Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury.

BACKGROUND: Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. METHODS: A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. RESULTS: Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). CONCLUSIONS: Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury / Análise dos custos diretos da craniectomia descompressiva em vítimas de traumatismo cranioencefálico

ABSTRACT Background: Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. Methods: A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. Results: Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). Conclusions: Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

RESUMO Introdução: A craniectomia descompressiva (CD) é procedimento necessário em alguns casos de trauma cranioencefálico (TCE). Este manuscrito objetiva avaliar os custos diretos e desfechos da CD no TCE em um país em desenvolvimento e descrever o perfil epidemiológico. Métodos: Estudo retrospectivo foi realizado usando banco de dados neurocirúrgico de cinco anos, considerando amostra de pacientes com TCE que realizaram CD. Algumas variáveis foram analisadas e foi desenvolvida uma fórmula para cálculo do custo total. Resultados: A maioria dos pacientes teve múltiplas lesões intracranianas, sendo que 69.0% evoluíram com algum tipo de complicação infecciosa. A taxa de mortalidade foi de 68,8%. O custo total foi R$ 2.116.960,22 (US$ 653,216.00) e o custo médio por paciente foi R$ 66.155,00 (US$ 20,415.00). Conclusões: CD no TCE é um procedimento caro e associado á alta morbidade e mortalidade. Este foi o primeiro estudo realizado em um país em desenvolvimento com o objetivo de avaliar os custos diretos. Medidas de prevenção devem ser priorizadas.

Retroauricular pain caused by Eagle syndrome: A rare presentation due to compression by styloid process elongation.

Eagle syndrome is a rare condition presenting with retroauricular pain (usually as main symptom) associated with dysphagia, headache, neck pain on rotation and, much rarelier, stroke. This occurs due to styloid process elongation. Sometimes, there is also styloid ligament calcification, which can cause compression of nerves and arteries and the symptoms above. Treatment can be conservative with pain modulators (e.g. pregabalin) or infiltrations (steroids or anesthetics drugs). In refractory cases, surgical approach aiming to reduce the size of the styloid process can be performed. We present a rare case of Eagle syndrome (documented by computed tomography) with good response to clinical treatment.

Retroauricular pain caused by Eagle syndrome: A rare presentation due to compression by styloid process elongation / Dor retroauricular causada pela síndrome de Eagle: uma apresentação rara por compressão pelo alongamento do processo estiloide

Summary Eagle syndrome is a rare condition presenting with retroauricular pain (usually as main symptom) associated with dysphagia, headache, neck pain on rotation and, much rarelier, stroke. This occurs due to styloid process elongation. Sometimes, there is also styloid ligament calcification, which can cause compression of nerves and arteries and the symptoms above. Treatment can be conservative with pain modulators (e.g. pregabalin) or infiltrations (steroids or anesthetics drugs). In refractory cases, surgical approach aiming to reduce the size of the styloid process can be performed. We present a rare case of Eagle syndrome (documented by computed tomography) with good response to clinical treatment.

Resumo A síndrome de Eagle é uma condição rara na qual ocorre dor retroauricular (usualmente é o principal sintoma) associada a disfagia, cefaleia, cervicalgia durante a rotação da cabeça e, mais raramente, a AVC. Isso ocorre por conta do alongamento do processo estiloide e, às vezes, há também calcificação do ligamento estiloide. Essas estruturas podem comprimir nervos e artérias causando os sintomas citados. O tratamento pode ser conservador com moduladores da dor, como pregabalina, ou com infiltrações (corticoides ou drogas anestésicas). Em casos refratários, cirurgia para reduzir o tamanho do processo estiloide pode ser realizada. É apresentado um caso raro de síndrome de Eagle (documentado com tomografia computadorizada) com boa resposta ao tratamento clínico.

Cerebrospinal fluid shunt infection caused by Corynebacterium sp: case report and review.

