Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia using a Stereotactic Approach due to a Pterygoalar Bar / Termocoagulação por radiofrequência do gânglio de Gasser na nevralgia do trigêmeo, guiada por estereotaxia devido à presença de barra pterigoalar

The treatment of trigeminal neuralgia (TN) consists of pharmacotherapy and neurosurgical procedure, such as percutaneous radiofrequency rhizotomy. Here, we present the case of a patient with TN refractory to clinical treatment who presented an anatomical variation in the oval foramen, which required stereotactic-guided surgery to access the Gasser ganglion. This is a 63-year-old male patient who presented with TN refractory to drug treatment. He used carbamazepine and nortriptyline, with no satisfactory response. The percutaneous approach to radiofrequency thermocoagulation was indicated, in view of the comorbidities presented and the patient's age. Due to the presence of a rare anatomical variation, stereotactic-guided surgery was used to cannulate the foramen ovale and, thus, successfully perform the neurosurgical procedure with an excellent clinical response. The use of stereotaxy to guide cannulation of the foramen ovale due to anatomical variation was essential for the success of the procedure. The knowledge of the existence of this anatomical variation, and the mastery of the stereotactic technique enabled the adequate management in the face of the unusual situation.

O tratamento da neuralgia do trigêmeo (NT) consta de farmacoterapia e procedimento neurocirúrgicos, como a rizotomia percutânea por radiofrequência. Aqui apresentamos o caso de um paciente com NT refratária ao tratamento clínico que apresentava uma variação anatômica no forame oval, o que exigiu a realização de cirurgia guiada por estereotaxia para acesso ao gânglio de Gasser. Trata-se de um paciente do sexo masculino, com 63 anos de idade, que apresentava quadro de NT refratária ao tratamento medicamentoso. Fez uso de carbamazepina e nortriptilina, sem resposta satisfatória. Foi indicada a abordagem percutânea para termocoagulacão por radiofrequência, tendo em vista comorbidades apresentadas e a idade do paciente. Devido à presença de uma rara variação anatômica, utilizou-se a cirurgia guiada por estereotaxia para canular o forame oval, e, dessa forma, realizar o procedimento neurocirúrgico com sucesso e uma excelente resposta clínica. A utilização de estereotaxia para guiar a canulação do forame oval devido à variação anatômica foi essencial para o sucesso do procedimento. O conhecimento da existência dessa variação anatômica, e o domínio da técnica estereotáxica possibilitaram o adequado manejo frente a uma situação incomum.

Tradução e Adaptação Transcultural do Instructional Materials Motivation Survey (IMMS) para o Português do Brasil / Translation and Transcultural Adaptation of the Instructional Materials Motivation Survey (IMMS) to Brazilian Portuguese

Resumo: Introdução: No cenário educacional, diversas metodologias de ensino-aprendizagem vêm sendo utilizadas como ferramentas instrucionais, com o objetivo de aumentar a motivação dos estudantes e favorecer a aprendizagem significativa. Por sua vez, instrumentos que avaliem a motivação, após exposição a diferentes estratégias e materiais de ensino, podem contribuir para análise e decisão sobre sua efetividade. Nesse sentido, o questionário Instructional Materials Motivation Survey (IMMS) avalia a motivação, após atividades instrucionais, por meio de quatro domínios: atenção, relevância, confiança e satisfação. Assim, esta pesquisa teve como objetivo realizar a tradução e adaptação transcultural do IMMS para o português brasileiro. Método: A tradução e adaptação transcultural foram realizadas em seis etapas: tradução do questionário original, síntese das traduções, retrotradução, revisão pelo comitê de especialistas, teste da versão pré-final, confecção da versão final e auditoria pelo comitê externo. As traduções foram realizadas por duas professoras de inglês, de língua nativa brasileira. As retrotraduções foram realizadas por dois professores de inglês, de língua nativa inglesa. O comitê de especialistas foi formado por um professor de medicina e educação médica, dois professores de medicina, uma pedagoga, um estatístico e um professor de inglês. A versão brasileira final do IMMS foi testada, após aula invertida, tendo como objetivo avaliar a consistência interna do instrumento. Considerou-se como aceitável valor de alfa de Cronbach ≥ 0,70. Resultados: No processo de tradução e adaptação transcultural, foram atingidas todas as equivalências: semântica, idiomática, cultural e conceitual. Na avaliação da consistência interna, dos 52 estudantes submetidos à aula invertida, 48 (92,3%) responderam à versão brasileira do IMMS. O instrumento apresentou consistência interna de 0,718, avaliada por meio do teste alfa de Cronbach. Conclusões: A versão final do instrumento IMMS, após processo de tradução e adaptação transcultural, manteve todas as suas 36 sentenças e as instruções do instrumento original, e apresenta boa consistência interna, de acordo com o teste alfa de Cronbach. A possibilidade de avaliação da motivação, no contexto educacional, por instrumento amplamente validado, traz consigo ganhos tanto no campo da prática quanto da pesquisa pedagógica. Seu emprego no Brasil possibilitará novas validações em cenários educacionais nacionais e contextos diversos.

