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APPROVED ABSTRACTS
ORAL PRESENTATIONS
Código: 44146
Temário: Neurocirurgia
Data: 3/25/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: IMPORTANCE TO MOTIVATE BRAIN TUMOR BOARD – THE IMPACT OF THE
MULTIDISCIPLINARY NEURO-ONCOLOGY TEAM TO APPROACH PATIENTS HARBORING BRAIN
TUMORS KEY-WORDS
Apresentador: Roberto leal Silveira
Instituição: HOSPITAL MADRE TERESA
Autores: Roberto Leal da silveira; Marcos Vinicius Calfat Maldaun;
Resumo: Introduction: The interdisciplinary setting together with neurosurgery, radio-oncology
and medical oncology is still controversial and difficult to be settled. Objective: The aim of this
study is to evaluate the importance of motivating a brain tumor board, and to measure the
impact of a multidisciplinary neuro-oncology team on the patients harboring brain tumors.
Patients and Methods / Results: The interdisciplinary collaboration and approach of 30
consecutive patients with brain tumors were enrolled in this work after their clinical cases were
discussed in a brain tumor board. Neuro-oncology strategies for patients with brain tumors are
presented and discussed. The main idea was always to question if the initial conduct was the
most appropriate. The following methods were evaluated / and the results obtained from the
brain tumor boards of 30 consecutive cases of patients were as follows: a-the conduct of the
neurosurgery has changed? /Results: yes=12(40%), no=18(60%). b- the conduct of the oncology
has changed: /results- yes=13(47%)/no=17(53%). c- the conduct of the radiotherapy has
changed: /results - yes=10(33%)/no=20(67%). d- the image (radiology) has suggested new ideas:
/results- yes=22(73%, no=08(27%) e- The medical doctor in charge of the patient became more
confident after the brain tumor board? /results - yes=23(77%)/no=07(23%). f- the results of the
tumor board changed the conduct for the patient? /results - Yes=14(47%)/no=16(53%). g- the
conducts of the tumor board were beneficial for the patient? /results: yes
=26(87%)/no=04(13%). h- the specialists have learned from the clinical case of the tumor
board?/results: yes=30(100%). i- what was the benefit for the participants: academic = 17(57%),
Conduct=13(43%). j- what happened that the conducts of the tumor board were not accepted
by the patients? Accepted = 19(63%), not accepted=11(37%), 03 were in terminal status and 08
patients the family did not accept the conducts. Discussion: Brain tumor boards had a
meaningful impact in 54,6% of the patients, and have made changes in 73% of the imaging and
confidence improvement in 77% of the specialists. Some conducts have changed in 67% of the
patients. A brain tumor board should be established and driven together to improve outcome
and care of patients with brain tumors. Conclusion: It is very important to motivate brain tumor
boards. The patients harboring brain tumors suffer significant impact if a neuro-oncology team
approaches them.
Contato: [email protected]
Código: 44257
Data: 3/25/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: ‘HIGH MAGNIFICATION MICROSURGERY’ FOR HIGH GRADE GLIOMAS. TECHNIQUE AND
RESULTS WITH LONG-TERM FOLLOW-UP
Apresentador: Tommaso Tufo
Instituição: ISTITUTO NEUROLOGICO NEUROMED
Autores: Tommaso Tufo; Valentina Pizzuti; Luigi Pavone; Alessandro D‘Elia; Tommaso
Vangelista; Vincenzo Esposito;
Resumo: Objectives: Many studies have shown that the ratio of gross total resections of high
grade gliomas (HGGs) was higher if the fluorescence technique (5-ALA and fluorescein-guided
resection) was used. The authors report their experience with a ‘high magnification technique’
for HGGs surgery without fluorescent molecules. Materials and Methods: The inclusion criteria
of this retrospective study were the same as the 5-ALA study of 2006 (Stummer et al). 27 adult
patients (mean age 62 yrs, range 42-77 yrs) with supratentorial glioblastoma multiforme (GBM)
were included. ‘High Magnification’ surgery (12,5x 220 mm Carl Zeiss and Leica Microscope) was
performed considering as limits of resection: micro vascular architecture of sub cortical and
deep white matter (medullary arteries); pial borders (interpial dissection);Sharp gray-white
matter interface.The median preoperative tumour volume was 37 cm3 (range 2.7–140 cm3).
The median pre-operative Karnofsky Performance Scale (KPS) score was 80 (range 60-90). The
tumour volume and residual tumour volume (MRI contrast-enhancing area greater than > 0.175
cm and CT-volumetric scan) were calculated using 3DSlicer v.4.4.0. All patients were treated
according to the Stupp protocol. The median duration of follow-up was 27 months (range 3-72
months) Results:The micro vascular structures were identified in all cases (normal architecture
reported by Duret et al, Nonaka et al). Complete removal (>95% of contrast-enhanced tumour)
was achieved in 81.5% of the patients The 6-months progression-free survival (PFS) rate was
62.5% and median survival of 18.2 months. Mean survival was 21.6 months. 3 pts (7.4%) had
post-operative neurological deterioration. 0% of mortality Conclusions: Microsurgical technique
in HGG surgery are often not used in many centres or considered unnecessary. Analysis of these
27 cases suggested that ‘high magnification technique’ is a useful tool in glioma surgery, safe,
no time consuming, with short learning curve, less expensive and rate of resection comparable
with other fluorescence-guided technique. Our preliminary report showed that PFS and overall
survival are also comparable to fluorescence-guided technique. Prospective comparative trials,
however, are still necessary to prove the impact of these techniques on both progression-free
survival and overall survival.
Código: 44259
Data: 3/25/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: PROGNOSTIC AND PREDICTIVE FACTORS OF BRAIN METASTASES FROM BREAST CANCER
IN DIFFERENT BIOLOGICAL SUBTYPES: A 406 PATIENTS CLINICAL SERIES
Apresentador: Dhiego Chaves de Almeida Bastos
Instituição: UNICAMP
Autores: Dhiego Chaves de Almeida Bastos; Marcos Vinícius Calfat Maldaun; Sujit Prabhu; Dima
Suki; Jeffrey Weinberg; Frederick F Lang; Raymond Sawaya;
Resumo: Introduction:Brain metastases (BM) from breast cancer are considered a late disease
feature, associated with a poor prognosis. With new treatments, patients might expect an
improvement on quality of life and survival time. There is recognition that breast cancer is a
collection of heterogeneous diseases divided in subtypes based on combined molecular features
such as hormonal receptors (HR) and HER2 status. We conducted this study to analyze possible
prognostic and predictive factors impacting recurrence and overall survival (OS) studying clinical
differences among biological subtypes.Methods:Retrospective study with 406 consecutive
patients with BM from BC from the Department of Neurosurgery from 1997 to 2014. Subtypes
were classified as luminal A (HR+/HER2–), luminal B (HR+/HER2+), HER2 (HR-/HER2+), and basal
(HR-/HER2–). End points were time to development of brain metastasis (TDBM), brain
metastasis free survival (BMFS) and overall survival (OS). Univariate and multivariate cox
proportional hazard regression models were used to analyze possible prognostic and
predictive.Results:In Luminal A, TDBM was 41 months; 58 months for Luminal B; 30 months for
HER2; 27 months for Basal (p<0,001). BMFS was 9 months for Luminal A; 24 months for Luminal
B; 9 months for HER2; and 7 months for Basal (p=0,06). For Luminal A, the OS was 20 months,
for Luminal B was 22 months, for HER2 was 24 months; and Basal was 9 months (p<0,001). In
multivariate analyses Basal subtype showed lower OS compared with others subtypes with a
hazard ratio of 1,9 (p<0,001). The mean local recurrence time for inflammatory subtypes was 24
months and 42 months for non-inflammatory subtypes (p=0,008). On distant recurrence, the
use of upfront WBRT showed a mean time of 53 months, compared to 30 months in patients
who didn’t, with a hazard ratio (HR) of 1,5 (p=0,024). On OS, both univariate and multivariate
analyses showed statistical significance for HER2 status (HR 1,5 for negative), estrogen receptor
negativity (HR 1,4), no primary tumor control (HR 1,5), KPS lower than 70 (HR 2,7), more than
three brain metastasis (HR 1,6) and age above 60 years (HR 1,4). No difference in OS was found
among local treatment modalities and use of WBRT.Conclusion:HR and HER2 are the most
significant biomarkers that drive BC behavior, including BM. The use of WBRT delays the BM
recurrence, but didn’t alter the OS. Prognostic scores for BC should include the biological
subtype, age, KPS and number of BM.
Código: 44260
Data: 3/25/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: INSULAR GLIOMAS AND THE ROLE OF INTRAOPERATIVE ASSISTIVE TECHNOLOGIES:
RESULTS FROM A VOLUMETRY-BASED RETROSPECTIVE COHORT
Apresentador: Breno José Alencar Pires Barbosa
Instituição: FACULDADE DE MEDICINA DA USP
Autores: Breno José Alencar Pires Barbosa; Artemisia Dimostheni; Manoel Jacobsen Teixeira;
Marcos Tatagiba; Samia Yasin Wayhs; Guilherme Lepski;
Resumo: INTRODUCTION: In the field of Glioma surgery, there has been an increasing interest
in the use of assistive technologies to overcome the difficulty of preserving brain function while
improving surgical radicality. In most reports, tumor localization has seldom been considered a
variable and the role of intraoperative adjuncts is yet to be determined for gliomas of the insula.
OBJECTIVES: To evaluate the efficacy of fluorescence-guided resection, neurophysiological
monitoring, neuronavigation, and tractography in the Extent of Resection (EOR), functionality
scores, overall survival and progression-free survival in a retrospective cohort of insular gliomas.
METHODS: We reviewed all cases of insular tumors operated on at the Department of
Neurosurgery, University Hospital of Tübingen – Germany, between May 2008 and November
2013. Extent of resection was determined by comparative volumetric analysis. Mann Whitney,
Chi-square and Kaplan-Meier functions were used for assessment of each technology’s effect on
primary and secondary outcomes. RESULTS: 28 cases (18 men (64%) and 10 women (36%);
median age at diagnosis: 52,5 years, range 12 - 59) were considered eligible for the retrospective
cohort. High grade gliomas accounted for 20 cases (71%) and the remaining 8 cases (29%) were
low grade gliomas. The most used technologies were Intraoperative Neurophysiological
Monitoring (64%) and Neuronavigation (68%). Fluorescence-guided resection with 5-ALA was
the only technique associated with resections > 90% (p = 0,04). Secondarily, tractography
determined higher rates of improvement in the postoperative Karnofsky performance status
(50% vs 5%, p = 0,02); CONCLUSION: We demonstrate for the first time that for insular gliomas
Intraoperative fluorescence with 5-ALA and DTI-based tractography may play a significant role
in achieving higher EOR while preserving patients functionality.
Código: 44273
Data: 3/25/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: DIFFERENTIAL DIAGNOSIS BETWEEN NEOPLASTIC AND NON-NEOPLASTIC BRAIN LESIONS
IN RADIOLOGY.
Apresentador: NÍCOLLAS NUNES RABELO
Instituição: HOSPITAL SANTA CASA DE RIBEIRAO PRETO
Autores: NÍCOLLAS NUNES RABELO; LUCIANO JOSÉ SILVEIRA FILHO; DANIEL ALVES BRANCO
VALLI; BRUNO NASCIMENTO BETTENCOURT DA SILVA; CHRISTIEN DANNEMBERG CUNHA; IGOR
DE SOUZA FURTADO; VITOR HUGO HONORATO PEREIRA; GEORGE SANTOS DOS PASSOS;
MARCO AURÉLIO FERRARI SANT‘ANNA; NEIFFER NUNES RABELO; LUIZ ANTONIO ARAUJO DIAS;
LUIZ ANTÔNIO ARAUJO DIAS JUNIOR; KOJI TANAKA; FERNANDO EDUARDO PLASTINA;
Resumo: Introduction: Observation of multiple lesions in the skull computed tomography (CT)
scan is always cause for concern because of the frequent possibility of neoplastic etiology,
although granulomatous diseases, infectious, vascular, iatrogenic, demielinating, trauma, and
parasitic or not, and strokes can produce similar aspect on radiology. A wide range of nonneoplastic conditions can mimic a brain tumor, both clinically and radiologically, representing a
potential pitfall for physicians involved in patient care. The study‘s goal is to alert the possibility
of other neoplastic and non-neoplastic etiologies in the differential diagnosis of hypodense
lesions in non-contrast. Methods: Literature review using PubMed, MEDLINE, Google Scolar,
Clinical Trials, EBSCO, Scielo, Topics in radiology,. Were selected by 1986-2015 period.
Discussion: Knowledge of various etiologies when faced with multiple lesions on computed
tomography allows the targeting of diagnosis and the realization of this is of fundamental
importance for the proper treatment, avoiding the irradiation of non-neoplastic lesions and
unnecessary surgeries. The lesions were most often the neoplasm (74% to 86%), especially
gliomas, followed by infections (8% to 15%) and infarcts (0.6% to 6%), which represent nonneoplastic lesions. Conclusion: As a possible result of the relatively high percentage of wrong
diagnoses neuroradiological. Histological diagnosis should be necessary most cases, because
even RMI give some dificult to make diference of this lesions.
Código: 44198
Temário: Neurologia
Data: 3/26/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: PREDICTING PREOPERATIVE AND EARLY POSTOPERATIVE SEIZURES IN PATIENTS WITH
INTRA-AXIAL BRAIN TUMORS: A RETROSPECTIVE STUDY
Apresentador: Ghazaleh Tabatabai
Instituição: DIVISION OF NEURO-ONCOLOGY, UNIVERSITY HOSPITAL TÜBINGEN, EBERHARD
KARLS UNIVERSITY OF TÜBINGEN
Autores: Ghazaleh Tabatabai; Thomas Wuttke; Jens Schittenhelm; Sabine Rona; Marcos
Tatagiba; Marco Skardelly;
Resumo: OBJECTIVES: Antiepileptic treatment of brain tumor patients is only recommended
after a tumor-associated seizure had occurred. However, in clinical practice, prophylactic
antiepileptic treatment of brain tumor patients without any evidence of seizure activity, is
frequently performed. We investigated the question whether defined clinical parameters could
help to formulate a model of risk estimations for subpopulations of brain tumor patients who
could benefit from prophylactic antiepileptic treatment. METHODS: In total, 650 patients (age
> 18 years) with intra-axial brain tumors were included in this retrospective observational single
center study. Logistic regressions were performed to determine the effect sizes of seizurerelated risk factors and to develop prognostic scores for the occurrence of preoperative and
early postoperative seizures. RESULTS: Among the total population of 650 patients, 492 patients
(334 gliomas) were eligible for logistic regression for preoperative seizures, and 338 patients for
early postoperative seizures. Age ≤ 60 years (odds ratio [OR] = 1.66, p = 0.020), grades I and II
glioma (OR = 4.00, p = 0.0002), total tumor/edema volume ≤ 64cm3 (OR = 2.18, p = 0.0003), and
frontal location (OR = 2.28, p = 0.034) demonstrated an increased risk for preoperative seizures.
Isocitrate-dehydrogenase mutations (OR = 2.52, p = 0.026) were an independent risk factor in
the glioma subgroup. Age ≥ 60 years (OR = 3.32, p = 0.041), total tumor/edema volume ≤ 64cm3
(OR = 3.17, p = 0.034), complete resection (OR = 15.50, p = 0.0009), diencephalic location
(OR = 12.2, p = 0.013), and high-grade tumors (OR = 5.67, p = 0.013) were significant risk factors
for surgery-related seizures. Antiepileptics (OR = 1.20, p = 0.60) did not affect seizure
occurrence. For seizure occurrence, patients could be stratified into 3 prognostic preoperative
and into 2 prognostic early postoperative groups. CONCLUSIONS We present a preoperative and
a perioperative prognostic score that could help to identify patients who might benefit from
seizure prophylaxis. A prospective validation of these scores is warranted.
Código: 44202
Data: 3/26/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: THE VALUE OF INTRAOPERATIVE MRI (IMRI) IN PEDIATRIC BRAIN TUMOR SURGERY
Apresentador: GABRIEL MUFARREJ
Instituição: INSTITUTO ESTADUAL DO CÉREBRO PAULO NIEMEYER
Autores: GABRIEL MUFARREJ; NINA VENTURA; EMERSON GASPARETTO; PAULO NIEMEYER
FILHO;
Resumo: Objective:Intraoperative magnetic resonance imaging has emerged as an important
tool in guiding the surgical management of children with brain tumors.The authors point out the
value of the iMRI into a short series of pediatric brain tumors, especially when the gross total
resection is an imperative step to reduce the rate of early reoperation for residual lesion in
pediatric tumor. This study describes the initial pediatric experience at Paulo Niemeyer State
Brain Institute (IECPN), with a dual-multifunction room iMRIS 1.5-T with integrated
neuronavigation in the management of pediatric brain tumors. Methods: Nine children
underwent iMRI between May 2015 and November 2015. iMRI was performed in 4
Ependymomas, 2 Craniopharyngiomas, 1 SEGA,1 Ganglioglioma and 1 Cerebellar astrocytoma,
either to assess the extent of tumor resection after surgical impression of complete/intended
tumor resection or to update neuronavigation. The average time between the start of patient
shift until iMRI suite and your return to the operating room was 24.6 minutes. Results: Three
Ependymomas were re-operated due to the presence of residual lesion in the first surgery ,
performed without intraoperative MRI. In these surgeries we were able to achieve gross total
resection as well as the fourth Ependymoma that was operated on primarily with iMRI. The two
Craniopharyngiomas were not totally removed, however iMRI favored a much wider resection
obtaining a more satisfactory removal. In Subependymal giant cell astrocytoma, the iMRI was
performed when we thought we had already removed the entire lesion and surprisingly the
magnectic resonance revealed the presence of residual lesion, which was then completely
removed. In the posterior fossa astrocytoma and ganglioglioma the iMRI demonstrated a gross
total resection of the lesion. Conclusions: At our institution iMRI has led to increased rate of
tumor resection. It has resulted in a trend toward reduction in the need for repeat surgery in
the postoperative period compared with conventional pediatric neurosurgical resections for
tumor. By providing information about the possible presence of residual tumor, iMRI allowed
the neurosurgeon to identify and resect any remaining tumor that was thought to be safely
accessible.
Código: 44254
Data: 3/26/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: USE OF FLUORESCEIN SODIUM IN RESECTION OF INTRA-PARENCHYMATOUS BRAIN MASS
LESIONS
Apresentador: Maria da Penha Mendes Mariz
Instituição: CONSELHO REGIONAL DE MEDICINA PERNAMBUCO
Autores: Maria da Penha Mendes Mariz; Breno Macedo Santiago; Walter Matias Filho; Jose
Ronaldo Bezerra de Menezes; Cicero Jose Pacheco Lins;
Resumo: ABSTRACT Objective Evaluation of the degree of impregnation of fluorescein sodium
in expansive intra-parenchymal brain lesions, regardless the degree of contrast uptake of these
lesions in neuroimaging studies. Secondarily we will be determining whether this method affects
the degree of resection of these lesions. Method We recruited 28 patients with expansive intraparenchymal brain lesions, gliomas or not, divided into 2 groups: 1) the study group (N = 15)
received high doses of fluorescein sodium (20 mg / kg) and 2) control group (N = 13) did not
received any doses of fluorescein during surgery. The tumor volumes were measured at the pre
and post-operatory period from IRM images obtained using OsiriX MD software v.3.0.2 64 -bit.
Results Confirming the findings in the medical literature, we observed a greater degree of
impregnation by fluorescein in the iodine-uptake contrast lesions, not only gliomas, but also
lesions as craniopharyngiomas, cavernous angiomas and inflammatory granulomas. Statistical
analysis of results (Chi-square test or Fisher‘s exact test) indicated a relation between
fluorescein sodium impregnation and a higher frequency GTR (gross total resection). On lesions
with small or no iodine-uptake contrast lesions in the IRM exams the degree of impregnation by
fluorescein sodium was lower while the statistical results have shown a trend of a greater
resection, although there are no proven statistical evidence. Conclusion The use of fluorescein
sodium has proven to be an effective, safe, easy and inexpensive method in resection of
intraparenchymal brain lesions, even in a non-glial or non-enhancing contrast lesions.
Código: 44276
Temário: Oncologia
Data: 3/26/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: WHOLE-GENOME BISULFITE SEQUENCING OF A SUBSET OF IDH MUTANT GLIOMA
REVEALS CHANGES AT INTERGENIC REGIONS
Apresentador: Thais Sarraf Sabedot
Instituição: UNIVERSIDADE DE SÃO PAULO
Autores: Thais Sarraf Sabedot; Houtan Noushmehr;
Resumo: Gliomas, including glioblastoma, the most lethal intracranial tumor, exhibit a very
complex development that can lead to treatment resistance and repeated recurrences. This
heterogeneity can interfere in the diagnosis and, therefore, in the therapeutic approach.
Currently, gliomas are classified based on histology and then graded on a scale of I to IV,
depending on the degree of malignancy. However, the histological features are generally
inferred by pathologists’ observation of a biological sample collected from the tumor, which can
cause diagnostic discrepancies. This scenario has been changing for the past years with constant
updates on the molecular profiling of gliomas and the advance of technologies that allow the
enforcement of these results in the clinic. The most recent study about the genomic and
epigenomic landscape of gliomas showed a distinct subgroup of IDH mutant samples with poor
survival. This subtype (GCIMP-low) is characterized by a loss of DNA methylation, based on array
data (27k/450k), when compared to other IDH mutant samples also without codeletion of
chromosomes 1p and 19q. (GCIMP-high). We propose to analyse the changes across the entire
epigenome between GCIMP-low and GCIMP-high samples, in order to identify regulatory
regions that may be deregulated, thereby understanding progression among IDH mutant
samples. In total, three samples were profiled using whole-genome bisulfite sequencing (WGBS),
one GCIMP-low and two GCIMP-high, with more than 20 million CpGs overlapping the samples
(min 5 reads). We compared the global DNA methylation alterations using open source tools
(R/Bioconductor) and could confirm previous results reported using DNA methylation array data
(r2 ≈ 85%). Interestingly, we were able to find larger regions of DNA methylation changes that
could only be captured using sequencing data (> 10k differentially methylated CpGs at 90%; 47%
overlapping known IMR90 PMDs). Furthermore, we integrated these regions with gene
expression data (RNAseq) from a larger group of GCIMP-high/low samples to identify potential
regulatory elements that can influence the aggressiveness of the tumor and, consequently,
clinical outcome. Understanding how the methylome is affected on different glioma subtypes
may contribute to the development of new targeted therapies that can improve clinical outcome
and, also, allow us to possibly comprehend better about carcinogenesis.
Código: 44277
Temário: Oncologia
Data: 3/26/2016
Horário: 13:10 - 13:50
Sala: Room 2
Título: EPIGENOMIC LANDSCAPE OF GLIOMAS, NON-BRAIN TUMORS AND STEM CELLS
Apresentador: Tathiane Maistro Malta
Autores: Tathiane Maistro Malta; Andre Moreira Pessoni; PanCanAtlas working group of The
Cancer Genome Atlas Research Network; Houtan Noushmehr;
Resumo: Although some progress has been seen in the past years, glioma field faces suboptimal
disease classification which may impact patient management and hinder the correct treatment.
Mutation in the IDH genes, the hypermethylator G-CIMP phenotype and codeletion of
chromosome arm 1p/19q e.g. were associated with subtypes of gliomas and improve their
classification. Notably, DNA methylation has been shown to play an important contribution to
glioma and other tumors classification. We propose to compare DNA methylation data from
glioma samples to different types of tumors and to stem cells in order to identify tumors with
common DNA methylation pattern and expand our comprehension of glioma biology. We
analysed DNA methylation data from 9,648 TCGA samples, from 33 different types of tumors,
including 686 gliomas (532 low grade, LGG; and 154 high grade, GBM). We also included 99 stem
cell samples from the Progenitor Cell Biology Consortium (PCBC). All samples were profiled using
Illumina HM450 platform. Across all tumors, LGG samples showed the higher genome wide
levels of DNA methylation while GBM showed an intermediary profile. Among LGG samples, 82%
have mutation in the IDH1/2 genes which may have a role in the epigenetic regulation and in
the high levels of DNA methylation. We next search for glioma samples that bear a resemblance
to stem cell in order to correlate with clinical and molecular data. For that, we used PCBC data
to define stem cell signatures for pluripotent stem cells and for cells differentiated into
ectoderm, endoderm, mesoderm and embryoid bodies. We then applied a supervised random
forest model to classify tumors into one of the stem cells category. One GBM sample was
classified as pluripotent stem cell. Interestingly, the remaining GBM samples and all LGG samples
were classified as embryoid bodies. The one GBM sample classified as pluripotent stem cell was
previously classified based on DNA methylation as LGm6-GBM, a group with very poor
prognosis, reinforcing the correlation between stemness and aggressivity of tumors. Our
preliminary results showed that DNA methylation can be used to classify gliomas and identify
tumors with stem/progenitor-like phenotypes, which should be further investigated.
Understanding how glioma samples behave in comparison to other tumors and to
undifferentiated cells will improve our understanding of the tumor biology and potentially will
provide tools to predict the aggressiveness and prognosis of gliomas.
Código: 44255
Temário: Oncologia
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: EPIGENOMIC AND TRANSCRIPTOMIC ANALYSIS OF ADULT GLIOMA REVEALS CANDIDATE
DRIVER TRANSCRIPTION FACTORS INVOLVED IN GLIOMA PROGRESSION.
Apresentador: Tiago Chedraoui Silva
Autores: Tiago Chedraoui Silva; Houtan Noushmehr;
Resumo: Identifying and understanding the molecular differences between Lower grade glioma
(LGG) and glioblastoma multiforme (GBM) is of utmost importance for a more accurate
prognosis and the development of new treatments against these types of gliomas. Using two
new bioconductor packages TCGAbiolinks and ELMER, we analysed the molecular differences
between samples of GBM and LGG existent in the TCGA database. The TCGAbiolinks package
was used to retrieve DNA methylation data (Infinium HumanMethylation450 platforms), gene
expression data (IlluminaHiSeq RNASeqV2 platform), and clinical data from TCGA data portal for
51 GBM and 516 LGG samples. The ELMER package was used to identify enriched DNA motifs
for the distal enhancer probes which are significantly differentially CpG methylated and linked
to putative target gene and to identify regulatory TFs whose expression associate with DNA
methylation at these motifs. Comparing LGG samples versus GBM samples using as threshold
probes with a DNA methylation difference ≥ 0.25 and P-values < 0.05 and a probe set considered
significantly enriched for a particular motif if the 95% confidence interval of the Odds Ratio was
greater than 1.1, we identified 3 transcription factors (HOXA5, HOXA6 and TGIF1) to be highly
expressed in GBM samples while they were lower expressed in LGG samples. In order to evaluate
the impact of of these findings, a survival analysis showed that patients with these transcription
factor highly expressed had a better survival than those with a lower expression. Finally, the
literatures associates HOXA5 to the upregulation of the tumor suppressor p53, TGIF1 to a
structural anomaly of the brain, and HOXA6 to the encoding of a DNA-binding transcription
factor which may regulate gene expression, morphogenesis, and differentiation. Results indicate
molecular differences between LGG and GBM samples, whose understanding can lead us to an
improvement in treatments.
Código: 44262
Temário: Oncologia
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: CYCLIN E EXPRESSION AND RECURRENCE IN MENINGIOMA
Apresentador: Breno José Alencar Pires Barbosa
Instituição: FACULDADE DE MEDICINA DA USP
Autores: Breno José Alencar Pires Barbosa; Pedro Augustto de Santana Júnior; Paulo Henrique
Pires de Aguiar; Sueli Mieko Oba Shinjo; Guilherme Lepski; Isac de Castro; Manoel Jacobsen
Teixeira; Suely Kazue Nagahashi Marie;
Resumo: Cell cycle checkpoints are critical for controlling cell proliferation. Tumors like colon,
breast and gastric carcinomas appear to deregulate cyclin expression, especially cyclin E, which
plays a major role in the G1-S transition of the cell cycle. Although meningiomas are usually
benign tumors, 10-15% of patients will present an unfavorable course, with recurrence before
10 years, despite aggressive surgery. There is currently no consensus regarding the potential
prognostic value of genes such as cyclin E in meningiomas. Between 2000 and 2007, we assigned
83 consecutive patients harboring suspected intracranial meningiomas at our institution to the
present study. After histopathological confirmation, frozen tumor samples were used for RNA
extraction, followed by reverse transcription. We used quantitative real-time PCR and
immunohistochemistry to assess the relative expression levels of the genes Cyclin E, SKP2 and
p27. In order to calculate relative gene expression, we compared the threshold cycles (Cts) of
Cyclin E to those of housekeeping genes. We normalized reactions using the median expression
of CCNE in benign meningiomas (grade I) and used the chi-square test and Kaplan-Meyer
functions to analyze the data. Results were considered significant at p < 0.05. RESULTS: Twentyfive cases were excluded due to lack of follow-up or unavailable tumor samples. Of the
remaining 58 cases, 17 (29%) were men and 41 (71%) were women with a median age at
diagnosis of 53 years (range 22 – 80). Of these, 19,6% were atypical. Recurrence was observed
in 18 cases (33%), after a median follow-up of 66 months. Cyclin E levels higher than 53 x 10-5
were associated with a 62.5% increased probability of recurrence (p=0.0017). Neither SKP2 nor
p27 expression levels predicted recurrence in our sample. CONCLUSIONS: In accordance with
the oncologic literature for other tumors, the present study suggests that Cyclin E is a potential
molecular marker for meningioma recurrence. Overexpression of Cyclin E was associated with
higher rates of recurrence, a finding of major relevance in the context of molecular neurooncology.
Código: 44280
Temário: Oncologia
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: INDISULAM REDUCES GLIOBLASTOMA CELL MIGRATION, ATTENUATES TUMOR
GROWTH, AND PROLONGS SURVIVAL IN MOUSE MODELS.
Apresentador: Silvia Aparecida Teixeira
Instituição: FACULDADE DE MEDICINA DE RIBEIRÃO PRETO-USP
Autores: Silvia Aparecida Teixeira; Augusto Faria Andrade; Mohan Sobhana Nandhu; Mariano
Sebastian Viapiano; Carlos Gilberto Carlotti; Luiz Gonzaga Tone; Caio Cesar Damasceno Monção;
Carlos Alberto Scrideli;
Resumo: Purpose: The treatment of glioblastoma (GBM), the most common type of primary
braincancer, remains a major challenge for clinicians. These extremely aggressive and invasive
tumors are highly resistant to radio- and chemotherapy and their recurrence is practically
inevitable. Due to their fast growth in hypoxic conditions, GBM cells acidify their extracellular
environment, which leads to GBM overexpression of membrane-bound carbonic anhydrases
(CAs), a family of ubiquitous enzymes that regulate intracellular pH. Indisulam (IS) is a potent
sulfonamide inhibitor of CAs that has been used as anti-cancer drug. IS downregulates genes
that promote cytotoxic drug resistance and cell proliferation, therefore preventing cell cycle
progression in tumor cells. The aim of this study was to evaluate the inhibitory effects of IS on
the anhydrases CA-IX and CA-XII and the resulting effects on GBM growth, radio/chemosensitization, and animal survival. Materials and Methods: The GBM cell lines U87-MG and
U251-MG were cultured in DMEM supplemented with 10% calf serum. The effect of IS on cell
proliferation and migration (using nanofiber-coated plates) was measured at 24 to 72h in
culture. Sensitization studies were performed by combining IS treatment with radiotherapy (2 6 Gy) or chemotherapy (250 µM – 1500µM temozolomide, TMZ) in vitro. The antitumor and
chemo-sensitizing effects of IS in vivo were assessed in athymic nude mice stereotactically
implanted with U87-MG cells. Tumor growth and potential toxicity were monitored until survival
endpoint. Results: IS significantly reduced proliferation of glioma cells, inhibited cell migration,
and potentiated the effect of radiotherapy in vitro. Studies in mouse xenograft models
demonstrated that IS significantly reduced SQ tumor growth (66-84%) and potentiated the antitumor effect of TMZ (tumor growth inhibition of 96%; p<0.05). In orthotopic glioma xenografts
IS significantly increased median survival, suggesting that it effectively crossed the blood-brain
barrier. Conclusion: This study suggests that IS has therapeutic potential as a radio- and chemosensitizing agent in drug-resistant tumor cells, thus representing an attractive strategy to
improve adjuvant therapy for GBM. Financial Support: FAPESP
Código: 44379
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: ENDONASAL ENDOSCOPIC SURGERY FOR RESECTION OF CLIVUS CHORDOMAS ANALYSIS
OF CURRENT RESULTS
Apresentador: Joao Paulo Almeida
Instituição: INSTITUTO DE CIÊNCIAS NEUROLÓGICAS (ICNE)
Autores: Joao Paulo Almeida; Arthur Silva; Vitor Nagai Yamaki; Mateus Dal Fabbro; Marcelo
Sampaio; Mateus Reghin Neto; Feres Chaddad Neto; Evandro de Oliveira;
Resumo: Introduction:Chordomas are difficult-to-treat tumors due to its high recurrence rates.
Radical tumor resection plus adjuvant radiotherapy have been advocated as treatment of choice
for chordomas. The success of gross total resection (GTR) depends on an optimal surgical
approach based on tumor extension and surgeon expertise. Several series have been published
with promising results of GTR using endoscopic approaches to skull base chordomas with low
incidence of recurrence and complications. Objective: To evaluate the current results of the
endoscopic endonasal approach for the treatment of clivus chordomas. Methods: We
performed a systematic review of studies analyzing endoscopic treatment of clival chordomas.
Studies were identified through a Medline-based search of studies about the endoscopic
treatment of clivus chordomas published between January 2000 and December 2015. The
search was performed by using the following keywords: “chordoma”, “clivus” “endoscopy” and
“skull base” in both “AND” and “OR” combinations. Consecutive case series studying the
endoscopic treatment of clivus chordomas with five or more patients were included. Patients’
characteristics, treatment outcomes, complications and follow-up were collected. Gross total
resection (GTR) was considered with ≥ 95% resection in post-operative imaging. We performed
descriptive statistics analysis for comparing study outcomes. Results:The Medline search yielded
896 papers, of which 10 met our inclusion criteria. There were included 245 patients with mean
age of 45.1 years (range 3.5-89 years) and 54.2% male. GTR was achieved in 74% of tumors,
while subtotal was obtained in 26%. Improvement of pre-operative cranial nerve deficits
occurred in 44% of cases (54 of 123; reported in 7 studies). The most common complication was
postoperative CSF leak, present in 13% of the cases (28 of 219). Mortality rate of 4% was
associated with the endoscopic endonasal approach. Adjuvant radiotherapy was implemented
in 67% of patients (159 of 236 in 7 studies) with 14% (31 of 219) of local recurrence reported in
9 studies. Conclusions: The results of our study demonstrate that the endoscopic endonasal
approach is an effective option for resection of clivus chordomas, with GTR rate of almost 75%.
Moreover, low rates of surgical complications related to injuries of the neurovascular structures
are reported. However, post-operative CSF leak (13%) and local recurrence (14%) rates are not
negligible.
Código: 44787
Temário: Oncologia
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: THE USE OF 5-ALA FLUORESCENCE-GUIDED SURGERY FOR GLIOMAS IN BRAZIL
Apresentador: Ricardo Ramina
Instituição: Instituto de Neurologia de Curitiba
Autores: Ricardo Ramina; Erasmo Barros da Silva Jr; Mauricio Coelho Neto;
Resumo: The current neurosurgical goal for patients with malignant gliomas consists in surgical
maximal safe resection of the contrast-enhancing tumor. Usually tumor extension goes beyond
the zone of contrast enhancement on MRI and in many cases during surgery, even using
neuronavigation and intraoperative MRI (iMRI) it is not possible to identify the limits of tumor
infiltration. About 15 years ago the use of fluorescence-guided glioma surgery (5-aminolevulinic
acid (5-ALA) was started. Protoporphyrin IX (PpIX) accumulates in higher concentrations in
tumor tissue and can be well visualized using filters within the surgical microscope. It is now
standard of care in many countries. Fluorescence may differ in different tumor cell types and
different grade tumors. In Brazil and other latin american countries this drug is not available and
this technique is not currently being used. Since October 2015 fluorescence-guided glioma
surgery with 5-ALA has been performed at the Neurological Institute of Curitiba (INC). Ten
patients harboring gliomas (8 glioblastomas, 1 grade III astrocytoma and 1 grade II astrocytoma)
have been operated on with this method. The 5-ALA solution (20mg per kg) was administered
orally, three hours before induction of anesthesia. All tumors were removed with the aid of
neuronavigation, cortical and subcortical stimulation, intraoperative MRI and fluorescence with
5-ALA. “Awake-surgery” technique were used for tumors near the motor and speech areas. The
method of using 5-ALA fluorescence (pre, intra and postoperative), the intraoperative findings
in high-grade and low-grade tumors and surgical results will be presented. There was no sideeffect related to 5-ALA in this series. In clinical practice, the 5-ALA showed a good safety profile
and iMRI in combination with 5-ALA enhanced tumor resection.
