Metastatic meningioma to the eleventh dorsal vertebral body: total en bloc spondylectomy. Case report and review of the literature
Metástasis de meningioma en la undécima vértebra dorsal: vertebrectomía total en bloque. Caso clínico y revisión de la literatura
P.D. Delgado-López
, V. Martín-Velasco, J.M. Castilla-Díez, O. Fernández-Arconada, A. Galacho-Harnero, A. Rodríguez-Salazar
Servicios de Neurocirugía. Hospital General Yagüe. Burgos
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Alday" "autores" => array:1 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Alday" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147306703451?idApp=UINPBA00004B" "url" => "/11301473/0000001700000003/v1_201305151254/S1130147306703451/v1_201305151254/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Metastatic meningioma to the eleventh dorsal vertebral body: total en bloc spondylectomy. Case report and review of the literature" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "240" "paginaFinal" => "249" ] ] "autores" => array:2 [ 0 => array:4 [ "autoresLista" => "P.D. Delgado-López, V. Martín-Velasco, J.M. Castilla-Díez, O. Fernández-Arconada, A. Galacho-Harnero, A. Rodríguez-Salazar" "autores" => array:6 [ 0 => array:3 [ "nombre" => "P.D." "apellidos" => "Delgado-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Martín-Velasco" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Castilla-Díez" ] 3 => array:2 [ "nombre" => "O." "apellidos" => "Fernández-Arconada" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Galacho-Harnero" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Salazar" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicios de Neurocirugía. Hospital General Yagüe. Burgos" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Neurocirugía. Hospital General Yagüe. Avda Cid 96. 09005 Burgos." ] ] ] 1 => array:3 [ "autoresLista" => "E.M.ª Corrales-García, B. Pérez-Mies" "autores" => array:2 [ 0 => array:3 [ "nombre" => "E.M.ª" "apellidos" => "Corrales-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Pérez-Mies" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oncología Radioterápica. Hospital Divino Valles. Burgos" "etiqueta" => "<span class="elsevierStyleSup">*.</span>" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Servicios de Anatomía Patológica. Hospital General Yagüe. Burgos" "etiqueta" => "<span class="elsevierStyleSup">**.</span>" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis de meningioma en la undécima vértebra dorsal: vertebrectomía total en bloque. Caso clínico y revisión de la literatura" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-03-31" "fechaAceptado" => "2005-05-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159285" "palabras" => array:3 [ 0 => "Total spondylectomy" 1 => "Meningioma" 2 => "Metastasis, radical resection, en bloc resection" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159284" "palabras" => array:5 [ 0 => "Vertebrectomía total" 1 => "Meningioma" 2 => "Metástasis" 3 => "Resección radical" 4 => "Resección en bloque" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">One in every thousand intracranial meningiomas metastatize extracranially. Lung and intraabdominal organs are most frequently affected. Only 7% involve vertebrae and just a dozen cases have been reported in the literature. To our knowledge, this is the first description of a total en bloc spondylectomy through a posterior approach for the treatment of an intraosseous metastatic meningioma to the eleventh dorsal vertebra.