Endoscopic aqueductoplasty in the treatment of aqueductal stenosis.

OBJECTIVE: Endoscopic aqueductoplasty is an option of treatment of obstructive hydrocephalus caused by aqueductal stenosis. We report on our experience with this endoscopic technique. MATERIALS AND METHODS: Eighteen patients with primary or secondary aqueductal stenosis underwent endoscopic aqueductoplasty (EA) with or without stenting between July 2004 and January 2007. EA, EA with a stent, EA with endoscopic third ventriculostomy (ETV), and EA with stenting in addition to ETV were performed in eight, five, three, and two patients, respectively. A repeat endoscopic procedure was done in one patient. EA with a stent was performed in case 1, 8 months after first endoscopic procedure. In four cases, aqueductoplasty with stent was performed through a suboccipital approach. RESULTS: There were no deaths due to the neuroendoscopic procedures. All of the patients showed improvement or resolution of their preoperative symptoms, although in case 1 a new endoscopic procedure was performed: EA with a stent. CONCLUSION: Cerebral aqueductoplasty is an effective and successful treatment for membranous and/or short-segment stenosis of the sylvian aqueduct. Endoscopic aqueductoplasty candidates must be selected very carefully but longer follow-up periods are necessary to evaluate long-term aqueductal patency after aqueductoplasty.

Aggressive intracranial fibromatosis: case report.

UNLABELLED: Fibromatosis is a locally aggressive, proliferative fibroblastic lesion affecting musculoaponeurotic structures, most often in the limbs and trunk. Intracranial fibromatosis is extremely rare and requires aggressive treatment to prevent recurrence. CASE DESCRIPTION: We present the case of a 20 year old woman with aggressive skull base fibromatosis. The lesion extended through the sphenoid, ethmoid sinus and nasal cavity, destroying the right roof of the orbit and penetrating in anterior skull base. A combined anterior craniofacial approach was performed; complete resection with surgical margin was impossible due to the localization of the tumor and relation to important neurovascular structures. Complete resection with surgical margin is often impossible because of its widely infiltrative nature. Radiotherapy and chemotherapy are often required to improve local control of the lesion.

Aggressive intracranial fibromatosis: case report

Fibromatose é lesão fibroblástica proliferativa com agressividade localizada, afetando as estruturas músculo-aponeuróticas e acometendo, mais freqüentemente, os membros e tronco. A fibromatose intracraniana é rara e requer tratamento agressivo para evitar recidiva. Descrevemos uma paciente de 20 anos portadora de fibromatose agressiva de base de crânio. A lesão se estendia através da cavidade nasal, seios esfenoidal e etmoidal, destruindo o teto da órbita direita e invadindo a porção anterior da base do crânio. A paciente foi submetida a uma via craniofacial anterior combinada, não sendo possível uma ressecção completa devido ao envolvimento de estruturas neurovasculares. A ressecção completa é, freqüentemente, impossível devido sua natureza infiltrativa. Radioterapia e quimioterapia são indicadas para melhorar o controle da lesão.

[Size and proliferative index correlation in acoustic neuromas]. / Associação entre tamanho e potencial proliferativo em neurinomas do acústico.

Acoustic neuromas are the most common tumors in the cerebellopontine angle. The molecular mechanisms involved in generation and growth of these tumors are not completely elucidated. Many radiological, clinic and immunohistochemistry data were correlated to tumor growth. We studied 11 acoustic neuromas surgically treated at Hospital São Paulo/Unifesp and correlated clinical and radiological data with proliferative index (Ki-67). The size of the tumors were positively correlationated with proliferative index. No other correlation had statistic significativity.

Associação entre tamanho e potencial proliferativo em neurinomas do acústico / Size and proliferative index correlation in acoustic neuromas

Schwanomas do acústico são os tumores mais freqüentes localizados no ângulo pontocerebelar. Os mecanismos moleculares que levam a sua geração e crescimento ainda não são bem conhecidos. Várias características clínicas, radiológicas e imuno-histoquímicas já foram estudadas e correlacionadas ao crescimento tumoral. Estudamos e correlacionamos aspectos clínicos e imuno-histoquímicos (MIB-1) de 11 schwanomas do acústico operados no Hospital São Paulo/UNIFESP. O tamanho dos tumores correlacionou-se com o índice proliferativo (Ki-67), não havendo correlação com significância estatística entre a idade dos pacientes, duração dos sintomas e índice proliferativo.

Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report.

Headache as a chief complaint is rare in the paediatric emergency room. Actually, very seldom cases secondary to life threatening conditions as non-traumatic subarachnoid haemorrhage have been reported. A child with severe headache and nuchal rigidity and no other abnormalities on the physical examination is reported. Magnetic resonance angiography and cerebral angiography disclosed a ventricular arteriovenous malformation in the choroid plexus, supplied by the anterior choroidal artery, classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2). The differences in the clinical presentations of the central nervous system arteriovenous malformation between children and adults are discussed.

Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report

Cefaléia como queixa principal raramente ocorre num serviço de emergência pediátrica. Quando isso acontece, casos de cefaléia secundária que trazem risco de vida, tais como a hemorragia subaracnóide são raramente relatados. Apresentamos o caso de uma criança que apresentou cefaléia de forte intensidade associada a rigidez de nuca, sem outras anormalidades no exame físico. A angioressonância e angiografia digital evidenciaram malformação arteriovenosa na topografia do plexo coróide do ventrículo lateral direito, nutrida pela artéria coroidéia anterior, grau III na classificação de Spetzler (drenagem venosa profunda: 1; área de eloqüência: 0 e tamanho: 2). Nós discutimos as diferenças na apresentação clínica das malformações arteriovenosas encefálicas nas crianças e adultos.