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Thèse de Habilitation à Diriger des Recherches
DOI
10.11606/T.5.2009.tde-26032009-094135
Document
Auteur
Nom complet
Mario Augusto Taricco
Adresse Mail
Unité de l'USP
Domain de Connaissance
Date de Soutenance
Editeur
São Paulo, 2006
Jury
Reed, Umbertina Conti (Président)
Azevedo Filho, Hildo Rocha Cirne de
Chadi, Gerson
Gabbai, Alberto Alain
Machado, Hélio Rubens
Titre en portugais
Avaliação da evolução pós-operatória dos tumores intramedulares.
Mots-clés en portugais
Astrocitoma
Ependimoma
Ganglioglioma
Hemangioblastoma
Imagem por ressonância magnética
Neoplasias da medula espinhal/cirurgia
Neoplasias da medula espinhal/diagnóstico
Neoplasias da medula espinhal/patologia
Recidiva local de neoplasia
Seguimentos
Resumé en portugais
A ressonância magnética propiciou o diagnóstico preciso e precoce dos tumores intramedulares. Esse advento foi ainda mais contundente nos doentes oligossintomáticos cuja queixa principal é dor, muitas vezes não característica, e sem alteração neurológica significativa. Ainda existem controvérsias sobre se o melhor tratamento é a exerese subtotal agressiva ou parcial, associada ou não ao tratamento complementar com radioterapia e/ou quimioterapia. Foi realizado um estudo prospectivo do qual constam 48 pacientes com o diagnóstico de tumor intramedular confirmado por ressonância magnética e submetidos a tratamento cirúrgico. Dos 48 portadores desta afecção, 34 (71%) foram submetidos à exerese subtotal agressiva e 14 (29%) à exerese parcial. Quanto ao diagnóstico anatomopatológico, 32 (66,7%) eram ependimomas, sete (14,6%) angiomas cavernosos, três (6,3%) astrocitomas, dois (4,2%) astrocitomas anaplásicos, dois (4,2%) lipomas, um (2,1%) ganglioglioma e um (2,1%) hemangioblastoma. Com exceção de dois doentes portadores de astrocitoma anaplásico submetidos à radioterapia, os demais não receberam tratamento complementar após a cirurgia. Dos 14 pacientes submetidos à exerese parcial, cinco foram reoperados por apresentarem piora do quadro neurológico no período de dois anos. Na evolução pós-operatória, 19 (40%) melhoraram neurologicamente, 13 (27%) permaneceram estáveis, 12 (25%) pioraram e quatro (8%) faleceram. Os doentes oligossintomáticos melhoraram ou permaneceram estáveis e aqueles com alterações neurológicas mais graves tiveram tendência de piora ou óbito. Este estudo permite concluir que o procedimento cirúrgico com exerese subtotal agressiva é o melhor tratamento, principalmente para os doentes oligossintomáticos.
Titre en anglais
Post-operative follow-up of the intramedullary tumors evolution.
Mots-clés en anglais
Astrocytoma
Ependymoma
Follow-up studies
Ganglioglioma
Hemangioblastoma
Magnetic resonance imaging
Neoplasm recurrence local
Spinal cord neoplasms/diagnosis/pathology/surgery
Resumé en anglais
The medical imaging improvent, specially magnetic resonance imaging (MRI), made early and precise diagnosis of intramedullary spinal cord tumors possible. It was even more important for oligosintomatic patients whose main complaint is pain which, on many occasions, are uncharacteristic and without significant alterations on neurological exam. There is doubt whether the best surgical treatment is aggressive or partial excision complemented with radiotherapy and, or, chemotherapy. A prospective study was done with 48 patients with diagnosis of intramedullary spinal cord tumor confirmed by MRI and submitted to surgical treatment. Thirty four (71%) were submitted to aggressive subtotal resection and 14 (29%) to partial resection. The distribution of patients according to their anatomopathological diagnosis were 32 (66.7%) ependymomas, seven (14.6%) cavernous angiomas, three(6.3%) astrocytomas, two (4.2%) anaplastic astrocytomas, two (4.2%) lypoma, one (2.1%) ganglioglioma, and one (2.1%) hemangioblastoma. With exception of two patients that had anaplastic astrocytomas that were submitted to chemotherapy, the others had not received complementary treatment after the surgery. Of 14 patients that had partial resection, five were reoperated on for worsening of neurological status within two years. During the follow-up, 19 (40%) patients improved their neurological status, 13 (27%) remained stable, 12 (25%) worsened and four (8%) died. Those patients that were oligosintomatic improved or remained stable. Those with severe neurological alterations had a tendency to worsen or died. This study concludes that the surgical treatment with aggressive subtotal resection is the best form of treatment, specially for those patients that are oligosintomatic.
 
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Date de Publication
2009-03-27
 
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