Predicting survival and prognosis of postoperative breast cancer brain metastasis: a population-based retrospective analysis / 中华医学杂志(英文版)

BACKGROUND@#Breast cancer is one of the most common cancer in women and a proportion of patients experiences brain metastases with poor prognosis. The study aimed to construct a novel predictive clinical model to evaluate the overall survival (OS) of patients with postoperative brain metastasis of breast cancer (BCBM) and validate its effectiveness.@*METHODS@#From 2010 to 2020, a total of 310 female patients with BCBM were diagnosed in The Affiliated Cancer Hospital of Xinjiang Medical University, and they were randomly assigned to the training cohort and the validation cohort. Data of another 173 BCBM patients were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database as an external validation cohort. In the training cohort, the least absolute shrinkage and selection operator (LASSO) Cox regression model was used to determine the fundamental clinical predictive indicators and the nomogram was constructed to predict OS. The model capability was assessed using receiver operating characteristic, C-index, and calibration curves. Kaplan-Meier survival analysis was performed to evaluate clinical effectiveness of the risk stratification system in the model. The accuracy and prediction capability of the model were verified using the validation and SEER cohorts.@*RESULTS@#LASSO Cox regression analysis revealed that lymph node metastasis, molecular subtype, tumor size, chemotherapy, radiotherapy, and lung metastasis were statistically significantly correlated with BCBM. The C-indexes of the survival nomogram in the training, validation, and SEER cohorts were 0.714, 0.710, and 0.670, respectively, which showed good prediction capability. The calibration curves demonstrated that the nomogram had great forecast precision, and a dynamic diagram was drawn to increase the maneuverability of the results. The Risk Stratification System showed that the OS of low-risk patients was considerably better than that of high-risk patients ( P < 0.001).@*CONCLUSION@#The nomogram prediction model constructed in this study has a good predictive value, which can effectively evaluate the survival rate of patients with postoperative BCBM.

Plasmocitoma extramedular solitario rinosinusal: reporte de caso y revisión de literatura / Solitary extramedullary plasmacytoma of the rhinosinusal cavity: a case report and literature review

Resumen El plasmocitoma extramedular solitario (PES) es una neooplasia maligna infrecuente caracterizada por una proliferación aislada de células plasmáticas monoclonales en tejido extramedular. La localización más frecuente es en cabeza y cuello con predominio en el territorio rinosinusal, sin embargo, estas lesiones malignas representan menos del 1% de los tumores de esta región anatómica. El diagnostico requiere una alta sospecha clínica, análisis histopatológico acucioso, estudios serológicos y exámenes radiológicos sistémicos de acuerdo a los criterios diagnósticos establecidos en la literatura internacional. Se analiza el caso de un paciente masculino con un PES que se presentó como un tumor de fosa nasal derecha y obstrucción nasal de meses de evolución con hallazgos clínicos e imagenológicos inespecíficos. El diagnóstico definitivo se realizó mediante biopsia endoscópica nasal y estudio histopatológico. El tratamiento fue abordado de manera multidisciplinaria entre otorrinolaringología, hematología y radiooncología. De acuerdo a las guías internacionales, se decidió realizar radioterapia localizada con buen resultado clínico precoz. El PES requiere un abordaje multidisciplinario para lograr un diagnóstico y tratamiento oportuno, siendo imprescindible la exclusión del mieloma múltiple debido a las diferencias terapéuticas y en pronóstico clínico. El tratamiento puede realizarse con radioterapia y/o cirugía, siendo la radioterapia el pilar de tratamiento.

Abstract Solitary extramedullary plasmacytoma (SEP) is a rare malignant neoplasm characterized by isolated proliferation of monoclonal plasma cells in extramedullary tissue. The most frequent location is in the head and neck with a predominance in the rhinosinusal territory; however, these malignant lesions represent less than 1% of the tumors in this anatomical region. The diagnosis requires a high clinical suspicion, careful histopathological analysis, serological studies and systemic radiological examinations according to the diagnostic criteria established in the international literature. We analyze the case of a male patient with SEP that presented as a tumor of the right nostril and nasal obstruction of months of evolution with nonspecific clinical and imaging findings. The definitive diagnosis was made by nasal endoscopic biopsy and histopathological study. The treatment was approached by multidisciplinary teamwork. According to international guidelines, it was decided to perform localized radiotherapy with good early clinical results. SEP requires a multidisciplinary approach to achieve a timely diagnosis and treatment, being essential exclusion of multiple myeloma due to the therapeutic differences and prognosis. Treatment can be done with radiation therapy and/or surgery; radiation therapy is the mainstay of treatment.

