Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results.

OBJECT: The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution. METHODS: The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered. RESULTS: At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years. CONCLUSIONS: Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identical to other locations. Endovascular treatment may thus be proposed as an alternative to surgical clipping at this location. Nevertheless, a longer follow-up period is necessary to determine its efficacy, particularly in cases of unruptured aneurysms.

[Cerebral amyloid angiopathy presenting as a brain tumor: case report]. / Angiopatia amilóide cerebral simulando tumor cerebral: relato de caso.

We describe the unusual case of a 45-year-old male patient harboring an intracranial mass due to cerebral amyloid angiopathy whose clinical and radiological features were those of a low grade glioma. Biopsy revealed cerebral amyloid angiopathy. The clinical, radiological and pathological findings are discussed as we review the available literature.

[Expansive laminoplasty: an alternative for the treatment of cervical spondyloarthrosis]. / Laminoplastia expansiva: uma alternativa no tratamento da mielopatia espondilótica cervical.

We describe the surgical technique of expansive cervical laminoplasty and analyse the results in 28 patients treated by this method for cervical spondylotic myelopathy with a minimum follow-up of six months. Twenty-four patients (86%) had clinical improvement according to the Nurick scale while three (10%) had no improvement and one patient died on the first days post-operatively. The good results achieved demonstrate that this technique is simple, effective and has few complications on the treatment of spondylotic myelopathy.

[Penetrating brain injury due to a large asbestos fragment treated by decompressive craniectomy: case report]. / Lesão cerebral penetrante por grande fragmento de fibra de amianto tratada por craniectomia descompressiva: relato de caso.

We report the case of a 22-year-old man victim of penetrating brain injury due to a 15 x 12 asbestos fragment and a successfully treatment via decompressive craniectomy. Unlike gunshot wounds to the head, penetrating brain injury from low energy objects are unusual. Most cases reported involve cranio-orbitary injuries as well as self inflicted lesions in mentally ill patients. The reported case is noteworthy due to the large dimensions of the foreign body, the treatment via decompressive craniectomy and the good patient functional outcome.

[Paraclinoid aneurysms: surgical technique and results in 51 patients]. / Aneurisma paraclinóideo: técnica cirúrgica e resultados em 51 pacientes.

An analysis of the surgical results of 51 patients harboring 55 paraclinoid aneurysms is performed, along with a throughoutful description of its complex microsurgical technique. The anterior clinoid process was removed by the extradural route after sectioning the dural duplication between the superior orbital fissure and the dura of the temporal lobe, and/or by the intradural approach. All 55 aneurysms was excluded. In two cases the clipping was partial and the internal carotid artery were occluded in three cases. The surgical outcome was good in 42 (82%) patients, moderate incapacity occurred in five (10%) and severe incapacity in one patient (2%). Three patients (6%) died due to brain infarction. Seven patients (13,7%) had additional lesion of the optic nerve, being partial in 4 (7,7%) and total in 3 (6%).

Aneurisma paraclinóideo: técnica cirúrgica e resultados em 51 pacientes / Paraclinoid aneurysms: surgical technique and results in 51 patients

Analisam-se 51 pacientes portadores de 55 aneurismas paraclinóideos (APC) submetidos a tratamento cirúrgico. Em decorrência de tratar-se de procedimento de alta complexidade, descrevemos em pormenor os seus aspectos técnicos. O processo clinóideo anterior foi removido por via extradural após secção da duplicação dural da tenda da fissura orbitária superior e/ou por via intradural. Conseguiu-se exclusão do APC nos 51 pacientes. Em dois casos a clipagem foi parcial e, em três, ocorreu oclusão da ACI. Em 42 (82 por cento) pacientes ocorreu bom resultado; em 5 (10 por cento), incapacidade moderada; em 1 (2 por cento), incapacidade grave e três (6 por cento) faleceram por infarto cerebral. Sete (13,7 por cento) pacientes tiveram lesão adicional do nervo óptico, sendo parcial em 4 (7,7 por cento) e total em 3 (6 por cento).