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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Meningiomas are tumors of the cranial and spinal meninges&#44; arising from the arachnoid cap cells on the external layer of the arachnoid membrane&#46; Meningiomas are the most common primary non-glial intracranial tumors&#46; They represent 10&#8211;20&#37; of all adult intracranial tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2</span></a> Meningiomas are most commonly encountered in female and elderly patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#8211;4</span></a> They are generally solid&#44; well-vascularized&#44; benign tumors&#46; However cystic formation of the mass lesion may be seen in some instances&#46; Cystic meningiomas are quite rare&#44; and they represent only 1&#46;6&#8211;10&#37; of all meningiomas&#46; In contrast to solid meningiomas&#44; cystic meningiomas are seen more often in males than in females&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Because meningiomas are usually solid tumors &#40;as revealed by homogenous contrast enhancement&#41;&#44; diagnosis of cystic meningiomas through radiological investigations can be challenging&#46; The differential diagnosis of a solid lesion with a cystic component may include various pathologies&#44; such as hemangioblastoma&#44; neuroblastoma&#44; glioblastoma&#44; cystic astrocytoma&#44; or metastatic tumors with necrotic or cystic components&#46; Considering the incidence of cystic meningiomas&#44; they are not usually primarily considered in the differential diagnosis of these lesions&#46; The diagnosis of cystic meningiomas is usually established through histopathological investigations&#46; In this study&#44; we share our experience with six cases in order to discuss the clinical&#44; radiological&#44; surgical&#44; and pathological features of cystic meningiomas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Hospital records of the patients&#8212;all of whom underwent surgery for the excision of intracranial meningiomas&#8212;were retrospectively reviewed&#46; Six patients underwent operation for cystic meningiomas between the years 2007 and 2016&#46; The clinical&#44; radiological&#44; surgical&#44; and pathological features of these six patients were analyzed&#46; For each patient&#44; history of the complaints&#44; additional health problems&#44; and drug usage information were recorded&#46; Each patient had a complete neurological examination and radiological evaluation performed&#46; Each patient underwent preoperative magnetic resonance imaging &#40;MRI&#41; studies with and without contrast&#44; and preoperative computed tomography &#40;CT&#41; scans of the brain were performed in order to evaluate calcifications within the tumor and changes in the adjacent bony structures&#46; Nauta and Rengachary Classifications were used to describe the cyst location&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;7</span></a> Postoperative CT scans were performed within six hours following surgery in each patient&#46; In addition&#44; postoperative MRI was performed within 24<span class="elsevierStyleHsp" style=""></span>h following surgery in three patients&#46; Each patient underwent postoperative MRI scans at the third and 12th months after the operation&#59; the MRI scans were then repeated annually&#46; The patients were followed up in the outpatient clinic&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 1979&#44; Nauta et al&#46; divided cystic meningiomas into four subtypes according to the location of the cyst in relation to the brain and the tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> We have categorized our patients according to this classification&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 1</span> &#8211; Cyst formation is in the center of the tumor&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 2</span> &#8211; Cyst formation is at the periphery but still within the margins of the tumor&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 3</span> &#8211; Peritumoral cyst formation is seen in the adjacent brain rather than the tumor itself&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 4</span> &#8211; Cyst formation is at the interface between the tumor and the brain&#46;</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">In addition to this classification&#44; Rengachary classified meningiomas into two groups&#58; intratumoral and peritumoral cystic meningiomas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Besides the classification of Nauta&#44; we have also categorized our patients according to this classification&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The clinical features of the patients in the current series are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All patients presented with long standing headache dating back at least two years&#46; There was no gender predominance in our series &#40;three males and three females for a total of 6 patients&#41;&#46; The mean age of the patients was 57&#46;3 years &#40;range&#58; 27&#8211;76&#41;&#46; Radiological evaluation revealed two parasagittal and two convexity mass lesions with a cystic formation located at the frontal region&#46; In one patient&#44; the mass lesion was located at the tuberculum sellae and at the foramen magnum in one patient&#46; The tumors had cystic components and homogenously contrast-enhancing mural nodules&#44; as shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a>&#46; Two patients had <span class="elsevierStyleItalic">type 1</span> cystic meningiomas&#44; three patients had <span class="elsevierStyleItalic">type 2</span>&#44; and one patient had <span class="elsevierStyleItalic">type 4</span> according to the Nauta classification &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a>&#41;&#46; According to Rengachary classification&#44; there were four patients with peritumoral cystic meningiomas and two patients with intratumoral cystic meningiomas&#46; Two of the six patients &#40;33&#37;&#41; had cystic meningiomas in a parasagittal location&#46; All patients had a mural nodule and a concomitant cystic component&#46; MRI imagings revealed a dural tail in two patients&#46; The only patients who exhibited a contrast-enhanced cyst wall were the two patients with intratumoral cystic meningiomas&#46; In the diffusion-weighted images &#40;DWI&#41; series&#44; all of the lesions showed restriction of the mural nodule&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Operative technique</span><p id="par0055" class="elsevierStylePara elsevierViewall">The head position was established according to the tumor location in each patient&#46; In three instances&#44; the surgical planning was performed with the help of neuronavigation&#46; A merged CT- and MRI-neuronavigation system &#40;StealthStation<span class="elsevierStyleSup">&#174;</span> S7<span class="elsevierStyleSup">&#174;</span> System&#44; Medtronic&#44; Louisville&#44; USA&#41; was used in these three cases&#44; with frontal&#44; foramen magnum&#44; and parasagittal meningiomas&#46; Patients were managed according to standard microsurgical technique&#46; In two of these cases&#44; a PENTERO 900 surgical microscope &#40;Carl Zeiss&#41; equipped with the YELLOW-560 filter was used&#46; In these instances&#44; 2<span class="elsevierStyleHsp" style=""></span>ml &#40;2&#8211;4<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#41; of sodium-fluorescein &#40;Na-Fl&#41; &#40;10&#37;&#41; were injected intravenously through a central venous catheter after anesthesia induction&#46; The dura is always stained with Na-Fl under the YELLOW-560 filter following craniotomy&#46; The surgical plan created in the neuronavigation console was used&#44; and the surgical strategy was planned in a three-dimensional environment&#46; After exposure of the tumor&#44; the filter was switched&#44; and Na-Fl enhancement was documented&#46; Tumor dissection and resection were then performed using a standard microneurosurgical technique under white microscope light&#44; and the surgical field was periodically checked with the YELLOW-560 filter&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In five of the patients&#44; tumors were seen with a cystic formation and were dissected from the surrounding tissue&#46; The mass lesions were excised totally with the cyst capsule&#46; In one patient with a tuberculum sellae meningioma&#44; the sylvian fissure was opened&#44; and after removing the cerebrospinal fluid &#40;CSF&#41; from the carotid cistern&#44; optic nerves were identified and carefully dissected from the tumor&#46; The tumor was totally removed following the cyst puncture and internal tumor debulking&#46; After total excision of the lesions&#44; the dura was coagulated in one patient&#44; in five patients dural excision is made because of the dural invasion&#46; Galeal grafts that were harvested were used as dural substitute for dural closure&#46; No bony invasion was seen in any patient&#46; Craniotomy flap was repositioned in all of the patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In two patients who received Na-Fl&#44; the dura was enhanced with Na-Fl under the YELLOW-560 filter&#46; These two tumors in the current series showed diffuse&#44; strong Na-Fl enhancement&#46; Tumor tissue was enhanced until the end of tumor removal&#46; Both tumors were left frontal &#40;one convexity and one parasagittal&#41; tumors that had peritumoral cysts&#46; Na-Fl was very useful for clearly demonstrating the cleavage between brain tissue and the tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The cyst walls showed marked Na-Fl staining during surgery &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; It was particularly useful during tumor dissection and peeling away of the cyst wall from the adjacent cortical surface in order to achieve a total resection&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The clinical&#44; radiological&#44; and pathological features of the patients in the current series are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All of the tumors were totally excised &#40;Simpson Grade I and&#47;or Grade II&#41;&#46; Histopathologically&#44; all of the tumors were found to be World Health Organization &#40;WHO&#41; Grade I meningiomas&#46; Three patients had a pathology result of meningothelial meningioma&#44; whereas in two patients the pathology was reported as angiomatous meningioma&#44; and one patient had metaplastic meningioma according to the WHO 2007 classification&#46; Pathological specimens revealed no mitosis or necrosis&#46; The cyst capsules were separately sended to pathology in those two instances with Na-Fl enhancement&#46; They were positive for meningioma cells&#46; Detailed pathological staining results are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; None of the patients had any complications after the surgery&#46; Patients left the hospital with no neurological deficits&#46; Patients with seizures were seizure-free after three months&#44; and no neurological deficits or recurrences were noted&#46; The patients were followed-up for a mean period of 51 months &#40;range&#58; 16&#8211;102 months&#41; without recurrence&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Meningiomas are extra-axial tumors that are usually solid and they rarely present with cystic component along with the solid part&#46; They tend to have a good prognosis&#59; however&#44; meningiomas with cystic components may have a relatively aggressive natural clinical course&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> In solid meningiomas&#44; hyperostosis is a common finding&#46; If additional bone destruction is demonstrated on the CT scan&#44; it may be related to malignant behavior or to the invasive nature of the tumor&#44; which is indicative of poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> However&#44; that was not the case in our series&#46; On the contrary&#44; the meningiomas in this series had a very benign clinical course&#46; This may be related to two factors&#58; <a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> total removal of the meningiomas&#44; including the cyst wall&#44; and <a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> relatively benign histopathological features &#40;lower ki-67 index&#44; lower number of mitosis&#41;&#46; Today&#44; MRI and CT imaging technologies may contribute to the differential diagnosis of these cystic meningiomas&#46; In MRI&#44; dural enhancement is a typical sign of meningiomas&#44; which is called the &#8220;dural tail sign&#46;&#8221; The presence of a dural tail sign leads the surgeon to reconsider the prediagnosis&#46; Because meningiomas are generally isointense in the T1 sequence and isointense or hyperintense in the T2 sequence&#44; a contrast-enhanced series helps locate the contrast-enhanced mural nodule&#44; cystic formation&#44; and dural tail sign &#40;if present&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Unlike those of gliomas or metastatic glial tumors&#44; the cyst walls of meningiomas do not always enhance with contrast&#46; This could distinguish the cyst walls formed by gliotic tissue from those of tumor cells&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Total surgical excision generally results in total remission&#59; however&#44; to prevent the recurrence&#44; the cyst capsule must be removed totally along with the tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#8211;11</span></a> Recent studies show that contrast enhancement can be caused by the tumor cells embedded within the cyst wall&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> However&#44; although the cyst wall has no contrast enhancement&#44; tumor cells can be found within&#46; If the tumor is not totally resected&#44; there may be an increased risk of recurrence&#46; Peeling away of the cyst wall from the adjacent cortical surface should be performed meticulously&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Sodium fluorescein &#40;Na-Fl&#41; is a sodium salt and an organic fluorescent dye with peak excitation at 490<span class="elsevierStyleHsp" style=""></span>nm and emission between 500 and 550<span class="elsevierStyleHsp" style=""></span>nm&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> Several studies have shown the promising use of high-dose Na-Fl for determining the extent of resection under normal microscope light in various tumors&#44; including meningiomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#8211;22</span></a> A newly developed microscope &#40;PENTERO 900&#44; Carl Zeiss&#44; Meditec&#44; Oberkochen&#44; Germany&#41; equipped with a special filter &#40;YELLOW-560<span class="elsevierStyleHsp" style=""></span>nm&#41; designed to detect low-dose Na-Fl for the demarcation of tumor tissue was previously introduced&#44; and more promising reports have been published regarding extensive tumor resection