Aggressive management of orbital meningeal melanocytoma.

OBJECTIVE: Meningeal melanocytoma generally occurs in the posterior fossa. Orbital manifestation is rarely encountered. METHODS: A thirty-five year-old man presented with progressive proptosis of his right eye. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) of the brain showed an expansive intraconal mass lesion occupying the superior orbital compartment, the entire orbital apex, and the optic foramen. Histological analysis and Immunohistochemical staining for S-100 and HMB-45 monoclonal antibodies confirmed melanocytoma. FINDINGS: Microsurgical removal was accomplished through a fronto-orbital craniotomy. Chemotherapy and irradiation followed the initial intervention. The patient returned for follow up two years after surgery, complaining of headache and right visual loss. A subfrontal tumor with massive edema was found on follow up CT scan. INTERPRETATION: Meningeal melanocytomas are rare benign pigmented tumors of the central nervous system. They are predominant in the posterior fossa and spinal cord and frequently mistaken for melanomas, especially on frozen sections. Orbital presentation is rare. The natural history is poorly defined.

Unusual brain metastases from papillary thyroid carcinoma: case report.

OBJECTIVE AND IMPORTANCE: Brain metastases from papillary carcinoma of the thyroid gland are unusual. No consensus regarding management has yet been reached. We report a case, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data. CLINICAL PRESENTATION: A 33-year-old woman presented with signs of intracranial hypertension. The diagnostic evaluation included chest tomography, head computed tomography, brain magnetic resonance imaging with and without contrast enhancement, total-body scanning, and cerebral scintigraphy. Multiple supratentorial lesions and one right cerebellopontine angle lesion were observed. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland. INTERVENTION: A ventriculoperitoneal shunt was placed and a right suboccipital craniotomy was performed, with complete removal of the cerebellopontine angle tumor. Total-brain irradiation with 40 Gy/lesion followed the initial operation. One year after surgery, the patient presented with signs of increased intracranial pressure. A new left frontal lobe lesion with massive peritumoral edema was identified on magnetic resonance imaging scans. The edema was treated clinically and a left frontal craniotomy was performed, with complete resection of the tumor. The patient is currently faring well, with residual expressive aphasia. CONCLUSION: Surgery followed by radiotherapy seems to be a good alternative for the treatment of this specific type of metastasis. Thorough clinical and radiological evaluation, followed by genetic analysis of the surgical specimen, particularly with respect to the potential for tumor invasion under specific conditions, is recommended. The information obtained contributes to better management and better overall long-term outcomes for these patients.

Technological advances in the surgical management of trigeminal neuralgia.

For years, many controversies have arisen on the surgical management of trigeminal neuralgia and neuropathy. The purpose of this paper is to review most of the current surgical techniques for the management of trigeminal neuralgia and present our position on the current management of these situations.

Transporte mucociliar: implicacoes clinicas e metodos de estudo / Mucociliary transport: clinicals implications and methods of study

O transporte mucociliar desempenha um papel de extrema importancia na homeostase do individuo, uma vez que ele e responsavel pela eliminacao de impurezas e de microorganismos inalados juntamente com o ar inspirado. Considerando-se que as doencas respiratorias, principalmente as de carater infeccioso, sao importante causa de morte na populacao e que as alteracoes no transporte mucociliar tem papel fundamental na genese dessas doencas, justifica-se a escolha do tema dessa monografia. Com a finalidade de tornar mais clara a exposicao das alteracoes do transporte mucociliar nas entidades clinicas apresentadas (bronquite cronica, fibrose cistica, asma e cancer do pulmao), fizemos uma breve revisao dos mecanismos de batimento ciliar e regulacao da producao de muco. Ressaltamos, tambem, os principais metodos de estudo do transporte mucociliar, devido ao fato de serem eles pouco conhecidos, apesar de sua crucial importancia.