Acessos minimamente invasivos de lesões intracranianas

Orientador : Antonio Guilherme Borges NetoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Tumores, aneurismas, hematomas e outras lesões situadas nas fossas cranianas anterior ou média ou mesmo convexidade são abordados, geralmente, através de craniotomia. Novas técnicas têm sido utilizadas para abordar a órbita, a fossa anterior e a base do crânio. Com o advento do neuroendoscópio, abordagens supra-orbitárias demonstraram uma boa visualização anatômica da chamada 'pirâmide virtual supra-selar¿. A combinação da neuroendoscopia com a microneurocirurgia permitiu a redução do tamanho da craniotomia requerida para uma boa visualização de tumores, aneurismas, hematomas e estruturas circunvizinhas. Neste trabalho foi reportada a nossa experiência no uso de abordagem minimamente invasiva de lesões da base do crânio e hematomas traumáticos, nos quais bons resultados foram obtidosAbstract: Frequently tumors, aneurysms, hematomas, and other lesions situated in the anterior or middle cranial fossae or skull convexity are approached by craniotomy. Some other new techniques are also used to approach the orbit, anterior fossa and skull base. Recently several supraorbital endoscopic ¿keyhole¿ approaches have been developed and have demonstrated a good anatomic visualization of the so-called 'suprasellar virtual pyramid¿ with the aid of an endoscope. Combination of endoscopy and microneurosurgery permits the reduction of the size of the craniotomy required for good visualization of tumor, aneurysm, hematomas and surrounding structures if compared to traditional techniques. On this thesis we reported our experience with minimally invasive approach to skull base lesions and convexity traumatic hematomas, in which good results were obtained.DoutoradoNeurologiaDoutor em Ciências Médica

Simulação em 3D da redução da fossa posterior no Chiari do tipo I

We proposed a 3D model to evaluate the role of platybasia and clivus length in the development of Chiari I (CI). Using a computer aided design software, two DICOM files of a normal CT scan and MR were used to simulate different clivus lengths (CL) and also different basal angles (BA). The final posterior fossa volume (PFV) was obtained for each variation and the percentage of the volumetric change was acquired with the same method. The initial normal values of CL and BA were 35.65 mm and 112.66º respectively, with a total PFV of 209 ml. Ranging the CL from 34.65 to 29.65 24.65 19.65, there was a PFV decrease of 0.47% 1.12% 1.69%, respectively. Ranging the BA from 122.66º to 127.66º 142.66º, the PFV decreased 0.69% 3.23%, respectively. Our model highlights the importance of the basal angle and clivus length to the development of CI.No presente estudo, propusemos a criação de um modelo computacional em 3D com elaboração de software onde dois arquivos em formato DICOM com uma TC e RNM de crânio foram usados para simular diferentes mensurações na extensão do clivus (EC) e no ângulo basal (AB). O volume final da fossa posterior (VFP) foi obtido em cada variação, bem como a percentagem de volume alterada. O tamanho inicial da EC era de 35,65 mm e o do AB era de 112.66º, com um VFP de 209 ml. Variando a EC de 34,65 para 29,65 24.65 e 19.65, houve uma diminuição do VFP de 0.47%, 1.12% e 1.69%, respectivamente. Variando o AB de 122,66º para 127,66º e 142,66º, o VFP diminui para 0.69% e 3.23%, respectivamente. Nosso modelo enfatiza a importância da patogênese do aumento do AB e do encurtamento do clivus no desenvolvimento do Chiari I.74540540

Oftalmoplegia internuclear bilateral e fratura de clivus após traumatismo cranioencefálico: relato de caso

Internuclear ophthalmoplegia is a remarkable finding, particularly in patients victims of head injury. The medial longitudinal fasciculus, which is believed to be lesioned in cases of internuclear ophthalmoplegia, has an unique brain stem position and the mechanism involved in brain stem contusions implies a maximal intensity of shearing forces on the skull base. We describe a very rare association of bilateral ophthalmoplegia and clivus fracture following head injury, without further neurological signs. The patient history, his physical examination and the image investigation provide additional evidence to some of the mechanisms of injury proposed to explain post-traumatic internuclear ophthalmoplegia.Oftalmoplegia internuclear é um interessante achado clínico, sobretudo em pacientes vítimas de trauma cranioencefálico. O fascículo longitudinal medial, cuja lesão é responsável pelas alterações observadas na oftalmoplegia internuclear, localiza-se no interior do tronco encefálico. O acúmulo de forças de impacto geradas pelo traumatismo craniano na base do crânio é responsável pela formação de contusões no tronco encefálico. Descrevemos um caso em que se observa rara associação entre oftalmoplegia internuclear bilateral e fratura de clivus em um paciente com traumatismo cranioencefálico leve, sem outras anormalidades neurológicas. A história, o exame físico e a investigação imagenológica do paciente proporcionam evidências adicionais para alguns dos mecanismos propostos para explicar oftamoplegia pós-traumática.63663

