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Publicações | 2016

Endoscopic Endonasal Approach in Skull Base Chondrosarcoma Associated with Maffucci Syndrome: Case Series and Literature Review.

Beer-Furlan A, Balsalobre L, Vellutini EA, Stamm AC.World Neurosurg. 2016 Jan;85:365.e7-15.

Abstract:

BACKGROUND:

Maffucci syndrome is a nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. The potential malignant progression of enchondroma into a secondary chondrosarcoma is a well-known fact. Nevertheless, chondrosarcoma located at the skull base in patients with Maffuci syndrome is a very rare condition, with only 18 cases reported in the literature.

 

CASE DESCRIPTION:

We report 2 other cases successfully treated through na expanded endoscopic endonasal approach and discuss the condition based on the literature review.

 

CONCLUSIONS:

Skull base chondrosarcoma associated with Maffucci syndrome is a rare condition. The disease cannot be cured, therefore surgical treatment should be performed in symptomatic patients aiming for maximal tumor resection with function preservation. The endoscopic endonasal approach is a safe and reliable alternative for the management of these tumors.

Endoscopic endonasal management of cerebrospinal fluid rhinorrhea after anterior clinoidectomy for aneurysm surgery: changing the paradigm of complication management.

Beer-Furlan A, Balsalobre L, Vellutini Ede A, Stamm AC, Pahl FH, Gentil AF. Arq Neuropsiquiatr. 2016 Jul;74(7):580-6.

Abstract:

 

Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.

Abstract:

 

BACKGROUND:

Fampridine is a broad-spectrum voltage-dependent potassium channel blocker that enhances synaptic transmission. The drug has been shown to be able to ameliorate conduction in demyelinated axons, thereby leading to improved gait  in patients with multiple sclerosis (MS).

OBJECTIVE:

To assess the "real-life" efficacy and safety of fampridine prescribed for gait disorders in MS. This was an observational and prospective study carried out at MS Units participating in the Brazilian Multiple Sclerosis Study Group.METHODS: Patients with MS and gait disorders were prescribed fampridine (10 mg twice a day), irrespectively of the degree of disability determined by MS.Neurological disability determined by MS was assessed with the expanded disability scale score (EDSS). Outcomes for efficacy and safety of the drug were evaluated by the 25 foot-walk test and by the adverse events of fampridine.

RESULTS:

The time taken to walk 25 feet decreased by 20% or more in 62 patients (70%). Twenty-five patients were considered to be non-responders to this treatment. Improvement in walking speed was independent of improvement of disability. Mild or moderate adverse events were reported in 8% of patients.

CONCLUSION:

Fampridine is an efficient and safe therapeutic option for patients with MS and gait disorders.

Abstract:

 

Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities.

 

METHODS:

Retrospective data on patients with arterial dissection related to sports and recreation.

 

RESULTS:

Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature.

 

CONCLUSION:

Arterial dissection may be a complication from practicing sports.

Intradural calcifying pseudoneoplasm of the neuraxis presenting as a cauda equina syndrome.

Lopes AJ, Brock RS, Martins TG, de Medeiro RS, Montezzo D, de Oliveira MF, Teixeira MJ. Surg Neurol Int. 2016 Dec 26;7(Suppl 42):S1102-S1105. 

Abstract:

 

BACKGROUND:

Calcifying nonneoplastic pseudoneoplasms of the neuraxis (CAPNON)have been reported in 59 cases in literature, however, they rarely involve the spinal cord. Owing to the advances in immunohistochemical markers, their structure and origin are better understood now.

 

CASE REPORT:

We present the case of a 72-year-old female who had longstanding history of low back pain that exacerbated 20 days prior to the presentation to the emergency room with a frank cauda equina syndrome. The lumbar computed tomography scan showed a hyperdense lesion, suggestive of calcified tumor, whereas the magnetic resonance imaging revealed a hypointense lesion on theT1 and T2-weighted images, without contrast enhancement or edema on fluid-attenuated inversion recovery. She underwent an emergent L2-L4 laminectomy and L3-L4 discectomy with resection of L2 intradural tumor, following which she regained normal function.

