Cenurosis in a Sheep with Neurological Signs - Diagnosis with Computed Tomography

Background: Cenurosis is a parasitic disease caused by Coenurus cerebralis, an intermediate form of Taenia multiceps multiceps, causing a fatal disease in production animals. Its adult form (Taenia) lodges in the small intestine of canids and can infect several intermediate hosts.Sheep are the main species affected by the disease, having nervous symptoms as one of its manifestations.This study aimed to describe the changes observed in computed tomography, as well as the clinical findings of a case of Cenurosis in a sheep on the western border of Rio Grande do Sul.Case: A ram was referred to the Centro Universitário da Região da Campanha (URCAMP) with neurological signs.Clinical, hematological, radiographic, tomographic and necroscopic evaluation of the animal was performed.There were no significant hematological and radiographic changes.During the neurological examination, corneal opacity was found in the right eyeball, associated with a visual deficit in the same eye.Also, when stimulated to move, it was possible to observe ataxia with ambulation to the left side, with right lateral displacement of the head.The tomography showed a hypodense area of approximately 3 cm at the base of the brain, in the region of the thalamus and third ventricle.Macroscopically, a translucent spherical cyst with approximately 4 cm in diameter was observed, containing the protoescolex/scolices of Taenia multiceps in the same region.Discussion: Computed tomography identified the presence of an apparently circular volume of approximately 4 cm in diameter, causing ventricular dilatation.This evidence of ventricular dilation corroborates aspects described in the literature, which found bilateral dilation of the ventricles by compression promoted by a cyst in the 4th ventricle.As the location of the cyst was located at the base of the brain, in the region of the third ventricle, it would be difficult to perform the surgery in the treatment of this case.Signs of ataxia, walking movements, decreased reflexes, nystagmus, unilateral blindness and lateral decubitus are commonly observed.Reports described that the main neurological alterations observed in 20 sheep with cenurosis were postural deficit, locomotion alteration, visual deficit and behavioral alterations, with more than 50% of the animals showing at least one of these signs.The main neurological signs observed in the case described were changes in gait, with walking, blindness, lateral head deviation and ataxia. These signs guide the clinical diagnosis of cenurosis.At necropsy, a spherical translucent cyst with approximately 4 cm in diameter was observed, containing the protoescolex/scolices of Taenia multiceps, which extended dorsally from the third ventricle to the base of the thalamus, laterally displaced to the right side.Rostrocaudal the lesion extended rostrally across the entire length of the thalamus to the beginning of the caudate nucleus and caudally to the base of the caudal colliculus, causing compression of the adjacent parenchyma, enabling the diagnosis of cenurosis.Similar findings are described as Coenurus cerebralis. This lesion pattern macroscopically characterizes the parasite lesions.Thus, it is concluded that the visualization of a hypodense area in CNS regions of sheep with neurological signs allows the diagnosis of cenurosis and precise location of the lesion.The description of this case adds information so that other professionals in the field can be successful in diagnosing the disease.Keywords: parasitologia, Taenia multiceps multiceps, Coenurus cerebralis, ovelhas, torneio verdadeiro.Descritores: parasitology, Taenia multiceps multiceps, Coenurus cerebralis, sheep, true tournament.Título: Cenurose em ovino com sinais neurológicos - diagnóstico com tomografia computadorizada.

Laparoscopic diaphragmatic hernioplasty in a dog

A hérnia diafragmática é caracterizada pela passagem das vísceras abdominais para a cavidade torácica, podendo ser de origem congênita ou adquirida, que exige o tratamento cirúrgico. Quando houver ausência de tecido ou em casos de herniação com evolução crônica, recomenda-se a utilização de implantes biológicos ou sintéticos. O objetivo deste trabalho é relatar a técnica de herniorrafia diafragmática laparoscópica com o uso de pericárdio bovino conservado em um canino, a partir do acesso laparoscópico com três portais. Devido ao grande defeito diafragmático, optou-se pela sua redução com o auxílio de implante de pericárdio bovino conservado em formaldeído a 4%, este fixado a musculatura diafragmática com sutura intracorpórea, utilizando para isso duas camadas de sutura ambas com náilon 0, a primeira contínua simples seguida de pontos isolados simples, em toda extensão da membrana conservada. Apesar do animal vir a óbito nas primeiras 24 horas do pós-operatório, a técnica adotada se mostrou viável.A diaphragmatic hernia is characterized by the passage of the abdominal viscera into the thoracic cavity, which may be congenital or acquired. Its treatment is achieved by surgical correction. When there is no tissue or in cases of herniation with a chronic disease, the use biological or synthetic implants is recommended. The objective of this study was to report a technique of laparoscopic diaphragmatic hernia repair using bovine pericardium preserved in a canine, using three portal accesses. Due to the large diaphragmatic defect, reduction with the aid of a network of preserved bovine pericardium in formaldehyde 4% was chosen. The mesh was sutured to the transversus abdominus muscle in two layers. The first layer was sutured using simple continuous pattern, and the second one using simple interrupted sutures. The patient collapsed and died 24hours postoperatively. However, the purposed technique was feasible.

