Cavernom temporal asociat cu angiom venos cerebelar

Cavernom temporal asociat cu angiom venos cerebelar

CAVERNOM TEMPORAL STANG ASOCIAT CU ANGIOM VENOS CEREBELOS DREPT Stud. Ioana Pricopi Conf. Dr. Ligia Gabriela Tataranu Dr. Vasile Ciubotaru

PREZENTARE DE CAZ SEX MASCULIN VARSTA: 37 DE ANI SIMPTOMATOLOGIE: CRIZE EPILEPTICE GRAND MAL FARA ANTECEDENTE PATOLOGICE SEMNIFICATIVE EXAMEN CLINIC GENERAL NORMAL

EXAMENUL CLINIC NEUROLOGIC NORMAL EXAMENUL OFTALMOLOGIC NORMAL EXAMENUL IMAGISTIC IRM CEREBRAL ARIE LEZIONALA TEMPORALA STANGA, CU DIMENSIUNI DE 1,5 cm IN DIAMETRU, IN

HIPOIZOSEMNAL T1, T2, T2 FLAIRE SI PE SECVENTELE SENSIBILE LA HEMOSIDERINA DUPA ADMINISTRAREA DE SUBSTANTA DE CONTRAST LEZIUNEA SE INCARCA CU ASPECT NEOMOGEN SUGESTIV PENTRU MAV ANGIOM VENOS CEREBELOS DREPT

ANGIOGRAFIE ANGIOM VENOS CEREBELOS DREPT EXAMENUL IMAGISTIC, IRM T1 NATIV, SECTIUNE AXIALA EXAMENUL IMAGISTIC, IRM T1 NATIV, SECTIUNE AXIALA

EXAMENUL IMAGISTIC, IRM T2, SECTIUNE AXIALA EXAMENUL IMAGISTIC, IRM T1, GADOLINIUM, SECTIUNE AXIALA EXAMENUL IMAGISTIC, IRM T1, GADOLINIUM, SECTIUNE AXIALA EXAMENUL

IMAGISTIC, ANGIOGRAFIE EXAMENUL IMAGISTIC, ANGIOGRAFIE

EXAMENUL IMAGISTIC, ANGIOGRAFIE EVALUARE DIAGNOSTICA FACTOR IRITATIV CORTICAL: CRIZELE

EPILEPTICE GRAND MAL PROCES EXPANSIV INTRACRANIAN CONFIRMAT PRIN IRM PEIC (PROBABIL CAVERNOM) DEZVOLTAT TEMPORAL STANGA ANGIOM VENOS CEREBELOS DREPT

PLAN DE TRATAMENT INDICATIE NEUROCHIRURGICALA SCOP: DIAGNOSTIC ANATOMO-PATOLOGIC PROGNOSTIC SI PLAN TERAPEUTIC ULTERIOR REZECTIA TOTALA A TUMORII: CONTROLAREA

CRIZELOR EPILEPTICE PREGATIREA PREOPERATORIE ANALIZE DE LABORATOR: HLG, COAGULOGRAMA, BIOCHIMIE NORMALE EKG: RITM SINUSAL RX PULMONAR: FARA LEZIUNI PLEURO-PULMONARE EVOLUTIVE

INFORMAREA PACIENTULUI SI CEREREA DE CONSIMTAMANT TRATAMENT SIMPTOMATIC DEPLETIV CEREBRAL: DEXAMENTAZONA, FUROSEMID, MANITOL 20% TRATAMENT SIMPTOMATIC ANTICRITIC: FENITOINA, VALPROAT DE Na

TRATAMENT ANTIALGIC : PARACETAMOL TRATAMENT ANTIBIOTIC: CEFORT ABORD FRONTOTEMPORAL STANG POZITIONAREA PACIENTULUI: DECUBIT DORSAL (SUPINE) CU CAPUL ROTAT PE PARTEA STANGA

