RESUMO
OBJECTIVE: To investigate the clinical experience and application value of endoscopic resection of lesions in and around the third ventricle using a transcortical expanded transforaminal transvenous transchoroidal approach with an endoport. METHODS: Clinical data and follow-up results of seven patients who underwent the removal of lesions in the third ventricle and its adjacent area with an endoport-guided endoscopic system from January 2018 to December 2020 in the Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, were analyzed retrospectively. Two other patients from the Affiliated Pediatric Hospital of Fudan University and the Affiliated Hospital of Guizhou Medical University, respectively, were included in the analysis. RESULTS: A total of nine cases of third ventricle tumors were included in the study, including six women and three men, with an average age of 37.8 years (4-84 years old) and a follow-up time of 6-44 months. These nine tumor cases included two pilocytic astrocytomas, one diffuse midline glioma (H3 K27-altered), two craniopharyngiomas, two choroid plexus (CP) papillomas, one germinoma, and one pineal parenchymal tumor of intermediate differentiation. Total resection was completed in eight cases, with one near-total resection. There were no complications related to the surgical approach, such as epilepsy, aphasia, or hemiplegia. CONCLUSIONS: The endoscope transcortical expanded transforaminal transvenous transchoroidal approach using an endoport can safely and effectively remove third ventricle lesions. This approach can reach a wide area, from the anterior to the posterior third ventricle.
Assuntos
Neoplasias Encefálicas , Glioma , Papiloma do Plexo Corióideo , Glândula Pineal , Neoplasias Hipofisárias , Terceiro Ventrículo , Masculino , Criança , Humanos , Feminino , Adulto , Pré-Escolar , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Estudos Retrospectivos , Glioma/cirurgia , Neoplasias Encefálicas/cirurgiaRESUMO
The endoscopic expanded endonasal approach (EEA) has been reported in literature as a useful tool to treat sellar, parasellar, suprasellar, and clival lesions. The endoscope permits a panoramic view rather than a narrow microscopic view, and this approach can reach the lesion without brain retraction and with minimal neurovascular manipulation. However, because of the narrow corridor, the preoperative evaluation of the lesions should be of high priority. 3D fast-imaging employing steady-state acquisition (3D-FIESTA) or constructive interference in steady state (CISS) MR imaging provides high spatial resolution in the small structures within the cisterns. Therefore, this technique may be useful for better preoperative planning in detecting optic nerve, oculomotor nerve, chiasma, infundibulum, pituitary stalk, and small vessels in sellar region. Here we used the 3D-FIESTA MR images to evaluate EEA for seven midline skull-base lesions. Our report showed that, when EEA was used to treat midline skull-base lesions, 3D-FIESTA MR images were valuable in the assessment of vital structures in and around the tumor-involved midline skull-base region. 3D-FIESTA MR images can help in making a better preoperative planning, locating the intraoperative structures, and reducing the surgical risks. Otherwise, this approach is helpful for the craniopharyngioma classification based on EEA.
Assuntos
Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Sela Túrcica/patologia , Sela Túrcica/cirurgia , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/cirurgia , Adulto , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/normas , Feminino , Humanos , MasculinoRESUMO
This study reports the case of a 75-year-old woman with intermittent speech disturbance, headache, and general malaise. Brain magnetic resonance imaging showed a double lesion located in the third ventricle and temporal horn of the lateral ventricle. We completely removed the lesion in the third ventricle, adhering to the septum pellucidum. The histopathological diagnosis was Burkitt lymphoma, which was confirmed to be primary in postoperative investigation. To our knowledge, this is the first case of primary Burkitt lymphoma involving cerebral ventricles. Finally, we reviewed the characteristics of primary central nervous system Burkitt lymphoma.
Assuntos
Neoplasias Encefálicas/diagnóstico , Linfoma de Burkitt/diagnóstico , Neoplasias do Ventrículo Cerebral/diagnóstico , Ventrículos do Coração/patologia , Terceiro Ventrículo/patologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Literatura de Revisão como AssuntoRESUMO
We present a case of a 45-year-old male patient with left hemifacial spasm for 6 years. Magnetic resonance tomographic angiography confirmed that there were small vessels adjacent to the left facial nerve root entry zone, but the left internal carotid artery (ICA) was absent. Magnetic resonance angiography using three-dimensional time of flight technique showed the absence of the left ICA and vertebral artery, But the presence of a 6-mm aneurysm in the bifurcation of the right internal carotid artery. These abnormal arterial structures were further confirmed by angiogram. Aortic arch angiogram revealed a right-sided aortic arch and the Subclavian steal phenomenon. The left common carotid artery and the left Subclavian artery were absent. Right vertebral angiography showed retrograde filling of the left vertebral artery. The left upper limb was fed by this artery. The aneurysm was successfully clipped. Post-operatively, the hemifacial spasm was weakened. However, the operation did not change the neurovascular positional relationship, thus we advised follow-up visits. Cerebral artery anomalies should be taken into consideration when performing imaging and surgical corrections in patients with hemifacial spasm.