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.

Glioblastoma multiforme con presentación seudovascular / Glioblastoma multiforme with pseudovascular presentation

Introducción: El glioblastoma multiforme es el tumor cerebral primario más frecuente y agresivo en adultos, representa cerca de 25 por ciento de los tumores intracraneales. Las principales manifestaciones clínicas están dadas por cefalea, convulsiones, cambios de conducta y un síndrome focal más definido (frontal, temporal, parietooccipital o del cuerpo calloso). En algunos pacientes, el comienzo es brusco por hemorragia o crecimiento rápido de un quiste intratumoral. El diagnóstico se realiza por resonancia magnética y se confirma con biopsia cerebral. El tratamiento es multidisciplinario e incluye resección quirúrgica, quimioterapia y radioterapia. No obstante, el pronóstico es desfavorable en la mayor parte de los pacientes. Objetivo: Describir el caso de un paciente con glioblastoma multiforme que se presentó en forma seudovascular. Caso clínico: Se presenta el caso de un paciente masculino de 60 años de edad con antecedentes de hipertensión arterial y enfermedad cerebrovascular. Tres días antes de su ingreso comenzó a manifestar dificultad para hablar y alteración en la marcha por pérdida de la fuerza muscular en el hemicuerpo derecho. Por lo anteriormente expuesto fue llevado al Hospital Clínico Quirúrgico Julio Trigo López donde fue ingresado y se diagnosticó un tumor cerebral. El paciente evolucionó tórpidamente y falleció. El estudio anatomopatológico arrojó la presencia de un glioblastoma multiforme. Conclusiones: El caso presentado de glioblastoma multiforme forma de defecto motor ofrece información sobre esta afección que en nuestro centro no es habitual(AU)

Introduction: Glioblastoma multiforme is the most frequent and aggressive primary brain tumor in adults, representing about 25percent of intracranial tumors. The main clinical manifestations are given by headache, seizures, behavior changes and a more defined focal syndrome (frontal, temporal, parieto-occipital or corpus callosum). In some patients, the onset is abrupt due to bleeding or rapid growth of an intratumoral cyst. The diagnosis is made by magnetic resonance imaging and confirmed with brain biopsy. Treatment is multidisciplinary and it includes surgical resection, chemotherapy, and radiation therapy. However, the prognosis is poor in most patients. Objective: To describe the case of a patient with glioblastoma multiforme that presented in a pseudovascular form. Clinical report: The case of a 60-year-old male patient with a history of arterial hypertension and cerebrovascular disease is report. Three days before his admission, he began to show difficulty speaking and gait disturbance due to loss of muscle strength in the right half of his body. For the foregoing, he was taken to Julio Trigo López Surgical Clinical Hospital where he was admitted and diagnosed with a brain tumor. The patient evolved torpidly and died. The pathological study revealed the presence of a glioblastoma multiforme. Conclusions: The reported case of glioblastoma multiforme in the form of a motor defect provides information on this condition that is not common in our center(AU)

Microsurgical Resection of Glioblastoma in a Patient Infected with Covid-19: A Case Report

The COVID-19 pandemic has affected a large number of patients in all countries, overwhelming healthcare systems worldwide. In this scenario, surgical procedures became restricted, causing unacceptable delays in the treatment of certain pathologies, such as glioblastoma. Regarding this tumor with high morbidity and mortality, early surgical treatment is essential to increase the survival and quality of life of these patients. Association between COVID-19 and neurosurgical procedures is quite scarce in the literature, with a few reported cases. In the present study, we present a rare case of a patient undergoing surgical resection of glioblastoma with COVID-19.

Características sociodemográficas en cuidadores principales de pacientes operados de cáncer de cerebro / Socio-demographic characteristics in primary caregivers of patients with brain cancer surgery

