Quality of life in the pre- and postoperative periods in spinal fusion and discectomy / Qualidade de vida pré e pós-operatória da artrodese de coluna e discectomia / Calidad de vida en los periodos pre y postoperatorio en artrodesis de columna y discectomía

ABSTRACT Objectives: Considering the epidemiological and functional importance of spinal pathologies and the large number of surgeries performed today, the study aimed to evaluate the impact of spinal arthrodesis and discectomy surgeries on patients' quality of life. Methods: This is a retrospective, descriptive, and longitudinal study developed in the neurology and neurosurgery department of a strategic tertiary hospital in an inland town in the state of São Paulo. Data were collected through a telephone interview, using the Oswestry questionnaire (ODI) to assess lumbar pain in patients submitted to surgery in 2014 and 2015. Results: There was an improvement in the ODI results in all the periods analyzed. When the evaluations were subdivided by surgical type, there was an absolute improvement in the median ODI results in all procedures, however, only the cervical spine arthrodesis procedure was not statistically significant, probably due to the low number of procedures analyzed (n = 12). Conclusion: It can be concluded that the current surgical technique can contribute to the improvement of patients' quality of life. Level of Evidence III; Comparative retrospective study.

RESUMO Objetivo: Devido à importância epidemiológica e funcional das patologias de coluna e ao grande número de cirurgias realizadas atualmente, o estudo teve como objetivo avaliar o impacto das cirurgias de artrodese de coluna vertebral e discectomia na qualidade de vida dos pacientes. Métodos: Trata-se de um estudo retrospectivo, descritivo e longitudinal, desenvolvido junto ao Serviço de Neurologia e Neurocirurgia de um hospital estratégico terciário do interior do estado de São Paulo. A coleta de dados ocorreu por meio de entrevista telefônica, aplicando-se o Questionário Oswestry (ODI) para avaliação da dor lombar em pacientes submetidos à cirurgia entre os anos de 2014 e 2015. Resultados: Observou-se uma melhora dos resultados do ODI em todos os períodos analisados. Quando subdivididas as avaliações por tipo cirúrgico, houve melhora absoluta nas medianas de resultados do ODI em todos procedimentos, porém, apenas o procedimento de artrodese da coluna cervical não teve significância estatística, provavelmente devido ao baixo número de procedimentos analisados (n=12). Conclusão: Conclui-se que a técnica cirúrgica vigente pode contribuir com a melhora da qualidade de vida dos pacientes. Nível de Evidência III; Estudo retrospectivo comparativo.

RESUMEN Objetivo: Debido a la importancia epidemiológica y funcional de las patologías de columna y al gran número de cirugías realizadas actualmente, el estudio tuvo como objetivos evaluar el impacto de las cirugías de artrodesis de columna vertebral y discectomía en la calidad de vida de los pacientes. Métodos: Se trata de un estudio retrospectivo, descriptivo y longitudinal, desarrollado junto al servicio de neurología y neurocirugía de un hospital terciario estratégico del interior del estado de São Paulo. La recolección de datos ocurrió a través de una entrevista telefónica, aplicándose el cuestionario Oswestry (ODI) para evaluar el dolor lumbar en pacientes sometidos a la cirugía en los años de 2014 y 2015. Resultados: Se observó una mejora de los resultados del ODI en todos los casos períodos analizados. Cuando se subdividieron las evaluaciones por tipo quirúrgico, hubo una mejora absoluta en las medianas de resultados del ODI en todos los procedimientos, pero sólo el procedimiento de artrodesis de la columna cervical no tuvo significancia estadística, probablemente debido al bajo número de procedimientos analizados (n = 12). Conclusión: Se concluye que la técnica quirúrgica vigente puede contribuir con la mejora de la calidad de vida de los pacientes. Nivel de Evidencia III; Estudio retrospectivo comparativo.

Outcome of Percutaneous Radiofrequency Thoracic Sympathectomy for Palmar Hyperhidrosis.

