The extended pterional approach allows excellent results for removal of anterior cranial fossa meningiomas / O acesso pterional extendido permite excelente resultado para a ressecção dos meningiomas da fossa craniana anterior

ABSTRACT Objective To describe a unique operative strategy, instead the classical pterional approach, and to analyses it safety and effectiveness for removal of anterior cranial fossa meningiomas. Method We identify 38 patients with tuberculum sellae and olphactory groove meningiomas operated between 1986 and 2013. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed and analyzed retrospectively. The pterional craniotomy is extended toward the frontal bone providing access through the subfrontal route, besides the usual anterolateral view provided by the classical pterional approach. Results Surgical mortality occurred in one patient (2.6%). Gross total resection was achieved in 27 patients (86.8%). Median time of follow-up was 69.4 months. Conclusion The extended pterional approach allows excellent results. Total removal of meningiomas of the anterior cranial fossa was obtained in 86.8 % of patients, with low morbidity and mortality.

RESUMO Objetivo Descrever a craniotomia pterional estendida, ao invés da abordagem pterional clássica, e analisar sua segurança e eficácia para a remoção dos meningiomas da fossa anterior. Método Identificamos 38 pacientes com meningiomas do tubérculo da sela e da goteira olfatória operados entre 1986 e 2013. Os prontuários, relatórios cirúrgicos, exames de imagem e acompanhamento pós-operatório foram analisados retrospectivamente. A craniotomia pterional com extensão para o osso frontal permite acesso pela via subfrontal além da via anterolateral do acesso pterional clássico. Resultados A mortalidade cirúrgica foi de 2,6% (um paciente). A remoção total foi alcançada em 86,8% (27 pacientes) com um tempo médio de seguimento de 69,4 meses. Conclusão A abordagem pterional estendida permite excelentes resultados. A remoção total dos meningiomas da fossa craniana anterior foi obtida em 86,8% dos pacientes, com baixa morbi-mortalidade.

Atypical and anaplastic meningiomas in a public hospital in São Paulo State, Brazil / Meningiomas atípicos e anaplásicos em um hospital público de São Paulo, Brasil

Atypical/anaplastic (World Health Organization (WHO) grades II and III) are less common and have poorer outcomes than benign meningiomas. This study aimed to analyze the outcome of patients with these tumors.Method Overall/recurrence-free survivals (RFS) and the Karnofsky Performance Scale of 52 patients with grades II (42) and III (9) meningiomas surgically treated were analyzed (uni/multivariate analysis).Results Total/subtotal resections were 60.8%/35.3%. Patients <60 years-old and grade II tumors had longer survival. Grade II tumors, total resection andde novo meningioma had better RFS (univariate analysis). Patients >60 years-old, de novo meningioma and radiotherapy had longer survival and patients <60 years-old and with grade II tumors had longer RFS (multivariate analysis). Recurrence rate was 51% (39.2% Grade II and 66.7% Grade III). Operative mortality was 1.9%.Conclusion Age <60 years-old, grade II tumors and de novomeningiomas were the main predictors for better prognosis among patients with grades II and III meningiomas.

Meningiomas atipicos/anaplásticos (graus II e III da World Health Organization (WHO)) são menos comuns e tem prognóstico pior que os benignos. Este estudo visa analisar o prognóstico de pacientes com estes tumores.Método Sobrevida/sobrevida livre de doença (SLD) e índice de Karnofsky de 52 pacientes com meningiomas graus II (42) e III (9) tratados cirurgicamente foram avaliados (análises uni/multivariada).Resultados Pacientes <60 anos e com tumores grau II tiveram sobrevida mais longa. Tumores grau II , ressecção total e meningioma de novotiveram melhor SLD (análise univariada). Pacientes >60 anos, meningiomade novo e radioterapia tiveram sobrevida mais longa e, pacientes <60 anos e com tumores grau II tiveram SLD mais longa (análise multivariada). Recidiva ocorreu em 51% (39.2% Graus II e 66,7% Graus III). A mortalidade operatória foi 1,9%.Conclusão Idade <60 anos, meningiomas grau II e de novo foram preditores de melhor prognóstico entre pacientes com meningiomas graus II/ III.

Microsurgical ressection for parasagittal meningiomas with preservation of the parasagittal sinus and excelent neurovascular control / Ressecção microcirúrgica dos meningiomas parasagitais com excelente controle vascular e preservação do seio longitudinal superior

Objective: It was to observe whether a microsurgical gross total removal (GTR) of a parasagittal meningioma (PSM) outside the sinus is a safe and efficient procedure. Method: We identify 58 parasagittal meningiomas patients. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed. Results: GTR of the mass was achieved in 45 (77.7%) instances. The surgical mortality rate was 1.7%. The median follow-up time was 63 months. Conclusion: The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality, proving to be safe and effective. .

