ABSTRACT
STUDY DESIGN: A case report. OBJECTIVE: To report a case of the lumbar giant cell tumor (GCT) utilizing a new clinical treatment modality (denosumab therapy), which showed a massive tumor reduction combined with the L4 spondylectomy. SUMMARY OF BACKGROUND DATA: There are some controversies about spinal GCT treatments. Denosumab has provided good clinical results in terms of tumor shrinkage, and local control in a short-time follow-up clinical study phase 2, although for spinal lesions, it has not been described. Nonetheless, "en bloc" spondylectomy has been accepted as being the best treatments modalities in terms of oncological control. METHODS: A case study with follow-up examination and series radiological assessments 6 months after therapy started, followed by a complex spine surgery. RESULTS: The denosumab therapy showed on the lumbar computed tomography scans follow-up 6 months later, a marked tumor regression around 90% associated to vertebral body calcification, facilitating a successful L4 spondylectomy with an anterior and posterior reconstruction. The patient recovered without neurological deficits. CONCLUSION: A new therapeutic modality for spinal GCT is available and showing striking clinical results; however, it is necessary for well-designed studies to answer the real role of denosumab therapy avoiding or facilitating complex spine surgeries as spondylectomies for spinal GCT. LEVEL OF EVIDENCE: 5.
Subject(s)
Carcinoma, Giant Cell/drug therapy , Carcinoma, Giant Cell/surgery , Denosumab/administration & dosage , Spinal Neoplasms/drug therapy , Spinal Neoplasms/surgery , Adult , Carcinoma, Giant Cell/diagnostic imaging , Combined Modality Therapy/methods , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Male , Spinal Neoplasms/diagnostic imaging , Treatment OutcomeABSTRACT
Quinze pacientes com epilepsia do lobo temporal foram investigados com eletrodos de forame oval(EFO). A indicaçäo da implantaçäo desses eletrodos foi por incapacidade de registros de superfície/esfenoidais de permitir lateralizaçäo do início das crises ou por incongruência entre início ictal e achados de neuroimagem. Dos quinze pacientes, quatro apresentavam ressecçäo temporal prévia, um apresentava uma lesäo e os dez restantes tiveram os registros de superfície e com EFO comparados neste estudo. Nesses dez pacientes foi possível lateralizar o início de 82 (por cento) das crises com os EFO, em contraste com um índice de 33 (por cento) com eletrodos de superfície e esfenoidais (p<0,001). O lado envolvido no início das crises correlacionou com maior atrofia das estruturas mesiais, conforme a análise qualitativa do exame de ressonância magnética. Como complicaçäo grave houve um caso de meningite séptica. Dois pacientes tiveram parestesia facial transitória e um apresentou também paresia reversível do VI nervo craniano. O uso dos EFO para registro de crises em pacientes selecionados permite lateralizaçäo confiável do início das crises, com qualidade superior ao registro com eletrodos de superfície e esfenoidais e custo e complexidade inferiores à investigaçäo com eletrodos de profundidade e placas subdurais crônicas