RESUMEN Introducción: la atención al enfermo es llevada a cabo por una secuencia específica de la familia, por lo que esta es considerada un cuidador principal. Objetivo: describir las características sociodemográficas en cuidadores principales de pacientes operados de cáncer de cerebro. Materiales y métodos : se realizó un estudio descriptivo, retrospectivo, en un universo de 128 cuidadores principales de pacientes operados de cáncer de cerebro en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, entre 2016 y 2018. Criterio de inclusión: cuidadores que residían en la provincia y aceptación del consentimiento informado. Se excluyeron familiares de pacientes que fallecieron durante la investigación. Se aplicaron cuestionarios y entrevistas para caracterizar los resultados. Los mismos se analizaron en frecuencias absolutas, relativas, porcentual, en paquete estadístico de SPSS versión 20.0 en Windows. Resultados : predominó el sexo femenino (79,68 %). El 100 % de los cuidadores principales residían en casa del enfermo. Prevaleció el nivel de escolaridad de técnico medio (35,93 %); 88,28 % de los cuidadores mantenían vínculo laboral, y 41,40 % eran hermanas de los enfermos. Dentro de las necesidades de aprendizaje del cuidador, el déficit de conocimientos sobre la enfermedad constituyó el 73,43 %. Conclusiones: imperó el género femenino en los cuidadores con vínculo laboral, y con mayor incidencia las hermanas. Se evidenció la complejidad del cuidado en el hogar de los pacientes con secuelas, minusvalía progresiva producidas por la enfermedad, y que generalmente la mujer asume con más facilidad (AU).

ABSTRACT Introduction: the care of the patient is carried out by a specific sequence of the family, catalogued as a main caregiver. Objective: to describe the socio-demographic characteristics in main caregivers of patients who underwent a brain cancer surgery. Materials and methods: a retrospective, descriptive study was carried out in a universe of 128 main caregivers of patients who underwent brain cancer surgery in the University Hospital Faustino Perez Hernandez, of Matanzas, from 2016 until 2018. Inclusion criteria: caregivers living in the province of Matanzas and giving the informed consent. The relatives of patients who died during the research were excluded. Interviews were made and questionnaires applied to characterize the results. They were analyzed in absolute, relative, and percentage frequencies in statistical packet Windows SPSS, 20.0. Results: female sex predominated (79.68%). 100% of main caregivers lived in the house of the patient. The technician scholarship predominated (35.93%); 88.28% of the caregivers kept their employment bonds, and 41.40% were patients' sisters. The deficit of knowledge on the disease was 73.43% of the caregiver learning necessities. Conclusions: female genre prevailed in caregivers with employment bonds, with higher incidence of sisters. It was evidenced the complexity of home care of the patients with sequels, progressive disabilities caused by the disease, generally assumed more easily by women (AU).

Utility of Intraoperative Ultrasound in Neurosurgery

Objective The purpose of the present study is to demonstrate the usefulness of intraoperative ultrasound guidance as a technique for the assessment, in real time, of tumor resection and as a navigation aid during intra-axial brain lesion removal on patients admitted in the Neurosurgical Department at the Hospital Universitario de Caracas, Caracas, Venezuela, in 2018. Methods A total of 10 patients were enrolled, each with intra-axial brain lesions with no previous neurosurgical procedures and a mean age of 49 years old, ranging from 29 to 59 years old. Results A male predominance was observed with 7 cases (70%) over 3 female cases (30%). Six patients had lesions in the dominant hemisphere. The frontal lobe was the most commonly affected,with 5 cases, followed by the parietal lobe,with 4 cases. After craniotomy, ultrasound evaluation was performed previously to dural opening, during tumor resection and after tumor removal. The mean tumor size in axial, coronal and sagittal views was 3.72 cm, 3.08 cm and 3.00 cm, respectively, previously to dural opening with intraoperative ultrasound. The average tumor depth was 1.73 cm from the cerebral cortex. The location and removal duration from the beginning of the approach (ultrasound usage time) was 83.60 minutes, and the average surgery duration was 201 minutes. Navigation with intraoperative ultrasound served to resect intra-axial tumors more precisely and safely. There was no postoperative complication associated with the surgery in this series of cases. Conclusions Intraoperative ultrasound guidance for intra-axial subcortical tumor resection is a technique that serves as a surgical and anatomical orientation tool.

Efectividad de intervención enfermera en capacidad de adaptación-afrontamiento de cuidadores de operados de cáncer cerebral con cambios conductuales / Effectiveness of a Nursing Intervention regarding the Adaptation-Coping Capacity of Caregivers of Patients Operated on for Bran Tumor with Behavioral Changes