Objetivo: Foi observar se a ressecção microcirúrgica extrassinusal dos meningiomas parasagitais é uma técnica segura e efetiva. Método: Foram estudados 58 pacientes portadores de meningiomas parasagitais. Quadros médicos, relatórios de operações, exames de imagem e seguimento clínico foram revisados. Resultados: A remoção total da lesão, fora do seio, ocorreu em 45 casos (77,7%). A taxa de mortalidade cirúrgica observada nesta série foi de 1,7%. O tempo médio de seguimento foi de 63 meses. Conclusão: A estratégia microcirúrgica empregada propiciou a remoção total dos meningiomas na maioria dos pacientes, com baixa mortalidade e morbidade, mostrando ser segura e efetiva. .

Meningioma clinoideo / Clinoidal meningeoma

Los meningiomas clinoideos son tumores benignos originados en la leptomeninges que rodea el proceso clinoideo anterior, representando el 17 por ciento de los basales. Con el objetivo de caracterizarlos se estudiaron los pacientes operados en el Servicio de Neurocirugía del Hospital Hermanos Ameijeiras (2000 al 2010). La serie estuvo integrada por 10 pacientes, 9 mujeres y un hombre, la edad promedio fue de 49,8 años, clínicamente caracterizados por cefalea (10 pacientes) y déficit de la agudeza visual (9 pacientes). A todos se les practicó un abordaje frontotemporal-orbitozigomático (FTOZ) alcanzándose 7 resecciones totales y 3 subtotales, 3 pacientes sufrieron complicaciones, al alta ocho de los diez operados egresaron en excelente estado, no tuvimos recidiva ni recrecimiento tumoral en los casos con resecciones parciales y al año de seguimiento la calidad de vida según la escala de Karnofsky fue superior o igual a 80 puntos en todos los casos. Concluimos que los meningiomas clinoideos por su asiento en el centro de la base craneal relacionados anatómicamente con estructuras neurovasculares críticas y por las grandes dimensiones que alcanzan en el momento de su diagnóstico, representan un desafío en la práctica neuroquirúrgica, comportándose en nuestra serie más frecuentes entre las mujeres con la cefalea y el déficit visual monocular como síntomas principales. Las técnicas de base de cráneo y en nuestras manos la craneotomía FTOZ complementadas con osteotomías basales de diferentes grados, han demostrado ser una alternativa eficaz para mejorar la suficiencia de la resección tumoral con mínima morbilidad, ausencia de recurrencias y mortalidad.

Clinoidal meningeomas are benign tumors originated in the liptomeningeo surrounding the anterior clinoidal process representing 17 percent of basal tumors. With the objective to characterize it, studied were patients operated in the neurosurgical service of Hermanos Ameijeiras hospital from 2000 to 2010.The series were composed of 10 patients, 9 female and a male, the mean age was 49.8 years and were clinically characterized with headache (10 patients) and visual deficit (9 patients). To all were practiced a frontotemporal orbitozygomatic approach (FTOZ) reaching 7 total and 3 subtotal removal,3 patients suffered complications, 8 out of 10 patients operated were discharged in good condition. There was no recurrence after total removal and after a year of fellow up, the life quality following Karnofsky scale was superior o equal to 80 points in all the cases. In conclusion Clinoidal meningeomas due to its placement in the cranial base with anatomical relations with critical neurovascular structures and also the great dimension to reach in the moment of its diagnosis represents a challenge to neurosurgical practice. It comports in our series with more frequency within females presenting headache and mono ocular visual defect as the principal symptoms. Craneal base techniques and in our case frontotemporal-orbitozygomatic craniotomy complimented with basal osteotomy of different grades, had demonstrated to be an efficient alternative to better the technique of total removal with less mobility, zero recurrence and mortality.

Intraventricular meningiomas in adults: clinical series and review of the literature

Background: Intraventricular meningiomas are rare tumors and pose clinical, radiological, and surgical challenges. Individualized approach helps to establish successful results. Methods: Thirteen patients underwent craniotomy for intraventricular meningioma resection from 1999 to 2007. The mean age was 45 years (23-64), time of presentation between 25 days to three years. There were ten females and three males. Headaches and seizures were the most frequent initial presentations. Tumors were located in the ventricular trigone in 11 patients and in the temporal horn in two. Results: There were seven posterior temporal and seven parieto-occipital transcortical craniotomies, one patient was operated two times. Resection grade was Simpson I in nine patients, Simpson II in four, and Simpson III in one case. Surgical mortality was zero. There were six complications. Two patients had ventriculitis, one patient had hematoma of the surgical bed, one patient had severe post-operative cognitive impairment and one presented with progression of motor deficits. In two patients, there was transient memory disturbance after the parieto-occipital approach. Conclusion: Correct understanding of microsurgical anatomy cooperates for further success in operation of intraventricular meningiomas. Pre-operative embolization is helpful to reduce bleeding when a suitable tumor feeder can be accessed with no reflux. Dynamic changes in the shape of the ventricular cavity have to be considered when planning the most suitable route. Rigorous hemostasis and ventricular drainage are important points to avoid main complication.