BACKGROUND: A 36-year-old immunocompetent woman with a posterior fossa arteriovenous malformation (PF-AVM) and hydrocephalus presented with low fever and mental confusion 4 days after ventriculoperitoneal shunting (VPS). METHODS: Cerebrospinal fluid (CSF) and ventricular catheter tip cultures isolated Corynebacterium sp. Similar to previous cases in the literature, species determination was not possible. However, the antibiotic sensitivity profile of this isolate suggested Corynebacterium jeikeium. Conversion to external ventricular drainage (EVD) was done and intravenous vancomycin was administered for 21 days. RESULTS AND CONCLUSIONS: The patient showed progressive improvement. Since the first CSF shunt infection caused by Corynebacterium sp., 16 other cases in the literatures have been reported. Additionally, this study reports the difficulties in recognizing CSF shunt infection caused by this agent and the possible clinical or laboratory patterns as observed in the literature.

Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas.

A retrospective study of 81 patients with low-grade astrocytoma (LGA) comparing the efficacy of aggressive versus less aggressive surgery in eloquent and non-eloquent brain areas was conducted. Extent of surgical resection was analyzed to assess overall survival (OS) and progression- free survival (PFS). Degree of tumor resection was classified as gross total resection (GTR), subtotal resection (STR) or biopsy. GTR, STR and biopsy in patients with tumors in non-eloquent areas were performed in 31, 48 and 21% subjects, whereas in patients with tumors in eloquent areas resections were 22.5, 35 and 42.5%. Overall survival was 4.7 and 1.9 years in patients with tumors in non-eloquent brain areas submitted to GTR/STR and biopsy (p=0.013), whereas overall survival among patients with tumors in eloquent area was 4.5 and 2.1 years (p=0.33). Improved outcome for adult patients with LGA is predicted by more aggressive surgery in both eloquent and non-eloquent brain areas.

Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas / Astrocitoma de baixo grau: resultado cirúrgico em área eloquente versus não eloquente

A retrospective study of 81 patients with low-grade astrocytoma (LGA) comparing the efficacy of aggressive versus less aggressive surgery in eloquent and non-eloquent brain areas was conducted. Extent of surgical resection was analyzed to assess overall survival (OS) and progression- free survival (PFS). Degree of tumor resection was classified as gross total resection (GTR), subtotal resection (STR) or biopsy. GTR, STR and biopsy in patients with tumors in non-eloquent areas were performed in 31, 48 and 21% subjects, whereas in patients with tumors in eloquent areas resections were 22.5, 35 and 42.5%. Overall survival was 4.7 and 1.9 years in patients with tumors in non-eloquent brain areas submitted to GTR/STR and biopsy (p=0.013), whereas overall survival among patients with tumors in eloquent area was 4.5 and 2.1 years (p=0.33). Improved outcome for adult patients with LGA is predicted by more aggressive surgery in both eloquent and non-eloquent brain areas.

Foi realizado estudo retrospectivo em 81 pacientes com astrocitoma de baixo grau (LGA) comparando a eficácia da ressecção cirúrgica com cirurgia menos agressiva em relação à área eloquente e não eloquente do cérebro. A extensão da ressecção cirúrgica foi analisada para avaliar a sobrevida geral (OS) e o tempo livre de doença (PFS). O grau da ressecção cirúrgica foi classificado como ressecção total (GTR), subtotal (STR) e biópsia. Nos pacientes com lesão em área não eloquente foram realizadas GTR, STR e biópsia em 31, 48 e 21% dos casos, enquanto, naqueles com lesão em área eloquente, em 22,5, 35 e 42,5%, respectivamente. A sobrevida geral foi de 4,7 e 1,9 anos em pacientes com lesões em área não eloquente submetidos à GTR/STR e biópsia (p=0,013). Nos pacientes com lesão em áreas eloquentes, a sobrevida geral foi de 4,5 e 2,1 anos (p=0,33), respectivamente. A extensão da ressecção é fator preditivo de sobrevida tanto nas lesões em áreas eloquentes quanto nas não eloquentes.

Xenograft transplantation of human malignant astrocytoma cells into immunodeficient rats: an experimental model of glioblastoma.

