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1.
Chinese Medical Journal ; (24): 2398-2402, 2021.
Article in English | WPRIM | ID: wpr-921130

ABSTRACT

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.


Subject(s)
Brain Mapping , Brain Neoplasms/surgery , Glioma/surgery , Humans , Language , Multilingualism
2.
Rev. Col. Bras. Cir ; 48: e20202722, 2021. graf
Article in English | LILACS | ID: biblio-1250705

ABSTRACT

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.


Subject(s)
Humans , Brain Neoplasms/surgery , Glioma/surgery , Anesthesia , Wakefulness , Craniotomy
3.
Arq. neuropsiquiatr ; 77(11): 797-805, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055187

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Brain Neoplasms/surgery , Brain Neoplasms/complications , Brain Neoplasms/etiology , Drug Resistant Epilepsy/surgery , Glioma/surgery , Glioma/complications , Postoperative Period , Seizures/surgery , Seizures/etiology , Brain Mapping , Brain Neoplasms/mortality , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Kaplan-Meier Estimate , Glioma/mortality , Glioma/diagnostic imaging
4.
Rev. medica electron ; 41(5): 1129-1141, sept.-oct. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1094117

ABSTRACT

RESUMEN Introducción: el astrocitoma anaplásico y el glioblastoma multiforme son las formas más agresivas de glioma maligno. Existen avances en radioterapia, quimioterapia y tratamientos de resección quirúrgica agresiva. Esto último incluye métodos como los de tomografía de coherencia óptica, cirugía guiada por fluorescencia, craneotomía de vigilia, terapia térmica intersticial con láser para la ablación por glioblastoma multiforme, microscopía intraoperatoria confocal y espectrometría de masas intraoperatoria, pero a pesar de todo ello el pronóstico resulta sombrío. Objetivo: determinar el comportamiento de los gliomas de alto grado en el Servicio de Neurocirugía de la provincia Matanzas. Materiales y métodos: estudio observacional, descriptivo, transversal, con los pacientes diagnosticados de gliomas de alto grado, en el Servicio Neurocirugía, de la provincia Matanzas, en el período de 1ero de enero del 2017 a 1ero de enero del 2019, para un total de 40 casos. Resultados: la edad media de las lesiones fue de 52 años, la cefalea fue el síntoma predominante, con el 72,2 %. La sintomatología se presentó con una evolución de menos de un mes. Conclusiones: en el 62 % predominaron los gliomas frontales y la variedad histológica glioblastoma multiforme. La excéresis subtotal se aplicó en la mayor cantidad de cirugías, la calidad de vida al egreso fue superior que al ingreso (AU).


ABSTRACT Introduction. Anaplastic astrocytoma (AA) and Glioblastoma multiforme (GBM) are the most aggressive forms of malignant glioma. Despite advances in radiotherapy, chemotherapy and aggressive surgical resection treatments, such as optical coherence tomography, fluorescence-guided surgery, waking craniotomy, laser interstitial thermal therapy for GBM ablation, intraoperative confocal microscopy and intraoperative mass spectrometry, the prognosis remains bleak. Objective: to determine the behavior of high grade gliomas in the Neurosurgery Service of the province of Matanzas. Materials and methods: cross-sectional, descriptive, observational study with patients diagnosed with high-grade gliomas in the Neurosurgery Service of the province of Matanzas, in the period from January 1, 2017 to January 1, 2019, for a total of 40 cases. Results: the average age of the lesionated patients was 52 years; headache was the predominant symptom, with 72.2 %; the evolution at the presentation of symptoms was less than a month. Conclusions: frontal gliomas predominated in 62 % of the cases, and predominated also glioblastoma multiforme histological variety. Subtotal excision was used in most surgeries. Life quality at discharging was higher than at the moment of admission (AU).


