Estudo microanatômico dos ramos corticais distais da artéria cerebral anterior

Os ramos corticais distais da artéria cerebral anterior são habitualmente as artérias orbito-frontal (AOf), fronto-polar (AFp), frontais internas anterior (AFIA), média (AFIM) e posterior (AFIP), do lóbulo paracentral (ALP), parietais internas superior (APIS) e inferior (APII) e artéria calosomarginal (ACm) . A distribuição destes ramos e suas variações têm importância clínica no tratamento das lesões vasculares da região inter-hemisférica. Foram estudados os ramos distais da ACA em 38 cérebros injetados com látex e dissecados sob magnificação. Os diâmetros e distâncias entre a origem dos vasos corticais distais e a ACoA foram analisados estatisticamente. O diâmetro médio da ACA após sua origem da ACoA foi de 2,61±0,34 mm e as médias dos diâmetoros das artérias corticais variou de 0,79±0,27 mm a 1, 84±0, 3 mm. As distâncias médias entre as origens de vários vasos e a ACoA variou de 7,68±3,91 mm (órbito-frontal) a 112,6±11,63 mm (parietal interna inferior). Variações anatômicas foram encontradas neste estudo: uma ACA ázigos estava presente em um caso e uma terceira ACA em 3. Em 26,3% dos casos, ramos cruzados da ACA distal suprindo o hemisfério contralateral foram encontrados. A presença de ramos cruzados da ACA distais à ACoA (artéria comunicante anterior) em 26,3% dos casos indica a importância desta variação anatômica quando se considera o diagnóstico e tratamento das lesões envolvendo a ACA. Nenhuma diferença estatisticamente significante foi encontrada entre os lados direito e esquerdo no padrão de ramificação, na distância entre a origem dos vasos e a ACoA e no calibre dos vasos.The distal branches of the ACA (anterior cerebral artery) are usually the orbitofrontal, frontopolar, anterior, middle and posterior internal frontal, paracentral lobe, the superior and inferior internal parietal arteries and the calosomarginal. The distribution of these branches and their variations have significant clinical importance in the treatment of vascular lesions of the interhemispheric region. The distal branches of the ACA in 38 brains injected with latex and dissected under magnification. The diameters and the distances between the origin of the distal cortical vessels and the anterior communicating artery were recorded and statistically analyzed. The average diameter of the ACA at origin was 2.61±0.34 mm and the average cortical branches diameter ranged from 0.79±0.27 mm to 1.84±0.3 mm. The average distances between the origin of the various vessels and the ACoA (anterior communicating artery) ranged from 7.68±3.91 mm (orbitofrontal) to 112.6±11.63 mm (inferior internal parietal). Anatomical variations were found in this study: an azigos ACA was present in one case anda triplicate ACA in 3. In 26.3% of the cases crossing branches of the distal ACA supplying the contralateral hemisphere were found. The presence of crossing branches of the ACA distal to the ACoA in 26.3% of the cases indicates the importance of this anatomic variation when considering the diagnosis and treatment of lesions involving the ACA. No statistically significant differences were found in the branching pattern, distance between the origin and the ACoA and caliber between the left and right sides

PERFIL DOS PACIENTES ACOMETIDOS PELA INCONTINÊNCIA URINÁRIA PÓS AVE ATENDIDOS EM UM CENTRO DE REABILITAÇÃO DE ALTA COMPLEXIDADE DO INTERIOR DO RIO GRANDE DO SUL.

INTRODUÇÃO: São vários os fatores relacionados com a ocorrência da Incontinência Urinária (IU), dentre eles, doenças prevalentes na população como o Acidente Vascular Encefálico (AVE). OBJETIVO: Verificar o perfil dos pacientes acometidos pela IU pós AVE atendidos em um centro de reabilitação de alta complexidade no interior do Rio Grande do Sul. MÉTODOS: Trata-se de um estudo transversal, no qual foram incluídos pacientes de ambos os sexos que apresentaram IU pós AVE  e, excluídos aqueles que apresentavam IU devido a outras patologias associadas ao sistema nervoso central (SNC) ou sistema nervoso periférico. As principais variáveis analisadas foram sexo, idade, tipo de AVE, antecedentes patológicos, presença de IU pré e pós AVE, Índice de Massa corporal (IMC), além da utilização do Índice de Barthel e do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). RESULTADOS: Amostra composta por 21 indivíduos, com idade média de 56 ± 12,44 anos. Todos eram continentes antes do AVE e, a maioria evoluiu para a incontinência. A predominância do tipo de AVE foi de etiologia isquêmica, houve um maior grau de dependentes leves na realização das atividades da vida diária, já conforme o ICIQ-SF a perda de urina causa um impacto tido como severo.  CONCLUSÃO: Concluímos que houve uma breve predominância de mulheres que sofreram AVE e que tornaram-se incontinentes, apresentando nível de dependência leve embora, impacto que a perda urinária gera foi considerado severo, interferindo na qualidade de vida