 

CONCLUSION:

A 72-year-old female presented with a cauda equina syndrome attributed to an L2 intradural CAPNON. Following gross total resection, the patient was neurologically intact.

Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in themanagement of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction.

Pahl FH, de Oliveira MF, Beer-Furlan AL, Rotta JM.Surg Neurol Int. 2016 Jun 3;7(Suppl 14):S405-9. 

Abstract:

BACKGROUND:

Internal carotid artery bifurcation (ICAb) aneurysms account for about 2-15% of all intracranial aneurysms. In giant and complex cases, treatment may be difficult and dangerous, once some aneurysms have wide neck and anterior cerebral artery (ACA) and middle cerebral artery (MCA) may arise from the aneurysm itself. Clip reconstruction may be difficult in such cases. Whenever possible, the occlusion of ACA transform the bifurcation in a single artery reconstruction (ICA to MCA), much easier than a bifurcation reconstruction.

 

METHODS:

In patients with giant and complex ICAb aneurysms, we propose routine preoperative angiography with anatomical evaluation of anterior communicating artery (ACoA) patency during cervical common carotid compression with concomitante contralateral carotid artery injection. This allowed visualization of the expected reversal of flow in the A1 segment-ACoA complex. When test is positive, we can perform ipsilateral ACA (A1 segment) clip occlusion and flow modification of the ACA-ACoA complex transforming a three vessel (ICA, ACA, and MCA)reconstruction into a two vessel (ICA and MCA) reconstruction.

 

RESULTS:

Two patients were treated, with 100% of occlusion and good outcome.

 

CONCLUSIONS:

Surgical treatment of giant and complex ICAb may be achieved with acceptable morbidity.

Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms.

Pahl FH, de Oliveira MF, Brock RS, Lucio JE, Rotta JM.Arq Neuropsiquiatr. 2016 Apr;74(4):314-9. 

Abstract:

 

Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms.

 

METHOD:

From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes.

 

RESULTS:

Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months).

 

CONCLUSION:

Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.

Endoscopic Endonasal Management of Skull Base Chordomas: Surgical Technique,Nuances, and Pitfalls.

Mangussi-Gomes J, Beer-Furlan A, Balsalobre L, Vellutini EA, Stamm AC. Otolaryngol Clin North Am. 2016 Feb;49(1):167-82. 

Abstract:

 

Chordoma is a rare primary bone tumor derived from transformed notochord remnants. It has a local aggressive behavior and high recurrence rates. Treatment of skull base chordomas is complex and challenging. Control of the disease relies mainly on surgical excision of the tumor, sometimes followed by high-dose radiation therapy. The main surgical goal is to achieve maximal tumor removal with minimal morbidity. Development of the expanded endoscopic endonasal approach has improved surgical and prognostic results of skull base chordomas. This article highlights important aspects of approach selection, technique, and nuances of surgical management of this tumor.

Blister-Like Aneurysms: Report of Successful Surgical Treatment of Consecutive Cases and Review of the Literature.

Pahl FH, de Oliveira MF, Teles Gomes Mde Q, Capel Cardoso AC, Rotta JM. World Neurosurg. 2016 May;89:376-81. 

Abstract:

 

INTRODUCTION:

Blister-like aneurysms (BAs) are usually defined as arterial lesions arising from nonbranching sites on intracranial arteries. Because of specific peculiarities such as different pathophysiology, fragility of the aneurysmal wall, high risk of intraoperative bleeding, and high probability of losing parent vessel patency, their treatment is controversial, and both endovascular and surgical options have been reported.

 

METHODS:

From 2006 to 2015 (10 years), 7 aneurysms in 6 patients were treated. We retrospectively reviewed the records of these patients to analyze clinical pictures and outcomes, which are expressed as modified Rankin Score.

 

RESULTS:

In our sample of 7 aneurysms in 6 patients, all BAs were successfully treated (complete exclusion in 100% on follow-up angiography). A good outcome (modified Rankin Score = 0) was achieved in all patients, with no difference related to aneurysm size and location. There was no mortality.

 

CONCLUSIONS:

Surgical treatment of BAs may be effective and have acceptable complications and outcomes.

Vasa Vasorum and the Growing of Thrombosed Giant Aneurysm of the Vertebral Artery: A Case Report.

