RESUMO

El Cáncer de Mama sigue siendo una causa importante de muerte en mujeres en el mundo. En el Perú representa la segunda neoplasia más común en mujeres. El desarrollo de metástasis en el sistema nervioso central es una de las consecuencias más devastadoras de la progresión de la neoplasia. La carcinomatosis leptomeníngea ocurre en el 3.5% a 5% de los pacientes con Cánceres de Mama avanzado. Hay factores de riesgo para el desarrollo de la misma, como edad temprana al diagnóstico, metástasis pulmonar previa, Cáncer de Mama triple negativo, sobre expresión de HER-2, entre otros. El cuadro clínico generalmente es multifocal y debe ir acompañado del hallazgo de células neoplásicas en el líquido cefalorraquídeo, aunque esta tiene un nivel de sensibilidad bajo. Además se puede evidenciar hallazgos en resonancia magnética que nos orienten al diagnóstico. En los últimos 20 años las pacientes con Cáncer de Mama han experimentado un aumento en el tiempo de sobrevida, gracias al avance de los tratamientos sistémicos. Sin embargo, debido a esta causa existe un incremento en la incidencia de metástasis cerebrales, lo mismo que en la carcinomatosis leptomeníngea. Actualmente se tienen escasas opciones terapéuticas con poco impacto en el tiempo de sobrevida. El tratamiento se orienta más hacia buscar una adecuada calidad de vida. Aún faltan más estudios que respalden los buenos resultados de capecitabina, trastuzumab, lapatinib y ARA-C liposomal, encontrados en reportes aislados para definir un tratamiento estándar.

Breast cancer remains a major cause of death in women worldwide. In Peru it is second most common malignancy among women. The development of metastases in the central nervous system is one of the most devastating consequences of the progression of disease. Leptomeningeal carcinomatosis occurs in 3.5 to 5% of patients with advanced breast cancers, there are risk factors for developing it such as: early age at diagnosis, previous lung metastases, triple negative breast cancer, overexpression of HER -2, among others. The clinical picture is usually multifocal and mustbe accompanied by the presence of neoplastic cells in the cerebrospinal fluid, although this is anunusual finding. Magnetic resonance imaging findings can help in the diagnosis. In the past 20 years, breast cancer patients have experienced an increase in survival time, due to improvement insystemic treatments, however in relation to this there is an increasing incidence of brain metastases, and leptomeningeal carcinomatosis. Currently there are few treatment options with little impact onsurvival time, treatment being more oriented toward improving quality of life. We need more studies to support the success of capecitabine, trastuzumab, lapatinib and liposomal ARA-C are found inisolated reports to define a standard treatment.

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Objetivo: Revisão da literatura sobre os cistos aracnóides intracranianos – formação e evolução, dados epidemiológicos e clínicos, aspectos de neuroimagem e tratamento. Método: Realizamos pesquisa bibliográfica utilizando como base de dados o MEDLINE (National Library of Medicine), abrangendo operíodo de 1980 a 2006. As palavras-chave utilizadas foram arachnoid cysts e intracranial cysts. Também realizamos pesquisa manual em jornais e revistas médicas. Artigos com dados clínicos incompletos não foram incluídos no trabalho. Conclusões: Embora haja um consenso sobre a intervenção cirúrgica para os casos sintomáticos, a abordagem ideal ainda é controversa.

Objective: To review the current literature on intracranial arachnoid cysts related to its formation,evolution, the epidemiological, clinical and neuro imaging aspects and also its treatment. Method:Bibliographic review was done using Medline data base from 1980 to 2006. The key words used were arachnoid cysts and intracranial cysts. Manual research on pertinent medical publications was also done.Articles with incomplete clinical data were not included. Conclusions: Although there is a consensus that surgery should be performed only in the symptomatic cases, there is no general agreement whichis the best surgical approach to deal with arachnoid cysts.

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Objectives: the aim of this paper is to present the results of endoscopic intervention in retrocerebellar arachnoid cysts. Material and methods: the patients with posterior fossa arachnoid cysts in which a neuroendoscopic intervention had been done between 2000 and 2004 were retrospectivelly reviewed. Age, gender, presenting symptoms and signs, radiological findings and previous modes of treatment were evaluated. A rigid neuroendoscope was used in all procedures. Results: there were 6 boys and 3 girls who ranged in age from 1 month to 16 years (mean 29.9 months). Endoscopic cyst fenestration was successful in 7 of 9 patients. Of the 4 patients who had been previously shunted, 3 became shunt free. Conclusion: endoscopic cysto cisternostomy should be the first step in the management of posterior fossa arachnoid cyst in the institutions where neuroendoscopy is routinely practiced (AU)

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The arachnoid cysts are intracranial liquid collections with a congenital etiology. It is necessary to establish the absence of bibliographical information about this disease and its relation with pregnancy. A case is presented related to the treatment of a nineteen year old pregnant patient with a 31 week pregnancy and a history of arachnoid cysts with convulsions as the main symptom.

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O cisto aracnóideo é um importante processo expansivo que atinge o sistema nervoso. Os autores reuniram, nesta revisäo, aspectos relevantes para a compreensäo e o manejo desta patologia

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