Código: 44837
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: IMPACT OF THE PER-OPERATORY APPLICATION OF CARMUSTINE WAFERS IN
COMBINATION WITH TEMOZOLOMIDE AND GAMMA KNIFE RADIO-SURGERY IN HIGH GRADE
GLIOMAS
Apresentador: Andres M Alvarez Pinzon
Instituição: MIAMI NEUROSCIENCE CENTER
Autores: Andres M Alvarez Pinzon; Aizik Wolf; Jose E Valerio-Pascual; Sammie Coy;
Resumo: Introduction The wafers of Carmustine have been used as a coadjutant therapy
inserted into the operation cavity in patients with glioblastoma multiforme. This is followed by
concurrent Gamma knife Radiosurgery (GKS) and chemotherapy with temozolomide (TMZ)
according to the variation of Stupp protocol. No studies have been investigated this kind of
treatment regimen and the impact in terms of survival and toxicity of the combination of Gliadel
with TMZ and GKS. METHODS Retrospective, observational study (Level of evidence IV). We
analyze charts From Jan 2008 to December 2013. 31 subjects with a newly diagnosed
glioblastoma was fined. Subjects have undergone a craniotomy-tumour resection which was
considered to be macroscopically complete in all cases. All patients underwent subsequently
GKS 1 month after surgery followed by cycles ofTMZ as an adjuvant treatment. The mean
number of cycles of adjuvant TMZ was 7. RESULTS: The mean age at the moment of diagnosis
was 56.4 years. The median overall survival of our patients was 20.1 months and the median
progression free survival was 14.7 months. The median OS was 15.34 months. Chemotherapy
with TMZ had to be stopped prematurely in 6 cases due to digestive toxicity, early relapse or
haematotoxicity. CONCLUSIONS: The protocol used in our institution doing concomitant use of
total tumor resection with implantation of Carmustine wafers, GKS and TMZ seems to be well
tolerated in most of the patients. Despite the low number of subjects treated, the type of the
study and current clinical practices a particular attention should be paid to the potential
hematological consequences and general complications of this multimodal treatment regimen.
We recommend prospective randomize clinical trials evaluating the effectivity of concomitant
therapies using gamma knife radio surgery and Carmustine wafers.
Código: 44838
Temário: Oncologia
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: PRIMARY CNS LYMPHOMA: ANALYSIS AND SURVIVAL USING GAMMAKNIFE
RADIOSURGERY AND METHROTEXATE
Apresentador: Andres M Alvarez Pinzon
Autores: Andres M Alvarez-Pinzon; Jose E Valerio Pascua; Aizik Wolf; Sammie Coy;
Resumo: Background: Primary central nervous system lymphomas (PCNSL) include 4% of all
primary brain- tumors. It can involve the brain parenchyma, leptomeninges, eyes and the spinal
cord. Unlike systemic lymphoma, durable remissions remain uncommon. Different
combinations of chemotherapy and Methotrexate is the gold standard. This is a clinical study
comparing the outcomes using Methrotexate vs patients treated with Methrotexate and
Gamma knife Radiosurgery (GKRS) in PCNSL . Methods: Retrospective, comparative study
evaluating the treatment of PCNSL with Methotrexate as a single agent, in dose of 8 g/m2 and
Methrotexate plus GK. Strict inclusion and exclusion criteria were employed and review of
histologically confirmed PCNSL. Primary objective were survival rate. Secondary outcomes were
the remission or re-incidence of a lesion. Results: Between June 1995 and May 2015, 128 charts
was evaluated. 73 Methotrexate (Control Group) and 55 Metrothexate plus GKRS. Follow-up
period was 24 to 49 months (mean 36.9 months). There were no statistically significant
differences in patient demographics or histology diagnosis. Patients was treated with GKRS
doses ranging from 12 Gy to 26 Gy (median:13.6 Gy). Median survival was rate 26. 8 months in
control group and 47.6 in treatment group from the initial diagnosis. All lesions showed a
complete response after Radiosurgery when evaluated using magnetic resonance imaging 3-8
weeks (mean range 5.8 weeks). Conclusions: The use of GKRS is non-invasive, safe, and shows
rapid success, improving the prognosis of the patient. This noninvasive treatment modality
should be considered as an adjuvant treatment option for patients with diagnosis of Primary
CNS lymphoma.
Código: 44839
Temário: Radioterapia
Data: 3/26/2016
Horário: 15:10 - 16:15
Sala: Room 2
Título: GLIOBLASTOMA MULTIFORME: CLINICAL EXPERIENCE USING GAMMA KNIFE
RADIOSURGERY AND CHEMOTHERAPY
Apresentador: Jose E Valerio Pascua
Autores: Andres M Alvarez Pinzon; Jose E Valerio Pascua; Aizik L Wolf;
Resumo: Introduction: Management of Glioblastoma multiforme (GBM) is a demand of polemic
when it comes to determining which management is the most beneficial. Gamma knife radiosurgery become progressively employed modality for patients diagnosed with gliomas. The
purpose of this article is to evaluate the efficacy of gamma knife radiosurgery plus chemotherapy
in GBM. Methods: Prospective, observational study between January 2008 and April 2012. 201
patients with a diagnosis of GBM and no previous radiotherapy were added in a protocol of
gamma-knife radiosurgery and temodar chemotherapy management. Results: Median age at
diagnosis was 69.6 year old (57.6- 81.1 y/o), median survival from time at diagnosis was 31.6
months (95%CI: 17.4-44.7) with progression-free survival 19.9 months, (95%CI: 12.5-28.8), and
local tumor control 73%. A multivariate analysis adjusted for possible confounding factors
(tumor volume, recursive partitioning analysis class, neurological deficits, time to recurrence,
adjuvant therapy, and tumor location) showed considerably longer survival. Time to the 1st
recurrence was (mo) 19.7 (median) (range, 4-41.8). Adjuvant chemotherapy was 89% Temodar,
11% Procarbazine, Lomustine, and Vincristine (PCV). Conclusion: Gamma knife radiosurgery is a
secure and successful management alternative for select patients diagnosed with GBM.
POSTER
PRESENTATIONS
Código: 44210
Número do Painel: 1
Título: QUALITY OF LIFE IN ONCOLOGY PATIENTS WITH METASTÁSE IN CENTRAL NERVOUS
SYSTEM (CNS) AFTER INTERVENTIONS IN PALLIATIVE CARE: APPLICATION OF THE
QUESTIONNAIRE MQOL-BR
Temário: Cuidados paliativos
Modalidade Aprovada: Pôster
Autores: Franklein Vieira Maia; Thais Laudares Soares Maia; Sureya Maria Gibelli; Sueli
Monterroso da Cruz; Nayara Zortea Lima; Marcelo Antonio Duva Borgheresi; Deolinda
Fernandes Matos da Silva; Ticila Peixoto Melo; Marcelo Trindade Cecchi; Ytalo Bruno Soares;
Ana Paula Odoni Rocha; Rebeca Grezos;
Instituição: HOSPITAL ANA COSTA
Resumo: The central nervous system is common website for distant metastasis of various
neoplasms. It is estimated that approximately 20% to 40% of patients with diagnosis of
oncological disease shall submit cerebral metastases during treatment. The study had as
objective to evaluate the quality of life of patients diagnosed with CNS metastasis after
radiotherapy, chemotherapy interventions, surgical or both in palliative care. This is a crosssectional study performed with nine patients with CNS metastasis in palliative care, after
completion of radiotherapy, chemotherapy or surgery. For data collection, we used the
questionnaire of quality of life for cancer patients in Palliative Care (Mqol-Br) adapted and
validated for Brazil. The total score for quality of life after treatment in this population was 5.9.
The physical symptoms and physical well-being, were low in the first result average 4,2 and the
second 4.4. Findings in the literature emphasize that part of the symptoms are characterized by
primary disease, and it should also consider the Karnofsky performance status, in which was not
evaluated in this work. In the Items welfare- existential, psychological well-being and family
support were results > than 5.0 that represents better quality of life. Despite the commitment
in the aspects related to the welfare physicist, patients in this sample are able to submit quality
of life. The people diagnosed with advanced cancer can prosper, despite a cancer diagnosis
challenging, reserved prognosis and treatment is difficult. Through relationships, the ability to
create meaning and purpose in life in the face of difficult circumstances, and acceptance along
with a desire for personal growth.
Código: 44292
Título: CONGENITAL BRAIN TERATOMA: CASE REPORT
Temário: Imagem
Autores: Plínio Luiz de Arruda Armelin; Heliantho de S. Lima Filho; Alexandre Peroni Borges;
Raíssa Miranda Santos Chiarelli; Luciano de Souza Queiroz; Leandro Luiz Lopes Freitas;
Instituição: CENTRO MÉDICO DE CAMPINAS
Resumo: Congenital brain tumors, defined as those presenting within the first 60 days of life,
are rare, representing only about 0.5%–1.9% of all childhood brain tumors. Teratomas constitute
about one-third to one-half of these and are the most common neonatal brain tumor. Previous
reports have described several forms of congenital intracranial teratoma, including massive
tumors replacing the intracranial contents, smaller tumors producing hydrocephalus, large
intracranial tumors extending into the orbit or neck, and incidentally discovered tumors in
stillborn infants. Although it is often impossible to determine the exact site of origin, prenatally
diagnosed intracranial teratomas are predominantly supratentorial, in contrast to their
infratentorial location in older children. The prevalence of congenital intracranial teratomas is
reported to be nearly equal in males and females in most series. Despite the benign
histopathologic features of most intracranial teratomas, tumor growth is rapid and the tumor
frequently replaces all normal brain tissue, resulting in massive craniomegaly. We present a case
of a 35-week-gestational-age male infant, born after an ill-defined intracranial mass and
secondary obstructive hydrocephalus diagnosed prenatally with ultrasound. He was delivered
by elective cesarean section, without any complications. Head circumference increased rapidly,
and follow-up CAT scan on 2 months of life, revealed an expansive homogeneous mass
occupying the lower region of the left frontal lobe, accompanied by large supratentorial
hydrocephalus. An inconclusive biopsy followed the exam. The first brain MRI at 5 months
showed bilateral mass crossing the midline by the frontobasal portion of the brain. On the left
hemisphere, the lesion showed signal characteristics similar to those of the brain, but in a
disorganized appearance, and on the right hemisphere a solid-cystic appearance. The second
brain MRI at 8 months of life, showed a better mass definition on the left hemisphere,
resembling gray and white substances unevenly mixed. There was also an increase of the cystic
structures, and presence of calcifications. This changes led to a second biopsy in this region,
which defined the mass as a teratoma. The patient was submitted to a complete resection of
the lesion at 6 months of life, and unlike the poor prognosis and high mortality rate, the patient
is stillbirth with developmental delay.
Código: 44879
Título: CONTRIBUIÇÃO DOS MÉTODOS AVANÇADOS POR RESSONÂNCIA MAGNÉTICA DE ALTO
CAMPO NA AVALIAÇÃO PRÉ-OPERATÓRIA DE TUMORES DO SISTEMA NERVOSO CENTRAL
Temário: Imagem
Autores: Andrea Silveira de Souza; Ivanei Edson Bramati; Fernanda Ferreira; Jorge Moll;
Fernanda Tovar-Moll;
Instituição: IDOR / UNIRIO
Resumo: A ressonância magnética estrutural tem papel fundamental e estabelecido na
avaliação de lesões tumorais do sistema nervoso central, permitindo definir se há lesão única
ou múltipla, qual a localização, extensão, e a relação da(s) lesão(ões) com estruturas anatômicas
vizinhas, assim como da caracterização tecidual (inclusive verificando se há sinais de anaplasia).
Com o advento de métodos funcionais por Ressonância Magnética (RM), incluindo a RM
funcional BOLD, a tractografia, a perfusão, a espectroscopia de prótons e o estudo do fluxo
liquórico, informações adicionais puderam ser agregadas de forma a incrementar o arsenal da
avaliação radiológica pré-cirúrgica, permitindo potencialmente um melhor planejamento
terapêutico. Várias informações relevantes podem ser obtidas, tais como avaliação das áreas
eloquentes, do trajeto dos principais feixes de substância branca, quais áreas tumorais exibem
sinais de maior atividade e não somente quebra da barreira hematoencefálica (sobretudo
quando há necessidade de escolha de local para biópsia), entre outros aspectos. Estes métodos
avançados também têm relevância na avaliação pós-operatória, permitindo verificar como a
anatomia dos feixes de substância branca ou das áreas eloquentes foram ou não comprometidas
ou modificadas. Este trabalho visa demonstrar, de forma didática, as vantagens que cada
método funcional pode oferecer no planejamento pré-cirúrgico de lesões expansivas do sistema
nervoso central.
Código: 44285
Título: EXTRA-AXIAL HIGH-GRADE GLIOMA: CASE REPORT
Temário: Imagem
Autores: Plínio Luiz de Arruda Armelin; Heliantho de S. Lima Filho; Alexandre Peroni Borges;
Luciano de Souza Queiroz; Raíssa Miranda Santos Chiarelli; Leandro Luiz Lopes Freitas;
Instituição: CENTRO MÉDICO DE CAMPINAS
Resumo: The extra-axial origin of a glioma (astrocytoma or oligodendroglioma) in the
topography of the meninges is exceptionally rare. The literature is limited to isolated cases and
the most recent reports refer only about 15 published examples.The main characteristics are
the subarachnoid space location with no obvious connection to the brain parenchyma. It may
be present as focal or diffuse lesion, and sometimes indistinguishable from a glioblastoma
multiforme. The origin of these tumors would be cell nests derived of aberrant migration in the
embryonic or fetal period.The differential diagnosis, in face of an extra-axial location is primarily
made with meningiomas and metastases. We present a case of a 42 years old male patient,
hospitalized after severe headache onset in November 2010. The CAT scan revealed a
subarachnoid hemorrhage and right temporal hematoma with no need of surgical intervention.
In January 2011 starts with seizure and a drug treatment was instituted. Further MRI brain exam
in March 2011, showed a homogeneous mass in the topography of the hematoma. In April 2011
a right temporal craniotomy showed anterior temporal gliosis and an expansive lesion closely
related to the leptomeninges. Pathology report showed that all examined areas had strong
positivity for glial fibrillary acidic protein (GFAP), the intermediate filament protein of astrocytes
and ependymal cells. Its presence defined the tumor as a glioma, excluding other hypotheses
that had been raised due to the lesion’s extra-axial location in the previous exams. Positivity for
the Ki-67 cell marker proliferation was seen in about 10 to 15% of all the nuclei. This supports
the presence mitosis, vascular proliferation and necrosis, laying this tumor between high-grade
gliomas.
Código: 44902
Título: MR IMAGING CHARACTERISTICS OF PROTOPLASMIC ASTROCYTOMA
Temário: Imagem
Autores: Leandro Moreira; Leonardo Rocha-Carneiro Garcia-Zapata; Yvens Barbosa Fernandes;
Heliantho de Siqueira Lima Filho; Luciano de Souza Queiroz; Camila Andrade de Sousa; Jose
Alberto Pereira Pires; Paulo Ricardo Correia Soares; Filipe Rocha Viana; Sinval Malheiros Pinto
Neto; Marcel Ramos Olivatto; Plínio Luiz de Arruda Armelin;
Instituição: SANTA CASA DE MISERICÓRDIA DE LIMEIRA
Resumo: The protoplasmic astrocytoma is a rare histologically variant of the diffuse
astrocytomas, classified as 2 degree by the (OMS). It usually affects the younger ages, comparing
with the other histologically subtypes of difusive astrocytomas like the fibrilar and gemistocytic.
With a discrete predominance in the male gender and with an average age of 20 years old. The
main clynical manifestation of the disease are the sudden convulsing crisis related with the
typical frontotemporal location of the tumor, commonly in the temporal lobe. Pacient K.R.S, 34
years old, female gender with hemiparesis to the right muscular strenght 3 degree, with a
constant decrease. At that moment, an encephalon tomography and resonance was done, with
a large neoplasic injury, located on the left parietal region, intra axial with a exophytic
component. A resection of the injury was done 18 months ago. The pacient presents the same
neurological situation comparing to the pre-procedure situation. The protoplasmic astrocytoma
has a slow and infiltrative growth on the hemispheric white substance. The diagnose is done by
the histological exam guided by the image exam to gather the tissue on the exact location. The
tomography has non-specific aspects, showing how a expansive formation of large dimensions,
can be visualized through the remodeling of the adjacent skullcap. The magnetic resonance is
the chosen method for the image diagnose of this type of tumor, because the analysis of the
injury in FLAIR is a great lead to the diagnose, suppresing the content inside the injury, as the
75% cases registered by Kevin L. Tay and collaborators. Its constituded mainly by scarce
cytoplasm cells and short processes, round cores with rare or absent types of mitosis, often
creating mycrocysts and the neuropil is loose and soft, sometimes even mucoid. Its not always
that it identification is recognized and easily reproducible by pathologists, creating a diffcult
analysis to see the difference from the pylocitic astrocytoma. The main differential exams
include the other diffuse astrocytomas, the oligodendroglioma and the dysembryoplastic
neuroepithelial tumor. Taking into consideration that it is a better prognosis. This tumor shows
some distinct characteristic images on the magnetic resonance of the encephalon, although is a
rare subtype of diffuse astrocytoma. These discoveries need to be recognized, so the diagnosis
of this pathology can be taken into consideration.
Código: 44905
Título: PITUITARY MACROADENOMA WITH BILATERAL INVASION OF SINUS CAVERNOUS
CAUSING PTOSIS AND SUDDEN OPHTHALMOPLEGIA - A CASE REPORT
Temário: Imagem
Autores: Amauri Pereira da Silva Filho; Lucas Silva Xavier; Pâmmela Dayana Lopes Carrilho
Machado; Lucas Eduardo Vilarinho Guimarães; Verônica Cavalcanti Pedrosa; Adysia Moreira
Florentino da Silva; Édna Maria de Macêdo; Mylena Gaudêncio Bezerra; Eduarda Barros de
Almeida Brandão; Décio Fernando Coutinho Filho;
Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA
Resumo: Introduction: Pituitary tumors correspond to 10% to 25% of intracranial tumors, being
the most frequent adenomas. Invasive adenomas are able to penetrate adjacent structures such
as cavernous sinus, bone lamina and dura mater and comprise 35% of pituitary tumors. Only a
minority of cases are symptomatic, presenting mainly hormonal changes and changes in visual
acuity. Objective: We report a case of a pituitary adenoma with bilateral invasion of the
cavernous sinus and atypical symptoms. Case Report: A male patient, 66 years, with
hypertension, diabetes and chronic stable angina with hemorrhagic stroke history 6 years ago
without sequelae. He presents sudden moderate headache associated with hypertensive peak,
resistant to medication in the Emergency Room. The patient developed right eyelid ptosis,
becoming bilateral later, then was forwarded to the reference service. On admission he had
bilateral ptosis, complete ophthalmoplegia, marked decrease in visual acuity without
appendicular deficits, glycemia 150 g/dl, blood pressure 140x100 mmHg. Were performed ice
test and therapeutic trial to exclude myasthenia gravis and requested cranial CT. As a result, it
was found a hyperdense and heterogeneous suprasellar lesion measuring approximately 3.2 x
2.6 x 2.3 cm with bilateral cavernous sinus invasion without hydrocephalus. With the follow-up
after seven days, MRI showed intrasellar expansive (upper and bilaterally) infiltrative, solid /
cystic mass obliterating the suprasellar cistern and touching the optic chiasm, measuring 3.5 x
3.6 x 3.5cm. The radiological clinical diagnosis of Macroadenoma Pituitary was made and it was
requested laboratory analysis for decision of the neurosurgical procedure. Conclusion: Pituitary
adenomas, when secreting generally represent a condition of good prognosis. However the
infiltrative and bilateral features of this tumor associated with their rapid development
determined unusual focal deficits that require rapid intervention. In this case report impresses
the speed with which symptoms were shown and the number of structures rapidly affected.
Código: 44282
Título: PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA IN IMMUNOCOMPETENT PATIENTS:
IMAGING FEATURES OF SIX CASES.
Temário: Imagem
Autores: Alexandre Nascimento Ottoni; Leonardo Gilmone Ruschel; Guilherme Augusto de
Souza Machado; Bruno Augusto Telles; Maurício Coelho Neto; Erasmo Barros da Silva Júnior;
Ricardo Ramina;
Instituição: UNIVERSIDADE POSITIVO
Resumo: Introduction: Primary Central Nervous System Lymphoma (PCNSL) is an aggressive
Non-Hodgkin lymphoma confined to the CNS, which can affect eyes, brain, leptomeninges or
spinal cord. Corresponding to 1-5% of all brain tumors, the majority of PCNSL are pathologically
classified as Diffuse Large B-Cell Lymphoma (DLBCL). Its incidence in immunocompetent patients
has increased in the last few decades, without age or gender predilection. Diagnosis is based on
histopathologic findings traditionally established by biopsy only. Contrast-enhanced MR imaging
is the method of choice to evaluate CNS lymphoma. Its characteristic appearance is due to
hypercellularity, high nuclear/cytoplasmic ratio, violation of the blood-brain barrier, and its
predilection for the periventricular and superficial regions, in contact with ventricular or
meningeal surfaces. Objective: This study’s aim is to alert for the importance of the correct
diagnosis in PCNSL cases and the role of MR images, in order to avoid inadequately management
of this condition. Methods: Literature review and retrospective discretion of six cases diagnosed
in a Brazilian’s hospital. MR examinations were performed in all cases with biopsy proven PCNSL.
Proton spectroscopy were performed in only three cases as well as the perfusion. Results: Five
patients presented solitary lesions and only one with two lesions. Four of them were located in
capsular-nucleo, one in the splenium of corpus callosum and the other sub-ependimary. Iso- to
hypointense signal on T2-weghted and T1 images were identified. The majority part (4) were
homogeneously enhancing after contrast injection, while two were heterogeneous. All lesions
presented with moderate restricted diffusion. The proton spectroscopy were performed in only
three cases and all were markedly by the presence of lipids lactate, decrease of Nacetylaspartate (NAA), a massive increase of choline (Cho), N-acetyl-aspartate/choline ratio
nearly 2.0. Only three patients underwent the perfusion and all of them presented with white
matter ratio of 0.8 to 1.3 times, being considered warm pattern. Conclusion: PCNSL is a rare
malignancy confines to the CNS, which has different treatment comparing with other tumors.
Although PCNSL may have characteristic imaging findings on MR imaging, perfusion and proton
spectroscopy, none of these will unequivocally differentiate from other brain lesions. For the
time, biopsy remains the unique manner to reach the correct diagnosis.
Código: 44859
Título: SPECTROSCOPY OR PERFUSION: WHAT‘S THE BEST RADIOLOGICAL METHOD FOR
GLIOMAS?
Temário: Imagem
Autores: Carlos Alexandre Martins Zicarelli; Bruno Ribeiro Zuccoli; Francisco Spessatto Pesente;
Victor Guilherme Batistela Pereira; Barbara Itimura; Celia Almeida Jorge; Mariana Araujo
Cavallaro; Marcio Francisco Lehmann; Nicolas Pivoto; Tomas Catao Monte Raso; Felipe Inacio
Ferreira da Silva; Alexandre Casagrande Canheu; Karen Barros Parron Fernandes; Paulo
Henrique Pires de Aguiar;
Instituição: UNIVERSIDADE ESTADUAL DE LONDRINA
Resumo: INTRODUCTION: Gliomas are presented histologically diversified, with varying degrees
of cellular and nuclear pleomorphism, high mitotic activity and the magnetic resonance is the
best image method for their evaluation. Spectroscopy and perfusion are noninvasive and
complementary methods to conventional magnetic resonance, allowing the detection of
malignancy degree, locate preferred targets for stereotactic biopsy, distinction between residual
or recurrent tumor and can be performed as early as possible. Spectroscopy provides
biochemical information about the lesion that allow the distinction between active and inactive
regions, better defining the boundary between the tumor and normal tissue, optimizing,
thereby, the surgical resection. The perfusion allows the detection of neovascularization and
thus, identifies vascular proliferation that is presented as malignancy criterion in determining
the histological grade of the tumor. OBJECTIVE: Analyze spectroscopy and perfusion
characteristics as a complementary method to magnetic resonance and the main directions and
objectives of these tests in the evaluation of gliomas. METHODS: It was conducted a literature
review in the databases LILACS and PUBMED concerning additional tests in gliomas with main
focus on spectroscopy and perfusion in order to define the best method for evaluation of this
tumor. CONCLUSION: The additional assessment of gliomas by magnetic resonance using the
spectroscopy and/or perfusion proves to be efficient and indispensable, showing each one in its
own way the complexity of the tumor, being relevant to the neurosurgeon to know the
characteristics and peculiarities of these exams.
Código: 44870
Título: ATYPICAL MENINGIOMAS: OPTIMAL TREATMENT
Autores: Paulo Henrique Pires de Aguiar; César Cozar Pacheco; Iracema Araújo Estevão; Cristiani
Comparetti Janoti; Pedro Soghenet Gomes; Daniel de Andrade Gripp; Marcos Vinicius Calfat
Maldaun;
Instituição: UNIVERSIDADE SÃO FRANCISCO
Resumo: Background: Meningiomas are the most common of all non-malignant brain and
central nervous system tumors, and represent 36.4%% of tumors overall. Although the majority
of meningiomas are benign, 5%–23% are classified as atypical. While the recognition and
definition of this atypical subclass is in ongoing transition, its incidence appears to be increasing.
Atypical meningiomas are associated with a higher rate of recurrence and aggressive growth.
Atypical meningioma is associated with increased mitotic activity or three or more of the
following features: increased cellularity, small cells with a high nucleus-to-cytoplasm ratio,
prominent nucleoli, uninterrupted patternless or sheetlike growth, and foci of spontaneous or
geographic necrosis. Osseous involvement is associated with a poor outcome in patients with
atypical meningiomas. Objectives: Report four cases of atypical meningiomas operated by the
same group of neurosurgeons and show our outcome. Casuistry and Methods: We analyzed the
clinical and surgical data and imaging exams of four patients in a sample space of 93 intracranial
meningiomas operated from 2007 to 2016, 3 cases of atypical meningiomas (3.22 percent) were
diagnosed and 1 case of malignant meningioma (1.07 percent), all located in the convexity, 2
men and 2 women, 42.3 years average age. Results: After the surgery, they underwent
treatment by fractionated radiotherapy. The follow-up ranged from 48 months to 3 months with
tumor recurrence in 2 cases. Conclusion: The atypical meningioma should be treated as
malignant from the start, although the literature makes a distinction in the treatment of both
types. The medium proliferation index LI MIB-1 was 12 percent, showing the aggressiveness of
the tumor as the average value of benign was 2.20 percent.
Código: 44868
Título: AWAKE CRANIOTOMY FOR BRAIN TUMORS - A QUALITATIVE STUDY
Autores: Rafael Teixeira Magalhaes Leal; Edson da Rocha Constantino; Heros Henrique Melo
Almeida; Felipe Lameirao de Oliveira; Jose Alberto Landeiro;
Instituição: HOSPITAL UNIVERSITARIO ANTONIO PEDRO
Resumo: Object. The use of awake craniotomy for supratentorial tumors has been shown to be
safe and effective in precluding post operative deficits. It allows mapping wich is the gold
standard for localizing eloquent brain tissue. In this study the authors aim was to explore
patients’ perceptions about awake craniotomy. Methods. Qualitative research methodology
was used. A semistructured, open-ended interviews were conducted with 16 participants, who
were ambulatory adult patients who underwent craniotomy for brain tumor excision between
May 2014 and February 2015. Interviews were audiotaped and transcribed, and the data were
subjected to thematic analysis. Results. The following 6 overarching themes emerged from the
data: 1) sedation significantly affects memory and the perception of time; 2) awake craniotomy
is painless and perfectly tolerable; 3) patients had excellent recovery immediately after surgery;
4) patients who received good information pre-operatively had higher satisfaction; 5) in
comparison with previous minor/major surgery experiences, awake craniotomy was usually
better tolerated; and 6) patients had a positive overall experience with awake craniotomy.
Conclusions. Awake craniotomy is an extremely well tolerated procedure and patient’s
satisfaction is high. This procedure should be freely employed whenever the surgeon feels
mapping might be necessary. Concerns with patient’s well being should not preclude this type
of surgery, since negative events are extremely rare.
Código: 44853
Título: CAVERNOUS SINUS HEMANGIOMA: CASE REPORT
Autores: TOMAS CATÃO MONTE RASO; FABIO JUNDY NAKASONE; LUIZ DANIEL PEREIRA RIBEIRO
DE SOUZA PENZO; ALEXANDRE CASAGRANDE CANHEU; MARCOS VINICIUS CALFAT MALDAUN;
MARCIO FRANCISCO LEHMANN; PAULO HENRIQUE PIRES DE AGUIAR; CARMEN LUCIA
PENTEADO LANCELLOTTI ;
Resumo: INTRODUCTION: Hemangiomas of cavernous sinus are benign vascular malformations,
common in the cerebral hemispheres, however unusual in extra-axial. Represent 2% of the
cavernous sinus tumors, 3% of all benign tumors and less than 1% of intracranial mass.
OBJECTIVE: To report a rare case of hemangioma of the cavernous sinus; METHODS and
RESULTS: This was a retrospective study, type case report of a female patient, 50 years old, with
paresthesia in the right of the face, since one year. On Magnetic Resonance (MR) and magnetic
resonance angiography shown a tumor in the right cavernous sinus. Submited to partial excision
of the lesion with difficulty intraoperative technique (adhesion and bleeding in the surgical bed),
whose pathological results suggested it was a hemangioma of the cavernous sinus. Patients
referred for radiosurgery for further treatment of the residual lesion. DISCUSSION AND
CONCLUSION: The hemangiomas of the cavernous sinus appears more frequently in women in
the fifth decade of life. It is characterized by a vascular malformation with tumor behavior, signs
and symptoms causing compression of adjacent structures: retroorbital headache, compression
signals 3rd / 4th / 6th cranial nerve, pituitary endocrine disorders by compression. The risk of
spontaneous bleeding can occur, but less frequently in relation to hemispheric lesions.
Macroscopically are well rounded tumors, winy, multiloculated, vascularized. Microscopically, it
constitutes a "comb-honeymoon" richly vascularized, deficient in muscular component, vessels
with thin and dilated walls. Radiologically, it is necessary to distinguish with meningiomas and
schwannomas. In the CT scan, it shows iso or hyperdense, with homogeneous filling after
contrast. MRI studies are presented hypo / isointense in T1, and enhancement hyperintense on
T2. Post-contrast homogeneous uptake around the intracavernous internal carotid without
causing reduction in vessel caliber. The big challenge is the intraoperative bleeding. Are
indications for surgery: deficits of cranial nerves, radiographic lesion growth. Radiation therapy
may be indicated in the following situations: as primary therapy in expansive process (cases that
do not fill the surgical indication criteria), postoperative cases with lesions remaining adhered
to important structures, small and incidental injury.
Código: 44841
Título: CENTRAL NEUROCYTOMAS: OUR EXPERIENCE 2007-2015
Autores: FRANCISCO PAPALINI;
Instituição: HOSPITAL CORDOBA - CLINICA REINA FABIOLA
Resumo: Central Neurocytomas represent 0.15% of CNS tumors operated in this time period at
our Service (2007-2015). There is a frank majority of male patients among them; mean age at
presentation was 26 yerars-old. Central neurocytoma should be taken into account as
differential diagnosis in every intraventricular expansive lesion. The most often clinical
presentation was elevated ICP. Most of the central neurocytomas are the "typical" variant (Mib
1-2%); 42% of tumors in our series were the "atypical" type. Factors to be considered in the
recurrence rate are: - percentage of surgical resection -Mib between 1-2% -Grade of celular
atypia The most often used approach in our series was the transcortical-transventricular,
followed by the transcallosal approach. Tumors with Mib >2% where treated with adjuvant radio
and chemotherapy. The malignant neurocytoma variant can disseminate through CSF (1 case in
our series).
Código: 44730
Título: CHARACTERIZATION OF CNS TUMORS ON A PEDIATRIC POPULATION
Autores: Adysia Moreira Florentino da Silva; Lara Samara Bezerra Antunes; Laís de Albuquerque
Vasconcelos; Francisco Lucas de Sousa; Amauri Pereira da Silva Filho; Verônica Cavalcanti
Pedrosa; Lucas Silva Xavier; Pâmmela Dayana Lopes Carrilho Machado;
Resumo: Introdution: Tumors of the central nervous system (CNSt) represent the main cause of
cancer deaths in children and correspond to the second most prevalent cause of tumors in that
age range, comprising more than 20% of all tumors during infancy. Approximately 80% of CNSt
occur in the first decade of life, which is the first incidence peak, the second peak occurs around
the seventh and eighth decades. In children, there is a higher incidence of medulloblastoma and
pilocytic astrocytoma, and the last decade, there was an increased incidence of CNSt, directly
related to a greater number of diagnoses that were not performed. Objective: To characterize
the CNS tumors involvement profile in the pediatric population in a Neurosurgery reference
service inside the Paraíba regarding: location, firstness of lesions and histological types.
Methods: A retrospective, descriptive study to survey of all new cases of brain tumors in children
admitted to the aforesaid hospital and diagnosed with CNS tumors. It was conducted in the
period of January 2010 to December 2015. Data were collected 64 charts of patients with mean
age of 9 years and for epidemiological analysis of the data was used Microsoft Excel 2007.
Results: It was observed on the location, 50% of supratentorial involvement (n = 32) - included
all cases of metastasis -, 31% of infratentorial involvement (n=20) and 19% of spinal cord
involvement (n = 12). Metastatic tumors reached 6.3% (n = 4) in all cases, with one site of kidney,
one of osteosarcoma, one melanoma and one leukemia record, while primary tumors accounted
for 93.7% of the cases (n = 60), and confirmed 16 different histological types by
anatomopathology. Of these, there was a predominance of pilocytic astrocytoma, with 25% of
cases (n = 15), medulloblastomas, 17% (n = 10), Ependymomas, 15% (n = 9), and Glioblastoma
multiforme 10% (n = 6) on the other. Conclusion: The data analysis allows the identification in
our sample of significant incidence of supratentorial tumors, although the literature indicates
tumors of posterior fossa as more prevalent. The CNS neoplasms study in children have great
importance and its early diagnosis is needed to reduce morbidity and mortality.
Código: 44888
Título: CHILDHOOD CRANIOPHARYNGEOMA : 15 YEARS OF MULTIMODAL TREATMENT
EXPERIENCE
Autores: Patricia Alessandra Dastoli; Valérie Claudine Manicacci; Amanda Lopez; Frederico
Adolfo Silva; Jardel Mendonça Nicácio; Andrea Maria Cappellano; Nasjla Saba da Silva; Sergio
Cavalheiro;
Instituição:
Resumo: INTRODUCTION: Treatment strategies for patients with craniopharyngioma is still
controversial. Gross total resection was advocated for many years, regarding post operatory
clinical conditions. Currently, quality of life is the goal for all treatment modalities. OBJECTIVE:
To analyze the several treatment strategies and outcomes of craniopharyngioma patients in 15
years of experience in a single institution. METHODS: The authors retrospectively evaluated 101
craniopharyngeoma patients treated between 2000 and 2015, at IOP/GRAACC/UNIFESP . Data
regarding initial clinical presentation, body mass index (BMI), endocrinological complications,
treatment modalities and outcomes were collected. RESULTS: From 101 patients treated with
craniopharyngioma at our institution, 78 patients were elegible for evaluation and 13 excluded
for loss of follow-up. Forty- four were boys and 34 girls. The mean age at treatment was 10,5
years (range 3,25-25,08). Fifty-six percent of children presented with signs and symptoms of
intracranial hypertension, 24% with visual impairment and 38,5% with endocrinological
disturbances. At the time of diagnosis, the mean BMI was 20,48kg/m2 (range 12,7- 32,8).
