Volume 27 - nº 1 - janeiro / fevereiro / março 2016

  • Volume: 27
  • Número: 1
  • Período: janeiro / fevereiro / março 2016
  • ISSN (versão impressa): 0103-5118
  • e-ISSN (versão online): 2446-6786
  • Editor: Ricardo Ramina - Curitiba/PR

Artigo completo

Ricardo Ramina, Erasmo Barros da Silva Júnior, Maurício Coelho Neto, Leonardo Gilmone Ruschel, Felipe Andrés Constanzo Navarrette

Introduction: In the last two decades the 5-aminolevulinic acid (5-ALA) has been utilized in primary brain lesions and metastases surgery to aid the identification of tumor limits and infiltration. Objectives: In this retrospective study, we demonstrate our experience with the first 41 cases Latin America of surgical resection of central nervous system (CNS) lesions with 5-ALA. Methods: In 41 consecutive patients, we recorded age, sex, histopathological diagnosis, intraoperative 5-ALA fluorescence tumor response, 5-ALA post-resection resection grade through magnetic resonance image (MRI) and other concomitant intra-operative techniques utilized (transoperative imaging, awake surgery, electrophysiological stimulation and monitoring). Results: Twenty seven high-grade gliomas and 4 non-glial lesions were 5-ALA fluorescence positive; 6 low-grade gliomas, 1 high-grade glioma and a hippocampal gliosis were 5-ALA fluorescence negative. In one case of a low-grade glioma, the patient developed a cardiac arrhythmia, probably not related to 5-ALA administration, but the surgery was suspended. Conclusions: 5-ALA fluorescence-guided surgery is a safe and easy technique to be used, increasing tumor total gross resection in glioma cases, proving to be an invaluable neurosurgical tool for intracranial tumor surgery. There was no serious side effect in this series. This dye should be utilized in all cases of high-grade gliomas.
Key words: 5-aminolevulinic acid; Glioma; Brain cancer; Metastasis; Extent of resection; Fluorescence-guided resection

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Artigo completo

Pablo Villanueva, José Ignacio Santamaria, Juan Francisco Villalonga, Andrés Cervio

Objective: We make a presentation about our experience in spinal meningiomas surgical treatment. Material and methods: This descriptive-retrospective study included 24 patients with spinal meningiomas diagnosis, surgically treated, from September 2009 to December 2016. Epidemiological data, personal history, symptoms, radiological characters, operative findings, neuropathology description, post operative evolution and degree of resection has been analyzed. Results: Twenty four patients underwent surgery; 83% were female. Lesion localization was 79% in thoracic, 17% in cervical y 4% in lumbar spine. Neuropathology revealed grade 1 (WHO) for all cases. In 63% of all patients, hemilaminectomy was used as surgical approach, reaching a good resection level for all of them (Simpson 1 and 2). Nearly about 66% of the patients showed a good neurological recovery. Average period of follow up was 14.9 months. Conclusion: Surgery is still the gold standard treatment for spinal meningiomas. Hemilaminectomy approach
type is useful and valid for lateral implantation tumors. Ventral lesions, with a calcic component and motor deficit present before surgery, are often technically complicated and with a poor prognosis.
Key words: Meningioma; Spinal; Laminectomy; Hemilaminectomy; Microsurgery

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Artigo completo

Henry Koiti Sato, Maurício Coelho Neto, Erasmo Barros da Silva Jr, Luis Fernando Moura da Silva Junior, Ricardo Ramina