with the use of this system&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#8211;33</span></a> However&#44; these studies have mainly focused on the resection of intra-axial brain tumors&#46; To our knowledge&#44; only Da Silva et al&#46; published their surgical results of Na-Fl-guided resection of extra-axial brain tumors under standard white microscope light&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#8211;22</span></a> By using quantitative digital analysis of tumor enhancement with Na-Fl&#44; they objectively demonstrated a strong presence of enhancement in all of the tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> They noted that all of the tumors showed marked contrast enhancement &#40;gadolinium&#41; on preoperative MRI&#44; and this corresponded well with the Na-Fl enhancement because a disrupted blood brain barrier plays a role in the effect mechanism of both drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> All meningiomas and dural tails showed strong Na-Fl enhancement intraoperatively&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> The current series contains two cystic meningiomas&#44; which were surgically removed with the use of Na-Fl under a YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm filter&#46; As stated before&#44; Na-Fl was found to be very useful in demonstrating the brain-tumor interface&#44; and it was especially effective in resecting the cyst wall in peritumoral cystic meningiomas&#46; Its effects on solid meningioma surgery require further investigation&#44; but Na-Fl guidance was found to be a useful technical adjunct in cystic meningioma surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">There have been some studies in the literature concerning the pathophysiology of cyst formation since the 1970s&#46; In these studies&#44; it has been shown that the degeneration&#44; hemorrhage&#44; and ischemia in the central region of the tumor lead to cystic formation&#59; peripherally-located cyst formation is generated by the gathering of the xanthochromic fluid in the subarachnoidal space and reactive gliosis&#46; In addition&#44; white matter edema and perfusion deficits may cause demyelination&#44; leading to the formation of cystic cavities&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;34</span></a> Thus&#44; cystic meningiomas have a higher risk of intratumoral hemorrhage than solid meningiomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;35</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In our study&#44; out of six patients&#44; four of them had intratumoral cyst component &#40;&#37;66&#46;6&#41;&#46; This was not consistent with the recent literature showing that peritumoral cystic meningiomas are more common than intratumoral cystic meningiomas&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> Previous studies have shown that cystic meningiomas tend to be found in the cerebral convexity and parasagittal regions&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">35&#44;37</span></a> In our study two of the six patients had cystic meningiomas in a parasagittal location and two patients&#8217; lesions were located in the cerebral convexity&#46; Even though there are limited number of cases in our study&#44; our results were consistent with the previous literature&#46; The number of cases should be augmented in order to get reliable data regarding this matter&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nauta et al&#46; described the cyst location associated with meningiomas in four categories&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> We have seen cysts of type 1 in two patients&#59; type 2 in three patients and type 4 in one patient&#46; There is not a certain predominance according to Nauta classification however&#44; previous case reports also show predominance of type 1 and 2 cysts&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In our study&#44; we found that all of the mural nodules showed restriction on DWI series on MRI which was consistent with the previous literature&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> MRI of two patients with intratumoral cystic meningiomas revealed contrast-enhanced cyst wall&#46; Because we know that the cyst wall enhancement can be found in intratumoral cystic meningiomas rather than the peritumoral cystic meningiomas&#44; we can claim that these findings are consistent with the recent literature&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Cystic meningiomas are rare entities within the meningioma group&#46; Because their differential diagnosis includes cystic astrocytomas&#44; hemangioblastomas&#44; neuroblastomas&#44; glial tumors&#44; and metastatic tumors&#44; it is important to note the specific changes in MRI induced by cystic meningiomas&#44; such as the dural tail sign&#46; In the literature&#44; it is somehow controversial that when the tumor is totally resected with the cyst capsule the prognosis is better&#59; however&#44; it is recommended to resect the capsule whenever possible&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> Na-Fl could be used as a useful adjunct to resect the cyst wall or capsule&#46; Because it is challenging to identify the diagnosis preoperatively because of the nonspecific clinical and radiological features&#44; it is important to include meningiomas in the differential diagnosis of intracranial cystic lesions&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests&#46;</p></span></span>"
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            0 => "Meningiomas qu&#237;sticos"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although meningiomas are the most common primary non-glial intracranial tumors&#44; cystic meningiomas are quite rare&#46; This study presents six cases in order to discuss the radiological and pathological features of cystic meningiomas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Six patients with cystic meningiomas were included in the study&#46; All patients underwent a cranial computed tomography scan and magnetic resonance imaging &#40;MRI&#41; evaluation&#44; pre- and postoperatively&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All patients presented with long standing headache dating back at least two years&#46; There was no gender predominance in our series&#46; Radiological evaluation revealed two parasagittal and two convexity meningiomas located at the frontal region&#46; Two lesions were located at the tuberculum sellae and the foramen magnum&#46; All of the tumors were totally excised &#40;Simpson Grade I or II&#41;&#46; Pathology results included meningothelial meningioma in three patients&#44; angiomatous meningioma in two patients&#44; and metaplastic meningioma in one patient&#46; In two patients&#44; the cystic meningiomas were resected with the use of sodium fluorescein &#40;Na-Fl&#41; under a YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm microscope filter&#46; Na-Fl was found to be very useful in demonstrating the brain&#8211;tumor interface&#44; and it was especially effective in resecting the cyst wall of the peritumoural cystic meningiomas&#46; None of the patients had any complications&#44; and no recurrences were noted in any of the patients within the mean follow-up period of 51 months &#40;range&#58; 16&#8211;102 months&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">It is important to note MRI changes specific to cystic meningioma and include meningiomas in the differential