The efficacy of neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral trauma complicated with temporal uncinate herniation / 中国医师进修杂志

Objective:To observe the effect of neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral injury complicated with temporal uncinate herniation.Methods:A total of 80 patients with craniocerebral trauma and temporal uncinate herniation hospitalized in Lanling County People′s Hospital from January 2017 to October 2020 were retrospectively included and divided into the observation group and the control group according to the surgical methods, with 40 patients in each group. Surgical procedures were performed by the same group of experienced neurosurgeons. The observation group was treated with neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression, while the control group was treated with large bone flap decompression only. Cephalic CT was reexamined before and 48 h after the surgery to compare the appearance rates of cisterna ambiens and suprasellar cistern. Intracranial pressure (ICP) was monitored at 3, 5 and 7 d after the surgery, and the scores of Glasgow coma scale(GCS) was recorded. Drainage time, postoperative cerebral edema and cerebral infarction complications were recorded and compared between the two groups. Six months after the surgery, the prognosis was assessed by the Glasgow prognostic scale (GPS).Results:The occurrence rates of cisterna ambiens and suprasellarcistern in the observation group were higher than those in the control group: 67.50%(27/40) vs. 45.00%(18/40), 65.00%(26/40) vs. 42.50%(17/40), χ2 = 4.11, 4.07, P<0.05. The ICP value in the observation group at 3, 5 and 7 d after the surgery were significantly lower than those in the control group, and the scores of GCS in the observation group were significantly higher than those in the control group, there were statistical differences( P<0.05). There was no statistically significant difference in drainage time between the two groups ( P>0.05). The incidence of postoperative cerebral edema in the observation group was lower than that in the control group:7.50%(3/40) vs. 25.00%(10/40), χ2 = 4.50, P<0.05. The incidence of postoperative cerebral infarction in the observation group was lower than that in the control group, and the volume of cerebral infarction was smaller than that in the control group: 5.00%(2/40) vs. 22.50%(9/40), (6.68 ± 1.75) cm 3 vs. (8.20 ± 2.15) cm 3, there were statistical differences ( P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group: 7.50%(7/40) vs. 40.00%(16/40), χ2 = 4.94, P<0.05. Six months after the surgery, the rate of good prognosis in the observation group was higher than that in the control group: 62.50%(25/40) vs. 35.00%(14/40), χ2 = 6.05, P<0.05. Conclusions:Neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral trauma and temporal uncinate herniation has good efficacy and safety.

Craniopharyngioma and anterior central space of brain base / 中国医师进修杂志

Objective:To analyze the surgical (anatomical) approach of craniopharyngioma based on the concept of anterior central space of brain base.Methods:The clinical data of MRI images of 10 cases of craniopharyngioma who treated in Sanbo Brain Hospital, Capital Medical University from January 2021 to December 2021 were analyzed retrospectively. The brain cisterns involved in the growth of craniopharyngioma were analyzed from the perspective of anterior central space of brain base. Meanwhile, the surgical approach and the basis of selection were discussed.Results:Among all the surgical approaches that can reach the anterior central space of the brain base, the fronto-basal interhemispheric approach was the best.Conclusions:The concept of anterior central space of the brain base is a new observation and interpretation of the anatomy of the brain base from a new perspective, and then create a new concept of brain base surgery. As a new method to analyze the surgical anatomy of this area, its inclusion has important clinical significance.

Prognostic analysis of continuous lumbar cistern external drainage after aneurysmal subarachnoid hemorrhage / 国际外科学杂志

