Estudo do efeito do ginseng para melhora de vasoespasmo cerebral em ratos pós hemorragia subaracnóidea / Study of the effect of ginseng for the amelioration of cerebral vasospasm in rats after subarachnoid hemorrhage

O Vasoespasmo cerebral é uma patologia caracterizada pelo estreitamento de artérias cerebrais localizadas na base do encéfalo pós hemorragia subaracnóidea, devido a formação de Oxihemoglobina, proveniente da degeneração dos produtos sanguíneos, que leva ao início de uma cascata de eventos no endotélio vascular, responsáveis por promoverem a contração da parede arterial e, consequentemente, a isquemia cerebral secundária.O Panax ginseng é uma erva asiática conhecida pelo seu poder terapêuticos e farmacológicos, utilizado na Ásia há muito tempo. Estudos em células progenitoras neurais mostraram que o Ginsenosídeo Rb1 tem efeito protetor contra lesões por estresse oxidativo.O trabalho teve como objetivo a avaliação do efeito protetor contra vasoespasmo do Panax ginseng.Como metodologia, realizou-se um estudo experimental com injeção de sangue autólogo na cisterna magna em vinte ratos, sendo dez do grupo controle e dez do grupo experimental que haviam sido gavados com Panax ginseng por duas semanas. Após o período de espera necessário para criar o vasoespasmo, os ratos foram reabordados a fim de medir o fluxo sanguíneo cerebral com probe intracraniano.Observou-se na análise dos extremos dos valores de velocidade de fluxo obtidos uma possível relação positiva do Ginseng na prevenção do Vasoespasmo cerebral

Cordomas: estudo anátomo-clínico de 8 casos

Eight patients with the diagnosis of chordoma during the period 1953 to 1985 were reviewed; 6 of them with tumor in the intracranial region, 1 in the cervical spine and 1 with probably sacrococygeal primary site. Clinical aspectsof physical and neurologic examination and diagnostic methods were analyzed. It is emphasized: the tumor's rarity, its predominancy in females and in the intracranial region, and its greater incidence in the third decade (average age: 31 years). The chordomas present multiform symptomatology,depending on their site; although they are hystologically benign, the 5-year survival rate is low, due to their infiltrative behaviour, to the occurence of reincidence after surgery and/or radiation therapy and to eventual metastasis.Foram estudados e revistos 8 casos de pacientes com cordomas, diagnosticados no período compreendido entre janeiro de 1953 e dezembro de 1985, sendo 6 de localização intracraniana, 1 de origem sacrococcígea provável e 1 cervical. Analisaram-se dados clínicos de exame físico e neurológico, bem como métodos diagnósticos. Ressaltam-se a raridade do tumor, o predomínio deste em pacientes do sexo feminino e em território intracraniano (estes dois últimos dados conflitantes com os da literatura) e seu acometimento na faixa etária de 30 anos (idade média de 31 anos). Os cordomas apresentam sintomatologia diversa, dependente de sua localização; apesar de possuirem caracteres histológicos benignos, a sobrevida em 5 anos é baixa, por causa do seu comportamento infiltrativo, da ocorrência de recidivas após tratamento radioterápico e/ou cirúrgico e de eventuais metástases

Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

Introduction: The spinal cord stimulation (SCS) has been described as a valuable neuromodulating procedure in the management of chronic and medically untreated neuropathic pain. Although, many studies have discussed the use of this technique, a question still remains regarding its efficacy in different medical conditions with different etiology in the long term. The aim of this paper is to discuss the risks, complications, cost-effectiveness and results of SCS in patients affected by chronic neuropathic pain based on the comprehensive literature review. Methods: Bibliographic search of references from 1950 to 2016 using the databases MEDLINE, LILACS, SciELO, PubMed, and applied language as selection criteria, choosing preferably recent articles written in Portuguese, Spanish or English. Results: Based on literature review, SCS is a safe, reversible, adjustable and nondestructive surgical procedure demonstrating a significant effect in the reduction of pain intensity and improvement in quality of life in these patients. Furthermore, in spite of the initial high cost to its application, SCS has been associated with lower rates of complications and high rates of cost-effectiveness when compared to standard therapies. Conclusion: Although used in medical conditions with different etiology, the procedure is still an effective and a cost-effective approach to neuropathic pain, mainly in patients affected by failed back pain syndrome (FBSS) and complex regional pain syndrome (CRPS)

