bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuroparacoccidioidomicose mimetizando metástase cerebral
Authors: Da Cunha Marcelo Lemos Vieira , Onuki Clézio Alex , Aymone Neto José Francisco De Assis , Piekala Cleiton , Pletz Ana Luiza Brunelli 
Published: April 2019

O diagnóstico da neuroparacoccidioidomicose (NPCM) é um desafio ao neurocirurgião. Exames de imagem são importantes para o diagnóstico e seguimento dos pacientes, porém a identificação histológica do P.brasiliensis é necessária para confirmação diagnóstica. Ressonância magnética émais sensível que a tomografia computadorizada (TC), pois revela lesões intraparenquimatosas não visualizadas à TC, particularmente as infratentoriais. Ambos os métodos, entretanto, fornecem imagens inespecíficas. Achadosradiográficos pulmonares podem auxiliar no diagnóstico já que os pulmões são acometidos em aproximadamente 60 a 80% dos casos de NPCM. Os testes laboratoriais e a análise de líquor têm valor limitado. Em áreas endêmicas, deve ser feito diagnóstico diferencial entre neoplasias, principalmente gliomas malignos e tumores metastáticos, toxoplasmose, neurocisticercose e outras micoses.Relatamos o caso de umhomem de meia idade com neuroparacoccidioiodomicoseconduzido, erroneamente, como metástase cerebral múltipla.
Giant Cervical Neurofibroma with Concomitant Deformity
Authors: Rodrigues Gleidson C. , Joaquim Andrei F. , Ghizoni Enrico , Queiróz Luciano , Tedeschi Helder 
Published: April 2019

A 27 years-old woman presenting with a giant cervical neurofibroma with spinal cord compression and cervical kyphosis is reported. We discuss the surgical nuances of the multiple surgeries required to achieve a total tumor resection and deformity correction. An algorithm used in our institution to treat cervical kyphosis is also presented.
Epilepsy Surgery in MRI Negative Patient
Authors: Herrera Enrique José , Palacitos Claudio , Suarez Julio César , Pueyrredón Francisco José , Surur Alberto , Theaux Ricardo , Fonticiella Silvia Perez , Viano Juan Carlos 
Published: April 2019

Background: Non-lesional epilepsy or MRI-negative epilepsy is characterized by the absence of a potentially epileptogenic lesion. In these cases surgical procedures are more complex and rather challenging. Case Description: A 6-year-8-monthold boy presented with refractory epilepsy since 8 months-old onset age was 8 months. Crises were predominantly complex partial seizures. Patient had no focal neurological signs but showed cognitive, learning and behavioral alterations. Video-EEG: left temporal-occipital focus radiating to the right. MRIs did not show lesion, interictal PET was negative and ictal SPECT showed left occipital and right temporal focuses, which was interpreted as propagation. Resection surgery of left focus was performed in two stages, withsubdural grid electrodes. Histopathological studies showed cortical dysplasia type IA. Follow-up (24 months): the patient presented only one annual seizure and showed cognitive, learning and behavioral improvement. Conclusion: In this case SPECT was very useful in localizing epileptogenic focus.
Trombose Venosa Cerebral com Transformação Hemorragica
Authors: De Oliveira Gustavo Henrique Reis , Vieira Emerson Dantas , Ruback Michelle Tebaldi , Pereira Christian Luis , Coelho Gabriel Costa Frizzera , Kill Cleverson Martins 
Published: April 2019

Introdução: A trombose venosa cerebral é uma entidade de grande importância na clínica neurológica. Consiste de evento de grande morbidade e mortalidade, sendo potencialmente recuperável se diagnosticada precocemente. É uma condição rara, constituindo menos de 1% dos acidentes vasculares. A transformação hemorrágica é uma complicação preditora deprognóstico desfavorável. O manejo desta patologia é de alta complexidade e demanda tratamento agressivo. Objetivo: revisar a literatura sobre esta patologia e relatar um caso clinico para exemplificar o beneficio do junto ao tratamento precoce. Conclusão: A trombose dos seios da dura-mater é entidade patológica de grande importância, e sua etiologia deve ser amplamente pesquisada para o tratamento adequado e prevenção secundária.
Spinal cord compression with manifestation primary of spinal metastasis
Authors: Pereira Carlos Umberto , Esmeraldo Augusto César Santos , Santos Liani Patrícia Andrade , Oliveira Débora Moura da Paixão 
Published: April 2019