Facial Paralysis Secondary to Hypothyroidism in a Dog

Background: Secondary neurological disorders hypothyroidism is unusual in dogs, especially when compared with other clinical signs, such as lethargy, weight gain and dermatological alterations. When manifested, these signals refer to the peripheral or central nervous system and the most common include: vestibular disease, seizures, laryngeal paralysis, poly­neuropathy and paralysis of the facial nerve. Several reports of neurological disorders associated with hypothyroidism are found in literature, basically international. In the national literature, however, there are few reports on the subject. Thus, the aim of this study was to report a case of facial paralysis associated with hypothyroidism in a dog.Case: A male canine, the boxer race, with 7-year-old were referred to the Veterinary Medical Teaching Hospital of the UFSM with a history of difficult water and food intake and asymmetry of the face for seven days. On neurological ex­amination, the animal found itself alert and locomotion, postural reactions and segmental reflexes without changes. In the evaluation of the cranial nerves, there was a menace response absent the right side, however with preserved vision, palpebral and lip ptosis of the right side and reflection palpebral absent on the same side. Opposite the historical, clinical, neurological and laboratory test findings, the diagnosis was facial paralysis secondary to hypothyroidism. As differential diagnoses were listed, inner otitis neoplasm in inner ear, trauma and idiopathic facial paralysis. After the diagnosis, clini­cal treatment was instituted with levothyroxine sodium, at a dose of 0.02 mg kg orally every 12 h, being observed total improvement of clinical signs (no changes for water intake and food, menace response and reflection palpebral normal and symmetry of the face) in 32 days.Discussion: The diagnosis of facial paralysis associated with hypothyroidism was based on the history, clinical and neurological examination findings, laboratory assessment of thyroid function by observing low serum free T4 and high concentrations of TSH, the therapeutic response after supplementation levothyroxine sodium, and exclusion of other pos­sible causes, such as otitis interna and traumatic. The pathogenesis of this change associated with hypothyroidism is not completely understood, although it is believed that cranial nerve paralysis (trigeminal, facial and vestibulocochlear) may result from the resulting compression of myxedema deposit nerve or in the tissues of the head and neck, demyelination caused by disordered metabolism of Schwann cells, decreased blood perfusion of the inner ear secondary to hyperlipidemia and increased blood viscosity or metabolic defects ranging from change in axonal transport to severe axonal loss. Treatment consists of supplementation of levothyroxine and most dogs with neurological disorders associated with hypothyroidism will present partial or total improvement of clinical signs between two and four months, generally being observed improve­ment within the first week of treatment. In the dog this report, after the beginning of treatment, improvement was observed partial and total clinical signs in 15 and 32 days, respectively. Therefore, with appropriate treatment, hypothyroidism is a disease with an excellent prognosis. The report brings to clinical relevance, the importance of hypothyroidism in the dif­ferential diagnosis of facial paralysis in dogs with face asymmetry history, the laboratory evaluation of thyroid function and response to therapy with levothyroxine sodium supplementation essential for definitive diagnosis. Keywords: neurology, facial nerve, peripheral neuropathy, dogs

Surgical Correction of Esophageal Stenosis by Right Aortic Arch Persistence in Two Cats