The impact of upper thoracic percutaneous sympathectomy with radiofrequency on the quality of life (QOL) of patients with palmar hyperhidrosis was evaluated. Thirty-six patients with palmar hyperhidrosis were selected for a prospective observational study. Treatment consisted of percutaneous radiofrequency thoracic sympathectomy of T3 and T4 ganglions in all cases. QOL questionnaires were applied preoperatively, on the 1st postoperative (PO) day, and on the 30th, 90th, 180th, and 360th PO days. Furthermore, compensatory hyperhidrosis (HDSSc) scale measures were used simultaneously, in order to evaluate the rate and frequency of this side effect. The QOL questionnaire evaluation showed preoperative values of 83.94 ±â€¯4.74 (meaning poor quality of life), decreasing to 24.61 ±â€¯2.86 on the 1st PO day, 25.14 ±â€¯3.12 on the 30th PO day, 31.28 ±â€¯4.42 on the 90th PO day, 32.97 ±â€¯4.54 on the 180th PO day, and 33.94 ±â€¯4.6 on the 360th PO day (all postoperative results with values below 35 were considered optimal). Compensatory hyperhidrosis (HDSSc) scale values were 1.14 ±â€¯0.35 on the 1st PO day, 1.42 ±â€¯0.55 on the 30th PO day, 1.83 ±â€¯0.85 on the 90th PO day, 1.92 ±â€¯0.91 on the 180th PO day, and 1.92 ±â€¯0.91 on the 360th PO day (meaning that hyperhidrosis was mainly unnoticed). Patients' subjective satisfaction was considered very good and the majority of patients would recommend the treatment procedure. Percutaneous radiofrequency thoracic sympathectomy had a positive impact on the quality of life of patients with palmar hyperhidrosis, compared to the surgical treatment, with a low rate and intensity of HDSSc and without other complications.

Endoscopic Endonasal Odontoidectomy: Nuances of Neurosurgical Technique / Odontoidectomia endoscópica endonasal: nuances da técnica cirúrgica

Odontoidectomy is the treatment of choice for some diseases that cause irreducible ventral compression of the brainstem. In this study, we present our series emphasizing the technical nuances of endoscopic endonasal odontoidectomy

Odontoidectomia é o tratamento de escolha para algumas doenças que cursam com compressão irredutível do tronco encefálico. Neste trabalho, apresentamos nossa série enfatizando as nuances da técnica cirúrgica da odontoidectomia por via endonasal endoscópica.

Open vs. Percutaneous Pedicle Screw Insertion for Thoracolumbar Traumatic A3 and A4 AO Fractures - 18-Months Follow-Up

Purpose To compare the efficacy and safety of the percutaneous screw fixation (PSF) and the open pedicle screw fixation (OPSF) on thoracolumbar (TL) fracture. Methods Sixty-four adult patients with TL vertebral fractures who underwent open or percutaneous posterior short-segment transpedicular screw fixation between January of 2013 and September of 2015 were retrospectively reviewed. All patients underwent clinical, radiological and quality of life follow-up for at least 18 months. Results There was no significant difference in age, gender, time between injury and surgery, and preoperative percentage of anterior column height, preoperative sagittal regional Cobb angle, or kyphotic angle of fractured vertebra between these two groups (p > 0.05). There was significantly less intraoperative blood loss in the PSF (87.6 24.6 mL) than in the OPSF group (271.4 142.6 mL) (p < 0.05). The mean surgery time was 62 minutes (range 42­130 minutes) for open and 58 minutes (range 35 to 128 minutes) for percutaneous screw fixation. The surgery time was shorter in the PSF group, but with no statistical significance (p > 0.05). The mean Oswestry disability index (ODI) scores after 18-months were 23.12 8.2 for the PSF and 24.12 9.2 for the OPSF group, without any statistical significance (p > 0.05). Conclusion Both open and percutaneous screw fixations are safe and effective. The percutaneous techniques significantly reduced the intraoperative blood loss compared with the open techniques.

