RESUMO
Benign osteoblastoma is an uncommon bone tumor accounting for approximately 1% of all bone tumors. There are only 35 cases of skull osteoblastoma reported in the literature. We describe the case of a 23 year old male with a giant osteoblastoma of temporal bone submitted to a total removal of the tumor after an effective embolization of all external carotid branches. The authors discuss diagnostic and management aspects of this uncommon skull tumor.
Assuntos
Neoplasias Ósseas , Osteoblastoma , Osso Temporal , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Humanos , Masculino , Osteoblastoma/diagnóstico , Osteoblastoma/cirurgia , Osso Temporal/cirurgiaRESUMO
In spite of increasing experience with skull base surgery, some of the guidelines for indications for operations may vary according to the institution. One-hundred two patients underwent craniofacial oncologic resections at our institution from 1982 to 1995. A retrospective analysis of the indications for and contraindications to these procedures was undertaken. The main indications for malignant tumors were skin lesions with direct invasion of the anterior or lateral skull base (69%) and nasal-paranasal sinus tumors (21%). The main indications for benign tumors were glomus lesions (26%), menigiomas (22%), and fibro-osseous lesions of the anterior skull base (19%). The main contraindications were extensive invasion of the central nervous system, invasion of the cavernous sinus and/or internal carotid artery by aggressive malignancies, and bilateral orbital invasion in a nonblind patient. Also, 6 patients had their procedures interrupted during craniotomy for several reasons - extensive central nervous system invasion (2 cases), bilateral orbital invasion (1), lack of brain retraction (1), lack of histologic diagnosis during the operation (1), and purulent discharge at the frontal sinus (1). Craniofacial oncologic operations are extensive surgical procedures that have to be properly indicated in order to obtain low levels of morbidity and mortality. The selection of cases is of paramount importance. In some instances, it seems advisable even to interrupt these operations in the first phase.
Assuntos
Craniotomia/métodos , Seleção de Pacientes , Neoplasias da Base do Crânio/cirurgia , Adulto , Contraindicações , Craniotomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios XRESUMO
The authors describe a case of cerebellar abscess by Nocardia in a patient with the acquired immunodeficiency syndrome (AIDS) that was submitted to a posterior fossa craniectomy for diagnosis and treatment. Pathological and neuroimage findings are discussed as well as the surgical approach taking into account literature data on the subject.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Abscesso Encefálico/complicações , Nocardiose/complicações , Nocardia asteroides , Adulto , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/cirurgia , Cerebelo/microbiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
The charts of 81 patients who underwent skull base surgery between 1982 and 1993 were reviewed retrospectively. Data relative to demographic aspects, clinical stage, previous treatment, surgical approach, type of reconstruction, histology, extent of disease, complications, and follow-up were analyzed. The craniofacial approach for the anterior fossa was used in 53% of patients, the lateral skull base approach in 12%, and a combination of both in 17. Malignant tumors were diagnosed in 58 patients (72%), and histologically benign tumors in the remaining 23 (28%). Forty-one patients (51%) had skin cancer. There was dural invasion in 31 patients (38%), and 32 (40%) underwent microsurgical flap reconstruction. From the malignant group, 31 (53%) were alive with no evidence of disease (NED), and 6 (10%) were alive with disease. From the benign group, 19 (83%) were alive NED. The most common complications were cerebrospinal-fluid fistula (10%) and flap necrosis (9%). Statistical analyses of survival showed significantly different rates associated with histologic types (P = 0.0002), type of reconstruction (P = 0.0039), and previous treatment (P = 0.0018).
Assuntos
Neoplasias Cranianas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/cirurgia , Criança , Dura-Máter/cirurgia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Neoplasias Cranianas/mortalidade , Taxa de SobrevidaRESUMO
Two seriously injured trauma patients presenting with intense and progressive neutropenia are described. Bone marrow examination in both cases showed virtually absent granulopoiesis but normal erythropoiesis and megakaryopoiesis, allowing the diagnosis of acute agranulocytosis. Discontinuation of only one drug (dipyrone) with no further treatment was required for normalization of blood parameters. The association of dipyrone with neutropenia is still debatable. The recent medical literature on dipyrone generation of agranulocytosis is reviewed.
Assuntos
Agranulocitose/induzido quimicamente , Dipirona/efeitos adversos , Adolescente , Adulto , Lesões Encefálicas/terapia , Dipirona/administração & dosagem , Humanos , MasculinoRESUMO
We report two patients who presented with a dramatic recovery from severe sensorineural hearing loss after total surgical removal of cerebellopontine angle tumors (meningioma and jugular foramen neurinoma). The factors that differentiate these "non-acoustic tumors" in relation to the prognosis for hearing are discussed. A surgical approach that maintains the labyrinthine structure and preserves the arachnoid membrane of the superior cerebellopontine angle cistern during tumor removal is stressed.
Assuntos
Neoplasias Cerebelares/complicações , Ângulo Cerebelopontino , Perda Auditiva Neurossensorial/etiologia , Adulto , Idoso , Audiometria , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/cirurgia , Feminino , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Meningioma/complicações , Meningioma/cirurgia , Neurilemoma/complicações , Neurilemoma/cirurgia , Indução de RemissãoRESUMO
The authors describe two patients with the association of polyposis-coli and central nervous system tumor (Turcot's syndrome). Clinical, genetic and therapeutic aspects are discussed.
Assuntos
Polipose Adenomatosa do Colo/cirurgia , Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/patologia , Adolescente , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Feminino , Glioblastoma/genética , Glioblastoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , ReoperaçãoRESUMO
The topodiagnosis allows the physician to determine the topographic localization of pathology involving the facial nerve. It is based on clinical tests that evaluate the function of each one of the rami of the facial nerve. With a statistic of 873 patients, the Facial Nerve Group of Hospital das Clínicas, São Paulo University, found that suprageniculate lesions are responsible for 50% of the facial nerve involvement of several etiologies. Based on these results, the physician is able to develop a rationale for therapy and surgical access for facial nerve lesions.
Assuntos
Paralisia Facial/diagnóstico , Paralisia Facial/cirurgia , Paralisia Facial/terapia , Humanos , Exame NeurológicoRESUMO
A abordagem operatoria das lesoes traumaticas do nervo optico e raramente descrita E relatado caso de doente submetido a descompressao cirurgica do canal optico para tratamento da compressao mecanica do nervo optico provocada por fragmento osseo.Com o tratamento houve melhora imediata da visa
Assuntos
Adulto , Humanos , Feminino , Lesões Encefálicas , Doenças do Nervo Óptico , Craniotomia , Fraturas CranianasRESUMO
A medida continua de pressao intracraniana e importante para a adequada avaliacao de muitas afeccoes neurologicas e neurocirurgicas. A medida da pressao intracraniana por meio de parafusos colocados no espaco subaracnoideo periencefalico e pratica, segura, fidedigna e simples, sendo ha varios anos empregada em muitos centros neurocirurgicos de destaque 3,4,7,10,12,13, 14,15,17. Numerosos problemas tecnicos e complicacoes sao observados com o emprego dos parafusos originais 1,19. Os autores apresentam modificacoes da tecnica de confeccao e de aplicacao dos parafusos atualmente utilizados, a fim de minorar os problemas observados com os parafusos tradicionais