Objective:To analyze the influencing factors, prevention and treatment strategy of short-term poor prognosis of continuous lumbar cistern external drainage after aneurysms subarachnoid hemorrhage (aSAH).Methods:Used retrospective research method, the clinical data of 300 patients with aSAH combined with continuous lumbar cistern external drainage treated in Sanya Central Hospital (Hainan Third People′s Hospital) from March 2019 to March 2021 were selected as the training set. In addition, the clinical data of 144 patients with aSAH with continuous lumbar cistern external drainage treated in Sanya Central Hospital (Hainan Third People′s Hospital) from March 2017 to May 2019 were selected as the verification set. According to the results of postoperative follow-up, the patients in the training set were divided into two groups: good prognosis group ( n=208) and poor prognosis group ( n=92). The demographic characteristics, past history, Hunt-Hess grade, modified Fisher grade, location of responsible aneurysm, postoperative complications, bone flap decompression and lumbar cistern drainage were compared between the two groups. The independent risk factors for prognosis of aSAH patients undergoing continuous lumbar cistern external drainage were screened by Cox proportional hazard regression model, and these factors were included and XGboost model was established. The prediction model was validated internally and externally in the training set and verification set: AUROC(C-index) was used to verify the model differentiation; GiViTI calibration band and Hosmer-Lemeshow test were used to verify the model calibration; DCA curve was used to verify the clinical validity of the model. Results:Hunt-Hess grade, modified Fisher grade, drainage duration, average daily drainage volume, shunt-dependent hydrocephalus, aneurysm rebleeding, cerebral vasospasm and delayed cerebral ischemia were independent risk factors for poor prognosis in patients with aSAH who underwent continuous lumbar cistern external drainage( P<0.05). The XGboost model was successfully established by incorporating the above independent risk factors, and the internal and external verification of the XGboost model was carried out in the training set and verification set, respectively, the area under the curve of receiver operating characteristic was 0.882(95% CI: 0.820-0.955) and 0.878(95% CI: 0.774-0.928) respectively, and the model differentiation was good; the 80%-90% confidence interval of the GiViTI calibration curve did not cross the 45° angle bisector ( P>0.05). In the Hosmer-Lemeshow goodness-of-fit test, the P value were 0.581 and 0.716, respectively. The threshold probability value in the DCA curve was 30.4%. The clinical net benefit rate of the training set and verification set were 31% and 34%, respectively, indicating that the prediction model was clinically effective. Conclusions:The independent risk factors for poor prognosis of aSAH patients undergoing continuous lumbar cistern drainage are Hunt-Hess grade, modified Fisher grade, cerebral vasospasm, delayed cerebral ischemia and shunt-dependent hydrocephalus. The XGboost model constructed in this study can effectively predict the prognosis of patients with aSAH undergoing continuous lumbar cistern drainage, and provide reference for the formulation of follow-up treatment plans.

Qualitative study on psychosomatic experience of patients undergoing lumbar cistern drainage after transnasal endoscopic surgery / 中国实用护理杂志

Objective:To understand the psychosomatic experience and needs of patients with lumbar cistern drainage after transnasal endoscopic sinus surgery in neurosurgery while lying in bed.Methods:Using the purposeful sampling method, one-to-on, face-to-face semi-structured interviews were conducted among 12 patients with lumbar cistern catheter drainage who were treated in Beijing Tiantan Hospital Affiliated to Capital Medical University from July to August 2020. Colaizzi phenomenology study was used to analyze the interview data, and summarized the themes.Results:The experience and needs of patients with lumbar cistern catheterization during the catheter placement were summarized into 3 themes. Obvious physical and mental discomfort: pain, discomfort of body position restriction, expectation minimization constraint scheme. Knowledge and cognitive needs: understand the reasons for intubation, intubation time and precautions. Affectionate and professional care needs: eager for professional care and more attention from medical staff, eager to be accompanied by family member to achieve greater improvement of comfort.Conclusions:Clinical nursing should be based on the patient′s psychosomatic feelings and needs, actively explore personalized intervention measures suitable for patients with lumbar cistern drainage, and formulate corresponding predictive care content to improve patients′ compliance, comfort and satisfaction.

Prognostication in Traumatic Brain Injury- A Prospective Study of 100 Patients in Tertiary Care Hospital in Rural Area.

