oócitos , Microscopia Eletrônica de Transmissão
2.
Childs Nerv Syst ; 39(3): 775-780, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36323954

RESUMO

OBJECTIVES: Intracranial cysts are fluid-filled sacs within the brain. There is a diversity of intracranial cysts with different incidences in addition to the growing awareness about comorbidities and the consequences. The present study aimed to evaluate cystic findings in children who were admitted to the department of pediatric neurology. METHODS: Children who were admitted to the Clinic of Pediatric Neurology and who had an MRI between 2016 and 2021 were evaluated. The MRI examination was performed with the pediatric epilepsy protocol. Children with primary intracranial cysts were enrolled in the study. Demographic and clinical findings were evaluated from the hospital's database and patients' files. RESULTS: Among the 78 patients, 36 (46.2%) were male and 42 (53.8%) were female. The mean age was 7 ± 5.4 years. The most frequent presenting complaint was a seizure (47.4%). Approximately one-quarter (28.2%) had mental and/or motor retardation. Nine (11.5%) of the children had a neuropsychiatric diagnosis. Most of the cysts were located at the midline (41%) with the majority located extra-axial (71.8%) and supratentorial (78.2%). Arachnoid cysts were observed most frequently with a percentage of 64.1%, followed by pineal cysts (15.4%). The history of seizure, epilepsy, presence of mental retardation, and neuropsychiatric problems were evaluated according to the population ratios based on z approximation in which significantly higher rates were observed among cases with intracranial cysts. CONCLUSION: Intracranial cysts should be taken into consideration for comorbid pathologies, especially in the childhood period. Early evaluation in patients with intracranial cysts for developmental delay and neuropsychiatric problems is important.


Assuntos
Cistos Aracnóideos , Cistos do Sistema Nervoso Central , Epilepsia , Criança , Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/patologia , Cistos do Sistema Nervoso Central/complicações , Imageamento por Ressonância Magnética/efeitos adversos , Epilepsia/etiologia , Epilepsia/complicações , Convulsões/complicações
4.
Neurosurg Rev ; 45(5): 3361-3379, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35982344

RESUMO

This study describes and characterizes a narrow, hollow tubular structure, termed as duct-like diverticulum (DV), found specifically at the basal midline of papillary craniopharyngiomas (PCPs) located within the third ventricle (3V). The presence of this structure was systematically investigated on autopsy studies and magnetic resonance imaging (MRI) scans of 3536 craniopharyngioma (CP) cases published in the medical literature from 1911 to 2021, as well as in other twelve 3V tumor categories (n = 1470 cases). A basal DV was observed in a total of 50 PCPs, including two of our own cases. This DV corresponds to a tubular-shaped recess invaginated at the midline bottom of the tumor, following the same angled trajectory as the pituitary stalk. It can be easily seen as a hypointense linear structure on T1- and T2-weighted MRI scans, with two main length types: long DVs (74%), which reach the tumor center, and short DVs (26%), which penetrate the tumor only a few millimeters. The DV sign identifies the papillary CP type with a specificity of 100% and a sensitivity of 33% in the overall CP population. This finding also serves to establish the strictly intra-3V location of the lesion with a 95% specificity and 42% sensitivity among papillary CPs. No similar basal DV was found in adamantinomatous CPs nor among other categories of strictly 3V tumors. Consequently, the presence of a diverticulum in a 3V tumor represents a morphological signature pathognomonic of the papillary type and a valuable sign to reliably define the strictly 3V topography.


Assuntos
Craniofaringioma , Divertículo , Neoplasias Hipofisárias , Terceiro Ventrículo , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/cirurgia , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Humanos , Hipófise , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/patologia , Terceiro Ventrículo/cirurgia
5.
World Neurosurg ; 163: e106-e112, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35307586

RESUMO

BACKGROUND: Sacral cysts are classically divided into Tarlov cysts and meningeal diverticula. However, the pathogenesis of sacral cysts remains unclear. This study aimed to clarify a novel type of sacral extradural spinal meningeal cyst with a specific arachnoidal structure. METHODS: Nine patients with prophylactic diverticula were included in the study. All patients underwent MRI preoperative reconstruction and traditional neck transfixation. RESULTS: All patients presented with more than one symptom. The major symptom was lower extremity pain, followed by lower extremity numbness (77.8%, 7/9), lower extremity weakness (55.6%, 5/9), bowel/bladder and sexual dysfunction (55.6%, 5/9), and tenesmus (22.2%, 2/9). After long-term follow-up, the outcome was classified as improved in 9 patients (100%). CONCLUSIONS: The clinical findings of this study illustrate a special subtype and may help explain the mechanism of sacral cyst formation.