 Background: Vascular ring anomaly is considered a hereditary change. It occurs when the fourth right aortic arch persists instead of the fourth left aortic arch, forming a vascular ring that compress the esophagus causing esophageal dilatation cranial to the compression site. Diagnosis is based upon anamnesis, physical examination, clinical signs and complementary exams (radiograph, complete blood count and biochemical tests). The clinical treatment is inadequate, since the dilatation persists and tends to progress causing irreversible tissue injury. Surgical correction is indicated and consists of the arterial ligament resection and correction of the esophageal stenosis.Case: The objective of the current study is to report two case of persistence of right aortic arch in two cats referred to the Veterinary Hospital of the Federal University of Santa Maria. On physical examination the patients were alert, in good nutritional status, adequately hydrated and presented normal colored mucous membranes. Each animal underwent radiog­raphy and esophagogram with barium sulphate. The exam demonstrated partial esophageal dilation cranial to the cardiac silhouette, suggestive of vascular ring anomaly. An exploratory thoracotomy was performed in order to achieve the definitive diagnosis. The arterial ligament was resected and esophageal stenosis corrected. Anesthesia, surgery and the postoperative period undergo without any complications. Patients remained hospitalized in the first 24 h for observation and were dis­charged after this period. Ten days surgery they returned for revaluation and removal of the skin suture. Four months after the surgical correction the animals underwent a new radiography and esophagogram examination. Radiographic findings evidenced persistence of esophageal dilation and narrowing of the esophageal lumen. Patients were evaluated periodically up to 10 months after surgery, verifying excellent quality of life and remission of clinical signs.Discussion: Vascular ring anomalies affects both dogs and cats, occurring more commonly in purebred dogs than in mixed breed. The literature reports cases in young Siamese and Persian cats, although the absolute numbers are insufficient to make conclusions about the racial predisposition. This case report enrolled two cases of PRAA in adult mixed breed cats (one male and one female from the same litter). Surgical correction is the recommended treatment for PRAA, either con­ventional or minimally invasive techniques. To assist the dissection of the fibrous ring and correction of esophageal stenosis we utilized a 22 Fr Foley catheter, introduced through the oral cavity to the esophageal stenotic area. The inflation of the balloon on the constricted area allows visualization of residual fiber rings and facilitates its dissection and removal. The PRAA mortality is associated with late diagnosis and the coexistence of aspiration pneumonia. Therefore, surgery should be performed as soon as possible after the onset of clinical signs, in order to reduce damage to the esophageal muscles and nerves. It is estimated that 80% of cases survived the postoperative period. In both cases, no clinical signs were observed, and there was a reduction of the esophageal diameter compared with the previous dilation, as well as better esophageal transit. Ten months after surgery, the animals returned for revaluation, presenting adequate body development and good quality of life. As shown in this case report, surgical intervention allowed for the accurate diagnosis and correction of PRAA in cats, with remission of clinical signs and full recovery of the animal.Keywords: cat, regurgitation, megaesophagus, thoracotomy, anomaly

One-stage Laparoscopic Nephrectomy and Ovariohysterectomy for Concurrent Dioctophymosis and Pyometra in a Bitch

