Ressecção microcirúrgica de um astrocitoma pilocítico de tronco cerebral - um relato de caso / Microsurgery resection of a brainstem pilocytic astrocytoma- a case report
DOI:
https://doi.org/10.34119/bjhrv5n1-107Keywords:
Astrocitoma pilocítico, tronco cerebral, microcirurgia, neuronavegaçãoAbstract
O astrocitoma pilocítico de tronco cerebral é uma entidade menos comum na população pediátrica, usualmente acometida por este tipo de tumor, correspondendo a 9% de todos os astrocitomas pilocíticos juvenis (APJ) (Burkhard et al., 2003). Será reportado um caso de APJ em um paciente de 22 anos que se apresentava com comprometimento do VIII, IX, X e XI nervos cranianos esquerdos além de hemiparesia direita. Foi submetido a abordagem microcirúrgica com ressecção subtotal guiada por neuronavegação. A ressecção foi limitada por instabilidade hemodinâmica intraoperatória. O paciente teve remissão dos sintomas neurológicos e controle adequado da lesão em 12 meses. Serão discutidas particularidades da estratégia cirúrgica e sobre o manejo oncológico do APJ. O astrocitoma pilocítico é tido como um dos gliomas de melhor prognóstico (Ostrom et al., 2015), no entanto, a localização no tronco cerebral limita a possibilidade de ressecção completa (Cavalheiro et al., 2015). A ressecção subtotal é viável (Sherry Liu et al., 2016), devendo-se priorizar a ressecção máxima segura.
References
AARSEN, F.K; VAN DONGEN, H.R; PAQUIER, P.F; VAN MOURIK, M; CATSMAN- BERREVOETS, C.E. Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology (2004).
BANDOPADHAYAY, P. et al. MYB-QKI rearrangements in angiocentric glioma drive tumorigenicity through a tripartite mechanism. Nat. Genet. 48, 273–282 (2016).
BERG, A.L.; OLSON,T.J; FELDSTEIN, N.A. “Cerebellar Pilocytic Astrocytoma with Auditory Presentation: Case Study.” Journal of Child Neurology (2005).
BOETHIUS, J.; ULFARSSON, E.; RAHN, T.; LIPPITZ, B. Gamma knife radiosurgery for pilocytic astrocytomas. J Neurosurg (2002).
BURKHARD; CHRISTOPH; DI PATRE, Pier-luigi; SCHULER, Danille; SCHULER, Georges; YASARGIL, M.Gazi; YONEKAWA, Yasuhiro; LUTOLF, Urs M. et al. “A Population-Based Study of the Incidence and Survival Rates in Patients with Pilocytic Astrocytoma.” Journal of Neurosurgery 98 (6): 1170–1174 (2003).
CAVALCANTI, Daniel D.; PREUL, Mark C.; KALANI, M.Y.S; SPETZLER, Robert F. “Microsurgical anatomy of safe entry zones to the brainstem.” J Neurosurg 124: 1359-1376 (2016).
CAVALHEIRO, Sergio; YAGMURLU, Kaan; DEVANIR, Marcos; MENDONÇA, Jardel; NICÁCIO; PEREIRA, Thiago; CHADDAD-NETO, Feres & RHOTON, Albert L.; Surgical approaches for brainstem tumors in pediatric patients. Childs Nerv Syst 31:1815–1840 (2015).
CHAMPAGNE, P.O; SAJADI, A.; HUOT, C.; TRAISTARU, M.; MERCIER, C.; WEIL, A.G.; CREVIER, L. Exophytic bulbar pilocytic astrocytoma and post-operative cerebral salt wasting syndrome. Medical Hypotheses (2017).
CHOURMOUZI; DANAI; PAPADOPOULO, Elissabet; KONSTANTINIDIS, Manolis; SYRRIS, Vasileios; KOUSKOURAS, Kostas; HARITANTI, Afroditi; KARKAVELAS, George. et al. “Manifestations of Pilocytic Astrocytoma: A Pictorial Review.” Insights into Imaging 5 (3): 387–402. (2014).
DIRVEN, C.M; MOOIJ, J.J; MOLENAAR, W.M. Cerebellar pilocytic astrocytoma: A treatment protocol based upon analysis of 73 cases and a review of the literature. Childs Nervous System;13:17–23. (1997).
FISHER; PAUL, G.; BREITER, Steven N.; CARSON, Benjamin S.; WHARAM, Moody D.; WILLIAMS, Jeffery A.; WEINGART, Jon D; FOER, Dana R; et al. “A Clinicopathologic Reappraisal Brain Stem Tumor Classification: Identification of Pilocytic Astrocytoma and Fibrillary Astrocytoma as Distinct Entities.” Cancer 89 (7): 1569–1576. (2000).
GE, J-J.; LI, C.; ZHANG, J-P. Long-term remission of recurrent brainstem pilocytic astrocytoma with neuraxis dissemination using recombinant human endostatin after failure of vincristine and carboplatin: A case report. World Neurosurgery. (2018).
