bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic endonasal resection of midline cranial base tumors
Authors: De Divitiis Enrico , Esposito Felice , Cappabianca Paolo , Cavallo Luigi M. , De Divitiis Oreste , Dal Fabbro Mateus
Published: April 2019

Objective: The advent of the endoscope in transsphenoidalsurgery has permitted to expand the indications of such approach also for the treatment of on tumors located in supra, para, retro and infrasellar regions, enabling the neurosurgeon to work under direct visual control in a minimally invasive way. Since 2004 we have started to use the extended endonasal transsphenoidal approach for a variety of lesions involving the midline skull base and, in particular, the suprasellar area, the cavernous sinus and the retroclival prepontine region. Methods: Over a 36-month period, sixty-four procedures have been performed. The series consisted of 29 males and 35 females, aged from 24 to 80 years (median 49.8 years). The mean follow-up was of 18 months (ranging from 3 to 36 months). Among the patients with midline lesions, who were 90.6 % of the total, seven patients had a pituitary adenoma, sixteen patients were affected by a craniopharyngioma, six patients had a suprasellar Rathke’s cleft cyst, seven subjects had a tuberculum sellae meningioma, four had an olfactorygroove meningioma, and six a clival tumor. Other lesions ofthe midline skull base were, 1 chiasmatic astrocytoma, 1 neuroendocrine tumor, 4 post-traumatic cerebro-spinal fluid rhinorrhea, and one optic nerve glioma. Three other patients had anterior cranial base meningoencephaloceles. Results: Overall, gross total removal of the lesion was achieved in 30/49 tumoral lesions (61.2%); subtotal removal was achieved in 12/49 cases (24.5%). The three cases of meningoencephaloceles were all successfully treated. Among the patients with preoperative visual deficits, most of them fully recovered or improved and only two worsened in one eye. Major complications consisted in 2 deaths (one not directly related with the surgical procedure), 6 postoperative CSF leak (one complicated with bacterial meningitis), one ICA injury, and 6 cases of permanent diabetes insipidus.Conclusion: The extended transsphenoidal approach tothe supra and parasellar lesions seems Endoscopy; Transsphenoidal surgery; Extended approach; Parasellar; Tumors; Anterior skull base. A promising minimally invasivetechnique for the removal of lesions affecting these areas,once thought to be suitable only of the transcranial routes.Concerning the lesion removal and the recurrence rate compared with the transcranial routes, it is too early to pose a definitive word, since the follow-up is still too short.
The expanded endoscopic endonasal approaches for the skull base
Authors: Prevedello Daniel M. , Kassam Amin B. , Carrau Ricardo , Gardner Paul , Zanation Adam , Mintz Arlan , Snyderman Carl
Published: April 2019

Background: Endoscopic endonasal approach (EEA) for skull base surgery (SBS) is a significant modification of the current practice. Methods: We reviewed our experience at the University of Pittsburgh with EEAs for 800 patients from 1998 to July 2007. Results: Modular approaches to multiple pathologies of the skull base were designed totally based on intrinsic anatomy. Stages of training were established based on the level of technical difficulty and potential risk of vascular and neural injury. Five levels were defined in an incremental manner. Conclusions: Practice standardization with modular, incremental training is projected to facilitate the gaining of knowledge and skills to safely master EEAs for SBS in an organized manner. We suggest adherence to the systematic acquisition of endoscopic skills, to work as an integrated team of surgeons and to have a thorough perspective of conventional SBS and endoscopic surgery. Therefore, the choice of approach must be a specific function of the anatomy and pathology rather than the surgeon’s bias or lack of experience with alternative approaches.
Endoscopic Third Ventriculostomy
Authors: Zymberg Samuel Tau , Marinello João Luiz Parra , Vaz-Guimarães Filho Francisco De Assis , Cavalheiro Sérgio
Published: April 2019

Objectives: In the present paper we report and discuss our experience with endoscopic third ventriculostomies (ETVs). We will point out surgical, technical data and complications involved. Methods: Between September 1995 and August 2007, we selected 283 patients with hydrocephalus which were submitted exclusively to ETV. Results: In our series, 145 (51.24%) patients were male, and 138 (48.76%) female. Age varied from 2 days to 83 years-old (medium of 15 years and 8 months). Most of the patients hadobstruction at the cerebral aqueduct level (aqueduct stenosis, benign tectal tumors). In our series there was not a single death directly due to the procedure. However 20 patients (7%) evolved with post-surgical complications and 3 of them were permanent, with memory deficit in one and epilepsy in two. There was failure in the procedure during the early post-surgical period in 37 (13%) patients, who then needed ventricular shunt systems to resolve hydrocephalus. Conclusions: Our results suggest that ETV should be considered as the initial treatment to hydrocephalus in all patients whose magnetic resonance exams shows a site of obstruction to the CSF flow. We consider that the most important factor to the treatment success is the adequate selection of patients.
Endoscopic Endonasal Approach to Pituitary Adenomas
Authors: De Aguiar Paulo Henrique Pires , Laws Junior Edward R. , Dodd Robert , Hwang Peter , Getz Anne E.
Published: April 2019

Microscopic transsphenoidal surgery is beyond any doubt a widely accepted and highly effective therapy for pituitary adenomas. Currently several centers have converted to an endoscopic transsphenoidal approach; suggesting that this technique provides more complete tumor resection, better visualization and reduce complications. However, there have been few series to document the results of this procedure. This report presents the technical details and compares it to the results of the microscopic method based on the experience of the group and a literature review. The endoscopic transnasal/ transsphenoidal technique is a safe and effective method for removal of pituitary adenomas. The results found in the literature suggest that the endoscope provides more complete tumor removal, and reduces complications. We believe that the advantages of the endoscopic technique will allow this procedure to become the future gold standard surgical therapy for pituitary adenomas.
Vascular complications in transsphenoidal surgery
Authors: Laws Eduard R. , Aguiar Paulo Henrique
Published: April 2019

