Meningioma Meningotelial cerebeloso complicado con absceso único a Nocardia / Meningioma Meningotelial cerebellar complicated with unique abscess to Nocardia

La presentación de abscesos cerebrales relacionados a meningiomas es muy poco frecuente. Usualmente son causados por bacterias comunes, siendo la Nocardia un agente etiológico excepcional. Presentamos la primera descripción en Paraguay de un absceso cerebral a Nocardia Spp asociado a meningioma en un paciente inmunocomprometido por consumo prolongado de corticoides (dexametasona).

The presentation of cerebral abscesses related to meningiomas is very rare. They are usually caused by common bacteria, nocardia being an exceptional etiological agent. We present the first description in Paraguay of a cerebral abscess to Nocardia spp associated meningioma in an immunocompromised patient for prolonged corticosteroid consumption (dexamethasone).

Importancia pronóstica de las mutaciones del gen promotor de la transcriptasa inversa de la telomerasa en los meningiomas de alto grado / Prognostic significance of telomerase reverse transcriptase promoter gen mutations in high grade meningiomas

Introducción. En los meningiomas, ocurren con frecuencia mutaciones en la región promotora de la transcriptasa inversa de la telomerasa. Objetivo. Estimar la importancia pronóstica de las mutaciones de la transcriptasa inversa de la telomerasa en pacientes colombianos con meningiomas de grados II y III. Materiales y métodos. Es un estudio de cohorte, retrospectivo y multicéntrico, que incluyó pacientes con diagnóstico de meningioma persistente o recidivante, de grados II y III, según la clasificación de la OMS, reclutados entre el 2011 y el 2018, con tratamiento sistémico (sunitinib, everolimus con octreótido o sin él, y bevacizumab). El estado de la mutación del promotor de la transcriptasa inversa de la telomerasa se determinó por medio de la PCR. Resultados. Se incluyeron 40 pacientes, en 21 (52,5 %) de los cuales se encontraron mutaciones en la transcriptasa inversa de la telomerasa, siendo las variantes más frecuentes la C228T (87,5 %) y la C250T (14,3 %). Estas fueron más frecuentes entre los pacientes con meningiomas anaplásicos (p=0,18), en aquellos con más de dos recurrencias (p=0,04), y en los que presentaron lesiones en la región parasagital y la fosa anterior (p=0,05). Los sujetos caracterizados por tener alteraciones puntuales fueron tratados con mayor frecuencia con la serie de medicamentos everolimus, sunitinib y bevacizumab (p=0,06). Tras el inicio del tratamiento médico, la supervivencia global fue de 23,7 meses (IC95% 13,1-34,2) en los pacientes con mutaciones y, de 43,4 meses (IC95% 37,5-49,3), entre aquellos sin mutaciones (p=0,0001). Los resultados del análisis multivariado demostraron que, únicamente, el número de recurrencias y la presencia de mutaciones en el gen de la transcriptasa inversa de la telomerasa, fueron factores que afectaron negativamente la supervivencia global. Conclusiones. Las mutaciones en el gen promotor de la transcriptasa inversa de la telomerasa permiten identificar los pacientes con alto riesgo, cuya detección podría ser de utilidad para seleccionar el mejor esquema terapéutico.

Introduction: Mutations in the promoter region of telomerase reverse transcriptase occur frequently in meningiomas. Objective: To estimate the prognostic importance of telomerase reverse transcriptase mutations in Colombian patients with grades II and III meningioma. Materials and methods: This was a multicenter retrospective cohort study of patients diagnosed with refractory or recurrent WHO grades II and III meningiomas, recruited between 2011 and 2018, and treated with systemic therapy (sunitinib, everolimus ± octreotide, and bevacizumab). Mutation status of the telomerase reverse transcriptase promoter was established by PCR. Results: Forty patients were included, of which telomerase reverse transcriptase mutations were found in 21 (52.5%), being C228T and C250T the most frequent variants with 87.5 % and 14.3 %, respectively. These were more frequent among patients with anaplastic meningiomas (p=0.18), with more than 2 recurrences (p=0.04); and in patients with parasagittal region and anterior fossa lesions (p=0.05). Subjects characterized as having punctual mutations were more frequently administered with everolimus, sunitinib and bevacizumab drug series (p=0.06). Overall survival was 23.7 months (CI95% 13.1-34.2) and 43.4 months (CI95% 37.5-49.3; p=0.0001) between subjects with and without mutations, respectively. Multivariate analysis showed that the number of recurrences and the presence of telomerase reverse transcriptase mutations were the only variables that negatively affected overall survival. Conclusions: Mutations in telomerase reverse transcriptase allows the identification of high-risk patients and could be useful in the selection of the best medical treatment.

