Simulation of endoscopic third ventriculostomy in fresh cadaveric specimens.

OBJECTIVE: The purpose of this research is to describe and analyze the endoscopic anatomy of cerebral ventricles, especially of the lateral ventricle and third ventricle. METHODS: 47 brains of adult human cadavers were studied at the Death Check Unit (DCU) of São Paulo. Age, sex, day and approximate time of death, day and time of study, cause of death, outcome of puncture and number of attempts were recorded. A rigid neuroendoscope was utilized. The approach to the ventricular system was via the pre-coronal point on the right side. RESULTS: The number of individuals studied was 47, of which 22 (47%) were women and 25 (53%) were men. Age ranged from 20 to 95 years. The minimum time lag between the death and the study was 8 h and the maximum time was 29 h. Of the cadavers studied, three presented alterations in the central nervous system as the cause of death. Successful puncture was obtained in 42 (89%) being 72% in the first attempt. In the analysis performed by Fisher's exact test with a 5% level of significance, an association between the number of attempts (2) and the cause of cerebral death was found (p=0.018). CONCLUSIONS: The visualization of neural structures without bleeding, the possibility of training techniques such as third ventriculostomy, the development of new techniques and to help sctructure new concepts about anatomic landmarks have by far overcome the difficulties.

Monopolar 250-500 Hz language mapping: Results of 41 patients.

OBJECTIVES: To determine whether high-frequency 250-500 Hz monopolar stimulation is effective for mapping cortical and subcortical language structures during brain tumor resection. METHODS: Using high-frequency monopolar stimulation, we mapped the speech areas of 41 awake patients undergoing brain tumor resection in the dominant hemisphere, subject to risk of lesions in the cortical and subcortical speech tracts. Patients were tested for object naming, semantic and other language tasks. RESULTS: Mapping was positive in 22 out of 41 patients. Nine patients presented clinical worsening immediately after surgery. Only one patient did not recover after the 30-day follow-up. Nineteen patients showed negative mapping for language tracts, none of whom exhibited worsening of symptoms at the final evaluation. The applied method showed 89% sensitivity and 56% specificity rates. CONCLUSIONS: The applied method was effective in identifying cortical and subcortical speech areas during the surgical resection of brain tumors. SIGNIFICANCE: Determining whether monopolar high-frequency stimulation is effective for language mapping is important, since it may be very effective in infiltrating tumor areas and nearby edema region.

Association of EGFR c.2073A>T polymorphism with decreased risk of diffusely infiltrating astrocytoma in a Brazilian case-control study.

Epidermal growth factor receptor (EGFR) gene overexpression has been implicated in the development of many types of tumors, including glioblastomas, the most frequent diffusely infiltrating astrocytomas. However, little is known about the influence of the polymorphisms of EGFR on EGFR production and/or activity, possibly modulating the susceptibility to astrocytomas. This study aimed to examine the association of two EGFR promoter polymorphisms (c.-191C>A and c.-216G>T) and the c.2073A>T polymorphism located in exon 16 with susceptibility to astrocytomas, EGFR gene expression and survival in a case-control study of 193 astrocytoma patients and 200 cancer-free controls. We found that the variant TT genotype of the EGFR c.2073A>T polymorphism was associated with a significantly decreased risk of astrocytoma when compared with the AA genotype [sex- and age-adjusted odds ratio 0.51, 95% confidence interval 0.26-0.98]. No association of the two promoter EGFR polymorphisms (or combinations of these polymorphisms) and risk of astrocytomas, EGFR expression or survival was found. Our findings suggest that modulation of the EGFR c.2073A>T polymorphism could play a role in future therapeutic approaches to astrocytoma.

Surgical removal of small petroclival meningiomas.

UNLABELLED: Treatment of large petroclival meningiomas causing brain stem compression is surgical removal followed by radiotherapy or radiosurgery if the lesion was partially resected. The management of small petroclival meningiomas is, however, controversial. Clinical observation, radiosurgery and surgical removal are the options of treatment. The natural history of these tumours is not well known. Published series of patients treated with radiosurgery are not comparable with surgical series because the latter also includes large size tumours. In this paper we present a series of 18 patients with small petroclival meningiomas (diameter

Surgical management in rerupture of internal carotid aneurysm after recanalization treated-coil: a case report

Introduction: Little is known about incidence, anatomical and clinical characteristics and results of endovascular treatment of the internal carotid artery (ICA) aneurysms. This type of the aneurysms can be approached by surgical with low morbidity and mortality. Clinical presentation: a 48-year-old woman submitted an endovascular embolization treatment in 2005, and in 2009 presents a new bleeding. The angiography shows that the same aneurysm was ruptured and a surgical repair was proposed. The surgical management shows detachable coils in the brain parenchyma. Conclusion: Some endovascular surgeons preferred the less invasive procedure (endovascular treatment) for intracranial aneurysms, but the surgical repair still remains the best choice for definitive treatment for intracranial aneurysms.

Interstitial irradiation for CNS lesions.

