Anaplastic meningioma: case report.

Intracranial meningiomas continue to challenge our best clinical efforts to eliminate them once discovered and deemed appropriate for treatment. Malignant meningiomas constitute 10% to 15% of all meningiomas and limited information exists regarding adjuvant treatment. The external whole brain irradiation is recommended. Traditional chemotherapy has proven ineffective; thus, new chemotherapeutic agents and new methods of delivery should be developed. Immunotherapy may be considered for patients with malignant meningiomas when all others previous treatment have failed. We report a case of anaplastic papillary meningioma. A 67-year-old man presented with partial complex seizures, headache and aggressiveness. A computerized tomography and magnetic resonance image demonstrated a large left temporo-occipital mass with diffuse contrast enhancement and extensive surrounding edema. A left temporo-occipital flap was performed. The tumor and the infiltrated dura were radically removed. Postoperatively, the patient remained neurologically intact. The treatment was complemented by external whole brain radiation.

Frontal sinus adenocarcinoma.

CONTEXT: Paranasal sinus cancer is considered rare, with an incidence of less than 1 per 100,000 per year, with the frontal sinus being the primary site in only 0.3%. We report a case of adenocarcinoma arising in the frontal sinus. DESIGN: Case report. CASE REPORT: A 59-year-old woman, secretary, came in February 1998 with a 4-month history of low intensity frontal headache. She denied contact with wood dust. On examination a non-tender swelling was noted over her right forehead next to the medial aspect of the right orbit. CT scan showed a soft-tissue mass involving frontal sinus with intracranial invasion through the posterior wall. The anterior ethmoid sinus and the medial aspect of the right orbit were also involved. MRI demonstrated dural thickening in communication with the frontal mass. She underwent an en-bloc tumor resection by craniotomy including orbital clearance. Histology revealed an adenocarcinoma. After surgery she had tumor recurrence, and chemotherapy and radiotherapy were started resulting in partial improvement.

[Multiple gliomas. Illustrative cases of 4 different presentations]. / Gliomas múltiplos: casos ilustrativos de quatro formas de apresentação.

Multiple gliomas are uncommon and may be classified according to: a) the time of presentation in early (at diagnosis) or late (during treatment); b) the characteristics of computed tomography or magnetic resonance imaging (CT/MRI) in multifocal (with evidence of spread) and multicentric (without evidence of spread). From 212 patients with histopathologic diagnosis of glioma evaluated from March/90 to September/99, 15 (7%) had multiple lesions. We describe 4 patients: early multicentric, late multicentric, early multifocal and late multifocal, with emphasis on characteristics of CT/MRI and possible differential diagnosis. The differential diagnosis of multiple lesions in the central nervous system includes mainly infectious/inflammatory diseases and metastasis, however multiple gliomas should always be considered, even in patients with known systemic cancer, as described by others. Considering that CT/MRI features are not definite, the diagnosis should always be confirmed by histopathologic examination.

Duraplasty with biosynthetic cellulose: an experimental study.

In the search for a new synthetic substitute for the dura mater, the authors conducted a research study using 32 mongrel dogs divided into three groups. Group I animals (21 dogs) underwent a right-sided parietooccipital craniotomy and substitution of two 1-cm pieces of dura mater by two different grafts: one piece of biosynthetic cellulose (50 mu thick) and one fragment of temporal fascia. The animals were observed for 30, 90, or 180 days. Group II animals (five dogs) underwent a somewhat larger craniotomy, removal of a 2-cm piece of dura mater, and lesioning of the cortex made by a thin sharp forceps, which caused bleeding that was controlled by application of a thin film of cellulose (10 mu thick). Duraplasty was performed using a 50-mu-thick cellulose membrane to complete the procedure and the animals were observed over a period of 270 days. Group III animals (six dogs) underwent smaller (1-cm diameter) bilateral parietal craniectomy, which included additional covering of the dura on the left side with 50-mu-thick cellulose and a suture of temporalis muscle. This group was observed for 40, 60, 80, or 120 days. Transient mild clinical symptoms were observed during the early postoperative period. At autopsy, macroscopic examination demonstrated good acceptance of the grafts with few and moderate extradural fibrosis, which caused adherence of the implants to the bone fragment. No adherence to the cortex was observed. Microscopic examination demonstrated absence of graft adherence to the cortical surface even when the cortex was injured. The cellulose was enveloped by two layers of connective tissue, the external layer being thicker than the internal one. Cellulose fibers increased in thickness over time until 30 days and then decreased in thickness until 270 days. This decrease in thickness between 30 to 270 days was statistically significant (p < 0.05). The physical properties of biosynthetic cellulose and the low cellular reaction to its implantation qualify this material as a dural substitute. Additional long-term studies must be undertaken to complete this report.

[Surgical treatment of cerebral vascular pathologies in epileptic patients]. / Tratamento cirúrgico das patologias vasculares cerebrais nos pacientes epilépticos.

Surgery of arteriovenous malformations (AVM) and of cavernous angiomas (cavernoma) in the majority of cases is indicated subsequently to episodes of bleeding. With the development of techniques for diagnosis and surgery for epilepsy of difficult control, indication for surgery of these vascular lesions has become greater. We present nine patients with cerebral vascular lesions and very frequent crises in spite of adequate clinical treatment. Ages ranged from 12 to 42 years with an average of 25 years; there was a prevalence of the male sex (2:1). Surgery consisted of exercises of the lesion in all cases and in four there was also resection of the perilesional irritative area shown by electrocorticography. The pathologic study of lesions showed five cases of cavernoma, three cases of AVM, and one case of venous angioma. As to localization, we observed three lesions in the temporal lobe, four in the frontal, and two in the parietal region. Outpatient follow-up showed a reduction in crises in all of the patients, and seven evolved seizure free following surgery.