</p> <span class="elsevierStyleSectionTitle">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In March 1996, a 37 year-old male underwent surgical resection for a left occipital intraventricular benign meningioma (WHO I). He was reoperated in February 2002 due to local recurrence. By the end on 2003 he developed progressively invalidating dorsolumbar pain. MRI studies revealed a T11 intraosseous mass. In March 2004, a percutaneous biopsy and vertebroplasty were performed. The pathological specimen was identified as adenocarcinoma and he initiated chemotherapy. Advice from a second pathologist was seeked, who suggested the diagnosis of intraosseous meningioma. Workup studies failed to reveal any primary tumor. In May 2004 the patient was admitted to our department and a new transpedicular biopsy confirmed the diagnosis. In June 2004 he underwent T11 total en bloc spondylectomy (Tomita's procedure), fusion with bone and calcium substitute-filled stackable carbon-fiber cages, and T9 to L1 transpedicular screw fixation. No postoperative complications ocurred and he is, so far, free from primary and secondary disease. Definite pathology: benign meningioma (WHO I).</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distant metastases from intracranial meningiomas are rare entities, arising from benign lesions in, at least, 60% of cases. Enam et al proposed a specific pathological score to differentiate benign, atypic and malignant meningiomas. Such score correlates with the chance of metastatizing: more than 40% in malignant meningiomas compared to 3.8% of brain tumors overall. The ability to metastatize seems to be linked to vascular or lifatic invasiveness. Metastases ocurr more frequently in angioblastic, papillary and meningothelial variants. Hematogenous (especially venous; Batson's perivertebral plexus), linfatic and cerebrospinal fluid are the main routes involved in the spreading of the tumor. Craniotomy itself may also play a role, for the majority of patients have been previously operated on repeatedly. The interval between the onset of the intracranial disease and the appearance of the metastasis varies from months to many years. The value of transpedicular biopsy is widely recognized (efficacy over 80%) and the suitability of the specimen for pathological examination improves when wide inner caliber trephines are used. In the case presented we applied the oncologic concept of vertebral en bloc resection. We believe this case represents a paradigmatic indication of this technique because it respects the concepts of radical resection and spinal stability, and offers an opportunity for the curation of the disease.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las metástasis distantes de meningioma intracraneal ocurren en uno de cada mil meningiomas. La mayor parte afectan a pulmón u órganos intraabdominales. Sólo un 7% aparecen en vértebras. Se han publicado en torno a una docena de casos. Presentamos la primera descripción hasta la fecha de una vertebrectomía completa por vía posterior para tratar una metástasis intraósea de meningioma benigno en el cuerpo de T11.</p> <span class="elsevierStyleSectionTitle">Caso clínico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Varón de 37 años de edad, intervenido en otro centro en Marzo de 1996 de meningioma benigno intraventricular occipital izquierdo de tipo transicional (OMS tipo I). Precisó reintervención por recidiva local en Febrero de 2002. A finales de 2003 comenzó con dolor dorsolumbar intenso y el estudio de RM espinal evidenció una masa intrósea en T11. En Marzo de 2004 se realizó biopsia transpedicular y vertebroplastia acrílica. El resultado histológico fue de adenocarcinoma y el paciente comenzó a recibir quimioterapia. Una segunda opinión sobre las muestras histológicas sugirió el diagnóstico de meningioma. El estudio de extensión tumoral no evidenció otra neoplasia primaria. En Mayo de 2004 ingresó en nuestro servicio donde se repite la biopsia transpedicular que confirma el diagnóstico de meningioma. En Junio de 2004 se realizó vertebrectomía T11 completa por vía posterior, según técnica de Tomita, artrodesis intersomática con cajas apilables de fibra de carbono rellenas de injerto óseo y sustituto cálcico, y fijación transpedicular T9 a L1. La evolución postoperatoria fue satisfactoria y, actualmente, se encuentra libre de enfermedad primaria y secundaria. Anatomía patológica definitiva: meningioma benigno (OMS I).