Assuntos
Cistos Aracnóideos , Cistos do Sistema Nervoso Central , Divertículo , Cistos de Tarlov , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Divertículo/complicações , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Humanos , Dor , Região Sacrococcígea , Sacro/diagnóstico por imagem , Sacro/patologia , Sacro/cirurgia , Cistos de Tarlov/complicações , Cistos de Tarlov/diagnóstico por imagem , Cistos de Tarlov/cirurgia
6.
World Neurosurg ; 158: e975-e983, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34871804

RESUMO

BACKGROUND: Spinal extradural meningeal cysts (SEMCs) are rare lesions, especially those spanning multiple vertebral segments, and the surgical strategy has remained controversial. In the present study, we have described the outcomes of 4 patients with SEMCs treated with dural defect repair alone assisted by neuroendoscopy. METHODS: From January 2018 to January 2020, 4 patients with SEMCs spanning multiple vertebral segments had undergone single-vertebral laminectomy or hemilaminectomy. RESULTS: The SEMCs in all 4 patients had spanned multiple vertebral segments, from T11 to L2. Using magnetic resonance imaging, the location of the dural defect was predicted correctly for 3 patients. Single-vertebral laminectomy was used in 2 patients and single-vertebral hemilaminectomy in 2 patients. Intraoperatively, the entire cyst, including the upper pole, lower pole, and middle segment of the cyst, was explored using neuroendoscopy. In each patient, only 1 dural defect was found, which had been located in the middle segment of the cyst (T12-L1). All cyst dural defects had been sutured under a microscope. In all cases, the cyst wall was not removed. Postoperatively, the symptoms for all the patients had improved significantly, and subsequent magnetic resonance imaging studies showed obvious cyst regression. During the follow-up period of 15-44 months, no recurrence was observed. CONCLUSIONS: For SEMCs spanning multiple vertebral segments, dural defect repair without cyst wall resection through single-vertebral hemilaminectomy or laminectomy can be effective. Intraoperative neuroendoscopy can assist, not only in finding the dural defect, but also in avoiding the omission of multiple dural defects as much as possible.


Assuntos
Cistos Aracnóideos , Cistos do Sistema Nervoso Central , Doenças da Medula Espinal , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Humanos , Laminectomia/métodos , Imageamento por Ressonância Magnética , Neuroendoscópios , Doenças da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia
7.
World Neurosurg ; 150: 17, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33741543

RESUMO

The bobble-head doll syndrome (BHDS) is a rare acquired head movement disorder characterized by up and down or side-to-side movement, most commonly seen in the first decade of life. The syndrome occurs more often in lesions causing third ventricle dilatation such as suprasellar or third ventricle cyst, but it is also found in other pathologies associated with hydrocephalus like shunt dysfunctions, trapped fourth ventricle, congenital aqueductal stenosis, Dandy-Walker syndrome, and cerebellar malformations. The pathophysiology of this head movement has different origins theories; one states that this stereotyped movements empties the cyst and move the dome away from the foramina of Monro, which relieves the symptoms of hydrocephalus; the other suggests that the extrapyramidal tracts (rubrotegmentospinal and reticulospinal) are stimulated by the compression of dorsomedial nucleus of the thalamus by the cyst, whose tracts innervate the neck muscles resulting in the bobbling head movements. This video (Video 1) presents a clinical case of BHDS caused by suprasellar cyst in a 10- year-old boy treated by endoscopic procedure. A ventricular-cyst-cisternostomy was performed resulting in complete improvement of the head movements and uneventful recovery. Postoperative images demonstrate decreasing of the cyst lesion and resolution of the hydrocephalus.