Subject(s)
Humans , Glioma/epidemiology , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Study , Glioma/surgery , Glioma/diagnosis , Neurosurgery
5.
Rev. medica electron ; 41(5): 1230-1241, sept.-oct. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1094125

ABSTRACT

RESUMEN A pesar de los avances en radioterapia, quimioterapia y los tratamientos de resección quirúrgica agresiva en el glioblastoma multiforme, el pronóstico sigue siendo sombrío. Con la presente revisión se describen, en un marco actual, las principales alternativas de tratamiento del glioblastoma multiforme. Se revisaron los principales artículos publicados en inglés, en revistas de alto impacto a nivel mundial, acerca de los principales avances en el tratamiento de este tumor. Se abordaron los importantes progresos neuroquirúrgicos en la resección del glioblastoma así como las implicaciones de las células madres tumorales en la génesis y control de la proliferación tumoral y el efecto de la hipoxia sobre la dinámica celular tumoral. Se explican las alteraciones del ADN que ocasionan tumorogénesis y las mutaciones del PTEN en el glioblastoma (AU).


SUMMARY Despite advances in radiotherapy, chemotherapy and aggressive surgical resection treatments in glioblastoma multiforme, the prognosis remains discouraging. With the current review, the main alternatives for the treatment of glioblastoma multiforme are described in a current context. The authors reviewed the main articles published in English, in high impact journals worldwide, on the main advances in the treatment of this tumor. The main neurosurgical advances in the resection of glioblastoma were addressed, as well as the implications of tumor stem cells in the genesis and control of tumor proliferation, as well as the effect of hypoxia on tumor cell dynamics. DNA alterations causing tumor genesis and PTEN mutations in glioblastoma are also explained (AU).


Subject(s)
Humans , Glioblastoma/therapy , Glioma/therapy , Glioblastoma/surgery , Neurosurgical Procedures , Glioma/surgery
6.
Arch. endocrinol. metab. (Online) ; 62(6): 648-654, Dec. 2018. graf
Article in English | LILACS | ID: biblio-983804

ABSTRACT

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.


Subject(s)
Humans , Female , Adolescent , Middle Aged , Brain Neoplasms/pathology , Third Ventricle/pathology , Glioma/pathology , Sella Turcica , Biopsy , Brain Neoplasms/surgery , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Treatment Outcome , Fatal Outcome , Third Ventricle/surgery , Third Ventricle/diagnostic imaging , Glioma/surgery , Glioma/diagnostic imaging
7.
Arq. bras. neurocir ; 37(2): 88-94, 24/07/2018.
Article in English | LILACS | ID: biblio-912122

ABSTRACT

Introduction The improvement on the extent of resection (EOR) of gliomas with the combination of 5-aminolevulinic acid (5-ALA) and intraoperative magnetic resonance imaging (iMRI) has been demonstrated in previous studies. We present our results with the combined use of 5-ALA and (iMRI) in the surgery of glial lesions. Methods A total of 64 cases of patients with intracranial gliomas who underwent image-guided surgery using 5-ALA with and without (iMRI) were reviewed. All patients underwent an early postoperative MRI to evaluate the EOR. Other intra-operative techniques (awake surgery, electrophysiological stimulation and monitoring) were also performed according to the location of the tumor. Results A total of 18 tumors did not show intraoperative 5-ALA fluorescence (according to the World Health Organization [WHO] classification of tumors, 2 WHO-grade I, 14 WHOgrade II, 1 WHO-grade III and 1 WHO-grade IV), and 46 tumors showed intraoperative 5-ALA fluorescence (3 WHO-grade II, 3 WHO-grade III, 40 WHO-grade IV). In 28 of the 46 5-ALA positive cases, a safe 5-ALA free resection was achieved. In the 5-ALA negative cases, the (iMRI) findings guided the EOR, and complete resection was achieved in 11 cases. Complete resection was opted out in gliomas infiltrating eloquent areas. Conclusions The combined use of 5-ALA and IMRI showed improved results in glioma surgery, offering the safest maximal EOR. In the 5-ALA positive cases (mostly highgrade), fluorescence was a more useful tool. In the 5- ALA negative cases (mostly lowgrade), the (iMRI) was decisive to guide the EOR of the tumor.


