Modified Trans-Sinusal Transglabellar Approach for Anterior Cranial Fossa Meningiomas: Technical Note and Literature Review.

Introduction Currently, skull base surgery faces the dilemma of achieving the maximum possible tumor resection through less aggressive approaches and with minimal retraction of brain tissue. The objective of this work is to report a minimally invasive step-by-step approach to anterior cranial fossa tumors and to perform a literature review. Methods In our work, we describe a step-by-step approach, with images, which is a variation of the transglabellar approach. Results In all cases, we achieved maximum total resection of the lesion. There were no postoperative complications related to the surgery. In one case, we used the access to remove a foreign body in the frontal lobe. Conclusion The frontal trans-sinusal transglabellar access allows direct access to anterior cranial fossa tumors and other frontal lobe lesions close to the floor of the anterior fossa, without the need for brain retraction, allowing early devascularization of the tumor. However, this access is not recommended for all types of tumors, and is being improved for more anteriorly located lesions.

Subarachnoid hemorrhage and COVID-19: Association or coincidence?

ABSTRACT: Some evidences suggest the involvement of the central nervous system in patients infected with SARS-CoV-2. We aim to analyze possible associations between coronavirus disease 2019 (COVID-19) pandemic and spontaneous subarachnoid hemorrhage (SAH), in a comprehensive neurological center.We conducted a retrospective case series of 4 patients infected by COVID-19, who developed spontaneous SAH. Clinical data were extracted from electronic medical records.Between March 24, 2020, and May 22, 2020, 4 cases (3 females; 1 male) of SAH were identified in patients infected with SARS-CoV-2, in a comprehensive neurological center in Brazil. The median age was 55.25 years (range 36 -71). COVID-19-related pneumonia was severe in 3 out of 4 cases, and all patients required critical care support during hospitalization. The patients developed Fisher grade III and IV SAH. Digital subtraction angiography (DSA) was performed in 3 of the 4 patients. However, in only 1 case, an aneurysm was identified. Inflammatory blood tests were elevated in all cases, with an average D-dimer of 2336 µg/L and mean C-reactive protein (CRP) of 3835 mg/dl The outcome was poor in the majority of the patients, with 1 death (25%); 2 (50%) remained severely neurologically affected (mRS:4); and 1 (25%) had slight disability (mRS:2).This study shows a series of 4 rare cases of SHA associated with COVID-19. The possible mechanisms underlying the involvement of SARSCoV-2 and SHA is yet to be fully understood. Therefore, SHA should be included in severe neurological manifestations in patients infected by this virus.

Hemotransfusion and mechanical ventilation time are associated with intra-hospital mortality in patients with traumatic brain injury admitted to intensive care unit.

OBJECTIVE: To identify the factors associated with the intra-hospital mortality in patients with traumatic brain injury (TBI) admitted to intensive care unit (ICU). METHODS: The sample included patients with TBI admitted to the ICU consecutively in a period of one year. It was defined as variables the epidemiological characteristics, factors associated with trauma and variables arising from clinical management in the ICU. RESULTS: The sample included 87 TBI patients with a mean age of 28.93 ± 12.72 years, predominantly male (88.5%). The intra-hospital mortality rate was of 33.33%. The initial univariate analysis showed a significant correlation of intra-hospital death and the following variables: the reported use of alcohol (p = 0.016), hemotransfusion during hospitalization (p = 0.036), and mechanical ventilation time (p = 0.002). CONCLUSION: After multivariate analysis, the factors associated with intra-hospital mortality in TBI patients admitted to the intensive care unit were the administration of hemocomponents and mechanical ventilation time.

Hemotransfusion and mechanical ventilation time are associated with intra-hospital mortality in patients with traumatic brain injury admitted to intensive care unit / Hemotransfusão e tempo de ventilação mecânica estão associados à mortalidade intra-hospitalar em pacientes com lesão cerebral traumática, internados em unidade de terapia intensiva

ABSTRACT Objective To identify the factors associated with the intra-hospital mortality in patients with traumatic brain injury (TBI) admitted to intensive care unit (ICU). Methods The sample included patients with TBI admitted to the ICU consecutively in a period of one year. It was defined as variables the epidemiological characteristics, factors associated with trauma and variables arising from clinical management in the ICU. Results The sample included 87 TBI patients with a mean age of 28.93 ± 12.72 years, predominantly male (88.5%). The intra-hospital mortality rate was of 33.33%. The initial univariate analysis showed a significant correlation of intra-hospital death and the following variables: the reported use of alcohol (p = 0.016), hemotransfusion during hospitalization (p = 0.036), and mechanical ventilation time (p = 0.002). Conclusion After multivariate analysis, the factors associated with intra-hospital mortality in TBI patients admitted to the intensive care unit were the administration of hemocomponents and mechanical ventilation time.

RESUMO Objetivo Identificar os fatores associados à mortalidade intra-hospitalar em pacientes com TCE internados em unidade de terapia intensiva (UTI). Métodos A amostra incluiu pacientes com TCE internados na UTI em um período de um ano. Foi definido como variáveis as características epidemiológicas, os fatores associados ao trauma e variáveis decorrentes dos cuidados clínicos na UTI. Resultados A amostra incluiu 87 pacientes com TCE, com idade média de 28,93 ± 12,72 anos, predominantemente do sexo masculino (88,5%). A taxa de mortalidade intra-hospitalar foi de 33,33%. A análise univariada inicial mostrou uma correlação significativa de morte intra-hospitalar e as seguintes variáveis: relato de uso de álcool (p = 0,016), hemotransfusão durante a internação (p = 0,036) e tempo de ventilação mecânica (p = 0,002). Conclusão Após análise multivariada, os fatores associados à mortalidade intra-hospitalar em pacientes com TCE internados na unidade de cuidados intensivos foram a administração de hemocomponentes e tempo de ventilação mecânica.

Cervical Internal Carotid Artery Saccular Aneurysm Manifesting with Progressive Dysphonia / Aneurisma sacular da artéria carótida interna cervical manifestando-se por disfonia progressiva

Aneurysm of the cervical internal carotid artery is a rare condition, which can trigger severe neurologic complications. The authors report a case of a female patient of 54 years, presenting as a progressive dysphonia, which revealed it to be an aneurysmof the extracranial portion of the internal carotid artery. Endovascular treatment was used.

Aneurisma da artéria carótida interna cervical é uma patologia infrequente, podendo desencadear severas complicações neurológicas. Os autores relatam o caso de uma paciente feminina de 54 anos, apresentando-se por disfonia progressiva, que revelou tratar-se de um aneurisma da porção extracraniana da artéria carótida interna, tendo sido empregado o tratamento endovascular.