JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA

Volume 28 - n° 2 - Abril / Maio / Junho 2017

  • Volume: 28
  • Número: 2
  • Período: Abril / Maio / Junho 2017
  • ISSN (versão impressa): 2446-6786
  • e-ISSN (versão online): 2446-6786
  • Editor: Ricardo Ramina - Curitiba/PR
TEXTO COMPLETO DO FASCÍCULO

Artigo completo

Isadora Pires Franco, João Paulo Bispo Gonçalves, José Angelo Favoreto Guarnieri, Victor Guilherme Batistela Pereira, Regina Célia Poli-Frederico, Bruno Martins Ferreira de Andrade, Bruno Ribeiro Zuccoli, Leonardo Valente de Camargo, Carlos Alexandre Martins Zicarelli

The artery of Uchimura is a type of anatomical variation of hippocampal irrigation that is a complex brain region responsible for memory, the learning process and emotions. The vascularization of the hippocampus is through the anterior choroidal artery, posterior lateral choroid, inferior temporal and posterior cerebral artery with branches in the hippocampal arteries. The artery of Uchimura exists over an anatomical variation in which the posterior cerebral artery gives rise to the hippocampal arteries and was described by Yushi Uchimura in 1928. This research detected six anatomical comparison studies showing 4 to 5 hippocampal irrigation patterns with significant variation. The designation “artery of Uchimura” was well described by only two studies. Therefore, hippocampal irrigation is variable and there is no agreement in the definition of the hippocampal arteries, leading to several results despite the same vascularization. This paper aims to review the literature concerning the anatomy of the artery of Uchimura, as well as its clinical correlations and its importance in diseases with hippocampal involvement.

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Juan Aramburu, Alejandra Jaume, Maria Cabrera, Mariana Romero, Humberto Prinzo, Edgardo Spagnuolo

ABSTRACT

Introduction: The incidence of subarachnoid hemorrhage (SAH) in Uruguay is 8/100 thousand inhabitants per year. The most frequent cause of SAH is bleeding from a saccular aneurysm. The objective of this work is to describe the topographic distribution and characteristics of aneurysms in the population of Uruguay. Materials and Methods: It is a multicentric study. Information was collected from all the healthcare centers that diagnose and treat this pathology in Uruguay between July 2015 and June 2016, considering as sources of data: Hospital de Clinicas, Administration of the service estate (ASSE), centers of Neuro-interventionism (CEDIVA, CEN, IDITE), Ministry of the Interior, Service of Montevideo and Federetion Medic the Interior (FEMI). For the collection of data, were taken into account as diagnostic aneurysm study; arteriography and angio Tomography (angio CT). We analyzed all the aneurysms found by any of these 2 methods, including ruptured aneurysms and witnesses, of the saccular and fusiform type. Traumatic or mycotic aneurysms were not included. Results: 149 patients were analyzed. Among the ruptured aneurysms, 79% are divided into the previous communicant, the posterior communicator and those linked to the middle cerebral artery in the same proportion. Within the total number of aneurysms (ruptures and controls), the most frequent is that of the middle cerebral artery, although this percentage increases considerably if only aneurysms (48%) are taken into account. Between 7 and 20% of aneurysms are of posterior circulation, with which our report of 8% is in the lower limit of frequency. The frequency of multiple aneurysms is variable from 7% to 25% in the different series, being 26% in our series, with which we can say that in Uruguay there is a high frequency of multiple aneurysms. Conclusions: The topographic distribution of aneurysms in Uruguay is similar to the series published in the rest of the world, except for some exceptions such as: the high frequency of multiple aneurysms, the lower number of aneurysms of the posterior circulation, and in the cases of Bleeding from a middle cerebral, presenting multiple, is very frequent the presence of a middle cerebral artery aneurysm in a mirror.