INTRODUCTION: Astrocytic gliomas are the most common intracranial central nervous system neoplasias, accounting for about 60% of all primary central nervous system tumors. Despite advances in the treatment of gliomas, no effective therapeutic approach is yet available; hence, the search for a more realistic model to generate more effective therapies is essential. OBJECTIVE: To develop an experimental malignant astrocytoma model with the characteristics of the human tumor. METHOD: Primary cells from subcutaneous xenograft tumors produced with malignant astrocytoma U87MG cells were inoculated intracerebrally by stereotaxis into immunosuppressed (athymic) Rowett rats. RESULTS: All four injected animals developed non-infiltrative tumors, although other glioblastoma characteristics, such as necrosis, pseudopalisading cells and intense mitotic activity, were observed. CONCLUSION: A malignant astrocytoma intracerebral xenograft model with poorly invasive behavior was achieved in athymic Rowett rats. Tumor invasiveness in an experimental animal model may depend on a combination of several factors, including the cell line used to induce tumor formation, the rat strains and the status of the animal's immune system.

Avaliação epidemiológica dos pacientes com traumatismo raquimedular operados no Hospital Estadual Professor Carlos da Silva Lacaz / Epidemiological evaluation of patients with spinal cord injury treated surgically on the Hospital / Evaluación epidemiológica de los pacientes con traumatismo raquimedular operados en el Hospital Estadual Professor Carlos da Silva Lacaz

OBJETIVOS: avaliar as características dos pacientes com traumatismo raquimedular tratados cirurgicamente no Hospital Estadual de Francisco Morato "Professor Carlos da Silva Lacaz". MÉTODOS: realizou-se estudo retrospectivo dos prontuários de pacientes operados com o diagnóstico de traumatismo raquimedular no Hospital Estadual de Francisco Morato "Professor Carlos da Silva Lacaz", no período de Maio de 2005 a Dezembro de 2008, avaliando-se características clínicas e epidemiológicas até a alta hospitalar. RESULTADOS: Sessenta e nove casos foram revisados. Houve prevalência de indivíduos do sexo masculino (72,7 por cento), com idade entre 30 e 40 anos (34,1 por cento). A distribuição do traumatismo raquimedular, quanto à localização, foi: cervical, com 25 casos (36 por cento); torácico, com 10 (14,4 por cento); toracolombar, com 28 (40,5 por cento) e lombar, com 6 (8,6 por cento). A maioria desses pacientes (56,6 por cento) chegou ao serviço apresentando índice E da escala ASIA, com predominância de lesões toracolombares (40,5 por cento). Foi observado Glasgow Outcome Scale de 5 na alta, em 71 por cento dos pacientes. A queda de laje foi a causa mais comum de traumatismo raquimedular, sendo responsável por 34,8 por cento dos casos. CONCLUSÕES: o traumatismo raquimedular em nosso serviço foi geralmente secundária a queda da laje, atingindo principalmente indivíduos homens em idade economicamente ativa. As fraturas na região toracolombar, seguidas pela região cervical, foram as mais comuns. A identificação desses dados permite criar intervenções racionalizadas de caráter preventivo com maior impacto e disponibilizar recursos para o tratamento das ocorrências.

OBJECTIVE: to evaluate spinal cord injury patients surgically treated at the Hospital Estadual de Francisco Morato "Professor Carlos da Silva Lacaz". METHODS: a retrospective study was performed with medical records of spinal cord injury patients surgically treated at the hospital, from May 2005 to December 2008. Their clinical and epidemiological characteristics, from hospital admission to discharge, were studied. RESULTS: 69 cases were reviewed. There was male prevalence (72.7 percent), with age varying from 30 to 40 years (34.1 percent). According to localization, spinal cord injury was: cervical in 25 cases (36 percent), thoracic in 10 (14.4 percent), thoraco-lumbar in 28 (40.5 percent) and lumbar in 6 (8.6 percent). Most of these patients were neurologically intact (56.6 percent), with thoraco-lumbar spine trauma (40.5 percent). Glasgow Outcome Scale of 5 was observed in 71 percent of these patients. The main cause of spinal cord injury was flagstone falling, in 34.8 percent of the cases. CONCLUSIONS: spinal cord injury, in our service, was generally due to flagstone falling, in economically active young males, in the thoracolumbar or cervical spine. The identification of these data allows the creation of rational interventions with great impact and resources for the treatment of these occurrences.

