ABSTRACT
Tumor-to-meningioma metastasis (TMM) is a fairly uncommon phenomenon. Only 7 cases of prostate cancer with TMM have previously been described in the literature. The present study aimed to report a case of prostate cancer TMM, and to discuss the relevant clinical and neuroimaging aspects of this condition. A 68-year-old patient presented with headaches, poor visual acuity in the left eye and ipsilateral eyelid droop 3 years after a Simpson II resection of a left sphenoid wing meningioma. Computed tomography revealed a hyperdense area suggestive of a recurrent left sphenoid wing meningioma. During microsurgical resection of tumor, the tumor presented a fibrous aspect and bled profusely. In the histological examination, a metastatic adenocarcinoma was identified inside the transitional meningioma. The immunohistochemical exam favored a prostatic primary site. The patient died two months later of septic shock from pneumonia. This is a rare metastatic presentation. The pre-operative diagnosis of TMM remains challenging in the majority of cases.
ABSTRACT
OBJECT The object of this study was to compare the clinical, functional, and aesthetic results of 2 surgical techniques, pterional (PT) and minipterional (MPT) craniotomies, for microsurgical clipping of anterior circulation aneurysms. METHODS Fifty-eight patients with ruptured and unruptured anterior circulation aneurysms were enrolled into a prospective randomized study. The first group included 28 patients who underwent the MPT technique, and the second group comprised 30 patients who underwent the classic PT craniotomy. To evaluate the aesthetic effects, patients were asked to grade on a rule from 0 to 100 the best and the worst aesthetic result. Photographs were also taken, assessed by 2 independent observers, and classified as showing excellent, good, regular, or poor aesthetic results. Furthermore, quantitative radiological assessment (percentage reduction in thickness and volumetric analysis) of the temporal muscle, subcutaneous tissue, and skin was performed. Functional outcomes were compared using the modified Rankin Scale (mRS). Frontal facial palsy, postoperative hemorrhage, cerebrospinal fistula, hydrocephalus, and mortality were also analyzed. RESULTS Demographic and preoperative characteristics were similar in both groups. Satisfaction in terms of aesthetic result was observed in 19 patients (79%) in the MPT group and 13 (52%) in the PT group (p = 0.07). The mean score on the aesthetic rule was 27 in the MPT group and 45.8 in the PT group (p = 0.03). Two independent observers analyzed the patient photos, and the kappa coefficient for the aesthetic results was 0.73. According to these observers, excellent and good results were seen in 21 patients (87%) in the MPT and 12 (48%) in the PT groups. The degree of temporal muscle, subcutaneous tissue, and skin atrophy was 14.9% in the MPT group and 24.3% in the PT group (p = 0.01). Measurements of the temporal muscle revealed 12.7% atrophy in the MPT group and 22% atrophy in the PT group (p = 0.005). The volumetric reduction was 14.6% in the MPT and 24.5% in the PT groups (p = 0.012). Mortality and mRS score were similar in both groups at the 6-month evaluation (p = 0.99). CONCLUSIONS Minipterional craniotomy provides clinical results similar to those of the PT technique. Moreover, it provides better cosmetic results. It can be used safely and effectively to surgically treat aneurysms of the anterior circulation instead of the PT approach.
Subject(s)
Craniotomy/methods , Intracranial Aneurysm/surgery , Adult , Aged , Esthetics , Female , Humans , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Treatment OutcomeABSTRACT
Os autores descrevem os resultados do tratamento de 25 doentes com dor de díficil controle, tratados pelo método de analgesia peridual. A analgesia propiciada pela administraçäo peridual, subaracnóidea e intraventricular de fármacos analgésicos é utilizada para o tratamento da dor rebelde à farmacoterapia sistêmica há muitos anos. Há controvérsias na literatura relacionadas aos benefícios e riscos deste método e, estudos que avaliem sua efetividade, complicaçöes e custo na realidade nacional, säo ainda necessários. Apesar de eficaz, complicaçöes e adversidades tais como infecçöes, deslocamentos e quebra de cateter, náuseas, vômitos, prurido e disforia foram observados