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Luiz Carlos de Araújo Souza, Ana Luiza Alves Nicoletti, Cinthia Mares Leão, Ian Torres de Lima, Janyara Teixeira de Souza e Silva, Sandra Lúcia Branco Mendes Coutinho

ABSTRACT

Introduction: Gliosarcoma presents glial and sarcomatous components in its constitution and an average survival between 6 and 14.8 months. Case Report: A 32-year-old patient who, in 2012, had meningioma diagnosis and underwent surgical resection. In 2013, after a severe headache and convulsive tonic-clonic seizures, the patient was submitted to computed tomography (CT) and magnetic resonance imaging (MRI), which suggested a relapse of the meningioma. A new surgery was performed and anatomical pathology analysis confirmed gliosarcoma, therefore, radiotherapy was chosen as adjuvant behavior. After treatment, the patient was discharged and indicated to perform control MRI. In 2015, she fractured the right femur and the imaging tests indicated lesions suggestive of metastasis, which was confirmed after anatomical pathology analysis, and chemotherapy treatment was instituted. Even after completion of therapy, other foci of metastasis were confirmed in the iliac crest, spine and lungs. The patient, due to systemic involvement, died 26 months after the initial diagnosis of gliosarcoma. Discussion and Conclusion: Regarding the systemic metastases involving gliosarcoma, a review of the literature has shown that bone metastases are uncommon and that, despite this, our patient had a survival rate higher than expected.

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Morgana Monteiro Moreira, Rodrigo Antônio Rocha da Cruz Adry, Carlos Umberto Pereira

ABSTRACT

Introduction: Decompressive craniectomy is considered the most used surgical method in the treatment of refractory intracranial hypertension due to severe brain injury. Despite being described as an effective method if correctly indicated, it can present severe early complications, among them the contralateral epidural hematoma. Objective: The aim of this study is to evaluate the main characteristics for the development of contralateral epidural hematoma, promoting the recognition and prevention of the complication. Methodology: This is a systematic review with no meta-analysis, performed by the Pubmed and Scielo databases. Results: Sixty-seven patients were found by contralateral epidural hematoma after decompressive craniectomy. The suspicion of new bleeding was observed by the pupillary abnormality (22.3%), increased intracranial pressure (18%), brain swelling (22.3%), or when accused by routine tomography (26.8%). At least 86.36% of the patients presented contralateral skull fracture to the initial hematoma. Conclusion: The incidence of contralateral hematoma following decompressive craniectomy for traumatic brain injury was 5.2%. A contralateral skull fracture is the main characteristic for contralateral epidural hematoma development. Unexplained brain swelling or the presence of pupillary abnormalities in the postoperative period stand out as good indicator of contralateral hematoma development. However, neurological deterioration and the presence of coagulopathies are not reliable indicators of contralateral epidural hematoma after decompressive craniectomy.

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Artigo completo

Joseph Franklin Chenisz da Silva, Arthur de Oliveira Veras, Adriano Scalzer Correia, Murilo Sousa de Meneses, Andre Giacomelli Leal

ABSTRACT

Traumatic vertebral artery dissection has an incidence of 1.1 to 1.5 for every 10,000 inhabitants. Although considered a rare disease, this type of injury may be associated with low-impact trauma or underappreciated mechanisms of injury. Many patients present with few symptoms or can be even asymptomatic, turning out the diagnosis particularly difficult, and, therefore, the option of proper treatment of this condition. Despite being oligosymptomatic, the vertebral artery dissection can occur along with areas of ischemia on the cerebral posterior fossa region. This injury whether not recognized could lead to death. We present the case of a young patient, who after a fall during surfing was attended in the emergency service, hospitalized with recent ischemic lesions in areas of the posterior circulation and during investigation showed a left vertebral artery dissection.

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Leonardo Gilmone Ruschel, Guilherme José Agnoletto, Jennyfer Paulla Galdino Chaves, Lucas Alves Aurich, Jerônimo Buzetti Milano, Ricardo Ramina

ABSTRACT

Ossification of the ligamentum flavum (OLF) of thoracic spine occurs along with a progressive spine lesion, and is a rare myelopathy in non-Oriental patients. Computed Tomography or Magnetic Resonance imaging of spine are used for diagnosis, and early decompressive laminectomy is the treatment of choice. We report a case of female patient, 73-year-old, who presented progressive and symmetrical paraparesis, and painful tactile hypoesthesia at T4 level with two months of evolution of the case. After OLF diagnosis, with myelopathy on T1-T2 segment, we performed spine decompression with significant functional better results. According to our research and knowledge, this is the third case to be reported on Brazilian medical literature of a patient with non-Oriental descent.