Objectives: Vascular complications can and do arise fromtranssphenoidal surgery and, when occur, they have a highincidence of mortality and serious morbidity. The anatomicsubstrate for such complications is discussed, along with technicalaspects of surgery and other methods for the avoidanceof vascular complications. The aim of this paper is discuss themain vascular complications of transsphenoidal approach. Methods: The authors retrospectively analyzed the data regarding4175 pituitary transsphenoidal operations from 1974to 2004. Results: Thirty-four (34) patients (0.8%) developed directvascular complications from transsphenoidal surgery. Nine (0.2 %) of these were fatal. Conclusions: Intra-operative injury of the carotid artery is predominately associated with microadenomas, basilar perforatorinjury may be associated with invasive macroadenomasand anterior cerebral artery injury may be associated withsupra- sellar tumors. Regarding outcomes, injury of anteriorcirculation vessels shows relatively low morbidity and mortality,and injury to posterior circulation vessels shows relativelyhigh morbidity and mortality.
Suction decompression assisted clipping of large and giant internal carotid artery aneurysms
Authors: Sinha Sumit , Watabe Takeya , Kato Yoko , Oguri Daikichi , Imizu Shei , Oda Junpei , Omura Masahiro , Sadato Akiyo , Hattori Natsuki , Irie Keiko Selecione , Hayakawa Motoharu , Sano Hirotoshi
Published: April 2019

Background: The microsurgical treatment of large and giant aneurysms poses a challenge and direct clipping is still prefferred: this is very dificulttask withrisksofintraoperativerupture. Microsurgical clipping with angioplastic arrangement of clips at the neck along with retrograde suction evacuation of the blood from the proximal internal carotid artery and aneurysm have been advocated in order to avoid these problems. Methods: This is a retrospective study of 13 patients with 13 large/ giant internal carotid artery aneurysms, who were managed surgically with retrograde suction decompression assisted clipping at our center over a period of last 2 years. The clinical profile, details of surgical management, complications and outcome of these patients were analysed. In the preoperative assessment, MRI/MR Angiography brain, 3Dimensional- Computed Tomography scan along with diagnostic angiography and balloon occlusion test were performed. The surgical technique has been described in detail. Results: The age ranged from 36-79 years old. There were 7 males and 6 females. 11 patients had unruptured aneurysms, while 2 presented with subarachnoid hemmorrhage. There were no peri-operative complications. In the post-operative period, one patient had severe disabilty with right sided hemiparesis due to the thrombo-embolic phenomenon, while the rest had an excellent outcom, with no mortality. Conclusions: Retrograde suction decompression is an effective aid in surgical management of large and giant aneurysms with many advantages. It is certainly an extremely useful adjunct for obtaining early proximal control so that safe clip application can be achieved. Intra-operative angiography can be performed easily to check adequacy of aneurysm clipping. Integration of endovascular techniques in management of complex aneurysms has made posible the advancement of the therapeutic armentarium.
Derivação ventrículo peritoneal
Authors: Val Filho José Aloysio Da Costa , Furtado Leopoldo Mandic Ferreira , Albuquerque Rafael Barbosa
Published: April 2019

Introdução: A incidência de infecção e a mortalidade dos pacientes com derivação ventrículo peritoneal (DVP) constituem problema mundial. O desenvolvimento de técnicas para diminuir esses índices são de grande importância na atualidade. Objetivo: Apresentar a incidência de infecção e de mortalidade em pacientes submetidos a derivação ventrículo peritonealconforme a técnica cirúrgica utilizada. Material e métodos: Foi realizado estudo retrospectivo de 353 pacientes com hidrocefalia, submetidos à primeira instalação de DVP entre Janeiro de 1996 a Dezembro de 2006, realizado no Hospital Biocor. Os grupos foram separados em Grupo I, onde foi utilizado o protocolo (Grupo Marseille) e grupo controle. As variáveis analisadas foram: idade, sexo, etiologia, duração da cirurgia, índice de infecções e mortalidade.Resultados: No presente estudo, a taxa de infecção geral foi de 3,10%. No grupo I (n=195) de 1,0% e no grupo II (n=158) de 5,7%, com significância estatística (p<0,005). Conclusão: A taxa de infecção nos pacientes tratados comDVP e submetidos ao protocolo de Marseille foi significativamente menor que no grupo controle.
Intracranial arteriovenous malformations
Authors: Pereira Filho Arthur A. , Jafar Jafar J.
Published: April 2019

Objective: The purpose of this report is to review intracranial arteriovenous malformations, present strategies for the evaluation and selection of optimal treatment modalities, and to discuss factors important to formulating a successful treatment plan. Methods: The authors performed a critical literature review in order to highlight recent and classic studies about intracranial arteriovenous malformations. Results: Recent advances in diagnostic techniques, microsurgery, endovascular therapy, and stereotactic radiosurgery have significantly improved the treatment outcome of vascularmalformations of the central nervous system. In patients who are minimally symptomatic, in normal neurologic condition, or whose treatment risk is high, not recommending any treatment can be an excellent viable option. For the others, microsurgery, endovascular embolization, and stereotacticradiosurgery offer complementary advantages and improve the chances of a lifetime cure. Conclusion: A thorough knowledge of the natural history ofintracranial arteriovenous malformations is fundamental to the treatment decision making process. A multidisciplinary team approach with the neurosurgeon taking a leading role is as well essential for a successful intracranial arteriovenous malformation management.
Protocol to the induction of loco-regional mild hypothermia for temporay clipping in the surgery of the middle cerebral artery aneurysm
Authors: Prandini Mirto N , Ribeiro Carlos H. , Lacanna Santino N. , Cavalcante Hamilton R
Published: April 2019