Introduction: Spinal compression from unknown primary neoplasms occurs in 5 to 14% in cancer patients. The most common metastasis is secondary to lung, breast and prostate neoplasms. The objective of this study is to describe the clinical characteristics and to evaluate outcomes in patients with spinal compression from unknown primary neoplasms. Methods: We developed a retrospective, observational and descriptive study. Six patients were analyzed according to gender, age, location of injury, treatment and prognosis. These patients were analyzed from January 2008 and July 2011 at Emergency Hospital of Sergipe. Results: Six patients were identified. The median age was 52 years. Male gender was the most affected. The main complaint was pain, followed by motor deficit and sphincter disturbances. The thoracic region was involved in four cases, one cervical and one lumbar. The primary source was lung in three patients, thyroid in one, prostate in one and unknown in one. The CT and MRI were gold standard exams to the diagnosis. Four patients were undergoing decompressive laminectomy, a radiotherapy combined with chemotherapy was performed in three patients and only chemotherapy in two cases. There was death in four cases. Conclusions: Spinal compression can be a late manifestation of primary cancer metastasis. The prognosis of these patients is reserved in several cases due to advanced stage of the primary lesion when the diagnosis is made.
Aneurismas intracraneales multiples
Authors: Showing Marco González-Portillo , Montenegro Luis Contreras , Sotomayor Marco Chipana , Tanta Luis Huamán 
Published: April 2019

Los aneurismas intracraneales múltiples (AIM) son relativamente comunes, ocurren aproximadamente en el 23 % de todos los pacientes con aneurismas. Los factores de riesgo asociados son: sexo femenino, hipertensión arterial, tabaquismo y posiblemente historia familiar de aneurismas intracraneales o enfermedades cerebrovasculares. La localización del aneurisma roto puede ser determinada con una alto índice de precisión con angiografía digital cuando se utiliza conjuntamente con tomografía computarizada (TC) y resonancia magnética (RM). El promedio de ruptura de aneurismas múltiples no tratados es entre el 1 y el 2.2%. El tamaño crítico asociado con riesgo significativo de hemorragia fue 7 mm. Los aneurismas múltiples se presentan con más frecuencia a lo largo de la arteria carótida interna (ACI) y en la bifurcación de la arteria cerebral media (ACM). Luego de presentarse sangrado de alguno de los aneurismas, se debe diagnosticar cuál fue el que sangró, ya que debe ser el primero en ser clipado, esto es importante especialmente cuando todos los aneurismas no pueden ser clipados con un solo abordaje. La mayoría de los aneurismas intracraneales múltiples de circulación anterior pueden ser clipados mediante abordaje frontotemporo-esfenoidal; inclusive, aneurismas localizados en el lado contralateral. Asimismo, el desarrollo de nuevas técnicas endovasculares (uso de hidrocoils, coils bioactivos, onix , técnicas de remodelado del aneurisma con balón o stent simple o doble), permiten más tratamientos satisfactorios, inclusive combinando ambas técnicas. Conclusión: Los abordajes multimodales, combinando microcirugía y tratamiento endovascular, se vienen usando con éxito en casos de aneurismas cerebrales múltiples.
Descompresion neurovascular en espasmo del nervio facial
Authors: Ramos Antonio Daher 
Published: April 2019