Assuntos
Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Discinesias/cirurgia , Endoscopia , Terapia a Laser , Terceiro Ventrículo/anormalidades , Cistos Aracnóideos/etiologia , Cistos do Sistema Nervoso Central/complicações , Criança , Discinesias/etiologia , Endoscopia/instrumentação , Endoscopia/métodos , Humanos , Masculino , Terceiro Ventrículo/cirurgia , Resultado do Tratamento
8.
J Neurosurg Pediatr ; 27(2): 185-188, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33276338

RESUMO

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient's subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors' knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.


Assuntos
Artéria Carótida Interna/cirurgia , Círculo Arterial do Cérebro/cirurgia , Procedimentos Neurocirúrgicos/métodos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Criança , Pré-Escolar , Círculo Arterial do Cérebro/diagnóstico por imagem , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/cirurgia , Dilatação Patológica/patologia , Dilatação Patológica/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
10.
Niger J Clin Pract ; 23(11): 1572-1577, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221784

RESUMO

AIMS: The present study aimed to evaluate the clinical usefulness of endoscopic treatment of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus and discuss the clinical features and outcomes of thirteen children treated at our institution. METHOD: We treated thirteen pediatric cases of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus between January 2012 and September 2018. Five female and eight male patients were enrolled in the study. The patients had increased intracranial pressure symptoms due to hydrocephaly. Endoscopic treatment was performed in all cases. RESULTS: The patients were followed-up for an average of 36.8 months. The postoperative intracranial pressure findings improved. There was a reduction in the size of the cyst and ventricles and enlargement of the cortical sulci. One patient suffered transient oculomotor nerve deficit. No further surgical interventions, such as shunt placement, were required during the follow-up period. The head circumference of two of the patients with macrocephaly were stable during the follow-up. There were no postoperative recurrences detected. CONCLUSIONS: Endoscopic cyst fenestration and third ventriculostomy are less invasive, safer, and more effective ways to treat suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus in children with hydrocephaly.


Assuntos
Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Endoscopia/métodos , Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adolescente , Cistos Aracnóideos/patologia , Cistos do Sistema Nervoso Central/patologia , Ventrículos Cerebrais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Hipertensão Intracraniana , Pressão Intracraniana , Masculino , Recidiva Local de Neoplasia , Período Pós-Operatório , Procedimentos de Cirurgia Plástica , Resultado do Tratamento
11.
Pediatr Neurosurg ; 55(4): 197-202, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32927459

RESUMO

INTRODUCTION: Endodermal cysts are congenital benign cystic lesions in the central nervous system and cause various symptoms. Although some have been reported in the posterior fossa, endodermal cysts located dorsal to the brainstem are extremely rare. CASE PRESENTATION: The case was of a 10-year-old girl who presented with bilateral upper limb weakness and tremor. Magnetic resonance imaging demonstrated a 4.5-cm cystic lesion with T1-weighted hypointense and T2-weighted hyperintense content in the midline of the cisterna magna dorsal to the medulla oblongata. The cyst was cerebrospinal fluid-like, causing us to suspect a symptomatic arachnoid cyst. The lucent cyst wall had no apparent attachment, and complete recovery ensued following total excision of the cyst wall. Pathology confirmed a diagnosis of endodermal cyst. DISCUSSION/CONCLUSION: Herein, we review the past literature on this rare entity. An endodermal cyst in the cisterna magna tends to be less strongly attached and to show a cerebrospinal fluid-like component on magnetic resonance images that mimics an arachnoid cyst. The characteristics of dorsally located endodermal cysts may differ from those in other locations.


Assuntos
Cistos Aracnóideos , Cistos do Sistema Nervoso Central , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Criança , Feminino , Forame Magno , Humanos , Imageamento por Ressonância Magnética
12.
Acta Neuropathol Commun ; 8(1): 27, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32151273