GUILLAMO, J.S.; MONJOUR, A.; TAILLANDIER, L.; DEVAUX, B.; VARLET, P.; HAIE-MEDER, C. et al. Brainstem gliomas in adults: prognostic factors and classification. Association des Neuro-Oncologues d’Expression Française (ANOCEF). Brain. Dec; 124(Pt 12): 2528–39. (2001).
GUNNY, R.S.; HAYWARD, R.D.; PHIPPS, K.P.; HARDING, B.N.; SAUNDERS, D.E. Spontaneous regression of residual low-grade cerebellar pilocytic astrocytomas in children. Pediatr Radiol; 35:1086–91. (2005).
HALPERIN, E.C. Pediatric brain stem tumors: patterns of treatment failure and their implications for radiotherapy. Int J Radiat Oncol Biol Phys. Jul; 11(7): 1293–8. (1985).
HOJER, C.; HILDEBRANDT, G.; LANFERMANN, H. SCHRODER, R.; HAUPT, W.F. Pilocytic astrocytomas of the posterior fossa. A follow-up study in 33 patients. Acta Neurochirurgica (Wien); 129:131–139. (1994).
JALLO, G.I.; BISER-ROHRBAUGH, A.; FREED, D. Brainstem gliomas. Childs Nerv Syst. Mar; 20(3): 143–53. (2004).
JONES, D.T.; et al. Recurrent somatic alterations of FGFR1 and NTRK2 in pilocytic astrocytoma. Nat. Genet. 45, 927–932. (2013).
JONES, D.T.; KOCIALKOWSKI, S.; LIU, L.; PEARSON, D.M.; BACKLUND, L.M.; ICHIMURA, K.; COLLINS, V.P. Tandem duplication producing a novel oncogenic BRAF fusion gene defines the majority of pilocytic astrocytomas. Cancer Res; 68: 8673–8677. (2008).
KANO; NIRANJAN; KONDZIOLKA, D.; FLICKINGER, J.; POLLACK, I.; JAKACKI, R.; LUNSFORD, L. Stereotactic radiosurgery for pilocytic astrocytomas part 2: outcomes in pediatric patients. J Neuro-Oncol 95: 219–229. (2009).
KESTLE, J.; TOWNSEND, J.J.; BROCKMEYER, D.L.; WALKER, M.L. “Juvenile Pilocytic Astrocytoma of the Brainstem in Children.” Journal of Neurosurgery: Pediatrics 101 (Pediatrics 2): 1–6. (2004).
KHALID, Syed I.; KELLY, Ryan; ADOGWA, Owoicho; CARLTON, Adam; TAM, Edric; NAQVI, Salik; KUSHKULEY, Jacob; AHMAD, Shahjehan; WOODWARD, Josha; KHANNA, Ryan; DAVISON, Mark; MUNOZ, Lorenzo; BYRNE, Richard. Pediatric Brainstem Gliomas: A Retrospective Study of 180 Patients from the SEER Database. Pediatr Neurosurg. (2019).
KOELLER, K.K.; RUSHING, E.J. “From the Archives of the AFIP: Pilocytic Astrocytoma: Radiologic-Pathologic Correlation.” Radiographics: A Review Publication of the Radiological Society of North America, Inc 24 (6): 1693–1708. (2004).
LOUIS, D.N.; OHGAKI, H.; WIESTLER, O.D.; CAVENEE, W.K. WHO Classification of Tumours of the Central Nervous System. Lyon, France: IARC Press. (2007).
LOUIS, D.N.; PERRY, A.; REIFENBERGER, G.; VON DEIMLING, A.; FIGARELLA-BRANGER, D.; CAVENNEE, W.K.; OHGAKI, H.; WEISTLER, O.D.; KLEIHUES, P.M.; ELLISON,W. “The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary.” Acta Neuropathologica. 131 (6): 803–20. (2016).
MAUFFREY, C. Paediatric brainstem gliomas: prognostic factors and management. J Clin Neurosci. May; 13(4): 431–7. (2006).
MANDELL, L.R.; KADOTA, R.; FREEMAN, C.; DOUGLASS, E.C.; FONTANESI, J.; COHEN, M.E. et al. There is no role for hyperfractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brainstem tumors: results of a Pediatric Oncology Group phase III trial comparing conventional vs. Hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys. Mar; 43(5): 959–64. (1999).
MCCLAY, J.E.; BOOTH, T.N.; PARRY, D.A.; JOHNSON, R.; ROLAND, P. “Evaluation of Pediatric Sensorineural Hearing Loss with Magnetic Resonance Imaging.” Archives of Otolaryngology–Head & Neck Surgery 134 (9): 945–952. (2008).
MIRONE, G.; SCHIABELLO, L.; CHIBBARO, S.; BOUAZZA, S.; GEORGE, B. Pediatric primary pilocytic astrocytoma of the cerebellopontine angle: A case report. Childs Nervous System , 25, 247 – 251. (2009).