Traumatic brain injury is a major health issue responsible for considerable mortality and morbidity worldwide especially in subjects under the age of 40 yrs. It is important to assess and grade the TBI as soon as possible to guide management and decrease the comorbidities. Various guidelines have been issued by the neurosurgical societies to immediately assess and intervene when ever required. In this study, we have tried to assess the role of basal cisternal effacement in the management and prognosis of RTA patients, and hence tried to simplify the prognostication process and improve the patient management.METHODS100 subjects were studied who were having history of traumatic head injury. NCCT was done for all the patients using 128 slice Multidetector CT- Ingenuity (Philips Medical Systems, USA). Other parameters like pupillary reaction, GCS at the time of presentation, midline shift and associated fractures and bleed were assessed. All the patients were followed up till the time of discharge. The data so obtained was analysed.RESULTSParameters like age, pupillary reflex, GCS at presentation, associated intracranial bleed, associated cranial vault fractures and presence or absence of midline shift correlated well with the final outcome with p value consistently <0.05. We analysed that the degree of obliteration of perimesencephalic cistern was a good prognostic marker in traumatic head injury patients. 36% of patients had favourable outcome out of which none of the patients had obliterated perimesencephalic cistern or interpeduncular cisterns. 64% patients had unfavourable outcome out of which 60% and 48% had obliterated or partially obliterated perimesencephalic cisterns and interpeduncular cisterns respectively, and only 4% and 16% had normal perimesencephalic cisterns and interpeduncular cisterns respectively.CONCLUSIONSIt is important to investigate, grade and prognosticate traumatic head injury patients at the earliest. Our study and various other studies prove that various clinical predictors including age, Glasgow coma scale, and pupil reactivity correlate with outcome of patient. Presence of midline shift, intraventricular haemorrhage, and obliteration of cisterns in patients of traumatic brain injury also correlate with the outcome and can be used; thus, making the prognostication process much easier. These findings can be used on the first day of admission itself.

Nursing experience of a patient with secondary catheter complications caused by cerebrospinal fluid drainage after endovascular aorticrepair / 中国实用护理杂志

Objective To summarize the nursing experience of a patient with secondary catheter complications caused by cerebrospinal fluid drainage after endovascular aorticrepair. Methods A retrospective analysis was made on the clinical situation of a patient who received cerebrospinal fluid drainage afterendovascular aorticrepair in 2017, and the cause of secondary catheter complications, symptoms and signs were identified and nursing. Results After careful observation, mean arterial pressure maintenance, painmanagement, cerebrospinal fluid drainage velocity management, catheter infection risk and control, psychological intervention and exercise rehabilitation, the patient was finally recovered and discharged. Conclusions In order to evaluate the postoperative complications, we should not only focus on the surgery but also on the adverse events caused by cerebrospinal fluid drainage. In addition,we should improve the ability to identify the source of problems, to risk management and to disease assessment.

Trochlear Nerve Palsy Caused by Quadrigeminal Cistern Lipoma

PURPOSE: To report a case of trochlear nerve palsy caused by quadrigeminal cistern lipoma located in the dorsal midbrain. CASE SUMMARY: A 65-year-old male visited our clinic for intermittent vertical diplopia over 2-year period. Symptoms of diplopia had worsened over the past two weeks. He had no previous medical history except having had diabetes for 1 month. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Pupillary examination was not remarkable. Extraocular examination showed 4 prism diopters (PD) left hypertropia at distant gaze and 4 PD exotropia at near gaze, with adduction elevation of the left eye. The Bielschowsky head tilt test revealed 6 PD left hypertropia on the left gaze and orthotropia on the right tilt. Fundus examination showed excyclotorsion of the right eye and incyclotorsion of the left eye. Brain magnetic resonance imaging revealed quadrigeminal cistern lipoma. Prism glasses were prescribed to alleviate diplopia, and we followed up the lesions without further treatment. CONCLUSIONS: Trochlear nerve palsy can be caused by quadrigeminal cistern lipoma; however, it is uncommon for this condition to be caused by a compressive lesion. Prompt neuroimaging can be helpful to rule out the causes of this condition in patients with atypical symptoms.

Vancomycin and meropenem combined with lumbar cistern drainage and curative effect of psychological intervention on the basis of the analysis of intracranial infection in treatment of brain injury after operation / 中国生化药物杂志

Objective To explore the basis of intracranial infection after craniocerebral operation with drainage combined with treatment in the application of vancomycin, meropenem and lumbar cistern on the use of psychological intervention clinical value. Methods 55 cases with intracranial infection craniocerebral injury patients were admitted to the Department of neurosurgery in Third Hospital of Jiaxing City in July 2012 to July 2017, the basic treatment in the application of drainage combined with vancomycin, meropenem and lumbar abroad, pay attention to the implementation of psychological nursing. Results The total effective rate of the group was 94.6%. Compared with before treatment, the number of WBC and protein in CSF decreased significantly, and the level of glucose increased significantly, with statistical difference (P<0.05). Compared with the intervention, the psychological status score improved obviously after intervention, with statistical difference (P<0.05). Conclusion The patients with craniocerebral injury complicated with intracranial infection after operation, basic drainage combined with treatment in application of meropenem and vancomycin, lumbar cistern on the use of psychological nursing, can improve the total clinical efficiency, improve psychological status.