Predominantly cystic tumors (cystic portion ≥ 60% of total lesion volume) occurred in 31 children
and were treated with intralesional interferon-alpha; of these patients, 48% (15/31) progressed
to surgical intervention and adjuvant radiotherapy. Among the 47 predominantly solid tumors,
3 were treated with microsurgery only, 32 with microsurgery + radiotherapy and 12 with
endoscopic transesphenoidal surgery + radiotherapy. The mean BMI of patients treated
exclusively with interferon-alpha was 22,88kg/m2 (ideal weight), with interferon-alpha +
microsurgery was 31,23kg/m2 (grade 1 obesity) and microsurgery + radiotherapy was
29,65kg/m2 (overweight). After treatment, 51 cases (65%) progressed to panhypopituitarism.
The mean follow up was 7,13 years (range 1-17), and 8 deaths occurred. Currently 34 patients
are out of treatment. CONCLUSION: Intracystic therapy with interferon-alpha offers best body
mass index control. However, panhipopituitarism is the most common and important
complication irrespective of treatment modalities.
Código: 44275
Título: CRANIAL ANGIOSARCOMA IN A CHILD WITH CONGENITAL ORBITAL ROOF ABNORMALITY
Autores: Juliana França da Mata; Paulo Taufi Maluf Junior; Leonardo Giacomini; Enrico Ghizoni;
Instituição: HOSPITAL SIRIO LIBANES
Resumo: DPG, 4 years old, male, presented with a malformation of right orbital bone roof at an
intra-uterus ultrasonography with no parenchymal abnormality. The exam showed no other
alteration. There was no neuropsychomotor development deficit but right abducens nerve palsy
by 2 years old. At 3 years old the infant presented with a right side proptosis with a periocular
hematoma and a temporo-parietal bulging. An audiometric exam showed a neurossensorial
hearing loss and no visual field exam changed was diagnosed at perimetry test. A head CT and
MRI were performed and an extent malformation of the ethmoid, temporal and frontal floor
with a diploic expansion and small encephaloceles were seen. A VPS (ventriculoatrial shunt) was
performed with a less then 24-hour head bulging resolution. Then was performed an
intradiploic-peritoneal shunt with no success. An other neurosurgical team performed both
procedures. The authors performed an orbital decompression, an anterior fossa dural repair and
a bone lesion biopsy. The diploic expansion looks like a tumoral lesion with a great amount
bleeding. The anatomical pathology presented a giant cell angioblastoma. Beta interferon was
started at that time with no results. After a discussion with the infant family, another procedure
was performed with aim of a maximal save resection with an otorhinolaryngology team. A 90%
resection was performed and the anatomical pathology analysis changed to giant cell
angiosarcoma. During post operative time he was diagnosed with small pleural and
diaphragmatic metastatic lesions. Treatment plan changed to chemotherapy with alkylating
agent ifosfamide 2g/m2 on D1 plus docetaxel 250mg/m2 D1-D3 plus daily sorafenibe. By the
third course tumor has significantly reduced leading to complete regression of proptosis and
facial assimetry. The child had returned to daily activities and a great quality-of-life improvement
was noticed. By the end of course 6 the child presented seizures and MRI showed extensive
growth at primary site with extensive brain dissemination. At chest CT massive pleural effusion
on right hemithorax was also documented. Child had uncontrolled seizures and rapid clinical
course with death by age 6. The authors intended to report an usual cause of pediatric tumor in
a child harboring congenital unknown orbital bone roof abnormality which could be related to
this particular cancer histology, despite previous documented similar cases due to its rare
incidence in children.
Código: 44901
Título: CRANIOPLASTY: PROPEDEUTIC, TECHNIQUES AND RESULTS
Autores: Andréa Costa de Andrade; Henrique Oliveira Martins; Cleomir da Silva Matos; Heliana
Maria da Costa Matos; Carlos Eduardo da Veiga Lima; Thainá Lima Sicsú; Raquel Ferreira Pontes;
Instituição: HOSPITAL UNIVERSITÁRIO GETÚLIO VARGAS
Resumo: INTRODUCTION: The cranioplasty is a neurosurgical repair procedure of skull
deformities caused by trauma, infections, aneurysms, tumors and previous surgery damage that
lead to profound changes in cerebral hemodynamic. The higher incidence of cranial deformities
are related to trauma brain injury, interventions by craniectomy, accidents or damage caused to
the cap. OBJECTIVE: This study compared the cranioplasty technology practiced in a public
hospital with other esplanades in the literature about the reconstruction of the cranial bone
defect, showing the best reconstructive method for the patient and for neurosurgical
procedures regarding the cost-benefit. METHOD: The methodology used is 10 subtracted of
SCIELO, 03 papers of LILACS, and retrospective analysis of cases, the total 06, between July/2015
to October/2015 in Neurosurgery Department in a Public Hospital, pioneer in popularizing
cranioplasty in northern Brazil. RESULTS: The techniques used for cranioplasty are divided
between the autologous materials (patient‘s own bone) and heterologous (hydroxyapatite,
bioceramic, titanium, methylmethacrylate and the like). Showed that the most commonly used
technique for cranioplasty in Health System Public (SUS) is using as technology hydroxyapatite,
considered an adequate substitute for the reconstruction of human bone, providing quality to
the target population and better value for money to the public coffers because it does not
require many devices, it is feasible resolution, benefiting the patient, the surgical team and
health facility about the results, procedure execution time and value for money. Some experts
are advocates of the use of autologous bone describing its mechanical, immunological and
functional properties as an aesthetic and psychological effect that make them the best material
for cranioplasty, however it comes to practice that requires great financial investment, when it
comes to bone bank and can generate a higher rate of infection for the patient that the stores
during the decompression period post-cranial damage. The practice in neurosurgical show that
the guard and abdominal withdrawal of damaged bone can cause infection due to lack of
asepsis. CONCLUSION: Although the technologies not used various heterologous materials, the
results from the use of hydroxyapatite have been satisfactory in cost-effective, skull repair and
protection, reducing pain complaints, the accident rates and providing the balance of cerebral
hemodynamic.
Código: 44731
Título: DISTRIBUTION OF CNS METASTASES IN A REFERENCE HOSPITAL IN NEUROSURGERY
Autores: Adysia Moreira Florentino da Silva; Lara Samara Bezerra Antunes; Laís de Albuquerque
Vasconcelos; Francisco Lucas de Sousa; Amauri Pereira da Silva Filho; Verônica Cavalcanti
Resumo: Introduction: Brain metastasis is the most common intracranial tumor in adults, and
its prevalence is mainly associated with primary neoplasms of the lung and breast. Demonstrates
a devastating complication of cancer - limited treatment and poor prognosis - with median
survival less than 1 year. The immunohistochemistry is the ideal tool to identify the histological
type, otherwise, imaging tests are essential for the differential diagnosis with other diseases.
The incidence of metastatic tumors of the CNS has been increasing in the last decade, and this
points to a greater need for vigilance with regard to tracking and long-term monitoring of
neoplasms. Objective: To analyze epidemiological distribution of tumors derived from CNS
metastases in patients treated in the neurosurgery service referral hospital in Campina Grande
- PB. Method: observational, cross-sectional, retrospective, with analysis of data obtained from
medical records of patients surgically treated from January 2012 to December 2015. For
statistical analysis of data collected by a standard form, a Microsoft Excel 2007 spreadsheet was
used. Results: In pediatric patients were registered 4 cases of metastasis to the CNS, all with
supratentorial location with 1: 1 ratio between the sexes and average of nine years of age
affected. The histological types were derived from kidney, skin, bone and bone marrow. About
adult patients, 46 cases were registered during the period, 56% of males and 44% females,
inserted in the age group 32-80 years old. There was a similar prevalence between cases arising
from breast cancer (f = 0.24) and lung (f = 0.20), overlapping the others, which included: uterus
(f = 0.15); gastrointestinal tract (f = 0.11); Melanoma (f = 0.09); Thyroid cancer (f = 0.04); NonHodgkin‘s lymphoma (f = 0.02) and further 15% of the sample where the primary tumor site
cannot be determined. Conclusion: Brain metastases are in a serious and deleterious health
surveillance problem. The presented study proved to be compatible with the literature
regarding the prevalence, and pointed to the importance of adequate follow-up of cancer, still
demonstrating the need for greater diagnostic accuracy with regard to cases whose site was
undetermined.
Código: 44347
Título: DROP METASTASIS MENINGIOMA
Autores: Washington Luiz de Oliveira; Alfredo das Neves Magalhães Fernandes; João Carlos de
Sá Campos; Bruno Loyola Godoy; Antônio Aversa Dutra do Souto;
Instituição: INSTITUTO NACIONAL DO CÂNCER
Resumo: Introduction Meningioma is a common intracranial neoplasm in adults. Local
recurrence and extra cranial metastasis are well described in the literature. However, drop
metastasis to 4th ventricle is rare. We review a case and discuss metastatic mechanisms,
histological features and consensual treatments. Case report A 10 year-old female presented
with a 3 months history of headache, gait disturbance, lethargy, visual deficit and seizures.
Neurological examination revealed left abducent palsy and bilateral optic nerve atrophy. A
cranial magnetic resonance imaging (MRI) revealed a left frontal tumor. Complete resection of
the tumor was performed and the MRI follow-up was normal until 49 months after initial surgery
when showed recurrence in the same site. Another total resection was performed and after 47
months the follow-up scan showed recurrence in the same site and a new enhancement area in
the IV ventricle. Lesions were resected and immunohistochemical study was papillary
meningioma. Immunoreactivity was positive for Vimentin and EMA (epithelial membrane
antigen) and negative for GFAP (Glial fibrillary acidic protein), S-100, CD34, progesterone
receptor, cytokeratin AE1/AE3, CK8-18, cromogranine and synaptophysin. Ki-67 labeling index
was about 10%. The post-operative MRI was negative and cerebrospinal fluid sampling were
negatives. Discussion Intraventricular meningiomas accounting for less than 3% of all
intracranial meningiomas and rarely metastasize (general rate of 1%). CSF dissemination occurs
in 4% of the cases of metastatic disease. Different routes of dissemination have been identified:
hematogenous, lymphatic, CSF and iatrogenic. According to our review, this is the second case
of drop metastase to 4th ventricle in the literature. Several factors influencing metastatic
spread: (i) the histologic meningioma malignancy; (ii) recurrent tumors; and (iii) venous sinus
invasion. Published data suggest that metastatic spread tends to be a late, with a latency of
months. Surgical resection might initiate the metastatic spread, but there were reports of
metastases in no operated cases. No effective systemic or intratecal chemotherapy have been
reported. Despite aggressive approach the median survival was 5.5 months. Postoperative
adjuvant radiotherapy or chemotherapy should be performed despite resection, as well as early
MRI scanning every 3–6 months.
Código: 44846
Título: ENDOLYMPHATIC SAC TUMORS; CASES REPORTS.
Autores: Bruno Vilela Gomes; Antônio Aversa Dutra do Souto; Alfredo das Neves Magalhães
Fernandes; Washington Luiz de Oliveira;
Resumo: INTRODUTION Endolymphatic sac tumors (ELST) are rare neoplasm of the posterior
temporal bone. Although such tumors have benign histopathological appearance, they course
with local destructive behavior and invasion of bone structures of the skull base such as petrous
bone, mastoid, semicircular canal and cranial nerves as well. It can be encountered sporadically
or in association with Von HippelLindau (VHL) disease. Because of the rarity of this neoplasm,
these tumors can easily be confused with other neoplasm such as paraganglioma, middle ear
adenoma, adenocarcinoma, papillary carcinoma of thyroid or choroid plexus papilloma. At
present, there is no consensus regarding the management and long-term follow up of these
tumors. Radical surgical resection is the standard treatment. This report presents 4 cases of
endolymphatic sac tumor and a brief review of the literature regarding this uncommon disease.
OBJECTIVE Describe four cases of patients with diagnosis of endolymphatic sac tumors who
underwent surgical procedure and review the literature on this unusual entity. MATERIALS AND
METHODS It was conducted a review of medical records of patients operated at the National
Cancer Institute in Rio de Janeiro, Brazil. RESULTS We found a high incidence in women with 3
patients had more than 40 years old at the time of diagnosis. The most common symptoms were
hearing loss, facial paralysis, headache, vertigo and tinnitus. One patient received postoperative
radiotherapy. We found only one patient with VHL disease. CONCLUSION Endolymphatic sac
tumors are rare primary neoplasms of temporal bone that manifest typical symptoms of vertigo,
tinnitus, hearing loss, headache, ataxia and facial paralysis. They may have from a few
millimeters to several centimeters in diameter and many of them are diagnosed at an advanced
stage with erosion of the temporal bone and the labyrinth. Most of them are associated with
VHL disease, but a few are sporadically. The standard treatment is surgery. The role of the
radiotherapy is still controversial.
Código: 44389
Título: ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY IN ELDERLY PATIENTS WITH
PITUITARY ADENOMAS
Autores: Jackson Gondim; Joao Paulo Almeida; Lucas Alverne de Albuquerque; Erika Gomes;
Michelle Schops; Jose Italo Mota;
Resumo: NTRODUCTION:With the increase in the average life expectancy, medical care of
elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little
information exists in the literature about the surgical treatment of these patients. The aim of
this study was to present the results of a single pituitary center in the surgical treatment of PAs
in patients > 70 years of age. METHODS:In this retrospective study, 55 consecutive elderly
patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal
surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The
clinical and radiological results in this group were compared with 2 groups of younger patients:
< 60 years (n = 289) and 60-69 years old (n = 30). RESULTS: Fifty-five patients ≥ 70 years of age
(average age 72.5 years, range 70-84 years) underwent endoscopic surgery for treatment of PAs.
Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower
frequency of pituitary apoplexy before surgery (p < 0.05). Tumors with cavernous sinus invasion
were treated surgically less frequently than in younger patients. Although patients with an
American Society of Anesthesiologists score of 3 were more common in the elderly group (p <
0.05), no significant difference regarding surgical time, extent of resection, and hospitalization
were observed. Elderly patients presented with more complications than patients < 60 years
(32.7% vs 10%, p < 0.05). Complications observed in the elderly group included 5 CSF leaks (9%),
2 permanent diabetes insipidus cases (3.6%), 4 postoperative refractory hypertension cases
(7.2%), 1 myocardial ischemia (1.8%), and 1 death (1.8%). Postoperative new anterior pituitary
deficit was more common in the younger group (< 60 years old: 17.7%) than in the elderly (≥ 70
years old: 12.7%); however, there was no statistical difference. CONCLUSIONS:Endoscopic
transsphenoidal surgery for elderly patients with PAs may be associated with higher
complication rates, especially secondary to early transitory complications, when compared with
surgery performed in younger patients. Although the worst preoperative clinical status might be
observed in this group, age alone is not associated with a worst final prognosis after endoscopic
removal of nonfunctioning PAs.
Código: 44243
Título: EPIDEMIOLOGICAL ANALYSYS OF 1318 SURGICAL BRAIN TUMORS DURING A PERIOD OF
TWELVE YEARS IN A TERTIARY REFERENCE HOSPITAL AT SÃO PAULO – BRAZIL
Autores: Aline Lariessy Campos Paiva; José Carlos Esteves Veiga; João Luiz Vitorino Araujo;
Americo Rubens Leite dos Santos; Alexandros Theodoros Panagopoulos; Nelson Saade; Luiz
Fernando Canonni; Juan Antônio Castro Flores; Flávio Key Miura; Eduardo Urbano; Guilherme
Brasileiro Aguiar; Vinicius Monteiro de Paula Guirado; Jefferson Walter Daniel; Vinicius Ricieri
Ferraz; Renan Maximiliano Lovato; Tiago Marques Avelar;
Instituição: SANTA CASA DE SAO PAULO
Resumo: INTRODUCTION: In the past decades it was observed an increase in brain tumor
diagnosis. Recently some studies are been developed trying to relate brain tumors with obesity
(which had a significant increase in the last years). Globally, the incidence tends to be similar
between both genders and there are some histological types (according to World Health
Organization – WHO) more common in each age group. Survival rate depends mainly on the
nature of the neoplasia (benign or not), Karnofsky Performance Scale (KPS), comorbities,
topography, grade of dissemination (on metastasis) and an early diagnosis. OBJECTIVES: To
analyze relevant epidemiological issues of brain tumors which were treated surgically in a period
of twelve years in a huge and reference hospital at São Paulo – Brazil. METHODS: Neurosurgical
database were used to perform this research, including data such us the total number of surgical
brain tumor, gender, all the histological types (immunohistochemical analysys was considered),
topography (skull base and non skull base lesions) and age groups. Conflitant informations and
inconclusive histopathologic analysys were excluded. RESULTS: In this period 1318 tumors were
surgically treated in our service. Among them, it could be observed a predominance in the
female gender (59%) whereas male corresponded to 41%. Regarding topography it was divided
between skull base lesions and non skull base. The first one corresponded to 27,4% as the
second to 72,6%. They were more diagnosed among the age group ranging from 36 to 60 year
old (45,3%), followed by those patients with more than 61 years old (27,3%). Between children
and teenagers (0-18 years) depending on the age, different types predominated (for example,
among those with less than 9 years it could be observed predominance of pilocytic
astrocitomas). Dividing in the most common histological types according to WHO orientations,
gliomas were the more prevalent tumor (24%) and among them the high grade lesions had
greater incidence, followed by meningiomas (21,7%), after by surgically treated metastasis
(17%) and then adenomas (10%). CONCLUSIONS: The incidence of brain tumors had increase in
the past years. They have different patterns of prevalence according to many factors such as
age. In primary and in secondary lesions the incidence were higher in the female gender. Early
diagnosis and knowing biological behavior and epidemiological data helps to manage these
lesions.
Código: 44751
Título: EPIDEMIOLOGICAL ANALYSYS OF 20 CASES OF CRANIOPHARYNGIOMAS IN THE PAST
DECADE IN A TERTIARY HOSPITAL AT SÃO PAULO – BRAZIL
Autores: Aline Lariessy Campos Paiva; João Luiz Vitorino Araujo; Milton Hikaro Toita; Américo
Rubens Leite dos Santos; Vinicius Monteiro de Paula Guirado; Flávio Key Miura; José Carlos
Esteves Veiga;
Resumo: INTRODUCTION: Craniopharyngiomas are rare tumors derived from epithelial rests
from imperfect closure of the hypophysial or craniopharyngeal duct. Its incidence is about 0.5
and 2.5 new cases per million population per year, however this number is greater between the
pediatric population. It most common occupy selar and parasselar regions. These lesions have a
slow growing pattern, but they tend to local recurrence although after a gross total removal.
Some signs and symptoms such as visual disfunction and disturbance of hypothalamic-pituitary
axis should aware the neurosurgeon to the early diagnosis of this tumor and premature
ressection for minimizing sequelae. OBJECTIVE: Epidemiological analysys of 20 cases of
craniopharyngiomas surgically treated during a period of 10 years in a huge and reference
hospital of São Paulo – Brazil and discuss relevant issues about this theme. METHODS: It was
used database information of the neurosurgery deparment including the total number in the
past decade, gender, age, shunt requirement, histopathological classification and topography.
RESULTS: In this period in our service it was diagnosed 20 patients with craniopharingiomas.
Among them, 12 (60%) were of the male gender and 8 (40%) were female. All the cases were
classified as adamantinomatous subtype (100%), and no papillary cases were observed. They
also predominated among children and young adults: 0-10y: 9 (45%), 11-20y: 5 (25%), 21-30: 0,
31-40: 3 (15%), 41-50: 2 (10%), 51-60: 1 (5%) and > 61y: 0. Only 2 cases (10%) required
permanent shunt. Regarding the topography of these tumors, all of them were in the
sellar/parasselar region, 6 (30%) were only sellar lesions, 3 (15%) only suprasselar lesions and
11 (55%) selar and suprasselar lesions. CONCLUSIONS: Craniopharyngiomas are rare tumors
more prevalent among young patients mainly until 15 years as was also observed in this review.
Male sex is more associated to this tumor as shown in huge worldwide studies and in this
analysys. Hydrocephalus generally is a transient condition because of the obstruction of the third
ventricle (due to lesions in selar and suprasselar regions are the most common localization) and
permanent shunt usually is not required after tumor ressection. These considerations refer to
adamantinomatous type because of patterns of papillary type is less known due to its lower
incidence.
Código: 44224
Título: EPIDEMIOLOGICAL ANALYSYS OF 224 SURGICAL BRAIN METASTASIS DURING A PERIOD
OF TWELVE YEARS IN A TERTIARY HOSPITAL AT SÃO PAULO – BRAZIL
Autores: Aline Lariessy Campos Paiva; João Luiz Vitorino Araujo; Vinicius Ricieri Ferraz; Renan
Maximiliano Lovato; Alexandros Theordoros Panagopoulos; José Carlos Esteves Veiga;
Resumo: INTRODUCTION: Brain metastasis is the most common type of central nervous system
tumor. Genneraly is related with progressive and advanced disease. In some cases could be the
first manifestation of neoplastic disease in patients who did not have this diagnosis yet. Patterns
of neuroimaging can suggest the secondary nature of the tumor and guide the investigation,
staging and so the therapeutic approach. Many times the disease is very disseminated and so,
agressive surgery may not bring benefit for patients and their life quality. For patients which did
not have this previous diagnosis, recente advances in immunohistochemical analysys could help
to elucidate doubtful cases. OBJECTIVE: Epidemiological analysys of all patients who undergone
neurosurgical intervention because of brain metastatic tumor in a huge and reference hospital
of São Paulo- Brazil between 02/2003 and 08/2015 and also literature review about relevant
epidemiological issues. METHODS: It was used database information of the neurosurgery
department including the total number (patients with brain metastasis but did not underwent
to surgical approach were not included in this analysys), gender, age and primary situs. RESULTS:
In this period in our service 224 patients underwent to neurosurgical intervention because of
brain metastasis. Among these patients, both gender had similar prevalence, with 45,98% in
male and 54,01% in female. The predominant primary situs was pulmonary (32,58%), followed
by breast cancer (14,28%) tumors with origin in gastrointestinal tract (12%) and another tumors
which the pathological analysys could not conclude about their origin (this result is most likely
because years ago the immunohistochemical analysys was not so available to elucidate some
doubts during the investigation). Brain metastasis predominated among people with age ranging
between 36 and 60 years (59,37%), mainly in the fifth decade (32,14%) and had the less
prevalence among those under 18 years old (2,67%). CONCLUSION: Surgical brain metastasis
correspond to an important portion of oncological neurosurgical procedure, mainly in elderly
patients with advanced disease and is more prevalent among lung cancer patients. Clinical
history is important during the evaluation to a patient with brain tumor and also neuroimaging
pattern can help the management.
Código: 44269
Título: EPIDEMIOLOGICAL PROFILE AND FOUND INTRA OPERATIVE OF GLIOBLASTOMA
MULTIFORME IN NEUROSURGERY SERVICE OF SANTA CASA OF RIBEIRÃO PRETO HOSPITAL - SP
(HSCMRP)
Autores: NICOLLAS NUNES RABELO; DANIEL ALVES BRANCO VALLI; LUCIANO JOSÉ SILVEIRA
FILHO; IGOR DE SOUZA FURTADO; VITOR HUGO HONORATO PEREIRA; GEORGE SANTOS DOS
PASSOS; FERNANDA STABILE DA SILVA; LUIZ ANTÔNIO ARAUJO DIAS; LUIZ ANTÔNIO ARAUJO
DIAS JUNIOR; FERNANDO EDUARDO PLASTINA; KOJI TANAKA; THAIS INÁCIO DE CARVALHO;
Instituição: HOSPITAL SANTA CASA DE RIBEIRAO PRETO
Resumo: Introduction - Glioblastoma Multiforme(GBM) or Astrocytoma grade IV (WHO),
represent 15-20% of CNS tumors and approximately 50% of gliomas in adults. Primary, originate
in older patients with short clinical history, secondary, develop from glioma grades II and III.
Objective: To reveal the epidemiological profile of HSCMRP, correlate macroscopic and
microscopic findings during surgery with tumor aggressiveness of GBMs, treated from January
2011 to November 2015 period. Method: Epidemiological study observational, descriptive,
retrospective, of medical records of 429 cases of intracranial tumors from data obtained from
the files of the institution and pathological records of patients treated surgically. The variables
were: age, sex, comorbidities, preoperative clinical, time of onset of symptoms to surgery,
topography, preoperative clinical, macro and microscopic aspects intraoperatively, degree of
resection and time to relapse. Results: Total tumors found 429 (100%) and total GBM 96
(22.37%) with a mean age of 59anos (6-89 years). The majority is between the sixth decade of
life 25% (51-60 years) and the seventh decade of life 33% (61-70 years). Predominated White
people (86%). A relationship between men and women was 1:1.12. The most common
complaints were headache (58%), confusion (41%), dizziness (8%), depression (8%) and seizures
(8%). With hemiparesis on admission 37%. Most prevalent comorbidities: hypertension (64%)
and diabetes (22%). Smokers (24%). Most common topography were followed by Left Front
Temporal. The average time of onset of symptoms to surgery was 39 days. Complete resection
in 76% of cases. The mean length of postoperative recurrence was 96 days, but in 22 cases of
this group (22.9%) who had relapsed in less than 60 days, 15 patients (68%) were noticed an
exuberance of thrombosed vessels during surgery, with matching patients with short time to
relapse. Pathological findings: necrosis 98%, atypical mitosis 96%, microvascular proliferation
73% and nuclear polymorphism 57%. Conclusion: Our results vary slightly with the literature.
The association of intraoperative observation thrombosed vessels, tumor aggressiveness in
patients with worse prognosis and shorter time to relapse, suggests that it is real, however, the
small number of cases, needs further investigation, including other findings and
immunohistochemical results.
Código: 44847
Título: EPIDEMIOLOGICAL PROFILE OF INTRACRANIAL TUMORS IN ADULTS OF A
NEUROSURGICAL SERVICE IN THE JANUARY PERIOD 2014 TO DECEMBER 2015
Autores: Marcos Antônio Pereira do Rêgo; Márcia Cristina da Paixão Rodrigues; Marco Túlio
Sette dos Santos; Rafael Basílio Guimarães; Martin Martelanc; Grace Mary Santos Lydia;
Instituição: FACULDADE DE MEDICINA DO ABC
Resumo: INTRODUCTION The incidence of primary brain tumor is 11 to 19 for every 100,000
individuals and brain metastases from 11 per 100,000 in the population. Mortality from brain
tumor is higher in the oldest age groups. The most common tumors are gliomas in adults,
followed by meningiomas. The more sites that give rise to metastases to the central nervous
system are: lung, breast, kidney, skin, gastrointestinal tract and about 10% of unknown origin.
OBJECTIVES Analyze the epidemiological profile of intracranial tumors operated in a
Neurosurgical Department from January 2014 to December 2015. METHODS This is a
retrospective, cross-sectional, observational study with analysis of the incidence of intracranial
tumors who underwent surgery in a sample of 38 adult patients. Variables are compared by
percentages. The authors show by tables and graphs correlations between variables and the
findings in the literature. RESULTS 38 pacients underwent surgery for intracranial tumor in the
period of 23 months, with 55% male and 45% female. The age range with the highest incidence
was between 46 and 70 years (55%), then greater than 71 years (29%) and between 19 and 45
(16%). In the histopathological report, 71% (27 cases) were primary central nervous system, 21%
(8 cases) metastatic, one lymphoma case (3%) and 2 inconclusive cases (5%). Primary tumors 15
were glioblastoma multiforme, 7 meningiomas (90% and 10% meningoendotelial fibrous), 2
oligodendrogliona (50% grade II and grade III 50%), 1 schwannoma, 1 pituitary adenoma, 1
medulloblastoma. The primary source of metastases was lung carcinoma (30%), thyroid
carcinoma (30%), stomach carcinoma (10%), melanoma (10%) and non-Hodgkin‘s lymphoma
(10%). Two cases (5%) had inconclusive report. CONCLUSIONS In the population studied ,
intracranial tumors were more prevalent among males, between 46-70 years, the primary
source of the central nervous system, with the highest incidence to glioblastoma multiforme.
Among the metastatic , the highest prevalence was lung and thyroid
Código: 44854
Título: EPIDEMIOLOGY AND MANAGEMENT OF CRANIOPHARYNGIOMA IN ADULT PATIENTS,
PUERTO RICO 2004-2014
Autores: Saryleine Ortiz de Choudens; Michael Ortiz Torres; Jaime Inserni Milán;
Instituição: UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE
Resumo: Introduction: The epidemiology and management outcomes of craniopharyngiomas in
Puerto Rico remain unknown, with limited information published on this subject worldwide, and
no available publications specifically concerning Puerto Rico. Craniopharyngiomas are benign
tumors that present a bimodal age distribution with highest incidence in age groups 5-14 years
and 65 years or older. Due to the variability of craniopharyngioma behavior and low incidence
of the disease, there is no general consensus on best management practices. Objectives: The
purpose of this study is to describe the epidemiology, management, and treatment outcomes
of craniopharyngiomas in Puerto Rico. Methods: A descriptive study of cranipharyngioma
patients at the Puerto Rico Medical Center between years 2004-2014 was performed. Data
collected retrospectively from medical records included: town of residency, gender, age at time
of diagnosis, recurrence, tumor subtype and location, clinical manifestations, tumor
management, and treatment outcomes. Initially, a total 34 patients were identified, and 21 of
them fulfilled our inclusion criteria of: age over 21 and pathology consistent with
craniopharyingioma. Results: Mean age was 51 years (95% CI, 45.6 - 58.1), and 86% of patients
were under the age of 65. Incidence rate for the 11 year period was 7.18 per million persons
(95% CI, 6.51 – 7.85). 57% of the subjects were female and 43% were male. 29% of the tumors
were pathologically described as adamantinomatous, while the rest (71%) remained
unspecified. The most common tumor localization was suprasellar (52%), and the most
performed treatment was transcranial resection (90%). Central diabetes insipidus was the most
common post-operative complication (57%). 33% of patients presented with at least one
recurrence. Conclusion: The mean age at time of diagnosis in Puerto Rican adult population was
significantly lower than the one observed in literature, not presenting the expected bimodal
distribution. The identified tumor subtype in adult population was consistent with tumor
subtype suggestive of juvenile disease. The preferred surgical approach was transcranial
resection, with one-third of patients presenting at least one recurrence. Post operatory diabetes
insipidus was the most common surgical outcome in patients who underwent transcranial tumor
resection.
Código: 44196
Título: ESTHESIONEUROBLASTOMAS: MULTIMODAL MANAGEMENT
Autores: Andrés Cervio; Marengo Ricardo; Barbón Jesús; Alejandro Mugeri; Julio Moreno;
Blanca Diez; Jorge Salvat;
Instituição:
Resumo: Introduction Esthesioneuroblastoma (ENB) is an uncommon malignant neoplasm of
nasal vault, believed to arise from the neuro-olfactory epithelium. It constitutes 3% of all
intranasal neoplasms and its etiology remains unclear. Objectives To evaluate the surgical
treatment Esthesioneuroblastomas (ENB), analizing the 3- and 5-years progression free survival
(PFS) and overall survival (OS) according to Hyams histological classification and Kadish stage.
Materials and Methods Eighteen patients with histological confirmation of ENB operated on
between June 1996 and November 2013 were analyzed retrospectively. PFS and OS were
calculated using Kaplan-Meier analysis. Hyams´ tumor grade and Kadish stage were evaluated
for their impact on OS using the log-rank test. Results Nine patients were female. The median
age at presentation was 56 years. The mean follow-up time was 56 months (5 – 216 months).
The most common presentation symptoms were anosmia, unilateral nasal obstruction,
headache and epistaxis. Three patients were diagnosed as Kadish stage A, 4 Kadish stage B, 10
Kadish stage C and 1 Kadish stage D. According to Hyams histological classification, 2 patients
present grade I, 8 grade II, 4 grade III and 4 grade IV. All patients were operated on using
different surgical approaches. Eigth patients underwent pure trans-nasal resection, 9 patients
were operated on by combined approaches (Cranial and trans-nasal) and 1 patient was treated
only by cranial approach. Eight patients received radiotherapy after surgery. Recurrences were
detected in 7 patients. Two patients showed distant metastases and 2 patient dissemination to
the lymph nodes. At 5 years PFS was 27% and OS was 56%. Hyams´ tumor grade I and II was a
statistically significant predictor of OS. Conclusions Surgery is still the main treatment in most
ENB cases. Patients with primary or recurrent lesion without intracranial extension (Kadish A or
B) are the best candidates for endoscopic techniques. Lesions Kadish C must be approach by
endoscopic or combined techniques depending on the experience of the surgeon. PFS and OS
were 27% and 56% at 5 years, respectively. Hyams´ tumor grade I and II was associated with a
significant improvement in overall survival.
Código: 44668
Título: EXPERIENCE OF NEURO NAVIGATION USE SYSTEMATICALLY ON THE IMPLANT OF
OMMAYA RESERVOIR ON 48 CASES OF LEPTOMENINGEAL CARCINOMATOSIS TREATMENT
Autores: Daniel Andrade Gripp; Marcos Vinícius Calfat Maldaun; Paulo Henrique Pires de Aguiar;
Luís Roberto Mathias Júnior; Tatiana Alves Vilas Boas Peres; Fabio Jundy Nakasone; Gustavo
Henrique de Araujo;
Instituição: UNIVERSIDADE SEVERINO SOMBRA
Resumo: Introduction: Ommaya and Salmon Hickham reservoirs often need to be surgically
implanted by neurosurgical teams treating oncologic central nervous system (CNS) conditions
but especially on the treatment of carcinomatous meningitis, it allows the chemotherapy is
delivered directly in the cerebrospinal fluid (CSF). Meticulous technique and precision during
catheter placement are required during implant.The catheter tip should ideally be positioned in
the ventricular frontal horn cavity, thus minimizing chances of drugs being infused off the
ventricular cavity and of damage to neural pathways. When slit like or displaced ventricles are
evidenced on pre-operative imaging, complementary methods are helpful to ensure ideal
catheter position. In order to accomplish this, a stereotactic method can be used and more
recently frameless neuro navigation. Our objective was to report 48 cases of Ommaya
placement with a low complication rate verified with immediate post-operative CT scan.
Methods: to describe in a stepwise fashion the technique used in 48 cases of Ommaya implant
surgery, from 2007 to the present date, all performed at Hospital São José or Hospital Sírio
Libanês, SP, Brazil and compare them to literature consulted. All cases were submitted to
meticulous skin prep. Frontal right ventricular horn was used in all cases and catheters were
attached to a pre calibrated tool to allow visualization on the navigation viewer and placed under
neuro navigation guidance until their tip was ideally positioned as verified on the 3D viewer
navigation station. Reservoirs were placed subcutaneously away from direct surgical skin
incision and a “no skin touch” technique was adopted by the medical team. We reviewed
patient’s medical records and immediate post-operative CT scans, routinely performed. Results:
on all 48 cases, using standardized technique, all of them conducted directly or supervised by
the senior author (Maldaun, M.V.C.), only 3 complications were identified, 2 infections
appropriately treated and 1 (2.08%) misplacement of the catheter tip that called for immediate
replacement. Conclusions: use of meticulous and standardized technique and navigation to aid
catheter placement on right frontal horn when implanting intraventricular devices was of
fundamental importance for obtaining a low post-operative complication rate as evidenced by
the pertinent literature.
