Volume 27 - nº 3 - julho / agosto / setembro 2016

  • Volume: 27
  • Número: 3
  • Período: julho / agosto / setembro 2016
  • ISSN (versão impressa): 0103-5118
  • e-ISSN (versão online): 2446-6786
  • Editor: Ricardo Ramina - Curitiba/PR

Artigo completo

Ana Luiza Pereira Velho, Karen Machado Lima, Carlos Fernando dos Santos Moreira

Introduction: The gliomas are the most common primary neoplasms of the central nervous system, and responsible for high morbimortality, especially when there is no appropriate treatment and follow-up. Objective: To evaluate the existence or nonexistence of the appropriate postoperative follow-up, relating it with sociodemographic data and histological tumor type. Material and Methods: A quantitative, observational, longitudinal, retrospective study was carried with secondary data collection. Patients who underwent surgery between 2015 and 2016 neoplasia removal and who were under postoperative follow-up in a medium-sized hospital in Southern Santa Catarina were selected. Results: The analysis was performed with 21 medical records, the majority of whom were men, white and married, between the sixth and seventh decades of life. The most common histological type was glioblastoma (76.2%). More than half of the patients performed oncological follow-up (71.4%), however none of them performed neurosurgical follow-up. Most of them used adjuvant therapy with chemotherapy and radiotherapy, and the temozolomide was the favorite drug. Two patients presented recurrence with histological type similar to the initial tumor. Conclusion: The study demonstrated that despite of the patients did not perform neurosurgical follow-up, most of them performed adjuvant therapy, obtaining greater survival.
Key words: Brain tumours; Glioma; Follow-up; Neurosurgery; Adjuvant therapy

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Cesar Cozar Pacheco, Bruno Camporeze, Iracema Araújo Estevão, Patrick Moro Mariano, Marcos Kendi Sekine, Ubiratan Passos Muniz, Paulo Queiroz Luciano, Eduardo Jorge Cury Filho, Carlos Tadeu Parisi de Oliveira

Metastasis of renal cell carcinoma to the sellar region is rare, representing less than 1% of the cases of metastasis to the sellar region. Objective: This paper aims to describe a case of metastasis of renal carcinoma to the sellar region attended at San Francisco of Assis Universitary Hospital. Methods: A case report based on retrospective analysis of medical records and additional tests was concluded. Clinical Presentation: The authors reported a case of patient affected by left palpebral ptosis after five years of left radical nephrectomy. The magnetic resonance imaging of the brain and orbits revealed the presence of an expansive intrasellar process resulting from metastasis of the renal cell carcinoma. Chest computed tomography also showed pulmonary pre-tracheal metastasis, hence the neurosurgical team chose not to perform the surgery. Conclusion: This clinic situation is a very rare variant of renal carcinoma and the parasellar region is a poorly described site. The authors emphasize the need to consider the metastasis of renal carcinoma as a differential diagnosis of parasellar region tumors.
Key words: Neurosurgery; Kidney Neoplasms; Neoplasm Metastasis; Pituitary Gland

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Cléciton Braga Tavares, Francisca das Chagas Sheyla Almeida Gomes Braga, Emerson Brandão Sousa, José Nazareno Pearce de Oliveira Brito

OBJECTIVE: This review aims to carry out a survey on the importance of Ki67 in the astrocytomas study. METHODS: A search in the electronic database of Medline via PubMed and using MESH terms was carried out. Articles were published between January 2005 and December 2015. All studies were analyzed by two experienced researchers, using inclusion and exclusion criteria for the selection of studies. RESULTS: Five studies showed an association between cell proliferation and survival time. Four articles mentioned as cut-off point for survival a Ki67 of 10% and a fifth article a Ki67 of 14.3. A study showed an association between therapeutic failure and Ki67. Four studies have made the association between Ki67 and World Health Organization classification. CONCLUSION: High levels of Ki67 are associated to high grade astrocytomas and lower survival time.
Key words: Astrocytoma; Glioma; Glioblastoma; Prognosis; Mortality

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Joseph Franklin Chenisz da Silva, Daniel Augusto Mauad Lacerda, Gustavo Henrique de Souza Machado, Marco Antonio Nihi, Paulo Ramos David João

The Vein of Galen Aneurysmal Malformation (VGAM) represents about 1% of the intracranial vascular malformations. It is characterized by an increased dilatation of the Vein of Galen, containing multiple arteriovenous fistulas that drain to a median prosencephalic vein called vein of Markowski, precursor of the Vein of Galen. The etiology of VGAM is still unknown and has no relation with family medical history. During the perinatal period, the first clinical manifestation is generally the presentment of heart failure. Diagnosis can be done during pregnancy through the pregnancy ultrasound and, posteriorly, through transfontanellar ultrasound, magnetic resonance imaging and angiography, which is the gold standard exam. Nowadays, the safest and most accepted method of treatment is the endovascular embolization. We report a case of a newborn with a pregnancy ultrasound suggesting VGAM, with a classic presentation of heart failure 8 days after his birth, confirming the hypothesis with neuroimaging investigation. After clinical stabilization during hospitalization, the patient underwent embolization in 3 stages with good clinical outcome. The deterioration of the prognosis if not treated highlights the importance of an early diagnosis of this condition. Even though its rarity, it should be considered as differential diagnosis when facing a newborn with heart failure.
Key words: Vein of Galen Malformations; Cerebral Veins; Aneurysm; Heart Failure; Therapeutic Embolization

