Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

BACKGROUND: The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high. OBJECTIVE: The aim of this study was to evaluate the factors that have influence over the outcomes in ANM patients. METHODS: A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance. RESULTS: The mean age of patients was 43 years (21 to 91) and 54.5 percent were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2 percent), external shunt (54.4 percent) and emergency surgery due to trauma (18.1 percent). Imipenem resistance was observed in 40.9 percent of cases, but ampicillin/sulbactam resistance was lower (27.2 percent). The mortality rate of ANM patients was of 72.7 percent. The only risk factor associated with mortality was inappropriate therapy within five days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2 percent of those who did not survive (OR = 5.15; IC = 0.45-54.01). CONCLUSIONS: The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic.

Meningiomas petroclivais: planejamento cirúrgico / Petroclival meningiomas: surgical planning

Objetivo: O tratamento cirúrgico dos tumores originários da região petroclival, ou com extensão para essa área, é um desafio para os neurocirurgiões. Aqui descrevemos duas abordagens de base de crânio a menigeomas petriclivais, definidos como tumores originários dos dois terços superiores do clivus, na junção petroclival, e medial ao nervo trigêmeo. Descrição: A abordagem cranio-orbito-zigomática (COZ) é descrita. para lesões localizadas no clivus superior, com e sem extensão ao seio cavernoso, e a abordagem petrosa posterior, usada para alcançar lesões no clivus médio com e sem extensão ao clivus superior ou inferior. Na abordagem COZ, o canal auditivo interno é uma extensão inferior. Conclusões: A remoção radical dos meningeomas (graus 1 e 2 da escala simpson) é bem estabelecida com o melhor tratamento. Abordagens à base do crânio são mais adequadas para a remoção radical de meningeomas petroclivais tumores moles como schawannomas trigemiais, cistos epidermóides ou meningeomas com extensão para a região petroclival, porém sem insersão, podem ser removidos pela abordagem retrosigmóidea.

Meningioma da região do forame magno / Foramen Magnum Meningiomas

Meningiomas do forame magno estão entre os tumores maisdifíceis de serem removidos. A abordagem cirúrgica, assimcomo a extensão da remoção óssea, são pontos de controvérsia.Neste trabalho os autores apresentam sua experiência com otratamento cirúrgico destes tumores, a forma de abordá-los,baseada na expansão tumoral e no local de origem são ospontos fundamentais que norteiam o planejamento cirúrgico. Asmanifestações clínicas, assim como a morbidade mais comumrelacionada com estes tumores serão apresentadas.

Primary melanoma of Meckel's cave: case report

Apresentamos um caso de neuralgia do trigêmeo com investigação radiológica de ressonância magnética (RM) e tomografia computadorizada apresentando resultado normal. A dor não apresentou alívio com carbamazepina, sendo indicado descompressão microvascular do trigêmio. Passados dois meses, o paciente queixava-se de dor com intensidade similar à do pré-operatório. Nova RM mostrou lesão expansiva no cavo de Meckel, a qual foi tratada cirurgicamente por abordagem extra-dural. O exame anatomopatológico foi compatível com melanoma primário. O seguimento radiológico, após seis meses da cirurgia, não apresentou anormalidades.

Trigeminal schwannoma. Classification and surgical approaches

This paper reviews and expands the Jefferson's Classification regarding the localization of trigeminal schwannomas. The authors present a series of specific surgical approaches best suited to remove these tumors. Using skull base neurosurgical techniques, the authors present the most direct, efficient and safety surgical approaches to remove each of five different types of trigeminal schwannomas. Three illustrative cases of their own are also presented.

Skull base chordomas

Chordomas are difficult and challenger tumors to treat. Despite of its pathological appearance that demonstrates an slow-growing behavior, their location and patterns of spread through the base of the skull make these tumors one of the most difficult diseases to treat at the base of the skull. The inadequate response to the conventional radiation therapy and the high incidence of recurrence, in cases treated with classical neurosurgical approaches, make mandatory a radical removal of the tumor mass and the surrounding pathological bone which can only be achieved with the use of skull base approaches associated with an extensive drilling of the bony tumor. In order to reach the goal of the surgical treatment of the skull base chordomas, the mastery of the skull base anatomy and the management of the drill are crucial points to obtain a successful results. In this report, we express our philosophy to treat these tumors which is based on the radical removal associated to a postoperative proton beam therapy. The main characteristic of the skull base chordomas is to spread through the base of the skull, which dictates the surgical approach that should be employed for each patient. In this article we will address the management of the skull base chordomas, with special emphasis to the role of the surgical and radiation treatment. The pathologic diagnosis and the radiological findings of chordomas of the skull base also will be discussed.