Introdução Em estudos anteriores, foi demonstrado um aperfeiçoamento na extensão da resecção (EDR) de gliomas com a combinação de ácido 5-aminolevulínico (5-ALA) e a imagem de ressonância magnética intraoperatória (iRM). Nossos resultados são apresentados com o uso combinado de 5-ALA e (iRM) para a cirurgia de lesões gliais. Métodos Foram revisados 64 casos de gliomas intracranianos submetidos a cirurgia guiada por imagem por meio do uso de 5-ALA, com ou sem RMI. Todos os pacientes foram submetidos a ressonância magnética (RM) pré-operatória para a avaliação da EDR do tumor. Outras técnicas intraoperatórias (cirurgia acordado, estimulação eletrofisiológica e monitoração) também foram realizadas segundo a localização do tumor. Resultados Um total de 18 tumores não apresentaram fluorescência com o 5-ALA (segundo a classificação de tumores da Organização Mundial de Saúde [OMS], 2 com grau OMS I, 14 com grau II, 1 com grau III e 1 com grau IV) e 46 tumores foram fluorescentes (3 com grau II, 3 com grau III, 40 com grau IV). Dos 46 casos positivos para 5-ALA, em 28 foi obtida uma ressecção segura e livre. Nos casos negativos para 5-ALA, os achados da (iRM) orientaram a EDR, e alcançou-se ressecção total em 11 casos. A ressecção total foi descartada em gliomas com infiltração em áreas eloquentes. Conclusões O uso combinado de 5-ALA e (iRM) mostrou melhores resultados na cirurgia de gliomas, oferecendo uma EDR de segurança máxima. Nos casos positivos para 5-ALA (a maioria de grau alto), a fluorescência mostrou-se um instrumento mais útil. Nos casos negativos para 5-ALA (a maioria de grau baixo), a RMI foi decisiva para orientar a EDR tumoral.


Subject(s)
Humans , Brain Neoplasms , Glioma/surgery , Magnetic Resonance Spectroscopy , Aminolevulinic Acid
8.
Rev. méd. Maule ; 33(1): 25-33, jun. 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-1283818

ABSTRACT

Development of neuroimaging in the last decades has revolutionized the neurological diagnosis, however for they interpretation clinical picture of the patient remains as a relevant aspect. Clinical case: a 30-year-old male patient with recent epileptic seizures, Jaksonian type, secondarily generalized, with no relevant history and normal neurological examination was presented. Initially a Magnetic Resonance of the brain was performed, the case was interpreted as Brain Abscess and treatment with intravenous antimicrobials was instituted for three weeks. A further analysis of the case revolves the diagnosis towards the possibility of a high degree malignant cerebral glioma, which was verified with the accomplishment of a craneotomy and biopsy. Conclusions: focal structural lesions of the brain, such as those caused by neuroepithelial tumors and abscesses, are among the most common causes of Epileptic Syndrome in adulthood. To date, there are no pathognomonic signs in the neuroimagenological differential diagnosis between the two entities. Despite the help of some advanced Magnetic Resonance techniques, the clinical correlation remains as the cornerstone for correct etiological interpretation, as well as pathological examination for the definitive diagnosis of both lesions.


Subject(s)
Humans , Male , Adult , Brain Abscess/diagnosis , Brain Abscess/physiopathology , Magnetic Resonance Imaging/methods , Glioma/surgery , Chile , Diagnosis, Differential , Epilepsy/etiology , Glioma/pathology
9.
Arq. bras. neurocir ; 36(1): 32-37, 06/03/2017.
Article in English | LILACS | ID: biblio-911122

ABSTRACT

Chordoid glioma is a rare tumor of the third ventricle whose imaging features are difficult to distinguish from other more common lesions in this location. There are only 83 cases described so far in the literature. Although gross total resection (GTR) is the treatment of choice, immediate postoperative mortality with this approach can be as high as 29%, and morbidity among survivors can reach 67%. We report a case of a male patient of advanced age, with a third ventricle mass lesion, who presented with a progressive right temporal hemianopia. Imaging was compatible with craniopharyngioma, meningioma or even metastasis. Chordoid glioma was not considered in the differential diagnosis. The patient underwent surgery and GTR was achieved. There were no postoperative complications, and the patient was discharged from the hospital three weeks later. Unexpectedly, two days afterwards, he suffered a major brainstem hemorrhagic stroke and, unfortunately, died.


