Background:
Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytic proliferative disorder classically as a massive cervical lymphadenopathy. However, over the years, extranodal locations were confirmed with the central nervous system involvement in less than 5% of cases, which is marked as a significant differential diagnosis of meningiomas, with which they are widely confused due to the similarity of their radiological images.
Case Description:
We report a 37-year-old man and 45-year-old man who were diagnosed with intracranial RDD but whose radiological images mimic meningiomas, requiring anatomopathological and tumor’s immunohistochemistry for definitive diagnosis. Moreover, a review of 184 publications with 285 cases of intracranial involvement of this disease was also performed, comparing these findings with those brought in the previous studies.
Conclusion:
Intracranial Rosai-Dorfman tumors should always be remembered as differential diagnosis of meningiomas since they are similar radiologically and macroscopically. Once remembered and diagnosed, the lesion must be treated following the same pattern of resection done in meningiomas and, treatment’s differences will not occur in the surgical excision technique, but in complementary chemotherapy implementation, radiotherapy, and even with radiosurgery aid, depending on the case. Thus, it is possible to obtain better results than with just the isolated surgical procedure.
Background Chronic low back pain (CLBP) is a global health problem, and gabapentin and pregabalin are often used in the treatment of patients without associated radiculopathy or neuropathy. Therefore, determining their efficacy and safety is of enormous value.
Objective To examine the efficacy and safety of using gabapentin and pregabalin for CLBP without radiculopathy or neuropathy.
Methods We performed a search on the CENTRAL, MEDLINE, EMBASE, LILACS, and Web of Science data bases for clinical trials, cohorts, and case-control studies that evaluated patients with CLBP without radiculopathy or neuropathy for at least eight weeks. The data were extracted and inserted into a previously-prepared Microsoft Excel spreadsheet; the outcomes were evaluated using the Cochrane RoB 2 tool, and the quality of evidence, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
Results Of the 2,230 articles identified, only 5 were included, totaling 242 participants. In them, pregabalin was slightly less efficacious than amitriptyline, the combination of tramadol/acetaminophen, and celecoxib, and pregabalin added to celecoxib showed no benefit when compared to celecoxib alone (very low evidence for all). On the other hand, although one study with gabapentin did not support its use in a general sample of patients with low back pain, another found a reduction in the pain scale and improved mobility (moderate evidence). No serious adverse events were observed in any of the studies.
Conclusion Quality information to support the use of pregabalin or gabapentin in the treatment of CLBP without radiculopathy or neuropathy is lacking, although results may suggest gabapentin as a viable option. More data is needed to fill this current gap in knowledge.
Introduction: Despite the deep-seated location of pineal region tumors, surgical resection has become safer and more effective, and now plays an essential role in their management. Tissue diagnosis allows the initiation of chemotherapy or radiotherapy, and resection can be curative or improve the efficacy of adjuvant therapies. Objective: Infratentorial supracerebellar (ITSC) and occipital transtentorial (OTT) approaches are the most used for pineal tumors resection. This study aims to describe feasible criteria for better approach indication based on our surgical experience. Methods: Forty-two patients were divided for tumor resection, using tentorial surface angle in sagittal MRI view in the approach selection: Group 1 (25 ITSC); Group 2 (15 OTT); Group 3 (two combined approaches). Results: Group 1 achieved successful total removal. It was observed one visual impairment, one hydrocephalus patient with postoperative meningitis, and other one with postoperative hematoma. Group 2 presented 13 total resections, one visual impairment and transient contralateral hemianesthesia. Group 3 resulted in one air embolism and one ventriculitis after ventriculoperitoneal shunt. No surgical mortality registered. Conclusion: A descriptive analysis of 42 pineal tumor cases showed minimal complications. The ideal approach is well decided based on the angle between tentorial surface and vertical midline on sagittal plane.
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