diagnosis of intracranial cystic lesions&#46; The use of sodium fluorescein &#40;Na-Fl&#41; under a YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm microscope filter is a useful tool to differentiate the brain-tumor interface&#44; as well as to identify the cyst wall in order to fully resect the tumor with the cystic component to avoid recurrence and achieve better clinical results&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aunque los meningiomas son los tumores intracraneales primarios no gliales m&#225;s frecuentes&#44; los meningiomas qu&#237;sticos son bastante raros&#46; Este estudio presenta 6 casos para discutir las caracter&#237;sticas radiol&#243;gicas y patol&#243;gicas de los meningiomas qu&#237;sticos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 6 pacientes con meningiomas qu&#237;sticos en el estudio&#46; Todos los pacientes se sometieron a una tomograf&#237;a computarizada craneal y a una evaluaci&#243;n por resonancia magn&#233;tica&#44; antes y despu&#233;s de la operaci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Todos los pacientes presentaron dolor de cabeza de larga duraci&#243;n de al menos 2 a&#241;os&#46; No hubo predominio de g&#233;nero&#46; La evaluaci&#243;n radiol&#243;gica revel&#243; 2 meningiomas parasagitales y 2 de la convexidad ubicados en la regi&#243;n frontal&#46; En los otros 2 pacientes las lesiones se ubicaron en el tub&#233;rculo selar y en el foramen magno respectivamente&#46; Todos los tumores fueron totalmente extirpados &#40;grado de Simpson I o II&#41;&#46; En 2 pacientes&#44; los meningiomas qu&#237;sticos se resecaron con el uso de fluoresce&#237;na de sodio bajo un filtro de microscopio AMARILLO de 560<span class="elsevierStyleHsp" style=""></span>nm&#46; Se encontr&#243; que la fluoresce&#237;na de sodio era muy &#250;til para demostrar la interfaz entre el cerebro y el tumor&#44; y fue especialmente eficaz para resecar la pared de los quistes peritumorales&#46; Los resultados de histopatolog&#237;a incluyeron meningioma meningotelial en 3 pacientes&#44; meningioma angiomatoso en 2 y meningioma metapl&#225;sico en uno&#46; Ninguno de los pacientes present&#243; ninguna complicaci&#243;n&#44; y no se observaron recurrencias en ning&#250;n paciente dentro del per&#237;odo de seguimiento medio de 51 meses &#40;rango&#58; 16-102 meses&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Es importante tener en cuenta los cambios en la resonancia magn&#233;tica espec&#237;ficos de los meningiomas qu&#237;sticos e incluir estos tumores en el diagn&#243;stico diferencial de las lesiones qu&#237;sticas intracraneales&#46; El uso de fluoresce&#237;na de sodio bajo un filtro de microscopio AMARILLO de 560<span class="elsevierStyleHsp" style=""></span>nm es una herramienta &#250;til para diferenciar la interfaz cerebro-tumor&#44; as&#237; como para identificar la pared del quiste y resecar completamente el tumor con el componente qu&#237;stico para evitar la recidiva y conseguir mejores resultados cl&#237;nicos&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Coronal and axial T1-weighted contrast-enhanced images shows a type 4 cystic meningioma at tuberculum sellae&#46; &#40;C&#41; Coronal T1-weighted contrast-enhanced image shows a type 2 cystic convexity meningioma &#40;according to Nauta Classification<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#41;&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; A mass lesion located in the left frontal region can be seen in the T1 FLAIR sequence&#44; causing a midline shift of 16<span class="elsevierStyleHsp" style=""></span>mm on the cranial MRI&#46; In addition to the cystic components&#44; a 8<span class="elsevierStyleHsp" style=""></span>mm hyperintense mural nodule is seen on the contrast-enhanced T1 sequences&#46; &#40;B&#41; Postoperative cranial CT shows total excision of the tumor&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Preoperative cranial MRI of the patient with a left frontal lesion indicates the cystic component of the lesion on the axial view of the T1 contrast enhanced sequence&#46; &#40;B&#41; Preoperative axial view of T1 contrast-enhancing sequence shows the mural nodule of the lesion&#46; &#40;C and D&#41; Postoperative cranial MRI on an axial view of the T1 contrast enhancing sequence shows the resected tumor cavity&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Cranial MRI &#8211; axial view of T1 sequence with contrast enhancement shows a mural nodule near the border of the dura along with the cystic component&#46; &#40;B&#41; Coronal view of the T2 sequence shows the cystic and solid components of the lesion&#46; &#40;C and D&#41; Postoperative contrast enhancing axial and coronal T1 sequences show total excision of the cystic-solid meningioma&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Intraoperative microscopic view of a parasagittal frontal meningioma under normal microscope light&#46; &#40;B&#41; The same meningioma showed diffuse Na-Fl staining under YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm filter&#59; note that both the cyst wall and the solid tumor show Na-Fl enhancement&#46; &#40;C&#41; Following the resection of the solid component and cyst drainage&#44; the cyst walls were excised&#46; Note the Na-Fl enhancing cyst wall within the tip of the aspirator under YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm filter&#46;</p>"
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age &#40;yrs&#41; &#8211; sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Presenting symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MRI findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; visual loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;convexity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatous meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; seizure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;parasagittal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatous meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; seizure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;parasagittal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metaplastic meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; seizure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;convexity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2065532.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">summarizes clinical&#44; radiological and pathological symptoms&#46; TS&#58; tuberculum sella&#44; FM&#58; foramen magnum&#44; LF&#58; left frontal&#44; DT&#58; dural tail seen on MRI&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age &#40;yrs&#41; &#8211; sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ki-67 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CD34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vimentin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S-100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pan-CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mitosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#62;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatous meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Clinical Research
Intracranial cystic meningiomas: A series of six patients
Meningiomas quísticos intracraneales: una serie de seis pacientes
Muhittin Emre Altunrendea,c, Burcu Gökerb, Müge Dolgunc, Mehmet Osman Akçakayab,
Autor para correspondencia
moakcakaya@gmail.com

Corresponding author.
