Meningioma primario intraóseo esfenotemporal: presentación de caso / Primary spheno-temporal intra-osseous meningioma: a case report

RESUMEN Fundamento: los meningiomas ectópicos, definidos como aquellos que no tienen ninguna conexión con la duramadre, poco frecuentes. Son una variante rara y representan cerca del uno por ciento de todos los meningiomas intracraneales. Objetivo: presentar una variante poco frecuente de un meningioma ectópico como causa de proptosis y oftalmoparesia encontrado en una paciente joven. Presentación del caso: paciente de 40 años de edad, que hace seis meses comenzó con dolor en el ojo derecho de moderada intensidad, aumento de volumen de la región frontorbitaria, disminución de la agudeza visual y visión doble. Los estudios de tomografía axial computarizada y resonancia magnética de cráneo y órbita mostraron lesión extraaxial a nivel de la pared lateral de la órbita con extensión extra e intraorbitaria con compresión de estructuras adyacentes que provocó desplazamiento anterior del globo ocular. Se realizó tratamiento quirúrgico con excéresis y el estudio histológico concluyó un meningioma meningotelial ectópico del hueso grado I. Conclusiones: los meningiomas ectópicos resultan poco frecuentes, el tratamiento quirúrgico con la resección total de la lesión es la elección para evitar recurrencias y pueden tener indicación de tratamiento oncológico complementario.

ABSTRACT Background: ectopic meningioma, defined as those that have no connection with the dura mater, are rare. They are a rare variant and represent approximately 1 % of all intracranial meningioma. Objective: to present a rare variant of an ectopic meningioma as a cause of proptosis and ophthalmoparesis found in a young patient. Case report: patient of 40 years of age, who 6 months ago began with pain in the right eye of moderate intensity, increased volume of the front-orbital region, decreased visual acuity and double vision. Computed tomography and MRI of the skull and orbit showed extra-axial lesion at the level of the lateral wall of the orbit with extra and intra-orbital extension with compression of adjacent structures that caused anterior displacement of the eyeball. Surgical treatment was performed with resection and the histological study concluded an ectopic meningotial meningioma of bone grade I. Conclusions: ectopic meningioma are infrequent, surgical treatment with total resection of the lesion is the choice to avoid recurrences and may have an indication of complementary oncological treatment.

Meningioma intramedular cervical: relato de caso e revisão da literatura / Intramedullary cervical meningioma: a case report and literature review

Os meningiomas estão entre os tumores benignos mais comuns do canal espinhal, em adultos, encontrados, predominantemente, nos segmentos torácicos. Segundo a literatura, a ocorrência de um meningioma intramedular cervical é muito rara, com apenas oito trabalhos científicos relatados até o momento. Apresentaremos o nono relato de caso ? talvez o primeiro relato publicado na literatura médica brasileira ? e revisaremos os estudos anteriores. Paciente, de 40 anos de idade, iniciou com sintomas de fraqueza na mão direita e dores cervicais que se agravavam durante a noite. A ressonância magnética revelou lesão intramedular extensa cervical. A paciente foi submetida somente à biópsia, por causa de dificuldades na ressecção, sendo depois proposta radioterapia. O tumor teve uma discreta redução, a paciente permaneceu sem piora dos sinais e sintomas durante os oito anos de evolução. Embora muito raros, meningiomas intramedulares cervicais existem e devem estar no diagnóstico diferencial de tumores nessa localização. O principal tratamento dessas lesões, de acordo com relatos anteriores, é a cirurgia, com bons resultados.

Meningiomas are among the most common benign tumours of the spinal canal in adults, found predominantly in the thoracic segments. According to the literature, the occurrence of an intramedullary cervical meningioma is very rare, with only eight scientific papers reported in the literature so far. We present the ninth case report ? probably the first reported in the Brazilian medical literature ? and review the previous reports. 40-year-old patient, who started the symptoms with weakness in her right hand and neck pain that worsened at night. The MRI revealed extensive intramedullary cervical lesion. The patient underwent biopsy only and, then, underwent radiotherapy. The tumor had a slight reduction and the patient remained without worsening of signs and symptoms during the eight years of evolution. Although very rare, intramedullary cervical meningiomas should be in the differential diagnosis of tumors of this location. The main treatment of these lesions, according to previous reports, is surgery with excellent results.

