Third Ventricle Craniopharyngioma Intraventricular Tumor: A Case Report and a Brief Literature Review.

Craniopharyngioma is a rare embryonic malformation, usually benign, of the sellar or parasellar regions. In this study, an uncommon case of third ventricle craniopharyngioma and a succinct review of its prevalence are presented. Even with low mortality rates, these injuries involve a high degree of endocrinological, visual, and neuropsychological morbidities, which have a huge impact on the patient's quality of life. Thus, surgical resection is the preferred therapy for tumors that compromise the flow of cerebrospinal fluid. However, due to the location of the craniopharyngioma, surgical management is accompanied by the risk of injury to important adjacent areas with postoperative repercussions. Therefore, the neurosurgeon's experience and the choice of the best surgical approach, are crucial for increasing prognosis.

Decompressive Craniectomy for Malignant Ischemic Stroke: An Institutional Experience of 145 Cases in a Brazilian Medical Center.

BACKGROUND: Malignant ischemic stroke (MIS) occurs in a subgroup of patients with cerebrovascular accident who sustain massive or significant cerebral infarction. It is characterized by neurological deterioration owing to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique that can be used to treat select cases of this condition in the presence of medically refractory intracranial hypertension. This study aimed to identify prognostic factors associated with clinical outcome, including timing of the procedure, and postoperative mortality. METHODS: We analyzed surgical characteristics associated with prognosis in 145 patients who underwent DC secondary to MIS between 2013 and 2018, assessing clinical outcome at discharge and 6 and 12 months after discharge. Our inclusion criteria were DC secondary to MIS in adult patients with raised intracranial pressure signs. RESULTS: Our analysis showed that although patients from cities >100 km from the neurosurgical center had a worse prognosis, only the surgical head side (left vs. right, P = 0.001), hospitalization length (P < 0.001), and earlier timing of procedure (P < 0.001) were statistically relevant in having worse outcomes. CONCLUSIONS: Patients in whom more time passed from presentation to the neurosurgical procedure, owing to living in a distant city or taking more time to be seen by a specialist, tended to have a worse prognosis. The timing of procedure, surgical side, and hospitalization length were independent predictors in determining the prognosis of patients who underwent DC after an MIS.

Decompressive craniectomy: Comparative analysis between surgical time and better prognosis.

Background: Malignant ischemic stroke is characterized by the involvement of 2/3 of the area of the middle cerebral artery, associated with cerebral edema, intracranial hypertension (ICH) and cerebral herniation, generating high morbidity and mortality. Over the years, several therapies have been studied in an attempt to reverse or reduce the damage caused by this vascular disorder, including decompressive craniectomy (DC), a surgical technique reserved for cases that evolve with refractory ICH. Methods: This study seeks to perform a comparative analysis on the effectiveness of decompressive craniectomy using four randomized clinical trials and the results found in the retrospective study conducted in a neurosurgical reference center between 2010 and 2018. Results: The total sample consisted of 263 patients, among which 118 were randomized and 145 were part of the retrospective study. The outcome was analyzed based on the modified Rankin Scale (mRS) for 6 and 12 months. The mean time to perform the DC was 28.4 h in the randomized trials, with the late approach (> 24 h) associated with unfavorable outcomes (mRS between 4 and 6). Conclusion: Compared to the aforementioned studies, the study by Bem Junior et al. shows that a surgical approach in < 12 h had a better outcome, with 70% of the patients treated early classified as mRS 2 and 3 at the end of 12 months (1). Decompressive craniectomy is currently the most effective measure to control refractory ICH in cases of malignant ischemic stroke, and the most appropriate approach before surgery is essential for a better prognosis for patients.

Endoscopic third ventriculostomy in the treatment of hydrocephalus: A 20-year retrospective analysis of 209 consecutive cases.