Introduction: Less than 30% of Middle Cerebral Artery (MCA) aneurysms are amenable for endovascular coiling. Microvascular surgery still carries a large number of complications, since many perforators arteries arise near to the neck of the aneurysm and, in many cases, one or more branches of bifurcation or trifurcation of the MCA originate in the aneurysm wall. Temporary clipping of the proximal MCA avoids the aneurysmal rupture, facilitates the aneurysm dissection and clip placement but long term temporary clipping carries a great risk of ischemic complications. Objective: We developed a protocol of brain protection based on the neuroprotective properties of mild hypothermia which would intend to permit a more extended time of temporary clipping. Methods: Sixty-eight cases of MCA incidental aneurysms or after the 12nd day of hemorrhage were operated on. Brain temperature was dropped at levels that varied from 29.5ºC at 15mm parenchymal depth to 32.5ºC at ventricular level. There was no change in the patient’s body temperature. Temporary MCA clipping varied from 8 to 28 minutes. Results: There was no intraoperative aneurysm rupture. All 68 patients were alive and neurologically unchanged at the 90th and 180th follow-up days. Conclusion: Loco-regional mild hypothermia may be effective in protecting cerebral parenchyma in cases of temporary clipping over 8 minutes up to 28 minutes in MCA aneurysms surgery.
Importance of load sharing column and canal violation in the management of thoracolumbar burst fractures.
Authors: Scardino Fabrizio Borges , Rotta José Marcus , Botelho Ricardo Vieira
Published: April 2019

Introduction: The ideal classification of spinal fractures should include every kind of fracture and suggest patterns of treatments. Vaccaro et al. proposed a classification and treatment rules according to a comprehensive severity score. In this one, fractures with exclusive lesion of the vertebral body, burst fractures, without either damage of the posterior ligament band or neurological deficit, are considered for conservative treatment. Objective: To demonstrate that some fractures, with an exclusive lesion of the load sharing column, the vertebral body, without any posterior ligament destruction, may be unable to share physiological loads and if associated with great compression of spinal canal, carries so much risk of neural damage that it should be submitted to surgery. Methods: This review is based on the discussion of the literature and is illustrated by a case description. Results: We demonstrate the importance of inclusion of the concepts, load sharing column and intensity of canal encroachment in therapeutic decision regarding thoracolumbar fractures. Conclusions: Patients with canal compression ≥ 50% should be considered for surgery. Patients with lesser degrees of canal encroach may be submitted to erect radiography and operated if there is an additional loss of vertebral body height or neurological symptoms.
Fractionated stereotactic radiotherapy for the treatment of optic nerve sheath meningiomas
Authors: Andrews David W.
Published: April 2019

Radiosurgery has become an important treatment alternative to surgery for a variety of intracranial lesions. As currently practiced, it has in fact replaced surgery as a standard of care in some instances, compliments surgery as a post-operative adjunct in others, and most commonly represents an alternative to surgery or the only treatment option. Radiosurgery techniques have evolved quickly with the development of new technologies enabling more complex yet more efficient treatment plans. As a consequence, these technologies have broadened radiosurgery applications and improved radiosurgery outcomes. Among these newer techniques, treatments involving fractionated stereotactic radiation referred to as fractionated stereotactic radiotherapy, or FSR, have emerged as a consequence of linear accelerators designed for and dedicated to stereotactic techniques. Without the logistical constraints of retrofitted general purpose linear accelerators used in radiation oncology, often available only once or twice a week, dedicated units have enabled the design of treatment paradigms that strive for an ideal treatment based on the radiobiology of the target and dose-limiting contiguous tissues.This chapter will summarize our fifteen year experience with the Varian 600SR, initially with the Radionics software more recently modified to a Novalis shaped beam radiosurgery unit, and our practice of FSR for a variety of intracranial lesions. Special attention will be devoted to tumors involving or near the special sensory cranial nerves. Given the versatility of the Novalis treatment planning platform, one has the option of comparing different treatment planning solutions at once, including stereotactic intensity-modulated radiation therapy (IMRT). For selected skull base lesions, we have found that stereotactic IMRT yields greater conformality than FSR and we will therefore include its application among fractionation strategies.
Stereotactic radiosurgery for the treatment of glomus tumors
Authors: Zaccariotti Vladimir , Arruda João , Paiva Jean , Abreu Wenzel , Dourado Criseide , Aires Nilceana , Pinezzi Juliana , Bezerril Carlos , Goulart Flamarion , Goulart Flamarion , Araújo Valdeis , Resende Kátia
Published: April 2019

Introduction: Despite of being a slow growing hypervascular benign tumor, Glomus Jugulare is a challenge for the neurosurgeon, due to its complex localization and relation to the cranial nerves. Microsurgery alone or associated with radiation therapy have been used for decades, and is frequently associated with severe neurological sequelae. In the last decade, radiosurgery has been employed for tumor growth control, but long term follow up is still missing. Objective: The objective is to analyze the late results of radiosurgery alone in the treatment of glomus jugulare tumors. Material and Methods: From a series of 596 patients submitted to radiosurgery at our institution, seven patients with eight complex glomus jugulare tumors were selected. All patients were submitted to radiosurgery, 4 men and 3 women, age 20 to 78. The median volume of the lesions was 12.56 cc (range from 3.06 to 19.6 cc). The primary symptoms were pain and tinnitus, one patient had facial palsy before the initial treatment. Two patients were submitted to surgery before radiosurgery, and both developed lower cranial dysfunction, one of them underwent to conventional radiotherapy before radiosurgery. The patients received a single dose of 18 Gy to 20 Gy, using a LINAC with a conformal shaped beam collimator. Results: All patients had important pain relief (no more medication necessary) and a follow up of 30 to 96 months showed slight reduction in all of eight lesions. No patient suffered a new lower cranial nerve deficit after conformal shaped beam radiosurgery. Conclusion: Despite of the small number of cases, long term follow-up showed that radiosurgery is safe and effective to provide tumor growth control and to reduce pain associated with glomus jugulare tumors.
Radiosurgery for trigeminal neuralgia
Authors: Gorgulho Alessandra A. , De Salles  Antonio A.F.
Published: April 2019

