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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 Temário: Neurocirurgia 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. Contato: [email protected] Código: 44259 Temário: Neurocirurgia 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. Contato: [email protected] Código: 44260 Temário: Neurocirurgia 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. Contato: [email protected] Código: 44273 Temário: Neurocirurgia 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. Contato: [email protected] 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. Contato: [email protected] Código: 44202 Temário: Neurocirurgia 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. Contato: [email protected] Código: 44254 Temário: Neurocirurgia 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. Contato: [email protected] 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. Contato: [email protected] 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 Instituição: UNIVERSIDADE DE SÃO PAULO 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. Contato: [email protected] 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 Instituição: UNIVERSIDADE DE SÃO PAULO 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. Contato: [email protected] 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. Contato: [email protected] 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 Contato: [email protected] Código: 44379 Temário: Neurocirurgia 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. Contato: [email protected] 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. Contato: [email protected] Código: 44837 Temário: Neurocirurgia 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. Contato: [email protected] 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 Instituição: MIAMI NEUROSCIENCE CENTER 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. Contato: [email protected] 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 Instituição: MIAMI NEUROSCIENCE CENTER 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. Contato: [email protected] 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. Contato: [email protected] Código: 44292 Número do Painel: 2 Título: CONGENITAL BRAIN TERATOMA: CASE REPORT Temário: Imagem Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44879 Número do Painel: 3 Título: CONTRIBUIÇÃO DOS MÉTODOS AVANÇADOS POR RESSONÂNCIA MAGNÉTICA DE ALTO CAMPO NA AVALIAÇÃO PRÉ-OPERATÓRIA DE TUMORES DO SISTEMA NERVOSO CENTRAL Temário: Imagem Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44285 Número do Painel: 4 Título: EXTRA-AXIAL HIGH-GRADE GLIOMA: CASE REPORT Temário: Imagem Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44902 Número do Painel: 5 Título: MR IMAGING CHARACTERISTICS OF PROTOPLASMIC ASTROCYTOMA Temário: Imagem Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44905 Número do Painel: 6 Título: PITUITARY MACROADENOMA WITH BILATERAL INVASION OF SINUS CAVERNOUS CAUSING PTOSIS AND SUDDEN OPHTHALMOPLEGIA - A CASE REPORT Temário: Imagem Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44282 Número do Painel: 7 Título: PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA IN IMMUNOCOMPETENT PATIENTS: IMAGING FEATURES OF SIX CASES. Temário: Imagem Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44859 Número do Painel: 8 Título: SPECTROSCOPY OR PERFUSION: WHAT‘S THE BEST RADIOLOGICAL METHOD FOR GLIOMAS? Temário: Imagem Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44870 Número do Painel: 9 Título: ATYPICAL MENINGIOMAS: OPTIMAL TREATMENT Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44868 Número do Painel: 10 Título: AWAKE CRANIOTOMY FOR BRAIN TUMORS - A QUALITATIVE STUDY Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44853 