Imaging Features And Treatment Of An Intradural Lumbar Cystic Schwannoma.

Spinal schwannomas are frequently observed among patients treated in a reference neurosurgery center. Cystic spinal schwannomas, however, are very scantly found. Due to its indolent behavior and benign course, the diagnosis of schwannomas may pose a challenge to the care giver, and the imaging findings can be misleading. In this article, we illustrate an example of a pauci-symptomatic 55 year-old male patient whose complaint was solely a non specific lumbar pain. Investigation revealed a large cystic lesion comprising the lower lumbar intradural space. He was then treated with microneurosurgical technique involving complete removal of the tumor and reconstruction of the dura mater. Histological and immunohistochemical diagnosis were consistent with cystic schwannoma. The patient presented with complete recovery of his symptom. In this article we aim to emphasize the clinical presentation and treatment of lumbar spine schwannomas, and to illustrate the imaging findings within this uncommon case.63681-

Simulação em 3D da redução da fossa posterior no Chiari do tipo I

We proposed a 3D model to evaluate the role of platybasia and clivus length in the development of Chiari I (CI). Using a computer aided design software, two DICOM files of a normal CT scan and MR were used to simulate different clivus lengths (CL) and also different basal angles (BA). The final posterior fossa volume (PFV) was obtained for each variation and the percentage of the volumetric change was acquired with the same method. The initial normal values of CL and BA were 35.65 mm and 112.66 degrees respectively, with a total PFV of 209 ml. Ranging the CL from 34.65 to 29.65 - 24.65 - 19.65, there was a PFV decrease of 0.47% - 1.12% - 1.69%, respectively. Ranging the BA from 122.66 degrees to 127.66 degrees - 142.66 degrees, the PFV decreased 0.69% - 3.23%, respectively. Our model highlights the importance of the basal angle and clivus length to the development of CI.We proposed a 3D model to evaluate the role of platybasia and clivus length in the development of Chiari I (CI). Using a computer aided design software, two DICOM files of a normal CT scan and MR were used to simulate different clivus lengths (CL) and als745405408sem informaçãosem informaçãoNo presente estudo, propusemos a criação de um modelo computacional em 3D com elaboração de software onde dois arquivos em formato DICOM com uma TC e RNM de crânio foram usados para simular diferentes mensurações na extensão do clivus (EC) e no ângulo ba

Incidence Of Basilar Invagination In Patients With Tonsillar Herniation? A Case Control Craniometrical Study.

A retrospective case-control study based on craniometrical evaluation was performed to evaluate the incidence of basilar invagination (BI). Patients with symptomatic tonsillar herniation treated surgically had craniometrical parameters evaluated based on CT scan reconstructions before surgery. BI was diagnosed when the tip of the odontoid trespassed the Chamberlain's line in three different thresholds found in the literature: 2, 5 or 6.6 mm. In the surgical group (SU), the mean distance of the tip of the odontoid process above the Chamberlain's line was 12 mm versus 1.2 mm in the control (CO) group (p<0.0001). The number of patients with BI according to the threshold used (2, 5 or 6.6 mm) in the SU group was respectively 19 (95%), 16 (80%) and 15 (75%) and in the CO group it was 15 (37%), 4 (10%) and 2 (5%).72706-1

The influence of early tracheostomy in the weaning of patients with severe traumatic brain injury