Abstract: Introduction: Several educational methodologies have been used as instructional tools, with the objective of increasing student motivation and promoting meaningful learning. In turn, instruments designed to assess a student's motivation after being exposed to different teaching strategies and materials can play an important role in reviewing the effectiveness of such methods. In this sense, the Instructional Materials Motivation Survey (IMMS) evaluates student motivation after instructional activities, through four domains: attention, relevance, confidence and satisfaction. This research aimed to perform the translation and cross-cultural adaptation of the IMMS into Brazilian Portuguese. Method: The cross-cultural translation and adaptation was performed in six stages: translation of the original questionnaire; synthesis of translations; back-translation; review by the Committee of Experts; testing of the pre-final version, preparation of the final version and review by the External Committee. The translations were performed by two English teachers, native Brazilian. The back-translations were performed by two English teachers, native English language. The expert committee was formed by a professor of medicine and medical education, two medical professors, a pedagogue, a statistician and an English teacher. The final Brazilian version of the IMMS was tested following a flipped classroom activity aimed at evaluating the internal consistency of the instrument. A Cronbach alpha value of ≥ 0.70 was considered acceptable. Results: In the process of translation and cross-cultural adaptation, all equivalences were achieved: semantic, idiomatic, cultural and conceptual. In the evaluation of internal consistency, of the 52 students submitted to the flipped classroom, 48 (92.3%) correctly answered the Brazilian version of the IMMS. The instrument presented an internal consistency of 0.718, evaluated using the Cronbach alpha test. Conclusions: The final version of the IMMS instrument, after cross-cultural translation and adaptation, maintained all its 36 sentences and the 3 instructions of the original instrument and presented good internal consistency according to the Cronbach alpha test. The possibility of evaluating motivation in the educational context by means of a broadly validated instrument, brings with it gains both in the field of practice and pedagogical research. Use of the IMMS in Brazil will support new validations in national educational settings and diverse contexts.

Neurocitoma central atípico: relato de caso / Atypical central neurocytoma: case report

Neurocitomas centrais são tumores do sistema nervoso central de comportamento usualmente benigno, que costumam ocorrer nos ventrículos laterais de indivíduos jovens. Apresentamos o caso de um paciente do sexo masculino, de 31 anos de idade, com uma lesão expansiva intraventricular ocasionando quadro de hidrocefalia e queixas visuais. O paciente foi submetido à ressecção completa da lesão. Apresentou hidrocefalia persistente no pós-operatório, necessitando de derivação ventrículo-peritoneal. A evolução foi favorável e o paciente recebeu alta para seguir acompanhamento ambulatorial. Exame anatomopatológico evidenciou neurocitoma central atípico. O objetivo deste relato é apresentar um caso clássico de uma neoplasia rara, realizando uma revisão da literatura e mostrando sua importância, dado o prognóstico favorável.

Central neurocytomas are central nervous system tumors. They are usually benign and tend to occur in the lateral ventricles of young adults. We report the case of a 31-year-old male patient with an intraventricular lesion, causing hydrocephalus and visual complaints. The patient was submitted to a complete surgical resection of the lesion. However, he persisted with hydrocephalus in the postoperative period and required a ventriculoperitoneal shunt. The clinical course was favorable and the patient was discharged to follow-up. Anatomic pathology test revealed an atypical central neurocytoma. The objective of this case report is to describe a classic presentation of a rare neoplasm, including a review of the literature, highlighting the importance of this diagnosis because of the favorable prognosis.

Defense style changes with the addition of psychodynamic group therapy to clonazepam in social anxiety disorder.

Psychodynamic Group Therapy (PGT) and clonazepam are strategies to reduce symptoms of generalized social anxiety disorder (GSAD). The addition of PGT might lead to changes in defense styles. The objective of this study is to examine changes in defense styles when comparing clonazepam to psychodynamic group therapy plus clonazepam in GSAD during 12 weeks. Fifty-seven patients that met DSM-IV criteria for GSAD participated. social anxiety disorder symptoms were evaluated with the Liebowitz Social Anxiety Scale, and defense styles with the Defense Style Questionnaire. All defense styles changed overtime for both groups, especially mature defense style, which increased independently of the treatment allocation group. Regression analyses found that overtime there was a reduction in neurotic defenses in the combined group, whereas there was an increase in the clonazepam group. Neurotic defense style can change toward greater adaptiveness with the addition of PGT to clonazepam in GSAD, even in 12 weeks.

The implications of microsurgical anatomy for surgical approaches to the sellar region.

