Microsurgical Resection of Giant Radio-Induced Cavernous Malformation: 2- Dimensional Video.

Radioinduced cavernous malformations (RICMs) are low-flow, angiographically occult vascular lesions. Giant radioinduced cavernous malformations (GRICMs) are a subtype of RICMs that are characterized by their large size. GRICMs are defined as RICMs that are larger than 3 cm in diameter.1 They are uncommon conditions accounting for 0.1% to 0.5% among patients who have received radiation therapy for head and neck cancer or brain tumors.2,3 The risk of developing GRICMs increases with the dose of radiation received and the length of time since radiation exposure.4 Other factors that may increase the risk of developing GRICMs include age, genetic predisposition, and underlying medical conditions.5 Due to the relatively low incidence of GRICMs and the limited number of studies on this condition, there are limited data about the management of this condition. This case report describes a 12-year-old female who was previously treated for a pilocytic astrocytoma in 2012. After undergoing stereotactic biopsy and whole-brain radiotherapy (50 gray in 28 sections), she was diagnosed with a radioinduced cavernous malformation in 2016 during follow-up imaging. The RICM was managed conservatively with imaging follow-up, which showed no increase in size between 2016 and 2019. However, in 2020, the patient experienced a seizure episode associated with left-sided hemiplegia. Further investigation with cranial magnetic resonance imaging and digital subtraction angiography showed a mixed-intensity image and surrounded by a low signal intensity rim on T2-weighted images, representing hemosiderin in the right central lobe, with intense perilesional edema, with no enhancement. Given the size and location of the mass, the patient underwent microsurgical resection of the RICM (Video 1). The surgery was successful, and the lesion was successfully resected. This case highlights the importance of careful monitoring for RICMs in patients who have received radiation therapy, as well as the potential for these lesions to cause significant symptoms and disability. The case also demonstrates that surgical intervention may be necessary in some cases to manage RICMs and that microsurgical resection can be an effective treatment option. The patient gave informed consent for surgery and video recording.

Are perceptions of climate change in Amazonian coastal communities influenced by socioeconomic and cultural factors?

Climate changes have become undisputed, as have their consequences for global ecosystems and mankind. The coastal areas are among the most affected areas on the planet due to their geographical location. The effects suffered by coastal areas can render the residing populations homeless, as well as compromise the continuity of the history and culture of these environments. The Marine Extractive Reserve of the city of Soure (coastal area of eastern Amazonia) stands out for housing populations that have developed an intimate relationship with nature and have knowledge that can explain people's perception of climate changes. In this context, this study investigated how local residents perceive climate change and its consequences considering different temporal and spatial scales. To this end, questionnaires were developed and applied using a 5-point Likert scale. Our results indicate that perception is shaped by socioeconomic and demographic factors, and that they are perceived on different time scales and geographic space. These findings reflect the awareness-raising efforts of the management body of this Conservation Unit and the local knowledge, derived from the relationship of the residents with the natural environment, which, together, provided the population with assertive information that favor a better understanding of this phenomenon.

Subcranial Approach: A Straightforward Approach to the Anterior Fossa Floor: 2-Dimensional Operative Video.

INDICATIONS CORRIDORS AND LIMITS OF EXPOSURE: Subcranial approach is a versatile keyhole approach mainly indicated to the tumors of the anterior fossa and midline invasive tumors from the nasal cavity and paranasal sinus. 1-5 Endoscopic endonasal video assistance enhances the exposure and the safety of the approach. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT: Preoperative images depicted the size of the frontal sinuses and the relations of the lesions with frontal, ethmoid, and orbits. ESSENTIAL STEPS OF THE PROCEDURE: After performing a bifrontal scalp flap and a pericranial flap, periorbits are dissected from the superior and medial orbital rims. After frontonasal osteotomy, we drill the posterior wall of the frontal sinus. PITFALLS/AVOIDANCE OF COMPLICATIONS: Avoiding disruption of the cantal ligaments prevents telecantus. Watertight closure of the dura with temporal fascia graft and reinforcement with the pericranial flap makes cerebrospinal fluid leak occurrence very rare. VARIANTS AND INDICATIONS FOR THEIR USE: Subcranial approach is our preferred approach for the tumors of the anterior fossa floor and the midline paranasal invasive tumors. This keyhole approach through a relatively small frontoethmoidal craniotomy combines the advantages of the regular craniotomies but with no manipulation of the frontal lobes. An advantageous inferior angle of view similar of the pure endonasal endoscopical approach is achieved, but better than in the pure endoscopical approaches, the subcranial approach allows a direct wider exposure and a superior watertight reconstruction of the anterior fossa floor.The patients consented to the procedure and to the publication of his/her image.