RESUMO

Brain tumors represent the second most frequent etiology in patients with focal seizure onset before 18 years of age and submitted to epilepsy surgery. Hence, this category of brain tumors, herein defined as low-grade, developmental, epilepsy-associated brain tumors (LEAT) is different from those frequently encountered in adults as (A): 77% of LEAT occur in the temporal lobe; (B): the vast majority of LEAT are of low malignancy and classified as WHO I°; (C): LEAT are often composed of mixed glial and neuronal cell components and present with variable growth patterns including small cysts or nodules; (D): LEAT do not share common gene driving mutations, such as IDH1 or 1p/19q co-deletions. Characteristic entities comprise the ganglioglioma (GG), the dysembryoplastic neuroepithelial tumor (DNT), the angiocentric glioma (AG), the isomorphic diffuse glioma (IDG) and the papillary glio-neuronal tumor (PGNT), representing 73.2% of 1680 tumors collected in a large German series of 6747 patients submitted to epilepsy surgery. In the realm of exciting discoveries of genetic drivers of brain tumors new genes have been also reported for LEAT. BRAF V600E mutations were linked to GG with CD34 expression, FGFR1 mutations to DNT, MYB alterations to AG and also IDG and PRKCA fusions to PGNT, suggesting the possibility to also develop a genetically driven tumor classification scheme for LEAT. Rare availability of LEAT in a single center is a challenging obstacle, however, to systematically unravel the neurobiological nature and clinical behavior of LEAT. Other challenges in need of clarification include malignant tumor progression of LEAT entities, seizure relapse in patients following bulk tumor resection and the controversial issue of associated focal cortical dysplasia as additional pathomechanism. In order to advance our understanding and promote reliable diagnostic work-up of LEAT, we recommend, therefore, international collaboration to achieve our goals.


Assuntos
Neoplasias Encefálicas/patologia , Epilepsias Parciais/patologia , Neoplasias Neuroepiteliomatosas/patologia , Cistos Aracnóideos/complicações , Cistos Aracnóideos/genética , Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Astrocitoma/complicações , Astrocitoma/genética , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/cirurgia , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/genética , Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Cisto Dermoide/complicações , Cisto Dermoide/genética , Cisto Dermoide/patologia , Cisto Dermoide/cirurgia , Cisto Epidérmico/complicações , Cisto Epidérmico/genética , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Epilepsias Parciais/etiologia , Epilepsias Parciais/cirurgia , Ganglioglioma/complicações , Ganglioglioma/genética , Ganglioglioma/patologia , Ganglioglioma/cirurgia , Humanos , Técnicas de Diagnóstico Molecular , Gradação de Tumores , Neoplasias Neuroepiteliomatosas/complicações , Neoplasias Neuroepiteliomatosas/genética , Neoplasias Neuroepiteliomatosas/cirurgia , Oligodendroglioma/complicações , Oligodendroglioma/genética , Oligodendroglioma/patologia , Oligodendroglioma/cirurgia , Proteína Quinase C-alfa/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas c-myb/genética , Receptor Tipo 1 de Fator de Crescimento de Fibroblastos/genética , Transativadores/genética
13.
Neurosurg Rev ; 43(5): 1373-1381, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31493062

RESUMO

To investigate the effectiveness of endoscopic fenestration in the patients with prior failed ventriculoperitoneal (VP) shunt treatment of suprasellar arachnoid cysts (SACs). Between 2012 and 2018, four pediatric patients of SACs with previous failed VP shunt treatment were surgically treated using endoscopic ventriculocystocisternostomy (VCC) in our hospital. The clinical symptoms, imaging data, and surgical outcomes were collected and analyzed retrospectively. A literature review is provided with regard to the reasons of shunt failure and surgical outcome of further endoscopic fenestration in the previously reported patients of SACs with prior failed VP shunt. For the 4 cases, the initial clinical symptoms relieved or even disappeared after shunt placement, but, respectively, recurred 2, 6, 11, and 6 months later. MR scans were conducted when the clinical symptoms reappeared and showed a cyst had greatly enlarged after shunt placement. Furthermore, VP shunt-related slit ventricle was also demonstrated in 3 cases. Clinical improvement and cysts shrinkage occurred in all 4 patients after VCC. Slit ventricle and hydrocephalus were also resolved. Three patients had their shunt apparatus removed after VCC, and another patient's guardian refused to remove the shunt apparatus. Subdural hematoma occurred in one case after shunt apparatus removal. Four patients have been stable during follow-up period (mean follow-up 26.5 months). All the three patients whose VP shunt were removed were shunt independence. There were 24 patients who underwent endoscopic fenestration as an alternative to the failed VP shunt treatment in the published reports. Added our 4 patients to the published group, the effective rate of endoscopic fenestration for SACs following previous failed VP shunt treatment was approximately 93% (26/28). Of the 24 patients, the shunt apparatuses were in situ or reimplantation in 9 patients due to shunt dependence. The correction to recognize the SAC is the first condition to select the optimal management philosophy. The analysis of the series suggests endoscopic operation is still an effective and safe option in the SAC patients with previous failed VP shunt, and the shunt apparatus can be removed for some patients. The short interval time between shunt operation and endoscopic fenestration is conductive to return patients to the shunt-free state.


