Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients.

OBJECTIVE: Observe whether a microsurgical gross total removal (GTR) of a spinal nerve sheath tumors (SNSTs) is safe and decreases the tumor recurrence. METHOD: We identify 30 patients with 44 SNSTs. RESULTS: We operated upon 15 males and 15 females patients; mean age 40 years. GTR was achieved in 29 (96.6%) instances. Surgical mortality was 3.3% and the recurrence rate was 3.3%. The median follow-up time was 6.2 years. CONCLUSION: The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality and low recurrence rates, proving to be safe and effective.

Foramen magnum meningiomas: To drill or not to drill the occipital condyle? A series of 12 patients.

BACKGROUND: Despite the development of microsurgery and cranial base techniques, the surgical management of Foramen Magnum Meningiomas (FMM) continues to be a technical challenge to neurosurgeons. Controversy concerning the utility of systematic condyle drilling for approaching FMM has been raised. Our aim was to describe the surgical technique, analyze its safety, and the postoperative outcome in 12 consecutive FMM patients. METHODS: From 1986 to 2011, 12 patients with FMM underwent operations in the Department of Neurosurgery at Servidores do Estado Hospital and in a private clinic. All patients were operated using a standard suboccipital craniectomy, preserving the occipital condyle, opening of the Foramen Magnum, and ipsilateral removal of the posterior arch of C1. RESULTS: There was no operative mortality, nine patients achieved Glasgow Outcome Scale 4 or 5. Condylar resection was not deemed necessary in any case. Gross total resection was achieved in nine patients. After surgery, four patients developed lower cranial nerve weakness. There was no significant postoperative complication in the remaining patients. The average follow-up is 8.2 years. CONCLUSION: The vast majority of FMM can be safely removed with a retrocondylar lateral suboccipital approach without condylar resection, using meticulous microsurgical techniques.

Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients / Remoção completa dos tumores da bainha dos nervos raquianos. Técnica cirúrgica e resultados de uma série de 30 pacientes

Objective: Observe whether a microsurgical gross total removal (GTR) of a spinal nerve sheath tumors (SNSTs) is safe and decreases the tumor recurrence. Method: We identify 30 patients with 44 SNSTs. Results: We operated upon 15 males and 15 females patients; mean age 40 years. GTR was achieved in 29 (96.6%) instances. Surgical mortality was 3.3% and the recurrence rate was 3.3%. The median follow-up time was 6.2 years. Conclusion: The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality and low recurrence rates, proving to be safe and effective. .

Objetivo: Observar se a ressecção microcirúrgica completa dos shwannomas ou neurofibromas raquianos é uma técnica segura e efetiva. Método: Foram operados 30 pacientes com 44 schwannomas ou neurofibromas intrarraquiano. Resultados: A remoção total da lesão ocorreu em 27 casos (96.6%). A taxa de mortalidade cirúrgica observada nesta série foi de 3.3%. O tempo médio de seguimento foi de 6.2 anos. Conclusão: A estratégia microcirúrgica empregada com esses pacientes propiciou a remoção total dos tumores na maioria dos pacientes, com baixa mortalidade e recidiva tumoral, mostrando ser segura e efetiva. .

Suboccipital craniectomy and duraplasty for Arnold-Chiari malformation 1: experience with 26 patients / Craniectomia suboccipital e duroplastia para o tratamento da malformação de Arnold-Chiari tipo 1: experiência com 26 pacientes

Objective: Observe whether the suboccipital foramen magno decompression, duraplasty and microsurgery lyses of arachninodal bands are a safe and an effective treatment. Method: A retrospective study was carried out with 26 consecutives patients with CM1 malformations diagnosed, evaluated and operated at the Neurosurgical department of Servidores do Estado Hospital (HSE), from 1986 to 2010. The radiological studies, patient records, surgical descriptions, and when available, surgical videos, were reviewed, creating a database from which information pertinent to the present study was collected. The follow-up varied from 8 to 168 months (mean, 48 months). Results: Twenty-six patients underwent posterior fossa decompression with duraplasty. In this series, there is no operative death. We noticed beneficial outcome in 69.2% of patients, and 4 cases of transient postoperative complications. Conclusion: This experience with 26 cases CM1 proved that suboccipital craniectomy; duraplasty with autologus pericranium and microlysis of adhesions is a safe and effective procedure.

Objetivo: Observar se a descompressão cirúrgica do forâmen magno associada à duroplastia é um procedimento seguro e eficaz para o tratamento da malformação de Arnold-Chiari tipo 1. Método: Realizaram-se revisão retrospectiva dos prontuários, descrições cirúrgicas e imagens de 26 pacientes com malformação de Arnold-Chiari 1 operados no Hospital dos Servidores do Estado (HSE) no período entre 1996 e 2010. Resultados: O tratamento em 18 pacientes (68%) constitui-se de craniectomia suboccipital, remoção do arco posterior de C1 e duroplastia. Os mesmos procedimentos foram acrescidos de laminectomia de C2 em 8 indivíduos (32%). Nesta série, não ocorreu nenhum óbito cirúrgico e observou-se melhora sintomática em 68% dos pacientes. Conclusão: A craniotomia occipital com a remoção do arco de C1 e/ou laminectomia de C2 e duroplastia mostrou-se eficaz, com baixa morbidade e sem mortalidade.

Fístulas crânio-nasais do líquido céfalo-raquiano. Estudo de 17 casos / Cerebrospinal fluid cranio-nasal fistulae. Report of 17 cases

Os autores estudam uma série de pacientes com fístula do líquido céfalo-raquiano (LCR). Analisam as etiologias mais comuns desse tipo de fístula e as classificam didaticamente em dois grandes grupos: espontâneas e traumáticas. O objetivo deste estudo é discutir a conduta terapêutica e chamar a atenção para as principais dificuldades no diagnóstico dessas lesões.