Número do Painel: 11 Título: CAVERNOUS SINUS HEMANGIOMA: CASE REPORT Temário: Neurocirurgia Modalidade Aprovada: Pôster 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 ; Instituição: UNIVERSIDADE ESTADUAL DE LONDRINA 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. Contato: [email protected] Código: 44841 Número do Painel: 12 Título: CENTRAL NEUROCYTOMAS: OUR EXPERIENCE 2007-2015 Temário: Neurocirurgia Modalidade Aprovada: Pôster 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). Contato: [email protected] Código: 44730 Número do Painel: 13 Título: CHARACTERIZATION OF CNS TUMORS ON A PEDIATRIC POPULATION Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA 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. Contato: [email protected] Código: 44888 Número do Painel: 14 Título: CHILDHOOD CRANIOPHARYNGEOMA : 15 YEARS OF MULTIMODAL TREATMENT EXPERIENCE Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44275 Número do Painel: 15 Título: CRANIAL ANGIOSARCOMA IN A CHILD WITH CONGENITAL ORBITAL ROOF ABNORMALITY Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44901 Número do Painel: 16 Título: CRANIOPLASTY: PROPEDEUTIC, TECHNIQUES AND RESULTS Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44731 Número do Painel: 17 Título: DISTRIBUTION OF CNS METASTASES IN A REFERENCE HOSPITAL IN NEUROSURGERY Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA 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. Contato: [email protected] Código: 44347 Número do Painel: 18 Título: DROP METASTASIS MENINGIOMA Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44846 Número do Painel: 19 Título: ENDOLYMPHATIC SAC TUMORS; CASES REPORTS. Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Bruno Vilela Gomes; Antônio Aversa Dutra do Souto; Alfredo das Neves Magalhães Fernandes; Washington Luiz de Oliveira; Instituição: INSTITUTO NACIONAL DO CÂNCER 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. Contato: [email protected] Código: 44389 Número do Painel: 20 Título: ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY IN ELDERLY PATIENTS WITH PITUITARY ADENOMAS Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Jackson Gondim; Joao Paulo Almeida; Lucas Alverne de Albuquerque; Erika Gomes; Michelle Schops; Jose Italo Mota; Instituição: INSTITUTO DE CIÊNCIAS NEUROLÓGICAS (ICNE) 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. Contato: [email protected] Código: 44243 Número do Painel: 21 Título: EPIDEMIOLOGICAL ANALYSYS OF 1318 SURGICAL BRAIN TUMORS DURING A PERIOD OF TWELVE YEARS IN A TERTIARY REFERENCE HOSPITAL AT SÃO PAULO – BRAZIL Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44751 Número do Painel: 22 Título: EPIDEMIOLOGICAL ANALYSYS OF 20 CASES OF CRANIOPHARYNGIOMAS IN THE PAST DECADE IN A TERTIARY HOSPITAL AT SÃO PAULO – BRAZIL Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: SANTA CASA DE SAO PAULO 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. Contato: [email protected] Código: 44224 Número do Painel: 23 Título: EPIDEMIOLOGICAL ANALYSYS OF 224 SURGICAL BRAIN METASTASIS DURING A PERIOD OF TWELVE YEARS IN A TERTIARY HOSPITAL AT SÃO PAULO – BRAZIL Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Aline Lariessy Campos Paiva; João Luiz Vitorino Araujo; Vinicius Ricieri Ferraz; Renan Maximiliano Lovato; Alexandros Theordoros Panagopoulos; José Carlos Esteves Veiga; Instituição: SANTA CASA DE SAO PAULO 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. Contato: [email protected] Código: 44269 Número do Painel: 24 Título: EPIDEMIOLOGICAL PROFILE AND FOUND INTRA OPERATIVE OF GLIOBLASTOMA MULTIFORME IN NEUROSURGERY SERVICE OF SANTA CASA OF RIBEIRÃO PRETO HOSPITAL - SP (HSCMRP) Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44847 Número do Painel: 25 Título: EPIDEMIOLOGICAL PROFILE OF INTRACRANIAL