Implante coclear em neurofibromatose tipo 2: uma opção para melhor reabilitação auditiva

UNIFESP Otorhinolaryngology DepartmentDFVUNIFESP, Otorhinolaryngology DepartmentSciEL

The role of pelvic rehabilitation in quality of life in a patient harboring metastatic chordoma: a case report

Introduction: Chordoma is a malignant tumor that usually involves the axial skeleton. Intradural chordomas are even rarer and 37 cases have been reported to the best of our knowledge. We present a case of a patient with an atypical metastatic diffuse intradural spinal involvement. Objective: To investigate therapeutic approaches such as pelvic physiotherapy for hospitalized and palliative patients in a private institution diagnosed with advanced cancer. Case Report: We present a 33-year-old woman previously submitted to five brain surgeries to treat a posterior fossa intradural chordoma since December 2012. There were new vertebral intradural lesions. The patient underwent complementary treatment with pelvic physiotherapy to improve the quality of life of the urinary and fecal system. Material and Methods: After six sessions of pelvic physiotherapy in bed and a month of behavioral monitoring and exercise practice, she returned to the condition of adequate urinary continence, thus obtaining an expressiveness in the overall quality of life

Endoscopic endonasal management of cerebrospinal fluid rhinorrhea after anterior clinoidectomy for aneurysm surgery: changing the paradigm of complication management

ABSTRACT Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed

Laceration of the posterior inferior cerebellar artery by suboccipital puncture of the cisterna magna: case report Laceração da artéria cerebelar póstero-inferior causada por punção suboccipital: relato de caso

We report the case of a 27 year old man who presented to the emergency room of a hospital with headache, vomiting and an episode of loss of conciousness. A cranial CT scan was normal and the patient discharged. Ten hours later he came to the emergency room of our hospital with the same complaints. A technically difficult cisternal puncture in an anxious patient who moved during the needle introduction was done. The CSF sample showed 1600 intact red blood cells without other alterations. His headache worsened and after 6 hours he became drowsy, numb and exhibited decerebration signs. A new CT scan showed diffuse subarachnoid and intraventricular blood. An emergency angiogram demonstrated laceration of a left posterior-inferior cerebellar artery in its retrobulbar loop with a pseudoaneurysm. He was succesfully treated by surgical clipping without injury. Sixteen days later he was discharged with a normal neurological exam.<br>Relatamos o caso de um homem de 27 anos que procurou o pronto atendimento de um hospital com cefaléia intensa, vômitos e um episódio de perda de consciência. Uma tomografia de crânio foi normal e o paciente foi dispensado. Dez horas após, o paciente procurou o setor de emergência do nosso hospital com as mesmas queixas. Uma punção suboccipital tecnicamente dificultada pela ansiedade do paciente que se movimentou durante a coleta foi realizada evidenciando amostra de LCR levemente hemorrágico. A análise do LCR mostrou presença de 1600 hemácias íntegras sem aumento de leucócitos nem alterações bioquímicas. Houve piora acentuada da cefaléia e após 6 horas apresentou sonolência, torpor e sinais de descerebração. Nova tomografia mostrou sangue no espaço subaracnóideo e nos ventrículos. Uma angiografia realizada de emergência demonstrou laceração da artéria cerebelar póstero-inferior esquerda com a formação de um pseudoaneurisma. O paciente foi de imediato operado tendo sido realizada a clipagem do pseudoaneurisma com sucesso. Dezesseis dias após o paciente teve alta com exame neurológico normal