Schwannoma of the Intermediate Nerve: A Rare Type of Cerebellopontine Angle Tumor

Abstract Background: Schwannoma of the Intermediate Nerve is rare. The most majority of Cerebellopontine angle (CPA) lesions are Vestibular Schwannomas. Case description: A 50-year-old woman presented with ear pain, facial palsy and hypoacusis. MRI revealed a CPA tumor. A left retrosigmoid approach and microsurgery was performed and the tumor origin was from the intermediate nerve. intraoperative neurophysiologic monitoring (MNIO) was used during the surgery. Conclusion: Schwannomas of the intermediate nerve is indistinguishable from vestibular schwannomas on preoperatory image, however it's possible to identify tumor origin during microsurgery dissection with aid of MNIO and origin from intermediate nerve is a reality

Surgical approaches to petroclival meningiomas Part 2 : narrative review of what we learned with 30 cases

Antecedentes: La resección quirúrgica de los meningiomas petroclivales es un desafío debido a su ubicación profunda y su relación con las estructuras neurovasculares vitales. Por lo general, son lesiones benignas, pero pueden involucrar o infiltrar huesos en la base del cráneo, la duramadre y el tronco encefálico. Esto hace que la extirpación total sea muy difícil o imposible sin causar déficits neurológicos. El objetivo de este estudio es revisar los abordajes quirúrgicos utilizados para tratar los meningiomas petroclivales y las lecciones que hemos aprendido en el manejo quirúrgico de 30 casos. Métodos: Serie de casos de 30 meningiomas petroclivales. Al comienzo de nuestra serie, utilizamos el abordaje petroso para todos los casos, pero con la adquisición de experiencia comenzamos a indicar cada vez más el abordaje retrosigmoideo, reservando los abordajes petrosos y cráneo-orbito cigomático para casos seleccionados. Resultados: Debido a la dificultad de acceso, los meningiomas petroclivales generalmente requieren diferentes abordajes quirúrgicos y presentan diferentes dificultades quirúrgicas. Hay tres abordajes principales: fronto-orbito-cigomático y variantes; petroso y variantes; y retrosigmoideo, pudiendo ser combinados. La elección del abordaje quirúrgico generalmente se basa en la ubicación y extensión del tumor, la forma del cráneo y la participación de las estructuras venosas, y la experiencia del cirujano. Conclusión: Los meningiomas petroclivales son raros y complejos en la base del cráneo. Elegir el abordaje correcto es crucial para un resultado quirúrgico exitoso.Background: The surgical ressection of petroclival meningiomas is challenging due to its deep location and relationship with vital neurovascular structures. Usually they are benign injuries, but they can involve or infiltrate skull base bones, dura mater and brainstem. This makes the total removing very difficult or impossible without causing neurological deficits. The objective of this study is to review the surgical approaches used on the treatment of petroclival meningiomas and the knowledge which we achieved upon the surgical management of 30 cases. Methods: Series of 30 petroclival meningioma-cases. In the beginning of our series we used petrous approach for all the cases, however, with the acquiring of experience, we are indicating the retrosigmoid approach, leaving the petrous and skull-orbito-zigomatics approaches for selected cases. Results: Owing to the difficulty of the access, the petroclival meningiomas usually require different surgical approaches and have distint surgical difficulties. There are three main approaches: fronto-orbito-zigomatics and variants; petrous and variants and retrosigmoid, and they can be combined. The choice for a surgical approach is usually on the location and size of the tumor, on the skull shape, the involvement of venous structures and according to the surgeon´s experience. Conclusion: Petroclival meningiomas are rare and complex on the skull base. The adequate choice is crucial to achieve the good surgical result