[Technical aspects of intracranial pressure monitoring by subarachnoid method in severe head injury]. / Aspectos técnicos da monitorização da pressão intracraniana pelo método subaracnóideo no traumatismo craniencefálico grave.

Two hundred and six patients with severe head injury (Glasgow Coma Scale of 8 points or less after nonsurgical resuscitation on admission), managed at Intensive Care Unit-Hospital das Clínicas - Universidade Estadual de Campinas were prospectively analysed. All patients were assessed by CT scan and 72 required neurosurgical intervention. All patients were continuously monitored to evaluate intracranial pressure (ICP) levels by a subarachnoid device (11 with subarachnoid metallic bolts and 195 with subarachnoid polyvinyl catheters). The ICP levels were continuously observed in the bedside pressure monitor display and their end-hour values were recorded in a standard chart. The patients were managed according to a standard protocol guided by the ICP levels. There were no intracranial haemorrhagic complications or hematomas due the monitoring method. Sixty six patients were punctured by lateral C1-C2 technique to assess infectious complications and 2 had positive cerebrospinal fluid samples for Acinetobacter sp. The final results measured at hospital discharge showed 75 deaths (36,40%) and 131 (63,60%) survivors. ICP levels had significantly influenced the final results (p<0,001). The subarachnoid method to continuously assess the ICP levels was considered applicable, safe, simple, low cost and useful to advise the management of the patients. The ICP record methodology was practical and useful. Despite the current technical advances the subarachnoid method was considered viable to assess the ICP levels in severe head injury.

[Spontaneous epidural hematoma. Report of two cases]. / Hematoma epidural espontâneo. Relato de dois casos.

Spontaneous epidural hematomas are rarely described in literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura-mater and metastasis to the skull. The authors report two cases of spontaneous epidural hematoma of different etiologies, and study parameters of hemostasis.

A study on hemostasis parameters in the neurosurgery of cerebral aneurysms.

BACKGROUND: This prospective study was accomplished with 14 patients, 10 women and 4 men, where some pre-, intra- and immediate postoperative parameters of hemostasis were analyzed and compared to a control group of normal individuals. METHODS: The patients included in this study were admitted to the Hospital das Clinicas at Unicamp in the 1990-1993 period. All the accepted patients have had their latest bleeding at least 30 days before surgery, therefore, after the acute bleeding phase, because in this phase there are alterations in hemostasis. In this period only dipyrone was used in all patients as analgesics and antipyretics. Opiates were used in all the anesthetic proceedings. The following parameters were determined: coagulation; prothrombin time, (PT), thrombin time, (TT), activated partial thromboplastin time, (APTT), platelets (PQ), fibrinogen, (FG) factor V, (F V), protein C, (P C), protein S (PS), antithrombin III (AT III); fibrinolysis, plasminogen (PLG), C 1 inhibitor (C 1), alfa 2 macroglobulin (A2M), prekallikrein (PK), euglobulin lysis time (ELT), lysis area in fibrin plates (LAFP), in 5 of these 14 patients. Activity of both plasminogen tissue activator (t-PA) and plasminogen activator inhibitor (PAI-1) were also determined. For analyze the hepatic function pre-albumin (PRE ALB) was determined. RESULTS AND CONCLUSIONS: In this study, the analysis of LAFP and ELT in the different surgical times suggests that the patients submitted to cerebral aneurysm surgery are head to hypofibrinolysis from the intraoperative to the immediate postoperative period and this evidence do not related whit PAI-1.

The predictive value of cerebrospinal fluid tap-test in normal pressure hydrocephalus.

Eighteen patients (mean age of 66.5 years) with normal pressure hydrocephalus (NPH) underwent a ventriculo-peritoneal shunt surgery. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of gait pattern and psychometric functions (memory, visuo-motor speed and visuo-constructive skills) before and after the removal of 50 ml CSF by lumbar puncture (LP). Fifteen patients improved and 3 were unchanged after surgery. Short duration of disease, gait disturbance preceding mental deterioration, wide temporal horns and small sulci on CT-scan were associated with good outcome after shunting. There was a good correlation between the results of CSF-TT and shunt surgery (chi 2 = 4.11, phi = 0.48, p < 0.05), with gait test showing highest correlation (r = 0.99, p = 0.01). In conclusion, this version of CSF-TT proved to be an effective test to predict improvement after shunting in patients with NPH.