[Extradural hematoma: comparative radiological study between comatose and non-comatose patients]. / Hematoma extradural. Estudo radiológico comparativo entre pacientes emcoma e não comatosos.

A series of 129 patients harbouring extradural hematomas was analysed considering the neurological state immediately before operation as the most consistent variable. Seventy eight patients were considered to be comatose (Group I) and 51 were noncomatose. Among the comatose group, 30 were investigated with computerized tomography (23.3% mortality, 50% good results), 31 were submitted to angiography (48.3% mortality, 38.7% good results), and 17 were operated based on the neurological examination and skull radiography (47% mortality, 35.2% good results). The presence or absence of skull fracture and the density of hematoma did not change the final outcome. Associated intracranial lesions increased the mortality and lowered the good results in both groups. Frontal hematomas (10 cases) in the comatose group were associated with high mortality (52.6%) due to bad neurological state (Glasgow 3-5) and to isolated or multiple intracranial associated lesions (6 patients).

Hematoma subdural cronico con dupla densidade na tomografia computadorizada. Relato de caso. / Chronic subdural hematoma with double density in computerized tomography. Report of a case

Os autores relatam o aspecto clinico, tomografico e cirurgico de um paciente portador de hematoma subdural cronico, cuja tomografia computadorizada revelou imagem de dupla densidade explicada por provavel ressangramento. A importancia da tomografia computadorizada para o bom planejamento cirurgico e ressaltada

[Edematous form of neurocysticercosis: report of 4 cases]. / Forma edematosa da neurocisticercose: registro de 4 casos.

Four cases of the oedematous form of neurocysticercosis are reported. This form is relatively rare and characterized by symptoms of intracranial hypertension and severe bilateral papilledema. Focal convulsive disorders are common. CSF studies show positive reaction for cysticercosis and ventriculography, the presence of small, narrowed lateral ventricles. Treatment based on ACTH and dexamethasone revelead good evolution as far as intracranial hypertension is concerned, not requiring surgical decompression as used before.

[Spinal epidural abscesses: report of 5 cases]. / Abscessos epidurais raqueanos: registro de cinco casos.

Five cases of acute spinal epidural abscess, all in male, two of them in children (6 and 7 years old) and the others in patients older than fifty years are reported. In four cases the pathology was related to skin infection and the staphylococcus was the main agent. All the patients had a severe infectious clinical picture, pain on the spine, radicular or spinal cord involvement or both. There was a delay in diagnosis showing that this pathology is still rather unknown. The cases were treated surgically. Two patients died, two had a complete recovery and the last one recovered with neurological deficit. The patients who died had impairment of the cervical cord and were operated on in very bad general and neurological conditions. Revision of literature was performed and the authors discussed the various aspects of this disease.

Abscessos epidurais raqueanos: registro de cinco casos. / Spinal epidural abscesses: report of 5 cases

Sao registrados 5 casos de abscesso epidural raqueano de evolucao aguda. Dos 5 pacientes, todos do sexo masculino, dois eram criancas de 6 e 7 anos e os demais, adultos com mais de 50 anos. Em 4 casos a fonte de infeccao estava na pele e em um nao foi detectado o foco. O agente infeccioso foi o estafilococo em quatro casos. Em todos os pacientes ficou evidenciado um grave estado toxico-infeccioso queda do estado geral e comprometimento do sistema nervoso manifestado por sindrome radicular ou sindrome de compressao medular dependendo do nivel da coluna acometida. Todos os casos foram tratados cirurgicamente e a demora do estabelecimento do diagnostico parece ter influido decisivamente na evolucao dos casos. Dos 5 pacientes, dois vieram a falecer, dois tiveram recuperacao completa, e um recuperacao parcial, com sequela neurologica. Os casos que evoluiram para obito, apresentavam comprometimento a nivel da coluna cervical e grave quadro septicemico e broncopneumonico. Os autores fazem uma revisao da literatura discutindo os varios aspectos desta entidade nosologica, ressaltando a necessidade do estabelecimento de um diagnostico precoce e imediata intervencao cirurgica, associada a antibioticoterapia

Forma edematosa da neurocisticercose: registro de 4 casos. / Edematous form of neurocysticercosis: report of 4 cases

Sao apresentados 4 casos de uma forma relativamente rara de neurocisticercose, forma edematosa, ja descrita por alguns autores de outros paises e que nas publicacoes nacionais ainda nao foi enfatizada e separadas das formas mais comuns que gracam em nosso meio. Esta forma caracteriza-se por sinais clinicos de grave hipertensao endocraniana, papiledema intenso bilateral, laboriatorialmente por reacao positiva para neurocisticercose no LCR e neuroradiologicamente, por ventriculos pequenos, esmagados ou normais, demonstraveis pela ventriculografia ou tomografia computadorizada. O autor chama a atencao para a boa evolucao dos casos tratados com ACTH e corticoidoterapia o que afasta de certo modo as medidas intervencionistas preconizadas ate ha alguns anos como a unica solucao para esta forma de neurocisticercose