Local perceptions do not follow rainfall trends: A case study in traditional Marajo island communities (eastern para state, BR).

The great current challenge for the conservation and use of natural resources refers to global climate change, because of its impacts felt in different intensities at global, regional, and local spatial scales. Within the system of environmental protection areas in Brazil, the extractive reserves ensure the sustainable use of natural resources by traditional populations, thus maintaining the cultural and biological aspects of a region. Such populations, being in close management of the surrounding environments, tend to perceive changes in ecological processes that many need for their livelihoods. The use of this perception of local populations in conjunction with academic research evidence has a high potential to allow a whole and systemic view of possible changes in natural phenomena. This study developed an integrated analysis of scientific evidence and local perceptions to understand the variation of precipitation in a community inserted in an extractive reserve in the eastern Amazon. We used 30 years of precipitation data from the Brazilian National Institute of Meteorology - INMET, the Southern Oscillation Index - SOI, and the Atlantic Meridional Mode Index - AMM. Furthermore, we applied a form to measure the population's perception of possible changes in rainfall cycles in the region. The meteorological data indicate that the region of the community has been presenting a rainfall reduction; however, people in the community do not perceive this trend. Although it is public knowledge that the global climate is undergoing changes, a fact noted after the integrating analysis of scientific evidence with local knowledge in Resexmar Soure is that the perceptions of traditional populations often focus on smaller temporal and spatial scale visions.

The drift effect on nestedness of ephemeroptera, trichoptera and plecoptera orders in the Xingu River / O efeito da deriva no aninhamento das ordens ephemeroptera, trichoptera e plecoptera no Rio Xingu

Abstract The drift movement consists of the displacement of the organisms inside the water column which allows its passive locomotion. This movement will result in a variation of the communities of organisms along the river, generating spatial patterns. Based on this, we tested the hypotheses a) the drift of individuals in an upstream-downstream direction creates a nestedness pattern, when the upstream is a subset of downstream communities of aquatic insects; b) there will be an increase in the number of individuals and genera as we approach the most downstream point. The present study was carried out in seven sampling points distributed along the Xingu River. The sampling occurred at night in the central area of the river. The number of genera along the river remained constant, and the nestedness distribution of the communities in the upstream-downstream gradient was not observed. Based on the results, it is possible to visualize a turnover of genera in the longitudinal gradient of the river, but with an accumulation of genera in the downstream region. Organisms that are transported by the flow of the water current respond to the characteristics of the body of water by adapting to the type of environment in which they are found.

Resumo O movimento de deriva consiste no desprendimento dos organismos dentro da coluna de água, o que permite a sua locomoção passiva. Este movimento resultará numa variação das comunidades de organismos ao longo do rio, gerando padrões espaciais. Com base nisto, testamos as hipóteses a) o movimento de indivíduos em direção montante-jusante criará um padrão aninhado, no qual as comunidades de insetos aquáticos a montante são um subconjunto das comunidades a jusante; b) haverá um aumento no número de indivíduos e gêneros à medida que nos aproximamos do ponto mais a jusante. O presente estudo foi realizado em sete pontos de amostragem distribuídos ao longo do rio Xingu. A amostragem ocorreu durante a noite no canal central do rio. O número de gêneros ao longo do rio se manteve constante, e não observamos uma distribuição de aninhamento das comunidades no gradiente ascendente e descendente do rio. Com base nos resultados, é possível visualizar uma substituição dos gêneros no gradiente longitudinal do rio, porém ocorrendo um acúmulo de gêneros na região mais a jusante. Os organismos que são transportados pelo fluxo da corrente de água respondem as características do corpo de água adaptando-se ao tipo de ambiente em que se encontram.

Structuring functional groups of aquatic insects along the resistance/resilience axis when facing water flow changes.