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Erika Tavares Ferreira, Camila Lima Alves, Ádria Maria Simões Silva

The rhabdoid terathoid tumor is a rare primary central nervous system (CNS) neoplasm that is most common in 3-years-old children. It has a peculiar evolution with a very short survival time mainly in the age groups inferior to 3-years-old. We reported a case of a 5-year-old child with tumor (TU) in the left fronto-parietal region with complaints of persistent, progressive headaches, refractory to common analgesics, and later progressing with nuchal rigidity and dyslalia. Brain computed tomography (CT) revealed CNS tumor-compatible expansive lesion. Patient was operated on, and the diagnosis was established by histopathological and immunohistochemical analysis which revealed to be ARTT. Due to the tumor recurrence in a short period of time, scores on the Karnofsky scale of 50 and impossibility of total tumor resection, the patient was submitted to palliative treatment only. Therapeutics today represents a challenge in onco-pediatrics, many approaches are described, but there is no consensus regarding to the best method. The superiority of one therapeutic scheme over the other is not observed until the present moment. Therefore, no significant increase of the survival or cure of the patient were seen.
Key words: Teratoide Rhabdoid Tumor; Neoplasm; Malignant; Oncology; Central nervous system.

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Simão Lunière Gonçalves

Astrocytomas are brain neoplasms derived from astrocytes. Among the histological subtypes of this neoplasm, degree IV is also known as glioblastoma multiforme (GBM) and the most common primary brain tumor. Cerebellar location for this neoplasm is extremely rare, and since 1975 to 2011 less than 180 cases were registered in the world. Several theories tried to explain its origin (embryonic cells, anaplastic progression), however, until this moment no conclusion was obtained. The clinical picture of cerebellar involvement is confused between the various lesions in the posterior fossa. The GBM should always be considered as a diagnostic hypothesis of aggressive tumor lesions of cerebellar hemisphere. Treatment is based on the microsurgical exeresis, radiotherapy and chemotherapy. The present report describes a male patient, who was affected by this rare neoplasm.
Key words: Cerebellum; Glioblastoma; Neurosurgery

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Artigo completo

Lucas Fontes Costa, Jorge Dornellys da Silva Lapa, Carlos Umberto Pereira, Érika de Abreu Costa Brito, Jerônimo Goncalves de Araújo, Joacir Gracioli Cordeiro

Neurohistoplasmosis is a rare disease and it is difficult to diagnose by its non-specific presentation with clinical-radiological overlap with other infections prevalent in immunosuppressed individuals. The objective of this work is to describe a case of an HIV positive patient with multiple brain lesions, evolving with clinical and imaging worsening despite the empirical antibiotic treatment in which the stereotactic biopsy defined the diagnosis of histoplasmosis.
Key words: Neurohistoplasmosis; Stereotactic Brain Biopsy; Diagnosis

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Artigo completo

Leandro Pelegrini de Almeida, Guilherme Finger, Pasquale Gallo, Eduardo Cambruzzi, Carolina Ferreira Colaço, Alana Thuane Rutzen, Sirlei Westernower Monteiro Iranso Ramos

Glioblastoma Multiforme is the most frequent primary brain neoplasm and can be histologically classified into three different subtypes. Giant Cell Glioblastoma is a rare and the least frequent subtype, with male predominance especially in the fourth decade of life. Image exams hardly distinguish the different forms of glioblastomas. Once natural history of this specific subtype is unknown, and, consequently, the therapeutic management is not standardized, the authors report an interesting case of Giant Cell Glioblastoma followed by a literature review of the disease.
Key words: Brain Neoplasms; Glioblastomas; Giant Cell Glioblastoma; Astrocytoma grade IV; Surgical Oncology

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Leonardo Carmo Kawakame da Silva, Matheus de Quadros Ribeiro, Tiago Gonçalves Rosa

Introduction: Chronic extradural hematoma is an uncommon condition representing 3.9-30% of all cases of extradural hematoma. There is no consensus among the authors as to an exact definition of the lesion or the time interval necessary for its onset. Objective: To describe a case of chronic calcified external hematoma after 18 years of traumatic brain injury (TBI), in addition to reviewing a literature on the subject. Clinical Case: The case was based on imaging exams, histological study and surgical result, besides a systematized review of the literature. A 45-year-old male patient who started with dizziness and postural instability within 11 days of admission. He reported that 18 years ago he had suffered an automobile accident with TBI but did not undergo a neurosurgical pro-surgical procedure. Computed tomography showed a biconvex hyperdense lesion at its edges and hypodense in its interior characterizing the chronic extradural hematoma. The patient was operated on and after 5 days of surgery was discharged without neurological deficit. Conclusion: Although it is an uncommon disorder, everyone should be aware of its eventual development and the correct measures for its treatment.
Key words: Extradural hematoma; Chronic extradural hematoma; Calcified extradural hematoma.

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Artigo completo

Mariana Romero, Alejandra Jaume, Verónica Bentancourt, Ignacio Aramburú, Teresa Lin, Roberto Crosa, Omar Thelis, Edgardo Spagnuolo

We report an extremely rare case of a patient illustrious 51 year-old who presented a progressive neurological symptoms, in which a giant partially thrombosed serpentine aneurysm (AS) was diagnosed and then an endovascular treatment performed to occlude the aneurysm.
Key words: Intracranial aneurysm; Cerebral revascularization; Fusiform aneurysm

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