Correlación entre aspectos clínicos, imagenológicos e histopatológicos en el diagnóstico de tumores y seudotumores raquídeos extramedulares / Correlation between clinical, imaging, histological and pathological aspects in the diagnosis of spinal extramedular tumors and pseudotumors i: en

Introducción: Los tumores intradurales extramedulares son causa de morbilidad y mortalidad. Para identificarlos y analizarlos, la resonancia magnética resulta el método diagnóstico imagenológico de elección. Objetivo: Caracterizar a pacientes con tumores y seudotumores raquídeos intradurales extramedulares según variables clínicas, imagenológicas (por resonancia magnética) e histopatológicas. Métodos: Se efectuó un estudio observacional, descriptivo, longitudinal y prospectivo en 20 pacientes con diagnóstico clínico de sospecha de tumor o seudotumor intradural extramedular o no, confirmado mediante resonancia magnética, quienes fueron atendidos en el Departamento de Imagenología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba de enero del 2014 a igual mes del 2017, procedentes de los hospitales generales de esta provincia y de Guantánamo. Resultados: Existió una mayor frecuencia del sexo masculino (70,0 %), principalmente en las edades de 60 y más años (30,0 %), así como del dolor vertebral (100,0 %) y las alteraciones de los reflejos osteotendinosos (65,0 %) como síntomas y signos de los procesos neoplásicos. Según la intensidad de las señales captadas en la resonancia magnética, primaron los tumores isointensos en la secuencia T1 (70,0 %) y los hiperintensos e isointensos en la secuencia T2 (35,0 % en cada uno), sobre todo de localización dorsal (60,0 %). Asimismo, el diagnóstico clínico de sospecha más usual fue el de mielopatía compresiva (25,0 %), en tanto, entre los diagnósticos imagenológicos e histopatológicos sobresalieron las metástasis y los meningiomas. Conclusiones: La resonancia magnética ofrece una aproximación al diagnóstico definitivo de estos tumores, el cual es corroborado con el estudio histopatológico.

Introduction: The intradural extraspinal tumors are morbidity and mortality cause. To identify and analyze them, the magnetic resonance is the imaging diagnostic means of election. Objective: To characterize patients with intradural extramedular spinal tumors and pseudotumors according to clinical, imaging (by magnetic resonance) histological and pathological variables. Methods: An observational, descriptive, longitudinal and prospective study was carried out in 20 patients with suspicious clinical diagnosis of intradural extraspinal tumor or pseudotumor or not, confirmed by means of magnetic resonance who were assisted in the Imaging Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from January, 2014 to the same month in 2017, coming from the general hospitals of this province and Guantánamo. Results: There was a higher frequency of the male sex (70.0 %), mainly 60 and more years (30.0 %), as well as of the vertebral pain (100.0 %) and disorders of the muscle stretch reflex (65.0 %) as symptoms and signs of the neoplasm processes. According to the intensity of the signs captured in the magnetic resonance, the isointense tumors prevailed in the sequence T1 (70,0 %) and the hyperintense and isointense in the sequence T2 (35.0 % in each one), mainly of dorsal localization (60.0 %). Also, the most common supicious clinical diagnosis was that of compressive myelopathy (25.0 %), as long as, among the imaging, histological and pathological diagnosis the metastasis and meningiomas were notable. Conclusions: The magnetic resonance offers an approach to the definitive diagnosis of these tumors, which is corroborated by means of the histological and pathological study.