OBJETIVO: evaluar las características de los pacientes con traumatismo raquimedular, tratados quirúrgicamente en el Hospital "Profesor Carlos Lacaz". MÉTODOS: se realizó un estudio retrospectivo de las historias clínicas de los pacientes operados con el diagnóstico de traumatismo raquimedular del Hospital Estadual de Francisco Morato "Profesor Carlos Lacaz" en el período de mayo de 2005 a diciembre de 2008, evaluándose características clínicas y epidemiológicas hasta el alta del hospital. RESULTADOS: 69 casos fueron revisados. Hubo mayor prevalencia de individuos del sexo masculino (72.7 por ciento), con edad entre 30 y 40 años (34.1 por ciento). La distribución del traumatismo raquimedular según su localización fue: cervical con 25 casos (36 por ciento), torácico con 10 (14.4 por ciento), toraco-lumbar con 28 (40.5 por ciento) y lumbar, 6 (8.6 por ciento). La mayoría de los pacientes (56.6 por ciento) llegó al servicio presentando un índice E de la escala ASIA, con predominio de lesiones toraco-lumbares (40.5 por ciento). El "Glasgow Outcome Scale" fue de 5 en el alta, se observó en 71 por ciento de los pacientes. La caída desde un lastre fue la causa más común del traumatismo raquimedular, siendo responsable por el 34.8 por ciento de los casos. CONCLUSIONES: el traumatismo raquimedular en nuestro servicio fue generalmente secundario a la caída desde un lastre, comprometiendo principalmente individuos hombres en edad económicamente activa. Las fracturas en la región toraco-lumbar seguidas por la cervical fueron las más comunes. La identificación de estos datos permite crear intervenciones racionales de carácter preventivo con mayor impacto.

Xenograft transplantation of human malignant astrocytoma cells into immunodeficient rats: an experimental model of glioblastoma

INTRODUCTION: Astrocytic gliomas are the most common intracranial central nervous system neoplasias, accounting for about 60 percent of all primary central nervous system tumors. Despite advances in the treatment of gliomas, no effective therapeutic approach is yet available; hence, the search for a more realistic model to generate more effective therapies is essential. OBJECTIVE: To develop an experimental malignant astrocytoma model with the characteristics of the human tumor. METHOD: Primary cells from subcutaneous xenograft tumors produced with malignant astrocytoma U87MG cells were inoculated intracerebrally by stereotaxis into immunosuppressed (athymic) Rowett rats. RESULTS: All four injected animals developed non-infiltrative tumors, although other glioblastoma characteristics, such as necrosis, pseudopalisading cells and intense mitotic activity, were observed. CONCLUSION: A malignant astrocytoma intracerebral xenograft model with poorly invasive behavior was achieved in athymic Rowett rats. Tumor invasiveness in an experimental animal model may depend on a combination of several factors, including the cell line used to induce tumor formation, the rat strains and the status of the animal's immune system.

Genetic therapy in gliomas: historical analysis and future perspectives.

High-grade gliomas are relatively frequent in adults, and consist of the most malignant kind of primary brain tumor. Being resistant to standard treatment modalities such as surgery, radiation, and chemotherapy, it is fatal within 1 to 2 years of onset of symptoms. Although several gene therapy systems proved to be efficient in controlling or eradicating these tumors in animal models, the clinical studies performed so far were not equally successful. Most clinical studies showed that methodologies that increase tumor infection/transduction and, consequently confer more permanent activity against the tumor, will lead to enhanced therapeutic results. Due to the promising practical clinical benefits that can be expected for the near future, an exposition to the practicing neurosurgeon about the basic issues in genetic therapy of gliomas seems convenient. Among the main topics, we shall discuss anti-tumoral mechanisms of various genes that can be transfected, the advantages and drawbacks of the different vectors utilized, the possibilities of tumor targeting by modifications in the native tropism of virus vectors, as well as the different physical methods for vector delivery to the tumors. Along with the exposition we will also review of the history of the genetic therapy for gliomas, with special focus on the main problems found during the advancement of scientific discoveries in this area. A general analysis is also made of the present state of this promising therapeutic modality, with reference to the problems that still must be solved and the new paradigms for future research in this area.

Clinical presentation, treatment and outcome of patients with cerebral metastases: the University of São Paulo series.