O glioma cordoide é um tumor raro do terceiro ventrículo, e as suas características imagiológicas são difíceis de distinguir de outras lesões mais comuns nesta localização. Até a data presente, existem apenas 83 casos de gliomas cordoides descritos na literatura. A remoção macroscópica total destes tumores deve ser o tratamento de escolha; no entanto, a mortalidade pós-operatória imediata pode chegar aos 29%, e a morbilidade pode atingir os 67% entre os sobreviventes. Nós descrevemos o caso de um homem idoso com uma lesão tumoral no terceiro ventrículo, que se manifestou com uma hemianopsia temporal direita progressiva. Os exames de imagem eram compatíveis com craniofaringioma, meningioma ou até metástase. O glioma cordoide não foi considerado como uma das hipóteses no diagnóstico diferencial inicial. O paciente foi submetido a cirurgia, tendo-se obtido a remoção macroscópica total. Não houve qualquer complicação no período pós-operatório, e o paciente teve alta hospitalar após três semanas. Inesperadamente, dois dias após a alta clínica, o paciente sofreu um AVC hemorrágico do tronco cerebral, e acabou por falecer.


Subject(s)
Humans , Male , Aged , Third Ventricle , Glioma , Hemianopsia , Glioma/surgery
10.
Arq. bras. neurocir ; 35(4): 329-333, 30/11/2016.
Article in English | LILACS | ID: biblio-911048

ABSTRACT

Cystic lesions inside the brain parenchyma are a common pathological finding in the investigation of patients with suspicion of cerebral tumor. Histological diagnosis is important to guide the patient's treatment and follow-up, and to determine prognosis. Among patients diagnosed with cerebral cysts, most are located in the parenchyma above the tentorium. The authors describe the case of a patient who had been suffering from dizziness and balance disturbance for 4 months; the investigation identified a cyst inside the cerebellar right hemisphere. A surgical procedure was performed, and the biopsy microscopic analysis diagnosis was glial cyst.


Patologias intraparenquimatosas de características císticas são comumente identificadas em pacientes que estão sob investigação de neoplasias cranianas. Lesões císticas são mais prevalentes acima da tenda cerebelar, e o diagnóstico histológico é fundamental para determinar o tratamento, seguimento e prognóstico do paciente. Os autores relatam o caso de um paciente com sintomas de vertigem e alteração no equilíbrio dinämico de 4 meses de evolução, cuja investigação diagnosticou cisto intraparenquimatoso no hemisfério cerebelar direito. Procedeu-se com intervenção cirúrgica cujo diagnóstico histopatológico foi compatível com Cisto Glial


Subject(s)
Humans , Male , Middle Aged , Glioma , Glioma/surgery , Cerebellum , Neoplasms, Cystic, Mucinous, and Serous
11.
Rev. otorrinolaringol. cir. cabeza cuello ; 75(3): 257-260, dic. 2015. ilus
Article in Spanish | LILACS | ID: lil-771698

ABSTRACT

Los gliomas nasales son restos de tejido neuroglial que se presentan como una masa craneofacial. Es poco frecuente y no tiene características malignas, pero local-mente es bastante agresivo. Se encuentra dentro del diagnóstico diferencial de masas congénitas de la línea media. Se presenta el caso de un recién nacido que presenta un pólipo nasal derecho y distrés respiratorio. La RNM revela una masa intranasal sin conexión intracraneal. Vía endoscópica se realiza exéresis de la masa sin complicaciones. Biopsia confirma diagnóstico de glioma.


Nasal gliomas are glial tissue residues presented as a craniofacial mass. It is rare and has no malignant features, but locally it is quite aggressive. It is included in the differential diagnosis of congenital midline masses. The case of a newborn is reported which presents a right nasal polyp and respiratory distress. The MRI reveals an intracranial mass with no intranasal connection. Endoscopic resection of the mass is done with no complications. Biopsy confirms glioma diagnosis.


