Pharmaceutical equivalent 5-aminolevulinic acid fluorescence guided resection of central nervous system tumors: feasibility, safeness and cost-benefit considerations.

PURPOSE: 5-aminolevulinic acid (5-ALA) fluorescence-guided resection (FGR) has been an essential tool in the 'standard of care' of malignant gliomas. Over the last two decades, its indications have been extended to other neoplasms, such as metastases and meningiomas. However, its availability and cost-benefit still pose a challenge for widespread use. The present article reports a retrospective series of 707 cases of central nervous system (CNS) tumors submitted to FGR with pharmacological equivalent 5-ALA and discusses financial implications, feasibility and safeness. METHODS: From December 2015 to February 2024, a retrospective single institution series of 707 cases of 5-ALA FGR were analyzed. Age, gender, 5-ALA dosage, intraoperative fluorescence finding, diagnosis and adverse effects were recorded. Financial impact in the surgical treatment cost were also reported. RESULTS: there was an additional cost estimated in $300 dollars for each case, increasing from 2,37 to 3,28% of the total hospitalization cost. There were 19 (2,69%) cases of asymptomatic photosensitive reaction and 2 (0,28%) cases of photosensitive reaction requiring symptomatic treatment. 1 (0,14%) patient had a cutaneous rash sustained for up to 10 days. No other complications related to the method were evident. In 3 (0,42%) cases of patients with intracranial hypertension, there was vomiting after administration. CONCLUSION: FGR with pharmacological equivalent 5-ALA can be considered safe and efficient and incorporates a small increase in hospital expenses. It constitutes a reliable solution in avoiding prohibitive costs worldwide, especially in countries where commercial 5-ALA is unavailable.

Facial Nerve Adherence in Vestibular Schwannomas: Classification and Radiological Predictors.

Background Facial nerve palsy is one of the most frequent complications after resection of vestibular schwannomas (VS). Several mechanisms have been implicated in the poor postoperative facial nerve outcome. Adherence between the facial nerve and tumor capsule is one of the most relevant factors. There is no clear preoperative parameter permitting identification of these adhesions. Objective The aim of this study was to identify the correlation between the grade of adherence of the facial nerve to the tumor capsule and its functional outcome after VS resection. Methods A total of 26 patients with sporadic VS (tumor sized T3, T4A, and T4B according to Hannover classification) were evaluated. Grade of adherence of the facial nerve to the tumor capsule was checked during surgery and graduated according to a proposed scale into 1 to 3 different grades. Facial nerve function was assessed postoperatively and after 1-year follow-up. Size of tumor according to Hannover classification, presence of cystic components, "cerebrospinal fluid (CSF) cleft sign," and the contour of tumor capsule were tested as radiological predictors of grade of adherence to the facial nerve. Results and Conclusion Only Grade 2 (11 cases) and 3 (15 cases) of adherence were seen in large VS. Lower grade of adherence was associated with good facial nerve outcome after 1-year follow-up ( p = 0.029). Presence of the "CSF cleft sign" and regular contour of tumor capsule were independent predictors of adherence. When both factors were associated, sensitivity and specificity of this method were 83 and 80%, respectively.

Spontaneous intracranial epidural hematoma during rivaroxaban treatment.

According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.

Spontaneous intracranial epidural hematoma during rivaroxaban treatment / Hematoma epidural intracraniano espontâneo durante tratamento com rivaroxaban

Summary According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.

Resumo Segundo nossa pesquisa, descrevemos o primeiro caso na literatura de hematoma epidural intracraniano espontâneo secundário ao uso de Xareltor. Hematomas epidurais intracranianos espontâneos raramente são descritos na literatura, sendo comumente associados a doenças infecciosas cranianas, distúrbios de coagulação, malformações vasculares da dura-máter e metástases cranianas. A elaboração de relatórios de monitoramento em longo prazo de pós-comercialização e relatórios independentes provavelmente irá detectar o espectro completo de complicações hemorrágicas do uso desse medicamento.

Microsurgical training model with nonliving swine head. Alternative for neurosurgical education.