Código: 44391
Título: GIANT PITUITARY ADENOMAS: SURGICAL OUTCOMES OF 50 CASES OPERATED ON BY THE
ENDONASAL ENDOSCOPIC APPROACH
Autores: Jackson Gondim; Joao Paulo Almeida; Lucas Alverne de Albuquerquer; Erika Gomes;
Michelle Schops;
Resumo: INTRODUCTION/OBJECTIVES: To present our experience with the surgical
management of giant pituitary adenomas in a series of 50 cases operated on by an endoscopic
endonasal approach. METHODS: A retrospective data analysis of all patients who underwent
transsphenoidal endonasal endoscopic surgery at the General Hospital of Fortaleza, Brazil,
between January 1998 and November 2011 was performed. Patients who presented with
pituitary adenomas larger than 4 cm were included in the study. Analysis of factors related to
the choice of the operative approach, hormonal and visual status, extent of resection, tumor
control rates, clinical outcome, and complications were evaluated. RESULTS: Fifty cases (10.41%)
matched our inclusion criteria. Nonfunctioning tumors were present in 42 patients (84%);
among functioning adenomas, five patients (10%) had growth hormone-secreting adenomas,
and three patients (6%) had prolactinomas. Total removal of the tumor occurred in 19 cases
(38%), near-total removal in 9 cases (18%), and partial removal in 22 cases (44%). Postoperative
cerebrospinal fluid leaks occurred in four cases (8%). Postoperative diabetes insipidus was
present in 10% and new anterior pituitary insufficiency affecting one axis or more than one axis
was observed in 22% and 14%, respectively. The presence of Knosp score ≥3 was associated with
subtotal resection. Patients harboring hormonally active adenomas were submitted to adjuvant
medical therapy for long-term clinical control. Vision improved in 38 patients (76%), with only
one case of visual deterioration reported. CONCLUSION: Transsphenoidal endoscopic endonasal
surgery may provide effective treatment for patients with giant adenomas when performed by
a surgical team that specializes in pituitary surgery. In cases in which total resection by the
endoscopic approach may be associated with important complications, we advocate the use of
partial resections followed by adjuvant drug therapy or radiotherapy. In cases of progressive
enlargement of residual lesions, a second endoscopic debulking of the tumor may be considered
for control of the disease.
Código: 44900
Título: GLIOBLASTOMA WITH LONG-TERM SURVIVAL: CASE REPORT AND LITERATURE REVIEW
Autores: Guilherme Gago da Silva; Eduardo Schuch; Antônio Delacy Martini Vial; Octávio Ruschel
Karam; Fernando Antônio de Oliveira Costa; Othello Moreira Fabião Neto;
Instituição: UNIVERSIDADE CATÓLICA DE PELOTAS
Resumo: Introduction: High-grade gliomas, such as glioblastoma (GBM), are the most common
primary brain tumors and are associated with a poor prognosis. The current treatment includes
surgery, radiotheraphy and chemotherapy. Despite aggressive treatment and new therapeutical
options over the past decades the survival time after diagnosis is still about 12 to 15 months.
However 3-5% of the patients survives for more than 3 years and are referred to as long-term
survivors. Although certain clinical aspects, including age, extent of ressection, chemotherapy
and performance status, are well known prognostic features, it is obvious that other, yet
unknown genetic and epigenetic factors contribute to the unusually long survival of some GBM
patients. Objective: To report the case of a patient who survived for more than 6 years after
diagnosis of a fronto-parietal glioblastoma which was treated with agressive tumor removal,
radiotherapy and chemotherapy, reinforcing the importance of clinical and biological aspects
that may be involved with long-term survivors. Case report: This 56-year-old male patient
presented with a history of headache for 3 months, associated with vomiting, focal seizures and
progressive paresis in right hemibody. He also had experienced speech disorders 1 month prior
to admission. The examination revealed muscle strength grade 3, according to the modified
scale of the Medical Research Council, in the right hemibody, associated with mild hyperreflexia.
No more deficits were found. The patient was submitted to magnetic resonance imaging (MRI)
of the brain, which showed lesions in the left fronto-parietal lobe, raising the possibility of
glioblastoma, which was confirmed by anatomopathological and immunohistochemical studies.
Macroscopic lesion was completely removed and was performed subsequent radiation and
chemotherapy with temozolomide. Early postoperative period was characterized by significant
improvement of paresis and speech disturbance, with only subtle paresis in the right hemibody.
All postoperative MRI’s revealed no evidence of recurrence and the patient remains
asymptomatic so far. Conclusion: Glioblastoma has remained incurable and uniformly fatal
despite all efforts for understanding this disease. Despite the good results of our patient, the
group of patients known as long-term survivors are rare and reliable conclusions should be taken
into consideration only when clinical aspects and histopathological studies are reviewed.
Código: 44268
Título: GRADENIGO’S SYNDROME ON PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
MIMICKING CEREBELLAR-PONTINE-ANGLE (CPA) TUMOR
Autores: MAURO TAKAO MARQUES SUZUKI; Paulo Augusto Souza Lara Leão; Marcelle Rehem
Machado; Antonio Jorge Barbosa de Oliveira; Noel Peixoto Schechtman; Henrique Alves Costa
Afonso;
Instituição:
Resumo: Introduction: Apical petrositis described by Gradenigo in 1904 consists in VI nerve
palsy, facial pain and otorrhea, usually related to infectious mastoiditis or otitis. We present a
case of a woman with a mass effect lesion at CPA and Gradenigo’s Syndome, with complete
spontaneous resolution. Case report: 37 years woman with SLE presenting sudden onset of facial
pain, diplopia, hearing loss and mild facial palsy on the right side. MRI and CT showed a
hyperintense T1 and T2 cistern mass effect lesion at CPA associated with mild apex petrositis
without mastoiditis or otitis signs. No restriction in diffusion image sequences. Patient started
to recover spontaneously during observation without steroids or any other medication. A six
months control MRI and CT showed complete resolution of the intracranial CPA lesion.
Discussion: Gradenigo’s Syndrome, although related to infections apex petrositis, maybe related
to other mass effect lesions on CPA, even with minor or absent temporal bone disease. There is
no literature consistent data regarding the relation of Systemic Lupus Erythematosus (SLE) and
CPA inflammatory lesions. Other important intracranial mass-effect lesions of CPA must be
taken in account, although they do not have the tendency to resolve spontaneously: cholesterol
granuloma, mucocele, colesteatoma, epidermoid cyst and even meningiomas. Final comments:
Mass-effect lesions in CPA presenting as a atypical Gradenigo’s syndrome, even without
temporal bone inflammation, should be followed with extra care since they might be related to
inflammatory or non-tumor diseases.
Código: 44896
Título: HYDRANENCEPHALY: CHARACTERISTICS, PROPEDEUTIC SOCIODEMOGRAFHY IN THE
AMAZON STATE- BRAZIL
Maria da Costa Matos; Carlos Eduardo Veiga de LIma; Thainá Lima Sicsú; Ana Elisabeth Sousa
Reis; Bruna Martins Meireles;
Resumo: INTRODUCTION: Hydranencephaly is a brain anormality of uncertain etiology and
clinically well defined. The expression came up with Cruveilhier french pathologist (1856) and
Spielmeyer, german neuropathologist (1904) to describe congenital malformations. The
characteristics are: absence or almost all of the cerebral hemispheres, with integrity of
meningeal head coverings and the rest of the cavity flooded with cerebrospinal fluid. The
prognosis is negative, because the patient maintains own neurological status of the newborn;
has increased cranial volume; preserves reflexes of Moro and suction; It presents uncoordinated
eye movements, strabismus and lack of eye contact; expressed tremors or intermittent stiffness,
hyperextension crisis torso, head and limbs. The palpation of the skull shows fluctuation of
disjunctive bones. OBJECTIVE: To discuss the workup and the causes of hydranencephaly was
the objective of this work. As for the resolution, the neurosurgeon uses the imaging tests,
tomography and angiography and clinical tests, EEG and transillumination. METHOD: In a public
hospital in Amazon appear recurrent hydranencephaly´s cases. To establish an accurate
diagnosis, through by tomography, allows the implantation of ventricular peritoneal derivation
valve, an effective action. However, anencephaly will not be solved by providing to the minimum
balance for the newborn survive. RESULTS: The research motivated by the incidence of
hydranencephaly in Amazon, in the second half of 2015. It is emphasized that sociodemographic
data on the Medical Care Service and Statistics, is responsible for the statistical indicators in the
health institution in question, identified the following aspects: 1. All children are inside the
Amazon, specifically the middle region of the southwest and center Amazon (Eirunepé;
Iranduba; Tefé, a total of 05 cases); 2. All mothers were young, between 16-20 years-old, some
are single or are live in stable relationships. Two mothers confirm attempted abortion; 3. All
newborns are low income, which may suggest poor diet during obstetrical process; 4. All children
treated were male and brown. CONCLUSION: The sociodemographic data identified coincident
aspects. The regionalism aspect can be evaluated as a possible driver of the incidence of these
cases. Neurosurgical submission is resolute, but cannot solve anencephaly. Otherwise, the
survival time is still undetermined children survive and serve simply to environmental
reflections.
Código: 44778
Título: INTERHEMISPHERIC TRANSFALCINE APPROACH TO PINEAL TUMORS – TECHNICAL NOTE
Autores: Iracema Araújo Estevão; César Cozar Pacheco; Tatiana Vilasboas; Marcos Vinicius Calfat
Maldaun; Carlos Tadeu Parisi de Oliveira; Paulo Henrique Pires de Aguiar;
Resumo: Background: The pineal is an elliptical gland located on the quadrigeminal plate in the
posterior portion of the third ventricle. The tumors of the pineal region constitute a major
challenge for an experienced neurosurgeon and, currently, several technological resources are
required for the removal of theses neoplasms. There are three types of surgical approaches: (1)
Infratentorial Supracerebellar; (2) Interhemispheric sub occipital transtentorial approach; and
(3) Combined. This technical note describes a new surgical approach for tumors of pineal,
performing a transfalcine access on the supratentorial interhemispheric. Objectives: Describe
the technique of interhemispheric transfalcine approach to quadrigeminal plate and report the
case of two patients that underwent surgery using this technique. Casuistry and Methods: We
analyzed the clinical information, CT and MRI of eleven patients undergoing surgery to excision
of pineal tumor by the same group of neurosurgeons with the use of transfalcine approach.
Results: Eleven patients underwent surgery using the technique described with satisfactory
results of surgical access, allowing good visualization of the operative field for the surgeon.
Furthermore, none of them had venous infarction. Conclusion: The choice of surgical approach
depends essentially on the angle of the surface of the tentorium cerebelli seen in profile MRI
and the perpendicular line, leaving the torcular herophili (confluence of sinuses). If the angle is
greater than 45º, access may be the infratentorial supracerebellar in semi-sitting position.
Otherwise, due to the technical difficulties for this approach, the sub occiptal transtentorial
approach would be easier to acess these desired region. When the angle is too acute, usually is
made the transtentorial acess.However, for small tumors the surgeon’s vision can be very
limited. According to the authors‘ experience when the angle formed by the vertical cross out
of torcula with the line on the surface tentorial is less than 45º is preferred the inter-hemispheric
transfalcine access allowing the surgeon a good field-visual.
Código: 44261
Título: INTRACRANIAL GLIOBLASTOMAS: RETROSPECTIVE ANALYSIS OF 159 OPERATED CASES
Autores: Renan Maximilian Lovato; João Luiz Vitorino Araújo; Vinicius Ricieri Ferraz; Aline
Lariessy Campos Paiva; Tiago Marques Avelar; Alexandros Theodoros Panagopoulos; Flavio Key
Miura; Vinicius Monteiro de Paula Guirado; José Carlos Esteves Veiga;
Instituição: SANTA CASA DE SÃO PAULO
Resumo: Introduction: Glioblastomas have an incidence of 3,19 per 100.000, and are the most
common of the primary malignant brain tumors, representing 45,2% of the cases. It is also a very
agressive tumor therefore the importance of studies to know the epidemiological profile of
these patients. Objectives: The objective of this study is to increase awareness of the prevalence
of intracranial glioblastomas treated by surgery, and understand the epidemiological profile of
these patients in our institution. Methods: This was a retrospective study carried out at a tertiary
care hospital of the city of São Paulo, Brazil, a total of 159 patients with intracranial
glioblastomas were operated from January 2003 to December 2015, approval for the study was
obtained from the Human Research Ethics Committee. Patients with conflicting information or
doubtful diagnosis were excluded from our study. The patients were separated in groups
acording to gender, age and tumor location. Results: From January 2003 to December 2015 159
patients underwent surgical tratment for intracranial glioblastomas 98,11% (156/159)
ressections and 1,89% (3/159) biopsies. Male patients represented 62,26% (99/159), and
37,74% (60/159) were female. Age raged from 2 to 82 years old, 89,30% (142/159) of the
patients were 40 years old or more, patients from 50 to 59 years old represented 32,7% of the
cases (52/159). The most common site was the temporal lobe with 23,9% (38/159), followed by
frontal and parietal with 22,01% (35/159) each, and 4,4% (7/159) in the occipital lobe, only 3
cases (1,87%) were multicentric and there were no infratentorial glioblastomas. Conclusion:
Data found in our institution is similar to those previously published in most of the evaluated
factors. The incidence was higher in men and were more common in elderly patients, and the
most common location was in the temporal lobe.
Código: 44266
Título: INTRACRANIAL GLIOMAS: RETROSPECTIVE ANALYSIS OF 326 OPERATED CASES.
Autores: Renan Maximilian Lovato; João Luiz Vitorino Araujo; Vinicius Ricieri Ferraz; Aline
Lariessy Campos Paiva; Tiago Marques Avelar; Alexandros Theodoros Panagopoulos; Flavio Key
Miura; Vinicius Monteiro de Paula Guirado; José Carlos Esteves Veiga;
Resumo: Introduction: Gliomas are the second most common tumors of the central nervous
system, the most frequently reported histology is the glioblastoma, which is also the most
common primary malignant tumor. There are few studies in Brazil that focus on the
epidemiological profile of the patients with gliomas, despite the high incidence of these tumors.
Objectives: The objective of this study is to increase awareness of the prevalence of intracranial
gliomas treated by surgery, and understand its epidemiological profile of these patients in our
institution. Methods: This was a retrospective study carried out at a tertiary care hospital of the
city of São Paulo, Brazil, a total of 326 patients with intracranial gliomas were operated from
January 2003 to December 2015, approval for the study was obtained from the Human Research
Ethics Committee. The tumors were classified according to the 2007 WHO criteria. The patients
were separated in groups according to the gender, age, histopathology and grade. Results: From
January 2003 to December 2015 326 patients underwent surgical treatment for intracranial
gliomas, 58,9% were male and 41,1% were female. The age groups with the biggest number of
tumors were from 2 to 14 years old with 13,8%, and in the 6th decade of life with 20,24% of the
cases. In low grade tumors the highest incidence was from 2 to 14 years old with 29,51% and in
the 4th decade of life with 18,85% of the cases. In high grade tumors 82,45% were more than
40 years old, with 28,92% in the 6th decade of life. The high grade tumors were the most
common with 62,58% of the patients, and low grade with 37,42%. There were 159
glioblastomas, representing 48,77% of all gliomas and 77,94% of the high grade group. Among
all gliomas 89,57% were supratentorial, in this location 54,45% were glioblastomas, and 10,43%
infratentorial, of these 55,88% were pilocytic astrocytoma. In the oligodendroglioma group 68%
involved the frontal lobe, and in the glioblastomas 23,9% were temporal. Conclusion: Data found
in our institution is similar to those previously published. The incidence is higher in men, with
the low grades being most common among younger ages and high grade in elderly patients. High
grade tumors represented the majority of the cases. The majority of the cases among high grade
tumors were glioblastomas and among the low grade group was the ganglioglioma.
Código: 44246
Título: INTRACRANIAL MENINGIOMA AND VASCULAR MALFORMATION
Autores: Jackson Daniel; Renvik Demauri Silva; Bruno Silva Pereira; Gustavo Cardoso de Oliveira;
José Antonio Damian Guasti;
Instituição: HOSPITAL FEDERAL DE BONSUCESSO
Resumo: Introduction Meningiomas are among the most frequently diagnosed primary
intracranial tumors after the gliomas. While they are usually associated with other intracranial
tumors (neurofibromatosis), their association with vascular malformation is still little reported.
Objective Report a case of concurrent arteriovenous malformation and meningioma and discuss
about this association. Method We did revision of the enchiridion’s patient and revised the
literature about pathophysiologic between theses two lesions, using data of the Pubmed,
Medline and Lillacs. Results This 49-year-old patient had hemiparesis in right side, headache and
disorientation for 6 months. Cerebral MRI showed us two processes. One was an extra-axial
process of the midline in frontal lobe, exhibiting iso signal intensity in T1 and T2 weighted
sequences and showing intense contrast pushing, implying a meningioma of the foice. We can
see too, an AVM in left lobe parietal without sing of bleeding. The simultaneous presence in a
single individual of a primary tumor of the brain and cerebral AVM is rare. About 50 cases of
cerebral AVM combined with cerebral tumors have been reported. Classification has been
suggested depending on the location of the two lesions. Type I are lesion separated from each
other and situated in different anatomical location, type II are cerebral AVMs contiguous with
tumoral mass with or without a clear cleavage plane, while type III are cerebral AVMs adjacent
to the tumor within the same gyrus or lobe. Our case is type I. Several hypotheses have been
suggested to explain the coexistence of these two lesions, for exemple: cerebral AVM can induce
tumor formation; tumor can cause development of an AVM or increase blood flow from a
cerebral AVM quiescent. Cushing and Eisenhardt suggested that leptomeningeal tumors could
result from a chronic irritation of the arachnoid cells by a pathological process of some type,
including cerebral AVM. Other authors have incriminated humoral factors such as tumor
angiogenesis factor secreted by cerebral AVM and triggering appearance of the tumor. In fact,
although cerebral AVMs are thought to be congenital lesions, there is experimental and clinical
evidence that abnormal angiogenesis and vascular remodeling occur in adult patients
Conclusion The association between vascular malformation and meningiomas is rare and
pathogenesis roles of angiogenesis and inflammation are common to these lesions.
Código: 44177
Título: INTRACRANIAL MENINGIOMAS: RETROSPECTIVE ANALYSIS OF 267 PATIENTS.
Autores: Vinicius Ricieri Ferraz; João Luiz Vitorino Araujo; Renan Maximilian Lovato; Aline
Lariessy Campos Paiva; Thiago Marques Avelar; Alexandros Theodoros Panagopoulos; José
Carlos Esteves Veiga;
Instituição: IRMANDADE DA SANTA CASA DE MISERICORDIA DE SAO PAULO
Resumo: Introduction In Brazil there are few studies that focus on the epidemiological profile of
patients with meningiomas, although this is the most common intracranial neoplasm. Such
studies are of fundamental importance to determine government strategies on public health
and thus allow optimize resource allocation and enhance research related to meningiomas.
Objectives We aimed for this study to increase awareness on the prevalence of intracranial
meningiomas treated by surgery in our environment while highlighting the local epidemiology
of these tumors. Methods This was a retrospective study carried out at a tertiary care hospital
of the city of São Paulo, Brazil, a total of 267 patients with intracranial meningiomas were
operated, approval for the study was obtained from the Human Research Ethics Committee.
Tumors were classified according to the 2007 histopathological WHO criteria. In our series, the
following histopathological sub-types appeared: Grade 1: meningothelial, fibrous,
psammomatus, transitional, angiomatus, microcystic, secretory, metaplastic. Grade 2: atypical,
clear cells, chordoid. Grade 3: rhabdoid, papillary, anaplastic. Results During the study 267
patients underwent surgical treatment, of these, 15 underwent endoscopic procedure and had
histologically confirmed intracranial meningiomas. The majority of our patients were females
(183 patients, 68,54%). The average patient’s age at the time of the meningioma treatment was
54,58 year, 73% of patients were between 41-70 years at the time of treatment, most of these
patients being in the fifth and sixth decade of life. Considering the histopathological division:
229/85,76% Grade 1; 31/11,61% Grade 2; 7/2,62% Grade 3. The meningothelial was the most
prevalent subtype (98/37%). Taking into account the meningiomas location: 123/46,07% non
skull base meningiomas and 144/53,93% skull base meningiomas. Most non skull base
meningiomas were the parasagittal meningiomas (87/32,58%). Most skull base meningiomas
were sphenoid wing meningiomas (38/14,23%). Conclusion Analyzing epidemiological studies
previously conducted there is the similarity in most factors evaluated, however, some
peculiarities in the present study was recorded, unlike other studies, meningiomas in our series
are more prevalent in skull base, 85% are benign meningiomas and affects mostly patients in
the fifth/sixth decades of life.
Código: 44892
Título: LHERMITTE-DUCLOS DISEASE: REPORT OF 2 CASES
Autores: Leonardo Rocha-Carneiro Garcia-Zapata; Leandro Moreira; Filipe Rocha Viana; Luciano
de Souza Queiroz; Eduardo França Palhares; Marcelo Senna Xavier de Lima; Paulo Ricardo
Correia Soares; Sinval Malheiros Pinto Neto; Cicero Ronaldo Ferreira da Costa; Camila Andrade
de Souza; Jose Alberto Pereira Pires; Marcel Ramos Olivatto;
Instituição: CENTRO MEDICO DE CAMPINAS
Resumo: INTRODUCTION: Lhermitte-Duclos disease (LDD), also known as Dysplastic
Gangliocytoma of the Cerebellum, is an extremely rare lesion of unknown etiology classified as
grade 1 tumour by WHO. It is usually unilateral, with no gender preference and affects adults
between the 2nd and 4th decade of life. It may be associated with various developmental
abnormalities and Cowden´s disease. It´s anatomical and pathological findings are unique: global
hypertrophy of the cerebellum, the thickening of the gyrus and "inverted cortex" pattern.
Radiological findings are also notable: little contrast enhancement and striated pattern.
OBJECTIVE: To report 2 cases of rare LDD simultaneously appeared in the same hospital. CASE
REPORT: 1) Male, 22 y, with sudden blindness and spontaneous improvement presenting visual
blurring, double vision and headaches for 15 days. CT skull showed an expansive solid lesion in
the left cerebellar hemisphere lobulated without contrast enhancement promoting
contralateral deviation of the fourth ventricle and supratentorial hydrocephalus (HCF). The
patient underwent 3rd ventriculostomy (3VL) and an External Ventricular Drainage (EVD) was
placed until the resection of the lesion. During the 1st procedure he presented cardiac
arrhythmia was cardioverted and the procedure was suspended. In the 2nd procedure there
were no complications, but the resection of the tumor mass was incomplete. The patient
underwent a 3rd procedure with total withdrawal. It improved significantly and the EVD could
be removed soon. 2) Female, 32 a, with paroxysmal headache for 2 years. CT skull showed an
injury similar to the one in the previous case with discrete tonsillar herniation. The lesion was
completely removed, but shunt-dependent HCF appeared and 3VL was indicated, followed by
Ventriculoperitoneal Shunt, after which she presented intractable epilepsy and died.
DISCUSSION: Despite that this is a benign condition the outcome can be quite unfavorable
because of HCF. The intraoperative aspect of cerebellar injury is similar to normal parenchyma,
therefore we suggest using neuronavigation to delimit the boundaries of resection when there
is radiological suspicion, nowadays increasingly precise. CONCLUSION: More studies are needed
on this rare condition in order to understand the etiology and behavior of the injury, allowing
early diagnosis and specific treatment.
Código: 44174
Título: MALIGNANT MENINGIOMAS: RETROSPECTIVE ANALYSIS OF 38 PATIENTS.
Autores: Vinicius Ricieri Ferraz; João Luiz Vitorino Araújo; Renan Maximilian Lovato; Aline
Lariessy Campos Paiva; Thiago Marques Avelar; Alexandros Theodoros Panagopoulos; José
Carlos Esteves Veiga;
Resumo: Introduction Meningiomas constitute 13 to 26% of all intracranial tumors. Atypical and
anaplastic meningiomas account for 3.0-7.2% and 0.4-3.7% respectively, of intracranial
meningiomas. Female predominance is less marked and there is even male predominance
among them, and they are more common in the cerebral convexities. Objectives We aimed for
this study to increase awareness on the prevalence of intracranial atypical and anaplastic
meningiomas in our environment while highlighting the local epidemiology of these tumors.
Methods This was a retrospective study carried out at a tertiary care hospital of the city of São
Paulo, Brazil. A a total of 38 patients with malignant intracranial meningiomas were operated,
approval for the study was obtained from the Human Research Ethics Committee. Malignant
meningiomas were classified according to the 2007 histopathological WHO criteria. In our series,
the following histopathological of malignant meningiomas sub-types appeared: Grade 2:
atypical, clear cells, chordoid. Grade 3: rhabdoid, papillary, anaplastic. Results During the study
period, 38 patients underwent surgical treatment and had histologically confirmed intracranial
meningiomas. The majority of our patients were females (21 patients, 55.26%), considering only
patients with meningiomas grade II 52% are women, those diagnosed with meningiomas grade
III 71% are women. The average patient’s age at the time of the meningioma treatment was
50.28 year, 60.52% of patients were between 41-70 years at the time of treatment, most of
these patients being in the fourth decade of life (23% of grade 2; 43% of grade 3). Considering
the histopathological division: 31/81.57% Grade 2; 7/18.42% Grade 3. The atypical was the most
prevalent subtype (25/65.78%). Taking into account the malignant meningiomas location:
18/47,38% non skull base meningiomas and 20/52,63% skull base meningiomas. Most non skull
base meningiomas were the parasagittal meningiomas (11/28.95%). Most skull base
meningiomas were sphenoid wing meningiomas (6/15.78%). Conclusion Analyzing
epidemiological studies previously conducted in Brazil and in other countries there is the
similarity in most factors evaluated, however, some peculiarities in the present study was
recorded, unlike other studies, the malignant meningiomas in our series are more prevalent in
skull base, in women and affects mostly patients in the fourth decade of life.
Código: 44872
Título: MENINGIOMA ASSOCIATED WITH NEUROPSYCHOLOGICAL DISORDER
Autores: Fernanda Machado Ribeiro; Gabriela Fernanda Esquerdo Sampaio; Daniel de Andrade
Grippe; Fábio Jundy Nakasone; Tatiana Vilas Boas; Marcos Vinicius Maldaun; Carlos Tadeu Parisi
de Oliveira; Paulo Henrique Pires de Aguiar;
Resumo: Background: One of the most common types of tumors, meningiomas have
arachnoidal origin, long asymptomatic period, slow growth and prevalence in women. Its
symptoms are associated with the space occupied by the injury which causes compression of
the brain tissue and leads to increased intracranial pressure. When in the limbic system, can
cause mental disorders such as depression, anxiety and bipolar syndrome. Objectives: Analyze
the effect of decompressive surgery for the removal of meningiomas in neuropsychological
disorders. Casuistry and Methods: We analyzed the clinical data of 3 patients, 2 women and 1
man ages 44, 69 and 33 respectively, with meningiomas located in functional areas of their
limbic system. The injured areas were the nucleus accumbens in the first patient, the cingulate
gyrus and the corpus callosum in the second and the insula in the third. The manifestations were,
respectively, persecutory and depressive neurosis and anti social disorder; depression and
diagnosis of bipolarity, and finally auditory hallucinations, neurodegenerative disorder and
anxiety. Results: After microsurgical resection of these lesions, all patients showed improvement
of symptoms. The resection was SIMPSON I in all patients and the male patient presented an
atypical meningioma and underwent stereotactic radiotherapy. The female patients had benign
meningothelial meningiomas. Conclusion: The complete tumor resection and subsequent
decompression of the adjacent brain tissue relieved neuropsychological symptoms previously
diagnosed.
Código: 44173
Título: META-ANALYSIS : ACOUSTIC NEURINOMA 2 TO 3 CM IN PATIENTS WITH 50 AGE OF
HEARING AND FUNCTIONAL PRESERVED - SURGERY VERSUS RADIOSURGERY
Autores: LORENZA PEREIRA; MARCOS CALFAT MALDAUN; DANIEL DE CARVALHO KIRCHHOFF;
Instituição: ASSISTENCIA NEUROLOGICA SÃO BERNARDO
Resumo: Acoustic Neuromas are benign tumors from Schwann cells. Its incidence is of 1/100.000
habitants and corresponds to 10% of all brain tumors. Through a literature systematic review,
we tried to evaluate which is the best treatment option specifically to young patients, with
tumor varying to 2 and 3 cm and with preserved hearing. PubMed search was performed and
after thorough analysis, we found 14 systematic reviews and 19 clinical studies that structured
our meta-analysis. Among selected articles, 6 systematic reviews evaluated radiosurgery.
Average patient age was 55,1 years old, tumors sizing between 0,8 and 4,05 cm³, irradiated with
mean marginal dose of 14,38 Gy, with an 89.3% of tumor control, 64.5% of functional hearing
preservation, 2.43% of facial nerve lesion and 3% of complications, mainly trigeminal pain.
Median follow-up was of 54.5 months. Four meta-analyses evaluated distinctly results of
microsurgery. Tumor of all sizes and patients of all ages were included. Results showed
preservation of functional hearing in 50.6% of patients and facial nerve lesion in 18%. The most
common complication was liquor fistula in 8% of cases and mean follow-up was of 49.7 months.
In an altogether analysis of the 14 articles included in this study, only three considered patient
age, distributing hearing preservation proportional to age. Nine articles considered tumor size
but only 3 correlated size to hearing degree and 2 included only tumors from 1.5 cm to 2 cm.
Just 3 papers showed minimum follow-up of 60 months. In a general and superficial analysis one
can conclude unadvisedly and incorrectly that radiosurgery is a better treatment choice.
Without strict observation, one can note a significant superiority in functional hearing
preservation, with radio surgery use. Nevertheless, after rigorous review, we can find extreme
unconformity, several flaws and comparative analysis misleads. Therefore, we don´t have
reliable statistic and bibliographic data to develop a treatment guideline that guarantee which
is the best treatment to acoustic neuroma of 2 to 3 centimeters in young patients with preserved
functional hearing. Therewith, due to inadequate studies, treatment choice must be made
individually, regarding surgeon experience and ability, availability and patient access to
radiosurgery and especially patient choice, which should be informed about short and long
terms risks and benefits of each therapeutic option, making a reasonable decision.
Código: 44286
Título: METACHRONOUS SPINAL METASTASES FROM INTRACRANIAL GLIOBLASTOMA
MULTIFORM
Autores: MAURO TAKAO MARQUES SUZUKI; Igor A. Protzner Morbeck; Marcio Vinhal de
Carvalho; Renato Silva Campos; Eduardo Henrique Chiovaro Abdala; Diego Arthur Fernandes
Vendrusculo; Leandro Rodrigues Silva; Baldomero Pinto Soares; Guilherme Lima Matos;
Instituição:
Resumo: Introduction: although Glioblastoma Multiform (GBM) is the most common primary
malignant lesion of the brain, leptomeningeal metastases is considered rare. We present a case
of metachronous GBM sacral drop metastases on a middle age woman without current
intracranial disease. Case report: forty-nine years woman, with total gross resection of right
temporal GBM plus Stupp Protocol for 6 months on 2012. After three years of stable intracranial
disease, she presented progressive back pain and sudden left sciatica pain. No motors or
sensitive deficits where found. A lumbar MRI showed an intra-dural lesion with contrast
enhancement involving S1 and causing foramen enlargement on the right side. Decompression
and biopsy revealed a GBM drop metastases. Pain relief was obtained and intra-cranial disease
remained stable for a couple of months, when it recurred. Discussion: Drop metastases were
known to represent less than 5% of GBM presentations. However, since overall survivor has
increased, it is possible that the prevalence might be higher nowadays. Leptomomeningeal
metastases, maybe more common ammong long-term survivors, and ventricle or cistern lesions,
such as in SNC metastatic patients. The use of Bevacizumab has been correlated to drop
metastases, but a true cause and effect relation has not been proved yet. Final comments: Drop
metastases on GBM patients is becoming more common, even in patients with good intracranial
disease control.
Código: 44877
Título: MORPHINE PUMP IN PATIENTS WITH ONCOLOGICAL PAIN
Autores: Yuri Gurfinkel; Luis Roberto Mathias Junior; Fernanda Machado Ribeiro; César Cozar
Pacheco; Iracema Araújo Estevão; Rafael Mileo; Marcos Vinicius Calfat Maldaun; Paulo Henrique
Pires de Aguiar;
Resumo: Background: The current possibilities to obtain adequate analgesia are numerous and
include oral, intravenous, subcutaneous, transdermal and intrathecal medications.In most
cases, control of chronic pain is obtained through oral analgesic, however, despite the high pain
control rates at first, in most cases it is necessary to increase the dose over time, and from a
point, come into existence intolerable side effects or pain control is no longer effective. An
alternative would be the use of intrathecal release medicinal devices (drug pumps). Objectives:
Evaluate the use of morphine pump in five cases of cancer patients. Casuistry and Methods: We
analyzed the clinical data five male patients with oncological pain that underwent opioid pump
implantation (Meditronic EUA) with ages ranging from 29 to 85 years due to melanoma, colon
cancer, hypernephroma, lung cancer, adrenal cancer with bone metastasis and correlated the
findings with the literature. Results: We chose to pump opiates instead of cordectomy due to
the risks and prognosis. There were no procedural complications. Two patients developed
thrombosis associated with the underlying disease. Conclusion: There is still lack of a larger
number of randomized controlled trials. Review and constant refinement of the current
guidelines, and further studies will accelerate our understanding of this topic. For now, this
therapy is intended primarily for patients with advanced malignancy and well-selected patients
with chronic pain not malignancy requiring high doses of opioids and whose side effect is acting
negatively on quality of life.
Código: 44727
Título: MULTIPLE SCHWANNOMAS OF CAUDA
NEUROFIBROMATOSIS: A RARE CASE REPORT
EQUINA
IN
A
CHILD
WITHOUT
Autores: Amauri Pereira da Silva Filho; Anne Jamille Ribeiro Sampaio; Ayanne Alves de Oliveira;
Miriam Lucia Galvão Lucena; Verônica Cavalcanti Pedrosa; Lucas Silva Xavier; Pâmmela Dayana
Lopes Carrilho Machado;
Resumo: INTRODUCTION: Schwannomas are the primary tumors of the Peripheral Nervous
System (PNS). They are usually benign entities, with prevalence in the fifth decade of life,
histologically grade I in the WHO (World Health Organization) classification and account for
about 30% of primary spinal tumors. Furthermore, there is a high incidence of schwannomas in
patients with Neurofibromatosis type 2 (NF2), an association which is well discussed in the
literature. OBJECTIVE: This study aims to report a case of multiple schwannomas of cauda equina
in a child without neurofibromatosis. METHOD: Observational study developed from research
into medical records and outpatient treatment of a patient admitted in a referral hospital in
neurosurgery in Paraíba´s country side - Brazil, which was associated with the bibliographic
indexing in the database. RESULTS: Male patient, one year and six months of old, which
presented difficulties to walk and weakness in the right lower limb, with a history of treated
pulmonary tuberculosis. Magnetic Resonance Imaging (MRI) of the lumbosacral spine injury held
pointed at T12-L1, followed by spinal cord edema. After two months of observation, the
symptoms worsened and the investigation with biopsy of the lesion was done: the result showed
an inflammatory infiltration. The patient was referred to physical therapy, presenting, after six
months, worsening of symptoms, presence of "drop foot" and sphincter dysfunction. After new
MRI, it showed multiple lesions in cauda equina, suggesting spinal schwannomas. Thus was held
surgical resection of the lesions with histopathological analysis - with a confirmed diagnosis. The
patient, indeed, did not present criteria for neurofibromatosis, just café-au-lait spots.
CONCLUSION: Schwannomas in patients without NF2 are usually unique. The differential
diagnosis includes symptomatic disc herniation. In addition to that, more accurate imaging
methods are Computed Tomography with myelography or MRI. The prognosis is improved with
early detection and treatment, as well as a physical therapy is an important factor in
rehabilitation. It is worth mentioning that even spinal disorders can mimic symptoms of back
pain, routinely seen in clinical practice.
Código: 44234
Título: NEUROSURGICAL APPROACH TO PITUITARY APOPLEXY IN 18 YEAR OLD MALE PATIENT:
CASE REPORT AND REVIEW
Autores: Caio M. Perret; Raphael Bertani Magalhães; Bruno Tabajuihanski; Hélio Ferreira Lopes;
Instituição: UNIVERSIDADE FEDERAL DO RIO DE JANEIRO
Resumo: Introduction: Pituitary apoplexy is a life-threatening disorder due to acute hemorrhage
or ischemic infarction of a pituitary adenoma, disregarding its size and characteristics. The main
onset clinical features are headache, nausea, vomiting, and visual impairment. Although most
cases include gland function disturbances, some rare apoplectic events do not alter pituitary
function. The establishment of an early diagnosis to these conditions and prompt decompressive
neurosurgical approach may minor and even completely reverse symptoms and further
neurological damage. Objectives: This review and case report intends to elucidate pituitary
apoplexy main clinical features, the importance of an early differential diagnosis and therapeutic
measurements indications, drawing close attention to the case’s events and disclosure. Case
Report:18 year old male patient with no endocrine dysfunction prior to the acute clinical onset
of holocranial headache, bilateral galactorrhea, right eye right superior quadrantanopsy and left
eye blindness. Only prolactin levels were dysfunctional from the pituitary gland hormonal tests
(1500ng/ml). Head MRI scan suggested pituitary macroadenoma apoplexy. Immediate post op
naso-sphenoidal tumor subtotal resection and decompression resulted in complete reversion of
patient’s visual impairments and headache symptom, with normal prolactin levels (6,5ng/ml)
and no other endocrine level altering on early post op and later follow up. Conclusions: As shown
in the case, despite most of the events, not all pituitary apoplectic events include panhypopituitarism as a clinical feature. The early neurosurgical decompressive approach can minor
and even completely revert neurological impairments and further sequelae. In addition,
functional macroadenoma’s prolactin level control can be achieved without compromising
healthy gland tissue, exempting following dopaminergic agonist treatment.