Introducción: Es alta la incidencia de familiares cuidadores de operados de cáncer cerebral con trastornos conductuales que no tienen adecuada adaptación-afrontamiento, requiriendo de la intervención enfermera. Objetivo: Evaluar la efectividad de una intervención de Enfermería en la capacidad de adaptación y afrontamiento de familiares cuidadores de adolescentes y jóvenes operados de cáncer cerebral con cambios conductuales. Métodos: Estudio preexperimental con pretest postest, en el Hospital Universitario "Faustino Pérez Hernández", Matanzas, Cuba, durante 2018. Universo de 93 familiares cuidadores. Información obtenida de la variable capacidad de adaptación-afrontamiento, con Escala ECAPS, la intervención de enfermería se sustentó en los cuatro modos adaptativos de la teoría de Callista Roy. La información se procesó con distribuciones de frecuencias absolutas, porcentaje, media, desviación típica, varianza, valor mínimo y máximo, la asociación entre variables se obtuvo con la prueba no paramétrica de Wilcoxon. con regla de decisión: Si p ≤ 0.05 se rechaza Ho. Resultados: La capacidad de adaptación-afrontamiento de familiares cuidadores de operados de cáncer cerebral con cambios conductuales cambió entre las mediciones efectuadas antes y después de la intervención de enfermería basada en la teoría de Roy. (z=-8,391, p < 0,05) Conclusiones: La intervención de enfermería basada en el modelo de adaptación de Callista Roy fue efectiva en la capacidad de adaptación y afrontamiento de familiares cuidadores de adolescentes y jóvenes operados de cáncer cerebral con cambios conductuales(AU)

Introduction: There is a high incidence of family caregivers of patients operated on for brain tumor with behavioral disorders who do not manifest satisfactory adaptation or coping, therefore requiring nursing intervention. Objective: To assess the effectiveness of a nursing intervention in adaptation and coping capacity of family caregivers of adolescents and young people operated on for brain tumor with behavioral changes. Methods: Pre-experimental study with pre- and post-test carried out, during 2018, at Faustino Pérez Hernández University Hospital of Matanzas, Cuba. The universe was 93 family caregivers. The information was obtained from the variable adaptation-coping capacity, using the Coping and Adaptation Processing Scale (CAPS); the nursing intervention was based on the four modes of adaptation defined within Callista Roy's theory. The information was processed using distributions of absolute frequencies, percentage, mean, standard deviation, variance, minimum and maximum values. The association between variables was obtained using the non-parametric Wilcoxon test, under the decision rule If P ≤ 0.05, then Ho is rejected. Results: The adaptation-coping capacity of family caregivers of patients operated on for brain tumor with behavioral changes was different between the measurements made before and after the nursing intervention based on Roy's theory (z=-8.391, P < 0.05) Conclusions: The nursing intervention based on Callista Roy's adaptation model was effective with regard to the adaptation and coping capacity of family caregivers of adolescents and young people operated on for brain tumor with behavioral changes(AU)

Awake craniotomy in brain tumors - Technique systematization and the state of the art / Craniotomia em paciente acordado nos tumores cerebrais - Sistematização da técnica anestésica e o estado da arte

ABSTRACT The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.

RESUMO A anestesia para craniotomia em paciente acordado (CPA ou awake craniotomy) é técnica anestésica consagrada e aperfeiçoada ao longo dos últimos anos. Utilizada inicialmente para mapeamento de focos epilépticos, consolidou-se posteriormente como técnica padrão para a remoção de neoplasias de origem glial em áreas eloquentes cerebrais. A técnica de anestesia CPA apresentada constitui-se em três tempos primordiais denominados acordado-dormindo-acordado (asleep-awake-asleep) e respectivas particularidades, assim como o manejo quanto às medicações anestésicas utilizadas de forma pormenorizada. A utilização em gliomas de baixo e de alto grau se demonstrou favorável para a ressecção de tumores dentro dos limites funcionais dos pacientes, com menor tempo de internação hospitalar e de custos diretos. O presente estudo visa realizar a sistematização da técnica baseada na experiência do maior Hospital Filantrópico da América Latina e discute os aspectos mais relevantes que consolidaram essa técnica como a mais adequada na cirurgia dos gliomas em áreas eloquentes.

Intra-operative mapping and language protection in glioma / 中华医学杂志(英文版)

The demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients' full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.

Pure Endoscopic Excision of Parenchymal Brain Tumors: Feasibilty, Risks, Advantages and Realities - A Beginners Perspective

Background Neuroendoscopy is gaining popularity and is reaching new realms. Young neurosurgeons are exploring the various possibilities associated with the use of neuroendoscopy. Neuroendoscopy in excision of parenchymal brain tumors is less explored, and young neurosurgeons should be aware of the realities. The present article is an approach to put forward the difficulties faced by a young neurosurgeon and the lessons learnt. Objective To report the experience of surgical excision of parenchymal brain tumors, in selected cases, using pure endoscopic approach and to discuss its feasibility, technical benefits, risks and comparison with conventional microscopic excision. Method Eight patients of variable age group with parenchymal brain tumors were operated upon by a single surgeon and followed up for a period varying from6months to 2 years. Data regarding operating time, illumination, clarity of the field, size of craniotomy, blood loss and course of recovery was evaluated. All of the tumors were resected using rigid high definition zero and 30° endoscope. Results Out of eight cases, seven had lesions in the supratentorial and one in the infratentorial location. The age group ranged from 27 to 74 years old. Near to gross total resection was achieved in all except two cases. All of the patients recovered well without any significant morbidity or mortality. Hospital stay was reduced by 1 day on average. Conclusion Excision of parenchymal brain tumors via pure endoscopic method is a safe and efficient procedure. Although there is an initial period of learning curve, it is not steep for those already practicing neuroendoscopy, but the approach has its advantages.