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Artigo completo

Guilherme de Palma Abrão, André Didier Lyra, Matheus Miranda Barbosa

ABSTRACT

We describe a case of post-traumatic high-flow carotid-cavernous fistula that was successfully treated with coils and pipeline embolization device. Following the endovascular treatment, the patient experienced clinical improvement of symptoms with complete anatomical restoration of the internal carotid artery.

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Artigo completo

Augusto Cesar dos Santos Esmeraldo, Caio Lopes Pinheiro de Paula, Carlos Umberto Pereira

ABSTRACT

Introduction: The epidermoid cyst (EC) is a benign congenital tumor originating from the ectoderm. It occurs in the third and fifth decade of life corresponding to approximately 0.2 to 1.8% of the intracranial tumors. The location in the fourth ventricle is rare. The exam of choice is magnetic resonance imaging (MRI), although the diagnostic confirmation is through pathological anatomy. The ideal treatment is total exeresis. Case report: Female patient, 27 years old with history of headache and gait ataxia one year ago. Result: Brain MRI showed the presence of expansive lesion in the fourth ventricle. The total surgical excision of the lesion was conducted. Results from of the pathological anatomy was EC. Conclusion: EC is a benign intracranial lesion and is rarely located in the fourth ventricle. Its treatment is surgical and has a good prognosis.

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Fernando Antonio de Oliveira Costa, Othelo Moreira Fabião Neto, Guilherme Gago, Frederico de Lima Gibbon, Otávio Garcia Martins

ABSTRACT

The cavernous angioma is a vascular malformation that can affect various organs, and its location in the spinal cord is unusual. We report a case of a pregnant patient who presented with pain in the lower limbs and urinary retention, diagnosed with cavernous angioma of the spinal cord and treated with surgical excision. Our case highlights this rare pathology and its initial presentation during pregnancy.

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Roger Schmidt Brock, João Gustavo Rocha Peixoto dos Santos, Mario Augusto Taricco, Matheus Fernandes de Oliveira, Marcelo de Lima Oliveira, Manoel Jacobsen Teixeira, Edson Bor-Seng-Shu

ABSTRACT

Introduction. Surgical posterior fossa decompression of Chiari malformation type 1 (CM-I) is recommended in symptomatic patients. The classic surgery is a suboccipital craniectomy and C-1 laminectomy, with duroplasty. However, a range of complications associated with surgical management of CM-I includes pseudomeningocele, CSF leakage, aseptic meningitis, and wound infections, making dural closure and reconstruction one important step to determine morbidity. Our objective is to present a technique of pericranium harvest and dural closure and describe our experience. Methods. A retrospective study was conducted based on records of patients treated in Hospital das Clínicas of the University of São Paulo, diagnosed with CM-I and submitted to posterior fossa decompression from January 2008 until May 2015. We evaluated the occurrence of post-operative complications of symptomatic pseudomeningocele or incisional CSF leak. The occurrence of meningitis, surgical site infection or other complications were also available. Results. A total of 22 patients were evaluated in this study. Sixteen (72.7%) were female patients. Overall, the mean age at the time of surgery was 49 ± 13.6 years-old. Four patients (18%) presented complications: 3 CSF leakages (13.5%) and 1 pseudomeningocele (4.5%). Discussion. Postoperative complications of CM-I are still frequent and determinants of surgical success. We propose a new surgical technique with autologous pericranium graft and duraplasty. Additionally to dural closure, we propose another modality of muscular fascia closure, allowing increased tight closure. Our data corroborate with current literature. Conclusion. Our technique of dural closure using pericranium autologous graft in CM-I is safe and feasible.

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