Radiosurgery is a relatively novel technique in the armamentarium of TN treatment. Since 50% of the patients eventually require a surgical procedure to alleviate pain, the appropriate selection of patients to the different surgical techniques is a question of utmost relevance. The systematic literature reviews and the largest peer reviewed publications on the surgical treatment series of refractory trigeminal neuralgia are discussed considering the pros and cons of each surgical technique. Protocol variations and results of modern peer reviewed radiosurgery series are presented with focus on radiation doses and targets, aiming to maximize the understanding of the technique. Further well designed randomized trials focusing on the determination of the ideal target and radiation dose can optimize radiosurgery results, aiming to achieve the level of the results obtained with microvascular decompression, currently considered the gold-standard method.
Stereotactic irradiation for treatment of acoustic neuromas
Authors: Selch    Michael T.
Published: April 2019

Stereotactic cerebral irradiation is a radiotherapeutic technique for precise delivery of ionizing irradiation to an intracranial target with simultaneous sparing of adjacent parenchyma. Treatment can be administered by a multi-source cobalt-60 device (gamma knife) or a dedicated linear accelerator.The target dose can be delivered in a large, single fraction (stereotactic radiosurgery SRS) or in multiple, daily increments (stereotactic radiotherapy SRT). The latter approach combines the physical dose localization advantages of SRS with the radiobiologic benefits of dose fractionation. This literature review will present the rationale and clinical results of SRS and SRT for the treatment of acoustic neuromas. Emphasis will be placed on tumor control, imaging outcome and cranial nerve preservation. The findings demonstrate that SRS and SRT represent reasonable therapeutic options for patients with acoustic neuromas.
Fractionated stereotactic radiotherapy for optic nerve gliomas
Authors: Zabel-du Bois Angelika , Huber Peter , Debus Jürgen , Milker-Zabel Stefanie
Published: April 2019

Optic nerve gliomas represent approximately 5% of all pediatric intracranial tumors. Due to the highly variable clinical course optimal treatment is still discussed controversial. Since they often have little or no growth potential there is a strong recommendation for wait-and-see strategies. In patients with progressive loss of vision or local tumor progression in MR imaging, fractionated radiotherapy provides the greatest possibility of vision preservation. Radiotherapy plays an important role in these challenging tumors achieving high long-term local control rates and improved or stable visual function in approximately 90% of the cases. Recommended dose prescriptions vary between 45 and 54 Gy in standard fractionation. However, in children less than 5 years of age the role of radiotherapy is unclear. Here, chemotherapy is often used to delay radiotherapy treatment to avoid neuropsychological morbidity after irradiation during neurodevelopment. Typical late complications of radiotherapy include endocrinopathy,  vasculopathy, cognitive deficits and cataracts, especially in younger patients. Modern high-precision radiotherapy techniques like fractionated stereotactic radiotherapy (FSRT) are capable to achieve high local control rates with reduced treatment related late morbidity. Prospective randomised trials are needed to further define the role of modern radiotherapy techniques, especially in younger patients in a multimodal treatment approach.
A qualidade de vida no pré e pós-operatório de pacientes portadores de hérnia de disco lombar
Authors: Milani Jessica Pavan , Martins Marielza Regina Ismael , Da Silva Eduardo Carlos , Rocha Carlos Eduardo
Published: April 2019

Introdução: A relevância dos estudos que abrangem a hérnia de disco lombar (HDL) tem aumentado nos últimos anos, principalmente porque esta doença resulta em dor e déficit neurológico, gerando impedimento para a execução das atividades cotidianas e incapacidade para o trabalho. Objetivo: avaliar a qualidade de vida e o escore funcional de pacientes antes e após cirurgia de HDL. Casuística e Método: Trata-se de um estudo transversal, exploratório, mediante a avaliação dos questionários “Short Form Health Survey” (SF-36) e “Roland- Morris”(RM) no período de abril a setembro de 2008. A amostra foi composta de 20 pacientes e os escores foram avaliados antes da cirurgia e no pós-operatório de dois meses do procedimento. Resultados: observou-se que a maioria dos pacientes eram do sexo masculino (n=11, 55%), média de idade de 45,5 ± 14,79 anos (variando de 20 a 83 anos), com grande prejuízo laboral pré cirurgia (60%).Os resultados demonstraram que houve melhora significativa nos domínios do SF-36 para capacidade funcional, aspectos físicos, dor e saúde mental e para o Roland Morris foram observados ganhos funcionais com a diminuição de suas limitações provocadas pelas costas. Pela escala analógica de dor (EVA), os pacientes obtiveram uma diminuição importante do quadro álgico, pois no momento pré-cirúrgico obtiveram a média de 8,3 pontos e após 60 dias da cirurgia uma média de 4,55. Ressalta-se que apesar de 65% dos pacientes retornarem ao trabalho, apenas 45% aderiram à reabilitação. Conclusão: Novos estudos devem ser realizados de maneira a oferecer subsídios à equipe multiprofissional mostrando que, mais do que abolir a dor, a melhora funcional, expressa pelas atividades cotidianas, deve ser modificada, sendo para isto necessário um enfoque reabilitacional efetivo que inclua a terapia ocupacional, fisioterapia e psicologia, buscando operar mudanças e uma melhor qualidade de vida sempre.
Traumatismo cranioencefálico leve no idoso
Authors: Pereira Carlos Umberto , De Almeida Annie Merielle Gomes
Published: April 2019