Delayed Cerebral Metastasis of Breast Cancer: Case Report and Molecular Review

Breast cancer (BC) is a prevalent disease, and its incidence of brain metastasis (BM) varies from5 to 30% according to the literature.We present the case of a delayed isolated cerebral metastasis in a female patient following a period of 16 years after the diagnosis and first treatment. During this time, there was no other recurrence. We also review the literature concerning central nervous systemspread and themolecular subtypes of such late tumors.

Surgical treatment of drug-resistant epilepsy caused by gliomas in eloquent areas: experience report / Tratamento cirúrgico de epilepsias refratárias causadas por gliomas localizados em áreas eloquentes: uma série de casos brasileiros

ABSTRACT Drug-resistant epilepsy associated with central nervous system tumors is generally caused by low grade gliomas. This group of tumors is usually found in brain eloquent areas, such as the insular lobe, rolandic cortex and supplementary motor area and, historically, possess a greater risk of postoperative deficits. Objective: The aim of this investigation was to present our surgical experience on patients with drug-resistant epilepsy caused by gliomas in eloquent areas. We retrospectively investigated variables that impact seizure control, such as tumor location, extent of resection, invasion into the lenticulostriate arteries in the patient, especially those with insular gliomas. Methods: Out of 67 patients with eloquent area brain tumors operated on in our service between 2007 and 2016, 14 patients had symptoms of drug-resistant epilepsy. Volumetric analysis, extent of resection (EOR), type of approach and mapping, among other factors were correlated with the 12-month postoperative seizure outcome. Results: Univariate analysis showed that the factors showing statistical relevance with seizure control were preoperative volume (p = 0.005), EOR (p = 0.028) and postoperative volume (p = 0.030). Conclusion: There was a statistically significant association between the EOR and the Engel score for epilepsy control: an EOR < 70 was associated with Engel II, III, IV and an EOR > 90 was associated with Engel I. Eloquent area gliomas can safely be resected when surgeons use not only microsurgical anatomy concepts but also brain mapping.

RESUMO Epilepsia refratária secundária a tumores cerebrais são geralmente causadas por gliomas de baixo grau. Esse grupo de tumor é frequentemente localizado em áreas eloquentes do cérebro como na insula, córtex rolândico e área motora suplementar; e sua ressecção apresenta alto risco de déficits neurológicos no pós operatório. Objetivo: O objetivo do estudo consiste em apresentar nossa experiência no tratamento cirúrgico de pacientes com epilepsia refratária secundário a gliomas em áreas eloquentes. Métodos: O estudo consiste em investigação retrospectiva de variáveis que interferem no controle de crises, tais como localização do tumor, grau de ressecção, invasão tumoral de artérias lenticulo estriadas, principalmente em gliomas insulares. Dentre 67 pacientes portadores de gliomas em área eloquente operados no período de 2007 a 2016, 14 doentes apresentavam epilepsia refrataria associada. Análise volumétrica do tumor, grau de ressecção, acesso cirúrgico, bem como o uso de mapeamento cortical intraoperatório foram correlacionados com desfecho de controle de crises epilepticas em 12 meses. Resultados: Em análise univariada os fatores relacionados com controle de crises em 12 meses foram volume tumoral pré operatório (p = 0,005), grau de ressecção (p = 0,028) e volume tumoral pós operatório. Conclusão: O grau de ressecção apresentou significância estatística em relação ao controle de crises conforme escala de Engel. Ressecções menores que 70% apresentaram correlação com Engel II, III e IV; enquanto ressecções maiores que 90% apresentaram correção positiva com Engel I. Gliomas em áreas eloquentes podem ser ressecados de forma segura desde que seja realizada por equipe experiente com conhecimento acurado da anatomia microcirúrgica e emprego de mapeamento cortical intraoperatório.