The knowledge of the normal anatomy and variations regarding the management of tumors of the sellar region is paramount to perform safe surgical procedures. The sellar region is located in the center of the middle cranial fossa; it contains complex anatomical structures, and is the site of various pathological processes: tumor, vascular, developmental, and neuroendocrine. We review the microsurgical anatomy (microscopic and endoscopic) of this region and discuss the surgical nuances regarding this topic, based on anatomical concepts.

Long-term effects of environmental stimulation following hypoxia-ischemia on the oxidative state and BDNF levels in rat hippocampus and frontal cortex.

Environmental enrichment recovers memory deficits without affecting atrophy of the hippocampus adult rats submitted to neonatal hypoxia-ischemia (HI). The present study was designed to investigate whether the modulation of brain oxidative status and/or BDNF content, as assessed in adulthood, are involved with the functional neuroprotection caused by environmental enrichment in animals receiving neonatal HI. Male Wistar rats, in the 7th postnatal day, were submitted to the Levine-Rice model of neonatal hypoxia-ischemia, comprising permanent occlusion of the right common carotid artery and a 90 min period of hypoxia (8% O(2)-92% N(2)). Starting 2 weeks after the HI event, animals were stimulated by the enriched environment (1 h/day for 9 weeks). Rats were sacrificed approximately 24 h after the end of enrichment period and some oxidative stress parameters, specifically the free radical levels, macromolecules damage and superoxide dismutase activity, in hippocampus and frontal cortex samples were determined. BDNF levels were also measured in the same encephalic structures. Indexes of macromolecules damage, TBARS levels and total cellular thiols, as well as free radical levels were unchanged in both studied structures. An increased SOD activity in the right hippocampus of HI group maintained in standard environment was found, this effect was reversed in HI enriched group. Moreover, BDNF levels were increased only in the hippocampus of non-stimulated HI group. These results suggest that the environmental enrichment protocol bearing cognitive protection is not associated to increases in BDNF expression nor SOD activity in hippocampus of the rats, as assessed in adulthood, submitted to neonatal hypoxia-ischemia.

A pilot study of clonazepam versus psychodynamic group therapy plus clonazepam in the treatment of generalized social anxiety disorder.

BACKGROUND: Both psychodynamic group therapy (PGT) and clonazepam are used as treatment strategies in reducing symptoms of generalized social anxiety disorder (GSAD). However, many individuals remain symptomatic after treatment with PGT or clonazepam. METHOD: Fifty-eight adult outpatients with a diagnosis of GSAD according to DSM-IV were randomized to 12 weeks PGT plus clonazepam or clonazepam. The Clinical Global Impression-Improvement (CGI-I) Scale was the primary efficacy measure. Secondary efficacy measures included the Liebowitz Social Anxiety Scale (LSAS) total score, the World Health Organization Instrument to Assess Quality of Life-Brief (WHOQOL-Bref) Scale and the Beck Depression Inventory (BDI). RESULTS: CGI-I data from 57 patients (intent-to-treat population) showed that patients who received PGT plus clonazepam presented significantly greater improvement than those who received clonazepam (P=0.033). There were no significant differences between the two groups in the secondary efficacy measures. CONCLUSIONS: Our study suggests that the combination of PGT with clonazepam may be a promising strategy for the treatment of GSAD, regarding gains in the global functioning. However the present study failed to detect more specific changes in social anxiety symptomatology between the two groups.

Early enriched housing results in partial recovery of memory deficits in female, but not in male, rats after neonatal hypoxia-ischemia.

Our previous results indicated that stimulation by daily environmental enrichment (EE) recovered memory deficits without affecting hippocampus damage in adult male rats submitted to neonatal hypoxia-ischemia (HI). The present study investigated whether early continuous housing in an enriched environment would be effective in preventing spatial and recognition memory both in adolescent and adult female and male rats, as well as the possible benefits of continuous EE in alleviating hippocampal and striatal atrophy consequent to the neonatal HI. Wistar rats in the 7th PND were submitted to the HI and, in the day after, were housed in an enriched environment (8th-30th PND). Subsequently, performance of animals in the novel-object recognition and in two water maze tasks was assessed; in adulthood, animals' behavior was reassessed in the water maze. Rats were sacrificed and both hippocampal volume and striatal area were estimated following the completion of behavioral study. Post-HI cognitive deficits in the object recognition test were completely recovered by the EE. However, memory impairment in the water maze was only partially prevented by EE; this effect was observed especially in female rats on the working memory protocol. As for the morphological assessment, there was no enrichment effect over the loss of hippocampus volume and striatum area. In conclusion, present data indicate that early housing in EE caused performance recovery in object recognition and a partial improvement in the working memory spatial task in adolescent females after neonatal HI; however no effects of enrichment were revealed in adult animal's performance or in the extension of tissue atrophy of hippocampus and striatum consequent to HI.