Código: 44883
Título: PERFORMANCE OF COGNITIVE FUNCTIONS IN PATIENTS UNDERGOING CRANIECTOMY
DECOMPRESSION
Autores: Andréa Costa de Andrade; Henrique Oliviera Martins; Cleomir da Silva Matos; Heliana
Maria da Costa Matos; Carlos Eduardo Veiga de Lima; Thainá Lima Sicsú; Bruna Martins Meireles;
Resumo: INTRODUCTION: Intracranial aneurysms come from a weakness of a blood vessel which
forms a protuberance which may present a risk of bleeding. Diagnose an injury before the
aneurysm rupture and track possible comorbidities it is important for the proposed treatment.
OBJECTIVE: The aim was to evaluate cognitive function in patients who develop intracranial
aneurysms to cerebral edema and the evidence as decompressive craniectomy may favor the
improvement or not of the patients affected by the severity of aneurysms and prognosis.
METHOD: This is a prospective study of quantitative and descriptive methodology used as
sample 33 surgery of intracranial aneurysms by clipping from january to december 2015. After
submission to the Informed Consent (IC), applied the NEUPSILIN test in presurgical at all patients
diagnosed with aneurysms and postsurgical in survivors who developed cerebral edema.
RESULTS: It was considered in the quantification of the results, the clinical condition of the
patient, risk factors, birth, ethnicity, gender and age. Of the 10 patients who developed cerebral
edema, came the coma, 03 came to death due to bleeding, 05 recovered and 02 were sequelae.
After reapplication of NEUPSILIN, subsitiram visual problems, language and cognition in patients
with sequelae. Clinical data corroborate the epidemiological compliance between health and
disease. According to the literature, the higher incidence of aneurysms occur in african
americans and 91% of treated cases were of mixed race patients, 85% of women aged 50, 58
and 62 years-old. CONCLUSION: The impact of aneurysm bleeding in the life of a patient should
be evaluated precise ly, since breaks are fatal. Among the most effective methods used in
neurosurgery for brain edemas is decompressive craniectomy, which deserves to be highlighted
as a way of remedying the damage to the brain, yet they are the neuropsychological tests that
we give the credit assessment of cognitive functions.
Código: 44835
Título: PILOCYTIC ASTROCYTOMA IN CEREBELLOPONTINE ANGLE: A PEDIATRIC CASE REPORT
Autores: Antônio Rosa Bellas; Tatiana Protzenko Cervantes; Flavia de Abreu Alves; Jairo Guedes
Fioravante Rezende; Thalles José de Oliveira Antonio; Jose Francisco Manganelli Salomao;
Instituição: UNIVERSIDADE FEDERAL DO RIO DE JANEIRO
Resumo: Pilocytic astrocytoma (PA) is a slow-growing glioma, classified as grade I by the World
Health Organization (WHO) and is the second most common pediatric brain tumors. It most
commonly occurs in cerebellum, in brainstem, in optic chiasm, and hypothalamus. Gliomas in
the cerebellopontine angle (CPA) are rare and quite often are the exophytic extension of primary
brain stem or cerebellar tumors. The objective of this study is to describe a pilocytic astrocytoma
in CPA that was found to arise from the foramen of Luschka. G.S.S., an 11 year-old boy. He
presented sudden onset of dizziness after exercise. A brain MRI, showed an expansive lesion in
the right posterior fossa (topography cerebellopontine angle) with brainstem compression,
affecting the fourth ventricle, without dilatation of the supratentorial ventricular system.
Despite the location, the child had no cranial nerve compression symptoms (VIII, IX, X and XI
pairs). He was referred to our unit for surgical treatment of the lesion with parcial resection after
8 hours of surgery. The post-operative in ICU, evolved with drowsiness and difficulty of
extubation, both justified due to edema caused by manipulation of the posterior fossa, and
dysphagia. It was made an endoscopic third ventriculostomy for the treatment of
hydrocephalus; a tracheostomy due to unilateral vocal cord paresis and stridor. It also presented
other symptoms resulting from prolonged hospitalization, such as muscular hypotonia and
emotional lability. He was discharged one month after surgery, tracheostomized, with complete
recovery of cognition, motor and swallowing activity. Histopathological result was pilocytic
astrocytoma confirmed by two experts after immunohistochemistry. An exophytic extension of
brainstem glioma in CPA is a rare case of PA. The case of the aforementioned patient falls into
this category, being derived from the Luschka foramen. Most brainstem astrocytomas are
infiltrative fibrilar type or gemistocytic and only a minor portion appears as pilocytic
astrocytoma. The infrequency and the lack of clinical features that are unique to these tumours
make this case a formidable diagnostic challenge. Thus, it is important to consider in pediatric
patients PA as a differential diagnosis in cases of cranial neuropathy, cerebellar dysfunction,
brainstem compression signs, hearing impairment or dizziness.
Código: 44630
Título: PITUITARY ACTH ADENOMAS
Autores: Amanda dos Humildes Maia Santos; Gabriela Oliveira Barbosa; Igor Lima Maldonado;
Daniel Andrade Gripp; Marcos Vinícius Calfat Maldaun; Paulo Henrique Pires de Aguiar;
Instituição: ESCOLA BAHIANA DE MEDICINA E SAÚDE PÚBLICA
Resumo: INTRODUCTION: In the anterior pituitary about 10 to 20% of the cells are responsible
for the production of ACTH. Therefore, some patients may have an ACTH-producing pituitary
adenoma, changing the level of this hormone. To diagnose the disease, it is essential to carry
out the MRI scan of the sella region, for allowing the location of the adenoma. After diagnosis,
it’s known that the ACTH treatment is surgical. So, with this perspective, the study assesses the
prognosis of 14 patients with pituitary adenoma submitted to the following surgical techniques:
sublabial transphenoidal, endonasal endoscopic and endonasal with no endoscope. In addition
are evaluated the cortisol level, MIB-1, imaging, surgical postoperative complications and
healing. GOAL: To evaluate the surgical prognosis of patients with pituitary ACTH-secreting
adenoma with a comparison of surgical techniques. METHOD: Cross-sectional study with
medical record data collection RESULT: 149 surgeries have been made, among them 14 were
ACTH secreting adenoma. In all, 12 women and 2 men, one of whom was a teenager. The
minimum age was 15 years and the maximum was 65 years. They were performed 6
transsphenoidal endoscopic surgery, a non endoscopic endonasal and 8 transsphenoidal
sublabial. The average follow up was 129.36 months, with a minimum of 12 months and a
maximum of 252 months. The mean cortisol level was 474.8 and the average MIB-1 3%. All
patients did a MRI, and two of them also did CT. 5 patients had complications which were optic
chiasm injury, panhypopituitarism, endonsal fistula, meningitis and dysfunction of the
cavernous sinus. One of the patients progressed with traumatic pseudoaneurysm with carotid
occlusion. One patient required bilateral adrenectomia. CONCLUSION: According to Aguiar¹,
endonasal endoscopic surgery has shown increased tumor resection rate, a better view of the
surgical site and brings a lower rate of complications. Petry et al² argues that transsphenoidal
surgery is the most commonly used surgical procedure to handle the hypophyseal region,
sometimes associated with oronasal complications. However, from the study it was noted that
both techniques showed great chance of cure with just a few complications 1. AGUIAR, P. H. P;
JUNIOR, E. R. L.; DODD, R.; HWANG, P.; GETZ, A. E. Endoscopic Endonasal Approach to Pituitary
Adenomas. J Bras Neurocirurg, 19 (2): 54-63, 2008 2. PETRY, C. et al; Braz J Otorhinolaryngol,
75(3): 345-9, 2009.
Código: 44203
Título: PNET OF BRAIN STEM
Autores: GABRIEL MUFARREJ; NINA VENTURA; EMERSON GASPARETTO; PAULO NIEMEYER
FILHO;
Instituição: INSTITUTO ESTADUAL DO CÉREBRO PAULO NIEMEYER
Resumo: CASE REPORT: PNET OF BRAIN STEM ( Cervico Medullary Junction ) The authors report
an unusual case of PNET in a child of 13 years, located in the cervical medullary junction,
appearing in magnetic resonance imaging as a focal tumor of the brain stem. The injury, fleeing
to the traditional nature of your presentation, did not occupy the cavity of the fourth ventricle.
The patient in the supine position and under electrophysiological monitoring, underwent
median suboccipital craniotomy associated with the withdrawal of the C1 arch. Through
telovelar approach was taken to exposure of brain stem and its floor, which was not occupied
by the neoplastic lesion. During the arachnoid dissection we noted that the bulbar surface was
tense and bulging, herniated up through the dural opening. Excellent decompression of the
brainstem was performed through sub total resection. The patient demonstrated a very
satisfactory postoperative evolution, with evident improvement in the function of the lower
cranial nerves involved by .During the surgical procedure was not evidence of a worsening in the
electrophysiological monitoring, preserving the long tracts and the cranial nerves. The
histopathological study revealed to be a brain stem PNET.
Código: 44863
Título: POSTERIOR FOSSA MENINGIOMA DURING PREGNANCY: WHAT IS THE BETTER STRATEGY
Autores: Jackson Daniel Sousa Silva; Renvik Demauir Couzine Silva; Bruno Silva Pereira; Gustavo
Machado Cardoso; José Antonio Damian Guasti;
Instituição: HOSPITAL FEDERAL DE BONSUCESSO
Resumo: Introduction Primary brain tumor and pregnancy rarely occur together. Meningioma
and pregnancy rarer still. Surgery for intracranial meningiomas during pregnancy poses risks to
mother and fetus. Objective Report a case of cerebellopontine angle meningioma during
pregnancy and discuss about its management. Method We did revision of the enchiridion’s
patient and revised the literature about this association, using data of the Pubmed, Medline and
Lillacs. Results We present the case of 30 years old pregnant woman in the 19 th week of
pregnancy with complains of headache, sickness, vomiting, dizziness since tree week ago
without improvement with treatment. During physical exam we encountered paresthesis and
paresis in right side of her hemiface, loss of right hearing and imbalance to right side. She was
underwent Computed Tomography Scan (CT) that revealed a large extra-axial mass of the right
cerebellopontine angle with pronounced compression and displacement of the fourth ventricle,
pons and medulla, consistent with a petroclival meningioma. She was underwent surgery with
20th week of pregnancy due to worse of symptoms. Intracranial tumors during pregnancy is a
rare event, with an estimated incidence of about seven cases per 125.000 pregnancies, and only
two of this seven cases had meningiomas. But the great matter is the expression of the hormonal
receptors in the tumor cells. Meningiomas variably express receptors for progesterone,
estrogen, androgen and placenta growth factor, and their response to increased serum
hormones levels during second half of pregnancy may accelerate the growth of tumor. Some
patient can be managed conservatively antepartum, but urgent intervention may be required in
cases of malignancy, hydrocephalus and growth with progressive signs and symptoms of mass
effect leading to neurological deficit. What happened in our case. Conclusion The management
of brain tumor occurring during pregnancy has emphasized safety for mother and baby as a
primary goal of treatment. Advances in maternal and fetal monitoring, neuroanesthesia and
microsurgical techniques allow safe neurosurgical management (if necessary) and pregnancy
usually continues successfully to term.
Código: 44142
Título: PREOPERATIVE EMBOLIZATION OF INTRACRANIAL TUMOR
Autores: ALEX MARQUES BORGES SANTOS; LUANA ANTUNES MARANHA GATTO; THIAGO
TEIXEIRA SILVA; ROBERTO OLIVER LAGES; ZEFERINO DEMARTINI JUNIOR; GELSON LUIS KOPPE;
Instituição: HOSPITAL UNIVERSITARIO CAJURU
Resumo:
BACKGROUND
As
endovascular
techniques
have
become
more
advanced, preoperative embolization of brain tumors have become safer, increasing its use and
improving its results. Embolization can be used to decrease overall blood loss and to improve
visualization during surgery thus facilitating tumor resection. The main methods used for these
purposes are onyx and microparticles. OBJECTIVES In this study, the authors describe the routine
preoperative embolization of brain tumors, materials used and associated complications in a
hospital in Curitiba. MATERIALS AND METHODS This is a retrospective study based on medical
charts of patients with brain tumors who were submitted to arteriography study of these lesions
and subsequent embolization of these tumors, as preoperative preparation step for tumor
microsurgery. Twenty six patients were evaluated from 2014 to 2015, and the pathology of
lesions were stratified according to the results of embolization and related complications. The
materials used were mcroparticles, coils and glue (histoacryl). RESULTS There were 26 selected
patients for preoperative embolization of brain tumor, 18 men and 8 women, with a average
age of 40 years old. Seven patients did not realize embolization because arteriography study
show that the tumor had a pial nutrition, without a main feeder artery capable to emboization.
Nineteen patients were subjected tumor embolization , 15 men and 4 women. Six patients had
nasoangiofibroma, 5 hemangioblastoma, 4 meningioma and 3 glomus jugulare. Four patients
were embolized with glue, 2 with coils and thirteen with microparticles. Sixteen patients were
embolized under general anesthesia and 3 using local anesthesia. There were no deaths
associated to procedure, but 1 patient presented a carotid plaque embolism to middle cerebral
artery, that was partially corrected with solitaire, however, the patient was hemiparetic after
the procedure. The average of closure arterial nutrition of the tumor was 67.9%. CONCLUSIONS:
Preoperative embolization of brain tumor is a procedure that although providing significant
advantages during surgery, is not completely innocuous. Strict criteria is needed for selecting
patients to prevent them from being subjected to invasive procedures without proper need. The
literature has shown that the benefits outweigh the risks in the case of tumors at high risk of
bleeding and difficult surgical access, as the injuries mentioned above.
Código: 44599
Título: PRESACRAL GANGLIONEUROMA: DIAGNOSTIC AND THERAPEUTIC STRATEGY
Autores: Everton Pereira Dias Lopes; João Manoel Santos Botelho; Débora Coelho Duarte; Luiza
Mariana Cordeiro Silva;
Instituição: INSTITUTO TOCANTINENSE PRESIDENTE ANTÔNIO CARLOS
Resumo: INTRODUCTION: The ganglioneuroma is a rare benign tumor that originates from
neuroepithelium, which typically occurs in young adults and is more common in posterior
mediastinum and retroperitoneum. They are generally asymptomatic, and when a symptom
shows, is due to mass effect. The diagnosis is suggested by imaging studies but lacks histological
confirmation. Treatment is primarily surgical, chemotherapy or radiation therapy.aren’t
indicated. OBJETCTIVE: Report a case of pre sacred ganglioneuroma resection in an
asymptomatic patient, focusing on diagnosis and surgical technique. METHOD: Retrospective
review of medical records of the case, obtaining data from imaging and pathology exams and
surgical technique employed. RESULTS: A 64-year-old healthy man, asymptomatic, in a routine
assessment in urology, a palpable mass on a rectal exam was noticed. Computed tomography
(CT) and Ultrasonography Abdominal (US) were performed. The US showed a cystic formation
of dense content with hyperechoic areas , located in retrovesical region and volume 265mm³.
Abdominal CT scan revealed a retroperitoneal mass extending from the aortoilíaca fork to the
left inguinal region, in contact with: common iliac bilateral arteries, arteries inguinal, veins
inguinal and vertebral bodies L5, S1 and S2, left psoas muscle, small intestine, sigmoid and
bladders rear wall, without signs of invasion. A surgical resection was chosen. During surgery, a
well-defined mass , smooth surface and fibroelastic consistency was evidenced, in close contact
with the mesentery of the distal sigmoid colon , later mesorretal fascia to the superior rectus
level and average, presacral fascia, bladder, right and left ureter, aortic bifurcation artery and
left common iliac vein and intestinal loops . There wasn‘t sings of invasion in these anatomical
structures. Thus a marginal resection was performed without tumor violation, with preservation
of related structures. Preservation of the hypogastric plexus of the autonomic nervous system.
Histopathological suggested ganglioneuroma, which was later confirmed by
immunohistochemistry. CONCLUSION: The ganglioneuromas are rare slow-growing neoplasms,
being the pre sacred area even rarer. Although it is benign, the surgical approach is practically
mandatory. However, it is known that they are incidentaloma and its discovery is a incindental
diagnosis.
Código: 44725
Título: PREVALENCE OF PRIMARY TUMORS OF CENTRAL NERVOUS SYSTEM IN ADULT
POPULATION ON REFERENCE HOSPITAL IN NEUROSURGERY, CAMPINA GRANDE-PB
Autores: Amauri Pereira da Silva Filho; Humberto Fernandes Veloso Neto; Isabela Carvalho de
Aquino; Keyvid dos Santos Pereira; Ronaldo Barbosa de Farias Júnior; Verônica Cavalcanti
Resumo: INTRODUCTION: Depending on the histological type of brain tumor, the survival of
patients has a wide margin of variation, it is necessary to know which histological types most
commonly found primary tumor, respecting its prevalence in each age group, observing and
comparing data with other services, it is important to start an epidemiological profile of the
patients in the reality in which the service operates. OBJECTIVE: The objective is to establish
prevalence of brain tumors that affect the adult population in the city of Campina Grande (PB).
METHODS: Data were collected from medical records of patients admitted to the neurosurgery
service of Campina Grande reference hospital which were received during the period January
2011 to December 2015. We analyzed medical records of 65 patients (35 men and 30 women)
between 18 and 60 years. RESULTS: It was found the prevalence of GBM in 23% (n = 15) of the
analyzed medical records (n = 65), followed by the Low Grade Astrocytoma, 18.5% (n = 12),
Meningioma, 13.8% (n = 9), Ependymoma, 7.7% (n = 5), Oligodendroglioma, 6.2% (n = 4),
Schwannoma PCA, 6.2% (n = 4), Micro/Macroadenoma, 4.6% (n = 3), Craniopharyngioma, 3% (n
= 2), Choroid Plexus Papilloma, 3% (n = 2), Hemangioblastoma, 3% (n = 2), Dermoid
Cyst/Epidermoid Cyst, 3% (n = 2), Pineal Tumor, 3% (n = 2 ), Gangliocytoma, 1.5% (n = 1), Central
Neurocytoma, 1.5% (n = 1) and Neurinoma Olfactory, 1.5% (n = 1). CONCLUSION: The prevalence
rates obtained in this study are consistent with the present data from current literature. Besides
that, contribute as associative measure for the diagnosis, correlating age group most prevalent
CNS primary tumor to the group in question.
Código: 44726
Título: PRIMARY CENTRAL NERVOUS SYSTEM BURKITT LYMPHOMA IN A PATIENT WITH 17
YEARS OLD WITHOUT IMMUNODEFICIENCIES: A CASE REPORT
Autores: Amauri Pereira da Silva Filho; Anne Jamille Ribeiro Sampaio; Ayanne Alves de Oliveira;
Miriam Lucia Galvão Lucena; Verônica Cavalcanti Pedrosa; Lucas Silva Xavier; Pâmmela Dayana
Lopes Carrilho Machado;
Resumo: INTRODUCTION: Primary Central Nervous System Lymphoma (PCNSL) is an aggressive
lymphoma that, which diagnosis, is restricted to brain parenchyma, meninges, spinal cord and /
or the eyes. It is responsible for 4% of the tumors that affect the Central Nervous System (CNS),
considered as an infrequent disease and related, primarily, with immunodeficiencies. The PCNSL
cases in immunocompetent are even rarer and, when confirmed, affect patients from 45 to 70
years old, therefore is more unusual in children and young adults. OBJECTIVE: To report a case
of Burkitt Lymphoma (BL), appearing as PCNSL in a patient with 17 years old, who does not have
immunodeficiencies. METHODS: Observational study developed from research of the medical
records and inpatient and outpatient monitoring of a patient admitted in a referral hospital in
neurosurgery in Paraíba – Brazil. RESULTS: Male, 17 years old, with no history of disease. The
patient had head trauma accompanied by syncope and easily dealt headache. After a month,
suddenly the patient had simple partial seizure on the right side of his body, reported twice
again, when he sought hospital care. On examination: good general condition, conscious and
oriented; no change of the clinical and neurological examination. Cranial Computed Tomography
(CT) scan showed irregular injury, non-defined in the left posterior fossa with mild perilesional
edema. Blood tests without changes. HIV Testing was negative. He began treatment with
carbamazepine and corticoids. Cranial Magnetic Resonance Imaging (MRI) revealed
hyperintense lesions, irregular, non-defined and important perilesional edema. Since the injury
did not suggest any traditional neoplasia, it was decided to proceed with microsurgical resection.
The result of the pathological and immunohistochemical study showed BL. CT of the neck, chest
and abdomen, besides the ultrasound of the testicles were requested to assess whether the
lymphoma was primary or secondary. All results were negative, therefore it was diagnosed as
PCNSL. The patient had been treated with the combined regimen of chemotherapy and
radiation. CONCLUSION: Primary BL in CNS in immunocompetent is very rare, with few reports
in the literature and is considered one of the malignancies of fastest growing. A team with
extensive experience is essential for the correct diagnosis and treatment.
Código: 44298
Título: RARE SCHWANNOMA OF C1 ROOT WITH EXTENDED TO THE FORAMEN MAGNUM, CASE
REPORT.
Autores: Gustavo Jun Osugue; Alana Guimarães; Eduardo Segurasse Faria; Julio Cesar Meyer;
Instituição: HOSPITAL MUNICIPAL SÃO JOÃO BATISTA
Resumo: INTRODUCTION: Schwannomas located in spinal skull transition originating from the
first cervical root are extremely rare, especially when they are not related to neurofibromatosis.
It is known that schwannoma is originated in the dorsal sensory root, but it has been identified
that only 50% of human beings contain such root which dramatically reduces the incidence of
disease at that location. Most reports refer the far lateral approach for addressing cervical
schwannoma with intracranial extension, but resection can be performing with C1 / C2
laminectomy associated with mini occipital craniotomy. Objective: Report the occurrence of
unusual neoplasms of the central nervous system and discuss the surgical access. METHODS:
We report a case of large C1 root of schwannoma extending to the magnum foramen that
underwent C1-C2 laminectomy and occipital mini-cranioctomy being performed with complete
excision of the tumor. RESULTS: After complete resection of the tumor partial improvement of
neurological deficits was observed in the immediate postoperative. CONCLUSION: Schwannoma
of C1 spinal root is extremely rare, there are about 15 cases described in the literature. The
complete excision of a cervical schwannoma with occupation of bulbar cistern is easier
performed with C1-C2 laminectomy and occipital mini-cranioctomy.
Código: 44728
Título: SPINAL CORD TUMORS IN CHILDREN - AN EPIDEMIOLOGICAL SURVEY IN A
NEUROSURGEON REFERENCE HOSPITAL
Autores: Amauri Pereira da Silva Filho; Lucas Silva Xavier; Pâmmela Dayana Lopes Carrilho
Machado; Lucas Eduardo Vilarinho Guimarães; Huggo Luan Barros Medeiros; Verônica
Cavalcanti Pedrosa;
Resumo: Introduction: The spinal cord tumors in children have a difficult diagnosis because of
their low prevalence and insidious onset. Symptoms and signals are delayed and non-specific,
being respectively the most common the pain and progressive neurological deficit.
Astrocytomas represent 90% of spinal tumors in individuals under the age of 10 years and 90%
are benign. The Magnetic Ressonance imaging (MRI) is the gold standard for the diagnosis of
these tumors and the treatment of choice is microsurgery. Objective: To describe the
epidemiological profile of spinal cord tumors in children admitted to reference hospital in
neurosurgery in Campina Grande-PB. Methods: We conducted a retrospective cross-sectional
study of medical records of 17 patients from the reference hospital in neurosurgery in Campina
Grande - PB. The sample was defined as patients under 18 with spinal cord tumors discovered
by MRI and post surgical pathology report dealt with between January 2010 and December
2015. Results: There were 10 affected males (58.8%) and 7 females (41.2%). The average age
was 10 years, and the most affected ages were 9 and 12 years. The most affected location was
the thoracic spine, 47.1% (8), followed by cervical spine, 23.5% (4), cervico-thoracic transition
and cauda equina, 11.8% each (2), and head and neck transition, 5.9% (1). The low-grade
astrocytoma was the most frequent pathology, with 41.2% of the cases (7), male/female ratio
1.3:1 and reaching only patients between 8 and 15 years, mean age 11.5. The most common
symptom in these cases was paresis, with or without pain. Other diseases such as glioblastoma,
ependymoma, Aneurysmal Bone Cyst, and cauda equina’s schwannoma obtained similar
prevalence. The most frequent symptom was pain, present in 58.8% of cases (10) and location
associated with the level of spinal cord injury. Paresis was also a marked symptom with 52.9%
of cases (9), followed by hemiplegia, 23.5% (4), and other symptoms such as limp (17.6% 3),
torticollis (11.8 2%), loss of sensitivity and respiratory failure (5.9% each). Conclusion:
Understanding the epidemiology of spinal cord tumors in children is fundamental because,
despite its low prevalence, it’s an important differential diagnosis for paresis in infancy. As they
are usually benign lesions, post-surgical prognosis is optimistic.
Código: 44270
Título: SURGICAL APPROACHES TO THE VENTRICULAR TRIGONE AND THE IMPORTANCE OF THE
PREOPERATIVE DTI IN SURGICAL PLANNING
Autores: Renan Maximilian Lovato; João Luiz Vitorino Araujo; Vinicius Ricieri Ferraz; José Carlos
Esteves Veiga;
Resumo: Introduction: The ventricular trigone is a complex region because of its anatomical
relation with importante structures of the brain. Many surgical approaches have been described,
each with its advantage and disadvantages. We report a case of a ventricular trigone
meningioma and a review of the surgical approaches, also the importance of the DTI in the
surgical planning. Objectives: Our main objective is to discuss the possible surgical approaches
to the ventricular trigone with the advantages and disadvantages of each, also the importance
of the DTI in the preoperative evaluation for the surgical planning. Methods: We report a case
of a 35 years old female with a ventricular trigone meningioma operated through an
intraparietal sulcus approach, MRI with DTI was performed before and after the surgery, and a
visual field test after surgery. We review of the main surgical approaches to the atrium, and a
discuss the its peculiarities. Results: The trigone is in close proximity with important structures
in the brain, and during the surgical procedure there is a risk of injuring the visual, motor,
sensory and speech conduction tracts. We report the case of a 35 years old woman with a
ventricular trigone meningioma. She was operated through a transparietal approach with a good
functional outcome. The postoperative evaluation included clinical exam, DTI and visual field.
The superior parietal approach provides a direct access to lesions occupying the medial and
lateral regions of the trigone, but has been associated apraxia, acalculia, and visual field deficits,
most commonly a homonymous hemianopsia. Posterior interhemispheric parieto-occipital
approach is usefull for lesions involving the medial wall of the trigone, this does not transect the
corpus callosum, optic radiations and is not associated with language deficits, and the
contralateral transfalcine approach has similar advantages, with a wide surgical angle. Other
surgical approaches described are the transtemporal, posterior transcallosal, supracerebellar
infratentorial, supracerebellar transtentorial. Conclusion: The ventricular trigone is an
anatomically complex area and is closely related to important structures, the surgical treatment
of tumors in this area remains a challenge. The knowlege of the anatomy and the options of the
surgical approach is important for the surgical planning, as well as the adequate use of
preoperative imaging.
Código: 44248
Título: SURGICAL MANAGEMENT OF SPINAL INTRAMEDULLARY TUMORS: PERSONAL
EXPERIENCE WITH LONG FOLLOW-UP
Autores: Tommaso Tufo; Giulio Conforti; Mario Meglio; Beatrice Cioni;
Instituição: ISTITUTO NEUROLOGICO NEUROMED
Resumo: Motor evoked potentials (MEPs) monitoring has changed the role of intraoperative
neurophysiological monitoring (IOM) during spinal cord surgery. We report our experience in
the surgical treatment of adult intramedullary tumours Method. 97 cases of IMT underwent
surgical resection with the guide of at our Institution in the last 15 years. The monitoring
protocol included somatosensory (SEP) and motor evoked potentials (MEPs and D-wave).
Tumour was located at cervical level in 53% of the cases, thoracic in 35%, and at conus medullaris
in 12%. In most of the cases (65%) tumor had an extension from 1 to 3 vertebral levels. Histology:
42 ependymomas, 14 astrocytomas, 17 cavernomas, 7 hemangioblastomas, 4 metastases, 3
limphomas, 11 others. We evaluated surgical resection and neurological status according to
McCormick scale. Mean follow-up was 94 months (6-194 months). We evaluated the extension
of resection and the neurological outcome and compared the long term neurological outcome
obtained in this series with that obtained in a group of 15 adult patients, operated on without
the guide of IOM. Results and Conclusions. MEPs could be recorded in 96% of the cases, no false
negative and sensibility 100%. When muscle responses were lost, a significant increase of motor
deficit was present (specificity 96.7%); the new deficit was permanent in cases of associated
significant decrease of D-wave. SEPs showed a sensibility of 90.4% and a specificity of 88.5% as
regard as sensory outcome. Surgical resection was total in 66 patients, sub-total (>85%) in 15
and partial in 14. 76% of the patients were neurologically unchanged at follow-up, 10%
worsened and 14% improved. 1 patients died. All patients in McCormick grade I were uncharged
but one, as well as 80% of the patients in grade II and 70% in grade III. In conclusion, the majority
of lesions (70%) could be completely resected without any post-operative new neurological
deficit. Subtotal resection of low-grade astrocytomas did not show tumor regrowth at 7 years.
A neurological improvement was possible even in a few patients in McCormick grade IV. IOM
makes the surgeon more aggressive and has a significant favourable impact on neurological
outcome after surgery for intramedullary tumors.
Código: 44283
Título: SURGICAL MANAGEMENT OF TUBERCULUM SELLAE MENINGIOMAS VIA SUPRAORBITAL
KEYHOLE CRANIOTOMY
Autores: Arthur Maynart Pereira Oliveira; Augusto César Santos Esmeraldo; Jorge Dornellys da
Silva Lapa; Caio Lopes Pinheiro de Paula; Marcos Paulo dos Santos Teixeira; Cicero Santos de
Lima; Rilton Marcus Morais; Carlos Umberto Pereira;
Instituição: FUNDAÇÃO DE BENEFICÊNCIA HOSPITAL DE CIRURGIA
Resumo: Introduction and Objective: Surgical treatment for anteriorly located skull base
meningiomas is routinely done by pterional, cranio-orbitozygomatic or bifrontal approaches
with frequent shrinkage of the frontal cortex. Our goal is to demonstrate that access through
supraorbital keyholes approach is effective for tuberculum sellae meningiomas, allowing
satisfactory resection with less brain retraction and proper aesthetic results. Methods: We
reviewed retrospectively four patients operated from January to December 2015 by two
neurosurgeons (A.M.P.O. and A.C.S.E.) of the Neurosurgery Service of Surgery Hospital, Aracaju,
Sergipe, Brazil. In all cases we made a supraorbital keyhole craniotomy without removal of the
orbital rim. Three cases were made with eyebrow incision and one case through a small incision,
in an arc shape, at the hairline. Further details about the technique are described in the article.
Results: We operated three females and one male patient. The average age was 35 years. The
main complaint was headache in all cases and visual impairment in 75% of cases. We got gross
total resection in all cases. We did not observe complications related to neuro vascular
structures handling neither cranial closure (none CSF leak) nor endocrine disturbances.
Discussion: Routinely anterior skull base meningiomas are operated by large craniotomies, with
sub frontal cortex handling, requiring in some cases section of the anterior sagittal sinus, frontal
sinus exposure and sometimes requiring Galea flaps. Concern about these morbidities we saw a
growing need for development of surgical techniques that allow adequate access to anterior
skull base. The use of minimally invasive access through supraorbital keyhole craniotomies
allows satisfactory resection without increase morbidity. Conclusion: As noted in our results the
supraorbital craniotomy allow satisfactory access to the tuberculum sellae region associated
with good oncologic and aesthetic results.
Código: 44197
Título: SURGICAL TREATMENT OF CENTRAL NERVOUS SYSTEM HEMANGIOBLASTOMAS
Autores: Andrés Cervio; Juan Villalonga; Mormandi Ruben; Santiago Condomí Alcorta; Jorge
Salvat;
Instituição:
Resumo: Introduction Hemangioblastomas are uncommon tumors of the central nervous
system representing 1 - 2.5% of all intracranial tumors. They can present sporadically or in
patients with von Hippel-Lindau (VHL) disease and are most often located in the cerebellum,
brainstem, and spinal cord. VHL disease is a multiple neoplasia syndrome inherited in autosomal
dominant fashion caused by a VHL suppressor gene deletion. We present our experience in the
management of patients with HEB. Objectives To analize our experience in the surgical
treatment of patients with Hemangioblastomas (HEB) of the Central Nervous System (CNS).
Material and Methods Forty consecutive patients with HEB were included in this study. Hospital
charts, radiological images and operative records were reviewed. Modified Rankin scores were
used to evaluate clinical course of intracranial lesions, and Mc Cormick scores for spinal tumor
analysis. Results Thirty HEB (75%) were identified in the cerebellum, 6 (15%) in the brainstem, 2
(5%) in the spinal cord, 1 (2.5%) supratentorial and 1 in the cauda equina, respectively. Thirty
five (87.5%) were sporadic cases and 5 (12.5%) lesions were associated with VHL. Complete total
resection was achieved in 93% of cerebellar and 83% of brainstem lesions, respectively.
Postoperatively, 83% of cerebellar HEB and 66.6% of brainstem HEB showed good functional
results. Conclusions HEB of the CNS should be resected when symptomatic, or when tumor or
associated cyst enlarge. Surgical intent should seek en bloc resection to minimize intraoperative
bleeding. Patients with hemangioblastomas must be tested for VHL gene mutations and in
confirmed cases relatives should be offered genetic counseling.
Código: 44226
Título: SYNCHRONOUS OCURRENCE OF MENINGIOMA AND KIDNEY BRAIN METASTASIS –
RELEVANT ASPECTS OF AN UNUSUAL CASE
Autores: Aline Lariessy Campos Paiva; João Luiz Vitorino Araújo; Guilherme Lellis Badke; Vinicius
Ricieri Ferraz; José Carlos Esteves Veiga;
Resumo: INTRODUCTION: Simultaneous or synchronic ocurrence of brain tumors is uncommon.
It is most common described in some hereditary syndromes (such as Li Fraumeni and Lynch
syndrome) and also after cranial radiotherapy. Although any tumor may be potential recipient
of metastasis, renal cell carcinoma and meningiomas are the most common malignant and
benign recipients. There are many ideas about the development of these tumors, however it is
more likely because of an aggressive high-grade malignancy serves as the source of tumor and
a more indolent neoplasm serves as the recipient tumor. OBJECTIVE: The purpose is to relate a
case in which there are simultaneous brain tumors in a male patient (one of them has a
metastatic origin – kidney cancer – and another has a benign origin - meningioma). It was also
made a literature review about synchronic brain tumors (and a different manifestation known
as tumor-to-tumor metastasis) CASE REPORT: A 55 year old male patient was evaluated because
of a history of headache, behavior compromisse and progressive cognitive impairment. In his
pathological history he was undergone to a nephrectomy due to renal cell carcinoma. It was
requested brain MRI and CT wich disclose huge lesion in the frontal horn of the right lateral
ventricle and also another lesion with about 2 cm in the groove olfatory region (compatible with
meningioma). It was performed anterior transcallosal inter-hemispheric approach which
allowed complete lesion removal. Histopathological analysys confirm the diagnosis of renal cell
carcinoma. There were not complications in the post operative period and the patient presented
with improvement of behavior. He performed also brain radiotherapy after surgery and was
followed at the ambulatory. One year after it was noticed in brain MRI that the meningioma had
increase and also an occipital lesion (more suggestive of metastasis). A second surgery was
proposed through a lateral supraorbital approach (histopathological confirm that was
meningioma Grade I). The procedure occured without complications, the patient remained
without neurological impairment and was referred to complete treatment with radiotherapy.