Vancomycin and meropenem combined with lumbar cistern drainage and curative effect of psychological intervention on the basis of the analysis of intracranial infection in treatment of brain injury after operation / 中国生化药物杂志

Objective To explore the basis of intracranial infection after craniocerebral operation with drainage combined with treatment in the application of vancomycin, meropenem and lumbar cistern on the use of psychological intervention clinical value. Methods 55 cases with intracranial infection craniocerebral injury patients were admitted to the Department of neurosurgery in Third Hospital of Jiaxing City in July 2012 to July 2017, the basic treatment in the application of drainage combined with vancomycin, meropenem and lumbar abroad, pay attention to the implementation of psychological nursing. Results The total effective rate of the group was 94.6%. Compared with before treatment, the number of WBC and protein in CSF decreased significantly, and the level of glucose increased significantly, with statistical difference (P<0.05). Compared with the intervention, the psychological status score improved obviously after intervention, with statistical difference (P<0.05). Conclusion The patients with craniocerebral injury complicated with intracranial infection after operation, basic drainage combined with treatment in application of meropenem and vancomycin, lumbar cistern on the use of psychological nursing, can improve the total clinical efficiency, improve psychological status.

Clinical analysis of early application of nimodipine combined with lumbar cistern drainage in the treatment of severe traumatic brain injury / 国际检验医学杂志

Objective To explore the clinical value of early application of nimodipine combined with lumbar cistern drainage in the treatment of severe traumatic brain injury .Methods a total of 68 cases elderly patients with severe craniocerebral injury in our hospital from 2015 to 2017 were selected ,which were divided into control group and observation group according to random number table method .The control group was given routine medical treatment ,and the observation group was given nimodipine combined with lumbar cistern drainage on the basis of the control group .The Glasgow Coma Scale (GCS) score ,cerebral CT and blood flow velocity measurement of middle cerebral artery (MCA) were was performed ,and the recovery and prognosis were compared in the two groups .Results The GOS score and MCA blood flow velocity of the observation group at 7 ,14 and 21d after treatment were significantly higher than those in the control group(P＜0 .05);the decline rate of intracranial pressure in the observation group at 7 ,10 and 14d after treatment was significantly higher than that in the control group (P＜0 .05);the probability of infection in the observation group was significantly lower than that in the control group (P＜0 .05);the prognosis rate of the observation group was significantly better than that of the control group(P＜0 .01) .Conclusion Early use of nimodipine combined with lumbar continuous drainage in the treatment of severe traumatic brain injury can effectively improve the clearance rate of subarachnoid hemorrhage ,re-duce the occurrence of secondary brain injury ,avoid cerebral vasospasm ,and improve the prognosis of patients.

Quadrigeminal cisterna lipoma: report of two cases and literature review / Lipoma da cisterna quadrigeminal: relato de dois casos e revisão da literatura

Intracranial lipomas are congenital, benign and slow-growing tumors. The incidence were 0.1 to 0.5 percent of all primary brain tumors and are often diagnosed in incidental findings of neuroradiological investigation. Lipoma in quadrigeminal region occurs in 25 percent of intracranial lipomas and has been reported as lipomas in quadrigeminal cistern (perimesencephalic cistern), quadrigeminal plate, ambiens cistern or superior medullary velum. MRI is the most major exam. The treatment is conservative in most cases, surgical removal is hampered by their deep location and contiguous with adjacent neurovascular structures. The authors report two cases of lipoma in the quadrigeminal region, incidental findings and discuss the clinical findings, neuroimaging and treatment.