Understanding how differences in intensity and frequency of hydrological disturbances affect the resistance and resilience of aquatic organisms is key to manage aquatic systems in a fast-changing world. Some aquatic insects have strategies that improve the permanence (resistance), while others use strategies that favor recolonization (resilience). Therefore, we carried out a manipulative experiment to understand the influence of functional characteristics of aquatic insects in their permanence and recolonization against hydrological disturbances in streams in the biodiversity hotspot of the Cerrado of Brazil. We placed 200 artificial substrates in five streams and submitted them to changing water flow regimes that differed both in frequency and intensity, and we observed the response of the aquatic community for 39 days. We used a hierarchical Bayesian approach to estimate the probabilities of permanence and recolonization of each life strategy group (nine groups). We observed that the most intense changes in the water flow tended to affect the permanence of almost all groups, but the intensity of this effect reduced over time. On the other hand, less frequent disturbances, regardless of intensity, tended to reduce the permanence of most groups of aquatic insects over time. The different effects of disturbance intensity may have been related to a greater recolonization capacity of some groups. The results we present are worrisome in a scenario of reduced riparian vegetation around streams and with the expectation of precipitation becoming more concentrated in shorter periods of time due to climate change in the Cerrado hotspot, reducing the occurrence of many groups of aquatic insects in their habitat, particularly those with traits associated with resistance against hydrological disturbance.

Predictive Biomathematical Modeling Compared to Objective Sleep During COVID-19 Humanitarian Flights.

BACKGROUND: Biomathematical modeling software like the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model and Fatigue Avoidance Scheduling Tool (FAST) help carriers predict fatigue risk for planned rosters. The ability of a biomathematical model to accurately estimate fatigue risk during unprecedented operations, such as COVID-19 humanitarian ultra-long-range flights, is unknown. Azul Cargo Express organized and conducted five separate humanitarian missions to China between May and July 2020. Prior to conducting the missions, a sleep-prediction algorithm (AutoSleep) within SAFTE-FAST was used to predict in-flight sleep duration and pilot effectiveness. Here we compare AutoSleep predictions against pilots' sleep diary and a sleep-tracking actigraphy device (Zulu watch, Institutes for Behavior Resources) from Azul's COVID-19 humanitarian missions.METHODS: Pilots wore Zulu watches throughout the mission period and reported sleep duration for their in-flight rest periods using a sleep diary. Agreement between AutoSleep, diary, and Zulu watch measures was compared using intraclass correlation coefficients (ICC). Goodness-of-fit between predicted effectiveness distribution between scenarios was evaluated using the R² statistic.RESULTS: A total of 20 (N = 20) pilots flying across 5 humanitarian missions provided sleep diary and actigraphy data. ICC and R² values were >0.90, indicating excellent agreement between sleep measures and predicted effectiveness distribution, respectively.DISCUSSION: Biomathematical predictions of in-flight sleep during unprecedented humanitarian missions were in agreement with actual sleep patterns during flights. These findings indicate that biomathematical models may retain accuracy even under extreme circumstances. Pilots may overestimate the amount of sleep that they receive during extreme flight-duty periods, which could constitute a fatigue risk.Devine JK, Garcia CR, Simoes AS, Guelere MR, de Godoy B, Silva DS, Pacheco PC, Choynowski J, Hursh SR. Predictive biomathematical modeling compared to objective sleep during COVID-19 humanitarian flights. Aerosp Med Hum Perform. 2022; 93(1):4-12.

Pilot Sleep Behavior across Time during Ultra-Long-Range Flights.

Fatigue risk to the pilot has been a deterrent for conducting direct flights longer than 12 h under normal conditions, but such flights were a necessity during the COVID-19 pandemic. Twenty (N = 20) pilots flying across five humanitarian missions between Brazil and China wore a sleep-tracking device (the Zulu watch), which has been validated for the estimation of sleep timing (sleep onset and offset), duration, efficiency, and sleep score (wake, interrupted, light, or deep Sleep) throughout the mission period. Pilots also reported sleep timing, duration, and subjective quality of their in-flight rest periods using a sleep diary. To our knowledge, this is the first report of commercial pilot sleep behavior during ultra-long-range operations under COVID-19 pandemic conditions. Moreover, these analyses provide an estimate of sleep score during in-flight sleep, which has not been reported previously in the literature.

Exotic species are perceived more than native ones in a megadiverse country as brazil.