Assuntos
Artéria Carótida Primitiva/anormalidades , Espasmo Hemifacial/etiologia , Artéria Vertebral/anormalidades , Aneurisma/diagnóstico , Aneurisma/cirurgia , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Humanos , Imageamento Tridimensional , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
Aberrant expression of long noncoding RNA H19 has been associated with tumour progression, but the underlying molecular tumourigenesis mechanisms remain largely unknown. Here, we report that H19 expression is frequently downregulated in human primary pituitary adenomas and is negatively correlated with tumour progression. Consistently, upregulation of H19 expression inhibits pituitary tumour cell proliferation in vitro and tumour growth in vivo. Importantly, we uncover a function of H19, which controls cell/tumour growth through inhibiting function of mTORC1 but not mTORC2. Mechanistically, we show that H19 could block mTORC1-mediated 4E-BP1 phosphorylation without affecting S6K1 activation. At the molecular level, H19 interacted with 4E-BP1 at the TOS motif and competitively inhibited 4E-BP1 binding to Raptor. Finally, we demonstrate that H19 is more effective than cabergoline treatment in the suppression of pituitary tumours. Together, our study uncovered the role of H19-mTOR-4E-BP1 axis in pituitary tumour growth regulation that may be a potential therapeutic target for human pituitary tumours.
Assuntos
Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Alvo Mecanístico do Complexo 1 de Rapamicina/efeitos dos fármacos , Fosfoproteínas/metabolismo , Neoplasias Hipofisárias/metabolismo , RNA Longo não Codificante/antagonistas & inibidores , RNA Longo não Codificante/metabolismo , Animais , Cabergolina/farmacologia , Carcinogênese , Proteínas de Transporte , Proteínas de Ciclo Celular , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Progressão da Doença , Regulação para Baixo , Feminino , Células HEK293 , Xenoenxertos , Humanos , Alvo Mecanístico do Complexo 2 de Rapamicina/metabolismo , Camundongos , Fosforilação/efeitos dos fármacos , Neoplasias Hipofisárias/tratamento farmacológico , RNA Longo não Codificante/genética , Proteínas Quinases S6 Ribossômicas 70-kDa/metabolismo , Regulação para CimaRESUMO
OBJECTIVE: To investigate the indications, key point, advantages, and disadvantages of transmaxillary approach for microsurgical removal of clivus tumors. METHODS: The clinical data of 16 consecutive patients with clivus tumors operated upon through transmaxillary approach, based on Le Fort I ostectomy, July 1999 to May 2002 were retrospectively reviewed. RESULTS: Of the 16 patients, 8 patients suffered from chordoma, 2 from angiofibroma, 1 from pituitary adenoma, 1 from chondroma, 1 from adenocarcinoma of grade II, 1 from mucoid cyst, 1 from myeloma, and 1 from fibrous dysplasia of bone. Four out of the 16 cases were with recurrent tumors after operation performed in other hospitals. The operation field of all 16 patients was satisfactorily exposed. The tumors of 10 cases were totally removed under microscope, and 6 tumors were subtotally removed. The complications included rhinorrhea in 1 case and malocclusion in 3 cases. There was no operative mortality. All patients were followed up for 6 approximately 40 months (ion average 20 months) with MRI. Four of them had local recurrence within 1 year, 1.5 years, 2 years, and 9 months respectively after operational and have lived with tumors till now. The remainders had resumed their normal life. CONCLUSION: An ideal approach, transmaxillary approach facilitates the resection of clivus tumors, with satisfying exposure and fewer complications.
Assuntos
Microcirurgia/métodos , Neoplasias da Base do Crânio/cirurgia , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Cordoma/cirurgia , Fossa Craniana Posterior , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Procedimentos Neurocirúrgicos/métodos , Doenças dos Seios Paranasais/cirurgia , Neoplasias Hipofisárias/cirurgia , Estudos RetrospectivosRESUMO
Hemifacial spasm (HFS) is most frequently caused by vascular compression of the facial nerve at the root exit zone of the brain stem, but there are other rare causes. An enterogenous cyst (EC) is a rare congenital lesion which occurs rarely in the cerebellopontine angle. The authors report a patient with HFS from an EC and review unusual causes of HFS.