Use of Vacuum-suction in Depressed Skull Fractures ­ Case Report and Technical Nuances of Nonoperative Treatment

Up to 20% of victims from skull fractures are represented by the pediatric population, and 50% of these lesions are depressed skull fractures. The treatment is multimodal in nature, ranging from conservative treatment to open surgical repair. The last one is associated, although in a small proportion, to complications, such as infections, hematomas and even death, besides the risks of the anesthetic procedure itself. The authors of the present article present a case report of the successful treatment of a depressed skull fracture in a newborn patient, using the vacuum-suction technique. The use of vacuum-suction may be beneficial for the pediatric patients, as it is a quick, non-invasive procedure, without the need for general anesthesia.

Endoscopic Sural Nerve Removal in Obstetric Brachial Plexopathy Using Basic Endoscopy Instruments: Technical Note

Introduction The sural nerve (SN) is commonly used for grafting following resection of a neuroma-in-continuity in neonatal brachial plexus lesions (NBPL). The main drawbacks of the current open techniques are large scars and contractures in the late postoperative stage, which may, in severe cases, cause equinovarus contractures. Objective To describe the feasibility and the technical aspects of endoscopic SN harvesting with the use of basic endoscopy instruments and small incisions. Methods Prospective observational study of NBPL subjected to endoscopic nerve harvesting between February of 2012 and February of 2014 in a consecutive series. Patients were operated at the Felício Rocho Hospital (Hospital Felício Rocho) and the Clinical Hospital, Federal University of Minas Gerais (Hospital das Clínicas UFMG), Belo Horizonte/MG, in Brazil. The study outcomes assessed were: scar size, presence or absence of contractures in the calf, bleeding volume (measured by the number of gauzes used) and number of incisions. Only patients with a follow-up longer than 6 months were included. Results Seven patients were selected and twelve endoscopic nerves were endoscopically harvested. The average surgery time was 45 minutes. Nine SNs were harvested through two incisions, and three nerves through three incisions. The estimated bleeding was less than 5ml and there were no complications or contractures during the follow-up period of 6 months to 4 years. Conclusion Sural nerve harvesting in children with NBPL is feasible and it offers the advantage of needing only two or three small incisions using basic endoscopy instruments.

Introdução O nervo sural é a melhor opção para enxertia nas reconstruções microcirúrgicas da plexopatia braquial obstétrica. O método clássico aberto com incisão longitudinal desde o tornozelo até a fossa poplítea ou em incisões em degraus possuem as desvantagens de cicatrizes amplas e contraturas em equinovarus (pé torto). Atualmente, o emprego de endoscópios específicos para a retirada de enxertia de nervos e vasos mostra resultados satisfatórios em relação ao encurtamento do tempo cirúrgico e à redução no tamanho das incisões, mas tem como inconveniente o alto custo de aquisição e manutenção. Objetivo Discutir a viabilidade e descrever nota técnica da retirada do nervo sural utilizando instrumental básico de endoscopia e pequenas incisões. Métodos Estudo observacional prospectivo em pacientes com plexopatia braquial obstétrica submetidos a retirada do nervo sural por endoscopia no período de fevereiro de 2012 a fevereiro de 2014 no Hospital Felicio Rocho e no Hospital das Clinicas UFMG, Belo Horizonte/MG, Brasil. Resultados Sete pacientes foram selecionados e foram retirados doze nervos surais por endoscopia. O tempo médio da cirurgia foi de 45 minutos. Nove nervos surais foram retirados por duas incisões, e três nervos foram retirados por três incisões. O sangramento foi inferior a 5ml e não houve complicações no pós-operatório imediato e tardio em acompanhamento entre 6 meses e 4 anos. Não foram observadas contraturas no período observacional. Conclusão O nervo sural pode ser retirado utilizando duas ou três pequenas incisões por meio de instrumental endoscópico básico em crianças com plexopatia braquial obstétrica.

Burkitt's Lymphoma Mimicking a Subacute Subdural Hematoma: a Case Report

Burkitt's lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma. Although dural metastases are relatively frequent in malignancies, they are rarely associated with subdural hematoma (SDH). We present a case of subdural effusion secondary to dural metastases from Burkitt's lymphoma.

O linfoma de Burkitt é um linfoma Linfoma não Hodgkin de células B altamente agressivo. Embora a presença de infiltração meninges seja relativamente comum no contexto de neoplasias malignas o surgimento de hematoma subdural secundários é evento raro. Será relatado caso de coleção subdural secundaria a metástases dural de linfoma de Burkitt que apresentou-se radiologicamente semelhante a hematoma subdural em fase subaguda.