Research on environmental perception is essential for the understanding of individuals' relations and expectations towards natural environments. Here, we evaluated the perception of high school students on exotic and native species in Brazil. We interviewed 371 students from two high schools located in the state of Goiás, one with and one without a protected area within its premises. Students needed to identify native and exotic species and to indicate species origin. We used a t-test to evaluate differences between students' scores regarding the correctness of species origin and also ANOVA to assess whether these scores varied among taxonomic groups. Students identified exotic species better than native ones. Students better identified exotic mammals, fishes, and birds than native ones. We found there were no significant relationships of students' knowledge of species' origins with socioecological factors. Students' perceptions of exotic and native species were low and focused on charismatic large-bodied species. We suggest that students are encouraged to expand their knowledge of local biodiversity. Teachers, local schools, and policymakers are essential to achieve this aim. A more diverse methodology for teaching, including new technologies and citizen-science projects, can help establish a genuine interest of local biodiversity students.

Reliability of foveal avascular zone measurements in eyes with retinal vein occlusion using optical coherence tomography angiography.

BACKGROUND: To evaluate the reliability of foveal avascular zone (FAZ) area measurements using optical coherence tomography angiography (OCTA) in eyes with retinal vein occlusion (RVO). METHODS: Twenty-five OCTA exams of patients with RVO were evaluated retrospectively. Three examiners performed manual measurements of the FAZ, and interrater and intrarater reliability were obtained. RESULTS: The intraclass correlation coefficient (ICC) for interrater reliability for individual measurements was 0.62 (moderate) with a 95% confidence interval (CI) of 0.40 to 0.79 (p < 0.001). The ICC (95% CI) for intrarater reliability was 0.92 (0.82 to 0.96) for rater A, 0.96 (0.91 to 0.98) for B, and 0.88 (0.76 to 0.94) for C (p < 0.001). In all subanalyses including presence of edema and type of occlusion, interrater reliability was poor/moderate, and intrarater reliability was good/excellent. CONCLUSION: The FAZ varies significantly among eyes with RVO, so measurements obtained using OCTA should be analyzed with caution due to the moderate level of reliability among different examiners.

Impact of manual correction over automated segmentation of spectral domain optical coherence tomography.

OBJECTIVE: To study the automated segmentation of retinal layers using spectral domain optical coherence tomography (OCT) and the impact of manual correction over segmentation mistakes. METHODS: This was a retrospective, cross-sectional, comparative study that compared the automated segmentation of macular thickness using Spectralis™ OCT technology (Heidelberg Engineering, Heidelberg, Germany) versus manual segmentation in eyes with no macular changes, macular cystoid edema (CME), and choroidal neovascularization (CNV). Automated segmentation of macular thickness was manually corrected by two independent examiners and reanalyzed by them together in case of disagreement. RESULTS: In total, 306 eyes of 254 consecutive patients were evaluated. No statistically significant differences were noted between automated and manual macular thickness measurements in patients with normal maculas, while a statistically significant difference was found in central thickness in patients with CNV and with CME. Segmentation mistakes in macular OCTs were present in 5.3% (5 of 95) in the normal macula group, 16.4% (23 of 140) in the CME group, and 66.2% (47 of 71) in CNV group. The difference between automated and manual macular thickness was higher than 10% in 1.4% (2 of 140) in the CME group and in 28.17% (20 of 71) in the CNV group. Only one case in the normal group had a higher than 10% segmentation error (1 of 95). CONCLUSION: The evaluation of automated segmented OCT images revealed appropriate delimitation of macular thickness in patients with no macular changes or with CME, since the frequency and magnitude of the segmentation mistakes had low impact over clinical evaluation of the images. Conversely, automated macular thickness segmentation in patients with CNV showed a high frequency and magnitude of mistakes, with potential impact on clinical analysis.

Anthropogenic litter on Brazilian beaches: Baseline, trends and recommendations for future approaches.

Beaches are fundamental habitats that regulate the functioning of several coastal processes and key areas contributing to national and local budgets. In this study we provide the first large-scale systematic survey of anthropogenic litter on Brazilian beaches, covering a total of 35 degrees of latitude, recording the litter type, its use and size. Plastic comprised the most abundant litter type, followed by cigarette butts and paper. Small pieces (<5 cm) were dominant among litter size-classes and food-related use was associated to most litter recorded types. Generalized additive models showed that proximity to estuarine run-offs was the main driver to beach litter accumulation, reinforcing river drainages as the primary route of litter coastal pollution. Also, the Clean-Coast Index evidenced there was not a pattern of beach litter pollution among regions, which denotes that actions regarding marine pollution must be taken by all state governances of the country.

Microperimetry and OCT angiography evaluation of patients with ischemic diabetic macular edema treated with monthly intravitreal bevacizumab: a pilot study.