TUMORS IN ADULTS OF A NEUROSURGICAL SERVICE IN THE JANUARY PERIOD 2014 TO DECEMBER 2015 Temário: Neurocirurgia Modalidade Aprovada: Pôster 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 Contato: [email protected] Código: 44854 Número do Painel: 26 Título: EPIDEMIOLOGY AND MANAGEMENT OF CRANIOPHARYNGIOMA IN ADULT PATIENTS, PUERTO RICO 2004-2014 Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44196 Número do Painel: 27 Título: ESTHESIONEUROBLASTOMAS: MULTIMODAL MANAGEMENT Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44668 Número do Painel: 28 Título: EXPERIENCE OF NEURO NAVIGATION USE SYSTEMATICALLY ON THE IMPLANT OF OMMAYA RESERVOIR ON 48 CASES OF LEPTOMENINGEAL CARCINOMATOSIS TREATMENT Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44391 Número do Painel: 29 Título: GIANT PITUITARY ADENOMAS: SURGICAL OUTCOMES OF 50 CASES OPERATED ON BY THE ENDONASAL ENDOSCOPIC APPROACH Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Jackson Gondim; Joao Paulo Almeida; Lucas Alverne de Albuquerquer; Erika Gomes; Michelle Schops; Instituição: INSTITUTO DE CIÊNCIAS NEUROLÓGICAS (ICNE) 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. Contato: [email protected] Código: 44900 Número do Painel: 30 Título: GLIOBLASTOMA WITH LONG-TERM SURVIVAL: CASE REPORT AND LITERATURE REVIEW Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44268 Número do Painel: 31 Título: GRADENIGO’S SYNDROME ON PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) MIMICKING CEREBELLAR-PONTINE-ANGLE (CPA) TUMOR Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44896 Número do Painel: 32 Título: HYDRANENCEPHALY: CHARACTERISTICS, PROPEDEUTIC SOCIODEMOGRAFHY IN THE AMAZON STATE- BRAZIL Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Andréa Costa de Andrade; Henrique Oliveira Martins; Cleomir da Silva Matos; Heliana Maria da Costa Matos; Carlos Eduardo Veiga de LIma; Thainá Lima Sicsú; Ana Elisabeth Sousa Reis; Bruna Martins Meireles; Instituição: HOSPITAL UNIVERSITÁRIO GETÚLIO VARGAS 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. Contato: [email protected] Código: 44778 Número do Painel: 33 Título: INTERHEMISPHERIC TRANSFALCINE APPROACH TO PINEAL TUMORS – TECHNICAL NOTE Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Iracema Araújo Estevão; César Cozar Pacheco; Tatiana Vilasboas; Marcos Vinicius Calfat Maldaun; Carlos Tadeu Parisi de Oliveira; Paulo Henrique Pires de Aguiar; Instituição: UNIVERSIDADE SÃO FRANCISCO 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. Contato: [email protected] Código: 44261 Número do Painel: 34 Título: INTRACRANIAL GLIOBLASTOMAS: RETROSPECTIVE ANALYSIS OF 159 OPERATED CASES Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44266 Número do Painel: 35 Título: INTRACRANIAL GLIOMAS: RETROSPECTIVE ANALYSIS OF 326 OPERATED CASES. Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: SANTA CASA DE SÃO PAULO 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. Contato: [email protected] Código: 44246 Número do Painel: 36 Título: INTRACRANIAL MENINGIOMA AND VASCULAR MALFORMATION Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44177 Número do Painel: 37 Título: INTRACRANIAL MENINGIOMAS: RETROSPECTIVE ANALYSIS OF 267 PATIENTS. Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44892 Número do Painel: 38 Título: LHERMITTE-DUCLOS DISEASE: REPORT OF 2 CASES Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44174 Número do Painel: 39 Título: MALIGNANT MENINGIOMAS: RETROSPECTIVE ANALYSIS OF 38 PATIENTS. Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: IRMANDADE DA SANTA CASA DE MISERICORDIA DE SAO PAULO 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. Contato: [email protected] Código: 44872 Número do Painel: 40 Título: MENINGIOMA ASSOCIATED WITH NEUROPSYCHOLOGICAL DISORDER Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: UNIVERSIDADE SÃO FRANCISCO 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. Contato: [email protected] Código: 44173 Número do Painel: 41 Título: META-ANALYSIS : ACOUSTIC NEURINOMA 2 TO 3 CM IN PATIENTS WITH 50 AGE OF HEARING AND FUNCTIONAL PRESERVED - SURGERY VERSUS RADIOSURGERY Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44286 Número do Painel: 42 Título: METACHRONOUS SPINAL METASTASES FROM INTRACRANIAL GLIOBLASTOMA MULTIFORM Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44877 Número do Painel: 43 Título: MORPHINE PUMP IN PATIENTS WITH ONCOLOGICAL PAIN Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: UNIVERSIDADE SÃO FRANCISCO 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. Contato: [email protected] Código: 44727 Número do Painel: 44 Título: MULTIPLE SCHWANNOMAS OF CAUDA NEUROFIBROMATOSIS: A RARE CASE REPORT Temário: Neurocirurgia EQUINA IN A CHILD WITHOUT Modalidade Aprovada: Pôster 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; Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA 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. Contato: [email protected] Código: 44234 Número do Painel: 45 Título: NEUROSURGICAL APPROACH TO PITUITARY APOPLEXY IN 18 YEAR OLD MALE PATIENT: CASE REPORT AND REVIEW Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44883 Número do Painel: 46 Título: PERFORMANCE OF COGNITIVE FUNCTIONS IN PATIENTS UNDERGOING CRANIECTOMY DECOMPRESSION Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: HOSPITAL UNIVERSITÁRIO GETÚLIO VARGAS 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. Contato: [email protected] Código: 44835 Número do Painel: 47 Título: PILOCYTIC ASTROCYTOMA IN CEREBELLOPONTINE ANGLE: A PEDIATRIC CASE REPORT Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44630 Número do Painel: 48 Título: PITUITARY ACTH ADENOMAS Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44203 Número do Painel: 49 Título: PNET OF BRAIN STEM Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44863 Número do Painel: 50 Título: POSTERIOR FOSSA MENINGIOMA DURING PREGNANCY: WHAT IS THE BETTER STRATEGY Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44142 Número do Painel: 51 Título: PREOPERATIVE EMBOLIZATION OF INTRACRANIAL TUMOR Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44599 Número do Painel: 52 Título: PRESACRAL GANGLIONEUROMA: DIAGNOSTIC AND THERAPEUTIC STRATEGY Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44725 Número do Painel: 53 Título: PREVALENCE OF PRIMARY TUMORS OF CENTRAL NERVOUS SYSTEM IN ADULT POPULATION ON REFERENCE HOSPITAL IN NEUROSURGERY, CAMPINA GRANDE-PB Temário: Neurocirurgia Modalidade Aprovada: Pôster 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 Pedrosa; Lucas Silva Xavier; Pâmmela Dayana Lopes Carrilho Machado; Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA 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. Contato: [email protected] Código: 44726 Número do Painel: 54 Título: PRIMARY CENTRAL NERVOUS SYSTEM BURKITT LYMPHOMA IN A PATIENT WITH 17 YEARS OLD WITHOUT IMMUNODEFICIENCIES: A CASE REPORT Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA 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. Contato: [email protected] Código: 44298 Número do Painel: 55 Título: RARE SCHWANNOMA OF C1 ROOT WITH EXTENDED TO THE FORAMEN MAGNUM, CASE REPORT. Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44728 Número do Painel: 56 Título: SPINAL CORD TUMORS IN CHILDREN - AN EPIDEMIOLOGICAL SURVEY IN A NEUROSURGEON REFERENCE HOSPITAL Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA 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. Contato: [email protected] Código: 44270 Número do Painel: 57 Título: SURGICAL APPROACHES TO THE VENTRICULAR TRIGONE AND THE IMPORTANCE OF THE PREOPERATIVE DTI IN SURGICAL PLANNING Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Renan Maximilian Lovato; João Luiz Vitorino Araujo; Vinicius Ricieri Ferraz; José Carlos Esteves Veiga; Instituição: SANTA CASA DE SÃO PAULO 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. Contato: [email protected] Código: 44248 Número do Painel: 58 Título: SURGICAL MANAGEMENT OF SPINAL INTRAMEDULLARY TUMORS: PERSONAL EXPERIENCE WITH LONG FOLLOW-UP Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44283 Número do Painel: 59 Título: SURGICAL MANAGEMENT OF TUBERCULUM SELLAE MENINGIOMAS VIA SUPRAORBITAL KEYHOLE CRANIOTOMY Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44197 Número do Painel: 60 Título: SURGICAL TREATMENT OF CENTRAL NERVOUS SYSTEM HEMANGIOBLASTOMAS Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44226 Número do Painel: 61 Título: SYNCHRONOUS OCURRENCE OF MENINGIOMA AND KIDNEY BRAIN METASTASIS – RELEVANT ASPECTS OF AN UNUSUAL CASE Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Aline Lariessy Campos Paiva; João Luiz Vitorino Araújo; Guilherme Lellis Badke; Vinicius Ricieri Ferraz; José Carlos Esteves Veiga; Instituição: SANTA CASA DE SAO PAULO 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. Contato: [email protected] Código: 44899 Número do Painel: 62 Título: TECHNIQUES AND SCRIPT IN NEUROSURGERY FOR TREATMENT OF NORMAL PRESSURE HYDROCEPHALY Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Andréa Costa de Andrade; Henrique Oliveira Martins; Cleomir da Silva Matos; Heliana Maria da Costa Matos; Carlos Eduardo Veiga de Lima; Thainá Lima Sicsú; Raquel Ferreira Pontes; Instituição: HOSPITAL UNIVERSITÁRIO GETÚLIO VARGAS 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. Contato: [email protected] Código: 44300 Número do Painel: 63 Título: THE IMPACT OF RECURRENT SURGERY AND TEMOZOLOMIDE FOR HIGH-GRADE GLIOMAS OVER TIME Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44750 Número do Painel: 64 Título: THE ROLE OF NEUROSURGERY IN MELANOMA BRAIN METASTASES Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44267 Número do Painel: 65 Título: THREE-DIMENSIONAL MRI RECONSTRUCTION FOR PRESURGICAL PLANNING USING FREE OSIRIX SOFTWARE FOR INTRACRANIAL TURMORS Temário: Neurocirurgia Modalidade Aprovada: Pôster Autores: Renan Maximilian Lovato; João Luiz Vitorino Araujo; José Carlos Esteves Veiga; Instituição: SANTA CASA DE SÃO PAULO 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. Contato: [email protected] Código: 44244 Número do Painel: 66 Título: TRANSOPERATIVE ULTRASONOGRAPHY FOR LOCATING AND MONITORING THE RESECTION OF BRAIN TUMORS Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44871 Número do Painel: 67 Título: TUBERCULUM SELLAE MENINGIOMAS: IS THERE ANY IDEAL APROACH? Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: UNIVERSIDADE SÃO FRANCISCO 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. Contato: [email protected] Código: 44849 Número do Painel: 68 Título: TUMOR APOPLEXY: AN IMPORTANT DIFFERENTIAL DIAGNOSIS IN NEUROCRITICAL CARE Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44193 Número do Painel: 69 Título: TUMORS OF CENTRAL NERVOUS SYSTEM IN PEDIATRIC AGE – EPIDEMIOLOGY BASED ON A SERIES OF NEUROSURGICAL CASES FROM A SINGLE INSTITUTE Temário: Neurocirurgia Modalidade Aprovada: Pôster 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 Contato: [email protected] Código: 44445 Número do Painel: 70 Título: UNUSUAL OCCURRENCE OF A CERVICAL SCHWANNOMA: CASE REPORT Temário: Neurocirurgia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44788 Número do Painel: 71 Título: VASCULAR COMPLICATIONS OF TEMPORAL LOBE GLIOMAS Temário: Neurocirurgia Modalidade Aprovada: Pôster 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; Instituição: UNIVERSIDADE SÃO FRANCISCO 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. Contato: [email protected] Código: 44293 Número do Painel: 72 Título: DYSPLASTIC GANGLIOCYTOMA OF THE CEREBELLUM ASSOCIATED TO CHIARI I MALFORMATION Temário: Neurologia Modalidade Aprovada: Pôster Autores: Bárbara Elias Prado; Rangel de Sousa Costa; Barbara Andrade de Oliveira; Eliseu dos Santos Costa; Instituição: INSTITUTO TOCANTINENSE PRESIDENTE ANTÔNIO CARLOS 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. Contato: [email protected] Código: 44903 Número do Painel: 73 Título: GLIOMA RECURRENCE OF LOW GRADE OF TEMPORAL REGION TO INSULA’S REGION Temário: Neurologia Modalidade Aprovada: Pôster Autores: Bárbara Elias Prado; Barbara Andrade de Oliveira; Eliseu dos Santos Costa; Instituição: INSTITUTO TOCANTINENSE PRESIDENTE ANTÔNIO CARLOS 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. Contato: [email protected] Código: 44616 Número do Painel: 74 Título: PARASAGITTAL MENINGIOMA IN PEDIATRIC PATIENT Temário: Neurologia Modalidade Aprovada: Pôster Autores: Bárbara Elias Prado; Renato Miranda Ramalho Filho; Barbara Andrade de Oliveira; Instituição: INSTITUTO TOCANTINENSE PRESIDENTE ANTÔNIO CARLOS 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. Contato: [email protected] Código: 44897 Número do Painel: 75 Título: PEDIATRIC LOW-GRADE ASTROCYTOMAS EPIDEMIOLOGY IN A HOSPITAL IN TERESINA, PIAUÍ Temário: Neurologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44886 Número do Painel: 76 Título: CASE REPORT: COLLISION TUMOR – MENINGIOMA TO HEPATOCELLULAR CARCINOMA Temário: Neuropatologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44889 Número do Painel: 77 Título: CASE REPORT: DYSEMBRYIOPLASTIC NEUROEPITELIAL TUMOR Temário: Neuropatologia Modalidade Aprovada: Pôster 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: 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. Contato: [email protected] Código: 44126 Número do Painel: 78 Título: CLINICAL, RADIOLOGIC, AND HISTOPATHOLOGIC FINDINGS OF 4 PATIENTS WITH NEUROBEHCET’S DISEASE Temário: Neuropatologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44264 Número do Painel: 79 Título: HYBRID PERIPHERAL NERVE SHEATH TUMOR: CASE REPORT WITH ULTRASTRUCTURAL AND IMMUNOHISTOCHEMISTRY STUDIES. Temário: Neuropatologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44249 Número do Painel: 80 Título: HYDROCEPHALUS DUE TO A LEPTOMENINGEAL DISSEMINATION FROM THORACIC INTRAMEDULAR PILOCYTIC ASTROCYTOMA. Temário: Neuropatologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44893 Número do Painel: 81 Título: IMMUNOHISTOCHEMICAL ANALYSIS OF THE EXPRESSION OF THE NEUROKININ TYPE I RECEPTOR AND SUBSTANCE P IN GLIOBLASTOMAS. Temário: Neuropatologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44904 Número do Painel: 82 Título: MICROVASCULAR DENSITY IN GLIOBLASTOMA SUBTYPES Temário: Neuropatologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44882 Número do Painel: 83 Título: RETROSPECTIVE STUDY ANALYSING THE INCIDENCE OF CENTRAL NERVOUS SYSTEM NEOPLASMS IN RIO GRANDE DO SUL Temário: Neuropatologia Modalidade Aprovada: Pôster 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; Instituição: UNIVERSIDADE DE CAXIAS DO SUL 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. Contato: [email protected] Código: 44110 Número do Painel: 84 Título: SIMULTANEOUS DEVELOPMENT OF TWO PRIMARY DISTINCT INTRACRANIAL TUMORS IN THE SINGLE PATIENT: CASE ILLUSTRATIONS AND REVIEW OF THE LITERATURES Temário: Neuropatologia Modalidade Aprovada: Pôster 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 Contato: [email protected] Código: 44288 Número do Painel: 85 Título: ANALYSIS OF FEATURES AND SURVIVAL OF PATIENTS WITH HIGH GRADE GLIOMAS IN A REFERENCE CENTER IN SOUTHERN BRAZIL Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44865 Número do Painel: 86 Título: APPLICATION OF DENOSUMAB