Image-guided temporal bone dissection course

Introduction: Temporal bone anatomy is complex and demands a profound anatomical knowledge. Association between surgery and imaging helps in the process of learning three-dimensional (3D) anatomy and surgical techniques. High definition temporal bone imaging can play an important role in dissection training. Objective: To describe a computed tomography (CT) image-guided temporal bone dissection course for surgical training in otolaryngology and to verify the satisfaction level of the students with the course. Methods: Descriptive research. The course took place at a research laboratory, with three experienced temporal bone surgeons. The participants were 12 otolaryngology residents. The laboratory has 7 modern workstations with microscope and monitors linked with a computerized video system. Cadaveric temporal bones were donated to the university. Imaging acquisition of the cadaveric temporal bones used in the course was performed in a multislice CT scanner. The CT images of cadaveric temporal bones were available with real-time access on the laboratory monitor's screens during dissections. Results: A total of 13 temporal bones were included for dissection. Students had the opportunity to view on the same screen, simultaneously, both the dissection video and the respective CT images of their temporal bone anatomical specimens. This allowed correlating surgical and imaging aspects of temporal bone anatomy. At the end of the course, participants answered a satisfaction survey. Conclusion: Considering imaging methods are routinely used during most otologic surgeries, detailed knowledge of CT imaging should be explored in conjunction with the temporal bone anatomical dissection

Magnetic resonance imaging findings of the posterior fossa in 47 patients with mucopolysaccharidoses : a cross-sectional analysis

Background: Mucopolysaccharidoses (MPS) is a group of hereditary multisystemic lysosomal disorders. Most neuroimaging studies in MPS have focused on the supratentorial compartment and craniocervical junction abnormalities, and data regarding posterior fossa findings are scarce in the literature. Thus, our purpose is to describe posterior fossa findings on magnetic resonance imaging (MRI) of MPS patients. Methods: We reviewed routine MRI scans of MPS patients being followed up at our institution (types I, II, III, IV, and VI), focusing on posterior fossa structures. Results: Forty-seven MPS patients were included. MRI-visible perivascular spaces were commonly found in the midbrain and adjacent to the dentate nuclei (85% and 55% of patients, respectively). White-matter lesion was not identified in most cases. Its most frequent localizations were in the pons and cerebellum (34% and 30% of patients, respectively). Enlargement of cerebrospinal fluid (CSF) spaces in the posterior fossa was present in 55% of individuals and was more frequent in neuronopathic patients (73% vs 40%; P = .02). Cerebellar volume was classified as normal, apparent macrocerebellum, atrophic, and hypoplastic in 38%, 38%, 21%, and 3% of patients, respectively. A depression of the posterior fossa floor in the midline sagittal plane was found in 22 patients (47%), which was statistical significantly associated with enlargement of CSF spaces (P = .02) and with apparent macrocerebellum (P = .03). Conclusion: The present study compiled the main posterior fossa findings in MPS patients. Classically described in the supratentorial compartment, MRI-visible perivascular spaces, white matter lesions, and enlarged perivascular spaces were also found in the posterior fossa. However, atrophy, which commonly affects cerebral hemispheres, was not the most frequent cerebellar morphology found in our study. Moreover, potential findings for future research were described

Ruptured aneurysm in the posterior communicating segment of carotid artery presenting with contralateral oculomotor nerve palsy

Background: Brain aneurysms are mostly discovered during the investigation of subarachnoid hemorrhage (SAH). Some patients present neurological signs that may suggest the aneurysm’s topography, and the oculomotor nerve palsy (ONP) of the same side of the aneurysm is the most common sign. Only one case report of contralateral palsy was previously described in the medical literature. Case Description: Authors describe a patient who presented a classic manifestation of SAH associated with complete ONP, whose vascular investigation demonstrated a brain aneurysm located in the contralateral intracranial carotid. The patient was surgically treated with great neurologic outcome, and late angiography did not evidence other vascular abnormalities. Conclusion: The ipsilateral ONP is a common sign found in posterior communicating artery aneurysms; however, such aneurysm can have different presentations due to the elevation of intracranial pressure, and, in rarer cases, the ONP cannot be operated as a localizing sign