BACKGROUND: Functional and anatomical evaluation of patients with ischemic diabetic macular edema after monthly injections of Bevacizumab. METHODS: Five eyes from five patients with diabetic macular edema associated with macular ischemia in fluorescein angiography (FA), received 6 monthly intravitreal injections of Bevacizumab. All subjects underwent SD-OCT, FA, OCT angiography (OCTA) and microperimetry at baseline and after 6 months follow-up. Primary outcome measures were improvement of best corrected visual acuity (BCVA), microperimetry and assessment of macular perfusion (foveal avascular zone size and capillary loss). RESULTS: Five patients completed the follow-up. BCVA improved from 20/180 to 20/74 (p = 0.01) and macular sensitivity improved from 11.66 to 16.26 dB (p < 0.007). We also observed that areas of ischemia on OCTA represented areas of lower macular sensitivity on microperimetry. No changes in macular perfusion status were noted. CONCLUSIONS: Monthly intravitreal Bevacizumab in patients with ischemic diabetic macular edema improved BCVA and macular sensitivity without compromise of perfusion in the macula. Capillary dropout areas in OCTA correlated with lower retinal sensitivity on microperimetry.

Expanded Endonasal Endoscopic Surgery in Suprasellar Craniopharyngiomas: A Retrospective Analysis of 43 Surgeries Including Recurrent Cases.

BACKGROUND: The role of expanded endonasal endoscopic surgery for primary and recurrent craniopharyngioma is not yet fully established. OBJECTIVE: To report and evaluate our experience with the endoscopic endonasal approach (EEA) for the resection of primary and recurrent craniopharyngiomas. METHODS: This is a retrospective cohort analysis of 43 consecutive EEA procedures in 40 patients operated from September 2006 to February 2012 for suprasellar craniopharyngiomas. In 21 patients (48.8%) the disease was recurrent. We have assessed the surgical results, visual, endocrinological, and functional outcomes and resection rates in this patient cohort. RESULTS: At presentation, 31 (72.1%) patients had visual deficits, 15 patients (34.9%) complained of headaches, 25 patients (58.1%) had anterior pituitary insufficiency, and 14 (32.5%) had diabetes insipidus. Total resection was achieved in 44.2% surgeries, of which 77.3% were in primary lesions and 9.5% in recurrent lesions (P < .001). Vision improved in 92.6% patients and worsened in 2.3%. Complications other than vision were encountered in 25.6% including 9/43 cerebrospinal fluid leak, 2/43 meningitis. A total of 51.9% of patients with preoperative residual anterior pituitary function had new anterior pituitary deficiencies and 42.8% had new diabetes insipidus. There was no mortality. Six patients (14%) had recurrence of disease during the follow-up period (mean 56.8 mo), 5 of which required repeat surgery. CONCLUSION: The EEA can be integrated in the overall management of both primary and recurrent craniopharyngiomas with good results; however, in our series recurrent surgery was associated with significantly lower rates of gross total resection.

Exploratory Analysis into Reasonable Timeframes for the Provision of Neurosurgical Care in Low- and Middle-Income Countries.

BACKGROUND: In low- and middle-income countries (LMICs), 11.8% of the need for neurosurgical care is met. Delays in seeking and receiving care may further exacerbate this situation. Objective analysis of delay and its consequences is contingent on reference to established resource-appropriate acceptable timeframes. This study sought to 1) establish an estimate of the landscape of care provided in LMICs and 2) explore reasonable timeframes for various stages of patient-health care interaction. METHODS: Consensus input from neurosurgeons in select LMICs was collected; 1 high-income country was included for comparison. In phase 1, participants were asked to select neurosurgical procedures performed at their centers. In phase 2, based on procedures shared among all LMICs, representative case scenarios were generated and participants provided input on acceptable timeframes for each stage of patient-health care interaction: 1) presentation to health services, 2) diagnosis by primary care physician, 3) referral to neurosurgical specialist care, and 4) definitive neurosurgical management. RESULTS: Twenty neurosurgeons across 18 centers were identified; 12 participated in phase 1 and 7 in phase 2. The range of procedures offered was broad, similar in scope to high-income countries, and included pediatric and adult neurosurgery, trauma, degenerative spine, and hemorrhagic stroke. Acceptable timeframes had wide ranges in certain cases; however, the overall trend showed agreement between the participants. CONCLUSIONS: This exploratory analysis identified reasonable timeframes for the provision of neurosurgical care in LMICs. If validated, these data can be used to more objectively assess the prevalence of delay in neurosurgical care in individual LMICs, along with its consequences.