Lipomas intracranianos são tumores congênito, benigno e de crescimento lento. Sua incidência é de 0.1 a 0.5 por cento de todos os tumores cerebrais primários e são frequentemente diagnosticados em achados incidental de investigação neuroradiológica. Lipoma na região quadrigeminal ocorre em 25 por cento dos lipomas intracranianos e tem sido relatados como lipomas na cisterna quadrigeminal (cisterna perimesencefálica), placa quadrigeminal, cisterna ambiens ou véu medular superior. O exame de eleição é ressonância magnética. O tratamento é conservador na maioria dos casos, a remoção cirúrgica é dificultada pela sua localização profunda e da contiguidade com estruturas neurovasculares adjacentes. Os autores relatam dois casos de lipoma na região quadrigeminal achados incidentalmente e discutem os achados clínicos, imagem e tratamento.

Lesión como malformación de Chiari secundaria a quiste aracnoidal de la cisterna cuadrigémina / Chiari malformation-like lesion secondary to arachnoid cyst of the quadrigeminal cistern

Se presenta el caso de una mujer de 31 años de edad con cefalea y cervicalgia que se agravaba con la maniobra de Valsalva, presentando además mareos, encontrándose una malformación de Chiari secundario a un quiste aracnoideo cuadrigeminal. Después de efectuada la resonancia magnética diagnóstica, la paciente fue sometida a descompresión del agujero magno y extirpación del quiste cuadrigeminal, seguido por la resolución tanto de la malformación de Chiari y el quiste. Los síntomas desaparecieron después de la cirugía y han permanecido completamente resuelto hasta la actualidad. En pacientes adultos que presentan signos y síntomas de una malformación de Chiari debido a la compresión de la médula por las las amígdalas cerebelosas, la presencia de un quiste aracnoideo de cisterna cuadrigéminal es una rara patología asociada que puede ser tratada quirúrgicamente.

We report a rare case of a 31-year-old woman with headache and pain manifested by cervicalgia that worsened with the Valsalva maneuver and dizziness, who was found to have a Chiari malformation secondary to a posterior fossa arachnoid cyst. After magnetic resonance imagining (MRI), the patient was submitted to foramen magnum decompression and arachnoid cyst removal that were followed by resolution of both the Chiari malformation and the cyst. The symptoms disappeared after surgery and have remained completely resolved to the present day. In adult patients who present with signs and symptoms of Chiari malformation due to direct medulla compression by the tonsils, a quadrigeminal cistern arachnoid cyst is a rare associated pathology that can be treated surgically.

Clinical analysis of 66 cases of intraventricular hemorrhage / 中国基层医药

Objective To explore treatment methods and prognosis of external ventricular drainage .Methods A retrospective analysis of 66 cases with severe intraventricular hemorrhage patients were selected ,36 cases underwent bilateral ventricle drainage and urokinase ( UK ) intraventricular fibrinolysis therapy +terminal cistern drainages , 30 cases with bilateral ventricle drainage and urokinase for intraventricular fibrinolysis .The prognosis of the patients with modified Rankin Scale score was assessed .After multiple cerebral CT examination hematoma imaging changes were observed.Results A group of intraventricular hemorrhage clearing time (5.3 ±1.5)d,B group of intraventricu-lar hemorrhage clearing time (8.2 ±2.5)d,there was significant difference (t=-5.820,P=0.000).Rate in group A was 83.3%(30/36),group B was 66.7%(20/30), there was no significant difference (χ2 =2.475,P=0.116). Conclusion This study suggests that intraventricular hemorrhage were given bilateral ventricle drainage and uroki -nase for intraventricular fibrinolysis therapy +terminal cistern drainages effect is better .

Arachnoid Cyst in Oculomotor Cistern

Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of arachnoid cyst in oculomotor cistern, manifesting as oculomotor nerve palsy. The oblique sagittal MRI, parallel to the oculomotor nerve, showed well-defined and enlarged subarachnoid spaces along the course of oculomotor nerve. Simple fenestration was done with immediate regression of symptom. When a disease develops in oculomotor cistern, precise evaluation with proper MRI sequence should be performed to rule out tumorous condition and prevent injury of the oculomotor nerve.

Cystic Abducens Schwannoma without Abducens Paresis : Possible Role of Cisternal Structures in Clinical Manifestation

The abducens nerve paresis generally can aid in the presumptive diagnosis of abducens schwannoma along with the typical radiological features of schwannomas. The authors present a case of a 76-year-old male patient with a abducens schwannoma without abducens nerve paresis. Peroperatively, abducens nerve located in the cerebellopontine cistern had normal in contour and diameter, despite the mass originated from this nerve. We hypothesize that anatomic location of abducens nerve may affect the vector of tumor growth to prevent destruction of its origin, the abducens nerve.