IN CLIVAL GIANT CELL TUMOR Temário: Oncologia Modalidade Aprovada: Pôster Autores: Washington Luiz de Oliveira; Alfredo das Neves Magalhães Fernandes; Antônio Aversa Dutra do Souto; Instituição: INSTITUTO NACIONAL DO CÂNCER 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. Contato: [email protected] Código: 44729 Número do Painel: 87 Título: BRAIN TUMORS IN THE ELDERLY: PREVALENCE OF HISTOLOGICAL TYPE IN A NEUROSURGERY REFERENCE HOSPITAL Temário: Oncologia Modalidade Aprovada: Pôster 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 Pedrosa; Lucas Silva Xavier; Pâmmela Dayana Lopes Carrilho Machado; Instituição: H TRAUMA-CG / CLÍNICA SANTA CLARA 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. Contato: [email protected] Código: 44890 Número do Painel: 88 Título: CASE REPORT: AGRESSIVE EGFR NEGATIVE LUNG ADENOCARCINOMA METASTASIZING TO CENTRAL NERVOUS SYSTEM Temário: Oncologia Modalidade Aprovada: Pôster Autores: Rita De Cassia Costamilan; Alessandra Eifler Guerra Godoy; Isnard Elman Litvin; Marco Antonio Eduardo Koff; Natália Diel Lisboa; Marcia Flocke Cidade; Instituição: UNIVERSIDADE DE CAXIAS DO SUL 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. Contato: [email protected] Código: 44858 Número do Painel: 89 Título: CEREBRAL METASTASIS FROM TESTICULAR TUMOR : A CASE REPORT Temário: Oncologia Modalidade Aprovada: Pôster Autores: Carlos Alexandre Martins Zicarelli; Bruno Ribeiro Zuccoli; Francisco Spessatto Pesente; 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; Instituição: UNIVERSIDADE ESTADUAL DE LONDRINA 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 Contato: [email protected] Código: 44861 Número do Painel: 90 Título: CERVICAL SPINAL CORD COMPRESSION SECONDARY TO LEUKEMIA: A CASE REPORT Temário: Oncologia Modalidade Aprovada: Pôster Autores: Carlos Alexandre Martins Zicarelli; Bruno Ribeiro Zuccoli; Francisco Spessatto Pesente; Victor Guilherme Batistela Pereira; Barbara Itimura; Celia Almeida Jorge; Mariana Araujo Cavallaro; Nicolas Pivoto; Marcio Francisco Lehmann; Tomas Catao Monte Raso; Felipe Inacio Ferreira da Silva; Alexandre Casagrande Canheu; Paulo Henrique Pires de Aguiar; Instituição: UNIVERSIDADE ESTADUAL DE LONDRINA 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. Contato: [email protected] Código: 44867 Número do Painel: 91 Título: CLINICAL EVOLUTION OF GLIOBLASTOMA MULTIFORME IN THALAMUS LEFT Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44732 Número do Painel: 92 Título: COMPUTATIONAL SYSTEM FOR IMPROVING MULTIDISCIPLINARY TEAM MEETINGS Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44857 Número do Painel: 93 Título: DIFFERENCES BETWEEN PARANEOPLASTIC LIMBIC ENCEPHALITIS AND RADIO-INDUCED DEMENTIA Temário: Oncologia Modalidade Aprovada: Pôster Autores: Carlos Alexandre Martins Zicarelli; Bruno Ribeiro Zuccoli; Francisco Spessatto Pesente; Victor Guilherme Batistela Pereira; Barbara Itimura; Celia Almeida Jorge; Mariana Araujo Cavallaro; Nicolas Pivoto; Karen Barros Parron Fernandes; Tomas Catâo Monte Raso; Marcio Francisco Lehmann; Paulo Henrique Pires de Aguiar; Instituição: UNIVERSIDADE ESTADUAL DE LONDRINA 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. Contato: [email protected] Código: 44771 Número do Painel: 94 Título: ESTUDO COMPARATIVO ENTRE ANTI-ANGIOGÊNESE E IMUNOTERAPIA COM O USO DE CÉLULAS DENDRÍTICAS NA RECIDIVA DE GLIOBLASTOMA MULTIFORME: REVISÃO DA LITERATURA Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44862 Número do Painel: 95 Título: GLIOBLASTOMA MULTIFORME IN PREGNANCY: A CASE REPORT Temário: Oncologia Modalidade Aprovada: Pôster Autores: Carlos Alexandre Martins Zicarelli; Bruno Ribeiro Zuccoli; Francisco Spessatto Pesente; 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; Instituição: UNIVERSIDADE ESTADUAL DE LONDRINA 