Posterior Transtemporal Approach to a Thalamic Cavernous Malformation: 2-Dimensional Operative Video.

Cavernous malformations (CMs) account for 10%-15% of all vascular malformations and represent the second most common type of cerebral vascular lesion.1 They typically occur in the cerebral subcortex or white matter.2 CMs located in the thalamus are rare.3 When we isolate the group of thalamic CMs, we find a bleeding risk of >5% per year, with a rebleeding rate exceeding 60%, often occurring within 1 year of the initial bleeding.1 The deep location and proximity to eloquent brain regions make thalamic CMs challenging for neurosurgeons.4,5 Surgeons can access the posterolateral thalamus through various surgical approaches, such as transcallosal transventricular, supracerebellar transtentorial, intraparietal sulcus, and transcortical methods. Selecting the best surgical approach requires considerable expertise, considering the patient's preoperative condition and the lesion's location.6-12 We discuss a complex case involving a 24-year-old patient with a right thalamic cavernoma and a history of 3 prior bleeding events. We present a step-by-step transcortical approach through the posterior portion of the superior temporal gyrus (Video 1). The patient consented to the procedure and publication of images. We demonstrate how the transtemporal posterior trajectory provides an optimal working corridor for safely removing this cavernous malformation without introducing new deficits.

The Technique for Transorbital Ventricular Puncture: An Anatomic Approach.

BACKGROUND AND OBJECTIVES: Transorbital ventricular puncture is a minimally invasive described procedure with poor landmarks and anatomic references. This approach can be easily performed to save patients with intracranial hypertension, especially when it is secondary to an acute decompensated hydrocephalus. This study aims to describe anatomic structures and landmarks to facilitate the execution of transorbital puncture in emergency cases. METHODS: We analyzed 120 head computed tomographies to show the best area to perform the procedure in the orbital roof. Two adult cadavers (4 sides) were punctured in the predetermined area. Angles, distances, landmarks, and anatomic structures were registered. This approach to the ventricular system may be performed at bedside to relieve intracranial hypertension only in specific cases. RESULTS: The perforation point is 2.5 cm (female) or 3.0 cm (male) lateral to the midline and immediately inferior to the superciliary arch. A vertical line, parallel to midline, was drawn on the outer edge of the patient's forehead, the needle was 45° inferiorly and 20° medially and then progressed 2.0 cm backwards to reach the bone perforation point. After that, it was advanced another 4.5cm approximately until it reached the anterior horn of the lateral ventricle. CONCLUSION: Based on statistical and experimental evidences, we were able to establish reliable anatomic reference points to access the anterior horn of the lateral ventricle through transorbital puncture.

Microsurgical Treatment for Arteriovenous Malformation in Eloquent Area: A 2-Dimensional Surgical Video and Step-by-Step Practical Guide.

Cerebral arteriovenous malformations (AVMs) are dynamic neurovascular disorders that occur mainly in young adults, presenting an annual risk of rupture of 2% - 4% per year.1 They can be asymptomatic, representing an incidental radiologic finding, or present with neurologic deficits according to their brain location, size, and presence or absence of bleeding.2,3 AVMs located in eloquent areas4 represent a great challenge for neurosurgeons, sometimes directed to alternatives therapies (e.g., embolization, radiotherapy) due to the difficulty in planning and surgical technique. Despite the complexity, we consider that there is benefit to removing these lesions; this can be done safely, as with the adequate microsurgical strategy and neuroanatomic knowledge. In Video 1, we show the case of a 55-year-old male patient with an AVM positioned over the right central sulcus. He presented with intermittent left-hand paresthesia followed by an episode of involuntary movements in the left arm without loss of consciousness and with spontaneous resolution. Angiography showed an AVM feed by branches of the middle cerebral artery and multiple venous drainage for the Trolard complex and superficial middle cerebral vein, with a 4-cm nidus, making it grade III in the Spetzler-Martin classification.4 The patient underwent surgery with total resection of the lesion without any complication or new neurologic deficits.

Prevalência de transtornos mentais comuns em estudantes de medicina da Faculdade Evangélica do Paraná em 2011 / Prevalence of common mental disorders among medicine students at Faculdade Evangélica do Paraná in 2011

Transtornos mentais comuns (TMC)apresentam-se como sintomas de insônia, fadiga, esquecimento e dificuldade de concentração, podendo reduzir o desempenho de atividades diárias. Cerca de 25% dos estudantes de medicina encontram-se deprimidos, enquanto 50% apresentam exaustão. O objetivo do estudo foi avaliar a prevalência de TMC entre os estudantes do curso de Medicina da Faculdade Evangélica do Paraná (FEPAR). Foi aplicado o questionário SRQ-20 (Self Report Questionnaire ­ 20), versão validada para Português-Brasil. A população estudada constituiu-se de alunos entre o 1º e 8º semestres do curso de Medicina, matriculados em 2011. Considerou-se provável caso de TMC a pontuação ≥ 6 para homens e 8 para mulheres. O nível de significância foi de 0,05. O montante de 121 estudantes tiveram pontuação sugestiva de TMC (2/3 eram do sexo feminino) e 12,5% referiram pelo menos um dos sintomas. Conclui-se que a prevalência de TMC em estudantes da FEPAR, em 2011, foi de 31,51%

Common Mental Disorders (CMD) are presented symptoms as insomnia, fatigue, forgetfulness, concentration difficulties, what can decrease in daily performance. About 25% of the students are depressed while 50% present signs of exhaustion. The goal of the study was to evaluate the prevalence of CMD among the medicine students of Faculdade Evangélica do Paraná (FEPAR).The Self Report Questionnaire 20 was applied in Portuguese validated version. The studied population was constituted by students registered between the 1st and 8th semesters of graduation since 2011 at FEPAR. It was considered as likely cases when the score is ≥ 6 for men and 8 for women. The level of significance was 0,05%.The number of 121 students presented suggestive score of CMD (2/3 were women) and 12,5% presented at least one of the symptoms.It is concluded that the prevalence of CMD among medicine students of FEPAR was 31,51%