Introdução: A classificação de gravidade do traumatismo cranioencefálico (TCE) leve no idoso baseada na escala de coma de Glasgow (ECGl) tem sido largamente utilizada na evolução destes pacientes. Objetivos: Analisar causas do TCE leve no idoso, ECGl na admissão, exames de neuroimagem, conduta e prognóstico. Pacientes e Métodos: Estudo prospectivo e descritivo, com idosos portadores de TCE leve, em hospital de referência de Sergipe, entre agosto de 2007 e julho de 2008. Resultados: Estudados 44 pacientes entre 60 e 96 anos. O gênero masculino foi o mais acometido (72%). Os escores da ECGl na admissão foram 13 (18%), 14 (9%) e 15 (73%). As causas do TCE foram: queda acidental (72%) e acidente automobilístico (18%). Rx simples e TC de crânio foram realizados em 39% dos pacientes, cada um. Achados na TC: normal (18 pacientes), hemorragia intracerebral (quatro pacientes) e contusão cerebral (dois pacientes). Tratamento conservador foi realizado em 95% dos pacientes e cirúrgico, em 5%. Conclusão: A ECGl tem sido útil na avaliação da gravidade em pacientes com TCE. A principal causa do TCE leve no idoso foi queda da própria altura (72%). Radiografia de cranio foi o exame de eleição devido à disponibilidade.
Prejuízos neurocognitivos na hemorragia subaracnóide aneurismática no pré e pós operatório
Authors: Ambrosi Patricia Bozzetto , Ambrosi Caroline Bozzetto , Alencar Ivana , Filho Hildo Azevedo
Published: April 2019

Os prejuízos neurocognitivos após uma hemorragia subaracnóide (HSA) aneurismática, bem como as classificações de resultados neurocirúrgicos, vêm em processo de reavaliação. O tratamento endovascular dos aneurismas intracranianos, que inicialmente foi introduzido para a oclusão dos aneurismas mais difíceis, vem se tornando um método de escolha por ser menos invasivo, porem não se conhece o impacto neurocognitivo do tratamento da HSA aneurismática seja ele cirúrgico ou endovascular. Sabe-se que a HSA isoladamente também está associada com alterações cognitivas a longo prazo. Alguns fatores clínicos associados, como vasoespasmo, ressangramento,  hidrocefalia, ruptura intra-operatória também podem agravar essas alterações cognitivas. Os estudos correlacionando essas variáveis foram iniciados há pouco tempo e não existe consenso a partir de estudo controlado na literatura. O objetivo deste relato visa demonstrar a aplicação clínica e neuropsicológica direcionada para analisar o estado cognitivo pré e pós-operatório em uma paciente que foi internada após duas hemorragias subaracnóideas (HSA) aneurismáticas, cujo aneurisma da artéria cerebral média esquerda foi clipado. São analisados o estado pré e pós-operatório tentado-se delimitar a disfunção dentro de padrão de comportamento individual, os distúrbios pré-operatórios e a seqüelas pós-operatórias quando ela foi averiguada mais tarde, analisando-se o impacto de ambas, hemorragia e cirurgia sobre o funcionamento cognitivo e funções afetivas.
Considerações Técnicas no Treinamento de Anastomoses Microvasculares em Laboratório de Microcirurgia
Authors: Isolan Gustavo Rassier , Santis-isolan  Paola Maria Brolin , Dobrowolski Samuel , Giotti Marta
Published: April 2019

Anastomoses microvasculares são um procedimento cirúrgico complexo e um armamento essencial utilizado em diversas subespecialidades. A primeira etapa de treinamento em anastomose microcirúrgica deve ser sempre no laboratório. Este artigo é uma revisão sobre os fatores envolvidos no para a realização de anastomoses microvasculares. Instrumental cirúrgico, microscópio, estrutura do laboratório, procedimentos cirúrgicos, questões éticas e parâmetros radiológicos e histológicos são discutidos.
Spinal Epidural Abcess
Authors: Vasconcelos Douglas Serra , Meguins Lucas Crociati , Ribeiro Domingos Edno Castro , Mello Giselle Da Silva , Rodrigues Dicla Caroline Hartuique , Teixeira Victor Hugo Toyoki Motoki , Rogério Juvenal De Souza
Published: April 2019

Spinal epidural abscess (SEA) is an extremely rare life-threatening infectious disorder. It accounts for 0.2-2.0/10,000 hospital admissions per year. We report on a young man with a recent history of furunculosis that evolved febrile back pain associated with triparesia with right upper extremity paresis and crural paraplegia. He referred also symptoms of urinary incontinency. Magnetic resonance imaging (MRI) of the thoracolumbar spine showed an epidural mass compressing two thoracic vertebras, from T4 to T5. The patient underwenturgent surgical decompression of the epidural abscess and culture of the purulent collection grew Methicillin-sensitive Staphylococcus aureus. Postoperative combined intravenous antibiotic treatment was instituted with metronidazole, oxacilin and gentamicin during 30 days. The patient had anuneventful recovery without any residual neurologic deficits. This report highlights the importance of an early suspicion of SEA in patients with febrile back pain and initial neurologic deficits with known risk factors for epidural abscess. Aggressive treatment with surgical decompression and systemicantibiotics seems to be an appropriate approach to prevent permanent neurologic deficits.
Spinal Schwannomatosis
Authors: Holanda Maurus Marques de Almeida , Paz Daniel De Araujo , Marinho Segundo Luiz Márcio De Brito , Ferreira Christian Diniz
Published: April 2019