El espasmo hemifacial es una enfermedad rara, con una incidencia de menos de 1 en 100.000 habitantes en los Estados Unidos; y esta caracterizada por contracciones involuntarias de los músculos en una lado de la cara. Es un síndrome de aparición espontánea y progresiva con contracciones intermitentes de los músculos que se ocupan de la expresión facial. El espasmohemifacial tiene un efecto cosmético y psicológico importante en el paciente, y en los casos mas avanzados la visión puede estar afectada. En nuestra experiencia el espasmo hemifacial primario es una enfermedad que comienza generalmente entre los 41 y 60 años con un promedio de 50 años. Sin embargo en las diferentes series de la literatura la edad de aparición puede variar entre 18 y 77 años. La mayoría de los pacientes son del sexo femenino con una incidencia de 2.4 mujeres sobre hombres. El lado mas afectado de la cara es el lado izquierdo; la razón por la cual existe esta asimetría de movimientos involuntarios no esta muy clara. Se ha sugerido que la predominancia del lado izquierdo puede ser el reflejo de una predisposición embriológica en relación a la posición del nervio facial y el vaso compresivo en la zona de entrada del nervio en el lado izquierdo. El espasmo hemifacial bilateral es muy raro.
The prolonged use of temozolomide in glioblastoma patients
Authors: Neto Maurício Coelho , Da Silva Luis Fernando Moura , Ramina Ricardo , Oliveira Marcelo , Lima Mônica 
Published: April 2019

The temozolomide protocol established in 2005 increased overall survival rates in patients with glioblastoma. It defined a treatment period of 6 months, but most neuro-oncological centers prescribe more than this, reaching up to 3 years of continuous therapy. The objective of this paper was to compare duration of treatment in groups of patients and analyze the overall survival in each group. Retrospectively, 54 patients were evaluated with glioblastoma operated on from 2004 to 2009. All data were statistically analyzed using Kaplan-Meier curves, ANOVA test, multivariate logistic regression models and Pearson´s correlation. Analyses consisted on age, gender, Karnofsky Performance Scale (KPS) at diagnosis, side and localization of tumor, grade of surgical removal, period of use of temozolomide until recurrence, progression-free survival, KPS after recurrence and overall survival. According to uni and multi-varied analysis there was no statistic significant correlation between survival and age < 45, gender, KPS at diagnosis, and grade of resection. The overall survival in 6, 12, 18 and 24 months were 96.3%, 72.6%, 58.1% and 43.5% respectively. The length of treatment with temozolomide before recurrence showed strong positive correlation (r=0.66) with survival up to 15 months. Also, a correlation (r=0.64) between length of use of temozolomide and progression free-survival was found. Patients receiving treatment with temozolomide presented longer survival when compared with those not treated with it. Longer survival (p=0.04) was observed in those treated more than 12 months. This series could clearly show longer survival in patients treated with 15-cicles over patients treated with 6 or 12-cicles.
Tratamento endovascular de aneurismas intracranianos não rotos em idosos
Authors: Wasem Matheus Pedro , Sequinel Amanda Pereira , Rheinheimer Andréia Carpenedo , Leal André Giacomelli , De Meneses Murilo Sousa 
Published: April 2019

Introdução: A necessidade de tratamento de aneurismas intracranianos não rotos em idosos e a técnica a ser utilizada encontrase controverso na literatura. O objetivo deste estudo é relatar a experiência e o seguimento do tratamento endovascular de aneurismas intracranianos não rotos em idosos em um centro especializado de Curitiba – PR. Método: Foram avaliados retrospectivamente pacientes com 60 anos ou mais com diagnóstico de aneurisma intracraniano não roto tratados pela técnica endovascular entre 2007 e 2012 no INC. Foram excluídos pacientes com aneurisma fusiforme, micótico ou traumático. Foram coletados dados demográficos, características do aneurisma, técnica utilizada, resultados finais e complicações. Resultados: 27 pacientes e 30 aneurismas. A média de idade foi de 71 anos, sendo 70% do sexo feminino. Metade dos aneurismas tinha entre 5 e 15mm e 50% tinha colo largo (>4mm), enquanto na outra metade o colo era estreito. A técnica mais utilizada foi a de Remodeling. Obteve-se 74% de oclusão completa, 13% oclusão parcial e o procedimento não foi concluído em 13%. Houve 6% de complicações com morbi/mortalidade. Conclusões: O tratamento endovascular de aneurismas intracranianos não rotos em idosos mostrou-se seguro para 87% dos casos com complicações aceitáveis e específicas à faixa etária e próximas à população geral.
Inovação de aparelho e técnica de localização estereotácticos
Authors: Junior Marco Antônio Rocha , Rocha Marco Antonio , Christo Paulo Pereira , De Oliveira Mariana Brandão , Avelar Ribeiro Paula Veloso , Rocha Renata Bernardi , Ribeiro Bruna Veloso Avelar 
Published: April 2019