, Mustafa Ömür Kasımcanb, Fahir Şencanb, Mustafa Kemal Hamamcıoğlub, Talat Kırışb
a Department of Neurosurgery, GOP Taksim Training and Research Hospital, Istanbul, Turkey
b Department of Neurosurgery, Istinye University Medical Faculty, Liv Hospital, Istanbul, Turkey
c Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Preoperative cranial MRI of the patient with a left frontal lesion indicates the cystic component of the lesion on the axial view of the T1 contrast enhanced sequence&#46; &#40;B&#41; Preoperative axial view of T1 contrast-enhancing sequence shows the mural nodule of the lesion&#46; &#40;C and D&#41; Postoperative cranial MRI on an axial view of the T1 contrast enhancing sequence shows the resected tumor cavity&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Meningiomas are tumors of the cranial and spinal meninges&#44; arising from the arachnoid cap cells on the external layer of the arachnoid membrane&#46; Meningiomas are the most common primary non-glial intracranial tumors&#46; They represent 10&#8211;20&#37; of all adult intracranial tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2</span></a> Meningiomas are most commonly encountered in female and elderly patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#8211;4</span></a> They are generally solid&#44; well-vascularized&#44; benign tumors&#46; However cystic formation of the mass lesion may be seen in some instances&#46; Cystic meningiomas are quite rare&#44; and they represent only 1&#46;6&#8211;10&#37; of all meningiomas&#46; In contrast to solid meningiomas&#44; cystic meningiomas are seen more often in males than in females&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Because meningiomas are usually solid tumors &#40;as revealed by homogenous contrast enhancement&#41;&#44; diagnosis of cystic meningiomas through radiological investigations can be challenging&#46; The differential diagnosis of a solid lesion with a cystic component may include various pathologies&#44; such as hemangioblastoma&#44; neuroblastoma&#44; glioblastoma&#44; cystic astrocytoma&#44; or metastatic tumors with necrotic or cystic components&#46; Considering the incidence of cystic meningiomas&#44; they are not usually primarily considered in the differential diagnosis of these lesions&#46; The diagnosis of cystic meningiomas is usually established through histopathological investigations&#46; In this study&#44; we share our experience with six cases in order to discuss the clinical&#44; radiological&#44; surgical&#44; and pathological features of cystic meningiomas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Hospital records of the patients&#8212;all of whom underwent surgery for the excision of intracranial meningiomas&#8212;were retrospectively reviewed&#46; Six patients underwent operation for cystic meningiomas between the years 2007 and 2016&#46; The clinical&#44; radiological&#44; surgical&#44; and pathological features of these six patients were analyzed&#46; For each patient&#44; history of the complaints&#44; additional health problems&#44; and drug usage information were recorded&#46; Each patient had a complete neurological examination and radiological evaluation performed&#46; Each patient underwent preoperative magnetic resonance imaging &#40;MRI&#41; studies with and without contrast&#44; and preoperative computed tomography &#40;CT&#41; scans of the brain were performed in order to evaluate calcifications within the tumor and changes in the adjacent bony structures&#46; Nauta and Rengachary Classifications were used to describe the cyst location&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;7</span></a> Postoperative CT scans were performed within six hours following surgery in each patient&#46; In addition&#44; postoperative MRI was performed within 24<span class="elsevierStyleHsp" style=""></span>h following surgery in three patients&#46; Each patient underwent postoperative MRI scans at the third and 12th months after the operation&#59; the MRI scans were then repeated annually&#46; The patients were followed up in the outpatient clinic&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 1979&#44; Nauta et al&#46; divided cystic meningiomas into four subtypes according to the location of the cyst in relation to the brain and the tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> We have categorized our patients according to this classification&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 1</span> &#8211; Cyst formation is in the center of the tumor&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 2</span> &#8211; Cyst formation is at the periphery but still within the margins of the tumor&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 3</span> &#8211; Peritumoral cyst formation is seen in the adjacent brain rather than the tumor itself&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Type 4</span> &#8211; Cyst formation is at the interface between the tumor and the brain&#46;</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">In addition to this classification&#44; Rengachary classified meningiomas into two groups&#58; intratumoral and peritumoral cystic meningiomas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Besides the classification of Nauta&#44; we have also categorized our patients according to this classification&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The clinical features of the patients in the current series are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All patients presented with long standing headache dating back at least two years&#46; There was no gender predominance in our series &#40;three males and three females for a total of 6 patients&#41;&#46; The mean age of the patients was 57&#46;3 years &#40;range&#58; 27&#8211;76&#41;&#46; Radiological evaluation revealed two parasagittal and two convexity mass lesions with a cystic formation located at the frontal region&#46; In one patient&#44; the mass lesion was located at the tuberculum sellae and at the foramen magnum in one patient&#46; The tumors had cystic components and homogenously contrast-enhancing mural nodules&#44; as shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a>&#46; Two patients had <span class="elsevierStyleItalic">type 1</span> cystic meningiomas&#44; three patients had <span class="elsevierStyleItalic">type 2</span>&#44; and one patient had <span class="elsevierStyleItalic">type 4</span> according to the Nauta classification &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a>&#41;&#46; According to Rengachary classification&#44; there were four patients with peritumoral cystic meningiomas and two patients with intratumoral cystic meningiomas&#46; Two of the six patients &#40;33&#37;&#41; had cystic meningiomas in a parasagittal location&#46; All patients had a mural nodule and a concomitant cystic component&#46; MRI imagings revealed a dural tail in two patients&#46; The only patients who exhibited a contrast-enhanced cyst wall were the two patients with intratumoral cystic meningiomas&#46; In the diffusion-weighted images &#40;DWI&#41; series&#44; all of the lesions showed restriction of the mural nodule&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Operative technique</span><p id="par0055" class="elsevierStylePara elsevierViewall">The head position was established according to the tumor location in each patient&#46; In three instances&#44; the surgical planning was performed with the help of neuronavigation&#46; A merged CT- and MRI-neuronavigation system &#40;StealthStation<span class="elsevierStyleSup">&#174;</span> S7<span class="elsevierStyleSup">&#174;</span> System&#44; Medtronic&#44; Louisville&#44; USA&#41; was used in these three cases&#44; with frontal&#44; foramen magnum&#44; and parasagittal meningiomas&#46; Patients were