Background:This study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, and morphology of the aneurysm and the treatments outcomes of the fusiform aneurysms.Methods:We performed a literature review using PubMed. The search was limited to the studies published in English, from 2003 to 2017.Results:The studies analyzed that showed data about the patient features, clinical presentation, the aneurysm localization, morphology, and pathogenesis didn't present much divergence. The surgical and the endovascular approach showed similar treatments outcomes. The reconstructive techniques seem to be safer than the deconstructive. The flow diversion is a technique that showed great results.Conclusion:Most of the patients are men, younger than 50 years old, pediatric patients are the most affected. Surgical procedures still have an important place in this field. Reconstructive and deconstructive techniques are both effective; the reconstructive techniques are possibly safer than deconstructive techniques. The most important feature of an aneurysm to predict a bad prognose is to determine if the aneurysm is ruptured. The reconstructive EVT accompanied by dual antiplatelet after and before the procedure showed the best results to treat the basilar fusiform aneurysms. Deconstructive treatment including posterior inferior cerebellar artery occlusion should be considered.
Glioblastoma multiforme (GBM) is the most common glial tumor of the brain system; nevertheless, the giant cell (GC) subtype is uncommon. Recent reviews report for an incidence of 1% in adults and 3% in children. The GCs usually have a better prognosis than GBM and also an increasing long-term survival rate. It is known that the diagnosis of this tumor is due to its histological findings and patterns, such as the unusual increased number of giant cells. Unfortunately, due to its rarity, the immunohistochemical and cytogenetical analysis of this tumor is not well known. Some authors also suggest that there are few subtypes of GCs and their patterns of aggressiveness could be due to cytogenetical markers. It is recognized that maximum safe resection treatment and adjuvant radiotherapy can improve survival rate (5-13 months) similar to GBM patients.
An adult female patient presented with an exclusively spinal leptomeningeal infestation by cysticercosis (restricted to the cauda equina), verified in surgery. The rôle of the vertebral vein system in the spread of cysticercosis larvae is discussed. A commentary on the possibility that cysticercosis of the basal cisterns may be due to ascending migration of primarily spinal cysticerel, as originally proposed by Isamat de la Riva, is stated.
Modern brain tumor surgery stands in the pillar of maximum safe resection. Tumor borders are always challenging, especially infiltration zones in malignant brain tumors. Novel technologies are designed for a better delineation and to increase the extent of resection (EOR) in brain tumor surgery, such as: cortical and sub-cortical mapping strategies with somatosensory-evoked potentials, awake stimulation mapping and cortical/sub-cortical stimulation for motor pathways, important for resection in eloquent areas; intra-operative imaging as functional and intra-operative magnetic resonance imaging, diffusion tensor imaging and intraoperative ultrasound are important for the tumor borders and to achieve the gross total resection; neurochemical navigation methods as 5-aminolevulinic and sodium fluorescein are important for the non-contrast-enhanced tumor border; future methods can be achieved with augmented reality surgery, new intra-operative chemical markers, and visualization methods. Nevertheless all these techniques seem to be promising, the real challenge in the future will be held in how to apply them and how they really affect the prognosis of the patients. Also, new concepts in tumor genetics will provide knowledge for the tumor behavior and will guide resection. Despite all limitations, the increasing importance of safe EOR shows the possible benefits of the novel technologies and surgical advances in brain tumor surgery, taking it to a new step of the neuronavigation era.
Background: The present study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, morphology, pathogenesis, and the best treatment for each type of the nonsaccular aneurysms. Methods: We performed a literature review using PubMed. The search was limited to the studies published in English, from 2010 to 2017. Results: Data about the clinical presentation; the aneurysm pathogenesis, morphology, and localization; the patient features; and about the surgical or endovascular approach were analyzed for the four types of nonsaccular aneurysms presented. Conclusion: All types of nonsaccular aneurysms have a higher prevalence in young adults. Men are more affected by fusiform and mycotic aneurysms while women suffer more with blister-like aneurysms (BLAs). The mycotic and the BLAs affect more the anterior circulation while the fusiform affects more the posterior circulation. Mycotic and blister-like has as its major complication and clinical presentation the hemorrhage; however, the fusiform aneurysms usually present ischemia and/or mass effect. The reconstructive endovascular techniques for all types of nonsaccular aneurysms presented as the treatment with the best outcomes. Among this technique, the flow diversion presented good results in all types of aneurysms and it seems to promote the best outcomes.
