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3. Postere - rmr.medica.ro

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120<br />

with acute sixth nerve paresis, apparently without<br />

identifi able cause. BTX-A chemo denervation of<br />

the ipsilateral medial rectus was done, with favorable<br />

outcome and disappearance of diplopia; 6<br />

months after, patient was fully recovered. The last<br />

patient presented with left sixth nerve palsy, started<br />

14 months ago, after a craniocerebral trauma p<strong>ro</strong>duced<br />

by accident, with marked diplopia. Sixth<br />

nerve function was completely abolished. She underwent<br />

surgery: half lateral transposition of superior<br />

and inferior rectus (Hummelscheim technique)<br />

and medial rectus recession on the affected eye was<br />

performed. Evolution was good, with recovery of<br />

fusion at distance and near.<br />

VI nerve palsy app<strong>ro</strong>ach is different, depending<br />

on the etiology, onset and degree of neu<strong>ro</strong>muscular<br />

dysfunction. Interdisciplinary cooperation is mandatory<br />

for p<strong>ro</strong>per management of sixth nerve palsy.<br />

Key words: sixth nerve palsy, quality of life,<br />

treatment<br />

Specifi c features in brain metastasis aft er<br />

amelanoti c malignant melanoma<br />

V. Pruna 1 , M. Gorgan<br />

“Bagdasar-Arseni” Clinic Emergency Hospital,<br />

Bucharest, Romania<br />

1Student in Neu<strong>ro</strong>surgery “Ca<strong>ro</strong>l Davila” University<br />

of Medicine and Pharmacy Bucharest,<br />

Faculty of Medicine, Department of Neu<strong>ro</strong>surgery<br />

Abstract<br />

The incidence of brain metastases in patients<br />

with malignant melanoma ranges f<strong>ro</strong>m 6-43% of<br />

cases. Amelanotic melanoma is met only in 2-8%<br />

of cases with malignant melanoma. Melanoma is<br />

one of the most common malignancies that metastasize<br />

to the brain. Most common location of malignant<br />

melanoma is the skin, retina, brain and nail<br />

bed. Brain metastases are frequently associated<br />

with intratumorale hemorrhage. The current treatment<br />

includes: surgery, radiosurgery (Gamma-<br />

Knife, LINAC or WRBT), chemotherapy, immunotherapy<br />

and multimodal. Surgery is the treatment<br />

of choice and radiosurgery (Gamma-Knife or<br />

LINAC) is a therapeutic alternative.<br />

Case presentation<br />

We choose to present the case of 58-years-old<br />

men with a f<strong>ro</strong>ntal brain metastasis of amelanotic<br />

malignant melanoma. Cranial MRI (native and<br />

REVISTA MEDICALÅ ROMÂNÅ – VOLUMUL LIX, NR. 2, An 2012<br />

contrast) highlights a left f<strong>ro</strong>nto-basal tumor, with<br />

high signal intensity on T1 weighted images (T1WI)<br />

and high signal intensity on T2 weighted images<br />

(T2WI), policystic, about 54/46/50 mm in size,<br />

with perilesional edema and mass effect that moves<br />

the midline to the right. The patient underwent surgery.<br />

Histological examination: malignant amelanotic<br />

melanoma.<br />

Key words: amelanotic malignant melanoma,<br />

brain metastasis, intratumorale hemorrhage, surgery,<br />

LINAC<br />

Unruptured anterior communicati ng artery<br />

aneurysm encased in a giant tuberculum<br />

sellae meningioma. Case report<br />

Bogdan Constanti n Dumitrescu¹,<br />

Mircea Radu Gorgan<br />

¹Student in Neu<strong>ro</strong>surgery, University of Medicine and<br />

Pharmacy “Ca<strong>ro</strong>l Davila” Bucharest,<br />

Faculty of Medicine, Department of Neu<strong>ro</strong>surgery<br />

Clinic of Neu<strong>ro</strong>surgery, Third Department<br />

of Neu<strong>ro</strong>surgery, Emergency Clinical Hospital<br />

Bagdasar-Arseni, Bucharest<br />

Abstract<br />

We present a 64-year-old man with symptoms of<br />

optic chiasm and nerve compression f<strong>ro</strong>m a giant<br />

tuberculum sellae meningioma with unruptured<br />

anterior communicating artery aneurysm encased.<br />

Preoperative magnetic resonance imaging disclosed<br />

that the aneurysm was completely enclosed in the<br />

tumor, but angiographic studies did not reveal any<br />

important arterial nar<strong>ro</strong>wing. The embedded<br />

aneurysm caused neither SAH nor intratumoral<br />

hemorrhage. All of these factors pointed to little<br />

adhesion between the tumor and the encased<br />

arteries. Surgery was performed a week after<br />

admission and the intraoperative fi ndings revealed<br />

that the tumor did not adhere too much to the<br />

enclosed vasculature except for a little part attached<br />

to the left ICA. The aneurysm was safely clipped<br />

after piecemeal removal of the tumor, which was<br />

fi nally extirpated without fear of aneurysm rupture,<br />

and with a good visual outcome. To treat both the<br />

tumor and aneurysm simultaneously, careful stepwise<br />

operative p<strong>ro</strong>cedures were essential.

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