Pahl FH, Vellutini Ede A, Cardoso AC, de Oliveira MF. World Neurosurg. 2016 Jan;85:368.e1-4.

Abstract:

 

BACKGROUND:

Giant aneurysms arising from the vertebral artery (VA) are often associated with thrombosis and present as mass lesions with slow progression of symptoms and signs. A consensus is still to be established on the underlying growth mechanisms and surgical management of thrombosed giant aneurysms of the VA.

 

CASE DESCRIPTION:

Here, we report the case of a 54-year-old man who sought neurosurgical care after 3 months of progressive cervical axial pain. He underwent cervical magnetic resonance imaging and cerebral angiography, which revealed a giant VA aneurysm with thrombosed component. After failure of proximal and distal endovascular treatment, it was decided to adopt a surgical approach, which revealed a markedly developed vasa vasorum in the aneurysmal walls, raising the possibility of intra-aneurysmal nutrition from vasa vasorum. The patient recovered progressively and almost completely after surgery.

 

CONCLUSIONS:

Another report described the case of a 58-year-old woman harboring a partially thrombosed giant aneurysm of the VA. At the time of resection, a marked development of vasa vasorum on the occluded VA and the neck of the aneurysm was noted. We highlight the need to comprehend vasa vasorum as potential sources for  aneurysmal growth.

Survival score scales of patients operated with spinal metastases: retrospective application in a Brazilian population. 

Ribas EC, Mathias Junior LR, Guirado VM, Brock RS, Taricco MA, Daniel MM,Lourenço RB, Teixeira MJ.Arq Neuropsiquiatr. 2016 Jan;74(1):44-9.

Abstract:

 

Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting these patient's survival is a key factor to select the proper treatment modality, but the three most used score scales to predict their survival (Tokuhashi revised score, Tomita score and Bauer modified score) were designed in single institutions and their reliability to predict correctly the patient's survival were first tested only in those specific populations. This prognostication issue is addressed in this article, evaluating retrospectively the survival of 17 patients with SEM from a Brazilian general hospital with these score scales. Our results show that the actual survival of those patients were worse than the predicted of all three score scales, suggesting that diferences between the different populations might have affected their reliability and alert that their usage as a major factor to select the most appropriate treatment have to be done with caution.

Primary brain calcification in patients undergoing treatment with the biphosphanate alendronate.

Oliveira JR, Oliveira MF. Sci Rep. 2016 Mar 15;6:22961.

Abstract:

 

Brain calcification might be associated with various metabolic, infectious or vascular conditions. Clinically, brain calcification can include symptoms such as migraine, parkinsonism, psychosis or dementia. The term Primary Brain Calcification was recently used for those patientswithout an obvious cause (formerly idiopathic) while Primary Familial Brain Calcifications was left for the cases with autosomal dominant inheritance. Recent studies found mutations in four genes (SLC20A2, PDGFRB, PDGFB and XPR1). However, these gene represent only 60% of all familial cases suggesting other genes remain to be elucidated. Studies evaluating treatments for such a devastating disease are scattered, usually appearing as single case reports. In the present study, we describe a case series of 7 patients treated with Alendronate, a widely prescribed biphosphanate. We observed good tolerance and evidence of improvements and stability by some patients. No side effects were reported and no specific symptoms related to medication. Younger patients and one individual continuing a prescription (prior to study commencement) appeared to respond more positively with some referred improvements in symptoms. Biphosphanates may represent an excellent prospect for the treatment of brain calcifications due to their being well tolerated and easily available. Conversely, prospective and controlled studies should promptly address weaknesses found in the present analysis.

Effect of repeated transsphenoidal surgery in recurrent or residual pituitary adenomas: A systematic review and meta-analysis.

Heringer LC, de Oliveira MF, Rotta JM, Botelho RV. Surg Neurol Int. 2016 Feb 8;7:14. 

Abstract:

 

BACKGROUND:

Recurrent or residual pituitary adenomas previously treated by transsphenoidal surgery are not uncommon. There are no strongly established guidelines to perform treatment of such cases. The objective of this study is to elucidate the effect of transsphenoidal reoperation in residual or recurrent pituitary adenomas.