Assuntos
Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Endoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Cistos Aracnóideos/diagnóstico por imagem , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Pré-Escolar , Feminino , Seguimentos , Hematoma Subdural/etiologia , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/epidemiologia , Falha de Tratamento , Resultado do Tratamento
14.
World Neurosurg ; 133: 80-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574329

RESUMO

BACKGROUND: Bobble-head doll syndrome is a rare neurological syndrome presenting with repetitive anteroposterior head movements. It is usually associated with expansile cystic lesions in the third ventricular region. CASE DESCRIPTION: An 8-year-old boy presented with involuntary bobbling head movements. Magnetic resonance imaging of the brain revealed an extensive suprasellar cyst resulting in obstructive hydrocephalus. Endoscopic ventriculo-cysto-cisternostomy resulted in improved clinical outcome. CONCLUSIONS: Endoscopic ventriculo-cysto-cisternostomy is an effective, less-invasive technique in the treatment of suprasellar cysts that results in resolution of the bobbling head movements.


Assuntos
Cistos Aracnóideos/etiologia , Cistos do Sistema Nervoso Central/complicações , Discinesias/etiologia , Hidrocefalia/etiologia , Terceiro Ventrículo/anormalidades , Ventriculostomia/métodos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/cirurgia , Criança , Discinesias/diagnóstico por imagem , Discinesias/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imageamento por Ressonância Magnética , Masculino , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do Tratamento
16.
Oper Neurosurg (Hagerstown) ; 16(6): 667-674, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30124966

RESUMO

BACKGROUND: The transsphenoidal approach is the standard of care for the treatment of pituitary adenomas and is increasingly employed for many anterior skull base tumors. Persistent postoperative cerebrospinal fluid (CSF) leaks can result in significant complications. OBJECTIVE: To analyze our series of patients undergoing abdominal fat graft repair of the sellar floor defect following transsphenoidal surgery, describe and investigate our current, routine technique, and review contemporary and past methods of skull base repair. METHODS: A recent consecutive series (2008-2017) of 865 patients who underwent 948 endonasal procedures for lesions of the sella and anterior skull base was retrospectively reviewed. Three hundred eighty patients underwent reconstruction of the sellar defect with an abdominal fat graft. RESULTS: The diagnoses of the 380 patients receiving fat grafts were the following: 275 pituitary adenomas (72.4%), 50 Rathke cleft cysts (13.2%), 12 craniopharyngiomas (3.2%), and a variety of other sellar lesions. Fourteen patients had persistent postoperative CSF leak requiring reoperation and included: 5 pituitary adenomas (1.3%), 4 craniopharyngiomas (1.1%), 2 arachnoid cysts (0.53%), 2 prior CSF leaks (0.53%), and 1 Rathke cleft cyst (0.26%). Four patients (1.1%) developed minor abdominal donor site complications requiring reoperation: 1 hematoma, 2 wound complications, and 1 keloid formation resulting in secondary periumbilical infection. CONCLUSION: Minimizing postoperative CSF leaks following endonasal anterior skull base surgery is important to decrease morbidity and to avoid a prolonged hospital stay. We present an evolved technique of abdominal fat grafting that is effective and safe and includes minimal morbidity and expense.


Assuntos
Gordura Abdominal/transplante , Cistos do Sistema Nervoso Central/cirurgia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Complicações Intraoperatórias/cirurgia , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Sela Túrcica/cirurgia , Abdome/cirurgia , Adenoma/cirurgia , Cistos Aracnóideos/cirurgia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Craniofaringioma/cirurgia , Humanos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Osso Esfenoide , Infecção da Ferida Cirúrgica/epidemiologia
17.
Rehabilitación (Madr., Ed. impr.) ; 52(3): 198-201, jul.-sept. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-175765

