Cavernous malformations: surgical management in Belo Horizonte Santa Casa Hospital

The better understanding of the natural history of the cavernous malformations and the improvement of diagnostic methods and of microsurgical techniques have made the management of cavernous malformations possible through the conservative treatment, radiosurgery, and microsurgical resection. We present 33 cases operated at our service at Santa Casa Hospital, Belo Horizonte, from 1992 to 2001. Cortical and subcortical cavernomas manifested by epilepsy (57.5%) or mainly by hemorrhage (15.1%) were surgically approached, the deep lesions (basal ganglia, talamo and brain steam) represented 27.7% of our cases. They should only be operated when located near the pial or ependimary surface. the resection of spinal cord lesions (5.5%) and of deep brain lesions is also recommended when they present progressive focal deficit (13.8%) or recurrent episodes of hemorrhage (13.8%). Small and deep seated cavernomas that do not present bleeding must be conservatively treated. There has been no evident favourable result related to radiosurgery so far.Fac Ciencias Med Minas Gerais, Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilEscola Paulista Med, Belo Horizonte, MG, BrazilEscola Paulista Med, Belo Horizonte, MG, BrazilWeb of Scienc

Pituitary deficiency after aneurysmal subarachnoid hemorrhage

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p;0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome

Revista Brasileira de Enfermagem

Profile of patients with brain tumors and the role of nursing care Revista Brasileira de Enfermagem, vol. 69, núm. 1, enero-febrero, 2016, pp. 150-155 Associação Brasileira de Enfermagem Brasília, Brasil ABSTRACT Objective: to describe the profi le of 200 patients with central nervous system tumors (CNST), and the role of the nursing care. Method: prospective, quantitative and descriptive analysis of medical records of 200 patients with TSNC. Results: a total of 61% of our patients had benign CNST and 39% had malignant tumors. The extent of patient dependence, according to the Karnofsky Performance Status scale, was signifi cantly greater for patients with malignant CNST (p < .05), indicating that these patients needed more support with their activities of daily living. Conclusion: patients with CNST need specialized care, with specifi c guidance regarding their disease and aspects of daily living after treatment. Thus, the nurse can function as a key element for the effectiveness of care provided to patients and family members with the aim of enhancing the quality of life of all those affected, directly or indirectly, by the disease. Key words: Brain Neoplasms; Nurse's Role; Nursing Care; Karnofsky Performance Status; Oncology Nursing RESUMO Objetivo: descrever o perfi l de 200 pacientes com tumores no sistema nervoso central (TSNC) e o papel do cuidado em enfermagem. Método: análise prospectiva, quantitativa e descritiva de prontuários de 200 pacientes com TSNC. Resultados: 61% dos pacientes possuíam TSNC benignos e 39% tumores malignos. O grau de dependência do paciente de acordo com a Escala de Karnofsky foi signifi cativamente maior para pacientes com tumores malignos (P <0,05), indicando que estes precisam de maior esforço e, consequentemente, apoio em suas atividades diárias. Conclusão: Pacientes com TSNC necessitam de cuidados especializados, com orientações específi cas a respeito de sua doença e aos aspectos da sua vida diária após o tratamento. Assim, o enfermeiro pode ser um elemento-chave para a efi cácia dos cuidados prestados aos pacientes e familiares com o objetivo de melhorar a qualidade de vida de todas as pessoas afetadas, direta ou indiretamente, pela doença. Descritores: Neoplasias Encefálicas; Papel do Profi ssional de Enfermagem; Cuidados de Enfermagem; Avaliação de Estado de Karnofsky; Enfermagem Oncológica. RESUMEN Objetivo: describir el perfi l de los 200 pacientes con tumores del sistema nervioso central (TSNC) y el papel de la enfermería. Método: análisis prospectivo, cuantitativo y descriptivo de los registros médicos de 200 pacientes con TSNC. Resultados: 61% de los pacientes tenían TSNC benignos y 39% tumores malignos. El grado de la dependencia de los pacientes según la Escala de Karnofsky fue signifi cativamente mayor en los pacientes con tumores malignos (P <0,05), lo que indica que estos pacientes necesitan más apoyo en las actividades diarias. Conclusión: los pacientes con tumores cerebrales requieren atención especializada, con directrices específi cas sobre su enfermedad y aspectos de la vida diaria después del tratamiento. Por l

E-learning for neurosurgeons:Getting the most from the new web tools

As open access resource, the role of Internet has been increasing in our professional life. There are several emergent new tools that can facilitate and make it more efficient to get accurate and reliable information. In this article, we discuss how we can manage to get the most from these new instruments, like blogs, Facebook, Twitter, and LinkedIn, in order to improve clinical practice. With good sense and some caution, these can turn to be of valuable help in our careers