Meningioma Meningoendotelial Associado à Tuberculose: um Relato de Caso / Tuberculosis-Associated Meningoendothelial Meningioma: a Case Report

O presente estudo relata um caso de coexistência entre um meningioma meningoendotelial associado a múltiplos granulomas epitelioides com focos de necrose caseosa, sendo possivelmente um dos primeiros casos relatados em imagens anatomopatológicas com imuno-histoquímica desta associação de um tumor com colonização pelo bacilo de Koch. Paciente de 79 anos, oligossintomática acompanhada por onze anos devido à lesão em tomografia sugestiva de meningioma, dá entrada em hospital terciário com história de crise convulsiva e dificuldade de falar. Após crises convulsivas recorrentes, foi indicada exérese tumoral, sendo observada em anatomopatológico a existência de múltiplos granulomas epitelioides com focos de necrose caseosa, sendo confirmada a presença de bacilos após aplicação da coloração de Ziehl-Neelsen e imuno-histoquímica. Observou-se a inexistência de sintomas e/ou achados laboratoriais/imaginológicos que demonstrassem sítio de colonização pelo bacilo. A maior vascularização desses tumores, a estase sanguínea e edema perilesional causado pela compressão das estruturas adjacentes e seu lento crescimento tornam os meningiomas ambientes propícios à colonização de bactérias, fungos, vírus e micobactérias. Além disso, compreende-se que os meningiomas possuem uma série de diagnósticos diferenciais clínico-radiológicos, sendo, muitas vezes, necessário o exame histopatológico e imuno- -histoquímico para a confirmação do diagnóstico.

This study reports a case of coexistence of a meningoendothelial meningioma associated with multiple epithelioid granulomas with foci of caseous necrosis, possibly one of the first cases reported in anatomopathological images with immunohistochemistry of this association of a tumor with colonization by Koch's bacillus. A 79-year-old patient, oligosymptomatic, followed for eleven years due to a tomography lesion suggestive of meningioma, was admitted to a tertiary hospital with a history of convulsive crisis and difficulty speaking. After recurrent convulsive crises, there was an indication for tumor excision, and the anatomopathological examination revealed multiple epithelioid granulomas with foci of caseous necrosis, confirming the presence of bacilli after the application of Ziehl-Neelsen staining and immunohistochemistry. No symptoms and/or laboratory/imaging findings demonstrated a site of colonization by the bacillus. The increased vascularity of these tumors, the blood stasis, and perilesional edema caused by compression of adjacent structures and their slow growth make meningiomas favorable environments for colonization by bacteria, fungi, viruses, and mycobacteria. Furthermore, it is understood that meningiomas have several clinical-radiological differential diagnoses, and histopathologic and immunohistochemical examinations are often necessary to confirm the diagnosis.

Orbital roof and lateral wall reconstruction using split-thickness calvarial bone graft with titanium mesh complex for a spheno-orbital meningioma

Objective@#To describe our reconstruction of an orbital roof and lateral wall defect using a split- thickness calvarial bone graft with titanium mesh complex after resection of a meningioma of the left greater wing of the sphenoid with extension to the left frontotemporal bone and left orbital roof and lateral wall. @*Methods@#Study Design: Surgical Innovation. Setting: Tertiary Private University Hospital. Patient: One. @*Results@#A 44-year-old woman with a left frontotemporal mass associated with left eye proptosis and epiphora underwent reconstruction of the left orbital roof and lateral wall defect using split-thickness calvarial bone graft with titanium mesh and screws after a left frontotemporal craniectomy, superior and lateral orbital wall resection of a mass of the sphenoid wing with orbital and frontotemporal extension. Final histopathology was consistent with meningioma. Surveillance of the mass and orbital reconstruction showed evidence of bone growth and osteointegration of the titanium mesh into the bone grafts.@*Conclusion@#The initial good outcome of orbital roof and lateral wall reconstruction using split-thickness calvarial bone graft with titanium mesh is evidenced by osteointegration of the titanium mesh and revascularization leading to new bone growth. This autogenous-alloplastic complex may provide a more stable option for orbital reconstruction, but long term follow-up is needed for surveillance of recurrence and monitoring the status of orbital reconstruction.

Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

Pediatricmeningiomas are rare and account for only 2.2% of the central nervous system (CNS) tumors. In this age group, they aremore frequently located in atypical sites, such as, mainly, the ventricular system, with a frequency of 8.8 to 13.6%. Adding this to the fact that the angiomatous subtype constitutes only 2.1% of allmeningiomas, the rarity of the case reported here is corroborated. We report a 17-year-old female patient diagnosed with intraventricular angiomatous meningioma; she underwent surgical resection of the tumor in the body and frontal horn of the right lateral ventricle, and there were no neurological sequelae. With a follow-up of 26 months, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach a considerable size until they cause symptoms and then are diagnosed. In addition, the deep location of the tumor and its proximity to eloquent areas make these tumors a neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of > 50% of vascular components), may, in some cases, hinder surgical resection as well as be erroneously diagnosed. However, surgical treatment aimed at total resection of the lesion remains the conduct of choice in the case reported here, especially in patients in the first two decades of life, in which the use of radiation is avoided. Specifically when it comes to the surgery, we chose a transcalosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

Sarcoidosis Mimicking Skull Base Meningioma

Sarcoidosis is a systemic disease characterized by granulomatous inflammation. Pulmonary and lymphatic granulomatous involvement are common.We present a rare case report of involvement of the central nervous system affecting the ocular region and mimicking optic nerve sheath meningioma. We report the case of a 79-year-old female patient with progressive visual impairment with an evolution of 4 years. Amagnetic resonance imaging scan of the cranium with gadolinium and intense homogeneous contrast enhancement revealed an expansive lesion in the right optic nerve, at the height of the optic canal. The patient was submitted to the neurosurgical approach with lesion biopsy, which showed sarcoidosis of the central nervous system. Due to the rarity of central nervous system involvement, the diagnosis of this pathologymay unfortunately be postponed. The present article aims to elucidate this pathology as a differential diagnosis of retro-orbital tumors.

Meningiomas de fosa posterior: nomenclatura con orientación anatomo-quirúrgica y presentación de casos ilustrativos / Posterior fossa meningiomas: nomenclature with anatomical-surgical orientation and presentation of illustrative cases

Introducción: Los meningiomas de la fosa posterior representan el 20% de todos los meningiomas intracraneales. Cada subtipo tiene una base de implantación, abordaje quirúrgico y morbimortalidad postoperatoria muchas veces diferente. Advertimos que en reuniones científicas y publicaciones no se sigue una forma de clasificar uniforme, sencilla y clara con orientación netamente quirúrgica. Esto genera que el neurocirujano en formación no cuente con herramientas suficientes para la toma de decisiones. Objetivos: Proponer una clasificación sencilla de los meningiomas de la fosa posterior con un fundamento anatomo-quirúrgico y presentar casos ilustrativos de cada subtipo. Materiales y métodos: Se estableció una nomenclatura considerando reportes previos, el criterio anatómico y la experiencia quirúrgica de los autores. Se presentaron casos revisando las historias clínicas y los archivos de imágenes correspondientes a cada subtipo de la clasificación. Resultados: Representamos a la fosa posterior como un compartimento con 3 anillos: el superior se divide en medial, lateral-anterior y lateral-posterior; el medio se divide en 6 variantes: clivales puros, esfeno-petro-clivales, petrosos anteriores, petrosos posteriores y de la convexidad suboccipital medial y lateral; el inferior se divide en anterior, lateral derecho, lateral izquierdo y posterior. Conclusión: Los meningiomas del anillo superior pueden resolverse mediante una vía suboccipital medial o lateral; los del anillo medio tienen un espectro de opciones más diverso; los del anillo inferior -siguiendo el esquema de división en cuadrantes de un reloj- pueden resolverse por medio de un abordaje suboccipital medial o extremolatera