BACKGROUND: Endoscopic third ventriculostomy (ETV) has been shown to be a sufficient alternative to shunts in surgical treatment of obstructive hydrocephalus. Long-term failure, age limitations, and outcome by cause are some of the issues debated in literature. The objective of this article is to analyze the clinical success and failure of ETV and its main complications. METHODS: A total of 209 patients with hydrocephalus were submitted to ETV, including a mixed population of children and adults (from 0 to 59 years). Patients were divided into five groups: A - tumors, B - aqueductal stenosis, C - myelomeningocele, D - infection and hemorrhage, and E - arachnoid cyst. Variables were analyzed: age, ETV success rate, cerebrospinal fluid (CSF) fistula, mortality, and complications. RESULTS: The two main causes of hydrocephalus were tumors (44.9%) and aqueductal stenosis (25.3%). The overall success rate was of 82.8%, and patients in Group E had the highest rate 90.9%. Group A had a success rate of 89.3%, and Group B had a rate of 88.6%. The ETV success rate was significantly higher in patients older than 1 year (P < 0.001); the former also had a lower risk of CSF fistula (P < 0.0001). The overall mortality rate was 2.8%. CONCLUSION: Better results were observed in the groups of patients with tumors, aqueductal stenosis, and arachnoid cysts, while those whose primary causes of hydrocephalus were myelomeningocele, infections, or bleeding had higher rates of failure after the procedure. This study demonstrated that age under 1 year and hydrocephalus caused by myelomeningocele, bleeding, and infection were considered independent risk factors of poor prognosis in ETV.

Transfer of the phrenic nerve to musculocutaneous nerve via sural nerve graft after total brachial plexus injury.

A middle age male presented a right total brachial plexus injury after motorcycle fall one year ago. Subsequent electromyographic evaluation was consistent with C5, C6, C7, C8 and T1 root avulsion. The patient was submitted to a right transfer of the phrenic nerve to musculocutaneous nerve , using rural nerve graft.

Pediatric Gunshot Head Injury: Prevalence of Prognostic Factors in Surgical Patients: An Institutional Experience in Ten Years.

This article aims to evaluate the predictive factors of morbidity and mortality in pediatric patients who suffered gunshot wounds to the head. We reviewed a series of 43 patients who were admitted to a referential neurosurgical hospital between 2010 and 2019. Data from 43 patients who underwent a surgical treatment in our institution were collected, and the following parameters were considered in the analysis: the initial Glasgow Coma Scale (GCS), age, sex, bullet entry site, and bullet trajectory. Computed tomography (CT) scans at admission, complications, midline crossing, and Glasgow score scale at the time of discharge (Glasgow Outcome Scale; GOS) were also factored in. Male sex corresponded to 90.7% of cases (N = 39), and 16-17 years of age was the most common age (60.5%). The frontal region was the most common entry site (41.9%), followed by the parietal wall and occipital entry. Penetrating trajectory was shown in 48.8% of cases, perforation/transfixing in 39.5%, and tangential in 11.6%. CT showed that sinking is the most common alteration (74.4%), followed by cerebral contusion (44.2%). According to the GOS, 23.3% died, 23.3% were classified by an unfavorable outcome (GOS, 2-3), and 53.5% a favorable outcome (GOS, 4 and 5). In our study, there was a significant association between the low GCS scores on admission and low GOS (1-3; p = 0.001) at time of discharge. Patients with wounds that crossed the midline also had a significant association with low GOS (p = 0.014) in our clinical experience. We concluded that low GCS scores at admission and children with a wound that crosses the midline are predictive factors of high mortality and morbidity, in our clinical experience.

Subarachnoid hemorrhage and COVID-19: Association or coincidence?

ABSTRACT: Some evidences suggest the involvement of the central nervous system in patients infected with SARS-CoV-2. We aim to analyze possible associations between coronavirus disease 2019 (COVID-19) pandemic and spontaneous subarachnoid hemorrhage (SAH), in a comprehensive neurological center.We conducted a retrospective case series of 4 patients infected by COVID-19, who developed spontaneous SAH. Clinical data were extracted from electronic medical records.Between March 24, 2020, and May 22, 2020, 4 cases (3 females; 1 male) of SAH were identified in patients infected with SARS-CoV-2, in a comprehensive neurological center in Brazil. The median age was 55.25 years (range 36 -71). COVID-19-related pneumonia was severe in 3 out of 4 cases, and all patients required critical care support during hospitalization. The patients developed Fisher grade III and IV SAH. Digital subtraction angiography (DSA) was performed in 3 of the 4 patients. However, in only 1 case, an aneurysm was identified. Inflammatory blood tests were elevated in all cases, with an average D-dimer of 2336 µg/L and mean C-reactive protein (CRP) of 3835 mg/dl The outcome was poor in the majority of the patients, with 1 death (25%); 2 (50%) remained severely neurologically affected (mRS:4); and 1 (25%) had slight disability (mRS:2).This study shows a series of 4 rare cases of SHA associated with COVID-19. The possible mechanisms underlying the involvement of SARSCoV-2 and SHA is yet to be fully understood. Therefore, SHA should be included in severe neurological manifestations in patients infected by this virus.

