Volume 26 - nº 4 - outubro / novembro / dezembro 2015

  • Volume: 26
  • Número: 4
  • Período: outubro / novembro / dezembro 2015
  • ISSN (versão impressa): 0103-5118
  • e-ISSN (versão online): 2446-6786
  • Editor: Ricardo Ramina - Curitiba/PR

Artigo completo

André Stavitski Costa de Oliveira, André Giacomelli Leal, Murilo Sousa de Meneses, Emanuel Cassou dos Santos, Guilherme Santos Piedade

Introduction: Carotid stenosis plays a major role in the etiology of cerebral ischemic events. We evaluated the variables thatimpact the evolution of these patients. Methods: Data were retrospectively checked from the medical records of patients treatedin the period between 2008 and 2015. Different variables were evaluated to determine the factors that influence the patientsclinically. Results: The analysis was conducted based on a sample of 63 patients with carotid stenosis who underwent surgery. Regarding the factors that influenced the outcome, there was significant association with age ≥70 years, smoking and previousischemic stroke. Although hypertension was the most prevalent comorbidity, no significant association as clinical worseningfactor was found, as well as the isolated analysis of each surgery showed no significant difference. Conclusions: The clinicalprofile and lifestyle habits associated with certain comorbidities are variables that influence the clinical outcome of patients withcarotid stenosis.
Key words: Demographic and clinical variables; Carotid Stenosis; Endarterectomy; Stent Angioplasty

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Cesar Cozar Pacheco, Bruno Camporeze, Iracema Araújo Estevão, Patrick Moro Mariano, Murilo Dias Joseph, Ubiratan Passos Muniz, Patrícia Guazzelli Vial Cury, Marcos Kenji Sekine, Eduardo Jorge Cury Filho, Carlos Tadeu Parisi de Oliveira

Introduction: Low back pain is a frequent cause of morbidity and incapacity and the spine facet joint dysfunction is one of themain causes. Objective: This paper aims to report the results obtained in the treatment of the elderly who suffer from chronic lowback pain with epidural anesthesia associated to percutaneous chemical rhizotomy of facet joint. Methods: Inclusion criteriawas patients who suffer from low back pain. The numerical scale of pain (NSP) was applied to analysis in the preoperativeand postoperative pain in outpatients. The patients were submitted to epidural anesthesia associated to percutaneous chemicalrhizotomy of facet joint bilaterally with intraoperative radioscopy aid. Results: This paper consisted of 19 patients. Mean scoreswere 8.2 and 1.8 points in the preoperative and postoperative period, respectively. The average follow-up was 50 months. Therewas no death or complication during and after the procedure, and patients were discharged on the day of admission. Conclusion: The shorter hospitalization stay, safety and low cost are favorable points of this therapy. This neurosurgical techniques associationis presented as a promising therapeutic option for low back pain.
Key words: Low back pain; Pain management; Neurosurgical procedures; Elderly.

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Artigo completo

Jaqueline Mezêncio de Resende, Murilo Sousa de Meneses, Djanira Aparecida da Luz Veronez

Objectives: The purpose of this work is to develop a morphometric analysis of the distances from the main reference points ofAnterior Temporal Lobectomy (ATL) and Selective Amygdalohippocampectomy (SelAH) surgical approaches until the lateral andmedial edges of the hippocampus. Methods: Twenty-seven brain slices with the hippocampus head visible at mammillary bodies’ topography were stained by Mulligan’s method. Ten distances were measured, from the starting points: Sylvian sulcus (SS), Sylviansulcus passing through insula cortex (SS–I), superior temporal sulcus (STS), middle temporal gyrus (T2), inferior temporal sulcus(ITS) until the finish points: lateral edge (LE) and medial edge (ME) of the hippocampus. Results: For 43 hippocampi visible,the distances (mean in cm ±SD) were: SS-LE of 3.73±0.37, SS–ME of 5.55±0.45, SS–I–LE of 4.34±0.40, SS–I–ME of 5.76±0.49,STS–LE of 1.73±0.52, STS–ME of 3.72±0.57, T2–LE of 2.89±0.36, T2–ME of 4.93±0.43, ITS–LE of 1.68±0.40 and ITS–ME of3.70±0.45. Conclusion: The ITS approach provides the shortest distance until the hippocampus. The STS approach shows ashorter distance to the hippocampus then via T2. There is no difference between cerebral hemispheres concerning distances fromcortical surface to hippocampus.
Key words: Amygdalohippocampectomy; Epilepsy; Neurosurgical approach

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Artigo completo

Rafael Gomes dos Santos, Guilherme Brasileiro de Aguiar, José Carlos Esteves Veiga