Introduction: Posterior fossa meningiomas represent 20% of all meningiomas, being each location associated with a specific approach, morbidity and mortality. The actual classifications are focus on the dural attachment, without associating the anatomical with the surgical aspects, useful to the young neurosurgeons for decision making. Objectives: To propose a classification of the posterior fossa meningiomas with an anatomical-surgical view including the presentation of cases. Materials and Methods: A nomenclature was established concerning previous reports, the anatomical criteria and the surgical experience of the authors. Cases were presented by reviewing the medical records corresponding to each subtype of the proposed classification. Results: We represent the posterior fossa as a 3 rings compartment: the upper one is divided into medial, anterior-lateral and posterior-lateral; the middle ring is divided into 6 variants: pure clival, spheno-petro-clival, anterior petrosal, posterior petrosal, and medial and lateral suboccipital convexity; the lower ring is divided into anterior, right lateral, left lateral, and posterior. Conclusion: Superior ring meningiomas can be resolved by a medial or lateral suboccipital approach; middle ring meningiomas have a more diverse spectrum of options; while meningiomas of the inferior ring - following the scheme of division into quadrants of a clock - can be resolved by means of a medial or extreme-lateral suboccipital approach.

Epidemiological features of meningiomas: a single Brazilian center's experience with 993 cases / Características epidemiológicas de meningiomas: experiência de um centro único brasileiro com 993 casos

ABSTRACT Background: Meningiomas are the most frequent primary central nervous system (CNS) tumors. Their geographical and ethnic characteristics need to be known, in order to enable rational treatment. Objective: To investigate clinical and epidemiological aspects in a series of patients with meningiomas. Methods: Retrospective analysis on the demographic profile, location and histopathology of 993 patients with meningiomas (768 operated and 225 not operated). Results: Meningiomas represented 43.8% of the primary CNS tumors; 6.8% were multiple tumors (14.7% with neurofibromatosis 2) and 0.6% were radiation-induced tumors. The mean ages were 53.0 and 63.9 years for operated and non-operated patients and the female/male ratios were 3.2:1 and 6.3:1. Diagnosis was made later among females. The peak incidences were in the 6th and 7th decades respectively for operated and non-operated patients. The incidence was low at early ages and higher among patients aged 70+ years. The meningiomas were intracranial in 96.5% and most were WHO grade I (88.9%) and transitional. In the spinal canal (3.5%), they occurred mainly in the dorsal region (all grade I; mostly transitional). The racial distribution was 1.0% in Asian-Brazilians, 87% in Caucasians and 12% in African-Brazilians. 83.4% and 51.6% of the patients were estimated to be recurrence-free at 10 and 20 years, and the mortality rate was 3%. Conclusions: Most of the demographic data were similar to what has been observed in other western centers. Differences were higher incidence of meningiomas, female and older predominance in non-operated patients, predominance in Caucasian, and higher association with neurofibromatosis 2.

RESUMO Antecedentes: Meningiomas são os tumores mais frequentes do sistema nervoso central (SNC). Suas características étnicas e geográficas precisam ser conhecidas para o seu tratamento racional. Objetivo: Investigar aspectos clínicos e epidemiológicos de uma série de pacientes com meningiomas. Métodos: Análise retrospectiva demográfica de 993 pacientes com meningiomas (768 operados e 225 tratados conservadoramente) Resultados: Meningiomas constituíram 43.8% dos tumores primários do SNC. 0.8% deles eram múltiplos (14,7% com neurofibromatose 2) e 0,6% eram radioinduzidos. A idade média e o índice mulheres/homens foram respectivamente 53,0 e 63,9 anos e 3.2:1 e 6.3:1 para pacientes operados e não operados. O diagnóstico foi mais tardio em mulheres. Ocorreram picos de incidências na 6ª e na 7ª décadas respectivamente para pacientes operados e não operados. A incidência foi menor na infância e maior após 70 anos. Meningiomas predominaram no crânio (96.5%), a maioria grau I da OMS, subtipo transicional. Do total, 3.5% ocorreram no canal raquídeo, principalmente na região torácica, todos grau I, a maioria transicional. Em relação à distribuição racial, 1.0% dos meningiomas ocorreu em amarelos, 87% em brancos e 12% em negros. As taxas de sobrevida sem recorrência foram 83.4% e 51.6% em 10 e 20 anos e a mortalidade operatória foi 3%. Conclusões: A maioria dos dados demográficos observados foi similar aos de outros centros ocidentais. As diferenças observadas foram maior incidência, predominância em mulheres e idosos nos pacientes não operados e em caucasianos, e maior associação com neurofibromatose 2.