Background: Dioctophyme renale, also known as “giant kidney worm”, is a cosmopolitan parasite, which usually affects domestic and wildlife canids in wetlands. Nephrotomy and nephrectomy are the only treatment options. Laparoscopic nephrectomy for dioctophymosis was first performed in veterinary patients in the late 90’s. Canine pyometra is one of themost frequent surgical disorder in the small animal setting. The purpose of this study was to report a case of successful one-stage laparoscopic approach for nephrectomy and ovariohysterectomy in a bitch.Case: A female stray dog, rescued from a riverside community, was presenting hematuria. Abdominal echography revealed presence of Dioctophyme renale worms within the right renal parenchyma. Moreover, the uterus was moderately filled by anechoic content. The patient was clinically stable and undergone laparoscopy. A 10-mm trocar was established at the middle third of the right flank, followed by 12-mmHg CO2 insufflation. The telescope was inserted and a giant worm wasseen free within the abdominal cavity. A second 10-mm port was inserted cranial and dorsally to the first one. The parasite was retrieved using a laparoscopic Kelly forceps. A third 5-mm trocar was inserted in a classic laparoscopic triangulation port positioning. Renal artery and vein were individually triple ligated using titanium clips and then transected. The rightovarian pedicle was sequentially coagulated and transected using laparoscopic bipolar forceps. The right kidney was then dissected and detached from the abdominal wall, followed by cauterization and transection of the left ovarian pedicle. The uterus was exposed out of the abdominal cavity through the 5-mm port access. Uterine body and vessels were double ligated using polyglactin 910, with transfixating ligatures, and then transected. The opening of the retrieval bag was exposed through the cranial port site incision. Eight dioctophyme worms and the kidney sections were withdrawn through the sacusing a Kelly hemostat. Abdominal wounds were closed in two layers using cross-mattress polyglactin 910 sutures. Skinwas closed using interrupted horizontal mattress nylon sutures. Patient was discharged on the early post-op, receiving tramadol chloride and sodium dipyrone for three days and enrofloxacin for seven days. The patient recovered uneventfully. Owner was contacted by phone eight months following surgery, which informed the bitch was clinically stable.Discussion: Riverside stray dogs present high incidence of dioctophymosis worldwide, due to irregular feeding and consequent intake of intermediate hosts. The reported patient met those features, without previous background regarding infestation episode. It presented hematuria, which usually results from renal parenchyma consumption by the worms. The patient was retrieved nine dioctophyme worms. Laparoscopic approach for nephrectomy has already been reported in veterinary patients, as well as three-port lap-assisted OVH have been performed. Innovative aspect of this case report concerns the one-stage laparoscopic approach for both nephrectomy and OVH. Moreover, the procedures required only three-port access, which was considered a suitable and safe minimally invasive approach in dogs affected by Dioctophyme renale and concurrent indication for OVH. The three-port access shown is adequate to perform one-stage nephrectomy and ovariohysterectomy in bitches, for reaching benefits of laparoscopic surgery in comparison to conventional approaches.Keywords: canine, endosurgery, kidney, laparoscopy, videosurgery

Laparoscopic diaphragmatic hernioplasty in a dog

A diaphragmatic hernia is characterized by the passage of the abdominal viscera into the thoracic cavity, which may be congenital or acquired. Its treatment is achieved by surgical correction. When there is no tissue or in cases of herniation with a chronic disease, the use biological or synthetic implants is recommended. The objective of this study was to report a technique of laparoscopic diaphragmatic hernia repair using bovine pericardium preserved in a canine, using three portal accesses. Due to the large diaphragmatic defect, reduction with the aid of a network of preserved bovine pericardium in formaldehyde 4% was chosen. The mesh was sutured to the transversus abdominus muscle in two layers. The first layer was sutured using simple continuous pattern, and the second one using simple interrupted sutures. The patient collapsed and died 24hours postoperatively. However, the purposed technique was feasible

Metamizol and Scopolamine for Conventional or Two-Port Laparoscopic-Assisted Ovariohysterectomy in Dogs

Background: Ovariohysterectomy (OVH) is one of the most appliedtechniques in Veterinary Medicine. Although some analgesic protocols are used after this procedure in order to control post operatory pain, there is a lack of knowledge of the efficacy after conventional and two port laparoscopic-assisted techniques in dog female. Although the combined formulation of metamizol and scopolamine is used, there is no knowledge about the efficacy and collateral effects in a 6 h regimen after OVH. The aim of this research was to evaluate the efficacy of metamizol and scopolamine to analgesia after two techniques of OVH in dog female.Materials, Methods & Results: Fifteen adults and healthy dog female were submitted to OVH, being eight to the conventional procedure and seven to video assisted technic with two ports. The patients received a combination of metamizol and scopolamine, 6-6 h during 48 h and were evaluated before surgery, 60 min after extubation and on 1 h interval during the first 8 h, and at 12, 18, 24, 36, 48 and 72 h after surgery. For this, the University of Melbourne Pain Scale (UMPS) and the short-form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were applied by three evaluators blinded to surgical technic. Glucoses measurement was realized at 1, 6, 12, 24, 48 and 72 h after surgery. Analgesic rescue was not necessary for any animal. Punctuation of UMPS in GC decreases at 8 h and at 5 h, and to GV at 12 and 24 h. Difference between groups happened at 3 h with larger average to GV; at 48 h the punctuation in GC was lager. Considering CMPS-SF to CG, higher average was observed at 1 h and decreased at 2, 3, 8 and 18. At GV highest average points was verified at 1, 2 and 3 h and decreased at 5, 8 and 18 h. Correlation was strong and positive between each two evaluators. Animals of both groups had increased average glucose concentrations from baseline to after surgery and the values reduced to baseline after 24 h; difference between groups were observed at 1 h after surgery, with bigger average to GC. Three animals from the GC had postoperative emesis and one patient vomited after 3 h; other at 6 h and another at 36 and 48 h and owners related no vomiting or changes following hospital discharge. The time to first spontaneous food intake was earlier to GV and time to first defecation was no different between groups. Discussion: For the evaluation it was used the UMPS and CMPS-SF since it is know that pain assessment is better performed when multidimensional or composite scales are used. Considering the UMPS, 27 points is considered the most painful condition. In our study it was observed bigger average to GC at 1 h (4,5) and to GV at 2 and 3 h (5,0). According to CMPS-SF, higher punctuation to GC (7.0) was observed than GV (6,0) in a maximum of 24 points. Considering both scales, it could be suggested that the combination of metamizol and scopolamine promote good analgesic effect. The glucoses measurements and the first spontaneous food intake suggested that laparoscopic approaches results in less stress than the traditional procedures, as observed in other studies. Three animals of GC had postoperative emesis, and it signal can be associated to abdominal pain, as well nausea, vomiting, diarrhea and abdominal distention, probably because it is accepted that video surgery promotes less pain and stress than open procedures. The protocol was efficient to control pain after elective conventional and laparoscopic assisted OHV technique in dog female.