Introdução: A designação cirurgia estereotáxica foi criada para definir procedimento que consiste em atingir alvos encefálicos, por um equipamento apropriado, através de cálculos matemáticos. Os aparelhos estereotácticos atuais requerem instalação de halo no crânio através de parafusos, além da dependência de barras referenciais na realização de TCC (tomografia computadorizada de crânio) para obtenção das coordenadas tridimensionais. Objetivos: Desenvolver novo aparelho de localização estereotáctica sem a necessidade de pinos de fixação no crânio, extrair dos filmes de tomografia as três coordenadas tridimensionais (X,Y,Z) e demonstrar a acurácia da nova metodologia. Material e Métodos: Foram realizadas TCC de 4 crânios humanos com 6 alvos no interior de cada. Extração de coordenadas estereotácticas que foram transferidas para o novo aparelho desenvolvido. Análise estatística para calcular a acurácia da nova técnica nos 24 alvos instalados nos crânios. Resultados: O novo aparelho e técnica apresentaram média de erro de 0,47 cm em relação ao alvo desejado. Conclusão: Foram desenvolvidos novo aparelho e metodologia de localização estereotácticos capazes de extrair dos filmes de TCC as coordenadas tridimensionais (X,Y,Z) e localizar alvos intracranianos sem a necessidade de pinos de fixação no crânio ou barras referenciais.
Lombalgia crônica secundária a doença degenerativa discal
Authors: Joaquim Andrei F. , Ghizoni Enrico , Tedeschi Helder 
Published: April 2019

Objetivos: Compararar a eficácia do tratamento cirúrgico da lombalgia axial crônica associada à doença degenerativa discal com o tratamento conservador. Métodos: Efetuou-se pesquisa na base de dados PubMed de ensaios clínicos randomizados que comparassem o tratamento cirúrgico com o tratamento conservador da lombalgia crônica, sendo obtidos seis trabalhos. Foram excluídos estudos cuja técnica cirúrgica consistisse em procedimentos percutâneos, como denervação facetaria, ou intradiscais. Resultados: Cinco estudos utilizaram a fusão lombar e um a artroplastia lombar para comparação do tratamento cirúrgico com o conservador. Apenas um ensaio sugeriu que a fusão fosse mais eficaz na diminuição da dor e incapacidade após um ano de seguimento do que o tratamento não cirúrgico convencional. Quatro trabalhos reportaram que os resultados do tratamento conservador estruturado com exercícios físicos associados à terapia cognitiva foi semelhante ao tratamento cirúrgico. O estudo com artroplastia sugeriu que, embora a mesma fosse estatisticamente mais efetiva no tratamento da lombalgia do que tratamento estruturado não cirúrgico, tal diferença era clinicamente irrelevante. Conclusões: Os resultados, embora heterogêneos, não sugerem grandes benefícios no tratamento cirúrgico da lombalgia axial crônica em relação a dor e incapacidade quando comparado com o tratamento conservador estruturado. Desta forma, concluímos que a cirurgia, seja a fusão como a artroplastia, não deve ser recomendada de rotina no tratamento de pacientes com lombalgia axial crônica secundária a doença degenerativa discal.
Hypothermia in the treatment of refractory intracranial hypertension in patients with severe SAH, cases associated with secondary vasospasms
Authors: De Paiva Bernardo Lembo Conde , Simões Raphael , Coelho Thiago , Simm Renata , De Aguiar Paulo Henrique Pires 
Published: April 2019