BACKGROUND AND OBJECTIVES: Actually, It?s doubtful if early tracheostomy (ET) can influence mechanical ventilation (MV) weaning time or the hospital length of stay in patients with traumatic brain injury (TBI). The main objective of this trial was to verify the influence of ET on weaning time of patients with severe TBI. METHODS: Prospective, observational study, including 33 patients with severe TBI (GCS &lt; 10 at hospital admission), evaluated according to tracheostomy performance time (early: t &lt; 6 days; intermediate: t = 7 to 11 days; and late: t > 12 days) and the weaning from MV. RESULTS: Total ventilation mechanical time has been reduced in the early tracheostomy group (n = 10; p 12 dias) e o desmame ventilatório. RESULTADOS: O tempo total de VM foi menor no grupo TP (n = 10; p < 0,0001). No grupo TP, a menor pontuação na ECG (média de 5,3 ± 2,5) esteve negativamente correlacionada com o tempo de internação hospitalar (p = 0,02). CONCLUSÕES: A traqueostomia precoce pode reduzir os tempos de ventilação mecânica, mas não influencia o tempo de internação hospitalar em pacientes com traumatismo cranioencefálico grave.17618

Evaluation of a questionnaire on symptom severity and functional status of patients with carpal tunnel syndrome

Este estudo consistiu na avaliação do questionário de Levine et al. (1993) Boston Carpal Tunnel Questionnaire, de avaliação da gravidade dos sintomas e do estado funcional de pacientes com síndrome do túnel do carpo (STC). O questionário consta de uma escala de gravidade dos sintomas – em domínios críticos na STC, como dor, parestesias, adormecimento, fraqueza, sintomas noturnos – e uma escala de estado funcional. Foi aplicado a 30 pacientes diagnosticados com a síndrome, que foram orientados a responder somente sobre a mão mais afetada pela patologia. Na análise dos resultados, não foram encontradas correlações entre a idade dos sujeitos e maior acometimento dos sintomas, nem com a prevalência de mão afetada. O questionário revelou-se consistente, pela estreita correlação entre as duas escalas: onde há maior gravidade dos sintomas, também há maior acometimentofuncional. Com a ressalva de que o questionário não prevê o caso de a mão mais afetada não ser a dominante, é um instrumento de fácil compreensão, adequado para padronizar a avaliação de pacientes com STC, sugerindo-se sua aplicação separadamente para cada mão.This study aimed at assessing the Boston Carpal Tunnel Questionnaire by Levine et al. (1993), a self-administered instrument for evaluating severity of symptoms and functional status in patients with carpal tunnel syndrome (CTS). It is made up of two scales: one on the severity of symptoms – pain, paresthesias, numbness, weakness, nocturnal symptoms – and the other on function impairment. It was answered by 30 patients with CTS, who were guided to answer only about the most affected hand. The analysis of results shows no correlation between age and severity of symptoms, nor between these and the most affected hand (right or left). The questionnaire proved consistent, since a highly positive correlation was found between the two scales: the more severe the symptoms, the worse the functional status. With the objection that it doen’st seem to have foreseen cases in which the dominant hand is not the most affected one, it is an instrument of easy application and understanding, hence suitable to standardize the assessment of CTS symptoms; it is here suggested that it be applied separately for each hand

Endoscopic Endonasal Transsphenoidal Resection Of Pituitary Adenomas: Preliminary Evaluation Of Consecutive Cases.

Endoscopic endonasal transsphenoidal surgery has gained increasing acceptance by otolaryngologists and neurosurgeons. In many centers throughout the world, this technique is now routinely used for the same indications as conventional microsurgical technique for pituitary tumors. To present a surgical experience of consecutive endoscopic endonasal trans-sphenoidal resections of pituitary adenomas. In this study, consecutive patients with pituitary adenomas submitted to endoscopic endonasal pituitary surgery were evaluated regarding the rate of residual tumor, functional remission, symptoms relief, complications, and tumor size. Forty-seven consecutive patients were evaluated; 17 had functioning adenomas, seven had GH producing tumors, five had Cushing's disease, and five had prolactinomas. Of the functioning adenomas, 12 were macroadenomas and five were microadenomas; 30 cases were non-functioning macroadenomas. Of the patients with functioning adenomas, 87% improved. 85% of the patients with visual deficits related to optic nerve compression progressed over time. Most of the patients with complaints of headaches improved (76%). Surgical complications occurred in 10% of patients, which included with two carotid lesions, two cerebrospinal fluid leaks, and one death of a patient with a previous history of complications. Endoscopic endonasal pituitary surgery is a feasible technique, yielding good surgical and functional outcomes, and low morbidity.80146-5