Schwannomatosis is a rare tumor syndrome characterized by more than one schwannoma without any evidence of other manifestations of neurofibromatosis (NF). A 32-year-old woman was admitted to our hospital because of weakness in her lower extremities. Neurological examination revealed paraparesis with hypoesthesia below T8 level. Magnetic ressonanceimaging (MRI) showed well-defined masses with strong contrast enhancement at the dorsal and lumbosacral spinal regions. After removal of six tumors compressing the spinal cord, the patient improved rapidly. The histological diagnosis was schwannomas. A detailed clinical examination and MRI scanning of the central nervous system excluded NF2. Not all patients with multiple schwannomas of cranial nerves, spinal nerve roots or peripheral nerves origin have NF-1 or NF-2. Surgery is indicated for symptomatic lesions, while asymptomatic tumors are followed conservatively.
Thoracic medulloblastoma metastasis
Authors: Polverini Allan Dias , Bortoluzzi Guilherme Fonseca , Cury Filho Eduardo Jorge , Sanchez Jr Santiago Luis , Szylewicz Stefan , Roberto Paulo , Da Silva Sagiorato , Domienikan Mauro Sergio , Rodrigues Jr. José Carlos , De Oliveira Carlos Tadeu Parisi
Published: April 2019

Introduction: Medulloblastoma is one of the most frequent malignancies of Central Nervous System (CNS) in childhood and has low incidence in adult population. Recurrences are frequent in both populations; systemic metastasis is a rare event. Objective: Report an unusual medulloblastoma case evolution, with thorax metastasis after 6 years of quiescence and compare results with literature data. Methods: Registers survey of previously operated patient from a posterior fossa medulloblastoma with diagnose of thoracic metastasis. Acquired data were analyzed and compared with those from literature. Case report: Twenty-two years-old patient, with a previously operated on posterior fossa medulloblastoma . Six years later, presents with asthenia and vertigo: an x-ray diagnosis of a lesion in the apex of left chest is confirmed with a thoracic computerized tomography. A laparoscopic biopsy is done, disclosing an infiltrative tumor, adherent to the parietal pleura and highly vascularized. AP diagnosis was compatible with metastasis of medulloblastoma. Conclusion: Posterior fossa recurrences are frequent in the adult population, followed by the subfrontal region. About 5% of meduloblastoma metastases are systemic, especially in bones (77%), and even rarer in the lungs, as shown in this report.
Schwannoma of the lumbar spine
Authors: Leal Filho Manoel Baldoino , Da Silva Júnior Raimundo Gerônimo , Leal Luciana Maria Pinheiro
Published: April 2019

Objective: To show a case of lumbar spine schwannoma that presented with low back pain and sciatica. Case: A patient that presented with low back pain and sciatica. The Gadoliniumenhanced Magnetic Resonance Imaging (MRI) showed a lumbar L4-L5 schwannoma. He underwent lumbar laminotomy and intradural microsurgery. The lesion was totally removed. There was an important improvement on postoperative and at one-year follow up MRI showed no tumor. Conclusion: The authors stress that spine schwannoma should be considered inthe differential diagnosis of a patient experiencing symptoms of disc herniation, a disease of more common occurrence.
Lipoma intradural extramedular sem disrafismo
Authors: Costa Rui Oliveira , Costa Yves Bohrer
Published: April 2019

Lipomas medulares são tumorações benignas pouco freqüentes, sendo considerada rara sua ocorrência sem disrafismo vertebral associado. O surgimento das manifestações clínicas ocorre predominantemente por volta 2ª e 3ª década de vida, determinando, na maioria dos casos, um curso arrastado de  deterioração neurológica que varia de acordo com sua localização. Descrevemos nesse relato um caso raro de lipoma medular intradural extramedular, sem associação com disrafismo; e fazemos uma breve revisão da literatura considerando a epidemiologia, tratamento e achados histológicos destas lesões.
O papel da abordagem endoscópica trans-esfenoidal extendida no manejo dos meningeomas do tubérculo da sela - Existe alguma indicação?
Authors: Isolan Gustavo Rassier , Antunes Ápio Cláudio Martins , Piltcher Otávio , De Aguiar Paulo Henrique Pires , Aires Rogério , Sodré Rafael , Turchetti Sarita , Arai Juliana , Meister Caio , Gallucci Maíra
Published: April 2019

A abordagem endonasal endoscópica é um novo armamentarium cirúrgico no tratamento das patologias da base do crânio. A abordagem endoscópica trans-esfenoidal extendida para a fossa anterior da base do crânio é uma de suas variações. Meningeomas do tubérculo da sela são lesões únicas que correspondem a 5 a 10% de todos os meningeomas intracranianos. Eles caracterizam-se por deterioração visual precoce. O melhor manejo destes tumores é a ressecção cirúrgica radical, que é realizada historicamente mediante craniotomia. Para pequenos meningeomas do tubérculo selar situados na linha média a abordagem a abordagem endoscópica trans-esfenoidal extendida pode ser indicada. Durante período de 30 meses, 10 meningeomas do tubérculo da sela foram operados por craniotomia fronto-orbital (7 casos) ou pterional (2 casos) unilateral e um paciente por abordagem trans-esfenoidal endoscópica. Nós apresentamos este último caso e discutimos as nuances técnicas bem como os fatores envolvidos na seleção da melhor abordagem.
Hemodynamic and metabolic parameters in brain injury
Authors: De Almeida Andrea Garcia , Stefani Marco Antônio , Netto Carlos Alexandre
Published: April 2019

