ABSTRACT
La tuberculosis causada por la bacteria Mycobacterium tuberculosis, se encuentra entre las 10 primeras causas de mortalidad a nivel mundial; la presentación extrapulmonar se produce por siembra vía hematógena o linfática desde un foco primario, correspondiendo a la afectación de sistema nervioso central el 5% de infecciones por TB y se presenta con menor frecuencia en personas inmunocompetentes. Las formas de tuberculosis de SNC son meningitis, tuberculosis espinal y tuberculomas que corresponden al 1% de infecciones por TB. El tratamiento se basa en la terapia antifímica, reservando el manejo neuroquirúrgico para puntuales indicaciones como deterioro neurológico, hidrocefalia o mala respuesta al tratamiento farmacológico.
Tuberculosis, caused by the Mycobacterium tuberculosis bacteria, is among the top 10 cau-ses of mortality worldwide; The extrapulmonary presentation is produced by hematogenous or lymphatic seeding from a primary focus, 5% of TB infections corresponding to central nervous system involvement and occurs less frequently in immunocompetent people. The forms of CNS tuberculosis are meningitis, spinal tuberculosis and tuberculomas that corres- pond to 1% of TB infections. The treatment is based on antifungal therapy, reserving neurosurgical management for specific indications such as neurodeterioration, hydrocephalus or poor response to pharmacological treatment
Subject(s)
Humans , Female , Pregnancy , Adult , Tuberculoma, Intracranial , Tuberculosis, Central Nervous System , Immunocompetence , Tuberculoma, Intracranial/surgery , Tuberculoma, Intracranial/diagnosis , Tuberculoma, Intracranial/drug therapy , Tuberculoma, Intracranial/diagnostic imaging , Diagnosis, Differential , Neurologic ManifestationsABSTRACT
The awake craniotomy is a procedure where the craniotomy and excision of the lesion is done in awake patient without general anaesthesia. This surgical technique enable surgeons to avoid damaging normal cerebral regions and allow real-time patient feedback while operating on important functional areas of brain like motor cortex and speech areas (motor, somatosensory, and language areas). Such surgical interventions would not be possible without anesthesia. This technique was originally introduced for the surgical treatment of epilepsy and has subsequently been used in patients undergoing surgical management of supratentorial tumours, deep brain stimulation and near critical brain regions. This surgical approach aims to maximize lesion resection while sparing important areas of the brain.
Subject(s)
Adult , Craniotomy/methods , Tuberculoma, Intracranial/surgery , Cerebral Cortex , WakefulnessABSTRACT
Os meningiomas do tubérculo selar, juntamente com os da goteira olfatória, estão entre os tumores mais frequentes da fossa craniana anterior. Os sintomas característicos são déficits visuais, distúrbios do comportamento, crises epilépticas, anosmia e déficits motores. Devido a seu crescimento lento, o período do início dos sintomas até o diagnóstico tende a ser longo, geralmente excedendo dois anos. Quando o tumor atinge mais de 4 cm e comprime as estruturas neurovasculares adjacentes, a possibilidade de remoção cirúsrgica total é limitada e a chance de melhora na função visual é baixa. O tratamento ideal de meningiomas de tubérculo selar é a ressecção completa do tumor com descompressão dos vasos e parênquima cerebral adjacentes. Em virtude da escassez de grupos experientes especializados em cirurgia da base do crânio, muitos dos pacientes portadores de meningiomas de tubérculo selar são tratados em alguns centros com procedimentos alternativos, os quais apresentam resultados significativamente piores as séries cirúrgicas mais recentes publicadas ma literatura. Neste artigo, os autores apresentam um panorama geral acerca dos métodos diagnósticos para detecção e avaliação pré-operatória dos meningiomas de tubérculo selar. Também são enfatizados os benefícios do tratamento cirúrgico, o qual, se realizado por uma equipe experiente, pode ser curativo, apresentando menor morbidade que outras modalidades terapêuticas.
Subject(s)
Humans , Central Nervous System , Meningioma/surgery , Meningioma , Tuberculoma, Intracranial/surgery , Tuberculoma, IntracranialABSTRACT
Os tuberculoses cerebrais foram relatados por neurocirurgioes famosos do século passado, sendo aceita a realizaçao de ressecçao radical como única possibilidade de cura diante da gravidade da lesao. Na primeira metade deste século, com o surgimento das drogas tuberculostáticas, houve grandes modificaçoes na história natural dessa doença. Existem vários relatos na literatura asiática, pricipalmente na indiana. Em nosso país, sao raras as publicaçoes sobre os tuberculomas da fossa posterior, suas peculiaridades clínicas e cirúrgicas. A finalidade deste trabalho é apresentar dois pacientes portadores de tuberculomas do cerebelo e os aspectos clínicos, tomográficos e cirúrgicos dessa doença.
Subject(s)
Humans , Male , Adult , Middle Aged , Cerebellar Diseases/diagnosis , Tuberculoma, Intracranial/diagnosis , Skull , Cerebellar Diseases/surgery , Giant Cells, Langhans , Granuloma/diagnosis , Granuloma/surgery , Lymphocytes , Necrosis , Photomicrography , Tomography, X-Ray Computed , Tuberculoma, Intracranial/surgeryABSTRACT
Fifteen patients with intracranial tuberculomas were treated in this centre. Diagnosis was based on high ESR, CT Scan and any other tuberculous lesion in the body. All the patients were given antituberculous therapy and those who improved were continued on drugs. Surgery was done in cases where there was failure to improve or diagnosis was in doubt and those who had clinical features of raised intracranial pressure. Repeated CT Scans are essential to know the progress of the disease. Sixty percent patients improved on drugs, while 40% underwent surgery. Mortality of 7% was seen which is quite low due to modern diagnostic facilities and drug availability. Treatment of intracranial tuberculomas is essentially medical and surgery is indicated when medical treatment fails