INTRODUCTION: Secondary neoplasias are the most common tumors affecting the central nervous system and several clinical aspects of this disease are still controversial. METHOD: Forty-seven consecutive patients with the diagnosis of cerebral metastases (CM) were retrospectively studied at the Clinical Hospital of Sao Paulo University Medical School. Mean age was 53.9 years and 25 patients were female. RESULTS: The most frequent primary sites were breast, lung and skin. Symptoms were related to increased intracranial pressure (ICP) in 48.9%, focal neurological events in 27.7% and both in 17.0%. Single brain metastases were found in 57.4% of those cases, the frontal lobe being most frequently affected. Surgical treatment was performed in 68.1%, radiotherapy in 40.4% and chemotherapy in 17.0%. CONCLUSION: After statistical analysis, there was a trend towards prolonged survival of female patients, patients with ICP symptoms and the surgical group. Data from different centers are essential to establish the best management of CM.

Clinical presentation, treatment and outcome of patients with cerebral metastases: the University of São Paulo series

INTRODUÇÃO: As neoplasias secundárias são o principal grupo de tumores que afetam o sistema nervoso central. Diversos aspectos da evolução e tratamento desta doença são controversos. MÉTODO: Quarenta e sete pacientes com metástase cerebral foram estudados retrospectivamente no Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. A idade média foi 53,9 anos e 25 pacientes eram do sexo feminino. RESULTADOS: Os sítios primários mais freqüentes foram mama, pulmão e pele. Os sintomas apresentados foram relacionados à hipertensão intracraniana (HIC) em 48,9%, sintomas focais em 27,7% e ambos em 17,0%. Metástases únicas foram encontradas em 57,8% dos casos. O tratamento foi cirurgia em 68,1% dos casos, radioterapia em 40,4% e quimioterapia em 17,0%. CONCLUSÃO: Após análise estatística, foram encontradas tendências a maior sobrevida nos pacientes do sexo feminino, no grupo de pacientes que apresentava sintomas de HIC e no grupo cirúrgico. Dados de diferentes centros são essenciais para o estabelecer a melhor forma de tratamento para as mestástases cerebrais.

Neuralgia do trigêmeo bilateral por cisticerco racemoso unilateral no Angulo-ponto cerebelar: relato de caso / Bilateral trigeminal neuralgia caused by unilateral racemose cysticercus of cerebellopontine angle. Case report

Descrevemos o caso de uma paciente de 42 anos portadora de cisticerco racemoso na regiäo do ângulo ponto-cerebelar (APC) direito com trigeminalgia bilateral mais intensa no lado ipsilateral à localizaçäo do parasita. O cisticerco foi totalmente removido por meio de craniotomia suboccipital. No primeiro dia pós-operatório houve desaparecimento bilateral da dor. Duas hipóteses fisiopatológicas foram aventadas para explicar a sintomatologia: lesöes que ultrapassam os limites da cisterna do APC poderäo através da cisterna pré-pontina alcançar a cisterna do APC atingindo o trigêmeo contralateral; lesöes com grande efeito de massa poderäo provocar rotaçäo do tronco cerebral e deslocamento e traçäo de estruturas ipsi e contralaterais, provocando compressäo arteriovenosa sobre o trigêmeo contralateral na porççÒo superior da cisterna do APC. Salientamos a necessidade de exames de imagem ante qualquer algia craniofacial e observamos que, em lesöes na regiäo do APC, a cisticercose näo pode ser esquecida

Transformação sarcomatosa em meningeoma / Sarcoma arising in meningioma

Os autores relatam o caso de paciente de 40 anos, raça amarela, sexo masculino, que apresentou história arrastada de déficit de força em hemicorpo direito com predomínio em membro inferior direito, cujo diagnóstico de imagem (tomografia computadorizada de crânio e ressonância magnética) revelou tratar-se de neoplasia parassagital esquerda com características semelhantes às de um meningeoma. Foi submetido à cirurgia com ressecção radical, incluindo o seio sagitalinvadido, com boa evolução no pós-operatório. O diagnóstico anatomopatológico foi de meningeoma com transformação sarcomatosa (meningeossarcoma/sarcoma meníngeo). Foi submetido à radioterapia e o seguimento de 8 meses não evidenciou recidiva. A transformação sarcomatosa é rara e infere um prognóstico reservado. Os autores discutem a doença e procuram identificar semelhanças e diferenças clínicas e radiológicas com as principais neoplasias do sistema nervoso central derivadas de células meningoteliais e de hemangiopericitos.