Subarachnoid hemorrhage (SAH) is a severe disease in which 10% of patients may present sudden death before arriving at the hospital. Patients are exposed to a high risk of secondary complications including vasospasm. For refractory vasospasm and essentially for ICP control, hypothermia may be employed for the treatment.We aimed to evaluate the influence of therapeutic hypothermia in mortality rates of patients with severe SAH with high intracranial pressure despite best clinical treatment. Temperatures were reduced using mattress for a target temperature of 33-35o C. Five patients were included. Two patients were admitted with a Hunt-Hess scale grade of 2, two of 3 and one of 4. The mean length of therapeutic hypothermia was 7.2 days. Two patients survived with a Rankin scale of 0, and three died. In our observational study we observed a 180 days mortality rate of 40% that increased to 60% in six month analysis. Recent trials describe a mortality rate of 90% in patients with SAH and refractory ICH11. We believe hypothermia may be the best method to be employed in this clinical situation.
Pineal region chordoid meningioma
Authors: Salviero Felipe , Ramalho Cláuder , Stavale João Noberto , Cavalheiro Sérgio , Neto Manoel Antônio De Paiva 
Published: April 2019

Background: Meningiomas correspond to only 8% of pineal region tumors. Chordoid meningioma (CM) comprises only 0.5 to 1.0% of all intracranial meningiomas and is even rarer in the pineal region. In the literature, we found only six cases of pineal region CMs reported. Clinical presentation: We describe a case of one patient with headache, confusion, slurred speech and gait disturbance. The ophthalmologic examination revealed vertical gaze paresis and near-light dissociation of papillary reflex. MRI disclosed a large pineal region tumor with heterogeneous contrast enhancement. The tumor was totally removed by an occipital transtentorial approach (OTA) in a “three-quarter prone” position. Histological analysis disclosed a CM. Conclusion: Chordoid meningioma is a very rare variant of meningioma and the pineal region is a poorly described site. This study contributes to the understanding of this heterogeneous entity, to consider the CM as a differential diagnosis of pineal region tumors and to provide proper management of affected patients.
The potential involvement of the pituitary transcription factor HESX1 in the septo-optic-pituitary hypoplasia with normal septum pellucidum but life-threatening neonatal phenotype
Authors: Ludwig Natasha Guimarães , Dias Marcos Antônio , Aoki Mateus Nóbrega , Lovato Renan , Amarante Marla Karine , Watanabe Maria Angelica Ehara , Mazzuco Tânia Longo 
Published: April 2019

Septo-optic dysplasia (SOD) is a heterogeneous developmental syndrome involving brain midline anomalies associated with pituitary-hypothalamic, ophthalmological and neurodevelopmental dysfunctions. The phenotype is highly variable making the disease classification difficult. We report a case of severe neonatal hypopituitarism leading to the discovery of cerebral malformations and optic nerve hypoplasia characterizing the SOD-like syndrome. Besides the mild MRI features with normal septum pellucidum, this patient exhibited a life-threatening endocrine phenotype. Rare mutations have been described in the HESX1 gene, which encodes a homeobox transcription factor, associated with various pituitary hormone deficiencies combined with SOD. We isolated the DNA coding region from this candidate gene for sequence analysis. In this 7-year follow-up case report and preliminary genetic screening we discuss diagnostic investigation after management of first clinical presentation, highlighting the neuroimaging on this syndrome.
Complications of Cerebral Angiography Performed at a University Hospital
Authors: Lehmann Márcio Francisco , De Aguiar Paulo Henrique Pires , Parreira Johnathan De Sousa , Antonucci Adriano Torres , Santiago Natally , Lehmann Ana Lucia Cruz Furstenberger , Reiche Edna Maria Vissoci , Kaimen-Maciel Damácio Ramon 
Published: April 2019