In this study, we investigated the efficacy of brachytherapy in the treatment of 138 patients with intracranial neoplasms of the CNS. Of the total number of patients, 50 presented with glioblastoma multiforme, 45 presented with low-grade glioma, 19 presented with anaplastic astrocytoma, 23 presented with metastases and 1 presented with meningioma. During the execution of this study, seeds of 125I (10-20 mCi) were inserted into the lesions to aim the irradiation at a low dose of 60 Gy in the margin of benign lesions or 1 cm beyond the radiological border of malignant lesions, which were visualized on CT scan. The results of this procedure were evaluated in terms of the survival rates, which were assessed by Kaplan-Meier curves. Significant relationships were not observed between the volume and location of the lesions, the whole-brain radiotherapy and chemotherapy, and the survival time of the patients. A low Karnofsky Index score and older age were associated with a short survival time. In light of the above, it was concluded that interstitial irradiation is a safe and effective method of treatment for brain tumors.

Bulbar trigeminal stereotactic nucleotractotomy for treatment of facial pain.

Many pharmacological and surgical treatments are available for the treatment of chronic facial pain. However, many of them are expensive and often very ineffective. Past publications suggested that bulbar trigeminal stereotactic nucleotractotomy is a very useful procedure for the treatment of neuropathic or oncologic facial pain. The authors describe the results of treatment with stereotactic nucleotractotomy in 58 patients with chronic facial pain. The intensity of the pain was evaluated according to the visual analogue scale, and daily life activities were also evaluated. The conclusion was that this procedure is a safe and effective method for treatment of postherpetic neuralgia, Wallenberg's syndrome and oncologic facial pain but not of trigeminal neuralgia.

Aspectos físicos e morfológicos e pH do sêmen de reprodutores bubalinos / Physical and morphological aspects and pH of semen of buffalo bulls

Foram estudados 22 búfalos Murrah e seus mestiços com idade entre quatro e oito anos, clinicamente sadios, criados extensivamente nos Estados de Minas Gerais e Bahia. Amostras de sêmen foram obtidas por meio de vagina artificial utilizando-se fêmeas bubalinas em estro natural ou induzido. Os valores médios do volume, motilidade, concentraçäo e pH do sêmen foram: 4,32 mais ou menos 0,34 ml, 78,63 mais ou menos 5,60 por cento, 116,63 mais ou menos 17,52 x 10 elevado à sétima potência sptz/ml e 6,86 mais ou menos 0,35, com 7,05 mais ou menos 3,63 por cento de defeitos maiores e 6,09 mais ou menos 2,58 por cento de defeitos menores num total de 13,14 mais ou menos 5,18 por cento de anormalidades

Adenocarcinoma pulmonar em lobo-guará (Chrysocyon brachyurus) / Pulmonary adenocarcinoma in Maned wolf (Chrysocyon brachyurus)

Descreve-se uma neoplasia pulmonar em um lobo-guará, fêmea, com nove anos de idade, procedente do Jardim Zoológico de Belo Horizonte. Após acompanhamento clínico revelando dispnéia, anorexia, prostraçäo e claudicaçäo do membro anterior direito e diarréia hemorrágica, sacrificou-se o animal. A necrópsia observou-se no lobo pulmonar direito formaçöes nodulares com diâmetro variando de 1 a 5 cm, de consistência firme, distribuídos pelo parênquima pulmonar, pleura parietal e linfonodos. O exame microscópico revelou tratar-se de uma neoplasia classificada como adenocarcinoma tipo bronquíolo alveolar

Coleta e avaliaçäo de sêmen canino / Semen collection and evalution in dogs

Foram estudados 171 ejaculados de 21 reprodutores caninos das raças Dobermann, Whippet, Beagle, Afghan Hound, Fila Brasileiro, Pastor Alemäo e Rotweiller com idades entre 12 e 84 meses. O sêmen foi coletado obedecendo-se a existência de fraçöes distintas do ejaculado normal e analisado quanto ao tempo de ejaculaçäo, volume e concentraçäo. A primeira fraçäo foi perdida durante a manipulaçäo dos animais; a segunda fraçäo apresentou os valores de 3,00 mais ou menos 0,20 min, 2,40 mais ou menos 1,80 ml e 258,00 mais ou menos 10,20 x 10 elevado à sexta potência sptz/ml; a terceira fraçäo, valores de 10,00 mais ou menos 0,50 min, 3,80 mais ou menos 2,10 ml e 15,00 mais ou menos 0,20 x 10 elevado à sexta potência sptz/ml. Na mesma ordem, o sêmen näo fracionado apresentou os seguintes valores: 15,00 mais ou menos 0,40 min, 6,48 mais ou menos 4,32 ml e 53 mais ou menos 2,10 x 10 elevado à sexta potência sptz/ml. Tempo de ejaculaçäo, volume e concentraçäo diferiram estatisticamente (P<0,05) em relaçäo às fraçöes e ao sêmen total. As anormalidades espermáticas apresentaram 15,73 mais ou menos 9,05 por cento de defeitos totais, snedo 5,74 mais ou menos 3,81 por cento de defeitos maiores e 9,99 mais ou menos 5,24 por cento de defeitos menores. Näo houve diferença significativa entre as características seminais dos ejaculados segundo o peso dos animais (abaixo ou acima de 20 kg de peso corporal), exceto quanto ao volume seminal