JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA

Volume 28 - n° 3 - Julho / Agosto / Setembro 2017

  • Volume: 28
  • Número: 3
  • Período: Julho / Agosto / Setembro 2017
  • ISSN (versão impressa): 2446-6786
  • e-ISSN (versão online): 2446-6786
  • Editor: Ricardo Ramina - Curitiba/PR
TEXTO COMPLETO DO FASCÍCULO

Artigo completo

Camilla Von Steinkirch, Maria Victoria Fujii Kato, Mariana Maranho Chyla, Vanessa Beatris Correia, André Giacomelli Leal

Introduction: Intracranial aneurysms (IA) consist of abnormal dilatation of a cerebral artery, caused by weakening of the vessel wall. It occurs due to genetic and acquired factors associated with mechanical stress of the blood flow. Studies show a prevalence of 1.5 to 5% in the general population. A rupture is the most common outcome of an IA, resulting in subarachnoid hemorrhage. The treatment of ruptured and non-ruptured aneurysm can be performed by surgical technique (clipping and wrapping) or by endovascular technique (embolization, and flow diversion implantation) achieved through endovascular embolization, clipping or wrapping. Objective: To analyze the characteristics of the IA and the profile of the patients treated in the INC. As well as to correlate some data with each other. Methods: A descriptive study with a sample composed of 254 clinical records of patients treated in the INC due to intracranial aneurysm, between 2010 and 2016. The following variables were evaluated: quantity of aneurysm, sex, age of the procedure, risk factors, location, size, presence of aneurysmal rupture or not, IA technique and complications. Chi-square test or Fisher’s exact test was used to calculate the level of significance. Results: The IA were more frequent in women (n = 187; 73.7%) than in men (n = 67; 26.3%). The mean age at the procedure was 54.6 years. SAH was present in 126 patients (44.7%), smoking in 35 (12.4%), dyslipidemia in 32 (11.3%), presence of a family history of IA in 18 (6.4%), hormone replacement therapy in 4 (1.4%), previous history of IA rupture in 1 (0.3%) and, finally, coronary arterial disease in 1 (0.3%). As to location, 259 (91.8%) were in the previous circulation and 23 (8.2%) in the posterior circulation. Regarding size, 218 (77.3%) were small, 49 (17.4%) were medium, 15 (5.3%) were large. A total of 112 (39.7%) patients were submitted to surgical technique (clipping and/or wrapping) and 170 (60.3%) underwent endovascular treatment (embolization or flow diversion). Conclusion: It was observed predominance of patients with only one AI, women, with a mean age of 54.6 years. The most prevalent risk factors were arterial hypertension and smoking. Among the IA characteristics, there were observed predominance of small ones, located in the anterior cerebral circulation and non-ruptured. The endovascular technique, mainly embolization, was the most realized treatment for the management of the IA.

 

 

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Lucas Crociati Meguins, Rodrigo Antônio Rocha da Cruz Adry, Sebastião Carlos da Silva Júnior, Carlos Umberto Pereira, Jean Gonçalves de Oliveira, Dionei Freitas de Morais, Gerardo Maria de Araújo Filho, Lúcia Helena Neves Marques

Introduction: Surgery for refractory temporal lobe epilepsy (TLE) has been a well-defined procedure to provide seizure control in the recent years. Objective: The aim of the present study is to evaluate seizure outcome of patients with TLE and bilateral mesial temporal sclerosis (bMTS) after cortico-amygdalohippocampectomy compared with those presenting unilateral (uMTS) lesions. Method: A case-controlled study was conducted in patients with TLE and bMTS or uMTS treated in the epilepsy clinic of the Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), a Brazilian tertiary referral epilepsy center, from January 2000 to March 2012. Patients with neuroradiological evidence and/or neuropathological confirmation of other diseases than MTS, as well as additional potential epileptogenic MRI-lesions, were excluded from the study. Results: During this period, 533 patients underwent multidisciplinary investigation of epilepsy and 229 (43%) fulfilled criteria to be included in the present study, 60 (26.2%) with bMTS and 169 (73,8%) with uMTS. Thirty-seven (61.6%) were classified as Engel I in bMTS group, while 107 (63.3%), were classified as Engel in uMTS group. There was no mortality in both groups. Conclusion: The present data highlight that a favorable seizure outcome can also be obtained in patients with bMTS after adequate pre-surgical evaluation.

