Pure Neuroendoscopic Resection of Cystic Cerebellar Tumors.

BACKGROUND: We describe the resection of cerebellar cystic tumors using pure neuroendoscopy. This technique consists of performing all of the procedures under an endoscopic view, with the instruments introduced into the operative field coaxially to the endoscope through a trocar. CASE DESCRIPTION: Three cases of cerebellar cystic lesions (two pilocytic astrocytomas and one hemangioblastoma) were approached using the pure neuroendoscopic technique. Under general anesthesia and prone positioning, a suboccipital burr hole was created. The endoscope was introduced into the tumor cavity, and a reddish nodule was identified. The monopolar electrode was used to coagulate and dissect the surrounding nodular tissue. Grasping forceps were used to remove the nodule. There were no complications related to tumor removal, and the patients recovered from their symptoms. The follow-up images showed reduction of the cavity with no contrast enhancement. CONCLUSION: The pure neuroendoscopic technique was shown to be minimally invasive and a successful and secure method to treat cystic cerebellar tumors.

Risk Factors for Graft Infection After Cranioplasty in Patients with Large Hemicranial Bony Defects.

OBJECTIVE: To identify infection incidence and related risk factors in patients who underwent cranioplasty (CP) after unilateral decompressive craniectomy (DC). METHODS: CP after DC was performed in 45 patients from April 2011 through January 2012. The covariates studied were compared with occurrence versus nonoccurrence of infection. Univariate analysis was performed, followed by a multivariate analysis and development of independent logistic regression models with significance of 5%. RESULTS: Wound infections were observed in 24% of cases. Patients treated with polymethyl methacrylate flaps had a 31% rate of infection compared with 12% in patients treated with autologous flaps, but the difference was not statistically significant (P = 0.279). Increased risk of infection was associated with performing CP during the same period of hospitalization as DC (45% vs. 8%; P = 0.006), recent systemic infection (53% vs. 10%; P = 0.003), a Glasgow Outcome Scale score lower than 4 (48% vs. none; P < 0.001), motor deficit (42% vs. 5%; P = 0.011), and lower levels of hemoglobin (P < 0.001). Another risk factor for infection was an interval between DC and CP of 29-84 days compared with >168 days (P = 0.007). CONCLUSIONS: The incidence of wound infection was high. Risk factors included motor deficits, Glasgow Outcome Scale score <4, lower hemoglobin levels, recent systemic infections, interval between DC and CP of 29-84 days, and DC and CP performed during the same hospitalization. Performing CP during a different hospitalization may reduce the risk of graft infection because the hemoglobin level would be higher, and patients would be less dependent and free of recent infection.

Fratura de chance em três irmãos: relato de caso / Chance fracture in three brothers: A case report

A fratura de Chance é incomum na população pediátrica. Resulta do mecanismo de flexão e distração. Apresenta forte associaçãocom o uso do cinto de segurança. A presença de lesões intra-abdominais é frequente. Pode apresentar alterações sutis no examede imagem. O atraso no diagnóstico contribui para o aumento de déficits neurológicos. Relatamos o caso de três irmãos vítimasde acidente automobilístico com fratura do cinto de segurança ou fratura do Tipo Chance atendidos no Hospital João XXIII deBelo Horizonte. Os casos descritos reforçam o mecanismo dessa fratura e sua associação com lesões intra-abdominais...

Chance fracture, suggestive of a flexion-distraction mechanism, is an uncommon type of injury in the pediatric population. Itsoccurrence, with associated intra-abdomimal lesions, has increased with the widespread use of seat belts. Since this type offracture presents subtle variations on common image examinations, its diagnosis may be delayed increasing the probability ofsubsequent neurologic deficits. In this paper we report the case of three siblings, victims of a motor vehicle head-on collision,either presenting seat belt fracture or Chance fracture. They were treated in the Hospital João XXIII, Belo Horizonte. The casereported reinforces the hypothesis describing the fracture mechanism and associated intra-abdominal injuries...