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[PMID]:27779560
[Au] Autor:Chern A; Hunter JB; Bennett ML
[Ad] Endereço:The Otology Group of Vanderbilt University, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
[Ti] Título:Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery.
[So] Source:Otol Neurotol;38(1):147-151, 2017 01.
[Is] ISSN:1537-4505
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. STUDY DESIGN: Retrospective case series. PATIENTS: One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. INTERVENTION: Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. RESULTS: One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65-$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28-$111404.55). The median cost of a CSF leak was $50401.25 (range, $0-$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. CONCLUSION: Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.
[Mh] Termos MeSH primário: Ângulo Cerebelopontino/cirurgia
Vazamento de Líquido Cefalorraquidiano/economia
Craniotomia/economia
Craniotomia/métodos
Complicações Pós-Operatórias/economia
[Mh] Termos MeSH secundário: Idoso
Vazamento de Líquido Cefalorraquidiano/etiologia
Vazamento de Líquido Cefalorraquidiano/cirurgia
Custos e Análise de Custo
Craniotomia/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


  2 / 2910 MEDLINE  
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[PMID]:29390569
[Au] Autor:Roh TH; Park YS; Park YG; Kim SH; Chang JH
[Ad] Endereço:Yonsei University Graduate School.
[Ti] Título:Intracranial squamous cell carcinoma arising in a cerebellopontine angle epidermoid cyst: A case report and literature review.
[So] Source:Medicine (Baltimore);96(51):e9423, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Most of the intracranial epidermoid cysts are benign, but malignant lesions are occasionally reported. These lesions appear as squamous cell carcinoma and carry a dismal prognosis. Here, we report a case of a primary intracranial squamous cell carcinoma arising in a cerebellopontine epidermoid cyst. The relevant literatures were also reviewed. PATIENT CONCERNS: A 53-year-old woman presented with dizziness and diplopia 9 months in duration. Magnetic resonance imaging revealed an epidermoid cyst in the left cerebellopontine angle and prepontine region with a focal enhancing lesion on T1-weighted gadolinium-enhanced images. DIAGNOSES: Histopathologic diagnosis revealed squamous cell carcinoma on a background of epidermoid cyst. Imaging studies excluded metastases. INTERVENTIONS: The tumor was removed subtotally through a lateral suboccipital approach. The patient received intensity modulated radiation therapy (6720 cGy total) postoperatively. OUTCOMES: The patient was free from recurrence of the tumor until 3 years after surgery, at which point she was lost to follow-up. The patient died 4 years after the surgery. LESSONS: The epidermoid cyst may occasionally become malignant. Finding an area of enhancement through preoperative magnetic resonance imaging can help to make a correct diagnosis. Based on the review of previous reports, surgical removal followed by radiotherapy shows the best result to treat malignant epidermoid cysts.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/etiologia
Neoplasias Cerebelares/etiologia
Ângulo Cerebelopontino
Cisto Epidérmico/complicações
[Mh] Termos MeSH secundário: Carcinoma de Células Escamosas/diagnóstico
Carcinoma de Células Escamosas/patologia
Carcinoma de Células Escamosas/terapia
Neoplasias Cerebelares/diagnóstico
Neoplasias Cerebelares/patologia
Neoplasias Cerebelares/terapia
Ângulo Cerebelopontino/patologia
Terapia Combinada
Feminino
Seres Humanos
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009423


  3 / 2910 MEDLINE  
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[PMID]:28552738
[Au] Autor:Taghipour M; Saffarrian A; Ghaffarpasand F; Azarpira N
[Ad] Endereço:Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
[Ti] Título:Dumbbell-Shape Hydatid Cyst of Meckel Cave Extending to Cerebellopontine Angle and Middle Fossa; Surgical Technique and Outcome of Rare Case.
[So] Source:World Neurosurg;104:1049.e7-1049.e10, 2017 Aug.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cerebral hydatid cyst is among the rare presentations of echinococcosis. Almost all the reported cases of intracranial hydatid cysts are in the cortical regions (parietal lobe in the territory of the middle cerebral artery), and all have been removed surgically using the water jet dissection technique. However, in locations in which there are several neuronal structures, such as the cerebellopontine angle, this method might not be applicable. CASE DESCRIPTION: A 62-year-old lady presented to our outpatient clinic with left-sided facial deviation, inability to close the eyes, and diplopia since a month before. She was diagnosed with having a dumbbell-shape lesion in the Meckel cave extending to the left cerebellopontine angle and middle fossa just lateral to the cavernous sinus. As it was adherent to the surrounding structures, we evacuated the contents using a fine needle and then dissected the cyst totally. The patient's symptoms alleviated after the surgery, and there was no residue. After the 2-year follow-up, our patient does not have recurrence. CONCLUSIONS: The Meckel cave and cerebellopontine angle are rare locations for hydatid cysts, and the surgical technique is different due to adhesion of the cyst to several neuronal structures (lower cranial nerve, brainstem, and cerebellum). Needle aspiration along with dissection of the cyst microsurgically is recommended in similar cases.
[Mh] Termos MeSH primário: Infecções Parasitárias do Sistema Nervoso Central/cirurgia
Ângulo Cerebelopontino/cirurgia
Fossa Craniana Média/cirurgia
Equinococose/cirurgia
Procedimentos Neurocirúrgicos
[Mh] Termos MeSH secundário: Infecções Parasitárias do Sistema Nervoso Central/diagnóstico por imagem
Ângulo Cerebelopontino/diagnóstico por imagem
Fossa Craniana Média/diagnóstico por imagem
Equinococose/diagnóstico por imagem
Feminino
Escala de Resultado de Glasgow
Seres Humanos
Imagem por Ressonância Magnética
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170530
[St] Status:MEDLINE