</p> <span class="elsevierStyleSectionTitle">Discusión</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las metástasis distantes de meningiomas intracraneales son entidades raras que en más del 60% de los casos provienen de meningiomas benignos. Enam y cols diseñaron una gradación según parámetros histológicos para diferenciar los meningiomas benignos de los atípicos y malignos. Dicha gradación correlaciona con la probabilidad de producir metástasis distantes: más del 40% en los meningiomas malignos frente a una media del 3.8% de todos los tumores cerebrales. La posibilidad de metastatizar parece relacionarse con la capacidad de invasividad vascular o linfática. Las metástasis son más frecuentes en las variantes angioblástica, papilar y meningotelial. Se describen tres vías de diseminación: hematógena (sobre todo venosa; plexo perivertebral de Batson) linfática y por LCR. La craneotomía podría ser otra vía de diseminación pues la mayoría de los pacientes han sido previamente multioperados del tumor craneal. El tiempo transcurrido entre el diagnóstico del meningioma intracraneal y la aparición de la metástasis vertebral puede variar entre meses y años. La rentabilidad diagnóstica de la biopsia transpedicular es mayor del 80% y mejora cuanto mayor es el diámetro interno de la trefina utilizada. En el caso descrito, aplicamos el concepto oncológico de resección en bloque de la vértebra afectada. Creemos que se trata de una indicación paradigmática de esta técnica pues respeta los conceptos de resección radical y estabilidad de la columna, y otorga una oportunidad de curación de la enfermedad.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Delgado-López, P.D.; Martín-Velasco, V.; Castilla-Díez, J.M.; Fernández-Arconada, O.; Corrales-García, E.M.; Galacho-Harnero, A.; Rodríguez-Salazar, A.; Pérez-Mies, B.: Metastatic meningioma to the eleventh dorsal vertebral body: total en bloc spondylectomy. Case report and review of the literature. Neurocirugía 2006; 17: 240–249.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:47 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Diciembre | 0 | 2 | 2 |
| 2023 Agosto | 0 | 1 | 1 |
| 2023 Marzo | 3 | 1 | 4 |
| 2022 Enero | 0 | 2 | 2 |
| 2021 Diciembre | 0 | 2 | 2 |
| 2018 Marzo | 0 | 5 | 5 |
| 2018 Febrero | 9 | 3 | 12 |
| 2018 Enero | 12 | 6 | 18 |
| 2017 Diciembre | 13 | 14 | 27 |
| 2017 Noviembre | 44 | 17 | 61 |
| 2017 Octubre | 9 | 11 | 20 |
| 2017 Septiembre | 11 | 9 | 20 |
| 2017 Agosto | 7 | 9 | 16 |
| 2017 Julio | 9 | 9 | 18 |
| 2017 Junio | 21 | 21 | 42 |
| 2017 Mayo | 22 | 13 | 35 |
| 2017 Abril | 17 | 10 | 27 |
| 2017 Marzo | 10 | 6 | 16 |
| 2017 Febrero | 4 | 3 | 7 |
| 2017 Enero | 12 | 5 | 17 |
| 2016 Diciembre | 47 | 13 | 60 |
| 2016 Noviembre | 40 | 14 | 54 |
| 2016 Octubre | 41 | 10 | 51 |
| 2016 Septiembre | 26 | 15 | 41 |
| 2016 Agosto | 0 | 9 | 9 |
| 2016 Julio | 0 | 4 | 4 |
| 2016 Febrero | 3 | 0 | 3 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Julio | 1 | 0 | 1 |
| 2015 Junio | 25 | 4 | 29 |
| 2015 Mayo | 50 | 8 | 58 |
| 2015 Abril | 29 | 9 | 38 |
| 2015 Marzo | 31 | 8 | 39 |
| 2015 Febrero | 31 | 11 | 42 |
| 2015 Enero | 28 | 14 | 42 |
| 2014 Diciembre | 42 | 12 | 54 |
| 2014 Noviembre | 19 | 11 | 30 |
| 2014 Octubre | 33 | 9 | 42 |
| 2014 Septiembre | 24 | 12 | 36 |
| 2014 Agosto | 21 | 14 | 35 |
| 2014 Julio | 26 | 9 | 35 |
| 2014 Junio | 15 | 14 | 29 |
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| 2014 Marzo | 20 | 21 | 41 |
| 2014 Febrero | 25 | 17 | 42 |
| 2014 Enero | 18 | 9 | 27 |
| 2013 Diciembre | 25 | 10 | 35 |
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| 2013 Octubre | 28 | 14 | 42 |
| 2013 Septiembre | 35 | 15 | 50 |
| 2013 Agosto | 43 | 25 | 68 |
| 2013 Julio | 35 | 21 | 56 |
| 2013 Junio | 21 | 13 | 34 |
| 2013 Mayo | 19 | 19 | 38 |
| 2013 Abril | 29 | 16 | 45 |
| 2013 Marzo | 17 | 17 | 34 |
| 2013 Febrero | 12 | 9 | 21 |
| 2013 Enero | 22 | 12 | 34 |
| 2012 Diciembre | 18 | 14 | 32 |
| 2012 Noviembre | 0 | 4 | 4 |
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| 2012 Enero | 5 | 0 | 5 |
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