CONCLUSION: Synchronic brain tumor is an uncommon situation at the neurosurgery practice
and knowing history of previous cancer could help the approach. Adjuvant therapies can help to
complete treatment, however a close follow-up is required to accompany the behavior of these
lesions.
Código: 44899
Título: TECHNIQUES AND SCRIPT IN NEUROSURGERY FOR TREATMENT OF NORMAL PRESSURE
HYDROCEPHALY
Maria da Costa Matos; Carlos Eduardo Veiga de Lima; Thainá Lima Sicsú; Raquel Ferreira Pontes;
Resumo: INTRODUCTION: The Hydrocephaly is diagnosed as increased volume cerebrospinal
fluid in the intracranial compartment, causing dilation of the ventricular system. Can occur in
two forms: obstructive or not communicating, when the fluid flow is blocked within the
ventricular system and not obstructive or communicating when it is due to the reduction in
absorptive capacity, determining the disproportion between production and absorption of fluid.
The Normal Pressure Hydrocephaly (NPH) affects around 60,000 people in Brazil (about 5% of
the population), mostly elderly over 60 years and can be mistaken with Alzheimer‘s disease
(which afflicts 50% of Brazilians) and disease cerebrovascular (25% of subjects). The differential
of NPH in relation to other diseases that cause dementia, such as Alzheimer‘s and strokes is its
ability to cure, if diagnosed previously it is operable and the patient recovers and leads a normal
life. But how to diagnose it? OBJECTIVES: This study has the following objectives differentiate
NPH from other diseases that it confused, in particular Alzheimer‘s considered a degenerative
disease. Therefore, the elderly with difficulty walking, using a cane; usually forget recent events
and have their clothes soaked with urine, have Alzheimer‘s or NPH? METHODS: This is a
descriptive research and literature review that lets you create a neurosurgical script for the
treatment of normal pressure hydrocephaly that allows: identify the triad of symptoms that are
classics (motor apraxia, memory changes and urinary incontinence); discuss imaging tests that
allow visualize the disease (magnetic resonance imaging and computed tomography); comment
on the predictive clinical tests that guide the neurosurgeon to indicate the surgical procedure or
not (TAP TEST, infusion test and the test of external lumbar drainage); and establish two
possibilities of treatments in neurosurgery for NPH, the implementation of a Peritoneal
Ventricular Derivation valve or the Third Endoscopic Ventriculostomy. RESULTS: The practice of
all script on the orientation for neurosurgical submission for NPH and the surgical procedure,
makes it possible to show improvements of memory, intellectual performance and control of
sphincters in patients affected by this disease. CONCLUSION: The multidisciplinary cares are
important in the postoperative period including neuropsychological treatment, physiotherapy
and occupational therapy in the individual‘s rehabilitation.
Código: 44300
Título: THE IMPACT OF RECURRENT SURGERY AND TEMOZOLOMIDE FOR HIGH-GRADE GLIOMAS
OVER TIME
Autores: Sâmia Yasin Wayhs; Eduardo Santamaria Carvalhal Ribas; Breno José Alencar Pires
Barbosa; Cesar Cimonari de Almeida; Leonardo Bilich Abaurre; Olavo Feher; Manoel Jacobsen
Teixeira; Guilherme Alves Lepski;
Instituição: HOSPITAL DAS CLÍNICAS DA FMUSP
Resumo: The standard treatment for High-Grade Gliomas (HGG) is currently maximal safe
surgical resection followed by radiation therapy and concomitant chemotherapy. Unfortunately,
the disease will invariably recur even with the best treatment available, and the goal should be
prolonging survival time and improving quality of life. The issue of re-operating patients when
the HGG recur changed during the last years, as the literature showed the positive impact of reoperation. As a result, the treatment strategy of these patients changed in our institution after
2009, as our neuro-oncological team was more prone to direct patients to re-operations if
recurrence was noted. The aim of this retrospective study was to analyze the impact of patient
survival with HGG after the current treatment view has slightly changed and patients were more
likely to be re-operated. All patients with newly-diagnosed HGG from 2008 to 2010 in a singleteaching hospital were included. Clinical, radiographic, and pathologic data were collected.
Median overall survival (OS) was calculated using Kaplan–Meier estimates. A total of 119
patients were selected. The mean age was 57 years; 77% (92/119) were submitted to any
surgical debulking and about 16% (19/119) were submitted to 2 or more surgeries (all of these
after October 2009). Chemotherapy was administered to almost 43% (51/119) of patients
(temozolomide 36, carmustine 18, irinotecan 6, bevacizumab 5, PCV 3 and lomustine 2). In a
second analysis, the patients were divided into two separated groups depending on the
treatment strategy, as defined before or after July 2009. This retrospective review showed the
survival trends with the addition of recurrent surgery to standard treatment, besides the
addition of temozolomide.
Código: 44750
Título: THE ROLE OF NEUROSURGERY IN MELANOMA BRAIN METASTASES
Autores: Leonard Rocha Fonseca de Brito; Mauro Cesar Grüdtner; Marcos Vinícius Calfat
Maldaun;
Instituição: HOSPITAL SÃO JOSÉ
Resumo: Introduction: Immunotherapy appears in the neuro-oncology scene as a new weapon
to fight cancer. As the chemotherapeutic drugs have a limited effects, neurosurgery and
stereotatic radiosurgery followed by whole brain radiation therapy are still the standard of care,
but the survival is still limited. The poor prognosis of these patients is a challenge for the
multidisciplinar team of medical oncologists, radiation oncologist and neurosurgeons who
manage daily this deadly disease in an attempt to promote a better prognosis and quality of life.
Objectives: Consolidate the role of surgery in brain metastases of melanoma in the era of
immunotherapy. Methods: Meta-analysis of searched articles in Medline and PubMed. Results:
Immunotherapy has shown benefits with increased overall survival rate. Ipilimumab, a
monoclonal antibody, has shown abscopal effect mediated by antigen-antibody, in patients
undergoing stereotaxic radiotherapy. Dexamethasone has been used for years for symptomatic
control of this type of patient, but by being a depressant of the immune system it appears to be
harmful, so its early removal has been recommended for a better response of the immune
system associated with immunotherapy. Neurosurgery has been proved more effective than
stereotatic radiosurgery on a selected group of patients in the management of brain metastases
of melanoma, due to the fact it causes an early weaning of corticoids, increasing performance
and survival. Conclusion: The surgery resection of melanoma brain metástases (MBM) improved
performance status in the majority of cases, and there were no surgical complications related
to the use os ipilimumab. Furthermore, allows an early weaning of corticoids, which is not
possible when opts for radiosurgery. Decrease corticoid treatment seems improve ipilimumab
action. A screening should be indicated for early detection of MBM, seeking a more aggressive
treatment? Neurosurgery treatment of multiple metástases should be more aggressive to have
a greater benefit with immunotherapy? Certainly, more trials are required in patients with
melanoma brain metastases.
Código: 44267
Título: THREE-DIMENSIONAL MRI RECONSTRUCTION FOR PRESURGICAL PLANNING USING FREE
OSIRIX SOFTWARE FOR INTRACRANIAL TURMORS
Autores: Renan Maximilian Lovato; João Luiz Vitorino Araujo; José Carlos Esteves Veiga;
Resumo: Introduction: The correct position of the craniotomy and the study of the anatomic
relations of the lesion with the neural structures around it is of great importance for modern
neurosurgery. The use of new tools to improve our capacity of lesions localization is important
to improve the safety of the surgery and decrease morbidity. We report the use of a free
software in 3D surface reconstruction of the brain for surgical planning. Objetives: The objctive
of this study is to show a technique of 3D surface reconstruction of the brain, using a free
software and a notebook, that can be performed minutes before the procedure by the surgeon.
We aim to improve our capacity of localizing the lesions and planning a safer surgery for the
patient. Methods: Patients underwent scans with 1.5T magnetic resonance scanner. The
sequences required for the 3D reconstructions were 1mm thickness slices T1 both nonenhanced
and enhanced with gadolinium. The reconstruction was performed using a MacBook and the
free version of the Software Osirix, and the images were compared with intraoperatory findings.
We use the technique routinely and will present illustrative cases to show the results of the
reconstructions. Results: The study of the relations between the central nervous system and the
skull topography and concept of Stereotaxy are of great importance for topographis localization.
These were the basis of the neuronavigation, wich is a very importante tool in the surgical
planning for brain tumors, but unfortunately, is not widely available worldwide. MRI and CT
scans have been used previously for 3D brain reconstruction, sometimes using complex and not
easily accessible software. The use of a personal computer and a free software is something that
can be reproduced in many centers. Through some illustrative cases we were able show that
this technique is helpfull in our surgical planning and that the findings of the reconstruction are
very similar to the introperative findings, making it easier to localize lesions and plan a safer
surgery. We believe this can replace the use of the neuronavigation system in some cases, with
an additional advantage being the extremely low cost. Conclusion: In our experience we found
that a simple and easily reproduced technique of 3D surface of the brain using only a personal
computer and a free software could help us with our surgical planning. The reconstructions were
very similar to the intraoperative findings.
Código: 44244
Título: TRANSOPERATIVE ULTRASONOGRAPHY FOR LOCATING AND MONITORING THE
RESECTION OF BRAIN TUMORS Temário: Neurocirurgia
Autores: Luiz Carlos Brasiliano Ferreira; Humberto de Matos Muller; Tais Amara Costa Souza;
Instituição: HPSC
Resumo: Introduction: Transoperative ultrasonography is a non-invasive technique that assists
in locating and monitoring the resection of a tumor lesion in real time. Objective: The aim of our
study is to show use of transoperative ultrasonography in locating brain tumors and in
monitoring the resection of gliomas. Material and Methods: The device used was an Esaote
myLab 50 Xvision 2014 with linear 7.5 MHz and convex 12.5 MHz transducer. The transducer
was placed in a sterilized jacket and used on the surface of the dura mater or on the surface of
the brain cortex, being rotated around the area of interest by changes in sagittal, axial and
coronal planes. As reference points we used the lateral ventricles, the third ventricle and the
falx cerebri. Over a period of 16 months, from July 2014 to October 2015, ultrasonography was
used in 20 nonconsecutive neurosurgical procedures, selecting small sub-cortical of difficult
access lesions and excluding such obvious lesions as large surface gliomas and meningiomas.
Our experience includes 2 brain abscesses and 18 neoplasms from metastases to solid and cystic
gliomas, with diameters ranging from 1 to 4.5 cm. The most significant finding of this
investigation of the use of intraoperative ultrasonography in real time is that the tumor lesion
was clearly identified and located in each case. However, the monitoring of tumor lesion
resection requires a learning curve and the resection borders a better image definition. To
conclud, intraoperative ultrasonography is a noninvasive technique that is useful in locating
small sub-cortical lesions in real time, thus reducing surgical time and surgical exploration. The
technique also helps in the transoperative monitoring by defining borders and identifying tumor
residues, especially in gliomas. This tool is of low cost and easy handling.
Código: 44871
Título: TUBERCULUM SELLAE MENINGIOMAS: IS THERE ANY IDEAL APROACH?
Autores: Paulo Henrique Pires de Aguiar; César Cozar Pacheco; Iracema Araújo Estevão; Natally
Marques Santiago; Luis Roberto Mathias Junior; Marcos Vinicius Calfat Maldaun; Carlos Tadeu
Parisi de Oliveira;
Resumo: Background: Tuberculum sellae meningiomas (TSM) are surely a challenge for all
neurosurgeons. They account for up to 10% of all intracranial meningiomas and represent a
small percentage of surgical case series. TSMs involve eloquent structures and important
vasculature, intimately related to the optic nerves, chiasma, anterior cerebral, internal carotid
arteries and their perforators. Therefore, due to their anatomy, decision making is usually
difficult. Objectives: Discuss the main approaches and the complications based on literature
review and the authors experience. Casuistry and Methods: We report our personal case series
of 38 patients with TSMs. (2) patients received an endoscopic endonasal approach, while 36
underwent different approaches for tumor resection: (12) bifrontal, (12) pterional, (6)
supraciliary, (4) unilateral frontal, (2) fronto-orbito-zygomatic. Simpson, morbidity and mortality
rates were analyzed by this study according to different approaches. Results: 31 patients had
Simpson grades 1 and 2 excisions, while the rest underwent Simpson grade 4 excisions. The
overall rate of nonvisual morbidity was 13.15% (5 of 38 patients) and mortality 5.2%. Conclusion:
The primary symptom leading to the diagnosis of a TSM was visual compromise and the main
goal of surgery is to achieve improvement of vision. Favorable outcomes were achieved with
appropriate selection of surgical approach. More studies are necessary to define the prognostic
factors for patients with TSM after surgical intervention.
Código: 44849
Título: TUMOR APOPLEXY: AN IMPORTANT DIFFERENTIAL DIAGNOSIS IN NEUROCRITICAL CARE
Autores: Gustavo da Fontoura Galvão; Leonardo Baron Spolidoro; Caio Moreno Perret Novo;
Leonardo Bacelar Cantanhede; Luiz Antonio Viegas de Miranda Bastos; José Lucas Peres Bichara;
Herbert Missaka; Cesar Augusto Ferreira Alves Filho; Clara Magalhães Paiva; José Massoud
Salame; Simone Maria Lindemayer Fernandes; Sion Divan Filho;
Instituição: UFRJ
Resumo: Introduction Spontaneous Intracranial Hemorrhage (ICH) has a wide range of
uncommon etiologies, including Intracranial Tumor Hemorrhage (ITH). The incidence of ITH is
between 1.6 and 15% of all spontaneous ICH. In 25% of all patients with ITH, sudden hemorrhage
occurs as the first signal, with a lack of a history of brain tumor or chronic increased intracranial
pressure. Acute or sub-acute onset is a common presentation in major part of the patients, an
event that resembles very much cerebrovascular disease. Thus, Intracranial Tumor Hemorrhage
is a commonly misdiagnosable condition. Objectives This case report intends to not only report
a case of a glioma apoplexy misdiagnosed as an hemorrhagic stroke due to similar CT scans
imaging and patient’s clinical condition, but also reminds that tumor apoplexy is a relevant
differential diagnosis in hemorrhagic stroke events, an important information in intensive care
follow up. Case A 66 years-old men reported a sudden and intense orbital-frontal headache
associated with a systemic hypertensive crisis (180x100mmHg), a left hemiparesis compromising
mainly the arm and hemispatial neglect to the left. The CT scan suggested a temporal-parietal
intraparenchymal hemorrhage of about 18ml associated with a midline deviation of more than
5mm and localized edema. Following the hemorrhagic stroke conservatory treatment, we
performed a new contrasted cranial CT due to the suspicion of a possible tumor apoplexy, which
showed an expansive lesion near the fusiform gyrus and another one at the cortical-subcortical
temporal-parietal region with perilesional digitiform edema, sparred midline shifting and
absence of basal cisternae compression. MRI was performed suggesting that the lesion was a
high degree glioma. Conclusion Tumor apoplexy may resemble very much spontaneous
hemorrhagic strokes. Fast onset, hypertensive crisis, focal lesions and head pain are classical
symptoms of ICH. Thus, CT scan might lead us to misdiagnosis. Contrast CT scan and MRI may
be required on doubtful scenarios for correct diagnosis and management.
Código: 44193
Título: TUMORS OF CENTRAL NERVOUS SYSTEM IN PEDIATRIC AGE – EPIDEMIOLOGY BASED ON
A SERIES OF NEUROSURGICAL CASES FROM A SINGLE INSTITUTE
Autores: Tiago Marques Avelar; João Luiz Vitorino Araujo; Vinicius Ricieri Ferraz; Renan
Maximilian Lovato; Aline Lariessy Campos Paiva; Milton Hikaro Toita; José Carlos Esteves Veiga;
Instituição: SANTA CASA SP
Resumo: Introduction: Tumors of central nervous system (CNS) are the most frequent solid
malignancy in pediatric age, exceeded only by leukemia, counting approximately to 16-23% of
all pediatric malignancies and are the leading cause of cancer death among children. According
to Central Brain Tumor Registry of the United States (CBTRUS), the annual incidence for children
0-14 years between 2007 and 2011 was 5.26 per 100000. Papers addressing epidemiology of
pediatric CNS tumors in our country are scarce and there is divergence about the most frequent
affected compartment, supra (ST) or infra tentorial (IT).Objectives: To describe epidemiology of
CNS tumors with surgical management in a single institution of São Paulo, Brazil, among children
0-18 year between 2002 and 2015.Methods: We reviewed all surgeries performed to
management of CNS tumors in this period. Non-neoplastic and outside CNS origin lesions were
excluded. Data about genre, age and histologic type were compiled and frequency measures
were calculated according to age groups, histologic type and topography. The tumors were
classified following the International Classification of Diseases for Oncology (ICD-O-3).Results:
Applying exclusion criteria, we found 169 cases. 60% were situated in ST, 32% in IT and 8% in
spinal cord. Topographic distribution according to ICD-O-3 sites revealed 21% occurring in brain
lobes hemispheres, followed by cerebellum (20%) and pituitary and craniopharyngeal duct
(14%). No difference among histologic types in <1y was found; pilocytic astrocytoma was the
leading type among 1-4y and 5-9y groups (20.6% and 22.2% respectively), followed by primitive
neuroectodermal tumor (PNET, 14.7%), ependymoma (8.8%) and medulloblastoma (8.8%) in the
1-4y group and by medulloblastoma (17.8%) and craniopharyngioma (15.6%) in 5-9y group.
Between 10 and 14y, craniopharyngioma, desmoplastic ganglioma and medulloblastoma shared
the leading cause with 11.9% each, followed by pilocytic astrocytoma and ependymoma (9.5%).
Among adolescents (15-18y), pituitary adenoma prevailed (9.5%), followed by
craniopharyngioma, desmoplastic ganglioma, PNET and germinoma (7.1% each). Overall the
most common type in ST was craniopharyngioma (17) and in IT, medulloblastoma (18).
Conclusion: Findings of this series may reflect the actual epidemiology of CNS tumors in pediatric
population in our country since the study was performed in a large institution that receives
patients from different regions in Brazil
Código: 44445
Título: UNUSUAL OCCURRENCE OF A CERVICAL SCHWANNOMA: CASE REPORT
Autores: David Plácido Lopes; David Plácido Lopes Júnior; Marcos Rafael Porto Bioca Alves;
Instituição: UNIVERSIDADE CATÓLICA DE PERNAMBUCO
Resumo: Introduction: Schwannomas are benign tumors and usually encapsulated, originating
from schwann cells. They grow slowly and represent approximately 30% of primary spinal
tumors. In literature it’s peak incidence is from 4 to 6 decade, regardless of gender. They prefer
the sensory roots, which may be follow with pain in the affected distribution, spinal cord
compression, block of cerebrospinal fluid (CSF) with protein concentration. The total excision of
tumors is the goal of treatment, with good results in most cases. Objectives: To report a case
with unusual initial presentation of a cervical schwannoma. Methods: Case report. Results:
A.R.S., male, 37, with decreased visual acuity, almost amaurosis right and hard left. Persistent
headache for three months. No other significant complaints. MRI brain showed great
hydrocephalus and semi-stenosis of the Sylvian aqueduct, no evidence of expansive lesions.
Retinography showed bilateral peripapillary hemorrhage with great papilledema. Admitted to
the neurosurgery service for evaluation of surgical treatment underwent emergency bypass
ventricular-peritoneal for control of intracranial hypertension. It was collected CSF for
evaluation of possible inflammatory etiology. The patient was discharged without headache and
improvement of visual acuity. Postoperative cerebral tomography showed no hydrocephalus
and retinography showed almost complete regression of hemorrhage and papilledema. The CSF
showed protein concentration (195 mg%) and positive in the tests for Neurocysticercosis. In the
meantime, the patient complained of weakness in the lower limbs, urinary incontinence and
occipital-cervical pain. On physical examination, quadriparesis grade 4 predominance of right
and hyperreflexia in the 4 members. MRI of the cervical and thoracic spine showed
intrarrhachidian cervical mass lesion, intradural, with C3 to C6 extension. The deficit symptoms
worsened and the patient underwent excision of the lesion through cervical laminotomy.
Histopathology of result, with immunohistochemical evidence was schwannoma benign with
degenerative changes. Patient is stable without symptoms of hydrocephalus with mild paresis
right. Conclusion: Acute hydrocephalus with blindness in adults without apparent cause, should
alert the physician assistant doing research with neuroimaging all neuroaxis because these
spinal schwannomas can, as in the case, present in an unusual way.
Código: 44788
Título: VASCULAR COMPLICATIONS OF TEMPORAL LOBE GLIOMAS
Autores: Paulo Henrique Pires de Aguiar; Iracema Araújo Estevão; César Cozar Pacheco; Bruna
Martinez Sales; José Jorge Sanches; Felipe Sartori; Pedro Soneghet Gomes; Marcos Vinicius
Calfat Maldaun;
Resumo: Background: Patients with gliomas are at risk of cerebrovascular accidents with
potential consequences on survival, function, and local tumor control. These way ischemic
strokes, intracranial hemorrhages and deep venous thromboembolism are frequent in patients
with gliomas. After a surgery, the glial scar alters the normal intraparenchymal architecture and
small vessels that can be normally saved may be injured and sacrificed. These vascular
complications might lead to greater incidence of perioperative infarction, with potentially
devastating effects. In this presentation we will demonstrate our experience and results in a
group with thirty-seven patients with temporal lobe glioma underwent surgical treatment for
the resection of the lesion, with three vascular complications due to the glioma position and the
surgical manipulation. Objectives: Report thirty-seven cases of temporal glioma, three of which
evolved with a vascular complication after the resection surgery, operated by the same group
of neurosurgeons and show our outcome and conclusions. Casuistry and Methods: We analyzed
the clinical and surgical data and imaging exams of thirty-seven patients with gliomas in the
temporal lobe (22 left and 15 right) which were operated from 2007 to 2016, through typical
temporal craniotomy with microsurgical resection of the lesion. Of these, 17 had complex partial
epilepsy under control, others had hypertensive cysts or intracranial hypertension. Resection
was subtotal in 17 cases and partial in the other 20 cases. The diagnosis of astrocytoma low
grade was obtained in 10 cases, high-grade and glioblastoma in 16 cases, oligodendroglioma in
3 cases and 1 case of xanthoastrocytoma. Results: Complications were observed in 3 cases with
severe motor deficit, which was performed one partial resection and subtotal resection in the
other 2. These three cases being in right temporal lobe. We noticed large edema area
surrounding the resection, which reach the central core. One progressed to ischemia of the
middle cerebral artery territory, with subsequent evolution to death. A case of left-handed
patient evolved with dysphasia. We consider the vascular injuries and complications due to the
damage of perforating M1, and not due to the lesion of M2 branches in their course to the insula.
Conclusion: Vascular injury is more common than we think, and certainly it is associated with
ischemic regions of the insula, the central core and inferior frontal occipital fibers.
Código: 44293
Título: DYSPLASTIC GANGLIOCYTOMA OF THE CEREBELLUM ASSOCIATED TO CHIARI I
MALFORMATION
Autores: Bárbara Elias Prado; Rangel de Sousa Costa; Barbara Andrade de Oliveira; Eliseu dos
Santos Costa;
Resumo: INTRODUCTION: The dysplastic gangliocytoma of the cerebellum, also called Lhermitte
Duclos, is characterized by distortion of cerebelar cytoarchitecture, leading to an expansive
process in the posterior fossa, usually unilateral and with slow growth. May be associated with
congenital malformations as megalencephaly, polydactyly and other cranial abnormalities. The
symptoms are usually related to mass effect, and there may be ataxia, hydrocephalus and
alteration of cranial nerves. Typical radiological findings are sufficient for diagnosis, however
concomitant reports with Chiari malformation are scarce. Hiari I malformation is defined as
herniation of the cerebellar tonsils through the foramen Magnum dipping with a 5mm or more,
being kind 1 the most common among Chiari malformations. OBJECTIVE: Report a case of
gangliocytoma dysplastic cerebellum concomitant to the Chiari I malformation, with emphasis
on diagnostic aspects. METHODOLOGY: Made retrospective study with collection of of medical
records and patient’s radiologic studies. It was also carried out literature review through
sensitized search strategy for comparation of this case report with the study findings. RESULTS:
35 years old patient, with hydrocephalus history in childhood evolved a year ago with headache,
cervical pain, right buzz, associated to right hearing loss six months ago. It was requested
magnetic resonance imaging (MRI) of the brain with spectroscopy and study of cerebrospinal
fluid flow, which showed bilateral cerebellar injury, striated aspect, with hyperintense signal on
T2 and hypointense signal in T1 causing not communicating hydrocephalus. Established
diagnosis of Cerebellar displastyc gangliocytoma by the typical radiological findings. It was also
observed herniation of the cerebellar tonsils, compatible with Chiari I malformation. FINAL
CONSIDERATIONS- In addition to the rarity of the described syndrome, the case in question has
as differential findings the lesion bilateralism, that’s usually unilateral, and association with the
Chiari I malformation.
Código: 44903
Título: GLIOMA RECURRENCE OF LOW GRADE OF TEMPORAL REGION TO INSULA’S REGION
Autores: Bárbara Elias Prado; Barbara Andrade de Oliveira; Eliseu dos Santos Costa;
Resumo: INTRODUCTION: Are considered gliomas of low degree malignancy tumors classified
as grade I and II, they may present atypical endotelial proliferation, but they have slow growth.
Diffuse astrocytoma grade II preferably have a supratentorial location, with infiltrative and bad
tendency delimitation of its borders, revealing potential for relapse. Epidemiological study these
lesions in the insula region accounted for up to 25% of all low grade glioma and 10% of all high
grade glioma. Surgical treatment in the insula region is unwieldy occurring in most cases
incomplete resection, which favors tumor recurrence. OBJECTIVE: Report and compare with
literature a case of recurrence of low-grade glioma in the temporal region extending to insula.
METHODOLOGY: This is a case study carried out by the patient‘s medical history, medical record
analysis and research in databases PubMed / MEDLINE. CASE REPORT: Pacient AGA, male sex,
60 years old. Patient has a history of injury by firearm from 29 years ago, a cartridge was retained
in the cerebellum and spinal column. Patient paralyzed, not being indicated surgery. Two years
ago he showed episodes of syncope associated with weight loss. Image examination was made
and showed a lesion from the temporal region to the insula, patient underwent surgical R2
resection. A year later there was asymptomatic recurrence detected by routine imaging and a
new R2 resection was performed. Patient developed headache and double vision, after a year
of the second resection. Made new imaging, MRI, was observed a mass lesion not captante
contrast, located in the right temporal lobe extending to the insular lobe, with poorly defined
boundaries measuring 5 x 5.45 x 6.6 cm, promoting compressive effect on the temporal horn of
the lateral ventricle corresponding and and post surgical area encephalomalacia. Patient
awaiting further surgical resection. CONCLUSION: MRI with contrast is the preferred method in
the diagnosis and monitoring of gliomas after surgeryThe immediate surgery is necessary when
there is a significant mass effect or significant neurological symptoms.It is recommended
maximum resection of the lesion avoiding neurological sequelae. Studies show that partial
resection favors relapses as there was in this case.
Código: 44616
Título: PARASAGITTAL MENINGIOMA IN PEDIATRIC PATIENT
Autores: Bárbara Elias Prado; Renato Miranda Ramalho Filho; Barbara Andrade de Oliveira;
Resumo: INTRODUCTION: Meningiomas are benign tumors more common in people between
40 and 70 years and in the female sex, rarely are found in children. Large part of the lesions have
slow growth and can reach considerable size asymptomatic form. OBJECTIVE: Report and
compare with literature a case of parasagittal meningioma in pediatric patient. METHODOLOGY:
The informations were obtained by retrospective study with analysis of medical records,
interview with person accompanying and literature review. RESULTS: Patient male, 4 years old.
Presented epileptic crisis in its first year of life that evolved into focal tonic seizures. With three
years of age held a Magnetic Resonance it was possible to detect a dimension 2,7x2,2x2,6 mass
lesion in the frontal parietal transition right with discrete erasure of cortical sulci and without
contrast enhancement. The following year, after new imaging study , we observed the growth
of the lesion which now has dimensions 7,73x2,27x2,87 without giving peritumoral edema and
intracranial hypertension. Made patient removal surgery progressed well, not resenting more
symptoms. DISCUSSION: The related case differs from the usual literature for attacking a child
and having no edema formation at the injury site. There was an episode of generalized seizure
that evolved to focus as following the evolution of literature. FINAL CONSIDERATIONS: The
complete removal of the lesion, dura mater of origin and affected bone flap is the Golden
pattern for the treatment of meningiomas and results in good prognosis.
Código: 44897
Título: PEDIATRIC LOW-GRADE ASTROCYTOMAS EPIDEMIOLOGY IN A HOSPITAL IN TERESINA,
PIAUÍ
Autores: Isys Fialho Nascimento; Bruna Afonso dos Santos; Jordanna Christine Freire Duarte
Lima; Mariana Ribeiro Veras; Karine Letícia Ferreira Machado da Costa; Déborah Castro Ferreira
de Oliveira; José Nazareno Pearce de Oliveira Brito;
Instituição: UNINOVAFAPI
Resumo: Introduction: Low-grade astrocytomas are the most frequent primary brain tumors
affecting children. These type of tumors are characterized by slow growth and relatively
circumscribed architecture, which allows for gross total resection and surgical cures in many
patients. However, some of these tumors progress, especially when they are located in
inaccessible surgical sites, and may then be associated with significant morbidity and mortality
over time. Objectives: The aim of present study was to evaluate the incidence, anatomic site
most affected, clinical symptoms, histopathological types, recidive and prognostic factors of
brain tumors in children treated in a reference hospital in Teresina, Piaui. Methods:
Retrospective analysis of 19 children with primary low-grade astrocytoma tumors diagnosed and
treated in a hospital of reference for cancer treatment in Teresina, Piauí, from January 2010 to
December 2015. Data was collected from medical records, radiological studies and
histopathological material. Results: Mean age of the patients was 7,5 years and the ages ranged
between 2 and 13 years; there was a female predominance (1.28:1). Most commonly type of
tumor found was pilocytic astrocytoma (37,5%), and the anatomic site most affected was
cerebellum (62,5%). Main clinical symptoms found were headache (56,25%), nausea and
vomiting (50%), sensitive loss (31,25%), motor disorders (31,25%) and convulsions (18,75%). Five
patients presented recidive in 11,5 months, one of them presented 2 recidives of cerebellar
astrocytoma in 6 months. Mortality rate in the time of this study was 12,5%. Better prognostic
of pediatric low-grade astrocytomas was related with total resection and histopathological type;
radiotherapy and quimioterapy was prescribed in a case of tumor recurrence. Conclusion: In
general, findings of this study were similar to that found in literature. Better prognostic of lowgrade astrocytoma in children was related with total resection and histopathological type;
adjuvant treatment more effective and less hazardous for patients health are required.
Código: 44886
Título: CASE REPORT: COLLISION TUMOR – MENINGIOMA TO HEPATOCELLULAR CARCINOMA
Temário: Neuropatologia
Autores: Alessandra Eifler Guerra Godoy; Isnard Elman Litvin; Guilherme Portella Coelho; Marco
Antonio Eduardo Koff; Natália Diel Lisboa;
Instituição: UNIVERSIDADE DE CAXIAS DO SUL
Resumo: Introduction: Collision tumores are the junction of two distinct histological features
neoplasms in a same tumoral mass. This study reports the case of a patient with hepatocelular
metastatic carcinoma colliding to a meningioma. Case Report: JAC, masculine, 59 years, relating
incessante headache and a 5cm hemorragic peripheral lesion, evidenced by imaging exam,
suggesting the hypotesys of a meningioma. The anatomopathological findings, associated with
imunohistochemistry, are consistente with a meningioma in juxtaposition to a hepatocellular
carcinoma metastasis. The collision was an ocasional finding. Citoqueratin 18, TTF-1, HepPar1
and CD10 were positive in hepatocellular carcinoma; vimentin 9 and progesterone receptor
were positive in meningeoma. Both expressed Ki67, 5% in meningioma and 25% in the
metastasis. Discussion: The first collision tumor related was published in 1930 by Fried et al.
Since this date, only a few more than 100 cases of collision tumor in SNC were discribed, making
this diagnosis rare. Even though any neoplasm could present colliding to another, meningioma
is the most frequent, associated principally to lung and breast cancer metastasis.
Hipervascularization, slow growing rate and elevated incidence are hipotesys to meningioma as
principal occurrence. Hepatocellular carcinoma metastasis are rare in a general context and
even more on central nervous system, alone or in association. To our search, there were no
other meningeoma to hepatocellular carcinoma metastasis described in the literature.
Código: 44889
Título: CASE REPORT: DYSEMBRYIOPLASTIC NEUROEPITELIAL TUMOR
Autores: Alessandra Eifler Guerra Godoy; Isnard Elman Litvin; Guilherme Portella Coelho; Marco
Antonio Eduardo Koff; Natália Diel Lisboa;
Resumo: Report: Patient JIS, 29 years, masculine. Lesion in left temporal cerebral hemisphere,
measuring 3,8cm in it’s bigger axis. Anatomopathological diagnosis revealed a dysembryoplastic
neuroepitelial tumor (DNET), simple by the WHO classification. The Alcian Blue histochemical
tecnique was positive, revealing mucin pools. In imunohistochemistryk, CD34+ was positive in
the vessels, S100 positive, GFAP and Ki67 were positive. Discussion: The DNET was inicially
described in 1988 by Daumas-Duport et al., in young patientes with refractary seizures to
pharmacological treatment. The most frequente location is in the temporal lobe, and the
average measure is 10-25mm. They are caracterized, histologically, by the presence of
oligodrendroglia-like-cells (OLC), small and round cells which get arranged in columnar pattern,
perpendicullary to the cortical surface. Togheter, there’s presence of neurons with no cellular
atipia, separataed by mucinous matrix. The WHO 2007 classification divides DNET in simple (with
just the presence of OLC) or complex (when associated to glial nodes, nuclear atipia or
nultinuclear cells, and focal cortical dysplasia associated). Although this, many studies report the
presence of a third group, characterized as difuse, which has the presence of glial nodes and
dysplasia without OLC. The imunohistochemical analysis include CD34 and MAP2, present in
stem cells, BRAFV600 (a MAPK cascade protein) and S100 positive in OLC. Also, NeuN,
synaptophysin and GFAP. Agressiveness is measured by Ki67, generally slow (less than 1-2%).
Part of the diferential diagnosis to low-grade glioma and DNT is negativeness of IDH-1 in the last
one.
Código: 44126
Título: CLINICAL, RADIOLOGIC, AND HISTOPATHOLOGIC FINDINGS OF 4 PATIENTS WITH NEUROBEHCET’S DISEASE
Autores: Ronald R. Butendieck, Jr.; Dennis W. Dickson; Kenneth T. Calamia;
Instituição: MAYO CLINIC
Resumo: Background: Neuro-Behçet‘s disease (NBD) is a potentially devastating complication of
Behçet‘s. While there are no pathognomonic histopathologic findings in NBD, the literature
describes a mixed inflammatory infiltrate around small vessels leading to necrosis and apoptotic
neuronal loss. The role of vascular inflammation in patients with NBD is less clear. Objectives:
To describe and compare the clinical, radiologic, and histopathologic findings of four patients
with NBD who underwent brain biopsy. Methods: We identified four patients who underwent
brain biopsy during a diagnostic evaluation for subacute neurologic deficits. We evaluated their
clinical, radiologic, and histopathologic findings. Results: All patients displayed clinical
manifestations consistent with BD prior to the onset of CNS symptoms, although only one
carried a previous diagnosis of BD. Neurological manifestations included headache, aseptic
meningitis, hemiparesis, aphasia, cognitive decline, and lethargy. Imaging for each patient
demonstrated deep brain lesions. Inflammatory pseudotumors were identified in two patients,
one resulting in a subfalcine/uncal herniation and a midline shift in the other. Histopathologic
findings in each patient showed a mixed perivascular inflammatory infiltrate without vasculitis
or malignancy, but with considerable immunohistochemical heterogeneity thought to perhaps
be related to the age of the lesions. Conclusions: There is no agreed upon diagnostic test for
NBD and diagnosis ultimately remains a clinical one. If a brain biopsy is performed to exclude
malignancy, histopathologic findings may support a diagnosis of NBD in those cases where BD is
suspected or should lead to careful clinical consideration of the diagnosis when the possibility
of the disease was not considered.