Objetivo Comparar a eficácia e segurança das técnicas de fixação convencional e percutânea para fraturas toracolombares. Métodos Sessenta e quatro pacientes adultos com fraturas da transição toracolombar que foram submetidos a fixação pedicular curta por técnicas aberta convencional e percutânea entre janeiro de 2013 e setembro de 2015 foram retrospectivamente avaliados. Todos foram submetidos a avaliação clínica, radiológica e de qualidade de vida com no mínimo 18 meses do seguimento. Resultados Não houve diferença significativa na idade, sexo, tempo entre o trauma e o tratamento, porcentagem da redução da altura do corpo vertebral pré-operatório, angulo de Cob sagital na região da fratura, ou ângulo de de cifose da vértebra fraturada entre os dois grupos (p > 0,05). Houve uma menor perda sanguínea no grupo percutâneo (87,6 24,6 mL) em comparação com a técnica convencional (271,4 142,6 mL) (p < 0,05). O tempo médio da cirurgia foi 62 minutos (42 - 130 minutos) para a técnica convencional e 58 minutos (35 - 128 minutos) para a percutânea. Apesar de mais curto na técnica percutânea, não houve diferença estatisticamente significante no tempo cirúrgico entre os dois grupos (p > 0,05). Em relação ao índice de incapacidade de Oswestry após 18 meses do tratamento cirúrgico, também não houve diferença significante do ponto de vista estatístico entre os dois grupos, sendo 23,12 8,2 para a técnica percutânea e 24,12 9,2 para o grupo da técnica convencional (p > 0,05). Conclusão Ambas as técnicas mostraram-se eficazes e seguras para o tratamento de fraturas da transição toracolombar. A técnica percutânea apresentou uma taxa de perda sanguínea significativamente menor em comparação à técnica aberta convencional.

Endoscopic and Microsurgical Approaches to the Cavernous Sinus ­ Anatomical Review

Cavernous sinus surgery has always represented a surgical challenge due to the great importance of the surrounding anatomical structures and to the high morbidity associated to it. Although the anatomy of this region has been extensively described, controversy remains related to the best treatment and approaches for different kinds of lesions. In this article, a literature review was performed on the surgical anatomy and approaches to the cavernous sinus.

A cirurgia da região do seio cavernoso sempre representou um desafio devido à grande importância das estruturas anatômicas e às altas taxas de morbidade associadas. Embora a anatomia da região tenha sido extensivamente descrita, permanece controverso o melhor tratamento e o acesso para diferentes tipos de lesão que acometem a região. Neste artigo foi realizada uma revisão de literatura focando a anatomia cirúrgica e os acessos à região do seio cavernoso.

Bilateral Vertebral Artery Dissection after a Chiropractic Therapy Session

Vertebral artery dissection (VAD) is a rare and sometimes unrecognized cause of stroke in patients younger than 45 years. Herein, we describe a very rare case of bilateral vertebral artery dissection after a session of cervical therapy manipulation (chiropractic).

Vertebral artery dissection (VAD) is a rare and sometimes unrecognized cause of stroke in patients younger than 45 years. Herein, we describe a very rare case of bilateral vertebral artery dissection after a session of cervical therapy manipulation (chiropractic).

Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects

Abstract Palmar hyperhidrosis affects up to 3% of the population and inflict significant impact on quality of life. It is characterized by chronic excessive sweating, not related to the necessity of heat loss. It evolves from a localized hyperactivity of the sympathetic autonomic system and can be triggered by stressful events. In this study, the authors discuss clinical findings, pathophysiological, diagnostic and therapeutic issues (clinical and surgical) related to palmar hyperhidrosis.

Spontaneous resolution of traumatic acute subdural haematomas: A systematic review / Resolución espontánea de hematoma subdural agudo traumático: una revisión sistemática

Introduction: Traumatic subdural haematomas often require emergency surgical evacuation. Spontaneous resolution of traumatic acute subdural haematomas (TASDH) is under-reported. Two patients are described with spontaneous resolution of TASDH correlating with previous reports. A discussion is presented on the clinical, pathological and radiological features of TASDH. Methods: A review of the literature was performed using PubMed (Medline), Embase, and Cochrane Library for similar cases. Results: A total 21 articles were included, involving 27 cases well detailed of TASDH with spontaneous resolution or neurological and radiological improvement in less than 24h. Conclusions: There are two main mechanisms for the spontaneous resolution of acute subdural haematomas: dilution in subarachnoid space and redistribution of the haematoma in the subdural space. The primary radiological characteristic of these lesions is a hypodense rim on the outer surface of the clot. Spontaneous resolution of TASDH is unusual. Clinical and radiological surveillance is essential for appropriate management of these patients (AU)