 

METHODS:

We made a systematic review of the literature to elucidate this effect through electronic search in MEDLINE/PubMed and Cochrane Central database. PRISMA statement was used as a basis for this systematic review and analysis of the risk of bias was made according to the Grading of Recommendations, Assessment, Development and Evaluation recommendations.

 

RESULTS:

In this review, fifteen studies were finally pooled analyzed. Although remission rates (RRs) and follow-up periods varied widely, from 149 patients with growth hormone-secreting tumors the mean RR was 44.5%, from 273 patients with adrenocorticotropic hormone-secreting tumors the mean RR was 55.5% and among 173 patients with nonsecreting tumors, RR was 76.1%. There was significant higher RR in nonsecreting tumors. Mean follow-up was 32.1 months. No difference was found between microscopic and endoscopic techniques.

 

CONCLUSIONS:

A second transsphenoidal surgery is accompanied by a chance of remission in approximately half of cases with secreting tumors. In nonsecreting ones, success is higher.

The Retrograde Ventriculosinusal Shunt in an Animal Experimental Model of Hydrocephalus.

Pinto FC, Becco R, Alho EJ, Poli-de-Figueiredo LF, Souza PA, Oliveira MF, Teixeira MJ.Pediatr Neurosurg. 2016;51(3):142-8.

Abstract:

 

Currently, hydrocephalus treatment is performed mainly with ventriculoperitoneal shunting. This experimental study aims at assessing whether the experimental model of hydrocephalus in dogs is applicable to the laboratory study of the retrograde ventriculosinusal shunt (RVSS). Four mongrel dogs were assessed. After randomization, the animals were divided into two groups: an experimental group that underwent the induction of hydrocephalus/RVSS and a control group, for the measurement of the mean arterial pressure, intracranial pressure and pressure in the superior sagittal sinus (SSS). The controls presented a mean arterial pressure of 68 mm Hg (71 and 65), an intracranial pressure of 163 mm H2O (149.6 and 176.8) and a pressure at the SSS of 40 mm H2O (40 and 40). The kaolin injection into the cisterna magna at a concentration of 0.3 mg/ml was capable of inducing the clinical and radiological mechanism of hydrocephalus (intracranial pressure = 250 mm H2O, pressure at the SSS = 50 mm H2O). The caliber of the SSS was 2.5 ± 1.0 mm. The fact that the SSS caliber of the dog was the same size as the external diameter of the catheter used resulted in the complete obstruction of the SSS when the catheter was inserted. We believe we could design and perform an experimental model to test the RVSS. It is applicable and feasible. The model of hydrocephalus, the surgical apparatus and the scenario were adequate, but the shunt system needs to be proportionally made to the canine anatomy.

Is there a relationship between spinal instability in neoplastic disease and Tokuhashi scoring system? 

de Oliveira MF, Rotta JM, Botelho RV.Neurosurg Rev. 2016 Jul;39(3):519-24.  

Abstract:

 

Spinal instability neoplastic score (SINS) classification evaluates spinal stability by adding together six radiographic and clinical components. The objective of this study was to verify the association between SINS and Tokuhashi scoring system (TSS) score. Fifty-eight patients with vertebral metastases were admitted from 2010 to 2014 at Hospital do Servidor Público Estadual de São Paulo. They were evaluated according to their SINS and Tokuhashi SS score. Fourteen patients (24.13 %) scored from 0 to 6 points (stable spine), 37 (63.79 %) scored from 7 to 12 (potentially unstable), and 7 (12.06 %) scored from 13 to 18 (unstable). In stable spine patients according to SINS, the mean TSS score was 9.2. In potentially unstable spine patients, the mean TSS score was 8.24. In unstable spine patients, mean TSS score was 6.28. There was a statistically significant difference of the TSS score between stable and unstable patients. After evaluating TSS score in each patient, the worse the SINS, the worse was also the TSS score.

Paraganglioma of the filum terminale - a case report.

Brock RS, Noleto G, Oliveira MF, Teixeira MJ. J Spine Neurosurg. 2016; 5:1.

