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.

Glioblastoma multiforme recém-diagnosticado: diagnóstico e tratamento cirúrgico inicial / Newly diagnosed glioblastoma multiforme: diagnosis and initial surgical treatment

Introdução: O glioblastoma multiforme (GBM) é o tumor cerebral primário mais comum e letal. Apesar dos avanços em seu entendimento biológico e tratamento, não houve aumento significativo da sobrevida nos pacientes acometidos. Manifesta-se clinicamente com déficits neurológicos focais, hipertensão intracraniana e/ou crise convulsiva. Métodos: A pesquisa da literatura foi realizada na base de dados online PubMed, no livro "Osborn's Brain: Imaging, Pathology and Anatomy" e na diretriz "National Comprehensive Cancer Network". Resultados: A ressonância magnética (RM) evidencia uma lesão bem característica e é essencial para seu diagnóstico e manejo cirúrgico. O diagnóstico definitivo é dado pela análise histopatológica e dos subtipos moleculares. O tratamento cirúrgico apresenta papel central no manejo do GBM recém-diagnosticado, devendo visar a uma ressecção de pelo menos 78 a 89% da lesão para se obter benefício na sobrevida, mas sempre equilibrando com a preservação da função neurológica. A cirurgia também está associada ao alivio sintomático e ao aumento da eficácia de terapias adjuvantes. Conclusão: Deve-se sempre tentar a ressecção total do GBM conciliando-se com a manutenção da função neurológica.

Introduction: Glioblastoma multiforme is the most common and lethal primary brain tumor. Despite advances in their biological understanding and treatment, there was no significant increase in survival in patients. It manifests clinically with focal neurological deficits, intracranial hypertension and / or seizures. Methods: Literature research was conducted in the online database PubMed, the book "Osborn's Brain: Imaging, Pathology and Anatomy" and the National Comprehensive Cancer Network guideline. Results: Magnetic resonance imaging shows a very characteristic lesion and is essential for its diagnosis and surgical management. The definitive diagnosis is given by histopathological analysis and molecular subtypes. Surgical treatment plays a central role in management in the newly diagnosed GBM and may aim for a resection of at least 78% to 89% of the lesion in order to obtain benefit in survival, but always in balance with the preservation of neurological function. Surgery is also associated with symptomatic relief and increased efficacy of adjuvant therapy. Conclusion: The total resection of the newly diagnosed GBM should always be attempted, when possible, by conciliating with maintenance of neurological function.

Compressão medular epidural metastática: uma emergência neurocirúrgica / Metastatic epidural spinal compression: a neurosurgical emergency

Introdução: A compressão medular epidural metastática (CMEM) é uma emergência oncológica. A doença metastática na medula ocorre por meio de disseminação hematogênica ou através da propagação direta do tumor. A queixa mais frequente em pacientes com CMEM é dor, no entanto, uma gama de manifestações neurológicas pode ser encontrada nos casos de CMEM. Métodos: O capítulo é uma revisão dos artigos das principais revistas de neurocirurgia e oncologia encontradas no banco de dados da biblioteca virtual MEDLINE e apresenta um protocolo de CMEM baseado nos guidelines internacionais. Resultados: A Ressonância Magnética (RM) é o principal exame quando há suspeita clínica de CMEM e deve ser realizado com brevidade, a fim de evitar atraso no diagnóstico e danos neurológicos permanentes. O tratamento inicial da CMEM é realizado com corticosteroides. Todavia o tratamento cirúrgico é a terapêutica definitiva, sendo a laminectomia posterior e a descompressão circunferencial as técnicas operatórias de escolha. Além disso, a radioterapia é uma alternativa ao tratamento cirúrgico e deve ser considerada. Conclusão: A CMEM é uma emergência oncológica importante que pode acarretar em danos permanentes aos pacientes. Todo médico deve se atentar para a possibilidade da CMEM diante de queixas álgicas e neurológicas em pacientes oncológicos.

Introduction: Metastatic epidural spinal cord compression is a medical emergency. Metastatic disease on the spinal cord occurs by hematogenous dissemination or through direct tumoral propagation. Back pain is the most frequent symptom associated with CMEM. However, neurological manifestations may be also present. Methods: This chapter is a review of the major articles from Neurosurgery and Oncology journals found on MEDLINE database and presents a protocol based on the international guidelines. Results: Magnetic Resonance is the main neuroimaging technology when CMEM is suspected and must be done as soon as possible in order to avoid diagnosis delay and permanent neurological damage. Initial management is carried with corticosteroids, but surgery is the definitive treatment. The commonly used techniques are Posterior Decompressive Laminectomy and Circumferential Spinal Cord Decompression. Radiotherapy can be used as an alternative treatment. Conclusion: CMEM is an important oncologic emergency that may lead to permanent neurological damages. Physicians should be vigilant for CMEM when oncologic patients have back pain and/or neurological disorders.