Encephalic Meningioma in Dogs

Background: Meningioma is the most common brain tumor in dogs. These extra-axial tumors originate in one of the meninges, and arachnoid is the most common. Several retrospective studies of brain tumors are found in the international literature. However there are few researches in the national literature. The purpose of this study is to report twelve dogswith brain meningioma. The breed, gender, age, neurological signs, the brain location, the clinical evolution, the tumor classifcation and diagnostics tests were investigated.Cases: Twelve dogs were attended at Veterinary Hospital of Santa Maria University: six mixed-breeds; four Boxer; a Dachs hund; and a Poodle. The age ranged from eight to 14 years, with average of ten years and nine months old. The clinical signs observed were generalized seizures (9/12); behavioral changes (6/12); walk in circle (5/12); swallowing diffculty (2/12 [16%]); hypermetria (2/12); central vestibular syndrome (1/12); and amaurosis (1/12). The presumptive diagnosis was brain neoplasm in all dogs. Six dogs were underwent symptomatic treatment with corticosteroids and anticonvulsants; two dogs were underwent corticosteroids; and four were euthanized without performing treatment. After starting treatment,four dogs (50%) showed clinical improvement in the frst week, however, the clinical signs worsened after two weeks. The thalamus-cortex region was affected in seven cases (59%), followed by cerebellar-pontine region (25%), brainstem (8%) and cerebellum (8%). In the histological classifcation of meningiomas, the meningothelial variant was observed in six dogs, three psammomatous, two transitional and a fbroblast.Discussion: The average age of initiation of clinical signs was ten years and nine months, similar result found in a large study about brain tumor. Female dogs were most affected (n = 8), although some authors did not report sexual predis position. The neurological signs of dogs with brain meningiomas occur through adjacent structures compression, directinvasion of tissues, interruption of circulation, edema, inflammation and necrosis. The thalamus-cortex region was the most affected and the seizures were the most common clinical signs observed in dogs, according to the international literature. The meningiomas canine are histologically classifed into two groups: benign tumors (meningothelial, fbroblast,transitional, psammomatous, angiomatous, papillary, myxoid and granular cells); and malignant tumors (anaplastic). The meningothelial variant was found most frequently in this stud (50%), according to the others authors. The clinical course of time was determined from the onset of signs found in neurological examination until the time of death or euthanasia of dogs, being progressive in all patients. In this study, encephalic neoplasms showed slow evolution of signals between fve to 180 days (mean 58 days). This time is longer compared to other study in which the mean survival of 86 dogs was 30 days. In the present study, there was only symptomatic treatment with corticosteroids and/or anticonvulsant. The conclusion of this study is that brain meningioma is a common tumor; occur in adult and older dogs of different breeds; the clinical signs more frequent were seizures, behavioral changes and walk in circle to the side of the lesion. The palliative treatment with corticosteroids and anticonvulsants may be effcient in controlling the clinical signs, however the long-term prognosis is adverse.Keywords: neoplasm, brain, neurology, dog