Aspectos epidemiológicos, clínicos y quirúrgicos de los tumores cerebrales metastásicos / Aspectos epidemiológicos, clínicos e cirúrgicos dos tumores cerebrais metastáticos / Epidemiological, clinical and surgical aspects of metastatic brain tumors

Introducción: los tumores que se diseminan en el cerebro, provenientes de una neoplasia primaria localizada en otros órganos del cuerpo son conocidos como tumores cerebrales metastásicos. Se estima que el 25 por ciento de los tumores malignos en otros lugares del organismo provocan metástasis en la cabeza. Objetivo: sistematizar los aspectos clínicos, epidemiológicos y quirúrgicos de los tumores cerebrales metastásicos, así como las herramientas diagnósticas y terapéuticas necesarias para ofrecerles al enfermo y familiares las mejores alternativas ante la enfermedad. Método: se realizó una revisión narrativa a partir del estudio documental de revisiones sistemáticas, metaanálisis, guías de práctica clínica, artículos originales y tesis doctorales que se encontraron en las bases de datos electrónicas. Resultados: la incidencia de la metástasis cerebral varía en dependencia de la localización del tumor primario. En los adultos, la incidencia más alta se observó entre la quinta y séptima década de vida, sin diferencias en el sexo. Los tumores cerebrales tienen diferentes formas de presentación clínica, entre ellas se encontraron el síndrome de hipertensión intracraneal, signos focales, crisis epilépticas y síndrome endocrino. Los tres componentes primordiales del manejo de pacientes con metástasis cerebral fueron las drogas no quimioterapéuticas y quimioterapéuticas, la intervención quirúrgica para la exéresis tumoral y la radioterapia. Conclusiones: los tumores metastásicos cerebrales constituyen un problema de salud con incidencia creciente, con un cuadro sindrómico complejo y polimorfo, poseen amplio arsenal terapéutico que abarca las drogas no quimioterapéuticas, la quimioterapia, la quirúrgica y la radioterapia las cuales deben ser ajustadas a las características de cada paciente para lograr una sobrevida lo más larga posible, con mayor calidad de vida(AU)

Introduction: tumors that spread in the brain, from a primary neoplasm located in other organs of the body are known as metastatic brain tumors. It is estimated that 25per cent of malignant tumors in other parts of the body cause head metastases. Objective: to systematize the clinical, epidemiological and surgical aspects of metastatic brain tumors, as well as the diagnostic and therapeutic tools necessary to offer the patient and family the best alternatives to the disease. Method: a narrative review was carried out based on the documentary study of systematic reviews, meta-analysis, clinical practice guides, original articles and doctoral theses that were found in the electronic databases. Results: the incidence of brain metastasis varies depending on the location of the primary tumor. In adults, the highest incidence was observed between the fifth and seventh decade of life, without differences in sex. Brain tumors have different forms of clinical presentation, including intracranial hypertension syndrome, focal signs, epileptic seizures and endocrine syndrome. The three primary ISSN 1028-9933 526 components of the management of patients with cerebral metastases were non-chemotherapeutic and chemotherapeutic drugs, surgical intervention for tumor excision and radiotherapy. Conclusions: metastatic brain tumors constitute a health problem with increasing incidence, with a complex syndromic and polymorphic picture, they have a wide therapeutic arsenal that includes non-chemotherapeutic drugs, chemotherapy, surgery and radiotherapy which must be adjusted to the characteristics of each patient to achieve a survival as long as possible, with a better quality of life(AU)

Introdução: tumores que se espalham no cérebro, a partir de uma neoplasia primária localizada em outros órgãos do corpo, são conhecidos como tumores cerebrais metastáticos. Estima-se que 25per cent dos tumores malignos em outras partes do corpo causem metástases na cabeça. Objetivo: sistematizar os aspectos clínicos, epidemiológicos e cirúrgicos dos tumores cerebrais metastáticos, bem como as ferramentas diagnósticas e terapêuticas necessárias para oferecer ao paciente e à família as melhores alternativas para a doença. Método: foi realizada uma revisão narrativa baseada no estudo documental de revisões sistemáticas, metanálises, guias de prática clínica, artigos originais e teses de doutorado encontradas nas bases de dados eletrônicas. Resultados: a incidência de metástases cerebrais varia de acordo com a localização do tumor primário. Nos adultos, a maior incidência foi observada entre a quinta e a sétima década de vida, sem diferenças entre os sexos. Os tumores cerebrais têm diferentes formas de apresentação clínica, incluindo síndrome de hipertensão intracraniana, sinais focais, convulsões epilépticas e síndrome endócrina. Os três componentes principais do tratamento de pacientes com metástases cerebrais foram medicamentos não quimioterápicos e quimioterápicos, intervenção cirúrgica para excisão de tumores e radioterapia. Conclusões: os tumores cerebrais metastáticos constituem um problema de saúde com incidência crescente, com quadro sindrômico e polimórfico complexo, possuem amplo arsenal terapêutico que abrange medicamentos não quimioterápicos, quimioterapia, cirurgia e radioterapia, que devem ser ajustados às características de cada paciente para alcançar a sobrevivência o maior tempo possível, com uma melhor qualidade de vida(AU)

