Ependymomas are rare neuroepithelial tumors that originate from a type of glial cell called ependymal cell. In general, they correspond to ∼ 1.2 to 7.8% of all intracranial neoplasms, and to ∼ 2 to 6% of all gliomas. Although it corresponds only to ∼2 to 3% of all primary brain tumors, ependymoma is the fourth most common cerebral neoplasm in children, especially in children younger than 3 years of age.1 2 In patients younger than 20 years of age, the majority (90%) of ependymomas are infratentorial, more precisely from the IV ventricle. In spite of this, in adults, medullary ependymomas are more frequent (60%). In this context, supratentorial and extraventricular ependymomas, as in the case reported in the present article, are infrequent in both adults and children.1 2 Both sexes are equally affected.3 Recurrence of intracranial ependymomas occurs in almost 50% of the cases, and the follow-up outcome is not favorable.4 In another perspective, the recurrence of extracerebral ependymomas is extremely rare, and even more unusual in the intraorbital site, as it occurred in the case in question.
Vein of Galen aneurysmal malformation (VGAM) is the result of the direct communication between the arterial network and the median prosencephalic vein. It is a rare vascular congenital malformation representing less than 1% of intracranial abnormalities. This finding is very rare in adults, and it may or may not present symptoms during childhood. Most cases of VGAM can be detected in the fetus by ultrasonography. The referral of pregnant women with fetuses with this condition to centers where better facilities and resources for childbirth and immediate postpartum care are available has resulted in considerable improvement in the prognosis of newborns. Regarding treatment, the endovascular approach to VGAM includes arterial embolization and percutaneous transvenous techniques. The transvenous endovascular treatment was chosen in the case presented in this article. Palavras-chave► malformação aneurismática da veia de Galeno ► veia prosencefálica mediana ► tratamento transvenoso endovascular ► veias cerebrais ResumoA malformação aneurismática da veia de Galeno (MAVG) é resultado da comunicação direta entre a rede arterial e a veia prosencefálica mediana. Trata-se de uma malformação vascular congênita rara, que representa menos de 1% das anormalidades intracranianas. Sua ocorrência é muito rara em adultos, e a malformação pode ou não apresentar sintomas durante a infância. A maioria dos casos pode ser detectada em fetos por ultrassonografia. O encaminhamento de grávidas com fetos com esta malformação para centros mais bem estruturados, com recursos para cuidados no parto e pós-parto, tem resultado em considerável melhora do prognóstico de recém-nascidos. Quanto ao tratamento, o acesso endovascular à MAVG inclui a técnica de embolização arterial e o tratamento transvenoso percutâneo. O tratamento transvenoso endovascular foi escolhido no caso apresentado neste artigo.
Intracranial hypertension (ICH) is a life-threatening condition that can be observed in several diseases. Its clinical presentation is variable, with headache, nausea, vomiting, visual disturbances, papilledema, and alterations in the level of consciousness. The gold standard for the diagnosis of ICH is still the intracranial implantation of invasive devices. Non-invasive techniques, such as ultrasonography of the optic nerve sheath (USONS), have emerged in recent years with promising clinical results. The authors report the case of a patient with progressive headache associated with visual impairment and papilledema, and the eventual diagnosis of idiopathic intracranial hypertension using USONS.
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