Meningioma parasagital y hematoma subdural crónico, una asociación inusual / Parasagittal meningioma and chronic subdural hematoma, unusual association

RESUMEN En muchas ocasiones, los pacientes con tumores cerebrales tienen una variedad de síntomas psiquiátricos inespecíficos. Algunos de estos pueden constituir la primera o única manifestación del tumor, sin la presencia de ningún síntoma o signo neurológico. El diagnóstico ha de basarse en la anamnesis completa y en la exploración neurológica; la neuroimagen confirmará el diagnóstico clínico. Con el presente trabajo se describió la asociación inusual de hematoma subdural crónico y meningioma parasagital en un caso presentado. Se trató de un paciente de 68 años con antecedentes de esquizofrenia. Acudió a consulta con una hemiparesia izquierda. Se le realizó una tomografía axial computarizada de cráneo y arrojó un hematoma subdural crónico y un meningioma parasagital derecho. Se le aplicó tratamiento quirúrgico en dos tiempos operatorios. Su evolución posquirúrgica transcurrió sin complicaciones (AU).

ABSTRACT In many cases, patients with brain tumors have a variety of nonspecific psychiatric symptoms. Some of them can be the first or the only manifestation of the tumor, without presenting any neurological signs or symptoms. The diagnosis must be based on the complete anamnesis and on the neurological examination. The neuroimaging will confirm the clinical diagnosis. The unusual association of a chronic subdural hematoma and a parasagittal meningioma was described in a case presented in the current work. It dealt with a patient, aged 68 years with antecedents of schizophrenia. He assisted the consultation with left hemiparesis. A skull computed tomography showed a chronic subdural hematoma and a right parasagittal meningioma. He underwent a two-steps surgery. His post-surgery evolution ran without complications (AU).

Can Routine Blood Biochemistry Parameters be Predictive Prognostic Marker(s) in Operated Patients with Meningioma WHO Grade 1?

Background Today, there is a need for new and independent additional advanced markers that can predict the prognosis of meningioma patients, postoperatively. The present study aimed to find out postoperative short-term prognostic markers in patients with meningioma using their demographic data and routine blood biochemistry findings evaluated preoperatively. Methods The Glasgow Coma Scale (GCS), and Glasgow Outcome Scale (GOS) scores of the patients were recorded. Additionally, preoperatively obtained serum glucose, Creactive protein (CRP), sodium, potassium, creatinine, blood urea nitrogen, aspartate aminotransferase (AST), alanine aminotransferase, and hemoglobin level values, platelet, leukocyte, neutrophil, lymphocyte, eosinophil, basophil, andmonocyte count results, erythrocyte sedimentation rate (ESR), neutrophil-lymphocyte ratio, plateletlymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) values were evaluated. Results In the present study, 23 operated patients with meningioma World Health Organization (WHO) grade 1 (17 females, 6 males) were included. Correlation test results revealed that the GCS score, platelet count, and serum potassium level values could directly predict the short-term prognosis of these patients. Additionally, these test results suggested that the lymphocyte, monocyte, and eosinophil count values, PLR, LMR, ESR, serum glucose, CRP, and AST level values could be indirect markers in predicting the short-term prognosis. However, likelihood ratio test results revealed that only monocyte count value, LMR value, and serum CRP level value could be the markers for prediction of the short-term prognosis. Conclusion At the end of the present study, it was concluded that the monocyte count value, LMR value, and serum CRP level value could be the best markers in predicting the short-term prognosis of the operated meningioma patients.

