Central neurocytomas of uncommon locations - Report of two cases

We report two patients with central neurocytomas at an uncommon location in the brain. the first, a 58-year-old man presenting with signs and symptoms of increased intracranial pressure, had a tumor located at the pineal region. the second, a 21-year-old woman with tumor in the aqueductal region had worsening migraine-like headaches and diplopia. Both patients had obstructive hydrocephalus treated by neuroendoscopic third ventriculostomy and biopsy of the tumors. No additional treatment was done. We conclude that neurocytomas should be considered in the differential diagnosis of tumors located in the pineal and acqeductal regions.Universidade Federal de São Paulo, Dept Neurol & Neurosurg, Discipline Neurosurg, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Discipline Neurosurg, São Paulo, SP, BrazilWeb of Scienc

Major depressive disorder as a predictor of a worse seizure outcome one year after surgery in patients with temporal lobe epilepsy and mesial temporal sclerosis

Purpose: the association between pre-surgical psychiatric disorders (PDs) and worse seizure outcome in patients with refractory epilepsy submitted to surgery has been increasingly recognized in the literature. the present study aimed to verify the impact of pre- and post-surgical PD on seizure outcome in a series of patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS).Method: Data from 115 TLE-MTS patients (65 females; 56.5%) who underwent cortico-amygdalohip-pocampectomy (CAH) were analyzed. Pre- and post-surgical psychiatric evaluations were performed using DSM-IV and ILAE criteria. the outcome subcategory Engel IA was considered as corresponding to a favorable prognosis. A multivariate logistic regression model was applied to identify possible risk factors associated with a worse seizure outcome.Results: Pre-surgical PDs, particularly major depressive disorder (MDD), anxiety and psychotic disorders, were common, being found in 47 patients (40.8%). Fifty-six patients (48.7%) were classified as having achieved an Engel IA one year after CAH. According to the logistic regression model, the presence of pre-surgical MDD (OR = 5.23: p = 0.003) appeared as the most important risk factor associated with a non-favorable seizure outcome.Conclusion: Although epilepsy surgery may be the best treatment option for patients with refractory TLE-MTS, our findings emphasize the importance of performing a detailed psychiatric examination as part of the pre-surgical evaluation protocol. (C) 2012 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilWeb of Scienc

Transtornos de humor pré-cirúrgicos associados ao prognóstico pós-cirúrgico desfavorável em pacientes com epilepsia do lobo temporal e esclerose mesial temporal

OBJECTIVES: This study aims at verifying the impact of pre-surgical PD on seizure outcome in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). METHODS: After previous consent, retrospective data from 115 surgically treated (corticoamygdalohyppocampectomy) TLE-MTS patients (65 females; 56.5%) were analyzed. Psychiatric evaluations were performed through DSM-IV criteria. Engel IA was established as a favorable prognosis. RESULTS: Forty-five patients (41.6%) were classified as Engel IA, while 47 (40.8%) presented pre-surgical PD. Depression (OR=5.11; p=0.004) appeared as a risk factor associated to a non-favorable seizure outcome. CONCLUSION: In patients with refractory TLE-MTS, the presence of depression predicts an unfavorable outcome.OBJETIVO: No presente trabalho avaliamos o impacto da presença de transtorno psiquiátrico pré-cirúrgico sobre o prognóstico cirúrgico em pacientes com epilepsia do lobo temporal e esclerose mesial temporal (ELT-EMT). METODOLOGIA: Analisamos, retrospectivamente, os dados de 115 pacientes com ELT-EMT (65 mulheres, 56,5%) tratados cirurgicamente (corticoamigdalohipocampectomia). As avaliações psiquiátricas foram feitas de acordo com os critérios DSM-IV. O prognóstico favorável foi definido como ausência de crises desde a cirurgia (Engel IA). RESULTADOS: Dos 115 pacientes tratados, 45 (42,6%) tiveram prognóstico favorável e 47 (40,8%) apresentavam transtorno psiquiátrico pré-operatório. A presença de depressão (OR=5,11; p=0,004) foi associada ao prognóstico cirúrgico desfavorável. CONCLUSÃO: A presença de depressão durante a avaliação psiquiátrica pré-operatória é um fator preditivo de prognóstico desfavorável em pacientes com ELT-EMT.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Department of Neurology and NeurosurgeryUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Laboratório Interdisciplinar de Neurociências ClínicasUNIFESP, Department of Neurology and NeurosurgeryUNIFESP, Department of Psychiatry Laboratório Interdisciplinar de Neurociências ClínicasSciEL