Código: 44264
Título: HYBRID PERIPHERAL NERVE SHEATH TUMOR: CASE REPORT WITH ULTRASTRUCTURAL
AND IMMUNOHISTOCHEMISTRY STUDIES.
Autores: Heveline Becker de Moura; Francineide Sadala de Souza; Maria Isabel Lima; Ana
Cristina da Silva Cotta; Isabel Cristina Soraes Brandão;
Instituição: REDE SARAH DE HOSPITAIS DE REABILITAÇÃO
Resumo: Peripheral nerve sheath tumors manifesting histologic features of more than 1 cell
subtype (schwannoma, neurofibroma and perineurioma-like) within the same neoplasm have
been increasingly recognized in recent years and are called hybrid lesions. Some hybrid
schwannoma-perineurioma shows predilection for fingers and are histologically typified by an
admixture of multiple areas with the 2 cell subtypes being sharply segregated. A 30-year-old
male presented a tumor in the subcutis of the left calf that he had been aware of for 6 months.
He had good general health and unremarkable medical history. There were no signs of
neurofibromatosis. The tumor was painless, mobile on the superficial planes, without skin
changes. The MRI revealed a well-demarcated, homogeneous subcutaneous mass of the left calf
measuring 32 x 8.5 x 6.1 mm that appeared hypointense on T1 and hyperintense on T2 with
contrast enhancement. The lesion was excised completely. Grossly, the tumor was welldelimited with a nerve emerging from it’s poles and gray-withe cut surface. Histologically, it had
a fibrous capsule and cells with spindle (wavy, bipolar) to stellate morphology with a tendency
for whorled growth or fascicular pattern and collagen deposition. Tissue cracking artifacts and
nerves fascicles were also present. The immunohistochemistry demonstrated an overlapping of
S-100 and EMA expression in neoplastic cells. Neurofilament protein showed rare nerve axons
in the tumor. The ultrastructural investigation demonstrated neoplastic perineurial cells with
elongated nuclei and cytoplasmic processes with pinocytotic vesicles; and schwann cells with
slender interdigitanting cell processes, continuous linear basal lamina, fair number of organelles
and long spacing collagen in the intercelular space. Germline and somatic genetic testing of the
tumor tissue was normal. A diagnosis of hybrid schwannoma-perineurioma was rendered. No
recurrence was observed 2 years after excision. Classical, hybrid nerve sheath tumors presents
typical morphological aspects with distinc schwannoma, neurofibroma and perineurioma-like
areas. The case indicate that these neoplams can possess bidirectional schwannomatousperineural differentiation without being morphologically sharply segregated and in those
situations ultrastructural and immunohistochemistry studies are indispensable in recognizing
the tumor cell differentiation.
Código: 44249
Título: HYDROCEPHALUS DUE TO A LEPTOMENINGEAL DISSEMINATION FROM THORACIC
INTRAMEDULAR PILOCYTIC ASTROCYTOMA.
Autores: Francineide Sadala de Souza; Heveline Becker de Moura; Rogerio Cirineu Sacco;
Alessandra de La Rocque Ferreira; Altamir Monteiro Junior; Bernardo Jose Alves Ferreira
Martins; Isabel Cristina Soares Brandão;
Instituição: REDE SARAH DE HOSPITAIS DE REABILITAÇÃO
Resumo: Pilocytic Astrocytoma (PA) is a low-grade tumor associated with an excellent outcome
and long-term survival occurring predominantly in pediatric patients. Dissemination of PA to
leptomeninges is a rare phenomenon and can be associated with obstructive hydrocephalus. A
10-year-old girl presented pain in the lower back and thorax radiating to the left thigh for 7
years. The sensitivity and strength were preserved. There were no pyramidal signs. She
continued to deteriorate with an increasing of bilateral limb weakness and progressive
headache. The Magnetic Resonance Imaging (MRI) revealed intramedullary expansive lesion in
the T4-T5 plan, mainly cystic and apparently with little solid component, predominantly
affecting the right hemimedulla. Surgical resection consisted of more than 90% of the
intramedullary expansive tumor. During the tumor excision, thickened and fibrotic spinal
leptomeningeal areas were noticed, and a simultaneous biopsy was performed in order to
establish a differential diagnosis between infectious arachnoiditis and leptomeningeal
dissemination. Histological examination revealed monomorphous low-grade glial neoplasm
composed of spindle “piloid” cells. The fibrotic leptomeningeal areas were infiltrated by cells
with similar features. Mitoses and necrosis were absent. Although the absence of some PA
immunomarkers (GFAP, BRAF 1, EGFR amplification and IDH), a diagnosis of Pilocytic
Astrocytoma with leptomeningeal dissemination was done. Her disease has remained stable for
10 months. One year after surgery, she was readmitted with headaches, blurred vision, vomiting
and diplopia. MRI showed a tetraventricular hydrocephalus associated with supratentorial and
infratentorial leptomeningeal spread of the tumor. Management included Vincristine and
Carboplatin chemotherapy. The patient’s condition gradually improved except for persistent
headache. By reason of the toxicity induced by chemotherapy, she underwent to radiation
therapy. Leptomeningeal dissemination of PA is a very rare condition and the best strategies for
the management of these patients is still controversial.
Código: 44893
Título: IMMUNOHISTOCHEMICAL ANALYSIS OF THE EXPRESSION OF THE NEUROKININ TYPE I
RECEPTOR AND SUBSTANCE P IN GLIOBLASTOMAS.
Autores: Allan Dias Polverini; Ismael Augusto Silva Lombardi; Giusepe Picone Junior; Carlos
Roberto de Almeida Júnior; Gisele Carana de Almeida; Carlos Afonso Clara;
Instituição: HOSPITAL DE CÂNCER DE BARRETOS
Resumo: Introduction Neurokinin type I receptor (rNK1) and substance P (SP) expression in
various malignancies suggests role in carcinogenesis and in tumor microenvironment regulation
as well the involvement of pathways enrolled in glioblastoma (GBM) carcinogenesis. Objective
Evaluate the expression of SP and rNK1 in human glioblastomas and correlate with survival.
Methods Records of patients that underwent surgical resection of GBM between June of 2000
and December of 2013 were reviewed, 171 cases were selected. Samples were represented in
triplicates in TMA and classified into three subtypes according to biomolecular signatures.
Expression of rNK1 and SP were assessed by immunohistochemistry. Microvascular density
(MVD) was assessed through CD-34 immunohistochemestry. Data were analyzed with SPSS
software (version 20). Results Seven (4.1%) cases were IDH-1 immunoreactive and 141 (83.9%)
for EGFR. Cases were classified in subgroups: 7 (4.2%) proneural, 135 (80.4%) classical and 26
(15.5%) others. MVD obtained was lower among pro-neural tumors and higher among cases
classified as others. Seventy-two (43.1%) were SP positive, 23 (13.7%) for rNK1.
Immunoreactivity to rNK1 in PN subgroup was not observed. Significant relationship between
OS and EOR (p = 0.009), chemotherapy (p <0.001), location (p = 0.043), radiotherapy (p <0.001),
IDH-1 (p = 0.048), SP (p = 0.072) gender (p = 0.114) and age (p = 0.053). Cox regression model
revealed relative risk for SP positive cases of 1.49 (p = 0.017, 95% CI 1.07-2.07), and less than 1
for chemotherapy (p<0.001, RR 0.35, 95% CI 0.20-0.62), radiation therapy (p <0.001, RR 0.31,
95% CI: 0.22 to 0.44) and IDH- 1 (p = 0.011, RR 0.30, 95% CI: 0.12-0.76). Discussion SP and rNK1
are related to higher tumor aggressiveness. Immunohistochemical studies in large glioma series
were not found. There are reports of its the expression in malignancies such as melanoma,
pancreatic and breast cancer, with the description of transactivation of the EGFR by SP in breast
cancer. The data obtained with MVD combined to the survival data suggest less aggressive
behavior of proneural GBM, and we noted absence of rNK1 positive among these tumors. Factor
as age, EOR, adjuvant chemotherapy and radiation therapy influencing OS, and the presence of
IDH-1 mutation related to better prognosis is on concordance with previous findings and, as
suggested, SP positive cases had worse OS. Conclusion Expression of SP correlates with reduced
OS in human GBM.
Código: 44904
Título: MICROVASCULAR DENSITY IN GLIOBLASTOMA SUBTYPES
Autores: Allan Dias Polverini; Ismael Augusto Silva Lombardi; Giusepe Picone Junior; Carlos
Roberto de Almeida Júnior; Gisele Carana de Almeida; Carlos Afonso Clara;
Instituição: HOSPITAL DE CÂNCER DE BARRETOS
Resumo: Introduction Microvascular density (MVD) is related to tumor aggressive behavior and
recent studies evidenced different clinical behavior of glioblastoma subtipes. Objective Evaluate
the MVD on glioblastomas subtypes. Methods Records of patients that underwent surgical
resection of GBM between June of 2000 and December of 2013 were reviewed, 171 cases were
selected. Samples were represented in triplicates in TMA and classified into three subtypes
according to biomolecular signatures into proneural, classical and others, that include neural
and mesenchimal subtypes, through immunohistochemistry for IDH-1 (H09-Dianova, 1:200) and
EGFR (31G-7, Zymed, 1:100). Microvascular density (MVD) was assessed through CD-34
(QBend10, Dako, 1:300) immunohistochemistry. Stained vessels were counted on hotspots with
400x magnification. Average and standard deviation were calculated for each subtype. Data
were analyzed with SPSS software (version 20). Results Seven (4.1%) cases were IDH-1
immunoreactive and 141 (83.9%) for EGFR. When considered all valid cases (n=168), the average
MVD was 37.37 (±45.90), it was higher among EGFR negative cases, average 40.73 (±52.96) and
lower for IDH-1 positive cases, 26 (±14,33). Cases were classified according to biomolecular
signature: 7 (4.2%) proneural, 135 (80.4%) classical and 26 (15.5%) others subgroup. After that,
MVD was analyzed and lower average was observed among proneural cases, 26 (±14.33),
intermediate values among classical cases, 37.29(±45.85), and higher values among the others
subgroup, 41.36(±53.95). Discussion MVD is related to tumor aggressiveness and poor overall
survival rates. We observed different MVD averages between the GBM subtypes, wich
corroborates to previous findings of different clinical behavior of GBM subtypes. Cases known
for better survival rates, classified as proneural, had lowest DMV average. The highest average
and standard deviation was observed among the others subtype which included mesechimal
and neural subtypes, not discriminated in this study. Conclusion MVD may reflect GBM subtype
clinical behavior.
Código: 44882
Título: RETROSPECTIVE STUDY ANALYSING THE INCIDENCE OF CENTRAL NERVOUS SYSTEM
NEOPLASMS IN RIO GRANDE DO SUL
Autores: Alessandra Eifler Guerra Godoy; Isnard Elman Litvin; Guilherme Portela Coelho;
Francine Hehn De Oliveira; Marco Antonio Eduardo Koff; Natalia Diel Lisboa; Apio Cláudio
Martins Antunes;
Resumo: Objective: to analysis the incidence of primary and metastatic central nervous system
neoplasms based on clinical database, in regarding to type, frequency, gender and age.
Metodology: retrospective study, based on clinical database analysis of two Patology
Laboratories: one reference laboratory in Serra Gaúcha and another from a medical school
hospital in Porto Alegre, in april/2013 to january/2016 period. There were identified 449
patients diagnosed with central nervous system neoplasms by anatomopathological exam.
Results: From 449 patients analysed, 213 (47,43%) were men and 236 (52,56%) women. The
average age was 51 years, standard deviation 16,3165. The higher incidence, in the primary
neoplasms, was Glioblastoma (104 cases, 23,16%), followed by Meningiomas (98 cases, 21,82)
and Schwannomas (38 cases, 8,46%). The metastatic tumors resulted in 16,75% of all tumors (75
cases), with principal primary site lungs, followed by breast. Discussion: According to the verified
references, the most of tumors are from astrocitic classification, followed by Meningiomas,
supporting the presente study. Data from Cancer Research UK show that women are more
frequently diagnosed than men (51% to 49%). The results of our study are compatible with
international data.
Código: 44110
Título: SIMULTANEOUS DEVELOPMENT OF TWO PRIMARY DISTINCT INTRACRANIAL TUMORS IN
THE SINGLE PATIENT: CASE ILLUSTRATIONS AND REVIEW OF THE LITERATURES
Autores: Choong Hyun Kim; Jin Hwan Cheong; Jae Min Kim;
Instituição: HANYANG UNIVERSITY GURI HOSPITAL
Resumo: Objective: The concomitant development of multiple primary intracranial tumors has
been reported formerly. However, the coexistence of two pathologically different primary
tumors in the same patient has been described rarely. We present 4 patients of two primary
intracranial tumors occurring simultaneously in the same brain, and review the pertinent
literatures. Methods: We describe 4 cases with synchronous occurrence of two distinct tumors
as shown by magnetic resonance imaging (MRI) on admission. After neurosurgical removal of
mass lesions in each patients, tumor specimens were reviewed by neuropathologists. Two
patients with cavernous tumor were diagnosed by MRI findings. Results: One patient revealed a
glioblastoma in the right temporal lobe with anaplastic astrocytoma in the right frontal lobe,
2nd case confirmed a glioblastoma in the right cerebellar hemisphere with vermian
oligodendroglioma, 3rd patient had a gliosarcoma in the right frontal lobe with left cavernous
tumor, and 4th case demonstrated a anaplastic astrocytoma in the right temporal lobe
extending into corpus callosum and left cavernous meningioma. Conclusion: The simultaneous
development of the two distinct brain tumors is rare, and a randomly occurring event most likely
accounted for this linkage in the patient. We suggest that extraordinary brain edema far remote
from the primary brain lesion warrants special attention for identifying other potentially
undetected lesions. In addition, further studies by large series are required to get adequate
therapeutic strategies in these tumors. Poster presentation, only
Código: 44288
Título: ANALYSIS OF FEATURES AND SURVIVAL OF PATIENTS WITH HIGH GRADE GLIOMAS IN A
REFERENCE CENTER IN SOUTHERN BRAZIL
Temário: Oncologia
Autores: Patricia Pacheco; Fabiana Spillari Viola; Leonardo Nazario Schmidt; Paulo Ricardo
Santos Nunes Filho; Facundo Zaffaroni Caorsi;
Instituição: PUCRS
Resumo: Background: Glioblastoma is the most common primary brain tumor, with an annual
incidence of 3,19 per 100 000 in the United States. The current standard of care combines
maximal surgical resection, followed by radiotherapy with concomitant and adjuvant
temozolomide. Despite this multimodal approach, median survival is limited to 16 to 19 months,
with approximately 25% to 30% of the patients alive at 2 years after diagnosis. Methods:
Retrospective study with 82 patients with histological diagnosis of high-grade glioma
(glioblastoma, gliosarcoma , anaplastic astrocytoma, anaplastic olidodendroglioma) treated in
an Oncology Reference Center in Southern Brazil between January 2010 and December 2014.
All the patients had histologically confirmed tumor. Data collected were: age at diagnosis,
gender, histologic type, treatment performed on diagnosis and during relapse, time to relapse
and overall survival. All analyses were performed using SPSS statistical software (Version 18.0).
Results: Among 82 patients studied, 50 (61%) were male and 32 (39%) were female. Patients
from private practice were 44 ( 53.7 %) and from social public health were 38 (46.3%). Median
age of patients was 56 years and 66 ( 80.5 %) patients had glioblastoma, 6 (7.3%) anaplastic
astrocytoma , 5 (6.1%) gliossarcoma and 5 (6.1%) had anaplastic oligodendroglioma. About the
treatment performed, 15 (20.5%) patients underwent surgical treatment, 32 (43.8%) patients
underwent treatment with surgery and radiation therapy and 26 (35.6%) patients underwent
combined treatment with surgery, chemotherapy and radiotherapy. There was progression of
disease in 42 patients (60.9%). Of these, 38 (46,3%) patients underwent a second treatment.
The median overall survival was 14 months for all patients. In patients with glioblastoma,
medium survival was 11 months. Conclusions: Glioblastoma remains a difficult disease to
manage despite multiple clinical trials. Better understanding of the patient population is a
potential to implement effective treatment. Multimodal treatment is primordial for better
results.
Código: 44865
Título: APPLICATION OF DENOSUMAB IN CLIVAL GIANT CELL TUMOR
Temário: Oncologia
Autores: Washington Luiz de Oliveira; Alfredo das Neves Magalhães Fernandes; Antônio Aversa
Dutra do Souto;
Resumo: INTRODUCTION Giant cell tumour of bone (GCT) is a rare osteolytic tumour. Typically
occur in the the epiphysis of long bones, but can also occur in unusual locations as the skull
bones. Advances in therapy using monoclonal antibodies modified the approach to this tumor,
but its use in skull GCTs is not reported in the literature. The present study presents a case of
GCT in clivus and sphenoid bones who was treated successfully with denosumab. CASE REPORT
A 21 year-old female with a eight months history of headaches and bitemporal hemianopsia.
Magnetic resonance imaging (MRI) of the brain demonstrated a irregular mass involving the
clivus. The patient was submitted to two attempts for surgical ressection in another hospital
(transphenoidal and transcranial approaches). After surgeries, the patient maintained the visual
complain and developed transient hypopituitarism. Histopathology revealed a giant cell tumor
and the patient was referenced to our hospital. The patient received 13 cicles of denosumab
(120 mg administered once every 4 weeks with additional 120 mg doses on days 8 and 15 of the
first month of therapy). After the forth cicle, the patient presented resolution of headache and
visual deficit. MRI control performed seven months after the treatment start showed regression
of the tumor. The follow-up has been performed for 20 months, the patient is asymptomatic
and subsequent exams also confirmed the regression of the tumor. DISCUSSION GCT are
histologically benign tumor but it exhibits local aggressive behavior. It accounts for 4-6% of
primary tumors of the skeleton and skull cases account < 1% of bone GCT. It affects adults aged
between 20 and 50 years and has higher incidence among females. It presents with headache,
endocrinopathy and dysfunction of cranial nerves. Giant cells have increased expression of the
RANK receptor and its activation promotes osteoclast function. The monoclonal antibody
denosumab binds RANKL, preventing activation of its receptor. Before denosumab, surgical
intervention was the only definitive therapy and it was associated with significant morbidity.
Denosumab is indicated for treatment of GCT that is unresectable or where surgical resection is
likely to result in severe morbidity, but this is the first case of skull tumor treated with
denosumab. This good outcome reinforces the beneficial result of this therapy in a unusual site
and should be considered an important alternative therapy.
Código: 44729
Título: BRAIN TUMORS IN THE ELDERLY: PREVALENCE OF HISTOLOGICAL TYPE IN A
NEUROSURGERY REFERENCE HOSPITAL
Temário: Oncologia
Autores: Amauri Pereira da Silva Filho; Humberto Fernandes Veloso Neto; Isabela Carvalho de
Aquino; Keyvid dos Santos Pereira; Ronaldo Barbosa de Farias Júnior; Verônica Cavalcanti
Resumo: INTRODUCTION: Brain tumors, unlike other types of cancer, are much less frequent.
However, acquire importance due to the high numbers of functional deficits and high mortality
in relation to other cancers. Associating this fact, there is an increase in life expectancy in the
elderly, also rising the number of diagnosed cases over 60 years, which also increases the
number of cases diagnosed with metastases in the central nervous system. OBJECTIVE: The
objective is to establish prevalence of brain tumors that affect the elderly population in the city
of Campina Grande (PB). METHOD: Data were collected from medical records of patients
admitted to the neurosurgery service of Campina Grande reference hospital which were
received during the period from January 2010 to December 2015. 45 charts of patients between
60 and 81 years were analyzed, with a mean age of 66 years. RESULTS: There was a slightly
higher prevalence among women, 54.8% (n = 23), whereas in males, 45.2% (n = 22). After biopsy,
two cases were diagnosed as neurocysticercosis and 1 as arachnoid cyst, and the remainder was
neoplastic processes (primary tumor and metastases). From the neoplastic processes (n = 42),
71.4% (n = 30) were primary tumors, and 28.6% (n = 12) brain metastases. In the group of
primary tumors, GBM was the most prevalent with 31% (n = 13) and more frequent in men,
69.2% (n = 9) than in women, 30.8% (n = 3), followed by meningiomas, 11.9% (n = 5),
ependymoma, 4.8% (n = 2), low grade astrocytoma, 4.8% (n = 2), pituitary adenoma, 4.8% (n =
2) APC schwannoma, 4.8% (n = 2), non-Hodgkin‘s lymphoma, 2.4% (n = 1), oligodendroglioma,
2.4% (n = 1), craniopharyngioma, 2.4% ( n = 1) and choroid plexus papilloma, 2.4% (n = 1). Among
the metastases, the lung was the most common primary site with 41.7% (n = 5), followed by
breast cancers, 16.7% (n = 2), melanoma 16.7% (n = 2), thyroid 8.4% (n = 1), cervix, 8.4% (n = 1)
and from unknown origin, 8.4% (n = 1). CONCLUSION: The prevalence corroborate those
reported in the literature, but it is important to emphasize that the characterization of
prevalence in the study of brain tumors in the elderly in the region, serves allowance in
epidemiological research to estimate the incidence of the most common histological type.
Neurocysticercosis and arachnoid cyst cases, despite not being neoplastic processes, were
present as differential diagnoses of intracranial tumors in this population.
Código: 44890
Título: CASE REPORT: AGRESSIVE EGFR NEGATIVE LUNG ADENOCARCINOMA METASTASIZING
TO CENTRAL NERVOUS SYSTEM
Temário: Oncologia
Autores: Rita De Cassia Costamilan; Alessandra Eifler Guerra Godoy; Isnard Elman Litvin; Marco
Antonio Eduardo Koff; Natália Diel Lisboa; Marcia Flocke Cidade;
Resumo: Introduction: Cerebral metastasis of lung neoplasms are common, totalling 30-60% of
metastatic tumors of central nervous system. The most of them are from small-cells carcinoma,
but non-small cells presented 18% of incidence in patients with no prophylactic radiotherapy in
a prospective study. By mass effect, often surgical remove is necessary. The case related has the
objective to highlight the presence of metastatic lung adenocarcinoma in young patients. Case
Report: JSO, 37 years, feminine, non-smoker. Reports that 1 year ago started with sporadic
dizziness, visual scotomas and headache. These symptoms got worse 3 moths ago and even
worse +- 2 weeks, when, headache got insupportable and she lost visual field. Also, slight
dyspnea and thoracic pain left decubitus. In neurological examination, homonymous
hemoanopia. Computerized tomography revealed 3 nodes, the larger measuring 3,5x2,5cm in
occipital lobe, and the other two in cerebellum and basal ganglia. The patient was submitted to
occipital craniothomy with total lesion ressection. The anatomopathological examination
diagnosed an adenocarcinoma metastasis, with primary site lung, subtype acinar. EGFR
rearrangment search resulted negative. Patient died 4 months after diagnosis, in the second
chemotherapy cicle based on platine. Discussion: The lung adenocarcinoma has occurrence
characteristics in non-smokers, frequently young patients. It’s pattern includes many subtypes,
according to the new classification published in 2015. The patient’s acinar pattern presentes
negativity to EGFR and positivity to ALK rearrangment. In imunohistochemistry, TTF-1 and MUC
2,5,6 are positive. The impossibility to use thyrosine kinase inibitors reduce survival, and the
surgery is indicated besides systemic disease to paliate the symptoms of nervous tissue
compression. The rapid evolution to death demonstrate the agressiveness of the neoplasm.
Código: 44858
Título: CEREBRAL METASTASIS FROM TESTICULAR TUMOR : A CASE REPORT
Temário: Oncologia
Victor Guilherme Batistela Pereira; Barbara Itimura; Nicolas Pivoto; Celia Almeida Jorge; Mariana
Araujo Cavallaro; Marcio Francisco Lehmann; Tomas Catao Monte Raso; Felipe Inacio Ferreira
da Silva; Alexandre Casagrande Canheu; Karen Barros Parron Fernandes; Lorraine Alves de
Souza; Paulo Henrique Pires de Aguiar;
Resumo: Introduction: Cerebral metastasis from urological sites are unusual, and testicular
origins one of the less common, when only urological primary sites are observed. About
testicular tumors, the non-seminoma tumors are frequently associated to send metastasis from
hematogenic route to the brain, where the junction zone between the white brain and the gray
brain is the most common site. The manifestations are intensive headaches, vomits, focal
neurological signs and the magnetic resonance with gadolinium of the encephalon is the exam
of choice to evaluate the suspected damages. The treatment may be individualized and based
on the service experience, clinical picture and it can vary from radiotherapy and chemotherapy
to radiotherapy and chemotherapy associated or not to surgery. Objective: In front of a rare
case of cerebral metastasis, showing a report of a case and use them as source to a brief
literature review about the theme. Clinical Case:28 year old patient , previously diagnosed with
a mixed neoplasia constituted by immature teratoma and seminoma in the right testicular
region, with synchronic and metastatic damages in lungs, liver submitted to a radical
orquiectomy on the right and posterior chemotherapy cicles. About six months after the end of
the chemotherapy, the patient evolved with headache and right hemiparesis. Skull computed
tomography is performed, showing parietal nodular damage on the left and presence of
extensive edema. Magnetic resonance showing expansive frontotemporoparietal damage on
the left with midline deviation. The interdisciplinary teams chose (observing that the patient has
multiple metastasis including the cerebral one) palliative treatment with death as clinical
outcome, one month after the neurological condition.. Conclusion:Testicular site as primary
origin to cerebral metastasis reveled to be infrequent and must be suspected in patients
previously diagnosed with testicular tumors and with neurological symptoms. The metastasis is
confirmed by imaging methods and the conduct based in the individuality of each situation
Código: 44861
Título: CERVICAL SPINAL CORD COMPRESSION SECONDARY TO LEUKEMIA: A CASE REPORT
Temário: Oncologia
Cavallaro; Nicolas Pivoto; Marcio Francisco Lehmann; Tomas Catao Monte Raso; Felipe Inacio
Ferreira da Silva; Alexandre Casagrande Canheu; Paulo Henrique Pires de Aguiar;
Resumo: INTRODUCTION: Spinal cord compression commonly manifests as secondary to tumors
located in the lung, prostate, kidney or hematopoietic tissue, being the spine the most common
spot of bone metastases, usually through the blood and males are the most affected. Spinal
cervical region proves to be less affected. Signs and symptoms present progressively by like,
being the localized pain and radicular type the most common ones. Motor déficits are indicative
to a worse prognosis. The curative treatment should occur early and can be used the radio or
chemotherapy, although is more common set with palliative intent. The life expectancy of these
patients varies in the literature in 2.5 to 6.5 months. OBJECTIVE: To provide, from case report of
spinal cord compression secondary leukemia, a rare event, a brief literature review on the topic.
CASE REPORT: Male patient, 25 years with previous diagnosis of leukemia receiving
chemotherapy seeks emergency room with cervicobrachialgia frame in the right upper limb
associated with paresthesia and loss of strength in the same member. Performed MRI cervical
spine which shows body destruction of the fifth cervical vertebra and intra spinal and spinal cord
compression. Patient submitted to emergency surgery for decompression of the spinal canal
associated with C5 corpectomy with placement of the CAGE and plate previously. Anatomic
pathology suggesting bone cyst. Material sent to immunohistochemistry with evidence of
cytoplasmic inclusions and CD43 +. CONCLUSION: Spinal cord compression secondary to
hematopoietic tissue neoplasms may present rare and belatedly. When present, the majority of
the time, confers a worse prognosis by association with the advanced development of the
primary neoplasm.
Código: 44867
Título: CLINICAL EVOLUTION OF GLIOBLASTOMA MULTIFORME IN THALAMUS LEFT
Temário: Oncologia
Autores: Barbara Andrade de Oliveira; Bárbara Elias Prado; Eliseu dos Santos Costa;
Instituição: ITPAC
Resumo: INTRODUCTION: The glioblastoma multiforme(GBM) is the most common primary
intracranial tumor and with a higher degree of malignancy. It mainly affects the cerebral
hemispheres, prevailing in the left hemisphere. The clinical history of the disease in most cases
is less than 3 months and presents estimated survival of 50 weeks. The pacientes may presente
headache, convulsion, cognitive changes or of unespecific personalities and focal neurological
signs. There are five independent predictors of survival related to the GBM, these are age, KPS,
the extension of tumor resection, the degree of necrosis and underling of GBM in in
preoperative imaging. The prognosis is poor and less than 20% survive for more than a year.
OBJECTIVE: Report and compare with the literature the clinical outcome of a case of
Glioblastoma Multiforme thalamus left. METHODOLOGY: The informations were obtained
through analysis of medical records, interview with the accompanying patient and research
articles database. RESULTS: MGJ, 59 years old, male sex. Patient had headache associated with
intense recent memory deficits and apathy. Performed imaging exam, magnetic ressonance
imaging, wich showed cortico / subcortical signal changes with expansive effect with features
Non-specific primary glial neoplasm of the central nervous system. The expansive / infiltrative
lesion with heterogeneous enhancement, about 3,7 x 2,9 cm, delimited area of liquefactive
necrosis in the central portion, centered in the left thalamus, promoting a reduction in the
amplitude of the third ventricle and cistern retropulvinar. The patient was referred for
stereotactic biopsy. After the procedure evolved with right hemiplegia, hemiparesis left, afasia
and KPS 40%. CONCLUSION: The MRI with contrast is the imaging method of choice for diagnosis,
local staging and post-treatment evaluation. The therapeutic approaches range from a biopsy,
stereotactic biopsy, clinical observation to surgical removal. In the case reported the tumor
topographic difficulty took the option of stereotactic biopsy. The non-resected GBM added to
the KPS of 40%, advanced age, high degree of necrosis and the enhancement found in cranial
tomography and magnetic resonance imaging are poor prognostic indications for the patient,
following with palliative clinical support.
Código: 44732
Título: COMPUTATIONAL SYSTEM FOR IMPROVING MULTIDISCIPLINARY TEAM MEETINGS
Temário: Oncologia
Autores: Ricardo da Silva Santos; Suzana Maria Fleury Malheiros; Sérgio Cavalheiro; Manoel
Antonio de Paiva Neto; Ana Lucia Mello de Carvalho; José Maria Parente de Oliveira;
Instituição: INSTITUTO TECNOLÓGICO DE AERONÁUTICA (ITA)
Resumo: Introduction: The treatment of brain tumors may be extremely complex.
Multidisciplinary meetings (MDM) to discuss and plan the best treatment options have been
increasingly used as a strategy to overcome these difficulties. Some studies show that many
barriers may impair the success of these meetings, two in particular: lack of information and
inadequate presentation of the available data. Goal: Develop a computational system to record
the MDM and yield statistic information to support therapeutic decisions. The system premise
is to provide essential information for treatment planning and the adequate presentation of this
information to the team. Methods: The research group attended the multidisciplinary meetings
at Hospital São Paulo - Department of Neurosurgery during three months in order to understand
the routine of hospital service and identify the particularities of MDM. Based on this
requirements, the software was designed with the following components: an integrator for
electronic patient record; software components to store clinical evaluations; case discussion and
treatment plan; a module to present a whole view of the case; and a module to yield statistic
information. The system evaluation was done by monitoring it use in Neuro-oncology
Departments of two public hospitals: HSP and HSPE. Results: The evaluation of the system
focused on utility and usability. Two technologists actively recorded 1,135 cases discussed in
MDM, evaluating some metrics system such as response time, system learning curve, and
sufficiency of information for patient follow-up and treatment planning. Despite some
difficulties related to system implantation, the results showed relevant benefits in the process
of treatment planning and patient follow-up with the software support. The system was used as
support tool for patient follow-up by 75% of recorded cases and as support for treatment plan
by 25%. According to 95,84% of team members, the SATTC provide sufficient information in both
situations and show the data in an appropriate manner. Conclusion: The project achieved the
goal of developing a computer system to record the MDM and provide essential information for
treatment planning, showing this information to the multidisciplinary team in an appropriate
manner. As future work we intend to expand the system to other types of tumors.
Código: 44857
Título: DIFFERENCES BETWEEN PARANEOPLASTIC LIMBIC ENCEPHALITIS AND RADIO-INDUCED
DEMENTIA
Temário: Oncologia
Cavallaro; Nicolas Pivoto; Karen Barros Parron Fernandes; Tomas Catâo Monte Raso; Marcio
Francisco Lehmann; Paulo Henrique Pires de Aguiar;
Resumo: INTRODUCTION: Dementias are characterized by an impairment of the cognitive,
behavioral, psychological or motor pattern in varying combinations and intensities. One quick
and detailed investigation is essential because of the possibility to find reversible causes of this
syndrome. Etiologically, the causes can be neurodegenerative, immune-mediated, vascular,
infectious, metabolic, toxic, secondary to tumors or psychogenic. In the case of limbic
encephalitis, from an autoimmune cause, mostly occurs because of the paraneoplastic effect,
and the dementia usually precedes the diagnosis of cancer. For the correct diagnosis, it is used
magnetic resonance and onconeurals antibody research in liquor. The radioinduced dementia
that occurs because of toxic effects, is developed as similar as encephalopathy with significant
cognitive impairment. There are characteristic changes on imaging exams in that
encephalopathy, that differentiates it from other causes beyond the prior history of radiation.
PURPOSE: Perform analysis of dementia patterns that are caused by autoimmune causes and
those whose etiology occurs because of toxic effects, showing the clinical similarities and the
differences in supplementary exams. METHODS: It was conducted a search in databases LILACS
and PUBMED platform with filter for topics of rapidly progressive dementias with main focus in
the limbic encephalitis and in the radioinduced dementia, with the purpose of showing
similarities and differences between these pathologies. CONCLUSION: The demential syndromes
defined as progressive changes in mental faculties require a quick and precise etiologic research,
being a challenge for the doctors. Even if the cause of dementia is reversible or if it needs a brain
biopsy, these causes should be organized in the clinical experience of the medical professionals,
among these the dementia by limbic encephalitis and the radioinduced dementia are unusual
causes and occurs by different etiologies.
Código: 44771
Título: ESTUDO COMPARATIVO ENTRE ANTI-ANGIOGÊNESE E IMUNOTERAPIA COM O USO DE
CÉLULAS DENDRÍTICAS NA RECIDIVA DE GLIOBLASTOMA MULTIFORME: REVISÃO DA
LITERATURA
Temário: Oncologia
Autores: Marcos Antônio Martins dos Santos Junior; Olavo Feher; Fabricio Goecking Avelar;
Instituição: HOSPITAL UNIVERSITÁRIO ALZIRA VELANO
Resumo: O Glioblastoma Multiforme continua sendo um grande desafio. Mesmo com
tratamento agressivo o prognóstico dos pacientes com essa patologia continua sombrio, com
uma sobrevida global média inferior a 15 meses. Enquanto tratamento de primeira linha parece
estar bem consolidado, as opções terapêuticas atuais são pouco efetivas quando ocorre a
recidiva tumoral. A proposta desse trabalho foi realizar uma meta-análise comparando a Terapia
Anti-Angiogênica com Bevacizumabe e a Imunoterapia baseada em Células Dendríticas, em
termos de sobrevida global e toxicidade. Realizei uma busca nas Bases de Dados do Pubmed e
Lillacs através de [MeSH] terms e Decs, respectivamente. Selecionei artigos com características
de estudos clínicos, estudos retrospectivos e séries de casos que incluíram pacientes tratados
após recidiva tumoral de Glioblastomas , com Bevacizumabe ou Vacinas Baseadas em Células
Dendríticas (VBCD) e que possuíam dados referentes a sobrevida global e
toxicidade/tolerabilidade. Um total de 23 estudos com Bevacizumabe, incluindo 1029 pacientes
e de 9 estudos com VBCD, incluindo 144 foram selecionados. A sobrevida global média foi de
9,01 meses para os pacientes submetidos a tratamento com Bevacizumabe [ I.C. 95% - 8.877031
a 9.143377], e de 14,66 meses para os pacientes tratados com protocolos de VBCD [ I.C. 95% 13.54691 a 15.77632]. A toxicidade foi, em média, de 15,27% para os pacientes tratados com
Bevacizumabe [I.C 95% - 14.73721 a 15.81562], e de 1,80% para os pacientes tratados com VBCD
[1.278073, 2.321927} . A análise estatística comparativa mostrou com 95% de confiança que, os
pacientes tratados com VBCD tem uma sobrevida global de 5,56 meses superior e um toxicidade
13,47% menor do que os pacientes tratados com Bevacizumabe. Concluimos que, o tratamento
na recidiva tumoral de Glioblastoma Multiforme com uso de VBCD tem sobrevida global maior
com menor toxicidade quando comparado com uso de terapia anti-angiogênica com
Bevacizumabe.
