JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA

Volume 29 - n° 1 - Jan/Fev/Mar 2018

  • Volume: 29
  • Número: 01
  • Período: Jan/Fev/Mar
  • ISSN (versão impressa): 2446-6768
  • e-ISSN (versão online): 2446-6786
  • Editor: Ricardo Ramina - Curitiba/PR
TEXTO COMPLETO DO FASCÍCULO

Artigo completo

Angelo César D’Urso Panerari, Bruno Cesar da Costa Bornelli, Júlia Miqueleto Santoro, Cármine Porcelli Salvarani, Wilson Eik Filho e Mirian Hideco Takahashi

Introduction: Pituitary adenomas account for 10% to 25% of all intracranial tumors, with a prevalence of approximately 17%, and a higher incidence in adenohypophysis. Transsphenoidal neurosurgery is the mainstay of treatment for most of these tumors, being performed by two main techniques, the microscopic and the endoscopic. Objective: To evaluate comparatively the treatment of pituitary adenomas by microscopic and endoscopic neurosurgery transsphenoidal analyzing whether there is superiority of one technique over the other to the presence or absence of postoperative complications, length of hospital stay and need for reoperation. Methods: Retrospective cross-sectional study by analysis of medical records of patients undergoing neurosurgical treatment of pituitary adenomas treated at the Santa Casa de Misericordia and the University Hospital of Maringá, between 1999 and 2013. Results: It was evident, with statistical significance, a higher rate of complications, length of stay and need for reintervention in patients undergoing transsphenoidal neurosurgery microscopic compared with the endoscopic technique. Conclusion: The endoscopic technique has demonstrated superiority in the therapeutic management of pituitary adenomas, reducing the risks and morbidity for patients.

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Artigo completo

Carlos Umberto Pereira, Francisco de Assis Pereira, Nicollas Nunes Rabelo, Neiffer Nunes Rabelo e Débora Moura da Paixão Oliveira.

ABSTRACT
The clinical manifestations of chronic subdural hematoma are variable, not limited to focal neurological deficit, but may present with psychiatric disorders, leading to misdiagnosis and delaying its treatment. Early diagnosis and appropriate treatment in a timely manner are important for functional recovery and good prognosis.

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Artigo completo

Jairo Batista Netto, Gustavo Soares Correa Silva, Bruno Fernandes Dias e Gabriel Vinicius Ferreira do Nascimento.

ABSTRACT

Introduction: Mesenchymal chondrosarcoma (MCS) is a rare type of malignant neoplasm of poor prognosis, which is originated predominantly from bones. However, some cases have been described in soft tissues, with meninges being the main site of involvement. Case report: Patient, female, 25 years old, with a history of chronic pain in the left dermatomes of the L3, L4 and L5 spinal segments diagnosed with extra MCS in the lumbar spine between the 3rd and 4th lumbar vertebrae. Discussion: A retrospective bibliographic study was carried out in the Medline database, between 1959 and 2018, in order to present the main themes about this tumor, such as symptomatology, diagnosis, treatment and prognosis. Conclusion: The MCS presents poor prognosis, mainly due to the frequent occurrence of local recurrences and lymphatic and hematogenic metastases. The indicated treatment refers to microsurgical excision of the tumor, as well as radiotherapy and adjuvant chemotherapy.

 

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Artigo completo

Vitor de Deus da Rocha Ribeiro Gonçalves, José Nazareno Pearce de Oliveira Brito, Jerusia Oliveira Ibiapina, Beatriz Mendes de Araújo e Cléciton Braga Tavares.

ABSTRACT
The Anaplastic Large Cell Lymphoma (ALCL) is a rare subtype of non-Hodgkin’s lymphoma (NHL). Citogenetically, it has a strong expression of the activation marker CD30 and around 65-80% of ALCL shows the expression of anaplastic lymphoma kinase (ALK). They are classified in ALK-positive ALCL when express the kinase, relating to a better therapy response and greater overall sur-vival, or in ALK-negative ALCL in case of non-expression. The incidence of CNS ALCL is highly rare, with less of 1% of cases corresponding to primary CNS anaplastic large cell lymphoma. In the following report, we present a rather unusual case of a primary CNS ALCL, ALK-negative, in a young fe-male patient, which has epidemiological characteristics opposite to the ones described in the literature for this kind of presentation. The first differential diagnostic hypothesis was a high-grade primary CNS glial neoplasia. However, the immunohistochemical defined it as ALK-negative ALCL, according to the cytogenetic expression pattern (positives CD30 and CD3, high cell proliferation rate and negative for ALK-1). The therapy of choice was 4 cycles of chemotherapy with methotrexate and cytarabine, associated with radiotherapy.

 

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Artigo completo

Williams Escalante, Denis Isao Ueoka, Eduardo Andre Goulart de Alcântara, Anderson Rodrigo de Sousa, Paulo Henrique Pires de Aguiar e Allan Zimmermann.

ABSTRACT
We report a case of coincident craniopharyngioma with an unruptured aneurysm at the right M1- M2 segment of the middle cerebral artery; and discuss the surgical approach to two different pathologies treated at same surgical time, as well as current theories to explain the coincidence or association between tumor and vascular lesions at the sellar and suprasellar regions. The patient was a 59-year-old woman; with a history of visual impairment and headache. Both lesions were identified by magnetic resonance imaging (MRI) and cerebral angiography, and were treated surgically. We suggest individualized treatment for each case, choosing the best neurosurgical approach to achieve an appropriate treatment of both pathologies in the same operative session.

 

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Artigo completo

Erasmo Barros da Silva Júnior, Gustavo Simiano Jung, Jerônimo Buzetti Milano, Joseph Franklin Chenisz da Silva e Ricardo Ramina.

ABSTRACT 
Background. Cranial navigation in brainstem surgery can be especially challenging due to registration method limitation and complex anatomic orientation. Surface anatomical landmarks are not available and fiducial registration usually needs image acquisition at the day of surgery. Intraoperative registration is often used during spinal navigation with safe and reliable accuracy. We present our technique of navigation for brainstem lesions surgeries using intraoperative anatomical landmarks for registration. Methods. From March 2008 to November 2018, 38 patients underwent suboccipital midline approaches for removal of brainstem and/or fourth ventricle lesions with frameless navigation. We performed CT scan and MRI sequence with gadolinium enhancement for each patient a day before the operation. The CT/MRI image fusion and surgical planning was performed in Brainlab® workstation. Navigation registration was performed after skin incision and external skull base anatomical landmarks exposure. Results. The anatomical landmarks used for registration was based on bone structures visible on CT images. The accuracy flaw was insignificant for brainstem navigation, especially for the roof and lateral limits of the fourth ventricle. The image-guided system was very useful for tumor localization and removal in all cases. Conclusions. Intraoperative anatomical landmarks registration is a fast and safe method for brainstem navigation. The brainstem is a fixed encephalic structure and the shifting is insignificant. Anatomical landmarks (inion, foramen magnum, nucal lines, C1 posterior arc) and a careful surgical planning are necessary in order to avoid accuracy lost.

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