Brain Abscess and Esophageal Dilatation: Where is the Link? ­ Case Report

Introduction Caustic substance ingestion is a common cause of esophageal stricture in children. The primary treatment is esophageal dilatation. Although it is known that endoscopic esophageal dilatation is a procedure associated with a high rate of bacteremia, current guidelines do not recommend routine throat swab cultures or antibiotic prophylaxis for the general children population. Case Report We describe a case of a 7-year-old boy presenting with refractory headaches who was diagnosed with cranial abscess after multiple esophageal dilatations due to stenosis caused by caustic soda ingestion. The patient was subjected to neurosurgical intervention and intravenous antibiotic treatment for 6 weeks. Streptococcus viridans culture was positive in purulent abscess content. Conclusion We highlight this condition that, although rare, needs immediate diagnosis and proper treatment. We also recommend routine testing of throat swabs and antibiotics prophylaxis to children undergoing esophageal dilatation.

Less is more: Parahippocampal resection or endoscopic assistance in ambient cistern surgery? Qualitative and quantitative assessment of subtemporal approach.

The ambient cistern is an arachnoid complex that extends from the crural cistern to lateral border of cerebral colliculi. The subtemporal approach has been recognized as the best access to reach pathologies in the ambient cistern, however many disadvantages exist. The present work aims to analyze quantitatively the area of exposure provided by the subtemporal access. The objective is to evaluate if there are advantages of using the neuroendoscope in conventional subtemporal access when compared to the subtemporal access with resection of the parahippocampal gyrus. A subtemporal approach was performed in six brain hemispheres. Qualitative and quantitative analyses were made. The linear exposition of the vascular structures and the surgical exposure area were evaluated. The linear exposure to the posterior cerebral artery was 5.95 for subtemporal access (ST) and 13.6 for subtemporal access with resection of the parahippocampal gyrus (STh) (p = 0.019). The total exposure area was 104.8 mm2 for ST and 210.5 for STh (p = 0.0001). Regarding endoscope assistance the medial area, ST was 81.0 mm2, and STend was 176.2 mm2 (p = 0.038). For the total area of exposure, we obtained a value of 210.5 mm2 for ST and a value of 391.3 mm2 for STend (p = 0.041). In conventional subtemporal access, the use of the neuroendoscopes avoids the need for resection of the parahippocampal gyrus for better visualization of the ambient cistern structures.

Intramedullary Spinal Capillary Hemangioma: Case Report

Capillary hemangiomas involving the neuraxis are very uncommon. In the spinal cord, they are located mainly intradural and extramedullary. To our knowledge, only four cases in conus medullaris have been previously described. In our case, a 46-year-old man was admitted with back pain, sphincter disturbances, as well as progressive weakness and numbness on the lower extremities. Magnetic resonance imaging revealed an undefined intramedullary lesion on the conus medullaris. The patient underwent microsurgery, which achieved complete removal. Histopathological diagnosis was compatible with capillary hemangioma. His postoperative course was uneventful and all symptoms, including bladder dysfunction clearly regressed. The treatment of intramedullary capillary hemangiomas is very critical in preventing unnecessary morbidity, providing accurate information with respect to prognosis, and establishes a regular outpatient follow-up. The natural history of this lesion involving the spinal cord is not well described, although they are common elsewhere in the body.

Hemangiomas capilares que envolvem o neuroeixo são raros. Quando localizados na coluna vertebral, geralmente são intradurais e extramedulares. Até a presente data somente 4 casos de hemangiomas no cone medular foram descritos. O caso refere-se a um homem de 46 anos com dor lombar, alterações esfincterianas, fraqueza e parestesias em membros inferiores de evolução progressiva. Ressonância magnética demonstrou lesão no cone medular de aspecto indefinido. Submetido a remoção microcirúrgica completa. Histopatológico compatível com hemangioma capilar. O pósoperatório ocorreu sem intercorrências e houve recuperação dos déficits, inclusive da disfunção esfincteriana. O tratamento dessa lesão não deve acrescentar morbidade. A história natural dessa lesão na medula espinhal ainda não está definida, apesar de ser uma lesão comum em outras partes do organismo.