Introduction: Resection of gliomas in eloquent areas such as motor and supplementary motor areas has always been a main challenge for the surgeon due to the risk of severe neurological sequelae. An important tool used during the procedure to avoid postoperative deficits is the intraoperative cortical stimulation of eloquent areas as a safe option of functional area mapping. Methods: In this study, authors examined 50 patients with gliomas located in the motor and supplementary motor area that have undergone surgery with cortical stimulation, using clinical assessment of muscle strength in the pre- and immediate postoperative assessments and three months after surgery as parameters. Results: There was significant difference (p<0.001) between the preoperative and immediate postoperative assessments regarding the occurrence of severe neurological deficit, demonstrating a worsening of the neurological status after surgery. Concerning the comparison between the immediate postoperative period and the assessment performed three months after surgery, it was observed that all the patients who had severe deficit (11 cases) improved (p<0.001). No statistical difference was found between the malignancy grade and the evolution of the neurological deficit in the assessments performed in the three evaluated periods. Conclusion: In the immediate postoperative period following surgical resection of glial tumors in the motor and supplementary motor areas with intraoperative cortical monitoring, most patients have significant alterations in their muscle strength. However, three months after surgery there was significant improvement of these neurological deficits and no patient had severe sequelae.
Key words: Glioma; Cortical stimulation; Intraoperative monitoring

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Artigo completo

Bruno Toshio Takeshita, Adriel Rowe, Fábio A. Nascimento, Joao Natel Pollonio Machado, Fabio Siquineli, André Issamu Takeshita, Pedro Andre Kowacs, Ricardo Ramina

Introduction: Natural disasters occur more and more frequently. In 2008, the cities of Itajaí Valley were hit by flooding of large proportion associated with landslides. Objective: To evaluate the frequency of cases of cerebrovascular disease (CVD) admitted to the Hospital Santa Isabel de Blumenau (HSI) in three periods and its possible relationship with the natural disaster occurred in November 2008. Method: CVD cases were selected among inpatients in the HSI in Period I: 2007 to 2008, Period II: 2008 to 2009 (period of natural disaster) and Period III: 2009 to 2010. Results: There was an increase in the absolute number of CVD cases over the three periods (32, 56 and 77, respectively). In the year of the disaster a significant elevation of the numbers of cases of CVD was seen. Conclusion: Statistically significant increase in the frequency of CVD after the natural disaster of November 22nd, 2008 could be considered as implication of correlation.
Key words: Natural disaster; Catastrophe; Cerebrovascular disease; Stroke

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Artigo completo

Camila Moura de Sousa, Janine Lemos de Melo Lobo Jofili Lopes, Francisca das Chagas Sheyla Almeida Gomes Braga, Elis Raquel da Silva Araújo, Jefferson Fonseca Dias, Emerson Brandão Sousa, Jose Nazareno Pearce de Oliveira Brito, Cléciton Braga Tavares

Ventriculoperitoneal shunt (VPS) is the most common treatment to control hydrocephalus. The most common complications of this method are nonfunctioning system and infections. Spontaneous intestinal perforation, on the other hand, caused by displacement of the distal catheter of the VPS, is an uncommon complication, and the externalization of the distal catheter through anus is even rarer. This study aims to perform a narrative review on the indexed literature about this rare complication, describing signs and symptoms, the ways to diagnose and to treat it. In order to justify this complication, several mechanisms have been proposed, like catheter’s rejection from colon wall, fragility of bowel, direct perforation by a trocar while inserting peritoneal catheter, and other. This is an important complication, usually asymptomatic, and, most of the times, it is necessary to exteriorize the VPS and to remove the shunt. In selected situations, laparotomy and closure of perforations are indicated.
Key words: Hydrocephalus; Ventriculoperitoneal shunt; Bowel perforation

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Artigo completo

Tiago de Paiva Cavalcante, Ellen Silva de Carvalho

Hygromas are collections located in the subdural space with several causes and variable prognosis. Although more frequent in the elderly, it became more common in young patients due to the increase in the number of decompressive craniotomies, especially for severe head injuries. This article reviews the main pathophysiological, diagnostic, therapeutic and prognostic aspects of subdural hygromas in non-craniectomized patients.
Key words: Subdural hygroma; Subdural effusion; Decompressive craniotomy; Chronic subdural hematoma

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Artigo completo

Roberto Crosa, Damian Glumcher, Veronica De los Santos, María Fernanda Rodriguez, Florencia Brunet, Jose Pedro Macadam