Extracerebral Pterional Metastasis from Malignant Meningioma: A Case Report

Anaplastic or malignant meningiomas that are classified as World Health Organization (WHO) grade III account for less than 1% of all meningiomas diagnosed. Despite the aggressive course, distant metastases are a rarity, occurring in only 0.1% to 0.2% of cases. We report the case of a 56-year-old woman who presented with parasagittal benign meningioma that underwent malignant transformation along with metastasis into the right orbitosphenoid region. The clinical, radiological, and histopathological aspects are highlighted, with an emphasis on the natural history of meningiomas.

Síndrome de Cotard en una paciente con lupus eritematoso sistémico y meningioma petroclival izquierdo / Cotard's syndrome in a female patient with systemic lupus erythematosus and left petroclival meningioma

El síndrome de Cotard es una entidad rara en la cual el paciente manifiesta ideas delirantes acerca de que se encuentra sin vida o que sus órganos internos se encuentran en estado de descomposición, entre otras alteraciones psicopatológicas. Existen diferentes reportes sobre el síndrome en diversas culturas y poblaciones. Usualmente tiene presentaciones neuropsiquiátricas y se lo identifica acompañando entidades neurológicas, metabólicas, infecciosas, entre otras. A través de este reporte de caso, se presenta una paciente con lupus eritematoso sistémico, que desarrolló este tipo de ideas delirantes y durante su hospitalización se detectó un meningioma petroclival izquierdo. Finalmente, se llegó a la conclusión de que no se encontraba en actividad lúpica y que la ubicación del tumor no sería la causante de la alteración conductual. El Síndrome de Cotard es un trastorno neuropsiquiátrico poco común, que debe ser considerado ante la existencia de ideas delirantes de tipo nihilistas

Cotard's syndrome is a rare entity in which the patient manifests delusional ideas about being lifeless or that his/her internal organs are in a state of decomposition, among other psychopathological alterations. There are different reports in different cultures and populations about the syndrome. It usually has neuropsychiatric presentations and is identified by accompanying neurological, metabolic, and infectious entities, among others. In this case report, a female patient with systemic lupus erythematosus is presented, who developed this type of delusions and during her hospitalization a left petroclival meningioma was detected. Finally, it was concluded that she was not in lupus activity and that the location of the tumor was not the cause of the behavioral alteration. Cotard's syndrome is a rare neuropsychiatric disorder, which should be considered when there are nihilistic delusions

Psicosis secundaria a meningioma: revisión a propósito de un caso / Secondary psychosis due to meningioma: review about a case

Resumen Los meningiomas son los tumores primarios más frecuentes del sistema nervioso central, tienden a ser benignos y de lento crecimiento. Pueden ser asintomáticos o incluso manifestarse únicamente con síntomas psiquiátricos, incluyendo un cuadro psicótico. No existen estudios clínicos controlados randomizados que estudien la relación entre meningioma y cuadros psicóticos. La evidencia disponible se basa en series y reportes de casos. Existe una relación entre la magnitud del edema perilesional y la presencia de síntomas psicóticos. Por otra parte, el tamaño de la lesión o su localización neuroanatómica específica tendrían menor relevancia. La resección quirúrgica de la lesión, en conjunto con el manejo psiquiátrico adecuado, usualmente conduce al cese de la sintomatología psicótica. En la evaluación de pacientes con síntomas psicóticos se debe tener un elevado índice de sospecha, en particular en cuadros de reciente inicio, con manifestaciones atípicas o resistentes al tratamiento. En estos casos se recomienda un estudio con neuroimágenes. Este artículo presenta el caso de una paciente evaluada en nuestro hospital diagnosticada con un meningioma frontal izquierdo de gran tamaño, que presentó sintomatología psicótica secundaria, y se expone una revisión bibliográfica actualizada de esta asociación.