Experiencia clínica del manejo anestésico en craneotomía vigil / Clinical experience of anesthetic management of Awake Craniotomy

OBJECTIVES: Describe the demographic characteristics of patients undergoing awake craniotomy, which are the anesthetic techniques and most commonly used drugs, as well as to identify the type and frequency of anesthetic and surgical complications. MATERIAL AND METHODS: Perioperative awake craniotomy records were reviewed in the operating room. All cases of patients with gliomas in which the need for cortical mapping was determined between november 2015 and august 2018 were included. Of a total of 27 operated patients, data were collected for 18 surgeries. RESULTS: Two thirds of the patients were men and one third were women. The average age was 42 years. 39% of the patients presented overweight, being obese by 28%. The most used anesthetic technique was asleep-awake-asleep in 56% of the cases, the rest was under conscious sedation. In all cases, remifentanil and propofol were used, in addition to the scalp block. Intraoperative complications are described in two patients and new-onset neurological deficit in seven patients. There was no conversion to general anesthesia in any case. CONCLUSIONS: Awake craniotomy remains the gold standard for the surgical management of brain tumors in eloquent areas. It is a challenge that requires clear communication with the patient and between the team. We share the experience of our center, with favorable results for patients.

OBJETIVOS: Describir las características demográficas de los pacientes sometidos a craneotomía vigil, cuáles son las técnicas anestésicas y fármacos más utilizados, además de identificar el tipo y frecuencia de complicaciones anestésicas y quirúrgicas. MATERIAL Y MÉTODOS: Se revisaron los registros perioperatorios de craneotomía vigil en pabellón. Fueron incluidos todos los casos de pacientes con gliomas en que se determinó la necesidad de mapeo cortical entre noviembre de 2015 y agosto de 2018. De un total de 27 pacientes operados se recolectaron datos para 18 cirugías. RESULTADOS: Dos tercios de los pacientes fueron hombres y un tercio mujeres. El promedio de edad fue de 42 años. Un 39% de los pacientes presentaron exceso de peso, siendo obesos en un 28%. La técnica anestésica más usada fue dormido-despierto-dormido en 56% de los casos, el resto fue bajo sedación consciente. En todos los casos se usó remifentanilo y propofol, además, del bloqueo pericráneo. Se describen complicaciones intraoperatorias en dos pacientes y déficit neurológico de nueva aparición en siete pacientes. No hubo conversión a anestesia general en ningún caso. CONCLUSIONES: La craneotomía vigil permanece como el estándar de oro del manejo quirúrgico de los tumores cerebrales en áreas elocuentes. Es un desafío que requiere de comunicación clara con el paciente y entre el equipo. Compartimos la experiencia de nuestro centro, con resultados favorables a los pacientes.

Suprasellar chordoid glioma: a report of two cases

SUMMARY Chordoid glioma (CG) is considered a slow growing glial neoplasm. We report two new cases with endocrinological presentation, management and outcome. Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass. An emergency ventricular peritoneal valve was placed due to obstructive hydrocephalus. Transcraneal surgery was performed. The patient developed central hypothyroidism, adrenal insufficiency and transient diabetes insipidus; she never recovered spontaneous menstrual cycles. Histopathologic study showed cells in cords, inside a mucinous stroma, positive for glial fibrillary acidic protein (GFAP). Due to residual tumor gamma knife radiosurgery was performed. Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache. An MRI showed a solid-cystic sellar mass 40 mm-diameter that extended to the suprasellar cistern. She had hypogonatropic hypogonadism and mild hyperprolactinemia. The tumor mass was removed via nasal endoscopic approach. Histopathological study reported cellular proliferation of glial lineage positive for GFAP. The patient evolved with central hypothyroidism and diabetes insipidus. She was re-operated for fistula and again under the diagnosis of extradural abscess. She evolved with cardiorespiratory descompensation and death, suspected to be due to a thromboembolism. In conclusion, the first case confirms that best treatment for CG is surgery considering radiotherapy as an adjuvant therapy. The other case, on the contrary, illustrates the potentially fatal evolution due to surgical complications.