Objective: The risk of complication of cerebral angiography has always been the focus of attention. The aim of this study was to evaluate the outcome of cerebral angiography performed in the first 30 months of operational training in the endovascular neurosurgery service of a university hospital. Methods: A retrospective study evaluated 129 digital cerebral angiography examinations in 91 patients at a univeristy hospital from Southern Brazil. Results: The rate of complication was 2/129 (1.55%); of them, one (0.77%) presented a transient complication (hematoma puncture), and one (0.77%) a permanent complication with death of the patient because of an association between clotting in the middle cerebral artery and complications from the initial trauma. Conclusion: The rate of cerebral angiography complication obtained was low (1.75%) and underscores its reduced risk when performed in a neurological service even with professional in training.
Tratamiento de la fístula carótido-cavernosa
Authors: Jaume Alejandra , Crosa Roberto , Salle Frederico , Aramburu Ignacio , Negroto Matías 
Published: April 2019

Introducción: Denominamos fístula carótido-cavernosa (FCC) a cualquier comunicación anómala entre la arteria carótida interna y el seno cavernoso generando un shunt arteriovenoso patológico. Métodos: Revisión retrospectiva, del servicio de Neurointervencionismo Uruguay “CEDIVA”, incluyendo 17 pacientes con FCC diagnosticados entre julio de 1998 hasta julio de 2013; valorando clínica, tratamiento realizado y resultados. Búsqueda bibliográfica de FCC en los últimos 10 años. Resultados: Edad promedio 48 años; 58% hombres y 42% mujeres. 76,4% tuvieron antecedente traumático, y 23,6% no tuvieron antecedente. Clínica más frecuente fue la ocular (94%). Todos los pacientes se hicieron arteriografía diagnóstica. De los 13 pacientes con antecedente traumático, todos fueron FCC directa. De los 4 pacientes sin antecedente traumático, 3 fueron FCC indirectas, y una fue FCC directa. El tratamiento en todos fue endovascular. La elección de la técnica a utilizar se basó en características de la FCC y el neurointervencionista encargado del procedimiento. A todos los pacientes se les realizó arteriografía de control a los 3 meses. Hubo mejoría clínica en 76,4% de los pacientes. Conclusiones: Es una entidad de gran importancia, siendo fundamental que el neurocirujano la conozca correctamente a fin de realizar un diagnóstico y tratamiento precoz para prevenir secuelas potencialmente graves.
Aneurysmal Subarachnoid Hemorrhage and Cognitive Deficits
Authors: De Souza Moysés L. Ponte , Vieira Ana Cláudia C. , Andrade Gustavo , Quinino Saul M. C. , Azevedo-Filho Hildo R. C. 
Published: April 2019

Objective: Discuss cognitive deficits caused by subarachnoid hemorrhage (SAH) after rupture of cerebral aneurisms, since about half of the patients have severe or at least striking declines in one or more functions of the cognitive domain. Methods: This paper presents a literature review on cognitive deficits secondary to aneurysmal SAH. There was no delimitation of periods of publications or the locality where it was applied. The bibliographic references were accessed through the database PubMed (http://www.ncbi.nlm.nih.gov/pubmed/). Results: There are three main etiologies for the development of cognitive worsening: the effect of the initial bleeding, the consequences of vasospasm and delayed ischemia and the secondary ones to the treatment. Aneurysms located in the anterior communicating artery and in the middle cerebral artery seem to be related to worse evaluations. As surgical treatment seems to contribute to cognitive worsening, at least when evaluated early. Conclusion: Defining theinvolved factors in this pathology is a great challenge, since the papers of literature use different tests (Glasgow outcome scale or neuropsychological assessments), evaluate the patients in several stages (before or after treatment, being early or late) and compare the SAH patients with different groups (population without pathology or patients with unruptured aneurysms).