Subject(s)
Humans , Male , Infant , Glioma/diagnosis , Glioma/surgery , Nose Neoplasms/diagnosis , Nose Neoplasms/surgery , Biopsy , Magnetic Resonance Imaging
12.
Rev. chil. neurocir ; 41(2): 174-179, nov. 2015. ilus, tab
Article in Spanish | LILACS | ID: biblio-869742

ABSTRACT

El MIBI (99mTc MIBI, methoxyisobutylisonitrile, MIBI, o sestamibi): Tiene una amplia disponibilidad al rico flujo de fotones, que mejora la detección de captación patológica por la gamma sonda, estas propiedades físicas hacen de este radiotrazador el de elección para la cirugía radioguiada. La Fluoresceína Sódica es una sustancia colorante orgánica hidrosoluble utilizada en el examen de los vasos sanguíneos del ojo. Se realiza el reporte de cinco casos diagnosticados con tumor cerebral de alto grado de malignidad, con el objetivo de demostrar que con el uso de la Cirugía Radio-Fluoro-Guiada (CRFG) se puede lograr resecciones tumorales completa sin que se añada mayor déficit, cumpliendo los criterios de inclusión y exclusión. La técnica de CRFG demuestro su utilidad en la resección tumoral total disminuyendo la cantidad de residuo tumoral, sin aumentar la complejidad de la cirugía ni los tiempos quirúrgicos. En nuestro estudio no se evidencio efectos adversos por la administración del radiofármaco y la fluoresceína.


The MIBI (99mTc MIBI, methoxyisobutylisonitrile, MIBI, or sestamibi): is a wide readiness to the rich flow of photons, which improves the detection of pathological uptake with gamma probe, these physical properties make of this radiotracer the election to radioguided surgery. The sodium fluorescein is a water-soluble organic coloring substance used in the exam of the sanguine glasses of the eye. We carried out the report of five cases diagnosed with brain tumor of high grade of malignancy, with the objective to demonstrated that use of Radio-Fluro-guided Surgery (RFGS) we can achieve gross total resections without bigger deficit, completing the inclusion and exclusion criteria. The technique of RFGS demonstrated utility in the gross total resection, diminishing the residual tumor, without increasing surgery complexity and surgical times. In our study doesn’t evidence of adverse effects for the administration of the cadiopharmaceuticals and fluorescein.


Subject(s)
Humans , Fluorescein , Glioma/surgery , Radiosurgery/methods , Contrast Media , Magnetic Resonance Imaging , Tomography, Emission-Computed, Single-Photon
13.
Arq. neuropsiquiatr ; 73(11): 924-928, Nov. 2015. tab, graf
Article in English | LILACS | ID: lil-762888

ABSTRACT

Objective To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome.Method A retrospective study was conducted with patients with temporal low-grade gliomas (LGG).Results Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection.Conclusion Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.


Objetivo Apresentar uma série cirúrgica de pacientes com gliomas temporais de baixo grau, causando epilepsia de difícil controle.Método Estudo retrospectivo de pacientes com diagnóstico de glioma temporal de baixo grau temporais.Resultados 65 pacientes com foram operados em nossa instituição. A média de idade de início das crises foi de 25,7 ± 9,2 (11-66 anos). Após um ano de acompanhamento, quarenta e dois pacientes (64,6%) estavam Engel I; dezessete (26,2%) Engel II; quatro (6,2%) Engel III e dois (3,1%) Engel IV. Houve diferença estatisticamente significativa no resultado do controle das crises quando se compara a extensão da ressecção. Engel I foi observada em 39 pacientes (69,6%) com a ressecção total e em apenas 3 (33,3%) pacientes com ressecção parcial.Conclusão A ressecção total de glioma temporal de baixo grau temporais é um fator extremamente importante no controle das crises.


Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Brain Neoplasms/surgery , Drug Resistant Epilepsy/surgery , Glioma/surgery , Seizures/surgery , Temporal Lobe/surgery , Brain Neoplasms/complications , Brain Neoplasms/pathology , Drug Resistant Epilepsy/etiology , Drug Resistant Epilepsy/prevention & control , Electroencephalography , Glioma/complications , Glioma/pathology , Kaplan-Meier Estimate , Magnetic Resonance Imaging , Neoplasm Grading , Retrospective Studies , Seizures/etiology , Seizures/prevention & control , Time Factors , Treatment Outcome , Temporal Lobe/pathology
14.
Arq. bras. neurocir ; 33(4): 340-346, dez. 2014.
Article in Portuguese | LILACS | ID: lil-782252

ABSTRACT

A neurocirurgia guiada por imagem permite ao neurocirurgião navegar no interior do crânio, orientado a partir das imagens de tomografia computadorizada (TC) ou ressonância magnética (RM) pré--operatórias, empregando, para isso, sistemas de rastreamento tridimensionais (3D), em tempo real,durante o procedimento cirúrgico. O presente estudo tem como objetivo revisar a literatura acerca dasprincipais aplicações da neuronavegação na neurocirurgia contemporânea. Foi feita uma revisão daliteratura por meio de busca na base de dados PubMed, nos últimos 15 anos, nas línguas portuguesa e inglesa, usando os seguintes termos: neuronavegação/neuronavigation, estereotaxia/stereotaxis, glioma surgery, neuroendoscopia/neuroendoscopy, epilepsy surgery, aneurysm. A neuronavegação auxilia a localização espacial, orientando acessos cirúrgicos, o que melhora a qualidade e a segurança do procedimento. Ressalta-se a importância desta nas cirurgias de gliomas em áreas eloquentes, associada a procedimentos neuroendoscópicos e cirurgia de epilepsia e combinada com ultrassom 3D e/ou RM intraoperatória, com significativa redução da morbidade do ato cirúrgico. O desvio dasestruturas após a abertura do crânio e da dura-máter (?brain shift?) é considerado o fator limitante para o método, impedindo a perfeita correspondência entre imagens pré-operatórias e a neuronavegaçãoem tempo real, o que pode ser minimizado com a realização de RM intraoperatória (renavegação).


The image-guided neurosurgery allows the neurosurgeon to navigate within patient?s skull, using preoperative images as a guide, through the use of 3D tracking systems, during the surgical procedure. This study aims to review the literature on the main applications of neuronavigation in modern neurosurgery. We performed a literature search through the database PubMed in the last 15 years in Portuguese and English, using the following terms: neuronavegação/neuronavigation, estereotaxia/stereotaxis, glioma surgery, neuroendoscopia/neuroendoscopy, epilepsy surgery, aneurysm. Neuronavigation improves the efficacy and security of surgery, with emphasis in surgery of gliomas in or around eloquent areas, association with neuroendoscopy and epilepsy surgery, as well combined with 3D ultrasound and intraoperative MRI. Dislocation of brain and structures after opening cranial vault and dura (?brain shift?) still is a limitation to the perfect correspondence between the surgery and preoperative images of neuronavigation, which can be solved with intraoperative MRI.


Subject(s)
Humans , Neuroendoscopy , Neuroimaging , Neuronavigation , Epilepsy/surgery , Glioma/surgery , Intracranial Aneurysm/surgery , Spine/surgery
15.
Rev. cuba. cir ; 53(3): 244-255, jul.-set. 2014. ilus
Article in Spanish | LILACS | ID: lil-750657