 

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Artigo completo

Cesar Cozar Pacheco, Bruno Camporeze, Iracema Araújo Estevão, Patrick Moro Mariano, Fernanda Machado Ribeiro, Ubiratan Passos Muniz, Eduardo Jorge Cury Filho, Carlos Tadeu Parisi de Oliveira

Introduction: The postherpetic neuralgia is the most common complication of acute Herpes Zoster, classified as a chronic neuropathic pain with presence of the autonomic component in the spread of pain. Objective: This paper aims to report the results obtained in the treatment of patients who suffer from postherpetic neuralgia of the first trigeminal branch though the percutaneous chemical block of stellate ganglion. Methods: The criteria for inclusion was patients that suffer from low back pain. The numerical scale of pain (NSP) was applied to analysis the pain in the preoperative and postoperative in outpatients. The patients were submitted to two percutaneous chemical block of stellate ganglion through anterior paratracheal approach associated to conventional pharmacological treatment. Results: This study was constituted by five patients. The mean score was 10 and 2,8 points in the preoperative and postoperative, respectively. The average outpatients follow-up was 48 months. No death was found during and after the procedure. Conclusion: The shorter hospitalization, security and low cost are positive points of this therapy. This association is presented as a promising therapeutic option in postherpetic neuralgia, once that implies in a positive way the quality of life of these patients.

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Cléciton Braga Tavares, Francisca das Chagas Sheyla Almeida Gomes Braga, Emerson Brandão Sousa, José Nazareno Pearce de Oliveira Brito

Stroke is characterized by the rapid development of focal neurological disorders and/or coma. We aim to conduct a narrative review of the publications that deal with the risk factors for the development of ischemic stroke in our population and the approach of this pathology by the public health system in Brazil. This narrative reviews works published in the last ten years in the Medline database. We found 18 papers, with 6 excluded, in a total of 12 articles. The main risk factors are atrial fibrillation, left ventricular hypertrophy, systemic arterial hypertension, sedentary lifestyle, smoking, low levels of LDL, carotid stenosis, diabetes and excessive alcohol intake. Most cases are diagnosed and conducted in the public health service, but are not properly treated and primary and secondary prevention is not effective.

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Othello Moreira Fabião Neto, Otávio Garcia Martins, Guilherme Gago, Frederico de Lima Gibbon

Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by a fungus known as Paracoccidioides brasiliensis. Central nervous system (CNS) is affected in 12% of the cases, but posterior fossa involvement is rarer. We report a case of a patient who presented an expansive lesion at the posterior fossa causing a right hemispheric cerebellar syndrome. After lesion excision and analysis, the diagnosis of Neuroparacoccidiomicosis was confirmed. Our case highlights this rare presentation of this pathology and its capacity to simulate neoplastic lesions.

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Fernando Antonio de Oliveira Costa, Pedro Henrique Almeida Soares, Bárbara Kraemer Ferreira, Guilherme Gago, Frederico de Lima Gibbon

Neurodegeneration with Brain Iron Accumulation (NBIA) belongs to a group of disorders characterized by the predominant involvement of the basal ganglia. Patients may present psychiatric symptoms, extrapyramidal signs and cognitive decline. Few cases of this disease have been reported in Brazil. We present a typical NBIA case. This case has the classical signs and symptoms of NBIA in a woman with advanced/end-stage disease, in addition to the presence of cerebral atrophy, which is not a common finding.