Meningiomas are the most frequent central nervous primary tumors, which tend to be benign and present a slow growth. They may be asymptomatic or present clinically just with psychiatric symptoms including a psychotic state. There are no clinical randomized controlled trials that study the relationship between meningioma and a psychotic episode. Available evidence is based on case reports and series. There is a relationship between the magnitude of perilesional edema and the presence of psychotic symptoms. On the other hand, the size of the tumor or its specific neuroanatomic location would have less relevance. Surgical resection of the tumor associated with psychiatric management usually leads to the cessation of psychotic symptoms. In the assessment of patients with psychotic symptoms, there must be a high index of suspicion, particularly in first psychotic episodes, atypical manifestations and resistance to treatment. In these cases, a neuroimaging study is recommended. This article presents the case of a patient evaluated in our hospital and diagnosed with a large left frontal meningioma with secondary psychotic symptoms, and an updated bibliographic review of this association is presented.

Analysis on endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach under the microscope for skull base tumor with intra and extra-cranial involvement / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement. Methods: A total of 7 patients (4 males and 3 females, aging from 27 to 65 years old, with a medium age of 48) undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively. The patients included 2 cases of recurrent invasive pituitary adenoma, 3 cases of basal skull meningiomas, 1 case of clivus chondrosarcoma, and 1 case of recurrent nasopharyngeal carcinoma. The lesion extensively infiltrated nasal cavity, extending to the paranasal sinus, bilateral cavernous sinus, sellar region, suprasellar, superior clivus, temporal lobe, pterygopalatine fossa, infratemporal fossa and important intracranial vessels. All the 7 patients were treated under general anesthesia by endoscopic endonasal approach combined with frontotemporal orbitozygomatic approach under the microscope. Total excision rate, intraoperative and postoperative complications and postoperative curative effect were observed. All of them were followed up for 6 to 12 months. The Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Result: Total tumor removal was performed in 5 cases, subtotal removel in 2 cases. There was no complication during the operation. Postoperative severe complications occurred in 2 cases, including 1 case of cerebrospinal fluid rhinorrhea and intracranial infection, which was cured by lumbar cistern drainage and intrathecal injection; 1 case occurred oculomotor nerve paralysis, which recovered during follow-up. Postoperative complications occurred in 1 case of trochlear nerve dysfunction, 2 cases of facial numbness, and 1 case of tinnitus. During follow-up, all patients recovered to varying degrees. There was no bleeding and death after the operation. No tumor recurred during the follow-up period. All patients were recovered well with GOS grade Ⅳ-Ⅴ. Conclusions: Endoscopic transnasal approach combined with microscopic frontotemporal orbitozygomatic approach can remove tumors in one stage, reduce surgical complications and improve surgical effect. It has good application prospects and is suitable for excising complex intracranial and extracranial communicating tumors of widely involving sellar, clivus and petrous apex area.

Intraosseous meningioma mimicking osteosarcoma

Background Predominantly intraosseous meningiomas are rare entities that include true primary intraosseous meningiomas (PIM), as well as meningiomas that may show extensive bone involvement, such as en plaque meningiomas. Different hypotheses have been proposed to decipher the origin of PIMs, such as ectopic arachnoid cap cell entrapment during birth or after trauma. Surgical resection is the treatment of choice of such lesions. Case presentation We present a case of a 65-year-old man with an enlarging mass in the parieto-occipital region that grew slowly and progressively over 13 years, following head trauma during a motor vehicle accident. One year prior to presentation, he started experiencing daily holocranial headaches and blurry vision. CT and MRI studies revealed a permeative midline calvarial lesion measuring 14 cm in greatest dimension with extensive periosteal reaction, extension into the subcutaneous soft tissues, subjacent dural thickening and intracranial extension with invasion of the superior sagittal sinus. The favored pre-operative clinical diagnosis was osteosarcoma. The abnormal calvarium was excised and histopathological examination confirmed the diagnosis of a predominantly intraosseous calvarial meningioma, WHO grade I. Conclusions The present case highlights the importance of histopathologic diagnosis in guiding therapeutic decisions and reiterates the necessity of considering PIM or meningiomas with extensive intraosseous component in the differential diagnosis of calvarial masses, even when imaging suggests a neoplasm with aggressive behavior, such as osteosarcoma.

Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases

Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.