  4 / 2910 MEDLINE  
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[PMID]:28479521
[Au] Autor:Alonso F; Dekker SE; Wright J; Wright C; Alonso A; Carmody M; Tubbs RS; Bambakidis NC
[Ad] Endereço:Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Seattle Science Foundation, Seattle, Washington, USA. Electronic address: fea4@case.edu.
[Ti] Título:The Retrolabyrinthine Presigmoid Approach to the Anterior Cerebellopontine Region: Expanding the Limits of Trautmann Triangle.
[So] Source:World Neurosurg;104:180-185, 2017 Aug.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The anatomic area exposed through exposure of Trautmann triangle may not be sufficient. We studied the additional exposure provided by skeletonizing the sigmoid sinus (SS). METHODS: In 5 human cadaveric heads, thin-cut computed tomography images of 2 sides of the temporal bone were obtained for a total of 10 sides. The estimated surgical working angle was calculated based on the relationship of the SS to the posterior semicircular canal (PSC), superior petrosal sinus, and jugular bulb on imaging. Mastoidectomy was performed, and heads with and without SS skeletonization were remeasured. RESULTS: Working angle calculated on computed tomography was 56° ± 11.3. Skeletonization of the SS increased the distance between the PSC and SS by 5 mm (P = 0.01) and between the lateral semicircular canal and SS by 4 mm (P = 0.01). Skeletonization and retraction of the SS significantly increased the distance between the PSC and lateral semicircular canal to the SS. On images obtained after mastoidectomy, skeletonizing the SS helped improve anterior visibility on most samples that had an SS that was lateral to the PSC on axial imaging. In samples in which the SS was medial to the PSC or had only minimal lateral displacement, skeletonizing the SS did not markedly improve visibility of the retrolabyrinthine space. CONCLUSIONS: Working area and visibility improved as the PSC and SS approached the same plane on axial imaging. Preoperative evaluation of the laterality of the SS to the PSC may assist a surgeon in determining the need for skeletonizing the SS and avoiding possible vascular injuries.
[Mh] Termos MeSH primário: Pontos de Referência Anatômicos/anatomia & histologia
Pontos de Referência Anatômicos/diagnóstico por imagem
Ângulo Cerebelopontino/anatomia & histologia
Ângulo Cerebelopontino/cirurgia
Craniotomia/métodos
Osso Temporal/anatomia & histologia
Osso Temporal/cirurgia
[Mh] Termos MeSH secundário: Adulto
Pontos de Referência Anatômicos/cirurgia
Cadáver
Ângulo Cerebelopontino/diagnóstico por imagem
Cavidades Cranianas/anatomia & histologia
Cavidades Cranianas/diagnóstico por imagem
Cavidades Cranianas/cirurgia
Feminino
Seres Humanos
Masculino
Osso Temporal/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170509
[St] Status:MEDLINE