Primary cardiac angiosarcoma with rare presenting feature and successful surgical treatment

Abstract Primary angiosarcoma is a rare clinical entity, it's typically located within the right atrium and known to be rapidly fatal. A 37-year-old female was presented with a history of recurrent facial paralysis and left hemiparesis. A cranial mass was identified at cranial magnetic resonance imaging and she underwent neurosurgery operation. The immunohistochemical examination was determined as metastatic cardiac angiosarcoma. The tumor, as well as part of the right pericardium, were resected. A piece of bovine pericardium was used to reconstruct the right atrial wall. Tricuspid valve was reconstructed with ring annuloplasty. Due to resection of right coronary artery with the tumor, coronary bypass surgery was performed successfully. The patient is currently healthful without any recurrence and complaint 12 months after the diagnosis as followed up.

Prolonged survival after surgical resection of cerebral metastasis from melanoma with multisystemic metastasis already present: a case report and literature review

ABSTRACT CONTEXT: Malignant melanoma is the third most common cause of cerebral metastases after breast and lung cancer. Despite advances in therapeutic options, the prognosis for patients with cerebral metastases from melanoma remains poor, with a median survival time of six months after diagnosis. CASE REPORT: A 65-year-old woman was diagnosed with a malignant melanoma on the third toe of her left foot.The tumorous spot was excised surgically. However, the melanoma reappeared after one year and skin biopsy confirmed recurrence of malignant melanoma. Investigations showed metastasis to the left pelvic region, left lobe of the liver and right lobe of the lung.The patient then received chemotherapy. Subsequently, the patient was brought to the emergency department with an altered level of consciousness (Glasgow coma scale: 9) and hemiplegia on the right side of her body. Computed tomography scans of the brain revealed hemorrhagic lesions in the parieto-occipital lobes of the brain. Urgent surgical evacuation was done to remove the lesion, following which the patient showed improvement in her score on the Glasgow coma scale and a concomitant decrease in weakness. She was discharged from hospital with full consciousness.The patient died of acute renal failure 14 months after the brain surgery and approximately 4 years after the initial presentation of the case. CONCLUSION: This case outcome is rare and shows the effectiveness of surgery to treat cerebral metastasis from malignant melanoma in a situation with multisystem metastasis already present.

Surgical Treatment of Cavernous Angiomas in the Pineal Gland ­ Case Report

Pineal cavernous angioma is a vascular malformation that has a prevalence lower than 1%. The etiology is debated. It is believed that it is originated from an autosomal dominant inheritance or from radiotherapeutic treatment. Complete resection enables the cure and prevents complications of the natural evolution of the lesion, mainly hemorrhagic events. A female patient, with 67 years of age, presented mental confusion and visual acuity deficit, which evolved to periods of psychomotor agitation. A magnetic resonance imaging (MRI) scan of the head showed a lobulated mass lesion in the pineal region with hypersignal on T1 and hyposignal on the susceptibility weighted imaging (SWI) sequence. Hydrocephalus was also noticed. The patient underwent a microsurgery for complete lesion resection though a supracerebellar/ supratentorial access. The anatomopathology revealed an arteriovenous malformation compatible with cavernous angioma. The pineal cavernous angioma is a rare malformation that should be considered in the differential diagnosis of expansive lesions of the pineal gland.

Papillary Tumor of the Pineal Region: Case Report and Literature Review

Papillary tumor of the pineal region (PTPR) is a neuroectodermal tumor thought to originate from cells of the subcommissural organ. Its oncologic properties are still under investigation, as well as the most suitable therapeutic measures for this type of neoplasm.We report the case of a 36-year-old woman with a 1-year history of headache and intermittent diplopia. The magnetic resonance imaging (MRI) scan showed a heterogeneously enhancing mass in the pineal region that caused an acute hydrocephalus, and an emergency shunt derivation was necessary. One week later, the patient was submitted to subtotal tumor resection, and remained asymptomatic in the post-operative period. In the follow-up, the patient remained asymptomatic; in the imaging control 3.5 years after the surgical resection, local recurrence was identified, and the patient was submitted to a local radiation protocol. Our literature review showed an early clinical onset due to intracranial hypertension signs. Definitive clinical onset might be reached only through a histopathological examination. Gross total resection followed by radiotherapy is the current standard of care. Local recurrence is often observed, with rare dissemination to the cerebral spinal fluid. The natural history of the PTPR remains unknown, as well as the best treatment strategy. Large case series with longer follow-ups are necessary for further conclusions.