managed according to standard microsurgical technique&#46; In two of these cases&#44; a PENTERO 900 surgical microscope &#40;Carl Zeiss&#41; equipped with the YELLOW-560 filter was used&#46; In these instances&#44; 2<span class="elsevierStyleHsp" style=""></span>ml &#40;2&#8211;4<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#41; of sodium-fluorescein &#40;Na-Fl&#41; &#40;10&#37;&#41; were injected intravenously through a central venous catheter after anesthesia induction&#46; The dura is always stained with Na-Fl under the YELLOW-560 filter following craniotomy&#46; The surgical plan created in the neuronavigation console was used&#44; and the surgical strategy was planned in a three-dimensional environment&#46; After exposure of the tumor&#44; the filter was switched&#44; and Na-Fl enhancement was documented&#46; Tumor dissection and resection were then performed using a standard microneurosurgical technique under white microscope light&#44; and the surgical field was periodically checked with the YELLOW-560 filter&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In five of the patients&#44; tumors were seen with a cystic formation and were dissected from the surrounding tissue&#46; The mass lesions were excised totally with the cyst capsule&#46; In one patient with a tuberculum sellae meningioma&#44; the sylvian fissure was opened&#44; and after removing the cerebrospinal fluid &#40;CSF&#41; from the carotid cistern&#44; optic nerves were identified and carefully dissected from the tumor&#46; The tumor was totally removed following the cyst puncture and internal tumor debulking&#46; After total excision of the lesions&#44; the dura was coagulated in one patient&#44; in five patients dural excision is made because of the dural invasion&#46; Galeal grafts that were harvested were used as dural substitute for dural closure&#46; No bony invasion was seen in any patient&#46; Craniotomy flap was repositioned in all of the patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In two patients who received Na-Fl&#44; the dura was enhanced with Na-Fl under the YELLOW-560 filter&#46; These two tumors in the current series showed diffuse&#44; strong Na-Fl enhancement&#46; Tumor tissue was enhanced until the end of tumor removal&#46; Both tumors were left frontal &#40;one convexity and one parasagittal&#41; tumors that had peritumoral cysts&#46; Na-Fl was very useful for clearly demonstrating the cleavage between brain tissue and the tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The cyst walls showed marked Na-Fl staining during surgery &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; It was particularly useful during tumor dissection and peeling away of the cyst wall from the adjacent cortical surface in order to achieve a total resection&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The clinical&#44; radiological&#44; and pathological features of the patients in the current series are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All of the tumors were totally excised &#40;Simpson Grade I and&#47;or Grade II&#41;&#46; Histopathologically&#44; all of the tumors were found to be World Health Organization &#40;WHO&#41; Grade I meningiomas&#46; Three patients had a pathology result of meningothelial meningioma&#44; whereas in two patients the pathology was reported as angiomatous meningioma&#44; and one patient had metaplastic meningioma according to the WHO 2007 classification&#46; Pathological specimens revealed no mitosis or necrosis&#46; The cyst capsules were separately sended to pathology in those two instances with Na-Fl enhancement&#46; They were positive for meningioma cells&#46; Detailed pathological staining results are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; None of the patients had any complications after the surgery&#46; Patients left the hospital with no neurological deficits&#46; Patients with seizures were seizure-free after three months&#44; and no neurological deficits or recurrences were noted&#46; The patients were followed-up for a mean period of 51 months &#40;range&#58; 16&#8211;102 months&#41; without recurrence&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Meningiomas are extra-axial tumors that are usually solid and they rarely present with cystic component along with the solid part&#46; They tend to have a good prognosis&#59; however&#44; meningiomas with cystic components may have a relatively aggressive natural clinical course&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> In solid meningiomas&#44; hyperostosis is a common finding&#46; If additional bone destruction is demonstrated on the CT scan&#44; it may be related to malignant behavior or to the invasive nature of the tumor&#44; which is indicative of poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> However&#44; that was not the case in our series&#46; On the contrary&#44; the meningiomas in this series had a very benign clinical course&#46; This may be related to two factors&#58; <a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> total removal of the meningiomas&#44; including the cyst wall&#44; and <a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> relatively benign histopathological features &#40;lower ki-67 index&#44; lower number of mitosis&#41;&#46; Today&#44; MRI and CT imaging technologies may contribute to the differential diagnosis of these cystic meningiomas&#46; In MRI&#44; dural enhancement is a typical sign of meningiomas&#44; which is called the &#8220;dural tail sign&#46;&#8221; The presence of a dural tail sign leads the surgeon to reconsider the prediagnosis&#46; Because meningiomas are generally isointense in the T1 sequence and isointense or hyperintense in the T2 sequence&#44; a contrast-enhanced series helps locate the contrast-enhanced mural nodule&#44; cystic formation&#44; and dural tail sign &#40;if present&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Unlike those of gliomas or metastatic glial tumors&#44; the cyst walls of meningiomas do not always enhance with contrast&#46; This could distinguish the cyst walls formed by gliotic tissue from those of tumor cells&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Total surgical excision generally results in total remission&#59; however&#44; to prevent the recurrence&#44; the cyst capsule must be removed totally along with the tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#8211;11</span></a> Recent studies show that contrast enhancement can be caused by the tumor cells embedded within the cyst wall&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> However&#44; although the cyst wall has no contrast enhancement&#44; tumor cells can be found within&#46; If the tumor is not totally resected&#44; there may be an increased risk of recurrence&#46; Peeling away of the cyst wall from the adjacent cortical surface should be performed meticulously&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Sodium fluorescein &#40;Na-Fl&#41; is a sodium salt and an organic fluorescent dye with peak excitation at 490<span class="elsevierStyleHsp" style=""></span>nm and emission between 500 and 550<span class="elsevierStyleHsp" style=""></span>nm&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> Several studies have shown the promising use of high-dose Na-Fl for determining the extent of resection under normal microscope light in various tumors&#44; including meningiomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#8211;22</span></a> A newly developed microscope &#40;PENTERO 900&#44; Carl Zeiss&#44; Meditec&#44; Oberkochen&#44; Germany&#41; equipped with a special filter &#40;YELLOW-560<span class="elsevierStyleHsp" style=""></span>nm&#41; designed to detect low-dose Na-Fl for the demarcation of tumor tissue was previously introduced&#44; and more promising