[Clinical correlations of vascular spasms in the surgery of aneurysms]. / Klinische Wechselbeziehung der Gefässspasmen in der Chirurgie der Aneurysmen.

62 patients with SHA were treated in the Hospital of the UNICAMP during 1984/85; all were diagnosticated with CT and/or angiography. Only 52 patients were submitted to surgery. Out of these, only 18 patients (35%) presented VS preoperatively. Until the 6th day after beginning of the hemorrhage, 34 patients non presenting VS were operated, 7 (20%) of these suffered clinical deterioration after surgery. The mortality rate lies by 23% (12 patients), 41% of them (5 patients) presented) VS preoperatively. Of the 10 patients non operated 3 died.

Cisto cerebral gigante na neurocisticercose. / Giant cerebral cyst in cysticercosis

Sao apresentados 4 casos da forma tumoral de neurocisticercose com cistos cerebrais gigantes, de localizacao supratentorial em 3 e infratentorial em um. Em 2 pacientes a sindrome predominante era de hipertensao intracraniana, ocorrendo nos outros 2 sinais focais deficitarios, num deles con instalacao aguda.A tomografia computadorizada cerebral revelou, em um dos pacientes lesao cistica unica supratentorial, levando a diagnostico diferencial com varias outras patologias. O resultado cirurgico obtido foi bom, sugerindo-se a indicacao desse procedimento para diagnostico e tratamento das lesoes cisticas extensas

[Contribution of computerized tomography to the diagnosis and postoperative study of sellar tumors]. / Contribuição da tomografia computadorizada no diagnóstico e no estudo pós-operatório dos tumores selares.

The computerized tomography (C.T.) of 18 patients with sellar tumours were analysed. The C.T. made before surgery in 6 cases was positive in 3 and the type of tumour suggested by C.T. was confirmed in 3. Twelve patients had a C.T. investigation after surgery and the examination suggest recurrent tumour in 5. Two of these were re-operated. One patients with cholesteatoma had the recurrent tumour verified by surgery and the other, with a pituitary adenoma during re-operation was noted only cicatricial tissue at sellar region.

[Intracerebral hematoma in metastatic tumors: report of 11 cases]. / Hematomas intracerebrais em tumores metastaticos: registro de 11 casos.

Spontaneous intracerebral haematoma caused by metastatic neoplasms are reported in 11 patients, 8 males and 3 females, with age between 19 and 74 years. We had 7 melanomas, 3 carcinomas and one choriocarcinoma. The presenting symptoms were those of classical spontaneous intracerebral hemorrhage with a history of sudden headache, coma or stupor, hemiparesis or hemiplegia or other focal signal, and bloody cerebrospinal fluid. Three patients presented more than one hemorrhagic episodes. In four cases the computerized tomography revealed multiple lesions. Seven patients were operated by large craniotomy with evacuation of the hematoma and in one a cerebral biopsy revealed a melanoma and in the other six a large tumoral mass was removed. The average survival was 39 days.

Hematomas intracerebrais em tumores metastaticos: registro de 11 casos. / Intracerebral hemorrhage hematoma in metastatic tumors: report of 11 cases

Sao apresentados 11 casos de hemorragias intracerebrais provocadas por tumores metastaticos. O exame histologico revelou 7 melanomas, 3 carcinomas e um corioptelioma. Em todos os pacientes o quadro clinico teve inicio subito sem sintomas previos de hipertensao intracraniana. Tres pacientes tiveram mais de um surto de hemorragia e em 4 casos a tomografia computadorizada revelou lesoes multiplas. Sete pacientes foram operados com exposicao ampla do hematoma. Em um deles foi feita biopsia da regiao do sangramento, sendo encontrado um melanoma; nos 6 restantes foi identificada massa tumoral volumosa que foi retirada. A sobrevida variou de 6 dias a 5 meses estando 3 pacientes ainda vivos