Adhesion sutures for seroma reduction in cranial reconstructions with polymethyl methacrylate prosthesis in patients undergoing decompressive craniectomy: A clinical trial.

BACKGROUND: Cranial reconstruction with polymethyl methacrylate (PMMA) prosthesis is used for calvarial defects secondary to decompressive craniectomies. Seroma is one of the most frequent complications of this procedure and can lead to the dehiscence, extrusion, infection, and loss of the prosthesis. The objective of the study is to analyze the effectiveness of the tacking sutures between the prosthesis and the scalp flap in reducing the seroma. METHODS: This is a prospective study with 63 patients submitted to cranioplasty between 2014 and 2017 for defects resulting from decompressive craniectomies. All patients were followed up postoperatively for at least 3 months and the diagnosis of seroma was made clinically. In the first 22 patients, the conventional technique was applied and, in the following 41, the technique with tacking sutures was used. The incidence of seroma was collected for both groups. RESULTS: The overall incidence of seroma was 65.1%. Compared to the conventional technique, the use of tacking sutures was associated with a statistically significant reduction in the incidence of seroma from 90.9% to 51.2% (P = 0.002). CONCLUSION: The use of the tacking sutures in cranioplasties with PMMA prosthesis reduced the incidence of seroma postoperatively.

Neuroendoscopia: conceitos e aplicaçöes / Neuroendoscopy: concepts and aplications

Os autores fazem uma revisäo histórica sobre a utilizaçäo da neuroendoscopia como método de tratamento na neurocirurgia desde o seu aparecimento até os dias atuais. Säo descritas as principais indicaçöes para a utilizaçäo do método bem como minucioso relato da técnica cirúrgica e instrumental utilizado. A destacar o menor índice de morbidade e mortalidade se comparado às tradicionais derivaçöes extra-craneanas com válvulas bem como a economia para os Serviços de Saúde Pública quando utilizada a terceiro-ventriculostomia endoscópica no tratamento da hidrocefalia

Esquistossomose cerebelar: relato de caso / Cerebellar schistosomiasis. A case report

Os autores relatam um caso raro de granuloma esquistossomótico no cerebelo removido completamente através de técnicas microcirúrgicas e tratado ulteriormente com oxaminiquine. Alguns aspectos etiopatogênicos assim como clínicos, neuradiológicos e cirúrgicos säo comentados

Goma sifilítica cerebelar: relato de caso / Cerebellar syphillitic gumma: a case report

Os autores relatam o caso de uma paciente portadora de sindrome de hipertensao intracraneana. A tomografia computadorizada de cranio revelou lesao expansiva ao nivel do vermis cerebelar com hidrocefalia supratentorial. O exame histopatologico revelou tratar-se de goma sifilitica. Foi feita uma revisao da literatura concernente e chamam atencao para a raridade atual desses processos alem de tecerem consideracoes sobre o quadro clinico e tratamento

Cavernoma mesencefálico: relato de caso tratado conservadoramente / Mesencephalic cavernoma: report a case conservatively treated

Os autores tecem consideracoes acerca de um caso de cavernoma situado profundamente em que tendo sido levado em consideracao o fato de tratar-se de malformacao vascular de carater benigno o risco do tratamento cirurgico foi considerado elevado e o tratamento conservador decidido mediante o diagnostico clinico e radiologico pre estabelecido de cavernoma

Aneurismas bilaterais da bifurcaçao da arteria cerebral media operados atraves de craniotomia unica / Clipping of bilateral aneurysms of the bifurcation of the middle cerebral artery using a single craniotomy. Report of one case

Os autores relatam um caso de aneurismas em espelho da bifurcacao arteria cerebral media clipados atraves de uma craniotomia unica.