bluuebunny/crossref_metadata_2025_split 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.
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.