Vascularization of the uncus : anatomical study and clinical implications

Background: The objective of this paper was to describe the arterial supply of the uncus and quantify the branches directed to the anteromedial aspect of the human temporal cortex. Methods: We studied 150 human cerebral hemispheres identifying main afferent arteries supplying the anteromedial temporal cortex with particular attention to the uncus, determining the territory supplied by each artery through either cortical or perforating branches. Results: The uncus was supplied by 419 branches of the anterior choroidal artery (AChA), 210 branches of the internal carotid artery (ICA), 353 branches of the middle cerebral artery (MCA), and 122 branches of the posterior cerebral artery (PCA). The total of supplying vessels was 1104 among the 150 hemispheres studied, which corresponds to 7.36 arteries per uncus. The average of branches per hemisphere was as follows: 2.79 from AChA, 1.40 from ICA, 2.35 from MCA, and 0.81 from PCA. The relative contribution of each artery for the total of specimens studied was as follows: 38% from AChA, 19% from ICA, 32% from the MCA, and 11% from the PCA. We identified cortical anastomoses mostly between the MCA and PCA (27 cases). Conclusion: We described and quantified the uncus’ vascularization, including anatomical variations. This updated, detailed description of the mesial temporal vascularization is paramount to improve the treatment of neurosurgical conditions

Ex vivo model with bovine heart : a proposal for training microscopic dissection and vascularmicroanastomoses

O treinamento é um processo que exige paciência e constante prática. A execução de procedimentos microscópicos está presente no dia a dia de diversas especialidades cirúrgicas, mas infelizmente modelos experimentais não são de fácil de acesso. Propomos um modelo com coração bovino usado por residentes e jovens cirurgiões no treinamento de dissecção microscópica e microanastomoses. É descrita a montagem deste modelo, que pode ser realizado de maneira individual e com material acessível aos departamentos cirúrgicos. Nossa experiência na elaboração das peças, assim como, dicas para o processo são descritas no texto. O modelo com miocardio bovino pode ser reproduzido em qualquer centro que disponha de bancadas e instrumental cirúrgico. Dentre as vantagens estão o baixo custo, rápido preparo e grande disponibilidade do tecido utilizado. Consideramos o projeto útil no treinamento de residentes cirúrgicos e jovens cirurgiões.Training is a process that requires patience and constant practice. The execution of microscopic procedures is present in the day-to-day of several surgical specialties, but unfortunately experimental models are not easy to access in our environment. We propose a bovine heart model used by residents and young surgeons in the training of microscopic dissection and microanastomoses. It is described the assembly of this model, which can be performed individually and with accessible material to the surgical departments. Our experience in the preparation of the pieces, as well as tips for the process, are described in the text. The bovine myocardial model can be reproduced in any center with benches and surgical instruments. Low cost, fast preparation, and wide availability of the used tissue are among the advantages of this model. We consider the project useful in the training of surgical residents and young surgeons

Elevated glutamate and lactate predict brain death after severe head trauma

Objective: Clinical neurological assessment is challenging for severe traumatic brain injury (TBI) patients in the acute setting. Waves of neurochemical abnormalities that follow TBI may serve as fluid biomarkers of neurological status. We assessed the cerebrospinal fluid (CSF) levels of glutamate, lactate, BDNF, and GDNF, to identify potential prognostic biomarkers of neurological outcome. Methods: This cross-sectional study was carried out in a total of 20 consecutive patients (mean [SD] age, 29 [13] years; M/F, 9:1) with severe TBI Glasgow Coma Scale ≤ 8 and abnormal computed tomography scan on admission. Patients were submitted to ventricular drainage and had CSF collected between 2 and 4 h after hospital admission. Patients were then stratified according to two clinical outcomes: deterioration to brain death (nonsurvival, n = 6) or survival (survival, n = 14), within 3 days after hospital admission. CSF levels of brain-derived substances were compared between nonsurvival and survival groups. Clinical and neurological parameters were also assessed. Results: Glutamate and lactate are significantly increased in nonsurvival relative to survival patients. We tested the accuracy of both biomarkers to discriminate patient outcome. Setting a cutoff of >57.75, glutamate provides 80.0% of sensitivity and 84.62% of specificity (AUC: 0.8214, 95% CL: 54.55–98.08%; and a cutoff of >4.65, lactate has 100% of sensitivity and 85.71% of specificity (AUC: 0.8810, 95% CL: 54.55–98.08%). BDNF and GDNF did not discriminate poor outcome. Interpretation: This early study suggests that glutamate and lactate concentrations at hospital admission accurately predict death within 3 days after severe TBI