A craniotomia extremo-lateral: dicas e truques

This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.O presente artigo visa descrever de forma didática e prática a realização da craniotomia suboccipital extremo-lateral. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização dessa craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurocirurgia VascularHospital Real e Benemérita Sociedade Portuguesa de Beneficência Instituto de Ciências Neurológicas Laboratório de MicrocirurgiaDepartamento de Neurocirurgia VascularHospital Brigadeiro Departamento de Neurocirurgia VascularUniversity of Florida Department of NeurosurgeryUniversidade Estadual de Campinas Faculdade de Ciências Médicas Departamento de NeurologiaUNIFESP, Depto. de Neurocirurgia VascularSciEL

Study of head positioning in pterional, pre-temporal and orbitozygomatic craniotomies and their variations in vascular and epilepsy surgeries

Orientador: Evandro Pinto da Luz de OliveiraTese (doutorado) - Universidade Estadual de Campinas. Faculdade de Ciencias MedicasResumo: A craniotomia pterional é o acesso cirúrgico mais utilizado na prática neurocirúrgica atual. É utilizada para abordar a maior parte dos aneurismas da circulação anterior e lesões tumorais envolvendo a região supra-selar e parte das estruturas da fossa anterior e média. No entanto, se caracteriza como sendo um acesso limitado para as lesões que envolvem a maior parte do lobo temporal, o assoalho da fossa média do crânio e o complexo da artéria basilar. Para tanto, foram desenvolvidas as craniotomias pré-temporal e orbitozigomática. No entanto a literatura é ainda relativamente carente quanto ao estudo do posicionamento exato da cabeça para a melhor abordagem de cada patologia, em particular. Esse trabalho tem por objetivo estudar o melhor posicionamento da cabeça para a realização das craniotomias mencionadas, visando a melhor exposição de cada lesão em particularAbstract: The pterional approach is the most applied neurosurgical access in the customized practice nowadays. It is used for approaching most of the anterior circulation aneurysms and tumors involving the anterior and the middle cranial space. However, it is considered a limited approach to some pathologies involving the temporal lobe, the middle cranial space floor and the basilar artery complex region. As a result, the orbitozygomatic and the pretemporal craniotomies developed since it was necessary to enlarge such access to the temporal area. However, there is not a systematic evaluation of head positioning study about the best approach to each specific pathology. This study aims to demonstrate the best way to position the head according to each specific pathology, in order to offer a better surgical visualization by using the most appropriated craniotomyDoutoradoNeurologiaDoutor em Ciências Médica

Case Report: Evolutionary Clinical-Radiological Features of a Diffuse Hemispheric Glioma, H3 G34 Mutant with Over 5 Years of Survival

Diffuse hemispheric glioma (DHG), H3 G34 mutant was included in the 5th edition of the World Health Organization Classification of Tumors of the Central Nervous System recently published. Given the recent inclusion in the current classification and its rarity in adult patients, there are scarce data on clinical-radiological characteristics, survival, and outcome. The authors report the case of a 35-year-old female with DHG, H3 G34-mutant characteristics and outcomes with an unusual presentation, recurrence, and prolonged survival. In conclusion, our case report demonstrates relevant details that should be observed in patients with suspicion or confirmation of the diagnosis of DHG, H3 G34 mutant, not only in the initial presentation but also in the evolution to ensure more personalized treatment

Transcortical selective amygdalohippocampectomy technique through the middle temporal gyrus revisited: An anatomical study laboratory investigation

The anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SeIAH) have been used for surgical treatment of mesial temporal lobe epilepsy. We examined the comprehensive white matter tract anatomy of the temporal lobe to gain an insight into the trans-middle temporal gyrus, a lateral approach which has been commonly used. The transmiddle temporal gyrus approach was performed in a stepwise manner on cadaveric human heads to examine the traversing white matter pathways through it and the structures located in the temporal horn. We reviewed the literature to compare the trans-middle temporal gyrus approach with other SeIAH techniques based on surgical outcomes. There does not appear to be a significant difference in seizure outcome between SeIAH and ATL. However, the SeIAH provides a better neuropsychological outcomes than the ATL in selected patients. Each SeIAH approach has individual advantages and disadvantages. Based on our anatomical study, in the transcortical amygdalohippocampectomy technique through the middle temporal gyrus the white matter pathways to be encountered. In the temporal horn, the collateral eminence, hippocampus, lateral ventricular sulcus, choroidal fissure, inferior choroidal point, choroid plexus, fimbria of the fornix, and amygdala are exposed. The subpial dissection is performed along the lateral ventricular sulcus from the collateral eminence on lateral side and from the choroidal fissure on medial side by microdissector for en bloc resection of the hippocampus proper. The trans-middle temporal gyrus approach is commonly used in treatment of mesial temporal lobe epilepsy patients. A better anatomical and functional understanding of the structures of the temporal lobe is crucial for safer and more accurate surgery. (C) 2016 Elsevier Ltd. All rights reserved.Univ Minnesota, Dept Neurosurg, Mayo Bldg,4th Floor 420 Deliware St SE, Minneapolis, MN 55455 USAUniv Fed Sao Paulo, Dept Neurosurg, Sao Paulo, BrazilBakirkoy Res & Training Hosp Neurol Neurosurg & P, Dept Neurosurg, Istanbul, TurkeyIstanbul Univ, Cerrahpasa Med Sch, Dept Neurosurg, Istanbul, TurkeyUniv Minnesota, Dept Otolaryngol, Minneapolis, MN USASt Josephs Hosp, Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ USADepartment of Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, BrazilWeb of Scienc