  5 / 2910 MEDLINE  
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[PMID]:28435113
[Au] Autor:Matsushima K; Komune N; Matsuo S; Kohno M
[Ad] Endereço:Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA; Department of Neurosurgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan. Electronic address: ken.matsushima.g@gmail.com.
[Ti] Título:Microsurgical and Endoscopic Anatomy for Intradural Temporal Bone Drilling and Applications of the Electromagnetic Navigation System: Various Extensions of the Retrosigmoid Approach.
[So] Source:World Neurosurg;103:620-630, 2017 Jul.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The use of the retrosigmoid approach has recently been expanded by several modifications, including the suprameatal, transmeatal, suprajugular, and inframeatal extensions. Intradural temporal bone drilling without damaging vital structures inside or beside the bone, such as the internal carotid artery and jugular bulb, is a key step for these extensions. This study aimed to examine the microsurgical and endoscopic anatomy of the extensions of the retrosigmoid approach and to evaluate the clinical feasibility of an electromagnetic navigation system during intradural temporal bone drilling. METHODS: Five temporal bones and 8 cadaveric cerebellopontine angles were examined to clarify the anatomy of retrosigmoid intradural temporal bone drilling. Twenty additional cerebellopontine angles were dissected in a clinical setting with an electromagnetic navigation system while measuring the target registration errors at 8 surgical landmarks on and inside the temporal bone. RESULTS: Retrosigmoid intradural temporal bone drilling expanded the surgical exposure to allow access to the petroclival and parasellar regions (suprameatal), internal acoustic meatus (transmeatal), upper jugular foramen (suprajugular), and petrous apex (inframeatal). The electromagnetic navigation continuously guided the drilling without line of sight limitation, and its small devices were easily manipulated in the deep and narrow surgical field in the posterior fossa. Mean target registration error was less than 0.50 mm during these procedures. CONCLUSIONS: The combination of endoscopic and microsurgical techniques aids in achieving optimal exposure for retrosigmoid intradural temporal bone drilling. The electromagnetic navigation system had clear advantages with acceptable accuracy including the usability of small devices without line of sight limitation.
[Mh] Termos MeSH primário: Ângulo Cerebelopontino/cirurgia
Microcirurgia/métodos
Neuroendoscopia/métodos
Osso Temporal/cirurgia
[Mh] Termos MeSH secundário: Cadáver
Artéria Carótida Interna
Fenômenos Eletromagnéticos
Seres Humanos
Veias Jugulares
Neuronavegação/métodos
Cirurgia Assistida por Computador
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170425
[St] Status:MEDLINE


  6 / 2910 MEDLINE  
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[PMID]:28400229
[Au] Autor:Cheng J; Liu W; Zhang S; Lei D; Hui X
[Ad] Endereço:Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
[Ti] Título:Clinical Features and Surgical Outcomes in Patients with Cerebellopontine Angle Hemangioblastomas: Retrospective Series of 23 Cases.
[So] Source:World Neurosurg;103:248-256, 2017 Jul.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Hemangioblastomas in the cerebellopontine angle (CPA) are uncommon and have rarely been reported. They may be easily misdiagnosed because of the atypical location and clinical and imaging features. The present study aimed to characterize clinical and radiologic features, treatment strategies, and outcomes in these rare lesions and to investigate various factors that may affect postoperative outcomes. METHODS: The medical records of patients with CPA hemangioblastomas who underwent surgery from 2003-2016 at the West China Hospital were reviewed retrospectively and statistically analyzed. RESULTS: Twenty-three patients (14 males and 9 females) presented with CPA hemangioblastomas. Eight patients (34.8%) had von Hippel-Lindau (VHL) syndrome. Gross total resection was achieved in 22 patients (95.6%). The mean follow-up was 45.1 ± 36.2 months (range 3-144 months). After surgery, the symptoms improved in 18 cases (78.3%), remained unchanged in 3 cases (13%), and were aggravated in 2 cases (8.7%). Four patients showed local recurrence during follow-up (17.4%). Patients with cystic hemangioblastomas had a better neurologic improvement (P = 0.041) compared with patients with solid tumors. Furthermore, patients with maximal diameter of tumors >3 cm (P = 0.035) or solid tumors (P = 0.018) showed a higher incidence of postoperative complications. The local recurrence was correlated with VHL disease (P = 0.027). CONCLUSIONS: Although hemangioblastomas of the CPA are challenging lesions to treat surgically, they can be removed safely when these lesions are appropriately diagnosed and treated. Patients with VHL disease are more likely to have a local recurrence. A regular follow-up is recommended to detect the local and distant recurrence, even if the clinical course is benign and the tumor is totally resected.
[Mh] Termos MeSH primário: Neoplasias Cerebelares/cirurgia
Ângulo Cerebelopontino
Hemangioblastoma/cirurgia
Recidiva Local de Neoplasia/epidemiologia
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Angiografia Digital
Ataxia/etiologia
Neoplasias Cerebelares/complicações
Neoplasias Cerebelares/diagnóstico por imagem
Neoplasias Cerebelares/etiologia
Angiografia por Tomografia Computadorizada
Feminino
Cefaleia/etiologia
Perda Auditiva/etiologia
Hemangioblastoma/complicações
Hemangioblastoma/diagnóstico por imagem
Hemangioblastoma/etiologia
Seres Humanos
Angiografia por Ressonância Magnética
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Neoplasia Residual
Procedimentos Neurocirúrgicos
Recuperação de Função Fisiológica
Estudos Retrospectivos
Zumbido/etiologia
Vertigem/etiologia
Doença de von Hippel-Lindau/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170413
[St] Status:MEDLINE