Laparoscopic Nephrotomy to Removal of Staghorn Calculus in a Canine

Background: Renal urolithiasis is the third most common disease of the urinary tract of dogs. In humans, staghorn lithiasis affects 1 to 1.5% of the population, often women over 50 years old. In veterinary medicine, this type of lithiasis has been little reported, and there are few descriptions of treatment, both in small and large animals. The objective of this work is to report a rare case of renal staghorn stones treated by laparoscopic nephrotomy.Case: A six-year-old female schnauzer with 6 kg body weight was evaluated clinically in order to spay. According to the owner, the animal showed polydipsia. Additional tests such as blood count, serum biochemistry, radiography and abdominal ultrasound were done, showing hematological examinations within the standards for the species. After the ultrasound we noticed an asymmetric kidneys with the right kidney with preserved cortical layer and hyperechoic line corticomedullary interface, with posterior acoustic shadow and left kidney with relative/corticomedullary differentiation and pelvis preserved without alteration; this evocative image of kidney stones in kidney right. In abdominal radiographs was possible to visualize radiopaque mass in the right kidney compatible with renal staghorn stones. Excretory urography was done, which demonstrated evident excretion of contrast material in the left kidney and the right kidney doubtful. Based on these findings, we opted for exploratory laparoscopy followed by laparoscopic nephrectomy or nephrotomy for removal of urolithiasis, depending of the lesions visualized during the procedure. All procedure were performed using a minimally invasive approach without the need for conversion to open or videoassisted procedures. The most complex and delicate step was the nephrorrafy, due the little time for suturing to avoid renal ischemia. Eight months after the surgery, the owner is contacted, and it said that the animal was well, without clinical signs of kidney disease. After returning and performing ultrasound and excretory urography revealed that the right kidney had atrophied, but there was still draining contrast shown by excretory urography.Discussion: Although the use of laparoscopy is increasing worldwide is still considered an underexplored approach to renal calculi in veterinary medicine. Our choice in this case was due the numerous potential advantages that have minimally invasive compared to open technique, as demonstrated in medicine and veterinary medicine studies. At the beginning of laparoscopy was possible to elect the procedure (nephrectomy or nephrotomy) to be performed; the anatomic changes presente as renal artery patency /coloring kidney and wrist, observed by laparoscopic visualization, with amplification, showed the possibly of renal preservation. This is an advantage associated with videosurgical access. Laparoscopic view allowed to discard residual gallstones as well as to promote the correct synthesis of renal tissue. All steps of the nephrotomy were performed by minimally invasive access. It was not possible to directly correlate with the histological analysis technique renal disorder before and after the surgery, because the kidney was already reduced in size in the first operation and biopsy was not done in that occasion. The present report demonstrates that laparoscopic surgery can be considered viable for the management of renal staghorn stones in dogs.Keywords: surgery, nephrolity, canine

Colopexia e deferentopexia em canino com Hérnia perineal recidivante: Colopexy and deferentopexy in a canine with recurrent perineal Hernia

O enfraquecimento seguido da descontinuidade da musculatura do diafragma pélvico é denominado hérnia perineal, podendo ocorrer de forma unilateral ou bilateral. O tratamento preconizado para essa alteração é cirúrgico e envolve a herniorrafia e pexias dos principais órgãos envolvidos. O objetivo do presente trabalho é relatar o caso de um canino com hérnia perineal bilateral recidivante, com ênfase as organopexias. Foi atendido um canino, sem raça definida, castrado, 9 anos e 9,2 Kg, com queixa de aumento de volume perineal bilateral e histórico de dois procedimentos cirúrgicos anteriores para correção do mesmo defeito. A partir do diagnóstico por ultrassonografia e exame físico constatou-se que o animal apresentava novamente defeito herniário na região perineal bilateral. O paciente foi encaminhado para procedimento cirúrgico de herniorrafia, e após 37 dias de pós-operatório apresentou prolapso retal, sendo encaminhado para deferentopexia e colopexia. Após a segunda intervenção cirúrgica apresentou melhora clínica e recebeu alta médica. A eficácia do uso da organopexia na herniorrafia perineal é amplamente discutida na literatura e apresenta resultados divergentes entre autores quanto à redução da taxa de recidiva. Conclui-se com o presente relato que a abordagem cirúrgica utilizada teve resultado satisfatório até o momento, sendo necessário o acompanhamento do paciente para uma conclusão definitiva sobre a técnica proposta