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BACKGROUND: The main treatments for hydrocephalus due to posterior fossa tumors are tumor resection with or without an external ventricular drain, ventriculoperitoneal shunt (VPS), and endoscopic third ventriculostomy. Although preoperative cerebrospinal fluid diversion by any of these techniques improves clinical outcomes, evidence comparing the efficacy of these techniques is scarce. Therefore, we aimed to retrospectively evaluate each treatment modality. METHODS: This single-center study analyzed 55 patients. Treatments were classified as successful (hydrocephalus resolution with a single surgical event) or failed and compared with a χ2 test. Kaplan-Meier curves and log-rank tests were employed. A Cox proportional hazard model was used to determine relevant covariates predicting outcomes. RESULTS: Mean patient age was 36.3 years, 43.4% of patients were men, and 50.9% of patients presented with uncompensated intracranial hypertension. Mean tumor volume was 33.4 cm3, and extent of resection was 90.85%. Tumor resection with or without an external ventricular drain was successful in 58.82% of cases, VPS was successful in 100%, and endoscopic third ventriculostomy was successful in 76.19% (P = 0.014). Mean follow-up time was 15.12 months. Log-rank test found statistically significant differences between survival curves of treatments (P = 0.016) favoring the VPS group. Postoperative surgical site hematoma was a significant covariate in the Cox model (hazard ratio = 17; 95% confidence ratio, 2.301-81.872; P = 0.004). CONCLUSIONS: This study favored VPS as the most reliable treatment of hydrocephalus due to posterior fossa tumors in adult patient; however, several factors influence clinical outcomes. We proposed an algorithm based on our findings and other authors' findings to facilitate the decision-making process.
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Neoplasias Encefálicas , Hidrocefalia , Neoplasias Infratentoriais , Terceiro Ventrículo , Masculino , Humanos , Adulto , Feminino , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Encefálicas/cirurgia , Neoplasias Infratentoriais/complicações , Neoplasias Infratentoriais/diagnóstico por imagem , Neoplasias Infratentoriais/cirurgia , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Ventriculostomia/métodos , Derivação Ventriculoperitoneal/métodos , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do TratamentoRESUMO
Mature fetiform teratoma, or homunculus, is a term coined for a rare variant of teratoma with a prevalence of 0.01% of teratomas. There have been very few cases reported in the world, and its thoracic presentation is extremely unusual. We present the case of a 31-year-old female patient with a history of progressive chest pain in the left hemithorax, associated with dyspnea on moderate exertion and cough. Imaging studies revealed a large intrathoracic tumor visually compatible with a teratoma. Surgical resection by a clamshell approach was successful, and subsequent anatomopathological studies of the operative specimen concluded that the mass was a mature fetiform thoracic teratoma. The treatment of this entity is generally surgical and includes wide resection due to its large adhesive component to surrounding tissues. Thus, the cardiothoracic surgeon must know approaches that allow wide resection, making these cases true surgical challenges.
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Resumen: La craneotomía con el paciente despierto se refiere a aquellos procedimientos en los que el paciente conserva su estado de consciencia durante toda la cirugía o en parte de ésta con el objetivo de explorar la integridad de sus funciones cerebrales superiores en tiempo real. Estas técnicas neuroanestésicas son útiles para ayudar al neurocirujano a preservar la integridad del tejido cerebral, o bien, no causar mayor daño del que la propia enfermedad ha causado.
Abstract: Awake craniotomy refers to those procedures in which the patient remains conscious for all or part the time, with the aim of explore in real time the integrity of their higher brain functions. This kind of neuroanesthetic techniques are useful in assisting the neurosurgeon to preserve the integrity of the brain or not to damage more than what the disease has caused.
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BACKGROUND: Changes in neutrophil to lymphocyte ratio (ΔNLR) have been used as a clinical tool for stratification and prognosis of patients with solid tumors, there is scarce evidence of their clinical relevance in patients with tumors of the central nervous system who have also undergone surgical resection. OBJECTIVE: Determine if (ΔNLR) are associated with poor response to treatment and worse prognosis in pediatric patients with central nervous system tumors (CNST) who underwent surgical resection. METHODS: We performed a retrospective cohort study; demographic, clinical, and hematological variables were evaluated, Kaplan-Meier survival curves and Cox proportional hazards regression model were performed to evaluate prognosis. RESULTS: The ΔNLR cutoff value obtained through the third interquartile range was 4.30; The probability of survival and complete response to treatment was different between patients with high ΔNLR when compared to patients with low ΔNLR (p= 0.013, p=⪠0.001, respectively). A high ΔNLR behaved as an independent predictor of worse Overall Survival (HR 2,297; 95% CI: 1,075-4.908, p= 0.032). CONCLUSION: An elevated ΔNLR was a predictor of poor response to treatment and a prognostic factor for worse Overall Survival in pediatric patients with CNST undergoing surgical resection.