When phylogeny and ecology meet: Modeling the occurrence of Trichoptera with environmental and phylogenetic data.

Ecological studies are increasingly considering phylogenetic relationships among species. The phylogeny is used as a proxy or filter to improve statistical tests and retain evolutionary elements, such as niche conservation. We used the phylogenetic topology to improve the model for occurrence of Trichoptera genera in Cerrado (Brazilian Savanna) streams. We tested whether parameters generated by logistic models of occurrence, using phylogenetic signals, are better than models generated without phylogenetic information. We used a model with Bayesian updating to examine the influence of stream water pH and phylogenetic relationship among genera on the occurrence of Trichoptera genera. Then, we compared this model with the logistic model for each Trichoptera genus. The probability of occurrence of most genera increased with water pH, and the phylogeny-based explicit logistic model improved the parameters estimated for observed genera. The inferred relationship between genera occurrence and stream pH improved, indicating that phylogeny adds relevant information when estimating ecological responses of organisms. Water with elevated acidity (low pH values) may be restrictive for the occurrence of Trichoptera larvae, especially if the regional streams exhibit neutral to alkaline water, as is observed in the Cerrado region. Using phylogeny-based modeling to predict species occurrence is a prominent opportunity to extend our current statistical framework based on environmental conditions, as it enables a more precise estimation of ecological parameters.

Collaborative research and the hunting in the Brazilian Cerrado: The case of Xerente Indigenous Land / Pesquisa Colaborativa e a Caça no Cerrado Brasileiro: O caso da Terra Indígena Xerente

Abstract: This paper presents a study of the hunting activities on Xerente Indigenous Land (XIL) in the Brazilian Cerrado. We used data from a Hunting Monitoring Program from eight villages to evaluate the effects of village age, distance from village to town and season (wet and dry) on the composition of hunted species, animals and biomass killed and availability of preferred game-species. We also assessed for any indication of fauna depletion around the villages. Distance from village to town and season were the only variables which affected composition. Preferred species occured more often in villages closer to the town. However, these villages present strong indications of local game-species depletion. The hunters' great capacity for spatial movement can eliminate this effect. Animals and biomass killed was high in the dry season. Game-species composition between seasons can avoid the overexploitation of some sensitive species, such as low-land tapir. These results are important in the design of local management and conservation plans. Our results also contribute to further understanding the impacts of hunting in open Neotropical environments.

Resumo: Este artigo apresenta um estudo sobre a atividade de caça na Terra Indígena Xerente (TIX), Cerrado brasileiro. Utilizamos dados do Programa de Monitoramento de Caça em oito aldeias para avaliar os efeitos da idade da aldeia, a distância da aldeia para cidade e a estação (úmida e seca) sobre a composição de espécies caçadas, animais e biomassa abatidos e a disponibilidade de espécies preferidas para o consumo. Também avaliamos a indicação de depleção da fauna ao redor das aldeias. Distância da aldeia para a cidade e estação foram as únicas variáveis que afetaram a composição das espécies. Espécies preferidas ocorreram mais frequentemente em aldeias mais próximas à cidade. No entanto, essas aldeias apresentam fortes indicativos de depleção local das espécies. Entretanto, a grande capacidade de locomoção dos caçadores pode eliminar esse efeito. Animais e biomassa abatidos foram maiores durante a estação seca. A composição das espécies cinegéticas entre as estações pode evitar a exploração excessiva de algumas espécies sensíveis, como a anta. Esses resultados são importantes na elaboração de planos locais de manejo e conservação. Nossos resultados também contribuem para o melhor entendimento dos impactos da caça em ambientes neotropicais abertos.

From craniofacial resection to endonasal endoscopic removal of malignant tumors of the anterior skull base.