RESUMO -Relatamos o caso de um paciente de oito anos de idade, com quadro clínico de cefaléia, náuseas e vômitos. A angiografia cerebral mostrava massa frontal não vascularizada. O paciente foi submetido a craniotomia, com remoção da lesão cujo estudo anátomo-patológico comprovou o diagnóstico de ganglioglioma. O paciente recebeu radioterapia no pós-operatório. Durante o seguimento, 16 anos após, houve recidiva da lesão, comprovada pela tomografia computadorizada do crânio, sendo submetido a nova cirurgia, cujo exame anátomo-patológico revelou ser glioblastoma multiforme. Gangliogliomas são tumores raros do sistema nervoso central, contendo mescla de células neuronais e gliais. A anaplasia ocorre somente no componente glial, sendo este, portanto, responsável pelo prognóstico desta lesão.PALAVRAS-CHAVE: tumor cerebral, ganglioglioma, ganglioglioma anaplásico, glioblastoma multiforme. Malignant evolution of a ganglioglioma: case reportABSTRACT -We present the case of a 8-years-old boy, admitted with a history of headache, nausea and vomiting. Cerebral angiography showed a non-vascular mass on frontal lobe. The patient underwent craniotomy and the lesion was removed. Neuropathological study revealed that the tumor was a ganglioglioma. The patient received pos-operative radiotherapy. On follow-up, 16 years after, a computed tomographic scan showed a recurrence of the tumor, and a second surgery revealed a glioblastoma multiform. Gangliogliomas are rare tumors of the central nervous system containg neoplastic ganglion cells and low grade neoplastic glial cells. The malignant degeneration occurs only in the glial component, so the prognosis of these tumors is related to the grade of that component.KEY WORDS: brain neoplasm, ganglioglioma, anaplastic ganglioglioma, glioblastoma multiforme.Gangliogliomas são considerados tumores raros, atingindo principalmente a população infantil 1-3 , sendo composto por mescla de células gliais e neuronais 3-9 . Apresenta crescimento lento, cuja sintomatologia resulta do efeito de massa tumoral ou crise convulsiva 9 . Entretanto a anaplasia do componente glial já foi relatada por alguns autores, podendo ocorrer a indiferenciação para glioblastoma multiforme [8][9][10] , fato este que altera significativamente a evolução do caso.Os autores relatam caso em que um paciente, então com 8 anos de idade, foi submetido a craniotomia frontal esquerda para remoção de processo expansivo, cujo diagnóstico foi ganglioglioma. O paciente foi acompanhado e, 16 anos após o primeiro procedimento, apresentou recidiva da lesão, sendo reoperado e tendo diagnóstico atual de glioblastoma multiforme.
RESUMO -Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.PALAVRAS-CHAVES: hematoma subdural crônico, craniotomia, trepanação. Chronic subdural hematoma: analysis of 35 casesABSTRACT -Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.KEY WORDS: chronic subdural hematoma, craniotomy, burr-hole evacuation.Os hematomas subdurals crônicos constituem condição neurocirúrgica potencialmente curável através de vários métodos cirúrgicos, mas ainda nos dias atuais com significativos índices de mortalidade, sendo a cura espontânea considerada ra ra 1,5,10,1214 .Uma série de 35 pacientes com diagnóstico de hematoma subdural crônico é apresentada e analisada frente a revisão bibliográfica do assunto. PACIENTES E MÉTODOSTrinta e cinco pacientes com o diagnóstico de hematoma subdural crônico foram tratados no período de janeiro-1988 a março-1995. Destes, 27 pacientes eram do sexo masculino e 8 do sexo feminino. A idade variou entre 19 a 80 anos, em 60% estando acima de 60 anos. O antecedente de traumatismo craniano estava presente em 68% dos casos.
Background:The association between neurofibromatosis type 1 (NF-I) and Chiari I malformation (CMI) is rare, and not many studies are reported in the literature. Performing magnetic resonance imaging (MRI) in patients with NF-1 is essential because several cases of Chiari type I are completely asymptomatic. We emphasize the need for inclusion of Chiari I as diagnosis in association with NF-1.Case Description:The patient was a 51-year-old black man who presented with complaints of pain and decreased motion and sensibility of his hands, wrists, and forearms, along with progressive dysarthria. Even though the computed tomography (CT) scan of the skull did not show changes, the MRI showed hydro/syringomyelia in the cervical spine area. Midline suboccipital craniectomy with total laminectomy of c1 and partial laminectomy of c2 was performed; tonsillectomy was also performed for cistern expansion because of intense thickening and obliteration of the obex by the cerebellar tonsils. Following treatment, the patient showed remission of symptoms.Conclusion:NF-1 in association with CMI is rare, and early diagnosis and surgical treatment are essential to slow down the myelopathy; although they prevent neurological damages, patients with NF-1 must remain under doctor's attention in case of association with CMI. Our literature review showed that symptoms can vary and include headache, gait disturbance, and sensory/motor diminution, until asymptomatic patients. Moreover, the incidence of NF-1 is considerably higher in CMI patients in comparison to the global incidence (8.6–11.8% and 0.775%, respectively). The surgical technique must be evaluated case by case according to the degree of cerebrospinal fluid obstruction.
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