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Neoplasias do Sistema Nervoso Central , Neutrófilos , Neoplasias do Sistema Nervoso Central/cirurgia , Criança , Humanos , Estimativa de Kaplan-Meier , Linfócitos/patologia , Neutrófilos/patologia , Prognóstico , Estudos RetrospectivosRESUMO
A sobrevivência de pacientes com câncer de cabeça e pescoço vêm melhorando, entretanto, algumas deformidades podem ocorrer devido dos tratamentos cirúrgicos que geram mutilações bucomaxilofaciais como perda de dentes, estruturas do palato, língua ou assoalho, resultando em alterações na fonética, mastigação e deglutição. Nesses casos há a necessidade que seja realizado uma reabilitação protética buscando torná-los indivíduos com menos problemas sociais, psicológicos e físicos, visto que mais procedimentos cirúrgicos estão contra indicados para solucionar os efeitos colaterais gerados pelo tratamento das neoplasias. Esse tipo de reabilitação protética com prótese ou placa obturadora possibilita benefícios na fonética, facilita a convivência social e atividades nutricionais como alimentação e deglutição, permitindo ao paciente uma vida com menos constrangimentos. Este trabalho tem como objetivo relatar dois casos clínicos onde os pacientes foram submetidos a reabilitação com placa obturadora palatina feitos após cirurgias oncológicas. Os pacientes de gêneros diferentes e com comunicações buco-nasal similares receberam o mesmo planejamento reabilitador que foram confeccionadas a partir de um molde que foi enviado ao laboratório. Após a instalação foi possível verificar que houve sucesso no tratamento, notando uma melhora imediata comprovando a eficácia do método reabilitador(AU)
This paper relates two clinical cases where patients were recovered with a palatal splint made after oncological surgeries. Survival of patients and necks can occur, however, some deformities can occur during oral and maxillofacial treatment, such as the appearance of teeth, palate structures, mutilations or posterior jaws, leading to changes in aesthetics, surgery and swallowing. If the need to perform a prosthetic rehabilitation is necessary so that the results are seen with less problems, psychological and physical, that more procedures are performed so that the effects of neoplasms are contraindicated by the treatment. This type of prosthetic rehabilitation with prosthesis or obturator plate provides benefits in phonetics, facilitates social coexistence and nutritional activities such as eating and swallowing, allowing the patient a life with less constraints. Patients of different genders and with similar oral and nasal communications received the same rehabilitation plan that were made from a mold that was sent to the laboratory. After installation, it was possible to verify that the treatment was successful, noting an immediate improvement, proving the effectiveness of the rehabilitation method(AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Obturadores Palatinos , Neoplasias de Cabeça e Pescoço , Estética , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/terapiaRESUMO
BACKGROUND: The reconstruction of the proximal humerus is possible from the resection of the tumor and the placement of a prosthesis. In some cases, they do not meet the anthropometric aspects of the patients. OBJECTIVE: To determine the parameters to size the components of a humeral prosthesis and the development of a set, using design software. METHOD: Forty patients were selected for prostheses, radiographs and CT scans were analyzed and statistical tests were applied to the measurements. RESULTS: The length of the tumors was 8-20 cm. The minimum length of the humerus was 28 cm and 33 cm the maximum. Correlation was observed between the humerus and the tumor and the height of the patient with p = 0.93088 and p = 0.904564, respectively; humerus diameter, p = 0.2345. The set will include three components, diameter 6-10 mm, and length of 24, 26 and 28 cm. Three modular spacers with lengths of 6, 8.5 and 13 cm. Crowns 6.5 and 8.5 cm long, 1.3 cm in diameter and 5 mm nut. CONCLUSION: With the development of the set, poorly calculated resections and adaptation to any humerus size can be resolved.
ANTECEDENTES: La reconstrucción del húmero proximal es posible a partir de la resección del tumor y la colocación de una prótesis. En algunos casos, las prótesis no cumplen con los aspectos antropométricos de los pacientes. OBJETIVO: Determinar los parámetros para dimensionar los componentes de una prótesis de húmero y el desarrollo de un set, mediante software de diseño. MÉTODO: Se seleccionaron 40 pacientes para prótesis, se analizaron radiografías y tomografías computarizadas, y se aplicaron pruebas estadísticas a las mediciones. RESULTADOS: La longitud de los tumores fue de 8-20 cm. La longitud mínima del húmero fue de 28 cm y la máxima fue de 33 cm. Se observó correlación entre el húmero y el tumor y la altura del paciente, con p = 0.93088 y p = 0.904564, respectivamente; para el diámetro del húmero, p = 0.2345. El set incluye tres componentes, con diámetro de 6-10 mm y longitud de 24, 26 y 28 cm; tres espaciadores modulares con longitudes de 6, 8,5 y 13 cm; coronas de 6,5 y 8,5 cm de largo, 1,3 cm de diámetro y tuerca de 5 mm. CONCLUSIÓN: Con el desarrollo del set se pueden resolver resecciones mal calculadas y la adaptación a cualquier tamaño de húmero.