Introducción: Los hematomas subdurales agudos traumáticos (HSDAT) requieren tratamiento quirúrgico de urgencia. Muy raras veces se describen casos de resolución espontánea de HSDAT. Describimos 2 casos de resolución espontánea de HSDAT y revisamos la bibliografía pertinente. Se discuten los aspectos clínicos, patológicos y radiológicos de resolución espontánea de HSDAT. Métodos: Revisamos la literatura en Pubmed (Medline), Embase y Cochrane Library en busca de casos similares. Resultados: Se incluyeron 21 artículos con 27 casos bien detallados de HSDAT con resolución espontánea o mejora clínica y radiológica en 24h. Conclusiones: Existen 2 mecanismos principales para la resolución espontánea de hematomas subdurales agudos: la dilución en el espacio subaracnoideo y la redistribución del hematoma en el espacio subdural. La principal característica radiológica de estas lesiones es una cerco hipodenso en la superficie exterior del coágulo. La resolución espontánea de HSDAT es rara. La vigilancia clínica y radiológica es esencial para el manejo adecuado de estos pacientes (AU)

Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis.

BACKGROUND: Malignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes. METHODS: A retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age. RESULTS: The final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs (67% vs. 41%; p = 0.039), whose group also had a worse outcome (76% with mRS 5 or 6) at 90 days (OR 3.91 CI95% 1.30-11.74), whereas only 24% had mRS of 0-4 (p = 0.015). All patients who presented with sepsis died (p = 0.003). The incidence of pulmonary infection was very high in the elderly group (76%) with significant intergroup differences (p = 0.027, OR 8.32 CI95% 0.70-98.48). CONCLUSIONS: Older patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be proved with a South American trial, and if confirmed, it can impact on future decisions regarding decompressive craniectomy for acute ischemic stroke in our region.

Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects.

Palmar hyperhidrosis affects up to 3% of the population and inflict significant impact on quality of life. It is characterized by chronic excessive sweating, not related to the necessity of heat loss. It evolves from a localized hyperactivity of the sympathetic autonomic system and can be triggered by stressful events. In this study, the authors discuss clinical findings, pathophysiological, diagnostic and therapeutic issues (clinical and surgical) related to palmar hyperhidrosis.

Spontaneous resolution of traumatic acute subdural haematomas: A systematic review.

INTRODUCTION: Traumatic subdural haematomas often require emergency surgical evacuation. Spontaneous resolution of traumatic acute subdural haematomas (TASDH) is under-reported. Two patients are described with spontaneous resolution of TASDH correlating with previous reports. A discussion is presented on the clinical, pathological and radiological features of TASDH. METHODS: A review of the literature was performed using PubMed (Medline), Embase, and Cochrane Library for similar cases. RESULTS: A total 21 articles were included, involving 27 cases well detailed of TASDH with spontaneous resolution or neurological and radiological improvement in less than 24 h. CONCLUSIONS: There are two main mechanisms for the spontaneous resolution of acute subdural haematomas: dilution in subarachnoid space and redistribution of the haematoma in the subdural space. The primary radiological characteristic of these lesions is a hypodense rim on the outer surface of the clot. Spontaneous resolution of TASDH is unusual. Clinical and radiological surveillance is essential for appropriate management of these patients.

Neurocirurgia e filosofia no século XIX: como o pensamento da época influenciou o desenvolvimento da neurocirurgia moderna / Neurosurgery and Philosophy in the 19th Century: How Modern Neurosurgery Development Relates to Past Thinking

O século XIX foi um período marcado por profundas mudanças sociais, políticas e econômicas que refletiram diretamente no desenvolvimento científico. Neste artigo, tenta-se estabelecer relação entre as linhas filosóficas deste período e o surgimento da neurocirurgia moderna.

