Intradural Intramedullary Primary Spinal Melanocytoma: A Rare Case Report

Ganesan, Sudhir; Acharya, Shankar; Kalra, K; Chahal, Rupinder

doi:10.1055/s-0036-1584589

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Acharya et al descrevem A intervenção cirúrgica e seu sucesso dependem fortemente de um diagnóstico preciso, um planejamento cuidadoso e a habilidade da equipe cirúrgica. Os riscos associados, particularmente a infecção, são uma consideração crucial no pós-operatório, exigindo vigilância e cuidados contínuos (Acharya et al, 2024).…”

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“…Ao avançar além dos desafios cirúrgicos e complicações, é vital refletir sobre as implicações a longo prazo do diagnóstico de mielomeningocele, incluindo questões de qualidade de vida e reabilitação. Este aspecto ressalta a importância de uma abordagem multidisciplinar no cuidado desses pacientes, envolvendo especialistas em neurocirurgia, ortopedia, urologia, fisioterapia e psicologia (Acharya et al, 2024).…”

Section: Resultsunclassified

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Mielomeningocele e anomalias associadas: uma série de casos e revisão sistemática

Goulart,

Silva,

Melo

et al. 2024

Braz. J. Hea. Rev.

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A mielomeningocele é uma malformação congênita grave do sistema nervoso central, representando um dos tipos mais complexos de defeitos do tubo neural. A condição é marcada pela exposição das meninges e, em alguns casos, da medula espinhal, através de uma abertura na coluna vertebral, desafiando tanto o prognóstico do paciente quanto as estratégias de tratamento. O presente estudo visa explorar os avanços recentes no diagnóstico, intervenções cirúrgicas e desfechos neurológicos associados à mielomeningocele, com foco particular na eficácia e segurança das abordagens atuais. Para isso, foi realizada uma revisão sistemática da literatura de 2016 a 2024 nas bases de dados PubMed (Medline), Cochrane Library e SciELO, aplicando critérios de inclusão e exclusão rigorosos para selecionar estudos que abordassem esses aspectos. Três estudos chave foram analisados, destacando-se pelas técnicas de diagnóstico antenatal, pela utilização de intervenções cirúrgicas inovadoras, como o fechamento fetal, e pelos cuidados pós-operatórios visando melhorias nos desfechos neurológicos. Os resultados indicam uma tendência positiva na melhoria da qualidade de vida dos pacientes, com avanços significativos no controle e na prevenção de complicações a longo prazo. No entanto, foi observada a necessidade de uma abordagem multidisciplinar no tratamento, integrando cuidados neurocirúrgicos, ortopédicos e reabilitativos. A mielomeningocele, apesar dos desafios, tem testemunhado progressos notáveis nas últimas décadas, sugerindo um futuro mais promissor para os pacientes afetados. Ainda assim, são necessários mais estudos para consolidar essas abordagens e otimizar as estratégias de tratamento na prática clínica.

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Section: Resultsunclassified

Mielomeningocele e anomalias associadas: uma série de casos e revisão sistemática

Goulart,

Silva,

Melo

et al. 2024

Braz. J. Hea. Rev.

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How Should We Treat Meningeal Melanocytoma? A Retrospective Analysis of Potential Treatment Strategies

Ricchizzi

Gallus

Stummer

et al. 2022

Cancers

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Background: Meningeal melanocytomas (MM) are rare primary melanocytic tumors of the leptomeninges with an incidence of 1:10,000,000. Until now, there has been only sparse information about this tumor entity. Here, we provide a meta-analysis of all cases published in the English language since 1972. Methods: A literature review was performed using PubMed and Web of Science. All published cases were evaluated for location, sex, age, therapeutic approach, and outcome. In total, we included 201 patient cases in our meta–analysis. Results: The majority of MM was diagnosed more frequently in men between the third and fifth decade of life. Surgery is the preferred therapeutic approach, and total resection is associated with the best outcome. Patients with partial resection or tumor recurrence benefit from adjuvant radiotherapy, whereas chemo- or immunotherapies do not improve the disease course. Malignant transformation was described in 18 patients. Of these, 11 patients developed metastasis. Conclusions: We present the first retrospective meta-analysis of all MM cases published in the English language, including an evaluation of different treatment strategies allowing us to suggest a novel treatment guideline highlighting the importance of total resection for recurrence–free survival and characterizing those cases which benefit from adjuvant radiotherapy.

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Unsatisfactory Neurological Outcome in an Intramedullary Thoracic Intermediate-Grade Melanocytoma—Systematic Review and Illustrative Case

Battistelli,

Grilli,

Rapisarda

et al. 2024

Cancers

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Background: Intramedullary melanocytomas are exceedingly rare, with only twenty-four cases reported up to now. They present as local invasive tumors despite their benign biological behavior. Attempting a complete safe resection often results in severe post-operative neurological deficits, as in our case presented here. Methods: A systematic review was conducted across the PubMed and Scopus databases including studies published till February 2024. Results: A total of 19 studies were included, encompassing 24 cases. A similar distribution between sexes was noted (M:F 13:11), with ages ranging from 19 to 79 years. The thoracic segment was most affected, and intermediate-grade melanocytoma (19 cases) was the most common histotype. Radiographically, intramedullary melanocytomas usually appear as hyperintense hemorrhagic lesions peripheral to the central canal with focal nodular enhancement. Intraoperatively, they are black–reddish to tan and are tenaciously adherent lesions. In the sampled studies, IONM employment was uncommon, and post-operative new-onset neurological deficits were described in 16 cases. Adjuvant RT was used in four cases and its value is debatable. Recurrence is common (10 cases), and adjuvant therapies (RT or repeated surgery) seem to play a palliative role. Case presentation: A 68-year-old woman presented with a three-year history of worsening spastic paraparesis and loss of independence in daily activities (McCormick grade 4). An MRI revealed an intramedullary tumor from Th5 to Th7, characterized by T1-weighted hyperintensity and signs of recent intralesional hemorrhage. Multimodal neuromonitoring, comprising the D-Wave, guided the resection of a black–tan-colored tumor with hyper-vascularization and strong adherence to the white matter. During final dissection of the lesion to obtain gross total resection (GTR), a steep decline in MEPs and D-Wave signals was recorded. Post-operatively, the patient had severe hypoesthesia with Th9 level and segmental motor deficits, with some improvement during neurorehabilitation. Histopathology revealed an intermediate-grade melanocytoma (CNS WHO 2021 classification). A four-month follow-up documented the absence of relapse. Conclusions: This literature review highlights that intramedullary T1 hyperintense hemorrhagic thoracic lesions in an adult patient should raise the suspicion of intramedullary melanocytoma. They present as locally aggressive tumors, due to local invasiveness, which often lead to post-operative neurological deficits, and frequent relapses, which overwhelm therapeutic strategies leading to palliative care after several years.

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Intradural Intramedullary Primary Spinal Melanocytoma: A Rare Case Report

Cited by 3 publications

References 9 publications

Mielomeningocele e anomalias associadas: uma série de casos e revisão sistemática

Mielomeningocele e anomalias associadas: uma série de casos e revisão sistemática

How Should We Treat Meningeal Melanocytoma? A Retrospective Analysis of Potential Treatment Strategies

Unsatisfactory Neurological Outcome in an Intramedullary Thoracic Intermediate-Grade Melanocytoma—Systematic Review and Illustrative Case

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