  7 / 2910 MEDLINE  
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[PMID]:28219164
[Au] Autor:Wang ZY; Jia H; Yang J; Tan HY; Wu H
[Ad] Endereço:Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University Ear Institute, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200011, China.
[Ti] Título:[A combination use of endoscope and microscope in cerebral pontine angle surgery].
[So] Source:Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi;52(2):85-88, 2017 Feb 07.
[Is] ISSN:1673-0860
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle (CPA) surgery. A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively. The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas, 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma. Twenty cases of vestibular swannnomas, 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach, while other cases undergone the surgery via retrolabyrinthine approach. Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion. The surgical results were evaluated according to subjective and objective criteria, and all patients were followed up for 15 years. The symptoms was disappeared in the cranial neuropathy patients, without facial paralysis, complication of other nerves or hearing loss. Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma, which gained completely surgical removal; useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up. A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques. It can provide better exposure with minimal invasion in CPA surgery, and is especially applicable in surgery for cranial neuropathy, vestibular schwannoma and CPA cholesteatoma, which should be performed through retrosigmoid approach and retrolabyrinthine approach.
[Mh] Termos MeSH primário: Ângulo Cerebelopontino/cirurgia
Endoscópios
Endoscopia/métodos
Microcirurgia/métodos
Neuroma Acústico/cirurgia
[Mh] Termos MeSH secundário: Feminino
Audição
Perda Auditiva
Seres Humanos
Masculino
Microcirurgia/instrumentação
Meia-Idade
Procedimentos Neurocirúrgicos/métodos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170802
[Lr] Data última revisão:
170802
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170222
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1673-0860.2017.02.002


  8 / 2910 MEDLINE  
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[PMID]:28192784
[Au] Autor:Bhaskar MK; Jaiswal M; Ojha BK; Singh SK; Chandra A; Meel M; Faheem M
[Ad] Endereço:Department of Neurosurgery, King George's Medical University, Lucknow, India.
[Ti] Título:Extra-Axial Cerebellopontine Angle Medulloblastoma in an Infant.
[So] Source:Pediatr Neurosurg;52(2):122-126, 2017.
[Is] ISSN:1423-0305
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:Medulloblastoma is a common tumor of the posterior fossa, representing 20-25% of all pediatric neoplasms. It commonly occurs in the midline (cerebellar vermis) and rarely at the cerebellopontine angle. Most of them are intra-axial, and an extra-axial location of this tumor is very rare. Extra-axial cerebellopontine angle medulloblastoma is extremely uncommon and has never been reported in an infant. We report an extra-axial cerebellopontine angle medulloblastoma in a 1-year-old child.
[Mh] Termos MeSH primário: Neoplasias Cerebelares/diagnóstico
Meduloblastoma/diagnóstico
[Mh] Termos MeSH secundário: Neoplasias Cerebelares/patologia
Ângulo Cerebelopontino/diagnóstico por imagem
Ângulo Cerebelopontino/patologia
Seres Humanos
Lactente
Meduloblastoma/diagnóstico por imagem
Meduloblastoma/patologia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170328
[Lr] Data última revisão:
170328
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170214
[St] Status:MEDLINE
[do] DOI:10.1159/000455921