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Neoplasias Ósseas , Osteossarcoma , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Próteses e Implantes , Desenho de Prótese , Resultado do TratamentoRESUMO
INTRODUCTION: Renal cell carcinoma comprises over 90% of renal cancers, thus, it is the most common form of renal neoplasia. This carcinoma can often present itself in a variable fashion, ranging from incidentalomas to metastatic diseases. Furthermore, the most common metastasis associated with this type of carcinoma occurs in the lungs, bones or liver. We aim to report a case of renal cell carcinoma which presented together with a fibromixoid sarcoma. CASE PRESENTATION: A 50 year-old woman presented with hematuria, weight loss, asthenia and right lumbar pain that started 7 months prior to the consult. CT scan was performed and revealed a solid injury of 10 cm in the right kidney together with a mass in the left flank. Total right nephrectomy was promptly performed and the patient was submitted 3 months later to a tumoral resection of the abdominal wall. Histopathological findings revealed a primary renal cell carcinoma and the second, metastatic tumor was shown to be a fibromixoid sarcoma. The patient was not submitted to chemotherapy and is currently under follow-up with the surgery and oncology staffs, without showing any symptoms. DISCUSSION: Renal cell carcinoma usually presents itself together with secondary tumors on the lungs and bones. The association of this type of carcinoma with a fibromixoid sarcoma of the abdominal wall is rare and poorly reported in the literature. CONCLUSION: This case reports shows a successful treatment regarding this rare association, which can help other physicians to re-evaluate their medical conduct.
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Intradural extramedullary spinal tumors were historically managed through traditional midline approaches. Although conventional laminectomy or laminoplasty provides a wide tumor and spinal cord exposure, they may cause prolonged postoperative neck pain and late kyphosis deformity. Minimally invasive ipsilateral hemilaminectomy preserves midline structures, reduces the paraspinal muscle disruption, and could avoid postoperative kyphosis deformity. A safe tumor resection through this approach could be complicated in large sized or anteromedullary located lesions. We present a surgical video of C3 antero located meningioma removed en bloc through a minimally invasive approach. The patient signed a written consent to publish video, recording, photograph, image, illustration, and/or information about him.
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Dumbbell-shaped thoracic tumors usually involve the spinal canal and the posterior thoracic cavity. Gross total resection is the treatment of choice, but techniques for surgical excision remain controversial. An anterolateral transthoracic approach may remove the paravertebral component of the tumor, but has limited or no control of the intracanal lesion. A combined posteroanterior approach requires a 2-stage surgery with significant morbidity. The preferred approach depends mainly on the tumor location, size, shape, and its specific anatomical relationship with the surrounding vital structures. We present a surgical video of a single-stage posterior minimally invasive approach for the management of a thoracic dumbbell tumor.
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BACKGROUND: Multimodal strategy including chemotherapy and hepatectomy is advocated for the management of colorectal liver metastases (CRLM). The aim of this study was to evaluate the impact of neoadjuvant Bevacizumab-based chemotherapy on survival in patients with resected stage IVA colorectal cancer and liver metastases. METHODS: Data from 120 consecutive patients who received neoadjuvant chemotherapy and underwent curative-intent hepatectomy for synchronous CRLM were retrospectively reviewed. Overall survival (OS) was stratified according to administration of Bevacizumab before liver resection and surgical strategy, i.e., classical strategy (primary tumor resection first) versus reverse strategy (liver metastases resection first). RESULTS: Patients who received Bevacizumab (n = 37; 30%) had a higher number of CRLM (p = 0.003) and underwent more often reverse strategy (p = 0.005), as compared to those who did not (n = 83; 70%). Bevacizumab was associated with an improved OS compared with conventional chemotherapy (p = 0.04). After stratifying by the surgical strategy, Bevacizumab was associated with improved OS in patients who had classical strategy (p = 0.03). In contrast, Bevacizumab had no impact on OS among patients who had liver metastases resection first (p = 0.89). CONCLUSIONS: Neoadjuvant Bevacizumab-based chemotherapy was associated with improved OS in patients who underwent liver resection of synchronous CRLM, especially in those who underwent primary tumor resection first.