Feasibility, safety, and efficacy of endovascular treatment of anterior cranial fossa dural arteriovenous fistulas: a systematic review and meta-analysis with a subanalysis for Onyx.

Dural Arteriovenous Fistulas (dAVFs) of the anterior cranial fossa (ACF) are uncommon but carry a high risk of hemorrhage and pose substantial treatment challenges. Recent advancements in endovascular treatment (EVT), including the introduction of novel liquid embolic agents, have markedly bolstered EVT's role in managing ACF-dAVFs, with notable series published in the last five years. We aimed to assess the feasibility, safety, and efficacy of EVT for ACF-dAVFs. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines. Eligible studies included those with ≥ 5 patients undergoing embolization of ACF-dAVFs, detailing both angiographic and clinical outcomes. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Publication bias was assessed by funnel-plot analysis and Egger's test. Outcomes included complete occlusion following embolization, unsuccessful endovascular embolization attempts, incomplete occlusion following embolization, symptom resolution or clinical improvement following embolization, recurrence; procedure-related complications, morbidity, and mortality. Additionally, a subanalysis for studies exclusively utilizing Onyx™ embolic system was done. Eighteen studies comprising 231 ACF-dAVF were included. Unsuccessful endovascular embolization attempts rate was 2%. Complete occlusion rate was 85%, with 4% of complications. Incomplete occlusion rate was 10%. Successfully embolized patients experienced either symptom resolution or clinical improvement in 94% of cases. Morbidity and mortality rates were 1% and 0%, respectively. Onyx subanalyses showed an overall rate of 0% for unsuccessful attempts, 95% for complete occlusion, and 5% for incomplete occlusion. Symptom resolution or clinical improvement was 98% and recurrence rate was 0%. EVT for ACF-dAVF is highly feasible, effective, and safe, with a low rate of complications, morbidity, and mortality. The subanalyses focusing on Onyx embolizations revealed superior efficacy and safety outcomes compared to the findings of the primary analyses involving all included studies.

A pólis arquipélago: notas do acompanhamento terapêutico / The archipelago polis: notes on therapeutic accompaniment

Este artigo discute algumas consequências teóricas derivadas do fazer singular do acompanhamento terapêutico (AT). Como no AT não há nem lugar fixo, nem propriedade privada - características ordinárias das instituições de tratamento, sejam equipamentos públicos, sejam consultórios particulares -, então o espaço onde ele acontece é o chão comum e o céu aberto. Essa condição primeira implica uma espécie de "novidade absoluta do encontro", e a terapêutica se encaminha por uma "fala pedestre" enunciada pelas passagens e pelas movimentações na cidade. A experiência de transitar para além das quatro paredes das diversas instituições de tratamento dispõe, como plano transferencial, um cenário composto de indivíduos e universos que se interpenetram e se constituem, constituindo mundos. Por tudo isso, o AT é um campo propício para pensar a atualidade das redes individuais e das redes coletivas, por exemplo, novas famílias e familiaridades.

This article discusses some theoretical consequences that derive from the singular therapeutic accompaniment´s (TA) making. Since in TA there are no fixed places, neither private properties - caracteristics in ordinary treatment institutions, whether public equipments or particular offices -, the space where it happens is the common ground and the open sky. This primary condition implies a kind of "absolute novelty of encounter" and the therapeutic leads away by a kind of "pedestrian speech" enunciated through passages and movimentation across the city. The transit experience beyond the four walls of treatment institutions disposes, as a transferencial plan, a scenery that is composed by individuals and universes which interpenetrate and constitute themselves, constituting worlds. Considering all that, TA is a favorable field to think the present of individual nets and collective nets, for instance, new families and familiarities.

A violência da instauração / The violence of foundation

Segundo o autor, o conceito de potencialidade nasce, em Piera Aulagnier, na medida em que a autora define a constituição do Eu de acordo com a capacidade que o Eu tem de introjetar os objetos da realidade que encontram o Eu. Quando os encontrados demandam o Eu de modo a quebrar o intrincamento que garante o núcleo modificável do Eu, o indivíduo é lançado na potencialidade psicótica, situação em que se desorganiza o próprio modo de metabolizar o mundo. Neste estado radical, os processamentos dos encontrados que demandam o Eu pessoal mas também colocam em questão os modos de organização da realidade do mundo. Os delírios de Schreber, a obra mestre de Max Weber, são duas expressões do trabalho de elaboração que o Eu realiza quando mergulhou neste estado de potencialidade psicótica.