ABSTRACT

Introducción: las complicaciones neurológicas en la cirugía de los gliomas de alto grado están relacionadas con problemas en localización y exposición, extensión de la resección y la manera en que se manipulan los tejidos. Hay factores secundarios que contribuyen a la evolución desfavorable y la muerte precoz de un paciente. Objetivos: establecer la relación que existe entre la mortalidad en los primeros 30 días y diferentes factores de riesgo e identificar causas de muerte. Métodos: fueron operados 131 pacientes en el Servicio de nNeurocirugía del Hospital Calixto García desde enero de 2005 a enero de 2010, con el diagnóstico de gliomas de alto grado. De ellos, 14 fallecieron en los primeros 30 días. Variables principales utilizadas: edad, localización tumoral, grado de resección quirúrgica y causas de la muerte. Se aplicó la prueba chi cuadrado de independencia con un nivel de significación de 0,05 para evaluar relación entre variables. Resultados: la mortalidad perioperatoria fue del 10,7 por ciento. El riesgo fue mayor en el sexo masculino; discretamente mayor en los mayores de 60 años. No estuvo relacionado con la localización del tumor. Operar con signos de enclavamiento cerebral, incrementó al máximo la probabilidad de fallecer en el primer mes. La resección parcial en relación con la total y con la biopsia mostró mayor probabilidad de mortalidad. No hubo muerte transoperatoria. Conclusiones: los factores que influyeron principalmente en la evolución desfavorable fueron: la baja puntuación en la escala de Karnofskyy una resección limitada, igual o menor que 50 por ciento en una craneotomía(AU)


Introduction: The neurological complications found in the high gradegliomas surgery are primarily related with location, exposure and extension of the resection and with the way of handling tissues. There are secondary factors that contribute to the unfavorable progression and even the early death of patients that suffers this disease. Objectives: To set the relationship between mortality within the first 30 days after surgery and the different risk factors, and to identify the causes of death. Methods: One hundred and thirty one patients diagnosed with high gradegliomas were operated on in the neurosurgery service of Calixto García hospital from January 2005 through January 2010. Fourteen of them died within the first thirty days. The study variables were age, tumor location, degree of surgical resection and causes of death. Chi-square test of independence with significance level of 0.05 was applied to evaluate the association among the variables. Results: The perioperative mortality rate was 10.7 percent. The risk of death was higher in males; slightly higher in those over 60 years and unrelated to the tumor location. If patients are operated on with signs of brain herniation, they are more likely to die in the first month. Partial compared to total resection and to biopsy showed higher mortality probabilities. There was no intraoperative death. Conclusions: The low scoring in the Karnofsky Scale, and a partial resection equal or smaller than 50 percent in a craniotomy were the influential factors in an unfavorable outcome of disease(AU)


Subject(s)
Humans , Male , Female , Cause of Death , Cerebellar Neoplasms/mortality , Cerebellar Neoplasms/surgery , Glioma/surgery , Risk Factors , Epidemiology, Descriptive , Longitudinal Studies , Prospective Studies
17.
Rev. chil. obstet. ginecol ; 79(6): 517-523, 2014. ilus
Article in Spanish | LILACS | ID: lil-734799

ABSTRACT

Presentamos el caso clínico de una paciente de 18 años sin antecedentes a destacar. Cursando las 30 semanas de embarazo se constata una tumoración abdominal que requirió tratamiento quirúrgico y se diagnosticó un teratoma inmaduro grado 3, asociado a gliomatosis peritoneal. Se realizó una cesárea al término y se instauró el tratamiento con quimioterapia presentando una recidiva a los siete meses que requirió tratamiento quirúrgico conservador y nuevo plan de quimioterapia estando actualmente libre de enfermedad y en seguimiento. Lo infrecuente de esta patología y asociada a embarazo, motivó su comunicación.


We report the case of a healthy 18-year old patient with adnexal mass diagnosed by her 30th week of pregnancy. It required surgical treatment and a grade 3 immature teratoma associated with peritoneal gliomatosis was diagnosed. A cesarean section was performed at term and subsequently chemotherapy was established. The patient presented a recurrence seven months later, which required fertility-sparing surgery and a new chemotherapy plan. The patient is currently disease-free and under surveillance. The infrequency of this disease and associated with pregnancy, led to their communication.