PURPOSE: This paper proposes a practical model of microneurosurgical training using a nonliving swine head. METHODS: Fresh porcine heads were obtained from butchery and dissected at our Laboratory of Microsurgery. Brain and skull base surgery were trained under microscopic magnification. RESULTS: Several neurosurgical procedures could be simulated in the nonliving pig model, including transcallosal approach to the lateral ventricle, lateral sulcus and middle fossa dissection, and posterior fossa surgery. CONCLUSION: The swine model perfectly simulates standard microneurosurgical procedures, and is a useful tool for developing and refining surgical skills.

Microsurgical training model with nonliving swine head. Alternative for neurosurgical education

PURPOSE: This paper proposes a practical model of microneurosurgical training using a nonliving swine head. METHODS: Fresh porcine heads were obtained from butchery and dissected at our Laboratory of Microsurgery. Brain and skull base surgery were trained under microscopic magnification. RESULTS: Several neurosurgical procedures could be simulated in the nonliving pig model, including transcallosal approach to the lateral ventricle, lateral sulcus and middle fossa dissection, and posterior fossa surgery. CONCLUSION: The swine model perfectly simulates standard microneurosurgical procedures, and is a useful tool for developing and refining surgical skills. .

Descompressão neurovascular para neuralgia do trigêmio em menina de 17 anos de Idade: Relato de caso / Neurovascular decompression for trigeminal neuralgia in 17-year-old Girl: A case report

A neuralgia do trigêmeo é geralmente uma doença de idosos. Raramente, a doença apresenta-se durante a infância. Porisso, procuramos explorar o papel da compressão vascular em pacientes pediátricos com neuralgia do trigêmeo refratária.Apresentamos um caso de compressão venosa relacionado à neuralgia do trigêmeo em uma menina de 17 anos de idade. Aveia petrosa superior foi relacionada ao conflito neurovascular, com resposta incomum para descompressão neurovascular eresolução completa dos sintomas no pós-operatório...

Trigeminal neuralgia in general is a disease of the elderly. Rarely, the disease presents during childhood. Therefore we sought toexplore the role of vascular compression in pediatric patients with medically refractory trigeminal neuralgia. A case of venouscompression related to trigeminal neuralgia is presented in a 17-year-old girl. Upper petrous vein was found to be related to aneurovascular conflict with unusual response to neurovascular decompression with complete resolution of symptoms in postoperativeperiod...

Automedicação em universitários / Self-mediation among university

JUSTIFICATIVA E OBJETIVOS: A automedicação é uma prática comum na sociedade, no entanto, pode possibilitar agravo de doenças, interações medicamentosas e intoxicações, entre outros problemas de saúde. O objetivo deste estudo foi verificar a prática de automedicação e os fatores associados entre universitários. MÉTODO: Foi realizado estudo transversal com 160 estudantes dos cursos de graduação em Medicina e Direito de uma Universidade do Sul do Brasil. Utilizou-se questionário semiestruturado com variáveis sociodemográficas, clínicas e perfil de utilização de medicamentos nos últimos três meses. RESULTADOS: A prevalência de automedicação entre os entrevistados foi de 72,5%. Houve associação entre automedicação e o aluno estar cursando medicina, ser filho de profissional de saúde, ter convênio médico e renda familiar superior a 10 salários mínimos. Constatou-se que a indicação do uso de medicamentos por parte de pessoas leigas prevalece na realização de automedicação. CONCLUSÃO: Os dados obtidos indicam a necessidade de intervenção junto à população em estudo, quanto ao uso racional dos medicamentos e a automedicação responsável.

BACKGROUND AND OBJECTIVES: Self-medication isa common practice in society, however, can aggravate diseases and cause poisoning and drug interactions, among other health problems. The objective this study was to assess the practice of self-medication and associated factors among university students. METHOD: A cross-sectional study was conducted with 160 undergraduate students in medicine and law at a university in southern Brazil. A semi-structured questionnaire was used to identify sociodemographic and clinical variables, and medications used in the previous three months. RESULTS: The prevalence of self-medication among the respondents was 72.5%. There was an association between self medicationand the student enrollment in medicine, being theson or daughter of a health care provider, have medical insurance and family income above 10 minimum wages. Findings revealthat drugs indicated by non-professional people prevail in self medication. CONCLUSION: These data indicate the need for intervention to promote the rational use of drugs and responsible self-medication.