Objective: Chronic subdural hematoma (CSDH) can be treated by different surgical techniques. The trend in recent years has beentoward treatment involving two trepanations and drainage, followed by exhaustive irrigation with saline solution and adaptation ofsubdural drain, as opposed to craniotomy. This conduct is based on published evidence showing that trepanation provides the sameefficacy yet lower morbidity and mortality rates. However, controversy remains and the type of surgical procedure is not universallyuniform. Given the lack of evidence for indicating craniotomy for the treatment of CSDH, the objective of present study was tocarry out a review of the literature on the subject. Method and Results: A search of the PubMed and SCIELO databases in Englishand Portuguese was conducted using the following key words: “Chronic Subdural Hematoma” and “Craniotomy”. The mainarticles were analyzed and references tracked to select the most relevant studies published in the last two decades. Indications forcraniotomy found were recurrence of the hematoma, presence of solid coagulations, heterogeneous organization of the hematoma,failure of the brain to expand and substantial presence of the acute component. However, some authors suggest superior efficacyof the craniotomy over other techniques, whereas others believe that craniotomy is more effective in the pediatric patient group. Conclusion: Despite some differences found, many authors suggest that craniotomy should be performed in situations of recurrentlesions or in cases of heterogeneous collections.
Key words: Craniotomy; Hematoma, Subdural; Chronic; Surgical Procedures, Operative; Neurosurgical Procedures.

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Artigo completo

Lucas Danielli, Roberto Augusto da Silva Bender, Jadi Colaço, Apio Cláudio Martins Antunes, Marjeane Cristina Jaques Hockmuller, Juliana Avila Duarte

Epidural hematomas in newborns (NB) are rare events, usually associated with trauma during delivery. Heterogeneous symptomsare presented and require early identification and management, if indicated. The method of choice for diagnosis is braincomputed tomography (CT). A case of a parietooccipital asymptomatic epidural hematoma, in a 5-day-old neonate with ChiariII malformation, born by Caesarean section with no history of trauma is reported. Considering the good neurological state andevolution, a conservative management was undertaken.
Key words: Epidural hematoma, Cranial; Newborn; Arnold-Chiari Malformation.

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Artigo completo

Afonso Henrique de Aragão, Kristel Larissa Back Merida, André Giacomelli Leal, Murilo Sousa de Meneses

Dural arteriovenous fistula (dAVF) is a rare disease that presents varied clinical manifestations. This disease is characterizedby anomalous communication between dural arteries and venous sinus and/or cortical veins. dAVF is a disorder responsible for10-15% of all intracranial vascular malformations, with the most affected age group being 50-60-years-old, but with variationsdepending on the type of fistula. In this study the goals were to report two clinical cases of dAVF, one of them considered “benign”and another “malignant” to illustrate this unusual condition, as well as to review the literature focusing on epidemiology,pathophysiology, diagnosis and treatment of this disease. The importance of the knowledge of this disorder has fundamentalimportance on the part of the medical professional, so as to provide an early diagnosis and an effective treatment.
Key words: Dural arteriovenous fistula; Borden; Cognard; Hemorrhage; Tinnitus pulsatile

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Artigo completo

Juliano Nery Navarro, Anderson Fellipe Matos de Souza, Guilherme Rossoni Silva, Paula Ribeiro Alberto, Raphael Vicente Alves

Chronic subdural hematoma is a rare neurosurgical pathology in children. We report a case in which this disease was associatedwith adjacent subcutaneous myiasis, highlighting a social problem behind the neurosurgical disease.
Key words: Chronic subdural hematoma; Preschool child; Young; Myiasis.

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Artigo completo

Fernando Antonio de Oliveira Costa, Othelo Moreira Fabião Neto, Patrícia Larrosa Freire, Guilherme Gago da Silva, Eduardo de Moraes Schuch, Octávio RuschelKaram

Subdural hematoma is an uncommon but serious complication which can occur after spinal anesthesia technique. Headache is thefirst clinical manifestation in most of the cases. We present a case of a puerperal 29 years old woman submitted to spinal anesthesiafor cesarean delivery who developed a subdural hematoma. The patient underwent conservative treatment without the need forneurosurgical intervention presenting full recovery. Subdural hematoma after spinal anesthesia is a serious condition that shouldalways be suspected in patients with headache, especially when associated with other neurological manifestations, in order todifferentiate from other conditions associated with this type of headache as low CSF pressure by dural puncture.
Key words: Subdural hematoma; Spinal anesthesia; Headache; Case report.

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Paulo Sérgio Faro Santos, Antonella Vinholi, Talita Ribeiro da Silva, Matheus Koike, Henry Koiti Sato

Lymphomatosiscerebri (LC) is considered a rare variant of primary lymphoma of the central nervous system (CNS). A patient withrapidly progressive dementia secondary to bilateral extensive injury in white matter and basal ganglia is described. Impregnationof paramagnetic contrast was intense. Given the diagnosis difficulty, the patient underwent biopsy revealing findings compatiblewith LC. Despite the treatment using methylprednisolone, cyclophosphamide, and azathioprine, after 5 months the patient evolvedto death. Due to the subacute development, and atypical neuroimaging results, this diagnosis possibility would not be considered,and the brain biopsy not performed. Treatment is based on high-dose chemotherapy with methotrexate, and no indication of tumorresection. However, it is known that this neoplasm has low response to the treatment and poor prognosis.
Key words: Lymphomatosiscerebri; Lymphoma; Rapidly progressive dementia.

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Artigo completo

Roberto Alexandre Dezena

In this article are presented endoscopic views of the membrane of Liliequist and adjacent structures inside the interpeduncularand prepontine cisterns.
Key words: Endoscopy; Lilliequist; Prepontine cistern

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