Reparación endoscópica de encefalocele esfenoidal, secundario a persistencia del canal de Sternberg / Endoscopic repair of sphenoid encephalocele, secondary to persistence of Sternberg's canal

Las fístulas de líquido cefalorraquídeo (FLCR) nasales se producen por la comunicación entre el espacio subaracnoídeo y el tracto aerodigestivo. Pueden ser adquiridas (secundarias a trauma o iatrogenia) o espontáneas. Éstas últimas pueden ser de origen congénito, tumoral o idiopáticas. El canal lateral craneofaríngeo o de Sternberg se produce por la falta de fusión de los puntos de osificación del seno esfenoidal durante el período embrionario. Esta región, ubicada posterolateral a la pared inferior del seno esfenoidal, queda cubierta solamente por tejido conectivo, siendo la zona de menor resistencia de la base de cráneo. La persistencia de este canal puede causar FLCR, especialmente cuando se asocia a elevación de la presión intracraneana y extensa neumatización. La cirugía endoscópica nasal es la técnica de elección para la resolución de estos casos. En el presente artículo se realiza una revisión de la técnica quirúrgica endoscópica nasal para la resolución quirúrgica de encefaloceles secundarios a persistencia del canal de Sternberg, en base a dos casos clínicos que fueron sometidos a cirugía endoscópica nasal.

Nasal cerebrospinal fluid leaks are caused by a nasal communication between the subarachnoid space and the aerodigestive tract. They may be acquired (secondary to trauma or iatrogenic) or spontaneous. The latter can be congenital, tumoral or idiopathic. The lateral craniopharyngeal canal or Sternberg canal is caused by the lack of fusion of the points of ossification of the sphenoid sinus during the embryonic period. This region, located posterolateral to the bottom wall of the sphenoid sinus, is covered only by connective tissue, being the area of least resistance of the skull base. The persistence of this canal can cause cerebrospinal fluid leaks, especially when associated with elevated intracranial pressure and extensive pneumatization. Nasal endoscopic surgery is the technique of choice for solving these cases. This article is a review of the endoscopic surgical technique of encephaloceles secondary to persistence of Sternberg canal, based on two clinical cases.

[Herpes simplex virus encephalitis during immunosuppressive treatment of ulcerative colitis]

Today, with the advent of new medications, treatment of Ulcerative colitis [UC] has been markedly improved. Immunosuppressive drugs used in therapy predispose patients to opportunistic infections. A 22-year-old woman was admitted to emergency department due to acute exacerbation of UC and decreased level of consciousness. She was under treatment with 5-aminosalicylate, prednisolone and azathioprine. In neurological evaluation, patient had cerebral herniation. Non-contrast CT scan revealed multiple hemorrhagic areas in both frontal lobes. Right frontal craniotomy was performed emergently. Histopathologic evaluation of brain tissue was reported as "Herpes simplex encephalitis". Polymerase chain reaction [PCR] assay was also positive for HSV DNA. Immunosuppressive drugs such as azathioprine have a pivotal role in the treatment of resistant and/or severe cases of UC. Prevalence of infectious complications was reported to be 7.4%, 1.8% of which were severe [including herpes zoster encephalitis] .Our review of literature indicates that no case of herpes simplex encephalitis following immunosuppressive therapy for UC has been reported

Meningoencefalocele do osso temporal / Meningoencephalocele of temporal bone

As meningoencefaloceles do osso temporal podem ser congênitas, devido a traumas do osso temporal ou ainda pós-cirurgias da mastóide, que é a causa mais comum. Apresentamos dois casos de meningoencefalocele após cirurgia da mastóide por otite média crônica colesteatomatosa, dando ênfase à via de abordagem cirúrgica e a importância do tratamento cirúrgico precoce para a correção da hérnia.