Introduction: Indirect monitoring of brain metabolism through parameters such as cerebral perfusion pressure (CPP), intracranial pressure (ICP), arterial CO2 partial pressure (PaCO2) and mean arterial blood pressure (MABP) is necessary to guide treatment and to prevent secondary cerebral ischemia. The aim of the present study was to analyze the association between cerebral hemodynamic and metabolic parameters and the occurrence of traumatic brain ischemia. Methods: Thirty-one patients were prospectively assessed in the pediatric or adult intensive care unit of Hospital de Pronto Socorro (HPS), in Porto Alegre, Brasil, from April to December, 2003. Patients were 23 adults (aged 17 to 66 years-old ) and eight children (aged 3 to 13 years-old) with severe traumatic brain injury( TBI ) . Mean age was 24 years. The inclusioncriteria were Glasgow coma scale (GCS) below 8 and abnormal cranial computed tomography (CT) results. Intracranial pressure, mean arterial blood pressure, arterial CO2 partial pressure and cerebral perfusion pressure were recorded. Results: Cerebral ischemia was identified in 13 adults (56.5%) and in seven children (87.5%). High MABP was associated with mortality (P<=0.005) in children. High ICP (P= 0.03) and low CPP (P=0.007) in adults were associated with cerebral ischemia. Fourteen patients (45.2%) died: 13 adults (56.5%) and one child (12.5%). Adult patients with low CPP had a worse outcome with higher mortality rate (P=0.045). Conclusions: High ICP, high MABP and low CPP were associated with traumatic brain ischemia and higher mortality rate in these patients.
Magnesium in subarachnoid hemorrhage
Authors: Aires Rogério , Lehmann Márcio Francisco , Simm Renata , Melgar Miguel , Zicarelli Carlos Alexandre Martins , De Aguiar Paulo Henrique Pires
Published: April 2019

Cerebral vasospasm is responsible for a great number of deaths and morbidity after acute subarachnoid hemorrhage. Beyond any doubt, it is related to physiopathology of endothelial cell contraction and relaxation. It has been proved as a therapeutic agent when administrated intravenously in patients after subarachnoid hemorrhage. A critical review of literature was accomplished by the authors in order to analyse all actions of vasospasm in SAH. The intravenous administration of magnesium is imperative and should be done immediately after the onset of SAH, as reccomended in the most important guidelines for the treatment of cerebral vasospasm.
Highly Effective Antiretroviral Therapy and Cerebral Aneurysms
Authors: Figueiredo Eberval Gadelha , Romão João Paulo Fadil , Welling Leonardo C. , Rosi Junior Jefferson , Teixeira Manoel J
Published: April 2019

Classically, the death of patients infected with the human immunodeficiencyvirus (HIV) has been due to multiple causes, including incurable systemic infections, neurological disease and multisystem failure. With the advent of the highly effective antiretroviral therapies (HAART), the survival has been longerand processes that have traditionally not had enough time to play a role in the functional decline of HIV-infected patients are appearing. Although vascular complications in HIV-infected patients in use of HAARTs has been addressed in the literature, there has been limited discussions regarding the possiblerelationship between infection with HIV, use of HAART and the development of cerebral aneurysms. The aim of the present study is provide insight into the understanding of cerebrovascular complications, especially cerebral aneurysms, associated with the use of HAARTs in HIV-infected patients.
Traumatismo de crânio por ferimento por arma de fogo
Authors: Da Cunha Marcelo Lemos Vieira , De Araújo Júnior Francisco A. , Veríssimo Denildo César Amaral , Rehder Roberta , Maingue José Antônio , Da Silva Paulo Eduardo Carneiro , Bark Samir Ale , Borba Luis Alencar Biurrum , Pinto Camila Araújo Scharf
Published: April 2019

Objetivo: verificar dados epidemiológicos de ferimentos por projétil de arma de fogo (FPAF) no período de junho de 2007 a agosto de 2008 em hospital referência em trauma, bem como revisão de literatura. Métodos: realizado estudo retrospectivo com ênfase nas variáveis sexo, idade, dia de semana do evento, escala de coma de Glasgow à admissão, trajetória do projétil e evolução do paciente pós injúria por FPAF em crânio, conforme ficha padronizada pelo serviço de neurocirurgia do referido hospital. Resultados: foram computados 33 casos. Três excluídos, pois, embora em região cefálica, não adentraram cavidade intracraniana. Idade média de acometimento foi de 28,75 anos; predomínio do sexo masculino (73,33%); 50% dos casos foram admitidos em Glasgow <6; 60% evoluíram ao óbito; orifício de entrada presente em quadrante anteriordireito em 30% dos casos, com porcentagem idêntica em quadrante posterior direito; 30% ocorreram na segunda feira, seguidos de 23,33% no domingo. Conclusão: os dados obtidos neste estudo corroboram literatura mundial. Glasgow abaixo de 6 à admissão e envolvimento ventricular ou multilobar traduzem mau prognóstico. População jovem masculina vitimada durante o final de semana compatível com relatos encontrados em revisão literária.
Eletroestimulação Epidural Medular no Tratamento da Dor de Difícil Controle e Melhora da Qualidade de Vida
Authors: Rocha Carlos Eduardo D´Aglio , Martins Marielza R. Ismael , Foss Marcos Henrique D´Alglio , Santos Junior Randolfo , Cunha Ana Márcia Rodrigues , Da Silva Junior Sebastião Carlos
Published: April 2019

