RESUMO
BACKGROUND AND IMPORTANCE: Stereotactic biopsies or needle aspirations of posterior fossa lesions are technically challenging. Here we report a novel technique for performing these procedures employing the Airo™ intraoperative computed tomographic (CT) scanner and the VarioGuide™ articulated arm (BrainLab, Munich, Germany). CLINICAL PRESENTATION: A 62-yr-old woman presented with an irregularly shaped, enhancing lesion of the left pons/middle cerebellar peduncle. Slowed diffusion on magnetic resonance imaging suggested an abscess, but no definitive infectious agent/source could be identified. When the patient deteriorated despite broad-spectrum antibiotic therapy, she was taken to the operating room for stereotactic drainage of the abscess employing the described technique. A specific infectious agent (Eikenella corrodens) was identified from the aspirate, allowing for tailored antibiotic therapy. The procedure was well tolerated and the patient made a full recovery with minimal neurological sequelae. CONCLUSION: The combination of the Airo™ intraoperative CT and the Varioguide™ articulated arm allows for safe, accurate, and efficient targeting of posterior fossa lesions.
Assuntos
Abscesso Encefálico/cirurgia , Tronco Encefálico/cirurgia , Drenagem/métodos , Eikenella corrodens , Infecções por Bactérias Gram-Negativas/cirurgia , Imageamento Tridimensional/métodos , Neuroimagem/métodos , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/instrumentação , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Tronco Encefálico/diagnóstico por imagem , Terapia Combinada , Drenagem/instrumentação , Eikenella corrodens/isolamento & purificação , Desenho de Equipamento , Feminino , Infecção Focal Dentária/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico por imagem , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neuroimagem/instrumentação , Radiografia Intervencionista/instrumentação , Técnicas Estereotáxicas/instrumentaçãoRESUMO
BACKGROUND: In this article, the authors described their experience in microvascular decompression for trigeminal neuralgia. METHODS: The microvascular decompression technique used in the authors' institution is described in a step by step manner with some illustrative cases as well as a cadaver dissection to highlight the differences with other previously described techniques. RESULTS: Since 2013, 107 patients were operated in the Neurosurgery Division of the University of São Paulo using the described technique, with a shorter operative time and avoiding cerebellar retractor compared with classic techniques. CONCLUSION: Our modified microvascular decompression technique for trigeminal neuralgia can be used with safety and efficiency for treating trigeminal neuralgia.
RESUMO
CONTEXTO: Deficiência de vitaminas do complexo B tem sido associada a deterioração cognitiva e quadros demenciais em idosos. OBJETIVO: Neste trabalho, foi avaliado se pacientes com doença de Alzheimer (DA) e com comprometimento cognitivo leve (CCL) apresentam níveis séricos de ácido fólico e cobalamina (vitamina B12) menores que idosos controles. MÉTODOS: Foram recrutados 146 idosos (40 com DA, 56 com CCL e 49 idosos controles) para este estudo. Os níveis séricos de ácido fólico e vitamina B12 foram avaliados pelo método de eletroquimioluminescência. RESULTADOS: Os pacientes com DA apresentaram redução estatisticamente significativa nos níveis de ácido fólico em relação aos idosos com CCL e controles (p = 0,02). Esses resultados mantiveram-se estatisticamente significativos após controlar por variáveis sociodemográficas e desempenho cognitivo. Não se observaram diferenças estatisticamente significativas nos níveis de vitamina B12 nem em variáveis hematológicas entre os grupos. CONCLUSÃO: Esses resultados reforçam a importância de anormalidades em aspectos nutricionais, em particular do metabolismo de um-carbono, na fisiopatologia da DA.
BACKGROUND: Complex B vitamin deficiency has been associated to cognitive impairment and dementing disorders in the elderly. OBJECTIVE: This work aims to assess whether patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) have lower levels of folic acid and cobalamin (vitamin B12) compared to age and gender-matched controls. METHODS: One hundred and forty six elderly subjects (40 AD, 56 MCI and 49 healthy older adults) were recruited for this study. Serum folic acid and vitamin B12 levels were measured by electrochemoluminescence. RESULTS: Compared to MCI and healthy controls a statistically significant reduction in serum concentrations of folic acid in AD patients was found (p = 0.02). This result remained statistically significant after controlling for socio-demographic and cognitive performance variables (p = 0.01). No significant differences were found in serum concentrations of vitamin B12 in patients with AD, MCI and healthy controls. No significant changes in hematologic parameters were observed across these diagnostic groups. DISCUSSION: The present study provides additional evidence that folic acid is reduced in patients with AD and reinforces the importance of nutritional changes, in particular the one-carbon metabolism, in the physiopathology of AD.