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. Contato: [email protected] Código: 44845 Número do Painel: 96 Título: GLIOBLASTOMA MULTIFORME: A RARE CLINICAL CASE WITH LONG SURVIVAL Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44111 Número do Painel: 97 Título: IMMUNOTHERAPY OF GLIOBLASTOMAS USING CYTOKINE-INDUCED KILLER CELLS AND CONCOMITANT CHEMORADIOTHEPAY WITH TEMOZOLOMIDE: TWO CASES REPORT Temário: Oncologia Modalidade Aprovada: Pôster 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 Contato: [email protected] Código: 44661 Número do Painel: 98 Título: INTRACRANIAL HEMORRHAGE BY ACRAL LENTIGINOUS MELANOMA METASTASIS Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44178 Número do Painel: 99 Título: INTRASPINAL PRIMITIVE NEUROECTODERMAL TUMOR: CASE SERIES AND RELEVANT ASPECTS Temário: Oncologia Modalidade Aprovada: Pôster 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; Instituição: IRMANDADE DA SANTA CASA DE MISERICORDIA DE SAO PAULO 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. Contato: [email protected] Código: 44281 Número do Painel: 100 Título: INVASIVE GLIOMA IN LATERAL VENTRICLE POSTERIOR HORN RIGHT: CASE REPORT. Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44860 Número do Painel: 101 Título: IS THERE ANY PROGNOSTIC VALUE OF P53 STATUS IN PEDIATRIC MEDULLOBLASTOMA? Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44826 Número do Painel: 102 Título: LIPID NANOPARTICLES IN GLIOBLASTOMAS Temário: Oncologia Modalidade Aprovada: Pôster 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 Contato: [email protected] Código: 44783 Número do Painel: 103 Título: LIVER INJURY INDUCED BY TEMOZOLOMIDE Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44287 Número do Painel: 104 Título: LOW GRADE GLIOMAS IN ADULTS: AN EPIDEMIOLOGICAL PROFILE Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44856 Número do Painel: 105 Título: PRIMITIVE NEUROECTODERMAL TUMORS OF THE BRAINSTEM: REPORT FROM A SINGLE INSTITUTION. Temário: Oncologia Modalidade Aprovada: Pôster Autores: Mariana Dórea P. Cunha; Andréa M Cappellano; Sergio Cavalheiro; Patricia D‘astoli; Daniela Barbosa; Maria Tereza Seixas Alves; Nasjla Saba da Silva; Instituição: IOP/GRAACC/UNIFESP 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. Contato: [email protected] Código: 44212 Número do Painel: 106 Título: PROFILE OF GLIOBLASTOMA MULTIFORME PATIENTS WITH THE HOSPITAL‘S ONCOLOGY. Temário: Oncologia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44834 Número do Painel: 107 Título: SINGLE AGENT VINORELBINE IN PROGRESSIVE UNRESSECTABLE LOW-GRADE GLIOMA IN CHILDREN AND ADOLESCENT. Temário: Oncologia Modalidade Aprovada: Pôster Autores: Andréa Maria Cappellano; Eric Bouffet; Sergio Cavalheiro; Frederico A Silva; Maria Teresa Seixas Alves; Andressa Azevedo; Nasjla Saba da Silva; Instituição: IOP/GRAACC/UNIFESP 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. Contato: [email protected] Código: 44891 Número do Painel: 108 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 Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44880 Número do Painel: 110 Título: ANAPLASTIC EPENDYMOMA WITH CERVICAL METASTASIS - CASE REPORT Temário: Radioterapia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44279 Número do Painel: 111 Título: PRIMARY MENINGEAL MELANOMA: CASE REPORT AND REVIEW OF THE LITERATURE Temário: Radioterapia Modalidade Aprovada: Pôster 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. Contato: [email protected] Código: 44874 Número do Painel: 112 Título: RADIOLOGICAL PREDICTORS OF VOLUMETRIC RESPONSE OF BRAIN METASTASES TREATED WITH STEREOTACTIC RADIOSURGERY Temário: Radioterapia Modalidade Aprovada: Pôster 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. Contato: [email protected]
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