S-A REALIZAT O INCIZIE TEGUMENTARA IN SEMN DE INTREBARE TEMPORALA ANTERIOARA STANGA S-A RABATAT VOLETUL CUTANAT S-A REALIZAT UN VOLET OSOS LIBER TEMPORAL ANTERIOR STANG, CARE S-A RIDICAT FARA INCIDENTE S-A INCIZAT DURA MATER ARCUAT, CU PEDICUL INFERIOR

ABORD FRONTOTEMPORAL STANG S-A DESCOPERIT O TUMORA SOLIDA CENUSIU-VIOLACEE, RELATIV BINE DELIMITATA, CU DIMENSIUNI DE 1,5 CM DIAMETRUL. S-A REALIZAT ABLATIA IN TOTALITATE A TUMORII S-A EFECTUAT HEMOSTAZA, SUTURA ETANSA SI SUSPENDAREA DUREI MATER

S-A REPUS SI S-A FIXAT VOLETUL OSOS S-A EFECTUAT SUTURA IN PLANURI SI S-A REALIZAT PANSAMENTUL PLAGII OPERATORII PRINCIPIILE REZECTIEI EXPUNEREA LEZIUNII MICSORAREA ACESTEIA CU AJUTORUL CAUTERIZARII

BIPOLARE DISECTIA CAVERNOMULUI DE TESUTUL NEURAL DIN JUR, UNEORI REALIZATA MAI USOR DATORITA EXISTENTEI UNEI PSEUDOCAPSULE GLIALE CE INCONJOARA LEZIUNEA SI OFERA UN PLAN CIRCUMFERENTIAL DE CLIVAJ IN CAZUL IN CARE ESTE PREZENTA, PSEUDOCAPSULA TREBUIE EXCIZATA DATORITA POTENTIALULUI SAU EPILEPTOGEN

DUPA ABLATIA TUMORII, ZONA TREBUIE ATENT EXAMINATA IN VEDEREA EVIDENTIERII DE LEZIUNI SATELITE SAU FRAGMENTE RESTANTE CARE TREBUIE REZECATE PENTRU A PREVENI RECIDIVA REZECTIA

DIAGNOSTIC ANATOMO-PATOLOGIC MACROSCOPIC: PIESA MONOBLOC, CENUSIUVIOLACEE, RELATIV BINE DELIMITATA MICROSCOPIC: HEMANGIOM CAVERNOS. PARENCHIMUL ADIACENT

PREZINTA GLIOZA ASTROCITARA REACTIVA, INFILTRATE HEMATICE SI SIDEROFAGIE EVOLUTIE POSTOPERATORIE FAVORABILA

AMELIORAREA SIMPTOMELOR NEUROLOGICE REEVALUAREA NEUROCHIRURGICALA LA: 3 LUNI, LA 6 LUNI (TIMP DE 2 ANI), LA 1 AN (TIMP DE 5 ANI), APOI LA 2 ANI CT CU SUBSTANTA DE CONTRAST, SECTIUNE AXIALA, LA 1 AN POSTOPERATOR

ASPECT IN LIMITE NORMALE CT, CU SUBSTANTA DE CONTRAST, SECTIUNE AXIALA, LA 1 AN POSTOPERATOR PARTICULARITATEA CAZULUI: DE OBICEI ANGIOMUL SE DEZVOLTA IN VECINATATEA CAVERNOMULUI

ELECTROCORTICOGRAFIE CONCLUZII: CAVERNOMUL: Poate aparea de novo (de cele mai multe ori, dupa radioterapie) sau poate fi congenital cu transmitere AD (pacientii prezinta leziuni

multiple); Poate fi asimptomatic, descoperit imagistic, sau simptomatic (2030%), cel mai frecvent manifestandu-se prin crize epileptice dar si prin: deficit neurologic focal, cefalee, HIC; IRM are specificitatea si sensibilitatea cea mai mare de diagnostic, pe cand angiografic nu se pot evidentia (sunt sisteme de presiune scazuta); Rezectia chirurgicala a cavernomului este singura optiune

terapeutica considerata curativa; VA MULTUMESC!

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