Edema peritumoral em meningiomas benignos: correlação com fatores clínicos, radiológicos, cirúrgicos e com recorrência tumoral / Peritumoral brain edema in benign meningiomas: correlation with clinical, radiological and surgical factors and role on recurrence

INTRODUÇÃO: O edema peritumoral (EP) está presente em aproximadamente 60% dos meningiomas. Os fatores responsáveis pela formação do edema e sua importância clínica permanecem como foco de discussão. OBJETIVOS: Analisar a correlação entre a presença de edema com características clínicas, cirúrgicas, radiológicas e recorrência tumoral. MÉTODOS: Foram selecionados 61 pacientes portadores de meningiomas benignos submetidos a tratamento cirúrgico pelo Grupo de Tumores Encefálicos e Metástases do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram incluídos no estudo os portadores de meningiomas benignos submetidos a ressecção tumoral completa (Simpson 1 e 2). Foram excluídos pacientes portadores de meningiomas malignos ou atípicos e aqueles localizados em tubérculo selar, seio cavernoso, forame magno, intraventriculares e região petroclival. RESULTADOS: Encontramos correlação entre as maiores medidas de edema peritumoral e recorrência tumoral (p = 0,042) e tumores com margens irregulares (p < 0,011) na análise bivariada. Além disso, os pacientes que apresentaram maiores volumes tumorais apresentaram maiores medidas de edema (p = 0,035) e nos pacientes com menores medidas de edema a localização tentorial foi mais freqüente (p = 0,032). Verificamos que ao estudo de regressão logística, o EP apresenta correlação com tumores maiores que 40 cm3 (Odds ratio=15,977), crises convulsivas (Odds ratio=3,469) e para cada cm3 acrescida ao tamanho tumoral o risco de edema cresce 1,082 vez (Odds ratio). CONCLUSÕES: Considerando os resultados obtidos, o EP esteve associado a maior recorrência tumoral, tumores multilobulados, grandes e a presença de crises convulsivas. A localização tentorial mostrou-se como um fator protetor ao EP. O EP pode estar associado a um potencial invasivo aumentado em meningiomas...

INTRODUCTION: Approximately 60% of meningiomas are associated with peritumoral edema.Various causative factors have been discussed in the literature. PURPOSES: Investigate the correlation of peritumoral edema with clinical, radiological and surgical aspects, and recurrence rate of meningiomas. METHODS: Sixty one benign meningiomas submitted to surgical treatment by the Group of Brain Tumors and Metastasis of the Division of Neurosurgery of the Hospital das Clínicas of São Paulo Medical School of São Paulo University. All patients underwent complete surgical ressection (Simpson 1 and 2) and were excluded the atypical and malignant hystopathological grades. The tumors located in the cavernous sinus, tuberculum sellae region, foramen magnum region, ventricular space and petroclival region were excluded. RESULTS: Edema extention had a positive correlation with the higher recurrence rates (p = 0,042) and with the presence of irregular margins (p < 0,011) on bivariate analysis. Meningiomas with greater edema sizes also showed correlation with large meningiomas (p = 0,035) and the ones with smaller edema sizes correlated with the tentorial location (p=0,032). Multivariate analysis showed an association between peritumoral brain edema and the presence of seizures (Odds ratio=3,469), large meningiomas (Odds ratio=15,977), and for each cubic centimeter added to its size, the risk of edema increased 1,082 times (Odds ratio). CONCLUSION: Peritumoral brain edema correlated with recurrence, irregular margins, seizures and larger tumors. The tentorial location demonstrated smaller edema sizes. Peritumoral brain edema may be related to meningioma's invading potentiality and may play a role in the recurrence pontential of the tumor. As a consequence, it's reasonable to consider edema's presence as an additional factor to be taken into account when arranging layout of strategies for meningiomas treatment.

Transcranial approach for resecting spheno-orbital meningiomas / 眼科

Objective To explore the effect and safety of transcranial approach for spheno-orhital meningioma. Design Retro- spective case series. Participants Thirty-two patients being operated with transcranial approach. Twenty-four cases were meningothelial meningiomas, 3 cases were fibrous meningiomas, 1 case was psammomatous meningioma, 2 cases were atypital meningiomas, 2 case were malignant meningiomas. Methods All patients underwent frontal-temporal craniotomy, the involved sphenoid wing bone and peri- orbit were removed to prevent recurrence. The superior orbital fissure and optic canal were decompressed, the dural and periorbital de- feet were repaired by autogenous temporal fascia or artificial dura. Main Outcome Measures Preoperative and postoperative exoph- thalmus and eyeball movement, the extent of tumor resection, the ratio of recurrence. Results The extent of tumor resection: 8 cases were Simpson gradeⅡ, 20 cases Simpson gradeⅢ, 4 cases Simpson grade IV. After surgery, proptosis were improved in all patients, ophthalmoplegia was found in 6 eases. There was no operation-related death or other significant complication. Tumor recurred in 6 cas- es. Conclusions Adequate exposure of the tumor and bony decompression of the cranial nerves can result from transcranial approach, all the involved bone should be removed in order to prevent recurrence. This approach is relatively safe and the ptoptosis are improved significantly. Complete surgical resection is difficult because of the involvement of the orbital apex, superior orbital fissure and cav- ernous sinus.