Abstract:

Paragangliomas are rare lesions, and in filum terminale region they account for only 3.3 to 3.5% of tumors. We report the case of a patient with history of progressive low back pain at night with altered sensitivity in the lower limbs and neurogenic bladder. Magnetic resonance imaging (MRI) revealed a mass lesion in the conus medullaris region. The patient underwent complete microsurgical resection and experienced improvement of his symptoms. Histologic evaluation was consistent with a paraganglioma of the filum terminale. We provide a brief review of the epidemiology and clinical and radiological features of this condition. Prognosis is associated with the ability to achieve total surgical resection. In the event of partial removal, longer follow-up is required.

Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?

Oliveira MF, Teixeira MJ, Reis RC, Petitto CE, Gomes Pinto FC. World Neurosurg. 2016 Aug;92:445-453. 

Transcranial Doppler in the evaluation of infants treated with retrograde ventriculosinus shunt.

de Oliveira MF, Teixeira MJ, de Lima Oliveira M, Seng-Shu EB, Norremose KA, Gomes Pinto FC.Childs Nerv Syst. 2016 Nov;32(11):2133-2142.

Intradural chordoma presenting with

intratumoral bleeding.

Vellutini E de A, de Oliveira MF. J Clin Neurosci. 2016 Mar;25:139-42.

Abstract:

Intradural clival chordomas are very rare, and only 29 cases have been reported to our knowledge. They arise purely intradurally without bone or dural involvement and may differ from classic clival chordomas in physiopathology and management. We present a 28-year-old woman who presented with intradural clival chordoma and tumoral bleeding. After initial gross macroscopic surgical resection, she presented with tumor recurrence after 2 years, again with intratumoral bleeding. Although usually considered to have a more favorable prognosis in comparison to typical chordomas, intradural chordomas appear to behave as typical chordomas. Intratumoral bleeding may be a sign of an aggressive lesion and risk of recurrence. We highlight the differential diagnosis of intrinsic posterior fossa bleeding, especially in young patients. Intradural chordomas may be underdiagnosed and incorrectly treated as other types of parenchymal hemorrhage.

Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage.

Pereira RM, Suguimoto MT, Oliveira MF, Tornai JB, Amaral RA, Teixeira MJ, Pinto FC.Arq Neuropsiquiatr. 2016 Jan;74(1):55-61.

Abstract:

Normal pressure hydrocephalus (NPH) is characterized by the triad of gait

apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.

Do Physically Active Patients Have Better Functional Outcome after Stroke?A Systematic Review.

Tumasz MT, Trócoli T, de Oliveira MF, Campos RR, Botelho RV.J Stroke Cerebrovasc Dis. 2016 Mar;25(3):527-32.

Abstract:

BACKGROUND AND PURPOSE:

Stroke is one of the major causes of mortality and, among survivors, disability. Physical activity has a protective effect maybe due to a major control of risk factors, such as hypertension, diabetes mellitus, and body  weight. However, the effect of prestroke physical activity and the poststroke functional outcomes needs clarification.

 

METHODS:

We made a systematic review of the literature to elucidate this effect through electronic search in the MEDLINE/PubMed database. Prisma statement was used as a basis for this systematic review and analysis of the risk of bias was made according to the Grading of Recommendations, Assessment, Development and Evaluation. Three studies were finally analyzed in this review.

 

RESULTS:

The largest of the studies (Rist et al) revealed no association between  prior physical activity and functional outcome after stroke. The second major study (Stroud et al) showed only a slight association. Only the smallest of the 3 studies (Krarup et al) showed a protective effect of physical activity.

 

CONCLUSIONS:

The evidence of the protective effect of physical activity is still conflicting. Better longitudinal studies are still needed to see the real effect of physical activity on functional outcome after stroke.

Improvement of hydrocephalus in patients with Chiari Malformation after posterior fossa decompression: case report.

Heringer LC, Oliveira MF, Sousa UO, Lima WC, Botelho RV.J Bras Neurocirurg 27 (1): 71-73, 2016.

