Cholesterol granulomas of the central nervous system are rare lesions and the petrous apex is the intracranial site most frequently involved. Cases of intracranial cholesterol granuloma have been reported associated with familial hypercolesterolemia and high serum lipid levels. With few cases reported in the literature, the pathogenesis of the event is until unclear.The following report shows a case of a young woman with a temporal mass with cholesterol granuloma diagnosed in the pathologic examination. CASEA black 20 year-old woman, presented at our service due to severe progressive headache and drowsiness. Physical and neurologic examination were normal. Neuroimaging showed a heterogeneous cystic mass in the posterior right temporal lobe, extending to the ventricular trigone ( Fig 1A, B, C). A temporal craniotomy was performed, and the lesion was resected completely. The post-operative period was uneventful. Pathologic examination was consistent with cholesterol granuloma. There was no dislipidemia nor familial hypercholesterolemia hystory. At 3-month followup, the patient resumed a normal life, with no complaints. The post-operative image shows no recurrence (Fig 1D).CErEbrAl CholEStErol grAnulomA Key WoRDS: granuloma, foreign-body, cholesterol, brain diseases. granuloma de colesterol cerebral: relato de casoReSUMo -Granulomas de colesterol intracranianos são lesões raras, sendo observados na região do ápice petroso. A ocorrência de granuloma de colesterol intracerebral é um evento incomum. Relata-se o caso de mulher de 20 anos submetida a craniotomia para ressecção de processo expansivo temporal, com exame anátomo-patológico evidenciando um granuloma de colesterol.PAlAvRAS-ChAve: granuloma de corpo estranho, colesterol, doenças cerebrais.
Objectives: The temporal venous drainage is essential to the favorable prognosis of the patients whose require subtemporal and petrosal approaches to the skull base. To obtain adequate exposure of the middle and posterior fossae the tentorial split is an important step. The aim of this paper is discuss the anatomical aspects of the venous patterns of the temporal lobe stressing the relevant correlations with the petrosal and tentorial approaches. Methods: The authors review the anatomic, surgical and radiological aspects of the temporal venous drainage with special concerning about the preservation of the temporal lobe integrity during the transtentorial and petrosal approaches. Results: The vein of Labbè is the most important vein of the lateral group of veins and it is present in almost 100% of the cases. The inferior system of veins is composed by three different groups of veins in the anterior, medial and posterior portions of the temporal lobe. The anteroinferior veins can be present in 70% of the temporal lobes, the medial-inferior veins in 40% and the posteroinferior in 90% of the cases. The anteroinferior and the posteroinferior groups of veins drain in an independent pattern of the lateral group in more than 10% of the cases. Conclusions: Despite of the preservation of the vein of Labbè during the transtentorial and petrosal approaches, temporal infarction has been observed as a complication of such approaches. The patterns of the venous drainage at the inferior temporal surface should be observed carefully in order to avoid temporal infarction. Angiographic preoperative studies are crucial to evaluate such venous anatomy. The correct positioning of the tentorial incisions according with the temporal venous anatomy and the intermittent gentle temporal retraction are the technical aspects, which permit the better final results.
SINOPSEIntrodução: O acesso transbasal é uma abordagem interessante para o manejo de patologias que acometem a base do crânio anterior, sejam elas intradurais ou extra durais. Estas lesões podem ter localização exclusiva no compartimento intracraniano, bem como estenderem-se aos terços superior e médio da face, tornando este acesso uma alternativa para as lesões craniofaciais.Objetivo: A revisão da utilização do acesso transbasal para o manejo das patologias da base do crânio e craniofaciais, assim como a discussão das vantagens desta via em relação às demais abordagens descritas na literatura. Material e método: Foram comentadas as principais etapas da técnica cirúrgica do acesso transbasal e apresentados três casos clínicos distintos para a ilustração da aplicação da abordagem.Conclusão: Os resultados obtidos com esta via para o tratamento destas lesões são muito satisfatórios, oferecendo ampla possibilidade de acesso, com resultados cosméticos excelentes, evitando incisões na face. A possibilidade de fístula de líquor é a complicação mais comum e que requer especial atenção.Palavras-chave: Abordagem transbasal, tumores da base de crânio, tumores craniofaciais, cirurgia da base de crânio. ABSTRACT Transbasal approach for the management of the skull base and craniofacial pathologies. Report of 3 casesIntroduction: The transbasal approach is interesting to the management of the pathologies of the anterior skull base in the intradural and extradural compartments. Such lesions can also extend to the upper and middle third of the face, becoming the approach an alternative to the treatment of the craniofacial diseases.Objective: To review the application of the transbasal approach to the treatment of the anterior skull base and craniofacial pathologies. The advantages of such approach are also discussed. Material and method:The key steps of the surgical technique are described and three clinical cases are presented with, to illustrate the approach. Conclusion:The results obtained in the management of the lesions located in the craniofacial and anterior skull base are encouraging, with wide exposition of the region and excellent cosmetic results, avoiding facial incisions. CSF leakage is the most frequent complication and it requires special attention. RelatosDA SILVA CE, MENDONÇA R, SOARES VB, PERON C -Aborgagem transbasal para o manejo de afecções da base do crânio e craniofaciais J Bras Neurocirurg 18 (3): 50-55, 2007 Relatos DA SILVA CE, MENDONÇA R, SOARES VB, PERON C -Aborgagem transbasal para o manejo de afecções da base do crânio e craniofaciais J Bras Neurocirurg 18 (3): 50-55, 2007
O Neuroblastoma olfatório foi primeiramente descrito por Berger e Luc em 1924. É encontrada em incidência bimodal mais comumente encontrada nas faixas de idade dos 10 aos 30 anos e dos 50 aos 70 anos e constituem 3% dos tumores intranasais. É uma neoplasia que normalmente se apresenta no teto da cavidade nasal, podendo avançar localmente e/ou metastatizar. Sintomas principais incluem cefaleia, dor local, obstrução nasal, anosmia, epistaxe e rinorreia. Apresentamos um caso em que a paciente apresentava somente cefaleia bifrontal de forte intensidade, sendo realizada tomografia computadorizada de crânio, evidenciando lesão incomumente ocupando o espaço do interior do seio esfenoidal. Exérese da lesão foi realizada através de cirurgia endoscópica e a imunohistoquimica comprovou Neuroblastoma Olfatório de seio respiratório. Recebeu alta no segundo dia pós-operatório. Concluindo, deve-se investigar sempre até mesmo queixas comuns, identificando possíveis lesões precocemente, iniciando o tratamento em fases iniciais da doença e facilitando o seguimento e melhorando o prognóstico frente a esta doença.
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