OBJECTIVE: To review the current literature and provide our institutional approach and opinion on the indications and limitations of traditional open craniofacial resection (CFR) and a minimally invasive pure endonasal endoscopic approach for anterior skull base tumors concentrating primarily on malignant lesions. METHODS: Based on 3 decades of experience with both open and more recently endoscopic techniques, we examined our current practice in treating tumors and other lesions involving the skull base and our current indications and limitations in the use of these techniques. We conducted a retrospective chart analysis to see which operative techniques were used for malignant tumors of the anterior skull base in the last 10 years at our institution. RESULTS: There were 30 cases identified. Traditional CFR was performed in 16, a pure endoscopic resection was performed in 9, and an endoscopic procedure combined with a frontal craniotomy was performed in 5. Gross total resection was achieved in 83.3% in the CFR group and 75% in the pure endoscopic resection group. Near-total resection was 10% in the CFR group and 33.3% in pure endoscopic resection group. Of the 5 patients who underwent a combined approach, 80% had gross total resection, and 20% had near-total resection. CONCLUSIONS: Both traditional CFR and the endonasal endoscopic approach offer advantages and disadvantages. Both approaches can achieve good results with appropriate patient selection. Numerous important factors, including location and the extent of tumor, should be taken into consideration when considering either approach. The most important determinant of outcome is the ability to achieve gross total resection with microscopic negative margins rather than the type of approach used. In the future, skull base surgeons will need to be familiar with and capable of offering both techniques to the patient.

A interação da Ortodontia com a Cirurgia de Reconstrução, Implantologia e Prótese em um tratamento complexo na região anterior / The interaction of Orthodontics with Reconstruction Surgery, Implantology and Prosthodontics in a complex treatment in the anterior region

A atuação multidisciplinar é a melhor maneira de trazer ao paciente a proposta de um tratamento odontológico de excelência. Não raramente, nos deparamos com situações em que a prática dessa Odontologia em conjunto é o grande diferencial para a finalização do caso clínico. O entrosamento da equipe e o conhecimento desses profissionais sobre as áreas afins faz com que a condução do tratamento seja feita de forma prática e no menor tempo possível, evitando manobras desnecessárias. O presente estudo tem o intuito de abordar essa prática, por meio da exposição de um caso clínico complexo com extrusão ortodôntica, onde todas as especialidades envolvidas foram fundamentais.

Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection.

UNLABELLED: OBJECT.: While the use of endoscopic approaches has become increasingly accepted in the resection of pituitary adenomas, limited evidence exists regarding the success of this technique for patients with large and giant pituitary adenomas. This study reviews the outcomes of a large cohort of patients with large and giant pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery at the authors' institution and focuses on identifying factors that can predict extent of resection and hence aid in developing guidelines and indications for the use of endoscopic endonasal transsphenoidal surgery versus open craniotomy approaches to large and giant pituitary adenomas. METHODS: The authors reviewed 487 patients who underwent endoscopic endonasal transsphenoidal resection of sellar masses. From this group, 73 consecutive patients with large and giant pituitary adenomas (defined as maximum diameter ≥ 3 cm and tumor volume ≥ 10 cm(3)) who underwent endoscopic endonasal transsphenoidal surgery between January 1, 2006, and June 6, 2012, were included in the study. Clinical presentation, radiological studies, laboratory investigations, tumor pathology data, clinical outcomes, extent of resection measured by volumetric analysis, and complications were analyzed. RESULTS: The mean preoperative tumor diameter in this series was 4.1 cm and the volume was 18 cm(3). The average resection rate was 82.9%, corresponding with a mean residual volume of 3 cm(3). Gross-total resection was achieved in 16 patients (24%), near-total in 11 (17%), subtotal in 24 (36%), and partial in 15 (23%). Seventy-three percent of patients experienced improvement in visual acuity, while 24% were unchanged. Visual fields were improved in 61.8% and unchanged in 5.5%. Overall, 27 patients (37%) experienced a total of 32 complications. The most common complications were sinusitis (14%) and CSF leak (10%). Six patients underwent subsequent radiation therapy because of aggressive tumor histopathology. No deaths occurred in this cohort of patients. Statistically significant predictors of extent of resection included highest Knosp grade (p = 0.001), preoperative tumor volume (p = 0.025), preoperative maximum tumor diameter (p = 0.002), hemorrhagic component (p = 0.027), posterior extension (p = 0.001), and sphenoid sinus invasion (p = 0.005). CONCLUSIONS: Endoscopic endonasal transsphenoidal surgery is an effective treatment method for patients with large and giant pituitary adenomas, which results in high (> 80%) rates of resection and improvement in visual function. It is not associated with high rates of major complications and is safe when performed by experienced surgeons. The preoperative Knosp grade, tumor volume, tumor diameter, hemorrhagic components on MRI, posterior extension, and sphenoid sinus invasion may allow a prediction of extent of resection and in these patients a staged operation may be required to maximize extent of resection.