Abstract:

INTRODUCTION:

The association between hydrocephalus and Chiari malformation (CM) has not been described frequently. Ventricular dilation affects 7% to 10% of patients with CM, but the ideal choice of surgical treatment is controversial. We report a case of a patient with Chiari malformation and hydrocephalus with improvement in clinical symptoms and ventricular dilatation. Case Description: A 19-year-old male complaining of frontal headache when coughing, laughing and during valsalva maneuvers, associated with dizziness for 2 months. Magnetic resonance (MR) showed hydrocephalus and small posterior fossa with overcrowding of contents, characterizing Chiari malformation type I, with cerebellar tonsils protruding through magnum foramen. Patient underwent surgery with posterior fossa decompression in a semi-sitting position and removal of the arc C1. After 3 months of follow-up, headache disappeared becoming asymptomatic. Control MR showed improvement of hydrocephalus with restoration of the cisterna magna and CSF flow. Discussion: Hydrocephalus has been related to CM for a long time. In our case, we performed treatment with intradural and intra-arachnoidal approach with bilateral tonsillectomy without placing ventricular shunt. The cisterna magna was “recreated”. There was improvement of hydrocephalus with decreased Evans ratio index and symptoms disappearance. Although there is no other studies addressing such matter, in this case, the improvement suggests that the CSF compression at the foramen magnum was the cause of associated hydrocephalus with Chiari malformation.

Functional Reconstruction of Temporomandibular Joint after Resection of Pigmented Villonodular Synovitis with Extension to Infratemporal Fossa and Skull Base: A Case Report.

Vellutini EAS, Alonso N, Arap SS, Godoy LFS, Souza E Souza RA, Mattedi RL, de Oliveira MF.Surg J (N Y). 2016 Aug 10;2(3):e78-e82. 

Abstract:

INTRODUCTION:

Pigmented villonodular synovitis (PVNS) is a benign but aggressive lesion arising from sinovia. The temporomandibular joint (TMJ) is hardly ever involved. Methods  We describe a case of PVNS arising in the left TMJ involving infratemporal fossa soft tissue and the skull base; we also present the reconstruction.

RESULTS:

A 37-year-old woman had progressive mandibular swelling for 6 months. Computed tomography of the skull revealed an osteolytic lesion in the left TMJ, involving the upper mandible, condyle, and glenoid fossa and extending to the infratemporal fossa and fossa media through a defect in temporal bone. Surgical management included a left pterional craniotomy to reach the temporal skull base and resect the intracranial tumor and a facial approach with  partial left mandibulectomy and resection of left condyle, glenoid fossa, and tumor removal in infratemporal fossa. Mandible function was restored with prosthetic reconstruction of the condyle. She progressively started to eat solid foods after 3 months, becoming increasingly functional and asymptomatic. At 30 months' follow-up, she had no sign of tumoral recurrence and showed asymptomatic and normal TMJ function.

 

CONCLUSION:

PVNS should be considered in the differential diagnosis of bone neoplasms affecting young patients. In such cases, radical excision is mandatory and TMJ prosthesis for local reconstruction may be used to preserve functionality.

Giant cell glioblastoma associated with intrinsic arteriovenous malformation: a case report

Brock RS, Gomes MQT, Oliveira MF, Lancellotti CLP.J Bras Neurocirurg 2016; 27(1):63-66. 

Abstract:

BACKGROUND:

Primary brain tumors associated with cerebral arteriovenous malformations (AVM) although known is a rarely reported finding. There have been approximately 50 cases reported. Only two cases of a single lesion with coexistence of AVM and glioblastoma were described. Case Report. We report a case of a 46-year-old woman with headache and seizures for 2 months who performed a MR which displayed a large right frontal lesion suggesting a glioblastoma. Results. During surgical resection, two large veins could be seen draining tumoral vascularization in the surrounding cortex. After reaching the deepest portion of tumor, veins were coagulated and cut to allow tumor removal. However, unexpected bleeding started to occur with associated lesion growth and edema, resembling an AVM. Material sent to pathology revealed giant glioblastoma in association to an AVM with some thrombosed vessels and ischemic necrosis. Two previous studies discussed similar cases. Conclusion. The need of magnetic resonance in all AVM cases is highlighted in order to analyze brain parenchyma within AVM. We also remark the need of pathological analysis of whole surgical material, in order to characterize whole piece and to avoid not diagnosing an associated lesion

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