reports have been published regarding extensive tumor resection with the use of this system&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#8211;33</span></a> However&#44; these studies have mainly focused on the resection of intra-axial brain tumors&#46; To our knowledge&#44; only Da Silva et al&#46; published their surgical results of Na-Fl-guided resection of extra-axial brain tumors under standard white microscope light&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#8211;22</span></a> By using quantitative digital analysis of tumor enhancement with Na-Fl&#44; they objectively demonstrated a strong presence of enhancement in all of the tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> They noted that all of the tumors showed marked contrast enhancement &#40;gadolinium&#41; on preoperative MRI&#44; and this corresponded well with the Na-Fl enhancement because a disrupted blood brain barrier plays a role in the effect mechanism of both drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> All meningiomas and dural tails showed strong Na-Fl enhancement intraoperatively&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> The current series contains two cystic meningiomas&#44; which were surgically removed with the use of Na-Fl under a YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm filter&#46; As stated before&#44; Na-Fl was found to be very useful in demonstrating the brain-tumor interface&#44; and it was especially effective in resecting the cyst wall in peritumoral cystic meningiomas&#46; Its effects on solid meningioma surgery require further investigation&#44; but Na-Fl guidance was found to be a useful technical adjunct in cystic meningioma surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">There have been some studies in the literature concerning the pathophysiology of cyst formation since the 1970s&#46; In these studies&#44; it has been shown that the degeneration&#44; hemorrhage&#44; and ischemia in the central region of the tumor lead to cystic formation&#59; peripherally-located cyst formation is generated by the gathering of the xanthochromic fluid in the subarachnoidal space and reactive gliosis&#46; In addition&#44; white matter edema and perfusion deficits may cause demyelination&#44; leading to the formation of cystic cavities&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;34</span></a> Thus&#44; cystic meningiomas have a higher risk of intratumoral hemorrhage than solid meningiomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;35</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In our study&#44; out of six patients&#44; four of them had intratumoral cyst component &#40;&#37;66&#46;6&#41;&#46; This was not consistent with the recent literature showing that peritumoral cystic meningiomas are more common than intratumoral cystic meningiomas&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> Previous studies have shown that cystic meningiomas tend to be found in the cerebral convexity and parasagittal regions&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">35&#44;37</span></a> In our study two of the six patients had cystic meningiomas in a parasagittal location and two patients&#8217; lesions were located in the cerebral convexity&#46; Even though there are limited number of cases in our study&#44; our results were consistent with the previous literature&#46; The number of cases should be augmented in order to get reliable data regarding this matter&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nauta et al&#46; described the cyst location associated with meningiomas in four categories&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> We have seen cysts of type 1 in two patients&#59; type 2 in three patients and type 4 in one patient&#46; There is not a certain predominance according to Nauta classification however&#44; previous case reports also show predominance of type 1 and 2 cysts&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In our study&#44; we found that all of the mural nodules showed restriction on DWI series on MRI which was consistent with the previous literature&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> MRI of two patients with intratumoral cystic meningiomas revealed contrast-enhanced cyst wall&#46; Because we know that the cyst wall enhancement can be found in intratumoral cystic meningiomas rather than the peritumoral cystic meningiomas&#44; we can claim that these findings are consistent with the recent literature&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Cystic meningiomas are rare entities within the meningioma group&#46; Because their differential diagnosis includes cystic astrocytomas&#44; hemangioblastomas&#44; neuroblastomas&#44; glial tumors&#44; and metastatic tumors&#44; it is important to note the specific changes in MRI induced by cystic meningiomas&#44; such as the dural tail sign&#46; In the literature&#44; it is somehow controversial that when the tumor is totally resected with the cyst capsule the prognosis is better&#59; however&#44; it is recommended to resect the capsule whenever possible&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> Na-Fl could be used as a useful adjunct to resect the cyst wall or capsule&#46; Because it is challenging to identify the diagnosis preoperatively because of the nonspecific clinical and radiological features&#44; it is important to include meningiomas in the differential diagnosis of intracranial cystic lesions&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests&#46;</p></span></span>"
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    "fechaAceptado" => "2019-01-14"
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            0 => "Cystic meningiomas"
            1 => "Surgical excision"
            2 => "Sodium fluorescein"
            3 => "YELLOW 560"
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            0 => "Meningiomas qu&#237;sticos"
            1 => "Escisi&#243;n quir&#250;rgica"
            2 => "Fluoresce&#237;na de sodio"
            3 => "AMARILLO 560"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although meningiomas are the most common primary non-glial intracranial tumors&#44; cystic meningiomas are quite rare&#46; This study presents six cases in order to discuss the radiological and pathological features of cystic meningiomas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Six patients with cystic meningiomas were included in the study&#46; All patients underwent a cranial computed tomography scan and magnetic resonance imaging &#40;MRI&#41; evaluation&#44; pre- and postoperatively&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All patients presented with long standing headache dating back at least two years&#46; There was no gender predominance in our series&#46; Radiological evaluation revealed two parasagittal and two convexity meningiomas located at the frontal region&#46; Two lesions were located at the tuberculum sellae and the foramen magnum&#46; All of the tumors were totally excised &#40;Simpson Grade I or II&#41;&#46; Pathology results included meningothelial meningioma in three patients&#44; angiomatous meningioma in two patients&#44; and metaplastic meningioma in one patient&#46; In two patients&#44; the cystic meningiomas were resected with the use of sodium fluorescein &#40;Na-Fl&#41; under a YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm microscope filter&#46; Na-Fl was found to be very useful in demonstrating the brain&#8211;tumor interface&#44; and it was especially effective in resecting the cyst wall of the peritumoural cystic meningiomas&#46; None of the patients had any complications&#44; and no recurrences were noted in any of the patients within the mean follow-up period of 51 months &#40;range&#58; 16&#8211;102 months&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">It is important to note MRI changes specific to cystic meningioma and include meningiomas in the differential diagnosis of intracranial cystic lesions&#46; The use of sodium fluorescein &#40;Na-Fl&#41; under a YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm microscope filter is a useful tool to differentiate the brain-tumor interface&#44; as well as to identify the cyst wall in order to fully resect the tumor with the cystic component to avoid recurrence and achieve better clinical results&#46;</p></span>"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