MONROE, J.A.; KRAUTH, L.; ARENBERG, I.K.; PRENGER, E.; PHILPOTT, P. “Normal Evoked Otoacoustic Emissions with a Profound Hearing Loss Due to a Juvenile Pilocytic Astrocytoma.” The American Journal of Otology 17 (4): 639–642. (1996).
MURRAY, R.D.; PENAR, P.L.; FILLIPI, C.G.; TARASIEWCZ, I. Radiographically distinct variant of pilocytic astrocytoma: a case series. Journal of Computer Assisted Tomography; 35(4):495–7. (2011).
NACHMAN, A.J. “Retrocochlear Hearing Loss in Infants: A Case Study of Juvenile Pilocytic Astrocytoma.” International Journal of Audiology 51 (8): 640–644. (2012).
OHGAKI, H.; KLEIHUES, P. “Population-Based Studies on Incidence, Survival Rates, and Genetic Alterations in Astrocytic and Oligodendroglialgliomas.” Journal of Neuropathology & Experimental Neurology 64 (6): 479–489. (2005).
OSTROM; GITTLEMAN; FULOP, J.; LIU, M.; BLANDA, R.; KROMER, C. WOLINSKY, Y.; KRUCHKO, C.; BARNHOLTZ-SLOAN, J. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro-Oncology Suppl 4:iv1–iv62 (2015).
PACKER, R.J.; ATER, J.; ALLEN, J.; PHILLIPS, P.; GEYER, R.; NICHOLSON, HS.; JAKACKI, R.; KURCZYNSKI, E.; NEEDLE, M.; FINLAY, J.; REAMAN, G.; BOYETT, J.M. Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas. J Neurosurg; 86: 747–754. (1997).
POMPILI, A.; CAPERLE, M.; PACE, A.; RAMAZZOTTI, V.; RAUS, L.; JANDOLO, B.; OCCHIPINTI, E. Quality-of-life assessment in patients who had been surgically treated for cerebellar pilocytic astrocytoma in childhood. Journal of Neurosurgery; 96:229–234. (2002).
RHOTON, A.L.Jr. Cerebellum and fourth ventricle. Neurosurgery 47:S7–S27. (2000).
SCHNEIDER, F.; KOMPIS, M.; OZDOBA, C.; BECK, J.; CAVERSACCIO, M; SENN, P. “Pilocytic Astrocytoma of the Cerebellopontine Angle in a Child Presenting with Auditory Neuropathy Spectrum Disorder.” Otology Neurotoogy 36: 101–103. (2015).
SCHWARTZENTRUBER, J. et al. Driver mutations in histone H3.3 and chromatin remodelling genes in paediatric glioblastoma. Nature 482, 226–231. (2012).
SHERRY, Liu J.; FOO, Denise; YEO, Tseng Tsai; HO, Kee Hang; NGA, Vincent Diong Weng; KARLSSON, Bengt. Twenty-three years follow-up after low-dose Gamma Knife surgery of a brainstem juvenile pilocytic astrocytoma: a case report and review of the literature. Child's Nervous System (2019).
SIMONOVA, G.; KOZUBIKOVA, P.; LISCAK, R.; NOVOTNY, J.J. Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results. J Neurosurg Pediatr 18:58–64. (2016).
STEINLIN, M.; IMFELD, S.; ZULAUF, P.; BOLTSHAUSER, E.; LOVBLAD, K-O.; RIDOLFI, Luthy A.; PERRIG, W.; KAUFMANN, F.; Neuropsychological longterm sequelae after posterior fossa tumour resection during childhood. Brain; 126:1998–2008. (2003).
TERASHIMA, K.; CHERNOV, M.F.; MURAGAKI, Y.; KESARI, S.; MCCUTCHEON, I.E. (eds): Intracranial Gliomas. Part II – Adjuvant Therapy. Prog Neurol Surg. Basel, Karger, vol 31, pp 162–167. (2018).
TRIFILETTI, D.; PEACH, M.; XU, Z.; KERSH, R.; SHOWALTER, T.; SHEEHAN, J. Evaluation of outcomes after stereotactic radiosurgery for pilocytic astrocytoma. J Neuro-Oncol 134:297–302. (2017).
WESSELING, P.; KROS, J.M.; JEUKEN, J.W.M.; The pathological diagnosis of diffuse gliomas: Towards a smart synthesis of microscopic and molecular information in a multidisciplinary context. Diagnostic Histopathology, 17(11), 486–494. (2011).
WHEELER, D.; WONG, H.; SHANLEY, T. Pediatric Critical Care Medicine: Basic Science and Clinical Evidence. New York, USA: Springer, p. 894. (2007).
YAMASOBA, T. Similarities and differences between auditory neuropathy and acoustic neuroma. In: K. Kaga & A. Starr (eds.). Neuropathies of the Auditory and Vestibular Eighth Cranial Nerves. New York, USA: Springer, pp. 113 – 121. (2009).