Malignancy in meningiomas is not frequent, however on rare occasions a benign meningioma may change into a tumor with features of malignancy or even sarcomatous cells. A case of sarcoma arising in a meningioma in a 40 year-old man is reported. Despite of the poor prognosis after thesurgical and radiotherapic treatment, this patient goes on without recurrence for eight months after surgery and radiotherapy. The pathological and radiological features as well as a differentialdiagnosis of this disease are discussed by the authors based on literature review.

Tumores malignos primários múltiplos: relato de caso / Multiple primary malignant neoplasms: case report

Os autores descrevem o caso de um paciente do sexo masculino, de 66 anos de idade, com lesão neoplásica gástrica Borrmann IV, desde 2 cm do cárdia até a região pré-pilórica, cujo exame anatomopatológico revelou adenocarcinoma tubulopapilífero pouco diferenciado. O mesmo paciente era portador de gioblastoma multiforme do lobo temporal esquerdo. Neoplasias malignas orimárias múltipals que incluam neoplasias cerebrais primárias são raras, havendo apenas 17 casos descritos na literatura. Os autores discutem a etiopatogenia dessa infrequente patologia.

Aspergillosis in the frontal sinus with intracranial extension: report of 1 case and analysis of the literature

The authors report a case of the 53 year old man carrier of aspergillosis in the both ethmoid and frontal sinus without association with the HIV virus. Aspergillosis in its focal and disseminated form is frequently associated with immune dysfunction, especially with patients carriers of the acquired immunodeficiency syndrome (AIDS), and it constitutes, when present in the central nervous system (CNS), a serious infection with difficult control and high morbidity index. The habitual treatment for these cases consists of the resection of the necrotic tissue and, so much as possible, of the lesions and also the administration and lingering use of liposomal amphotericin B.A lot of times, the invasion of the orbit and of the paranasal sinus can justify an aggressive conduct with extensive cranium-facial surgeries. The patient in subject was submitted to the partial resection of the lesion, which invaded the base of the anterior floor and the base of the frontal lobe to the orbitary cone and mesial face of the orbit. There was as postoperative complication, a liquoric fistula of difficult treatment due to the fragility of the dura mater in the base of the cranium infiltrated by the lesion. It received, for about 12 months, amphotericin in high doses and he comes maintaining himself stable of the clinical-neurological point of view. The authors discuss the etiopathogeny, the diagram of flow of the diagnostic and therapeutics conducts and they point out the need to include aspeergillosis of the SNC as disease of badly prognostic, deserving aggressive therapeutics in its initial phase

Sindrome do túnel do tarso: aspectos clínicos, diagnósticos e terapêuticos / Tarsal tunnel syndrome: clinical and surgical features

Os autores descrevem 5 casos de doentes com quadro clínico e eletromiográfico de síndrome do túnel do tarso, tratados cirurgicamente através de neurólise do nervo tibial no ponto de compressao. Os aspectos da anatomia da regiao, fisiopatologia, indicaçao cirúrgica e resultados sao discutidos.

Meningeoma cístico. Análise de 5 casos e revisäo da literatura / Intracranial cystic menigeoma. Report of 5 cases and literature review

Os autores relatam 5 casos de meningeoma cístico operados. Discutem os aspectos fisiopatológicos da formaçäo do cisto tumoral e sua classificaçäo com base na literatura revista. A histopatologia é avaliada, bem como a imunohistoquímica referente à proliferaçäo celular através da técnica do MIB1. Aspectos referentes à técnica operatória e conduta terapêutica säo analisados. Com este relato, as publicaçöes na literatura brasileira totalizam 14 meningeomas císticos.

Hematoma epidural crônico espontâneo intrarraquiano. Relato de caso / Spontaneous chronic spinal epidural haematoma. A case report

Um caso raro de hematoma epidural crônico espontâneo intrarraquiano em um paciente do sexo masculino com 14 anos de idade, tratado cirurgicamente com sucesso é apresentado. O quadro clínico e a etiopatogenia säo discutidos. O resultado do tratamento depende principalmente do tempo de duraçäo do déficit neurológico.