Olfactory groove meningiomas: surgical technique and follow-up review

BACKGROUND: Olfactory groove meningiomas comprise 4-10 percent of the intracranial meningiomas. Generally they give signs of brain compression due to great size they reach before diagnosis. In this study, the clinical outcome of patients with olfactory groove meningiomas surgically treated was analyzed. METHOD: 17 patients operated on from 1988-2006. Female: 16, Male: 1. Age: 19-76 years-old (mean=53.12± 13.11). Follow-up: 1-209 months (mean=51.07±12.73. Bifrontal/bifrontal-bi-orbital approaches were used. Outcome was analyzed using survival/recurrence-free Kaplan-Mayer curves. RESULTS:16 had WHO grade 1; one grade 2 meningiomas. Resection Simpson's grade 1 was in achieved in 64.7 percent, grade 2 in 29.4 percent and grade 3 in 5.9 percent. There was no recurrence during the follow-up. Global and operative mortality were 11.8 percent. Main postoperative complications were osteomielitis (11.8 percent) and pneumonia (5.9 percent). CONCLUSION: Extensive approaches allowed total resection of most olfactory groove meningiomas with no recurrence during the follow-up, but operative mortality and local complications were high.

INTRODUÇÃO: Os meningiomas da goteira olfatória constituem 4-10 por cento dos meningiomas intracranianos. Geralmente eles causam sinais de compressão do tronco cerebral porque atingem grandes tamanhos antes do diagnóstico. Neste estudo foram analisadas os resultados do tratamento cirúrgico de pacientes com meningiomas da goteira olfatória. MÉTODO: 17 pacientes operados de 1988-2006. Mulheres: 16. Homens: 1. Idade: 19-76 anos (média=53,12±13,11). Seguimento: 1-209 meses (média=51,07±12,73. Foram utilizados acessos bifrontal/bifrontal bi-orbital. A evolução clinica foi analisada usando curvas de sobrevida e de sobrevida livre de doença de Kaplan-Mayer. RESULTADOS: 16 pacientes tinham meningioma WHO grau 1; um tinha meningioma grau 2. Ressecção Simpson grau 1 foi obtida em 64.7 por cento, grau 2 em 29.4 por cento e grau 3 em 5.9 por cento. Não houve recidiva durante o seguimento. A mortalidade global e a pós-operatória foram 11.8 por cento. As principais complicações pós-operatórias foram osteomielite (11.8 por cento) e pneumonia (5.9 por cento). CONCLUSÃO: Abordagens extensas possibilitaram ressecção total da maioria dos meningiomas da goteira olfatória sem recidiva durante o seguimento, mas a mortalidade operatória e as complicações locais foram altas.

Hemangiopericitoma intracraneal: reporte de un caso / Intracranial hemangiopericytoma: report of a case

El Hemangiopericitoma es un tumor infrecuente del sistema nervioso central que simula ser un Meningioma en apariencia y sintomatología, pero que se comporta con gran agresividad presentando alta tendencia a la recidiva en resecciones quirúrgicas limitadas y a las metástasis dentro y fuera del sistema nervioso. Presentamos el caso de un paciente masculino de 28 años de edad con un Hemangiopericitoma frontal izquierdo adherido a la falx cerebral, con historia de cefalea intensa de un año de evolución, nauseas y vómitos de instauración progresiva, acompañado de trastornos de la personalidad y sin déficit neurológico focal, quien presenta en estudios imagenológicos LOE sugestivo de meningioma de la Falx cerebri y lóbulo frontal izquierdo.

Sarcoma meníngeo de alto grado de malignidad con invasión orbitaria: informe de un caso / Meningeal sarcoma of high degree of malignancy with orbitary invasion: a case report

Los sarcomas del sistema nervioso central son tumores primarios malignos, muy raros, que se originan de componentes de las meninges y que, por su baja frecuencia, sólo han sido consignado algunos casos de esta enfermedad en el Mundo. En el siguiente informe se presenta el caso de una paciente joven con un sarcoma meníngeo con invasión orbitaria. Se discuten aspectos clínicos, de neuroimagen y de histopatología, así como los factores pronósticos

Meningiomas intracraneales / Intracranial meningiomas

The author excised an intracranial meningioma from 28 patients, 17 women and 11 men, between 7 and 78 years of age, from 1974 to 1992. The tumor was located in the olfactory groove in 4 patients, in the cerebral convexity in another 4, in the falx in 8 (3 in the frontal and 5 in the parietal region). In 6 patients, the meningioma was found in the inner one third and in 1 in the middle third of sphenoid; in 1, in the clivus, in 1 in the petrous bone; in 2 patients the tumor was located in the tubercle of the sella turcica and in another patient it was in the cerebello-pontine angle. Total resection of the meningioma was accomplished in 16 patients (57.1%) because the tumor was in an accessible area. The tumor recurred in one patient, who died 5 years post operatively. In 8 (28.5%) of 12 patients in whom subtotal resection was done, post operative radiation was used, and in 3 of them recurrence occurred in less than 5 years after completion of treatment and in one, in less than 10. In 3 of the remain 4 patients, in whom subtotal resection was done but were not followed by radiation therapy, recurrence also occurred before 5 years post surgery, and in 1 patient at the end of 5 years