RESUMO

Un quiste aracnoideo se define como la presencia de una colección de líquido cefalorraquídeo contenido en la aracnoides. Su hallazgo en pediatría es infrecuente. Aparecen con una prevalencia del 1-3%, con diferentes etiologías. Predomina en el sexo masculino y su localización puede ser intracraneal o a nivel espinal. Puede presentarse ya durante la gestación y ser asintomático o sintomático. La clínica se manifiesta por alteraciones neurológicas. La detección mediante pruebas de imagen en un paciente sintomático permite el tratamiento quirúrgico oportuno. En este artículo explicamos el caso de una paciente pediátrica femenina con un quiste aracnoideo intradural a nivel torácico que presentó afectación neurológica prequirúrgica y siguió un programa de rehabilitación poscirugía


An arachnoid cyst is defined as the presence of a collection of cerebrospinal fluid contained in the arachnoid membrane. Its finding in paediatric patients is uncommon. The prevalence is 1-3%, with different aetiologies. There is a predominance of male sex and the location can be intracranial or spinal. These cysts can occur as early as during pregnancy and be asymptomatic or symptomatic. Clinically they cause neurological problems. Detection by imaging tests in a symptomatic patient allows timely surgical treatment. In this article we report the case of a female paediatric patient with an intradural arachnoid cyst in the chest who had preoperative neurological symptoms and followed a post-surgical rehabilitation programme


Assuntos
Humanos , Feminino , Lactente , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Modalidades de Fisioterapia , Cistos Aracnóideos/reabilitação , Cistos do Sistema Nervoso Central/reabilitação , Craniectomia Descompressiva/métodos , Recuperação de Função Fisiológica
18.
Coluna/Columna ; 17(1): 63-65, Jan.-Mar. 2018. graf
Artigo em Inglês | LILACS | ID: biblio-890932

RESUMO

ABSTRACT Introduction: Among the primary lesions occupying the spinal space, only 1% corresponds to the epidural arachnoid cyst (EAC). This condition is usually asymptomatic, and identified accidentally in imaging tests. In symptomatic cases, total surgical resection is recommended. Objective: To describe a case of EAC refractory to clinical treatment. Methods: A 45-year-old woman had lumbar pain for six years and increased pain in the last months, with irradiation to the left lower limb (corresponding to L1). No other alterations found in the physical examination. Magnetic resonance imaging (MRI) of the spine revealed an intravertebral cystic lesion at T12-L1 level, in the left posterolateral position, causing enlargement of the foramen, and suggesting an epidural arachnoid cyst. Results: Due to failure of the initial clinical treatment, the patient underwent left T12-L1 hemilaminectomy, resection of the cyst and correction of dural failure. The patient progressed with effective pain control and MRI confirmed absence of residual lesion. Conclusion: EAC is more common in men (4:1) and may be congenital or acquired. The most common topography is thoracic (65%). Its clinical presentation is low back pain, lower limb pain and paresthesia. MRI is the method of choice for diagnosis and surgical intervention is restricted to cases that are symptomatic or refractory to clinical treatment, and the prognosis tends to be excellent. We conclude that, in addition to being a rare and commonly asymptomatic condition, an adequate therapeutic approach is essential for complete cure, avoiding intense pain and manifestations that bring about a drastic reduction of functional capacity. Level of evidence: IV. Type of study: Case series.


RESUMO Introdução: dentre as lesões primárias que ocupam o espaço espinhal, apenas 1% corresponde ao cisto epidural aracnoideo (CEA). Esta patologia costuma ser assintomática, identificada acidentalmente em exames de imagem. Já em casos sintomáticos, a ressecção cirúrgica total é recomendada. Objetivos: descrever um caso de CEA refratário a tratamento clínico. Metódos: mulher, 45 anos, lombalgia há seis anos, com piora nos últimos meses e irradiação para membro inferior esquerdo (correspondente a L1). Sem demais alterações ao exame físico. A Ressonância magnética (RM) de coluna vertebral evidenciou lesão cística intravertebral a nível de T12 - L1, em situação póstero-lateral esquerda, provocando alargamento do forame, sugestivo de cisto epiduralaracnóideo. Resultados: Devido a falha do tratamento clínico inicial, a paciente foi submetida a hemilaminectomia de T12 - L1 à esquerda, ressecção do cisto e correção da falha dural. Evoluiu com controle álgico efetivo e RM de controle confirmou ausência de lesão residual. Conclusão: O CEA é mais comum em homens (4:1) e pode ser congênito ou adquirido. A topografia mais comum é a nível torácico (65%). Apresenta-se clinicamente com lombalgia, dor em membros inferiores e parestesias. A RM é o método diagnóstico de escolha e a intervenção cirúrgica é restrita aos casos sintomáticos ou refratários ao tratamento clínico e o prognóstico tende a ser excelente. Concluímos que, além de ser uma patologia rara e comumente assintomática, é essencial a adequada abordagem terapêutica para que ocorra cura completa, evitando quadros álgicos intensos e manifestações que cursem com drástica redução da capacidade funcional. Nível de evidência: IV. Tipo de Estudo: Série de casos.