The 19th century was a period with important social, politic and economic changes that strongly supported scientific development. In this paper, I tried to establish relationship between philosophical theories of this period and beginning of modern neurosurgery.

Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy.

Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults' patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy / Seguimento longo em pacientes com sacroileíte submetidos a terapia de radiofrequência ablativa

Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

A Sacroileíte pode ser responsável por até 40% dos casos de dor lombar crônica. Objetivo Análise da eficácia da denervação por radiofrequência na articulação sacro-ilíaca em seis, doze e dezoito meses.Método Trinta e dois pacientes com diagnóstico de sacroileíte foram incluídos em estudo prospectivo. O prognóstico primário foi avaliado pela escala visual analógico (NRS). O prognóstico secundário foi avaliado pela escala de impressão global de mudança pelo paciente (PGIC).Resultados Melhora a curto prazo da dor foi observada, com redução media na NRS de 7,7 ± 1,8 para 2,8 ± 1,2 após 1 mês e para 3,1 ± 1,9 em 6 meses do procedimento (p < 0,001). Após 12 e 18 meses, o NRS manteve-se 3,4 ± 2,1 e 4,0 ± 2,7, respectivamente.Conclusão A denervação da articulação sacro-ilíaca por radiofrequência pode reduzir significativamente a dor em pacientes com sacroileíte.

Endoscopic Endonasal Transsphenoidal Pituitary Tumors Approach: Nuances of Neurosurgical Technique / Abordagem endoscópica endonasal transesfenoidal para tumores hipofisários: detalhes da técnica neurocirúrgica

Pituitary tumors are responsible for 7 to 17% of all intracranial lesions. Over the past decade, advances in endoscopic microsurgical techniques have resulted in an increasingly aggressive endonasal approach to tumors of the midline skull base. We present our series emphasizing technical nuances of endoscopic endonasal transsphenoidal approach to treat pituitary adenomas.

Tumores hipofisários são responsáveis por 7 a 17% de todas as lesões intracranianas. Durante a última década, avanços nas técnicas microcirúrgicas endoscópicas resultaram no aumento de acessos endonasais agressivos para tumores de base de crânio de linha média. Apresentamos nossa série de casos, com ênfase nos detalhes técnicos do acesso endoscópico endonasal transesfenoidal para o tratamento de tumores da hipófise.

Calvarial ectopic meningothelial meningioma.

BACKGROUND: Meningiomas are the most common benign neoplasm of the brain whereas ectopic presentation, although reported, is rare. Among these ectopic tumors, there are a group of purely intraosseous meningiomas, which usually are diagnosed differentially from common primary osseous tumor such as fibrous dysplasia and osteoid osteoma. CASE DESCRIPTION: We report a 62-year-old female with a history of headaches and 6 months of progressive right parietal bulging, with no neurological signs. Parietal craniotomy was performed with immediate titanium cranioplasty of the parietal convexity. Histopathology exams revealed an ectopic intradiploic meningioma without invasion of cortical layers, with positive staining for progesterone receptors and epithelial membrane antigen. CONCLUSIONS: Ectopic intraosseous meningiomas remain a rare neoplasm with only a few cases reported. The main theories to justify the unusual topography appear to be embryological remains of neuroectodermal tissue or cellular dedifferentiation. Surgical treatment seems the best curative option.

Current management of brain metastases / Manejo atual de metástases cerebrais

Brain metastases are the most common tumors within the central nervous system. Recent advances on diagnosis and treatment modalities have allowed for longer survival. In this paper we review the indication of each modality of treatment: surgery, whole brain radiotherapy and stereotactic radiosurgery, as also recent advances on the knowledge of brain metastases biology that may improve the use of medical treatment and chemotherapy.

Metástases cerebrais são os tumores mais comuns do sistema nervoso central. Avanços recentes no diagnóstico e modalidades de tratamento têm aumentado a sobrevida dos pacientes. Neste artigo, revisamos a indicação de cada modalidade de tratamento: cirurgia, radioterapia convencional, radiocirurgia estereotáxica, como também os recentes avanços no conhecimento da biologia das metástases cerebrais que poderão ampliar o uso do tratamento clínico com quimioterapia.