Introdução: Estudo prospectivo em amostra de conveniência, recrutada seletivamente em indivíduos com causa inoperável e refratários ao tratamento convencional. Metodologia: Foram avaliados e acompanhados dois indivíduos com dor crônica não neoplásica, em tratamento na Clinica da Dor do HB. Os dados foram coletados no período de março de 2009 a junho de 2010. Os indivíduos haviam sido submetidos a agentes morfínicos, antidepressivos, neurolépticos e anticonvulsivantes, tendo também sido submetidos a tratamento fisiátrico com alongamento,acupuntura, infiltração dos pontos-gatilhos, calor, massagem e ultra-som. Resultados: Os resultados foram regulares em ambos os casos. A duração da queixa álgica variou entre 3 e 5 anos. A dor no caso I localizava-se região lombar secundária a síndrome dolorosa miofascial em músculoquadrado lombar e glúteo máximo com radiculopatia crônica L5. No caso II, houve lesão medular incompleta ASIA C tendo evoluído para ASIA A após 3 meses de cirurgia com descompressão do canal medular associada a artrodese . Em ambos foi implantado um eletrodo tipo placa quadripolar T3-T4 epidural e realizada reabilitação das incapacidades psicológicas, físicas e sociais através de atividades dinâmicas e educacionais com abordagem psicossocial e com objetivo de reduzir a dor, promoverem mudanças comportamentais e melhorar o desempenho de atividades da vida diária. Conclusão: Após acompanhamento, houve redução total do uso de opióides, permanecendo apenas os adjuvantes com melhora da qualidade de vida.
O Efeito das Estatinas na Prevenção de Vasoespasmo Cerebal Secundário à Hemorragia Subaracnoidea Espontânea
Authors: De Santana Diana Lara Pinto , Figueiredo Eberval G , Nogueira Adriano Barreto , Romero Flávio Ramalho , Teixeira Manoel J
Published: April 2019

Introdução: O vasoespasmo cerebral tardio é a maior causa de morbidade e mortalidade em pacientes com hemorragia subaracnóide1-5. Algumas teorias fisiopatológicas e algumas medicações têm sido testadas nos últimos anos2,5,15,16,19,20. Estudos randomizados em fase II demonstraram a melhora do fluxo sanguíneo cerebral e redução da incidência de vasoespasmo sintomático11,13. Métodos: Foi utilizada a base de dados Medline para pesquisar artigos dos últimos cinco anos relacionando Estatinas e Hemorragia Subaracnóide. Resultados: foram encontrados quatro artigos de relevância clínica para o presente trabalho. Três destes artigos eram ensaios clínicos duplo cegos, randomizados, controlados com placebo e um deles uma meta-análise de estudos. Os resultados encontrados nos artigos analisados indicam que as estatinas são superiores ao placebo para diminuir a incidência de vasoespasmo, mortalidade geral e a existência de deficits isquêmicos tardios.  Discussão: Apesar destes achados, a dose, o tempo de início do tratamento, o tempo total de administração e qual estatina deve ser empregada ainda permanecem indefinidos, já quecada um dos artigos utilizou um protocolo diferente. Conclusão: O número de pacientes tratados que foram apresentados nos estudos ainda é muito pequeno para que o uso de estatinas seja mandatório nos ambientes que tratam HSA aneurismática.
Unusual Presentation of Sequestered Cervical Disc Herniation
Authors: Joaquim Andrei F. , Ghizoni Enrico , Cabral Sérgio R. O. , Hamilton David Kojo , Shaffrey Christopher I.
Published: April 2019

Patients with cervical disc herniation can be asymptomatic or present with radiculopathy or myelopathy symptoms. Generally, they are located anterior or antero-laterally in the epidural space. We present a case of an extruded cervical disc with a dorso-lateral migration, similar to a tumoral extradural lesion. Sequestered cervical disc herniation should be considered in the differential diagnosis of dorso-lateral lesions.
Anatomia Microcirúrgica e abordagens ao seio cavernoso
Authors: Isolan Gustavo Rassier , Vedolin Leonardo , Bertholdo Débora , Dini Leandro Infantini , Braga Francisco , Perondi Gerson , Antunes Ápio Cláudio Martins , Lopes Nilo Mario Monteiro , Stefani Marco Antônio , Oppitz Paulo , Werneck Mariana , Cristovam Rafael
Published: April 2019

O seio cavernoso é uma das regiões mais complexas do corpo humano e pode ser acometido por diversas patologias. Atualmente, diversos tipos de tratamento podem ser usados para tratar doenças nesta região, porém o conhecimento anatômico ainda é fundamental para estabelecer o melhor manejo. Nosso objetivo é apresentar a anatomia microcirúrgica do seio cavernoso, as abordagens cirúrgicas (incluindo a abordagem endonasal endoscópica), a correlação radiológica desta anatomia, bem como uma série inicial de casos. As fotos são apresentadas pelo método convencional e anaglífico estereoscópico. São descritas as estruturas neurovasculares do seio cavernoso bem como suas relações ósseas e durais, as paredes e os triângulosda base do crânio relacionados ao seio cavernoso. As abordagens crânio-órbito zigomática, transpetrosa, zigomática e endonasal endoscópica são apresentadas, sendo as estruturas anatômicas identificadas também nos exames de imagem. Casos ilustrativos ilustram esta anatomia.
Apnéia do sono associada a obesidade
Authors: De Aguiar Paulo Henrique Pires , Miranda Barreto Icaro De Barros , Da Costa Isis Lozzi , Joseph Murilo , Neves Maick Fernandes , Simm Renata Faria , Maldaun Marcos Vinicius Calfat , De Paiva Bernardo Lembo Conde , Panagopoulos Alexandros Theodoros , Melgar Miguel
Published: April 2019

Os autores selecionaram um grupo de pacientes com apnéiado sono e aneurismas cerebrais e procuraram correlacionarcom casos de sobrepeso e obesidade, encontrando 80% depacientes com obesidade do sexo feminino, com idades entre 49 e 72 anos (média de 60,6 anos), todas submetidas a gastroplastia prévia, e tendo sido submetidas a repetidos regimes para emagrecer , com 60% de aneurismas rotos, todos Hunt-Hess entre III e V e Fisher 4 .. Aqueles com sobrepeso, idade entre 53 e 70 anos ( média 60,5 anos), 50% tabagistas, 75% com aneurismas rotos, com gradação Hunt-Hess 3.3 em média, e Fisher de 3.3 em média. Concluir sobre a correlação é muito incipiente e mais estudos devem ser feitos neste sentido.