Subject(s)
Humans , Adult , Female , Pregnancy , Glioma/surgery , Ovarian Neoplasms/surgery , Peritoneal Neoplasms/surgery , Teratoma/surgery , Glioma/diagnosis , Neoplasms, Multiple Primary , Ovarian Neoplasms/diagnosis , Peritoneal Neoplasms/diagnosis , Pregnancy Complications, Neoplastic , Teratoma/diagnosis
18.
Arq. bras. neurocir ; 32(2)jun. 2013. ilus
Article in Portuguese | LILACS | ID: lil-681386

ABSTRACT

A ínsula representa uma estrutura cortical de anatomia complexa, permanecendo recoberta pelos opérculos e superficialmente delimitada pela fissura silviana. Apesar de inicialmente serem consideradas não ressecáveis, as patologias insulares têm, na atualidade, posição de destaque, representando desafio ao neurocirurgião experiente. Preservação funcional e ressecção macroscópica total são os objetivos do tratamento, podendo ser atingidas em até 93% dos tumores de ínsula. Sistemas de navegação, bem como eletrofisiologia transoperatória e anestesia especializada, representam importantes ferramentas cirúrgicas. A escolha adequada dos métodos de auxílio é decisão difícil, sendo, em alguns aspectos, metodologias excludentes. Realizamos revisão de literatura voltada à discussão dos fundamentos da neurocirurgia de ínsula...


The insula represents a complex anatomic cortical structure being recovered by the operculum and superficially delimited by the sylvian fissure. Despite its initially non-ressecable consideration, insular pathologies actually have a standard position and represent a challenge to the experienced neurosurgeon. Functional preservation and gross total resection are the treatment goals and can be achieved in 93% of insular tumors. Navigation system as well as trans operative electrophysiology and specialized anesthesia represents important surgical tools. Acquired choice of auxiliary methods it?s a difficult decision becoming at certain aspects excluding methodologies. We reviewed the literature focused at the insular neurosurgical fundaments...


Subject(s)
Humans , Anesthesia , Cerebral Cortex , Glioma/surgery , Neurosurgical Procedures/methods
19.
In. Salamano Tessore, Ronald L; Scaramelli Giordan, Alejandro; Oehninger Gatti, Carlos L. Diagnóstico y tratamiento en neurología. Montevideo, Dedos, oct.2012. p.367-377.
Monography in Spanish | LILACS | ID: lil-759859
20.
Arq. neuropsiquiatr ; 69(6): 949-953, Dec. 2011. ilus, tab
Article in English | LILACS | ID: lil-612639

ABSTRACT

Literature has shown that extent of tumor resection has an impact on quality of life and survival of patients with gliomas. Intraoperative MRI has been used to increase resection while preserving procedure's safety. METHOD: The first five patients with gliomas operated on at the University of São Paulo using intraoperative MRI are reported. All but one patient had Karnofsky Performance Status of 100 percent before surgery. Presentation symptoms were progressive headache, seizures, behavior disturbance, one instance of hemianopsia, and another of hemiparesis. RESULTS: Gross total removal was achieved in two patients. Surgical resection was limited by tumor invasion of critical areas like the internal capsule or the mesencephalon in the remaining patients. CONCLUSION: Intra-operative MRI is an important tool that helps surgeons to remove glial tumors, however, knowledge of physiology and functional anatomy is still fundamental to avoid morbidity.


A literatura demonstra que extensão da ressecção do tumor tem impacto na qualidade de vida e sobrevida dos pacientes com gliomas. RM intraoperatória tem sido utilizada para aumentar a área de ressecção, preservando a segurança do procedimento. MÉTODO: Os cinco primeiros pacientes com gliomas operados na Universidade de São Paulo utilizando RM intraoperatória são relatados. Quatro pacientes tinham índice de Karnofsky de 100 por cento antes da cirurgia. Primeiros sintomas foram cefaléia progressiva, convulsões, distúrbios de comportamento, um caso de hemianopsia, e outro de hemiparesia. RESULTADOS: A remoção macroscópica total foi obtida em dois pacientes. A ressecção cirúrgica foi limitada pela invasão tumoral de áreas críticas como a cápsula interna ou o mesencéfalo no restante dos pacientes. CONCLUSÃO: A RM intra-operatório é uma importante ferramenta que auxilia o cirurgião para remover os tumores gliais, porém, o conhecimento da fisiologia e anatomia funcional ainda é fundamental para evitar a morbidade.


Subject(s)
Humans , Brain Neoplasms/surgery , Glioma/surgery , Magnetic Resonance Imaging, Interventional , Monitoring, Intraoperative/methods , Treatment Outcome
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