Cisternas para armazenamento de água de chuva e efeito na diarreia infantil: um estudo na área rural do semiárido de Minas Gerais / Rainwater cisterns and its effect in children diarrhoea: a study in semi arid rural area at Minas Gerais

O estudo avaliou a prevalência de diarreia em crianças menores de 60 meses, segundo o tipo de abastecimento de água utilizado. Foi conduzido estudo epidemiológico, seguindo o delineamento quase-experimental, com 664 crianças, sendo 332 moradoras de residência que têm cisterna e 332 que utilizam água de outra fonte. A variável dependente foi a ocorrência de diarreia nas últimas 72 horas; as outras informações foram obtidas por meio da aplicação de questionários estruturados. A prevalência total de diarreia foi de 5%, porém sem diferença significativa entre os grupos. As variáveis que explicaram a morbidade foram o grupo, a idade da criança, a ingestão de vitamina ou fortificante, e o local de descarte das fraldas sujas com fezes da criança. Não houve diferença significativa entre os grupos na avaliação da qualidade microbiológica da água, ou seja, o uso de água de chuva pode não ter proporcionado melhorias no acesso à água de melhor qualidade quando comparado com as outras fontes utilizadas. No entanto, há que se considerar falhas nos cuidados, no manuseio e no tratamento da água adotados. Destaca-se a necessidade de melhoria das práticas sanitárias da população do meio rural para que a higiene pessoal, domiciliar e em relação à água consumida sejam incorporadas como hábitos rotineiros.

The present text evaluated the diarrhea prevalence in children under 60 months, according to water supply. An epidemic study was conducted with quasiexperimental design with 664 children, 332 who lived in residence that had cistern and 332 that use water from another source. Diarrhoea occurrence in the last 72 hours was the dependent variable, the others informations were obtained by structured questionnaires. Total diarrhoea prevalence was of 5%, however with no significant difference among the groups. The variables that explained the disease were child's age; if it was taking vitamin and where the dirty diapers with the child's feces were displaced. There were no significant difference among the groups in water microbiological analyses; in other words, the use of rainwater had might not provided improvements in the access of a better quality water supply when compared with the other alternative sources. However, it has to be considered faults in handling and water treatment. It stands out the need of sanitary practices improvement of rural area population, so that personal and home hygiene and in relation to consumed water could be incorporated as routine habits.

A Case of Ectopic Rathke's Cleft Cyst in the Prepontine Cistern

A Rathke's cleft cyst (RCC) is a benign pituitary cyst derived from the remnant of Rathke's pouch, and usually presents as an intrasellar lesion with varying degrees of suprasellar extension. However, to date, a description of a primary prepontine RCC with no intrasellar component has not been reported. The author describes an exceptional case of a symptomatic RCC located behind the sella turcica in a 41-year-old woman who presented with severe headache. The author also provides an embryological hypothesis of the development of an ectopic RCC, with a special emphasis on radiologic characteristics.

Impacto do uso da água de cisternas na ocorrência de episódios diarréicos na população rural do agreste central de Pernambuco, Brasil / The impact of the use of water from water-tanks on the occurrence of diarrhea in the rural population of the Central Agreste region of the Brazilian State of Pernambuco

OBJETIVOS: avaliar o impacto do uso da água de cisternas na ocorrência de episódios diarréicos comparando o número e a duração de episódios entre moradores de domicílios com e sem cisternas, numa mesma área geográfica. MÉTODOS: estudo longitudinal prospectivo aninhado a um estudo de corte transversal com dois grupos de comparação (domicílios com e sem cisternas) realizado, em 21 municípios do Agreste Central de Pernambuco, em 2007. O período de coleta foi de 60 dias, e incluiu 1765 indivíduos. Para análise descritiva utilizou-se modelos mistos hierárquicos, Mann-Whitney e Kaplan-Meyer com nível de significância de 5 por cento. RESULTADOS: entre os 949 indivíduos com cisternas, obteve-se uma redução no risco de ocorrência de episódios diarréicos de 73 por cento quando comparados aos 816 indivíduos sem cisternas (RR=0,27; p<0.001). O número médio de episódios registrados nos residentes de domicílios sem cisternas foi de 0,48 (DP=1,17), contra 0,08 (DP=0,32) nos domicílios com cisternas(z=-10,26; p<0,001). A duração média dos episódios foi 1,5 vezes maior nos domicílios sem cisternas (χ²=8,99; p=0,003). CONCLUSÕES: os achados deste estudo destacam a importância do acesso à água potável na redução de doenças. A ocorrência de diarréia, bem como, seus indicadores de gravidade - número de episódios e duração da diarréia foram consistentemente maiores nos residentes de domicílios sem cisternas.

