Meningioma cervical intramedular: um relato de caso raro / Intramedullary Cervical Spinal Cord Meningioma: A Rare Case Report

O meningioma intramedular é uma entidade relatada clinicamente de forma rara, tendo apenas nove relatos. Neste estudo, descrevemos o caso de um paciente masculino, 67 anos, com evolução de 25 anos, severos déficits motores, sensitivos e autonômicos. O diagnóstico foi confirmado por ressonância magnética mostrando uma massa intramedular central ao nível de C6-C7. O paciente foi submetido à microneurocirurgia com monitoração neurofisiológica, obtendo-se ressecção total e em bloco da lesão tumoral. Os achados histopatológicos e imuno-histoquímicos confirmaram meningioma angiomatoso com expressão multifocal de GFAP e de neurofilamento. O transoperatório ocorreu sem intercorrências, mas, quinze dias após, o paciente evoluiu com piora motora à esquerda. Apesar de extremamente raros, os meningiomas devem ser considerados um diagnóstico possível de tumoração intramedular.

Intramedullary meningioma is a rarely reported clinical entity, with only 9 cases reported to date. We describe a male patient, 67 years old, with 25 years of evolution and severe motor, sensory, and autonomic deficits. Preoperative magnetic resonance imaging (MRI) showed an intramedullary mass at the C6-C7 level. The patient underwent microneurosurgery and neurophysiological monitoring confirmed total in bloc resection. The histopathological and immunohistochemical findings confirmed angiomatous meningioma with multifocal expression of glial fibrillary acidic protein (GFAP) and neurofilament. Trans-operative was uneventful and, fifteen days later, he Costa et al.

Risk of rupture in unruptured anterior communicating artery aneurysms: meta-analysis of natural history studies.

BACKGROUND: The decision of whether to operate on patients bearing UIAs is complicated by the limitations in current knowledge of the natural history of such lesions. The ISUIA has estimated the annual risk of rupture below that justifying surgery for most incidentally found lesions less than 7 mm in diameter. However, there is some evidence that aneurysms located in the ACoA show a higher risk of rupture, even with diameters of less than 7 mm. The present study was conducted to investigate the risk of aneurysm rupture in this site. METHODS: The available literature on the subject was thoroughly reviewed, and a meta-analysis was carried out comparing the risk of rupture of aneurysms found in the ACoA with that of aneurysms in other sites. RESULTS: Aneurysms found unruptured in the ACoA show a risk of rupture twice as high as that of other intracranial aneurysms (95% confidence interval, 1.29-3.12). It is the first time this fact has been demonstrated based on the follow-up of unruptured aneurysms. CONCLUSION: When deciding whether to operate on UIAs located in the ACoA, surgeons should consider their higher risk of rupture.