Código: 44862
Título: GLIOBLASTOMA MULTIFORME IN PREGNANCY: A CASE REPORT
Temário: Oncologia
Victor Guilherme Batistela Pereira; Nicolas Pivoto; Barbara Itimura; Celia Almeida Jorge; Mariana
Araujo Cavallaro; Karen Barros Parron Fernandes; Felipe Inacio Ferreira da Silva; Tomas Catao
Monte Raso; Marcio Francisco Lehmann; Alexandre Casagrande Canheu; Paulo Henrique Pires
de Aguiar;
Resumo: INTRODUCTION: It is rare the correlation between brain tumors and pregnancy, but
when associated it tends to occur in the second half of pregnancy. In the gravidarum physiology
occurs hypervascularization and tissue edema which influences in the development of brain
tumors. The trend in the concomitance between brain tumors and pregnancy is that the most
agressive, such as glioblastoma multiforme, have faster neoplastic growth. Clinically, they
manifest by extending the period of nausea, vomiting, headache or focal neurologic signs, which
are less common. In a suspected case, imaging tests must be ordered and the medical
management should be planned by the obstetrician in association with the neurosurgeon.
OBJECTIVE: Describe a case report of an uncommon neurological disease in pregnant women
and from this precedent, demonstrate the investigation and medical management of the case
and, finally, perform a short review in the medical literature. CASE REPORT: Pregnant woman,
G2 P1, 23 years old, 36 weeks of gestation goes to the emergency department complaining
about a strong headache followed by a low level of consciousness. In the physical examination,
GCS = 4, anisocoria with right mydriasis. It was requested cranial CT scan that showed up a rightfrontoparietal injury, which was causing mass effect and perilesional edema.Than, the pacient
was subjected to a cranial magnetic resonance test, which showed up a lesion contrastattractive by the edges, underled, and hot perfusion. It was indicated an emergency surgery for
tumoral resection and the placement of a cranial catheter for monitorating the intracranial
pressure during the cesarea surgery. During the postoperative period, the pacient regained
neurological function and in seven days she received hospital discharge. Glioblastoma was
confirmed in the anatomic-pathological exam. The patient was referred to oncology
department, and in the tenth day after surgery she returns with new lowering of the level of
consciousness and a new cranial CT evidences of new brain edema. The patient underwent a
decompressive hemicraniectomy, which had refractory cerebral edema and the pacient died six
weeks later. CONCLUSION: Although rare, brain tumors during pregnancy must be searched,
specially in patients who develops extended periods (beyond the physiological period) of nausea
and vomiting, progressive headache or onset of focal neurological signs.
Código: 44845
Título: GLIOBLASTOMA MULTIFORME: A RARE CLINICAL CASE WITH LONG SURVIVAL
Temário: Oncologia
Autores: Sara Cerqueira Alves; Joaquna Maurício;
Instituição: INSTITUTO PORTUGUÊS DE ONCOLOGIA - PORTO
Resumo: Glioblastoma multiforme is a malignant tumor with an aggressive behavior and is the
most mortal brain tumor. The median survival rounds 15 months. The authors describes a
women with 62 years old, that in April of 2006 developed headache, dizziness and hypertension
and was studied with a brain magnetic resonance imaging (MRI). The exam revealed at left
temporo-occipital level an expansive/invasive process, with 45 millimeters in de main diameter,
and with edema associated. She was submitted to a left temporal craniotomy in May of 2006
with all macroscopic mass removed. The histology described a malignant tumor with compatible
characteristics with glioblastoma. She did treatment with chemotherapy (QT) with
temozolamide (TMZ) administered concomitantly with radiotherapy until July of 2006. Followed
by TMZ adjuvant with good tolerance, in a total of 9 cycles. She is in follow-up evaluation since
June of 2007. Brain MRI’s of the follow-up don’t show tumor recurrence and the patient is
clinically well. In this cases surgery should remove as much as possible the tumor, followed by
chemoradiation and adjuvant QT. This is being considered the standard of care in patients with
less than 70 years old, because there is evidence showing survival benefit. Having less than 50
years old, removing almost of the tumor, the treatment with QT, a better Karnofsky
performance score, the mutation in IDH1 genes and MGMT methylation are associated with
longer survival. However, much remains unknown about why some patients survive longer with
glioblastoma.
Código: 44111
Título: IMMUNOTHERAPY OF GLIOBLASTOMAS USING CYTOKINE-INDUCED KILLER CELLS AND
CONCOMITANT CHEMORADIOTHEPAY WITH TEMOZOLOMIDE: TWO CASES REPORT
Temário: Oncologia
Autores: Choong Hyun Kim; Jae Min Kim; Jin Hwan Cheong;
Instituição: HANYANG UNIVERSITY GURI HOSPITAL
Resumo: Objectives: Although significant advances have been made in surgical techniques,
chemotherapy, and radiotherapy for glioma patients, glioblastoma (GBM) continues to have a
dismal prognosis. Therefore, novel therapeutic approaches should be required to manage
GBMs. Cytokine-induced killer (CIK) cell Immunotherapy is an attractive therapeutic option for
GBMs because of its potential to selectively target residual tumor cells, while sparing normal
brain. Methods: We tried CIK cell immunotherapy combined with standard concomitant
chemoradiotherapy with temozolomide (CCRT) following surgical resection in 2 GBM patients.
Results: The first patient was a 42-year-old female, who has been well-responded without local
recurrence at 6 months after multimodal therapy. However, the second patient had a poor
response to immunotherapy and CCRT. Conclusion: There are many types of adoptive
immunotherapy using dendritic cells or T cells for management of GBMs. Even though, its
efficacy remains unclear, adoptive transfer of CIK cells with additional CCRT may be another
option for therapeutic challenge of GBM. We also need a large sized-clinical trial to verify its
therapeutic efficacy in GBM patients. Poster presentation, only
Código: 44661
Título: INTRACRANIAL HEMORRHAGE BY ACRAL LENTIGINOUS MELANOMA METASTASIS
Temário: Oncologia
Autores: Barbara Andrade de Oliveira; Bárbara Elias Prado; Eliseu dos Santos Costa;
Instituição: ITPAC
Resumo: INTRODUCTION: Malignant melanoma is a kind of skin tumor that has big metastasis
capacity. In malignat melanoma’s variety, the acral lentiginous has the worst prognosis and
corresponds to between 5 and 10% of variants. The intracranial hemorrhage caused by
neoplasms happens in only 10% of cases of cerebral hemorrhage and malignat melanoma is the
main cause. OBJECTIVE: Report and compare with literature a case of intracranial hemorrhage
by brain metastasis of acral lentiginous malignat melanoma in elderly patient. METHODOLOGY:
Informations were obtained by means of retrospective with analysis of medical records,
interview with person accompanying and extensive literature review. RESULTS: 71 years old
patient, male sex, presented lesion of acral lentiginous malignant melanoma in the plantar
region of the right foot. The patient developed metastasis in the right inguinal lymph node and
posteriorly developed systemic disease progression with multiple brain metástases, presenting
symptology of constant headache. Subsequently occurred intracranial hemorrhage of injuries
and left hemiplegia. Patient remains in a coma and systemic disease progression. DISCUSSION:
The variant of acral lentiginous melanoma in vertical growth stage, as in the case reported, has
the worst prognosis, the biggest risk of metastasis and hemorrhage secondary to intracranial
metastasis as in literature. Although the first symptom of intracranial metastases of malignant
melanoma is usually hemorrhage and in the case reported was headache. CONCLUSION: The
treatment of intracranial hemorrhage caused by malignant melanoma metástases is still
controversial and has no cure, only an increase in patient survival time. The skull computed
tomography is the preferred method, it shows more precisely the location and usually the nature
of the injury.
Código: 44178
Título: INTRASPINAL PRIMITIVE NEUROECTODERMAL TUMOR: CASE SERIES AND RELEVANT
ASPECTS
Temário: Oncologia
Autores: Vinicius Ricieri Ferraz; João Luiz Vitorino-Araújo; Vinicius Monteiro de Paula Guirado;
Flavio Key Miura; Renan Maximilian Lovato; Aline Lariessy Campos Paiva; Jefferson Walter
Daniel; José Carlos Esteves Veiga;
Resumo: Introduction Primitive neuroectodermal tumors (PNETs) arise in a unique cell of origin
in different parts of the CNS, and each is recognizable by a distinctive pattern of differentiation.
The PNET concept was originally applied to tumors arising in the central nervous system (CNS),
which were termed central PNETs. The concept was later expanded to include non-CNS tumors
derived from the neural crest, which were referred to as peripheral PNETs. PNETs can also arise
in the pineal gland, cerebrum, brainstem, and peripheral nerves. Primary spinal localizations are
rare. PNETs are aggressive neoplasms that are usually diagnosed in children and young adults,
with a peak incidence in the second decade and a slight male preponderance. These tumors
make differential diagnosis: malignant meningioma, rhabdomyosarcoma, neuroblastoma and
lymphoma. All over the world there are few studies that focus on the specific features of PNETs,
thus the studies could not identify the prognostics factors of spinal PNETs. Due to small number
of patients and the heterogeneity of treatments, case series can contribute to a better
understanding of the disease. Objectives We aimed for this study is to increase awareness on
the specific features of intraspinal primitive neuroectodermal tumor in our environment while
highlighting the local epidemiology and management of these tumors. Methods This was a
retrospective study carried out at a tertiary care hospital of the city of São Paulo, Brazil, over a
period of 8 years. Between 2007 and 2015, a total of 5 patients with intraspinal PNETs were
operated, approval for the study was obtained from the Human Research Ethics Committee.
Results During the 8 years study period, 5 patients had histologically confirmed intraspinal
PNETs. The majority of our patients were females, having between 3 and 22 years of age. Taking
into account the PNETs location in our case series it appeared: lumbar spine PNETs (2/40%),
lumbosacral (1/20%) and cervical spine (2/40%). In four patients the intra vertebral component
were completely removed and arthrodesis was performed , in one patient a biopsy was carried
out. Conclusion Due to rarity of this disease and the lack of specific prospective studies, multi
center case series could help future researches and could have important role on revealing the
prognostic factors and therefore providing the scientific neurooncology community a better
treatment and management of spinal PNETs.
Código: 44281
Título: INVASIVE GLIOMA IN LATERAL VENTRICLE POSTERIOR HORN RIGHT: CASE REPORT.
Temário: Oncologia
Autores: Bárbara Andrade de Oliveira; Bárbara Elias Prado; Gustavo Carvalho Viveiros; Renato
Miranda Ramalho Filho;
Instituição: ITPAC ARAGUAINA TO
Resumo: INTRODUCTION: Gliomas are tumors that affect the brain injury glial cells, among these
the most affected are the astrocytes. This type of cancer is about 80% of the tumors in adults,
which may occur in the cerebral hemispheres, cerebellum, brain stem or spinal cord, and its
higher incidence of fourth to sixth decade of life. Seizures, headache and focal neurologic deficits
are among the main symptomatology of patients with glioma. OBJECTIVE: To report and
compare with literature and case invasive glioma in the right lateral ventricle in the posterior
horn in elderly patients, in order to emphasize its symptomatic profile and pathology.
METHODS: A retrospective study of medical records data analysis and interview with the escort.
Made literature review from selected items in SciElo and NCBI platforms. RESULT: Male patient
70 years hospitalized with level of consciousness of relegation frame, aphasia, headache,
deviation from the corner of the mouth, motor deficit left. Submitted examining CT scan was
evidenced suggestive hypodense mass lesion of invasive glioma paratalamic right with areas of
cerebral edema. After 48 days of hospitalization was held partial excision surgery of deep tumor.
DISCUSSION: brain gliomas are the most common primary tumors in the CNS and among the
most common symptoms are seizures, headache, loss of memory and changes in behavior. The
patient‘s history is compatible with the discussed symptoms combining with literature data. In
addition, data from radiological studies described in the literature as poorly defined mass with
heterogeneous signal intensity on all sequences, cystic / necrotic areas, with uneven walls and
heterogeneous contrast uptake present these findings in the analyzed patient. CONCLUSION:
Although the surgical removal of part deep tumor, gliomas have poor prognosis. Also the
patient‘s tumor is considered rare due to its location in the lateral ventricle posterior horn with
necrotic areas corpus callosum.
Código: 44860
Título: IS THERE ANY PROGNOSTIC VALUE OF P53 STATUS IN PEDIATRIC MEDULLOBLASTOMA?
Temário: Oncologia
Autores: Natalia M T F Borges; Andréa Maria Cappellano; Maria Teresa Seixas Alves; Sergio
Cavalheiro; Patricia D‘astoli; Daniela Barbosa; Nasjla Saba da Silva;
Instituição: IOP/GRAACC/UNIFESP
Resumo: Introduction: Currently medulloblastomas are stratifying according Chang’s criteria,
histological and biological evaluation. In this context, desmoplastic/nodular medulloblastoma
(DNMB) and SHH molecular subtype seems to have a better prognosis in children <3-5 years.
However, some of these patients caring a TP53 mutation seem to have a dismal outcome.
Objective: To describe a single institution treatment of children with DNMB ≤5 years of age and
their outcome correlating with p53 status. Methods: Retrospective review from medical records
and p53 protein analysis performed by immunohistochemistry. Results: Twenty-four children
with DNMB were admitted between 2008 and 2015, 14 (58%) of them with a mean age of 2
years. Seven patients were R0M0, 4 R+M0, 2 R+M+ and 1 R0M+. Seven (53%) patients
underwent 3 cycles of modifying HIT-SKK protocol and 7(46%) were submitted to Head Start or
Baby POG protocols, 2 of them admitted after relapse. The p53 protein was performed in 12
patients: Four had p53≥50% (2 died of progressive disease (PD), 1 after PD underwent ABMT
and is off treatment (OT), 1 in treatment); three had p53<50% (2 OT, 1 died of toxicity), 2 with
qualitative (+)p53 (1 died PD, 1 OT) and 1 (-)p53 (OT). Two patients had originally (-)p53 and
relapsed as (+)p53, one with disseminated disease and Gorlin Syndrome relapsed after ABMT
currently in other protocol and the other showed local relapse, underwent ABMT, 23.4Gy
craniospinal irradiation and is OT. The overall survival in 3 and 5 years for the all group was
63.5%. Conclusion: Despite the small sample, P53 protein seems to be a possible marker of
prognosis in the DNMB group as TP53 has been shown, since the worst outcomes were related
to p53 positivity (mostly ≥ 50%). Therefore combining p53 with other markers may guide better
treatment stratification.
Código: 44826
Título: LIPID NANOPARTICLES IN GLIOBLASTOMAS
Temário: Oncologia
Autores: Edmundo Luís Rodrigues Pereira; Rommel Mário Rodriguez Burbano; Daniella Brito
Rodrigues; Walace Gomes Leal; Raul Cavalcante Maranhão;
Instituição: UNIVERSIDADE FEDERAL DO PARÁ
Resumo: O glioblastoma (GBM) é a principal neoplasia maligna do cérebro adulto e uma das
formas mais agressivas de câncer humano, com grande resistência ao tratamento multimodal
empregando cirurgia e quimioradioterapia. Essa peculiar resposta a terapêutica se mostra
praticamente inalterada nos últimos 20 anos, e se deve, em parte, às propriedades biológicas
do tumor, que é dotado de impressionante cinética proliferativa e grande poder para infiltrar
áreas cerebrais dotadas de funções eloquentes. Tais características são reforçadas ainda por
capacidade de selecionar clones com resistência adquirida à radiação e aos agentes
quimioterápicos disponíveis, além da presença da Barreira Hemato-encefálica (BHE), que
restringe o acesso de substâncias ao SNC, limitando sobremaneira o efeito das drogas citotóxicas
disponíveis. Nos últimos anos, surgiram várias estratégias para melhorar esse panorama
adverso, algumas com resultados muito promissores. Uma dessas estratégias diz respeito ao uso
da nanotecnologia, uma nova ciência que utiliza partículas biocompatíveis em dimensões
próximas a átomos, momento em que a matéria passa a apresentar propriedades distintas
daquelas conhecidas em seu correspondente macroscópico, como maior difusibilidade, por
exemplo. Isso possibilita combinar substâncias terapêuticas conhecidas (Carmustina,
Temozolomida, Paclitaxel) para serem distribuídas com maior eficiência até o interior da
neoplasia, acarretando um mínimo efeito tóxico. O presente trabalho apresenta um resumo das
principais partículas lipídicas empregadas como veículos para diagnosticar e tratar o GBM,
demonstrando ainda experimento avaliando a biodisponibilidade de nanopartícula Lipídica no
cérebro de ratos Wistar
Código: 44783
Título: LIVER INJURY INDUCED BY TEMOZOLOMIDE
Temário: Oncologia
Autores: Camila Valadares Santana Recch; Bruna Gabriel Heinen; Igor Alexandre Protzener
Morbeck;
Instituição: UNIVERSIDADE CATÓLICA DE BRASÍLIA
Resumo: Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults
and the combination of radiotherapy with an oral alkylating agent temozolomide (TMZ) is
standard of care in adjuvant setting. This treatment has demonstrated improvement in overall
survival (OS) in comparison with radiotherapy alone. However, the use of TMZ increases some
hematologics adverse events such as anemia, trombocytopenia and lymphopenia. Nonhematologic side effects are mainly fatigue, nausea and vomiting occurring in approximately in
1/3 of patients. The hepatotoxicity related to TMZ is rare, potentially fatal and was not reported
in the pivotal phase III study. Objective Report a well-documented clinical case of severe liver
injury induced by Temozolomide after the induction phase of treatment. Methods Medical
records, laboratory, liver biopsy and imaging tests performed by the patient. Literature review
on databases Pubmed, LILACS, MedLINE and SciELO in published articles in the last 10 years
through keywords: toxicity, temozolomide, cholestatic hepatites temozolomide, gliobastoma
multiforme. Case report E.P.G, female, 58 years old, with finding of intra-axial mass lesion in the
left parietal and temporal lobes. Underwent craniotomy on 05/24/2014 with complete
macroscopic resection and with anatomic-pathologic finding confirmed diagnosis of GBM.
Treated with adjuvant radiotherapy in combination of temozolomide at the dose of 75mg / m2.
After 12 days of completion the induction treatment, the patient developed jaundice cholestatic
pattern associated with severe liver injury. Liver biopsy confirmed diagnosis of hepatitis drugrelated. Results The hepatotoxicity related to TMZ has been well reported when used in
monotherapy during the maintenance phase (150-200mg/m2 for five days each 28 days). Our
objective is to report a severe liver injury case due the use of temozolomide during induction
phase and sustained after drug suspension. Few cases were reported for this type of potentially
fatal adverse event and most of them were reversed with discontinuation of the TMZ.
Conclusion Despite being well tolerated, the use of TMZ requires careful monitoring of clinical
and laboratory parameters, especially the liver function. Dose reductions and discontinuation of
treatment, should be considered in those cases of liver damaged.
Código: 44287
Título: LOW GRADE GLIOMAS IN ADULTS: AN EPIDEMIOLOGICAL PROFILE
Temário: Oncologia
Autores: Patricia Pacheco; Fabiana Spillari Viola; Paulo Ricardo Santos Nunes Filho; Leonardo
Nazario Schmidt; Caroline Albuquerque Moreira da Silva;
Instituição: PUCRS
Resumo: Background Gliomas accounted for 45% of all these primary CNS tumors. Low grade
gliomas (LGG) correspond 8 to 15% of gliomas in adults. Most patients with LGG present
between the second and fourth decades of life and can progress to malignant gliomas with time.
Malignant transformation described in literature varies from 49 to 86%, with a medium period
of 3,7 to 7,5 years. Methods: Retrospective study with 78 patients with histological diagnosis of
low-grade glioma (astrocytoma, oligodendroglioma, oligoastrocytoma) treated in an Oncology
Reference Center in Southern Brazil between January 2010 and December 2014. All the patients
had histologically confirmed tumor. Data collected were: age at diagnosis, gender, histologically
type, treatment performed on diagnosis and during relapse and incidence of malignant
transformation. All analyses were performed using SPSS statistical software (Version 18.0).
Results: Among 78 patients studied, 41 (53%) were female and 37 (47%) were male. Patients
from private practice were 41 (53%) and from social public health were 37 (47%). Median age of
patients was 34,5 years and 56 (72%) patients had astrocytoma, 10 (13%) oligodendroglioma, 7
(9%) oligoastrocytom, and 5 (6%) had pilocytic astrocytoma. About the treatment performed,
57 (73%) patients underwent surgical treatment, 11 (14%) patients underwent treatment with
surgery and radiation therapy and 4 (5%) patients underwent combined treatment with surgery,
chemotherapy and radiotherapy. There was a second treatment in 14 patients (18%) and
malignant transformation in 8 (10%) patients. Conclusion Low-grade gliomas represent a
heterogeneous group of tumors with diverse presentations, radiographic and surgical
appearances and prognoses. The treatment of LGG envolves resection, radiation therapy (RT),
or chemotherapy, based on factors including age, performance status, location of tumor, and
patient preference.
Código: 44856
Título: PRIMITIVE NEUROECTODERMAL TUMORS OF THE BRAINSTEM: REPORT FROM A SINGLE
INSTITUTION.
Temário: Oncologia
Autores: Mariana Dórea P. Cunha; Andréa M Cappellano; Sergio Cavalheiro; Patricia D‘astoli;
Daniela Barbosa; Maria Tereza Seixas Alves; Nasjla Saba da Silva;
Resumo: Introduction: Diffuse brainstem tumors are frequent in children accounting for
approximately 10-20% of all pediatric central nervous system (CNS) tumors having gliomas as
the main diagnosis. However, although rare, primitive neuroectodermal tumors (PNET) and
atypical teratoid/rhabdoid tumors also may affect the brainstem. Objective: To describe
institutional cases of brainstem PNET and their outcome. Patients and methods: Retrospective
assessment obtained from medical records. Results: Between 2009 and 2015, four children with
histologically proven brainstem PNET not otherwise specified and two ependymoblastomas
were evaluated. The mean age at diagnosis was 2.6 years (8m- 8y), 2 male. All patients
underwent partial resection followed by postoperative chemotherapy that consisted of Head
Start in five patients ≤ 3 years of age. One patient >3 years of age performed 36Gy craniospinal
irradiation (CSI) upfront followed by maintenance chemotherapy with cisplatin, cytoxan and
vincristine. Two patients showed progressive disease and died, one died due to chemotherapy
toxicity and two are still alive in different protocols after progression. The last patient with 3
years of age at diagnosis underwent 23.4Gy CSI followed by ABMT and is off treatment for 5
years. Conclusion: Brainstem PNET tumors are rare but a differential diagnosis to be considered
in childhood brainstem tumors. So far seems to have a dismal evolution with the necessity to
identify new therapeutic approaches.
Código: 44212
Título: PROFILE OF GLIOBLASTOMA MULTIFORME PATIENTS WITH THE HOSPITAL‘S ONCOLOGY.
Temário: Oncologia
Autores: Sureya Maria Gibelli; Franklein Vieira Maia; Nayara Zortea Lima; Ana Paula Odoni
Rocha; Sueli Moterroso da Cruz; Marcelo Antonio Duva Borgheresi; Ticila Peixoto Melo; Marcelo
Trindade Cecchi; Ytalo Bruno Soares; Rebeca Grezos;
Instituição: HOSPITAL ANA COSTA
Resumo: Summary: Glioblastoma is classified as grade IV classification of astrocytomas. Surgical
treatment is the most suitable followed by conformal radiotherapy combined with concomitant
chemotherapy with temozolomide and maintenance therapy with temozolomide. The survival
of patients with GBM is 9 to 12 months. The purpose of this is to demonstrate paper the profile
of patients with GBM, treatment performed and survival in a Hospital´s Oncology. Results: In
five years were diagnosed 19 patients, 58% (11) men and 42% (8) women. The age group
between 31-81 years, mean 58 years. Median survival was 18 months, but one (5.26%) patient
survival four years, and 3 (patients are still alive and being treated with second-line
chemotherapy - Avastin + irinotecan with diagnosis two years ago) . All patients were treated
with radiotherapy associated with Temozolamide, followed by Temozolamide isolated for at
least six cycles after radiotherapy. Six (31.5%) patients progressed during treatment, then
modified protocol for Irinotecan + Avastin. Half of the second-line protocol in patients remain
on treatment. Discussion: According to the literature, the incidence of GBM is low compared to
other solid tumors (3). It affects males (4:06), with varied age involvement and can be evidenced
in children, and the elderly (6). The median survival is 9-12 months some papers state 24 months
of survival and only 4% survive for five years or more (5:07). Most patients with local recurrence
evolves, and these treatment with an increase in overall survival was the combination of
irinotecan with Bevacizumab (7), results in around 31 months. Conclusion: The incidence of GBM
at is 2 cases per 100,000 patients per year similar to the literature, is higher in males, mean age
58 years. Survival after surgery and radiotherapy with Temozolamide is 18 months. After disease
progression the average survival is 12 months and also similar to the literature.
Código: 44834
Título: SINGLE AGENT VINORELBINE IN PROGRESSIVE UNRESSECTABLE LOW-GRADE GLIOMA IN
CHILDREN AND ADOLESCENT.
Temário: Oncologia
Autores: Andréa Maria Cappellano; Eric Bouffet; Sergio Cavalheiro; Frederico A Silva; Maria
Teresa Seixas Alves; Andressa Azevedo; Nasjla Saba da Silva;
Resumo: Background: The management of progressive unresectable low-grade gliomas (PULGG)
remains controversial. Treatment options include chemotherapy, usually preceded by a period
of observation, to delay or even avoid radiotherapy and extensive surgery. Within this context
an institutional protocol with vinorelbine, a semi-synthetic vinca alkaloid, was conducted.
Objective: To evaluate the clinical and radiological response, as well as its toxicity profile.
Patients and methods: From July 2007 to May 2013, 41 patients with recurrent (10) and newlydiagnosed (31) PULGG were treated with vinorelbine 30 mg/m² on days 0, 8 and 22 for 18 cycles.
The response criteria was performed by magnetic resonance imaging, physical and visual
evaluation. Results: Mean age at diagnosis was 6.4 years. Twenty-seven patients had optic
pathway glioma, 7 brainstem, 3 hemispheric, 2 cerebellum, 1 intramedullary and 1 gliomatosis
cerebri. Four patients had diagnosis of neurofibromatosis type 1 and 3 diencephalic syndrome.
Twenty-eight patients were submitted to neurosurgical intervention, 21 grade I glioma and 7
grade II. Of the 41 patients enrolled in the study, 40 were assessable for response. The best
objective response was observed in 17 patients (42.5%) and 23 stable disease. The most
important toxicity was hematologic, with grade 3/4 neutropenia in 9 patients. Only one grade 3
neurotoxicity and no grade 3/4 gastrointestinal toxicity. With a mean follow-up of 56 months
the 40 available patients showed a progression-free survival in 3 years of 49.4% (I.C. a 95%:
33,2%; 65,4%) and in 5 years of 36.8% (I.C. a 95%: 20,7%; 52,9%) with an overall survival in 3 and
5 years of 81.8% (I.C a 95%: 69,6%; 94,0%). Conclusion: The results suggest that vinorelbine may
be an option for PULGG, showing activity with low toxicity and excellent quality of life.
Código: 44891
Título: SURGICAL OUTCOMES OF THE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL APPROACH
FOR LARGE AND GIANT PITUITARY ADENOMAS: INSTITUTIONAL EXPERIENCE WITH SPECIAL
ATTENTION TO APPROACH-RELATED COMPLICATIONS.
Temário: Oncologia
Autores: Edson da Rocha Constantino; Felipe Lameirão de Oliveira; Heros Henrique Melo
Almeida; Gabriel Pereira Escudeiro; Christian Cândido Ferreira; Rafael Teixeira Magalhães Leal;
Marcus André Acioly; José Alberto Landeiro;
Instituição:
Resumo: Objective: In this study, we sought to investigate our institutional experience of
patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large
and giant pituitary adenomas emphasizing the surgical results and approach-related
complications. Method: The authors reviewed 28 consecutive patients with large and giant
pituitary adenomas (defined as maximum diameter 3-4 cm and > 4 cm, respectively) who
underwent surgery between March, 2010 and March, 2014. Clinical presentation, endocrine
status, neuroimaging, histopathological evaluation, extent of resection, clinical outcomes, and
complication rates were analyzed. Results: The mean preoperative tumor diameter was 4.6 cm.
Gross-total resection was achieved in 14.3% (4 patients), near-total in 10.7% (3 patients),
subtotal in 39.3% (11 patients), and partial in 35.7% (10 patients). Improvement in visual acuity
was experienced in 32,9% (9 patients), while 3.5% of patients worsened. The most common
complications were transient diabetes insipidus (53%), permanent pituitary deficit (35.7%),
endonasal adhesions (21.3%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 10.7%.
Conclusions: Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for
large or giant pituitary adenomas, which results in high rates of surgical decompression of
cerebrovascular structures. Acute and long-term complication rates are still elevated, but well
accepted in terms of disease complexity.
Código: 44880
Título: ANAPLASTIC EPENDYMOMA WITH CERVICAL METASTASIS - CASE REPORT
Autores: Tatiana Leitão de Azevedo; Alllisson Bruno Barcelos Borges; Marcos Duarte Mattos;
Sahlua Miguel Volc; Larissa Gonçalves de Albuquerque Santos;
Instituição: HOSPITAL DE CÃNCE DE BARRETOS
Resumo: Introduction: Anaplastic ependymoma is a rare and unusual neoplasm of the central
nervous system (CNS ) , which rarely metastasize outside the CNS . It mainly affects 8-10 % of
the childrens and 3-5%of the young adults. These tumors are of neuroectodermal origin usually
arise intracranial within infratentoria l location or supratentorial brain and spinal cord. They
rarely metastasize outside the CNS. Extra neural metastasis occurs mainly in the lung, pleura,
liver and lymph nodes. Due to low incidence of ependymomas , outcome studies on prognostic
factors and treatment modalities are limited and are based on retrospective data , surgical
resection is the standard therapeutic , radiotherapy and chemotherapy appeared to play their
role . Material and Methods: Patient male, 18 years, diagnosed in another hospital, with brain
tumor and underwent surgery with complete resection, whose pathology revealed anaplastic
ependymoma grade III. He was performed adjuvant chemotherapy with CDDP + VP-16 for 6
cycles and local radiotherapy with 60 Gy. In 2013 he had local recurrence, and another total
resection of the lesion, which the pathological examination also revealed the same pathology.
Afterward he underwent chemotherapy with CDDP + VP-16 for 8 cycles until July 2014, in
another service. In October 2014, he was admitted with dizziness and left neck mass of
progressive growth. The MRI showed a brain injury in sickle of the frontal region, infiltrating the
adjacent brain parenchyma, with marked leptomeningeal enhancement. CT neck and chest
showed lymphadenopathy with pathological aspect and pulmonary micronodules. Brain
damage was deemed unresectable. He underwent biopsy of cervical mass and the pathology
was compatible with metastatic anaplastic ependymoma. He evolved with clinical worsening
and increased volume of the cervical mass. He was subjected to second-line chemotherapy with
VAC-IE for 8 cycles until October 2015, with partial response in the neck and brain, following By
underwent left neck dissection. Pathological examination revealed: ependimona anaplastic in
lymph nodes resected. Adjuvant radiotherapy was proposed in the left cervical region with 60
Gy dose. Conclusion: Ependymomas anaplasico is uncommon and rare, associated with cervical
metastases and further rare, and its management is complex and uncertain.
Código: 44279
Título: PRIMARY MENINGEAL MELANOMA: CASE REPORT AND REVIEW OF THE LITERATURE
Autores: Tatiana Leitao de Azevedo; Vanessa Silveira; Ismael Augusto Silva Lombardi; Caio
Augusto Dantas Pereira; Allisson Bruno Barcelos Borges; Marcos Duarte de Mattos;
Instituição: HOSPITAL DE CÃNCE DE BARRETOS
Resumo: Introduction: Primary meningeal Melanoma is a rare neoplasm, result of malignant
transformation of melanocytes from the neural crest. Virchow (1859) made the first description
and, currently, about fifty cases were reported. Objective: To report a case of primary meningeal
melanoma and literature review. Case report: A.C.F, 25 years old, female, patient, presented
hemiparesis. Inicial evaluation where was performed in another institution through a magnetic
resonance imaging (MRI) of the brain which was compatible with the hypothesis of expansive
meningeal lesion. As immediate treatment a gross total resection on was performed through a
craniotomy; the anatomopathological analysis resulted in an atypical meningioma. The disease
relapsed twice, in August and October 2014, which were surgically treated, without adjuvant
treatment; the anatomopathological analysis from the second relapse resulted in poorly
differentiated neuroendocrine neoplasm, different from the previous analysis. In January 2015
the patient was admitted in our institution, presenting right arm monoparesis. After initial
evaluation, the brain MRI requested showed two similar lesions, extra-axials, expansive, frontleft located, lobulated, with high signal intensity on T1 with enhanced of the contrast, measuring
approximately 5.3cm and 1,5cm. Previous microscope slides reanalyzed were compatible with
the hypothesis of melanoma. In interdisciplinary decision, multimodal treatment was opted:
new surgical approach, initially resulting in gross total resection confirmed with CT scans of skull.
The anatomopathologic was a meningeal melanoma, with profile immunohistochemistry
compatible with CNS primary melanoma, demonstrating positive marker S100 co-expression,
HMB45, SOX10 and BRAF mutation not detected, reviewed by international reference
laboratory. Staging tests showed no other primary or systemic disease. Adjuvant Fractioned
Stereotactic Radiotherapy was indicated at 27Gy (9Gy/fraction), completed in June 2015.
Conclusion: The low suspicion of entity and the difficult diagnosis corroborate to a poor
prognosis. Despite this, the patient remains in segment without evidence of disease.
Código: 44874
Título: RADIOLOGICAL PREDICTORS OF VOLUMETRIC RESPONSE OF BRAIN METASTASES
TREATED WITH STEREOTACTIC RADIOSURGERY
Autores: Bruno Loyola Godoy; Andrea S. de Souza; Marcello Reis da Silva; Fernanda Tovar Moll;
Jorge Paes Barreto Marcondes de Souza;
Instituição: Instituto Nacional do Cancer - INCA
Resumo: Introduction - Brain metastasis are the most common CNS tumors. Treatment
strategies of brain metastasis evolved from purely palliative to effective local oncologic control
as the main purpose. Stereotactic radiosurgery (SRS) has proved to be a very effective strategy
to treat these lesions, alone or in combination with other modalities of treatment. It is extremely
well tolerated and have low incidence of adverse effects. Despite high efficiency, roughly 20 to
30% of brain metastasis do not respond adequately, requiring salvage surgical intervention with
higher risks and morbidity. It is not well defined in the literature which radiological aspects could
serve as markers for adequate response after stereotactic radiosurgery. Objectives – This study
had the purpose of evaluating the ability of different tissue perfusion quantification methods, in
pre-treatment MRI, in predicting volumetric response of brain metastasis after stereotactic
radiosurgery treatment, and comparing with existing response predictors in the literature.
Methods - After acquiring authorization from the research ethics board of this institution, data
from 17 lesions treated with SRS were retrospectively analyzed in five variables: initial volume
of the lesion, solid or cystic predominance, perfusion MRI, arterial spin labeling (ASL) sequence
MRI, primary treatment or post-operative treatment of residual. Volumetry of all lesions was
accessed before and after treatment using manual segmentation technique. Statistical analysis
was done with SPSS 20.0, using Qui-square and fisher exact test for categorical variables, and
ANOVA for the other variables. Results - The mean initial volume was 6.79 cm3 (0.35 to 40.08
cm3 – DP ± 9.77), the mean final volume was 9.94 cm3 (0.25 to 97.74 cm3 – DP ± 23,57), the
mean time between initial image and post treatment image was 6.12 months (3 to 16 months –
DP ± 3.14). Volume reduction or stable course were seen in 58.8% of the lesions. Initial volume,
cystic predominance and post-operative treatment were not significantly associated with
volumetric response (p=0.335, 0.682 and 0.585, respectively). Both ASL and perfusion MRI
signals were correlated with volumetric response (p=0.034). Conclusions - Measurements of
tumoral tissular perfusion were stronger radiological predictors of volumetric response after SRS
for brain metastasis then the known predictors in literature.

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