OBJECTIVES: to evaluate the impact of the use of water-tanks on the occurrence of episodes of diarrhea, comparing the number and duration of episodes among the residents of households with and without water-tanks in the same geographical area. METHODS: a longitudinal prospective study, nested in a cross-section study comparing two groups (households with and without water-tanks), was carried out in 21 municipalities in the Central Agreste region of the Brazilian State of Pernambuco, in 2007. Data was gathered over 60 days and included 1,765 individuals. Descriptive analysis was carried out using mixed hierarchical models, Mann-Whitney and Kaplan-Meyer with the level of significance set at 5 percent. RESULTS: among the 949 individuals with water-tanks, there was a reduction in the risk of the occurrence of episodes of diarrhea of 73 percent compared with the 816 individuals without water-tanks (RR=0.27; p<0.001). The mean number of episodes registered among residents of households without water-tanks was 0.48 (SC=1.17), compared with 0.08 (SC=0.32) among households with water-tanks (z=-10.26; p<0.001). The mean during of episodes was 1.5 times greater in households without water-tanks (χ2=8.99; p=0.003). CONCLUSIONS: the findings of this study point to the importance of access to drinking water for the reduction of disease. The occurrence of diarrhea and its concomitant severity indicators-number of episodes and duration-were consistently higher among residents of households without water-tanks.

Characterization of the Anatomic Location of the Pituitary Stalk and Its Relationship to the Dorsum Sellae, Tuberculum Sellae and Chiasmatic Cistern

OBJECTIVE: The normal anatomic relationships characteristic of the pituitary stalk area were previously thought to involve only one location. The purpose of this study was to re-evaluate the anatomic location of the pituitary stalk and possible varying locations in relation to the tuberculum sellae and dorsum sellae using morphometric evaluation and anatomic dissection of human cadaveric specimens. The surgical implications of the variations are discussed. METHODS: The calvaria were removed via routine autopsy dissections, and the brains were removed from the skull while preserving the pituitary stalk. The diaphragma sellae, tuberculum sellae, and the location of the pituitary stalk were examined in 60 human cadaveric heads obtained from fresh adult cadavers. Empty sellae were excluded. RESULTS: The openings of the diaphragma sellae averaged 6.62 +/- 1.606 mm (range, 3-9 mm). The distance between the tuberculum sellae and the posterior part of the pituitary stalk was 1 to 8 mm. The upper face of the diaphragma sellae appeared flat in 26 (43%), concave in 24 (40%), and convex in 6 cases (10%), with a prominent tuberculum sellae in 4 cases (7%). The location of the chiasm was normal in 47 cases (78%), with a prefixed chiasm in 3 cases (5%) and a postfixed chiasm (17%) in the 10 cases. Four cadaver specimens had prominent tuberculum sellae and other parameters were not evaluated. CONCLUSION: When opening the chiasmatic cistern, neurosurgeons should be aware about the relationship between the pituitary stalk and the surrounding structures to prevent inadvertent injury to the pituitary stalk.

Lipoma of the Sylvian Cistern

Intracranial lipoma is a rare benign brain tumor and ususally occurs in the midline structures, especially in the corpus callosum. The author report a case of intracranial lipoma in the left sylvian cistern. Sylvian cistern lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. The majority of cases are incidental or autopsy findings and direct surgical approach is only rarely indicated. The patient complained severe headache after head injury, the severe headache did not respose to medical therapy. Craniectomy was performed and then the tumor was removed. The literatures on this rare tumor are reviewed and discussed.