Chronic Aspergillus sp. meningitis successfully treated with fluconazole. Case report.

We a case of chronic Aspergillus sp. meningitis in a healthy 43-year-old woman successfully treated with fluconazole given orally (300 ms/day). The diagnosis was made by detection of anti-aspergillus antibodies and positive culture to Aspergillus sp. in the cerebrospinal fluid.

Middle cerebral artery revascularization. Anatomical studies and considerations on the anastomosis site.

In the surgical management of skull base lesions and vascular diseases such as giant aneurysms, involvement of the internal carotid artery may require the resection or the occlusion of the vessel. The anastomosis of the external carotid artery and the middle cerebral artery with venous graft may be indicated to re-establish the blood flow. To determine the best suture site in the middle cerebral artery, an anatomical study was carried out. Fourteen cerebral hemispheres were analysed after the injection of red latex into the internal carotid artery. The superior and inferior trunk of the main division of the middle cerebral artery have more than 2 mm of diameter. They are superficial allowing an anastomosis using a venous graft. The superior trunk has a disadvantage, it gives rise to branches for the precentral and post-central giri. The anastomosis with the inferior trunk presents lower risk of neurological deficit even though the angular artery originates from it.

Comparison of MRI-guided and ventriculography-based stereotactic surgery for Parkinson's disease.

Stereotactic surgery for Parkinson's disease can be performed using different neuroimaging methods. Ventriculography has been used to locate the coordinates of the structures close to the third ventricle. Although it has several potential disadvantages related to the intraventricular injection of iodine contrast, it is considered a precise method. Computed tomography and magnetic resonance imaging have been used in some centers. In order to compare their efficacy, 50 stereotactic thalamotomies for Parkinson's disease were performed using either ventriculography (VE) (25) or magnetic resonance imaging (MRI) (25). In 14 out of 25 VE procedures, computed tomography (CT-scan) was also used and showed a significant mean difference of coordinate Y and Z. The clinical results employing either VE or MRI were similar, with 80% abolition of tremor in the VE group, and 84% in the MRI group, after a follow up period of at least 3 months. Another 12% of VE and 16% of MRI group showed significant improvement of tremor. Complication rate was 4% in both groups. MRI-guided stereotactic thalamotomy in Parkinson's disease has shown good clinical results, comparable to VE-guided stereotaxis.

Thoracic intraspinal Paracoccidioidomycosis. Case report.

Intramedullary lesions caused by Paracoccidioides brasiliensis have been rarely described. Its diagnosis may be challenging and surgical approach is indicated for diagnostic and therapeutic purposes. We hereby report a case with MRI and surgical findings in a 45 year-old woman with intramedullary paracoccidioidomycosis, and make a review of other cases presented in the literature.

[Stereotactic surgery for intracranial mass lesions: diagnosis and treatment]. / Cirurgia estereotáctica para processos expansivos intracranianos: diagnóstico e tratamento.

The authors present a study about 50 stereotactic procedures for intracranial lesions. In 12 cases stereotaxis was used as a treatment: stereotactic surgical resection (5 patients) and aspiration of lesions (7 patients). This study confirms the great accuracy and low morbidity of the stereotactic techniques. Computed tomography and magnetic resonance imaging determinate the precise stereotactic coordinates, but in some cases it is necessary to perform stereo-angiography. The stereotactic surgical resection of brain tumors allows the treatment of deep lesions or located at functional areas and considered to be inoperable before. The related literature is discussed.

[Actinomycotic abscess of the cerebellum: a case report]. / Abscesso actinomicótico do cerebelo: relato de caso.

A 38 year-old man presented fever and a clinical picture of intracranial hypertension and ataxic syndrome. A CT-scan disclosed an expanding lesion of the cerebellum. Surgical excision of the lesion was performed and pathological examination made the diagnosis of an actinomycotic abscess. The probable primary source of infection were the lungs and/or oral cavity. The postoperative course was uneventful, with complete recovery after a long period of treatment with penicillin (IV and PO). The authors review some aspects about central nervous system involvement in actinomycosis.

[Perimesencephalic subarachnoid hemorrhage nonaneurysmatic: report of a case and literature review]. / Hemorragia subaracnóidea perimesencefálica não-aneurismática. Apresentação de caso e revisão de literatura.

A 42 year-old man with subarachnoid hemorrhage was admitted in our Service (Hunt & Hess grade II). CT-scan disclosed predominantly perimesencephalic subarachnoid hemorrhage. Digital subtraction angiographic study did not disclose either cerebral aneurysm or any other potential site of intracranial bleeding. The evolution was uneventful. A DSA was repeated one month later and was negative. Four months later, the patient was asymptomatic. The authors review the literature and emphasize the importance in recognizing this benign clinical form of nonaneurysmatic subarachnoid hemorrhage.

[Microsurgery of neurovascular decompression for trigeminal neuralgia: study of 35 cases]. / Microcirurgia de descompressão neuro-vascular para neuralgia do trigêmeo. Estudo de 35 casos.

The authors report the study of 35 cases of microvascular decompression for trigeminal neuralgia. No mortality and a very low morbidity were associated with this procedure. The choice of the treatment and the advantages of each method are discussed.