We present a case of a 37-year-old female, with progressive left eye proptosis and an extensive ipsilateral en plaque spheno-orbital meningioma, with diffuse involvement of the lateral wall of the cavernous sinus and the orbit.A cranio-orbital zygomatic approach was performed to reach all extension of the lesion. We made an extradural clinoidectomy and an extensive bone removal of the orbit, exposition of the superior and lateral walls of the cavernous sinus, unroofing of the optic canal, superior orbital fissure, foramen rotundum, and foramen ovale. We performed the peeling of the lateral wall of cavernous sinus with total removal and preservation of the cranial nerves anatomy and function.In this video, we illustrate the importance of the first time aggressive removal of such tumors. We also demonstrate the concept that secondary invasion of the cavernous sinus are suitable for removal with cranial nerve preservation.The link to the video can be found at https://youtu.be/GJmkqVa6jSs.
RESUMO O treinamento é um processo que exige paciência e constante prática. A execução de procedimentos microscópicos está presente no dia a dia de diversas especialidades cirúrgicas, mas infelizmente modelos experimentais não são de fácil de acesso. Propomos um modelo com coração bovino usado por residentes e jovens cirurgiões no treinamento de dissecção microscópica e microanastomoses. É descrita a montagem deste modelo, que pode ser realizado de maneira individual e com material acessível aos departamentos cirúrgicos. Nossa experiência na elaboração das peças, assim como, dicas para o processo são descritas no texto. O modelo com miocardio bovino pode ser reproduzido em qualquer centro que disponha de bancadas e instrumental cirúrgico. Dentre as vantagens estão o baixo custo, rápido preparo e grande disponibilidade do tecido utilizado. Consideramos o projeto útil no treinamento de residentes cirúrgicos e jovens cirurgiões.
Purpose
The objective of this study is to evaluate the meningioma`s hormone receptor expression in patients who presented synchronous or metachronous meningioma and breast cancer and compare its profile to the non-breast cancer associated meningiomas described in the literature.
Methods
The authors conducted a retrospective descriptive study evaluating all cases of synchronous and metachronous meningiomas and breast cancer from January 1st, 1990 to December 31st, 2020. The study was approved by the Ethics Review Board. Variables related to meningioma (age and year of diagnosis, histological grade and subtype, topography, the presence of progesterone and/or estrogen receptors) and to breast cancer (age and year of diagnosis, the histological grade and subtype, the presence of progesterone and/or estrogen receptors) were collected on the hospital`s electronic health records.
Results
A total of 12 cases were included in the study, being 2 (17%) synchronous and 10 (83%) metachronous. The mean age at meningioma diagnosis was 60.58 (± 10,99). The most frequent intracranial topography was convexity and sphenoid wing meningiomas (25% each). Ten patients (83%) had grade 1 meningiomas and 2 patients (16.6%) presented with grade 2 meningiomas. Eleven cases of meningiomas expressed progesterone receptors (91.67%) while 3 cases expressed estrogen receptors (25%). One patient did not express hormonal receptor.
Conclusion
The WHO histological analysis and steroid receptors profile did not seem to be different in the meningiomas included in this sample when compared to the description of no-breast cancer associated meningiomas.
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