Contribuicao da tomografia computadorizada no diagnostico e no estudo pos-operatorio dos tumores selares. / Computerized tomography in the diagnosis and postoperative study of sellar tumors

E analisada casuistica de 18 pacientes com tumores na regiao selar com o uso da tomografia computadorizada (T.C.). Em 6 deles o exame foi feito antes da cirurgia e confirmou a neoplasia em 5, sendo que a natureza do tumor foi sugerida corretamente em 3 casos. Para 12 doentes a T.C. foi feita para estudo tardio do resultado cirurgico. Resultou normal em 5 casos, mostrou a existencia de um cisto supra-selar em 1, dilatacao ventricular em outro e sugeriu recidiva nos 5 restantes. Dos 5 pacientes em que a T.C. sugeriu recidiva, dois foram reoperados. Em um paciente com colesteatoma a cirurgia confirmou a recidiva e para o outro, com adenoma cromofobo a reoperacao mostrou apenas tecido cicatricial e aderencias na regiao selar

Massive spinal cord necrosis in schistosomiasis.

Spinal cord lesions are rare in schistosomiasis. Schistosomal ova usually elicit a granulomatous myelitis in which necrotic foci are sometimes observed, but necrotic foci are sometimes observed, but extensive cord necrosis is exceptional. A 19-year-old Brazilian woman had transverse myelitis that ended fatally one month and a half thereafter. Autopsy disclosed a total myelonecrosis below T-4, and ova at Schistosoma mansoni were demonstrated in the necrotic cord tissue and leptomeniges. This is, to our knowledge, the most extensive necrosis of the spinal cord reported to date in schistosomiasis.

[Frontal astrocytoma with spinal cord metastasis. Report of a case and review of the literature]. / Astrocitoma frontal com metástase medular. Registro de um caso e revisão da literatura.

A case of a right frontal astrocytoma with spinal metastatic lesion in the region of the third dorsal vertebra is reported. The metastatic nodule was removed six months after the craniotomy. In the literature concerning to the dissemination of tumors cells is suggested that there is not a causal relationship between CSF seeding and operative intervention. Access to the ventricular system or basal cisterns is of primary importance in the production of metastases.

[Inflammatory chronic processes of the central nervous system. Neurosurgical aspects]. / Processos inflamatorios cronicos do sistema nervoso central. Aspectos neurocirurgicos

A study into the neurosurgical approach to thirty-five patients with increased intracranial pressure due to inflamatory diseases affecting the central nervous system and meninges is reported. The entitites under consideration were found to have similar surgical aspects despite the heterogeneity of etiologic agents. As regards the surgical treatment, two groups of cases were recognized. Group 1 comprises 7 patientes with symptoms of a space-occupying lesion; in these patients craniotomies were performed with good results. Group 2 included the remainder 28 cases with acquired hydrocephalus. In this group differents methods for ventricular drainage were used, but ventriculo-auriculostomy and specially ventriculo-peritoneal shunts proved to give more gratifying results. Chemotherapy was administred when the etiologic agent was disclosed. Corticosteroids were institued to reduce inflammatory reations and cerebral edema. A review of the literature supported the practical classification and surgical techniques employed.

Pituitary carcinoma with liver metastases and Cushing syndrome. Report of a case.

A 38-year-old woman complained of headache, visual impairment, and diabetes insipidus for 18 months prior to rapid onset of Cushing syndrome and amenorrhea. An autopsy disclosed a pituitary carchinoma invading the right cavernous sinus and two liver metastases. The tumor cells were chromophobic and agranular, with scarce polymorphism and rare mitoses. A review of the literature showed that the association of Cushing syndrome to pituitary carcinomas increases in direct proportion to the occurence of metastases. Such association was noted in almost half of the reported cases of pituitary carcinomas with extracranial dissemination.