RESUMEN Introducción: Entre las lesiones primarias que ocupan el espacio espinal, solo el 1% corresponde al quiste aracnoideo epidural (QAE). Esta patología generalmente es asintomática e identificada accidentalmente en pruebas de imagen. En casos sintomáticos, se recomienda la resección quirúrgica total. Objetivo: Describir un caso de QAE refractario al tratamiento clínico. Métodos: Mujer de 45 años tuvo dolor lumbar durante seis años y un aumento del dolor en los últimos meses, con irradiación a la extremidad inferior izquierda (que corresponde a L1). No se encontraron otras alteraciones en el examen físico. La resonancia magnética (RM) de la columna vertebral reveló una lesión quística intravertebral en el nivel T12-L1, en la posición posterolateral izquierda, causando agrandamiento del foramen y sugiriendo un quiste aracnoideo epidural. Resultados: Debido a la falla del tratamiento clínico inicial, la paciente fue sometida a hemilaminectomía T12-L1 izquierda, resección del quiste y corrección de la falla dural. Ella progresó con un control eficaz del dolor y la RM confirmó la ausencia de lesión residual. Conclusión: EL QAE es más común en hombres (4:1) y puede ser congénito o adquirido. La topografía más común es torácica (65%). Su presentación clínica es lumbalgia, dolor en las extremidades inferiores y parestesia. La RM es el método de elección para el diagnóstico y la intervención quirúrgica se limita a los casos que son sintomáticos o refractarios al tratamiento clínico, y el pronóstico tiende a ser excelente. Concluimos que, además de ser una condición rara y comúnmente asintomática, un abordaje terapéutico adecuado es esencial para una curación completa, evitando el dolor intenso y las manifestaciones que provocan una reducción drástica de la capacidad funcional. Nivel de evidencia: IV. Serie de casos.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cistos Aracnóideos , Traumatismos da Medula Espinal , Dor Lombar , Cistos do Sistema Nervoso Central
19.
Acta Neurochir (Wien) ; 159(6): 1043-1048, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28190146

RESUMO

OBJECTIVE: The combination of electromagnetic navigation with continuous monitoring techniques allows for the best available anatomic and real-time functional intraoperative monitoring. Methodological aspects and technical adaptations for this combination of methods and the results from 19 patients with tumors in the pituitary region are reported. METHODS: We retrospectively identified 19 patients who were treated with transsphenoidal surgery using high-resolution endoscopy (eTSS) at our hospital between June 2015 and June 2016. All patients underwent surgery under electromagnetic navigation with visual evoked potential (VEP) monitoring. The cases were reviewed for information on disease, and the distance between the patient tracker and emitter was measured. RESULTS: In 19 patients, 17 had pituitary adenomas, 1 had a Rathke cleft cyst, and 1 had an arachnoid cyst. The optimal distance between the patient tracker and emitter was 20-25 cm. VEP monitoring could be performed with unaffected recording quality under electromagnetic navigation. Also we were able to perform the registration and eTSS at this distance using both navigation and VEP monitoring. CONCLUSIONS: We performed eTSS for pituitary tumor by simultaneously using electromagnetic navigation and VEP. The optimal distance between the emitter and tracker minimizes VEP monitoring noise and allows accurate electromagnetic navigation.


Assuntos
Potenciais Evocados Visuais , Monitorização Intraoperatória/métodos , Neuroendoscopia/métodos , Neuronavegação/métodos , Osso Esfenoide/cirurgia , Adenoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos Aracnóideos/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Neuroendoscopia/instrumentação , Neuronavegação/instrumentação , Neoplasias Hipofisárias/cirurgia
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