  9 / 2910 MEDLINE  
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[PMID]:28110401
[Au] Autor:Lagman C; Voth BL; Chung LK; Bui TT; Lee SJ; Barnette NE; Gopen Q; Yang I
[Ad] Endereço:Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
[Ti] Título:Evaluating the utility of a scoring system for lipomas of the cerebellopontine angle.
[So] Source:Acta Neurochir (Wien);159(4):739-750, 2017 Apr.
[Is] ISSN:0942-0940
[Cp] País de publicação:Austria
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cerebellopontine angle (CPA) lipomas are rare, benign, slow-growing masses. Resections are considered in symptomatic patients who are refractory to targeted medical therapies, but at those stages the lipomas have often reached considerable sizes and encompass critical neurovascular structures. The objective of this study is to develop and to evaluate the utility of a scoring system for CPA lipomas. The hypothesis is that CPA lipomas with lower scores are probably best managed with early surgery. METHODS: The PubMed database was searched using relevant terms. Data on patient and lipoma characteristics were extracted and used to design a scoring system. CPA lipomas were stratified by scores with corresponding managements and outcomes analyzed. RESULTS: One hundred and seventeen patients with CPA lipomas were identified and 40 CPA lipomas were scored. The remaining CPA lipomas were deficient in data and not scored. No lipomas were scored as 1. Score 2 lipomas (n = 12; 30%) most often underwent serial surveillances (n = 5; 41.6%), with the majority of symptoms remaining unimproved (n = 2; 40%). Patients with score 2 CPA lipomas treated with medical therapies (n = 3; 25%) often experienced symptom resolution (n = 2; 66.6%) (p = 0.0499). Patients with score 2 CPA lipomas undergoing surgical resections (n = 3; 25%) all experienced symptom resolution (n = 3; 100%) (p = 0.0499). Score 3 was most common (n = 16; 40%) and these lipomas were often surgically resected (n = 10; 62.5%). The majority of patients with score 3 CPA lipomas having undergone surgical resections (n = 10; 62.5%) experienced symptom improvement (n = 1; 10%) or resolution (n = 4; 40%). CONCLUSIONS: Score 2 CPA lipomas are smaller and would be deemed non-surgical in general practice. However, our data suggest that these lipomas may benefit from either medical therapies or early surgical resections. The advantages of early surgery are maximal resection, decreased surgical morbidity, and improved symptom relief.
[Mh] Termos MeSH primário: Neoplasias Cerebelares/patologia
Ângulo Cerebelopontino/patologia
Lipoma/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Masculino
Meia-Idade
Gradação de Tumores/normas
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170123
[St] Status:MEDLINE
[do] DOI:10.1007/s00701-017-3076-5


  10 / 2910 MEDLINE  
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[PMID]:28049034
[Au] Autor:Laviv Y; Thomas A; Kasper EM
[Ad] Endereço:Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: ylaviv@BIDMC.harvard.edu.
[Ti] Título:Hypervascular Lesions of the Cerebellopontine Angle: The Relevance of Angiography as a Diagnostic and Therapeutic Tool and the Role of Stereotactic Radiosurgery in Management. A Comprehensive Review.
[So] Source:World Neurosurg;100:100-117, 2017 Apr.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The cerebellopontine angle (CPA) is a narrowed skull base area containing important cranial nerves and vessels and bordering with eloquent areas of the posterior fossa. Tumors of the CPA are a heterogeneous group and can have extradural, intradural/extra-axial, or intra-axial origins. Their vascular supply changes depending on their anatomic origin. Symptomatic, large CPA tumors require surgical resection in order to prevent irreversible, severe neurological damages. However, its tight and strategical location make surgery in the CPA very challenging and require appropriate pre-surgical planning. Pre-surgical diagnosis is of great importance as it allows us to choose the optimal management for the particular patient. This is of further significance when encountering high-risk lesions such as hypervascular tumors. Neurosurgeons should utilize every available pre-surgical diagnostic modalities as well as neo-adjuvant treatments in order to reduce such risks. METHODS: We review all reported cases of hypervascular lesions of the CPA and discuss the roles of angiography and stereotactic radiosurgery in their management. RESULTS: Three lesions of the CPA can be considered as truly hypervascular: hemangioblastomas, hemangiopericytomas and paragangliomas. All lesions share many radiological features. However, each lesion has a different anatomical origin and hence, has a characteristic vascular supply. Pre-surgical angiography can be utilized as a diagnostic tool to narrow down the differential diagnosis of a vascular CPA lesion, based on the predominant supplying vessel. In addition, pre-surgical embolization at time of angiography will narrow the associated surgical risks. CONCLUSIONS: Angiography is a crucial diagnostic and therapeutic tool, helping both in narrowing the presurgical differential diagnosis and in controlling intraoperative bleeding. Because of the high surgical risks associated with resection of vascular tumors in the CPA, noninvasive treatments, such as stereotactic radiosurgery, also may have a crucial role.
[Mh] Termos MeSH primário: Neoplasias Cerebelares/diagnóstico por imagem
Neoplasias Cerebelares/radioterapia
Ângulo Cerebelopontino/diagnóstico por imagem
Angiografia Cerebral
Radiocirurgia
[Mh] Termos MeSH secundário: Feminino
Hemangioblastoma/diagnóstico por imagem
Hemangioblastoma/radioterapia
Seres Humanos
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170104
[St] Status:MEDLINE



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