We present the case of a 12-year-old with a subarachnoid hemorrhage secondary to aneurysmal rupture in an unusual location, confirmed by head computed tomography (CT). AngioCT revealed a left A1 segment aneurysm from which the left recurrent artery of Heubner originated. Endovascular treatment was performed, with successful coiling of the fundus and partial occlusion of the aneurysm’s body. At 1 month, patient remains asymptomatic, GOS 5.
Key words: Intracranial aneurysm; Anterior Cerebral artery; Endovascular; Coil; Recurrent artery of Heubner

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Artigo completo

Roger Schmidt Brock, Marcos de Queiroz Teles Gomes, Matheus Fernandes de Oliveira, Carmen Lúcia Penteado Lancellotti

Background: Primary brain tumors associated with cerebral arteriovenous malformations (AVM) although known is a rarely reported finding. There have been approximately 50 cases reported. Only two cases of a single lesion with coexistence of AVM and glioblastoma were described. Case Report: We report a case of a 46-year-old woman with headache and seizures for 2 months who performed a MR which displayed a large right frontal lesion suggesting a glioblastoma. Results: During surgical resection, two large veins could be seen draining tumoral vascularization in the surrounding cortex. After reaching the deepest portion of tumor, veins were coagulated and cut to allow tumor removal. However, unexpected bleeding started to occur with associated lesion growth and edema, resembling an AVM. Material sent to pathology revealed giant glioblastoma in association to an AVM with some thrombosed vessels and ischemic necrosis. Two previous studies discussed similar cases. Conclusion: The need of magnetic resonance in all AVM cases is highlighted in order to analyze brain parenchyma within AVM. We also remark the need of pathological analysis of whole surgical material, in order to characterize whole piece and to avoid not diagnosing an associated lesion.
Key words: Arteriovenous malformation; Glioblastoma; Differential diagnosis; Treatment

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Artigo completo

Fernando Antônio de Oliveira Costa, Othello Moreira Fabião Neto, Guilherme Gago da Silva, Frederico de Lima Gibbon, Ricardo Bettin Foster, Eduardo de Moraes Schuch

The Kernohan syndrome results from the compression of the cerebral peduncle against the tentorium cerebelli. This phenomenon represents a relevant clinical sign of transtentorial herniation due to an ipsilateral expansive lesion. We reported a case of a 50-year-old woman with a right temporal meningioma who developed a false localizing hemiparesis, which improved after microsurgical resection. This case emphasizes the mechanism and rarity of this pathology.
Key words: Kernohan syndrome; Meningioma; False localizing sign; Case report

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Artigo completo

Lindolfo Carlos Heringer, Matheus Fernandes de Oliveira, Ulysses Oliveira de Sousa, Wanderley Cerqueira de Lima, Ricardo Vieira Botelho

Introduction: The association between hydrocephalus and Chiari malformation (CM) has not been described frequently. Ventricular dilation affects 7% to 10% of patients with CM, but the ideal choice of surgical treatment is controversial. We report a case of a patient with Chiari malformation and hydrocephalus with improvement in clinical symptoms and ventricular dilatation. Case Description: A 19-year-old male complaining of frontal headache when coughing, laughing and during valsalva maneuvers, associated with dizziness for 2 months. Magnetic resonance (MR) showed hydrocephalus and small posterior fossa with overcrowding of contents, characterizing Chiari malformation type I, with cerebellar tonsils protruding through magnum foramen. Patient underwent surgery with posterior fossa decompression in a semi-sitting position and removal of the arc C1. After 3 months of follow-up, headache disappeared becoming asymptomatic. Control MR showed improvement of hydrocephalus with restoration of the cisterna magna and CSF flow. Discussion: Hydrocephalus has been related to CM for a long time. In our case, we performed treatment with intradural and intra-arachnoidal approach with bilateral tonsillectomy without placing ventricular shunt. The cisterna magna was “recreated”. There was improvement of hydrocephalus with decreased Evans ratio index and symptoms disappearance. Although there is no other studies addressing such matter, in this case, the improvement suggests that the CSF compression at the foramen magnum was the cause of associated hydrocephalus with Chiari malformation.
Key words: Chiari malformation; Hydrocephalus; Posterior fossa decompression

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