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Artigo completo

Lucas Crociati Meguins, Dionei Freitas de Morais, Carlos Eduardo Dall’Aglio Rocha, Ricardo Lourenço Caramanti, Thayanna Bentes Lemanski Lopes Rodrigues, Carlos Umberto Pereira, Matheus Rodrigo Laurenti, Mario José Góes

Introduction: Choroid plexus tumors (CPTs) are rare papillary neoplasms derived from choroid plexus epithelium. They account for only approximately 0.4%-0.6% of all intracranial tumors, but 10%-20% of brain tumors occurring throughout the first year of life. Objective: The present study describes the case of an adult man presenting a cerebellopontine angle choroid plexus papilloma (CPP) microsurgically treated through suboccipital far-lateral approach. Case report: A 67-years-old-man was admitted presenting progressive headaches and left lower limb weakness. Magnetic resonance images showed a large tumor on the left cerebellopontine angle with heterogeneous contrast enhancement. Total surgical resection was achieved through a right suboccipital far-lateral craniotomy on lateral position with neurophysiological monitoring of lower cranial nerves. No alterations on cranial nerves function was observed during tumor resection. The patient presented an uneventful recovery and was discharged home on the fifth post-operative day. On the six months follow-up, he was asymptomatic. Anatomopathological analysis confirmed the diagnosis of CPP, WHO grade I. Conclusion: Cerebellopontine angle’s cpp is an extremely rare neoplasm that challenges a neurosurgeon ability to deal with tumor in close relation to lower cranial nerves. Appropriate neurosurgical route, surgeons experience and adequate anatomical knowledge of important neural and vascular structures are fundamental to safely remove CPP of the posterior fossa. Suboccipital far-lateral craniotomy gives enough view with minimal retraction to manage the tumor.

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Augusto Cesar Santos Esmeraldo, Geraldo Ávila Reis, Jeanine Oliveira Silva, Luan Messias Magalhães, Carlos Umberto Pereira

Introduction: Glioblastoma multiforme is the most common primary tumor of the central nervous system. The preferred location is supratentorial, being considered rare its location in the posterior fossa. Magnetic resonance imaging (MRI) is fundamental for differential diagnosis with other lesions located in the cerebellopontine angle. Treatment is surgical and associated with radiotherapy and chemotherapy. Case report: A 60-year-old patient with a history of headache, decreased right auditory acuity and right peripheral facial paralysis. Results: Magnetic resonance imaging of the skull showed an expansive lesion in the right cerebellar angle. Subjected to right suboccipital craniectomy and total lesion excision. Pathological anatomy resulted in glioblastoma multiforme. Conclusion: Glioblastoma multiforme located in the posterior fossa presents clinical manifestation like other lesions in this region. The correct diagnosis is important for therapeutic planning.

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Louise Makarem Oliveira, Nícollas Nunes Rabelo, Vitor Hugo Honorato Pereira, Neiffer Nunes Rabelo, Carlos Umberto Pereira

Johann Otto Leonhardt Heubner (1843-1926) was an exceptional physician who devoted his work to the Charité Children’s Clinic of Berlin University, where he earned the title of “father of German pediatrics”. However, Heubner’s scientific discoveries were not limited to a specific field. His early research, for instance, focused on anatomical studies of the brain’s circulation, and culminated in the description of both Heubner’s disease (syphilitic endarteritis) and the recurrent artery of Heubner: a structure of utmost importance to neurosurgeons. This article aims to make a brief history of Heubner and depict some of his most remarkable contributions to medicine.

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Roberto Alexandre Dezena, Carlos Umberto Pereira, Raphael Guerra David Reis, Camila Inácio Matias

This brief note narrates the episode of the first surgery of parasagittal meningioma successfully performed by the great master Cushing. His patient, after the first surgery, carried out his activities leading a normal life. Unfortunately, the tumor recurred years after and a second surgery was tried without success. In these passages become evident the pioneering spirit and the courage of Cushing, based on his great scientific curiosity and encyclopedic knowledge, taking the first steps in the early days of neurosurgery as a specialty.

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