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          2 => array:2 [
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aunque los meningiomas son los tumores intracraneales primarios no gliales m&#225;s frecuentes&#44; los meningiomas qu&#237;sticos son bastante raros&#46; Este estudio presenta 6 casos para discutir las caracter&#237;sticas radiol&#243;gicas y patol&#243;gicas de los meningiomas qu&#237;sticos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 6 pacientes con meningiomas qu&#237;sticos en el estudio&#46; Todos los pacientes se sometieron a una tomograf&#237;a computarizada craneal y a una evaluaci&#243;n por resonancia magn&#233;tica&#44; antes y despu&#233;s de la operaci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Todos los pacientes presentaron dolor de cabeza de larga duraci&#243;n de al menos 2 a&#241;os&#46; No hubo predominio de g&#233;nero&#46; La evaluaci&#243;n radiol&#243;gica revel&#243; 2 meningiomas parasagitales y 2 de la convexidad ubicados en la regi&#243;n frontal&#46; En los otros 2 pacientes las lesiones se ubicaron en el tub&#233;rculo selar y en el foramen magno respectivamente&#46; Todos los tumores fueron totalmente extirpados &#40;grado de Simpson I o II&#41;&#46; En 2 pacientes&#44; los meningiomas qu&#237;sticos se resecaron con el uso de fluoresce&#237;na de sodio bajo un filtro de microscopio AMARILLO de 560<span class="elsevierStyleHsp" style=""></span>nm&#46; Se encontr&#243; que la fluoresce&#237;na de sodio era muy &#250;til para demostrar la interfaz entre el cerebro y el tumor&#44; y fue especialmente eficaz para resecar la pared de los quistes peritumorales&#46; Los resultados de histopatolog&#237;a incluyeron meningioma meningotelial en 3 pacientes&#44; meningioma angiomatoso en 2 y meningioma metapl&#225;sico en uno&#46; Ninguno de los pacientes present&#243; ninguna complicaci&#243;n&#44; y no se observaron recurrencias en ning&#250;n paciente dentro del per&#237;odo de seguimiento medio de 51 meses &#40;rango&#58; 16-102 meses&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Es importante tener en cuenta los cambios en la resonancia magn&#233;tica espec&#237;ficos de los meningiomas qu&#237;sticos e incluir estos tumores en el diagn&#243;stico diferencial de las lesiones qu&#237;sticas intracraneales&#46; El uso de fluoresce&#237;na de sodio bajo un filtro de microscopio AMARILLO de 560<span class="elsevierStyleHsp" style=""></span>nm es una herramienta &#250;til para diferenciar la interfaz cerebro-tumor&#44; as&#237; como para identificar la pared del quiste y resecar completamente el tumor con el componente qu&#237;stico para evitar la recidiva y conseguir mejores resultados cl&#237;nicos&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Coronal and axial T1-weighted contrast-enhanced images shows a type 4 cystic meningioma at tuberculum sellae&#46; &#40;C&#41; Coronal T1-weighted contrast-enhanced image shows a type 2 cystic convexity meningioma &#40;according to Nauta Classification<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#41;&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; A mass lesion located in the left frontal region can be seen in the T1 FLAIR sequence&#44; causing a midline shift of 16<span class="elsevierStyleHsp" style=""></span>mm on the cranial MRI&#46; In addition to the cystic components&#44; a 8<span class="elsevierStyleHsp" style=""></span>mm hyperintense mural nodule is seen on the contrast-enhanced T1 sequences&#46; &#40;B&#41; Postoperative cranial CT shows total excision of the tumor&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Preoperative cranial MRI of the patient with a left frontal lesion indicates the cystic component of the lesion on the axial view of the T1 contrast enhanced sequence&#46; &#40;B&#41; Preoperative axial view of T1 contrast-enhancing sequence shows the mural nodule of the lesion&#46; &#40;C and D&#41; Postoperative cranial MRI on an axial view of the T1 contrast enhancing sequence shows the resected tumor cavity&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Cranial MRI &#8211; axial view of T1 sequence with contrast enhancement shows a mural nodule near the border of the dura along with the cystic component&#46; &#40;B&#41; Coronal view of the T2 sequence shows the cystic and solid components of the lesion&#46; &#40;C and D&#41; Postoperative contrast enhancing axial and coronal T1 sequences show total excision of the cystic-solid meningioma&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Intraoperative microscopic view of a parasagittal frontal meningioma under normal microscope light&#46; &#40;B&#41; The same meningioma showed diffuse Na-Fl staining under YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm filter&#59; note that both the cyst wall and the solid tumor show Na-Fl enhancement&#46; &#40;C&#41; Following the resection of the solid component and cyst drainage&#44; the cyst walls were excised&#46; Note the Na-Fl enhancing cyst wall within the tip of the aspirator under YELLOW 560<span class="elsevierStyleHsp" style=""></span>nm filter&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localization&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complications&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#44; F&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Headache&#44; visual loss&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">TS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;convexity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatous meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; seizure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;parasagittal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatous meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; seizure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;parasagittal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metaplastic meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; seizure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LF&#40;convexity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Headache&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2065532.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">summarizes clinical&#44; radiological and pathological symptoms&#46; TS&#58; tuberculum sella&#44; FM&#58; foramen magnum&#44; LF&#58; left frontal&#44; DT&#58; dural tail seen on MRI&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age &#40;yrs&#41; &#8211; sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ki-67 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CD34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vimentin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S-100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pan-CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mitosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningothelial meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#62;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatous meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiomatous Meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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