Increase of the clivus-canal angle in patients with basilar invagination, without atlantoaxial displacement, treated with a simple maneuver of indirect decompression of the odontoid with the head clamp, during posterior occipitocervical arthrodesis.

BACKGROUND: Basilar invagination (BI) can be defined as the insinuation of the content of the craniovertebral junction through the foramen magnum toward the posterior fossa. BI is a prevalent condition in Northeast Brazil. The present study describes the changes in the clivus-canal angle (CCA) in the postoperative period in patients with symptomatic BI operated by a posterior approach, using a simple technique of indirect reduction of the odontoid associated with occipitocervical fixation. METHODS: Patients underwent radiological evaluations by magnetic resonance imaging in the pre and postoperative periods, where the height of the odontoid tip was measured in relation to the Chamberlain line and the ACC. All patients underwent posterior occipitocervical fixation with specific maneuvers of distraction and extension of the cephalic segment with the aid of a head clamp with three fixation points for anterior reduction of the odontoid. RESULTS: Among the 8 patients evaluated in the series, all had increased ACC in the postoperative period, with a mean of 14.81 ± 1.54°, and statistically significant difference between the pre and postoperative periods (P < 0.05). CONCLUSION: The indirect surgical reduction of the odontoid process by a posterior approach through the manipulation (distraction-extension) of a "Mayfield" type of head clamp followed by occipitocervical fixation proved to be effective in improving the ACC, being easily reproducible.

Injeçäo intratumoral de alcool absoluto em meningeomas e reduçäo de sangramento operatório: nota técnica e relato de caso / Intratumoral injection of absolute ethanol and reduction of operative hemorrhage in meningeomas: technical note and case report

A resseccao de meningiomas gigantes da base do cranio é, ainda, um processo associado a perda sanguinea consideravel, a despeito do progresso alcançado com as tecnicas microcirurgicas em uso ha 30 anos. A embolizacao pre-operatoria dessas lesoes, sem divida, minimiza o problema, todavia, sendo de custo elevado, inviabiliza o seu emprego na maioria dos pacientes. Ou autores relatam a sua experiencia com a injecao intratumoral de alcool absoluto em um caso de meningioma gigante da fossa anterior, analisam aspectos de ordem tecnica e chamam a atencao para sua utilidade e baixo custo, quando da resseccao de neoplasias ricamente vascularizadas.

Craniotomia fronto-órbito-pterional unilateral e clinoidectomia anterior extradural no tratamento de aneurisma bilateral do segmento oftálmico da artéria carótida interna / Unilateral fronto-orbito-pterional approach with extradural anterior clinoidectomy in the treatment of bilateral ophtalmic segment aneurism

Os autores relatam um caso de aneurisma bilateral em espelho do segmento oftálmico da artéria carótida interna tratado com craniotomia fronto-órbito-pterional direita associada com clinoidectomia anterior extradural

Aneurismas bilaterais da bifurcaçao da arteria cerebral media operados atraves de craniotomia unica / Clipping of bilateral aneurysms of the bifurcation of the middle cerebral artery using a single craniotomy. Report of one case

Os autores relatam um caso de aneurismas em espelho da bifurcacao arteria cerebral media clipados atraves de uma craniotomia unica.