ABSTRACT
PURPOSE: The purpose of this study was to introduce a method of using three-dimensional (3D) curved-multiplanar reconstruction (MPR) images for sylvian dissection during microsurgical treatment of middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS: Forty-nine patients who had undergone surgery for MCA aneurysms were enrolled. We obtained the 3D curved-MPR images along the sphenoid ridge using OsiriX MD™ imaging software, compared sylvian dissection time according to several 3D MPR image factors, and investigated the correlations between these images and intraoperative findings. RESULTS: Utilizing preoperative information of the sylvian fissure (SF) and peri-aneurysmal space on 3D curved-MPR images, we could predict the feasibility of sylvian dissection for a safe surgery. 3D curved-MPR images showed several features: first, perpendicular images to the sylvian surface in the same orientation as the surgeon's view; second, simultaneous visualization of the brain cortex, vessels, and cisternal space; and third, more accurate measurement of various parameters, such as depth of the MCA from the sylvian surface and the location and width of the SFs. CONCLUSION: In addition to conventional image studies, 3D curved-MPR images seem to provide useful information for Sylvian dissection in the microsurgical treatment of MCA aneurysms.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cerebral Aqueduct/surgery , Imaging, Three-Dimensional/methods , Intracranial Aneurysm/surgery , Microdissection/methods , Microsurgery/methods , Middle Cerebral Artery/surgeryABSTRACT
Achondroplasia is the most frequent cause of disproportionate short stature. Characterized by abnormal growth of long bones, it renders a short-limbed individual of normal intelligence. A serious potential complication is spinal compression, which can happen at any level but is particularly common at the craniocervical junction. It can cause important morbility during the first few years of life, including sudden death. We present a 22-month-old patient diagnosed with achondroplasia, who developed aqueductal stenosis with symptomatic spinal cord compression, diagnosed during a routine consultation, requiring decompressive surgery with excellent results.
La acondroplasia es la condición asociada a talla baja desproporcionada más frecuente, caracterizada por un crecimiento óseo anormal, que resulta en talla baja con extremidades cortas e inteligencia normal. Una de las complicaciones más habituales es la compresión medular, que puede ocurrir a cualquier nivel, siendo más frecuente en la unión cráneo cervical, generando alta morbimortalidad en los primeros años de vida, principalmente por muerte súbita. Presentamos una paciente de 1 año 10 meses con diagnóstico precoz de acondroplasia, que presentó en su evolución estenosis acueductal con compresión medular, sintomática, pesquisada en control rutinario, que requirió cirugía descompresiva con buena evolución posterior.
Subject(s)
Humans , Female , Infant , Achondroplasia/complications , Cerebral Aqueduct/surgery , Spinal Cord Compression/surgery , Cerebral Aqueduct/pathology , Spinal Cord Compression/diagnosis , Spinal Cord Compression/etiology , Constriction, Pathologic/surgery , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Decompressive Craniectomy , Hydrocephalus/diagnosis , Magnetic Resonance Imaging , Treatment OutcomeABSTRACT
Os autores apresentam a experiência adquirida com parte dos pacientes submetidos às derivaçoes ventricular, peritoneal e atrial, desde o início do Serviço de Neurocirurgia, em 1983. A técnica operatória, apesar de simples, tem ainda muitas controvérsias, em virtude do número elevado de revisoes que os sistemas de inúmeras procedências necessitam, levando ao aparecimento de complicaçoes, algumas vezes graves. Com estas ressalvas, a mortalidade foi de 14,28 por cento, comparável a outras séries. O primeiro shunt peritoneal é creditado a Ferguson, em 1898. Foi feito com agulha de prata, comunicando o espaço subaracnóide com o peritônio, através do corpo vertebral de L5. Este e outros métodos utilizados em tempos mais remotos falharam e novas tentativas somente foram feitas e publicadas 25 anos após. Quando a válvula Spitz Holter e os cateteres flexíveis começaram a ser usados, a cirurgia do shunting começou a ficar mais popular. Desde entao vem-se notando que as complicaçoes com a DVA usada na época nao eram tao infreqüentes. A partir de 1967, Ames & Murgathi chamaram a atençao para a possibilidade de utilizar a cavidade peritoneal para o desvio ventricular. Trabalhos mais recentes têm mostrado que tanto a DVA quanto a DVP sao eficientes para o tratamento dos hidrocéfalos, existindo significantes vantagens para o sistema peritoneal quando se leva em conta a gravidade das complicaçoes com a DVA.