Type II Odontoid Fractures: Is the Anterior Screw a Good Solution for all Patients? A Case Series of 60 Consecutive Patients.

OBJECTIVE: Type II odontoid fracture is the most common fracture type, and its treatment remains challenging. The objective of this study was to evaluate the results of anterior screw fixation for type II odontoid fractures in patients aged over and below 60 years. METHODS: A retrospective analysis of consecutive patients diagnosed with type II odontoid fractures who were surgically treated using the anterior approach by a single surgeon was conducted. Demographic characteristics, including age, sex, type of fracture, time from trauma to surgery, length of stay (LoS), fusion rate, complications, and reoperation, were evaluated. Surgical outcomes were compared between patients over and below 60 years of age. RESULTS: Sixty consecutive patients underwent odontoid anterior fixation during the analysis period. The mean age of patients was 49.58 ± 23.22 years. Twenty-three (38.3%) patients were aged over 60 years, and the minimum follow-up period was two years. Of the patients, 93.3% developed bone fusion, which was observed in 86.9% of patients over 60 years. Complications related to hardware failure occurred in six (10%) patients. Transient dysphagia was observed in 10% of the cases. Three (5%) patients required reoperation. Patients over 60 years had a significantly increased risk of dysphagia compared with those below 60 years (P = 0.0248). There was no significant difference between the groups regarding nonfusion rate, reoperation rate, or LoS. CONCLUSIONS: Anterior fixation of the odontoid showed high fusion rates with a low rate of complications. It is a technique to be considered for treating type II odontoid fractures in selected cases.

Thirty-day unplanned readmission after spine surgery: analysis of 650 cases / Readmissão não planejada em 30 dias após cirurgias da coluna: análise de 650 casos / Reingreso no planificado a los 30 días después de cirugías de la columna: análisis de 650 casos

ABSTRACT: Objective: Postoperative readmission rates can be used to assess hospital care quality. The rates of unplanned readmission within 30 days after spine surgery are variable in the literature, and no studies have evaluated such rates in a single Latin American center. This study aimed to assess the rate of unplanned hospital readmission within 30 days after a spine surgery at a single Brazilian institution and to identify possible risk factors. Methods: Patients who underwent spine surgery at a single private hospital between January 2018 and December 2020 were retrospectively analyzed, and those with unplanned readmissions within 30 days of discharge were identified. Risk factors were determined, and the reoperation rate was assessed. Results: 650 patients were included in the analysis, and 74 (11.28%) were readmitted within 30 days after surgery. Higher readmission rates were observed after vertebroplasty and surgeries involving spinal or bone tumors. The risk factors found in the series were older age, longer hospital stays, higher ASA scores, instrumented surgeries, diabetes mellitus, and surgeries involving primary or secondary spinal tumors. The most common causes of unplanned readmission were infection and pain. Of the readmissions, 28.37% required a return to the operating room. Conclusions: This study suggests infection and pain management were the most common causes of unplanned readmission after spine surgery. Strategies to improve perioperative and postoperative care are required to reduce unplanned readmissions. Level of Evidence III; Retrospective Comparative Study.

RESUMO: Objetivo: As taxas de readmissão pós-operatórias podem ser usadas para avaliação da qualidade assistencial hospitalar. As taxas de readmissão não planejada em 30 dias após cirurgias de coluna são variáveis na literatura, e não há estudos avaliando tais taxas em centros únicos da América Latina. Este estudo teve como objetivo avaliar as taxas de readmissões não planejadas em 30 dias após cirurgias de coluna em uma única instituição brasileira e identificar possíveis fatores de risco. Métodos: Pacientes submetidos a cirurgias de coluna em um único hospital privado entre janeiro de 2018 e dezembro de 2020 foram avaliados retrospectivamente, e aqueles readmitidos dentro de 30 dias foram identificados. Fatores de risco foram determinados e a taxa de reoperação foi avaliada. Resultados: 650 pacientes foram incluídos na análise, e 74 (11,28%) foram readmitidos dentro de 30 dias após a cirurgia. Maiores taxas de readmissão foram observadas após vertebroplastia e cirurgias envolvendo tumores espinhais ou tumores ósseos. Os fatores de risco encontrados em nossa série foram idade mais elevada, maior tempo de hospitalização, maior escore ASA, cirurgias com instrumentação, diabetes mellitus e cirurgias envolvendo tumores vertebrais primários ou secundários. As causas mais comuns de readmissão não planejada foram infecção e dor. Dentre os pacientes reinternados, 28,37% necessitaram de reoperação. Conclusões: Este estudo sugere que infecção e manejo de dor foram as causas mais comuns de readmissão não planejada após cirurgias de coluna. Estratégias para melhorar os cuidados pre e pós-operatórios são necessárias para reduzir readmissões não planejadas. Nível de Evidência III; Estudo Retrospectivo Comparativo.

RESUMEN: Objetivo: Las tasas de reingreso después de la cirugía de columna son variables y ningún estudio ha evaluado tales tasas en un solo centro latinoamericano. Este estudio tuvo como objetivo evaluar la tasa de reingreso hospitalario no planificado dentro de los 30 días posteriores a la cirugía de columna en una sola institución brasileña e identificar posibles factores de riesgo. Métodos: Se analizaron retrospectivamente los pacientes que se sometieron a cirugía de columna en un solo hospital entre enero de 2018 y diciembre de 2020, y se identificaron aquellos con reingresos no planificados dentro de los 30 días posteriores al alta. Se determinaron los factores de riesgo y se evaluó la tasa de reoperación. Resultados: En el análisis se incluyeron un total de 650 pacientes, y 74 (11,28%) reingresaron dentro de los 30 días posteriores a la cirugía. Se observaron tasas de reingreso más altas después de la vertebroplastia y las cirugías que involucraron tumores espinales u óseos. Los factores de riesgo encontrados en nuestra serie fueron la edad avanzada, la estancia hospitalaria más prolongada, las puntuaciones ASA más altas, las cirugías instrumentadas, la diabetes mellitus y las cirugías de tumores espinales. Las causas más frecuentes de reingreso fueron la infección y el dolor. De los reingresos, el 28,37% requirieron volver al quirófano. Conclusiones: Este estudio sugiere que la infección y el manejo del dolor fueron las causas más comunes de reingreso. Se requieren estrategias para mejorar la atención perioperatoria y posoperatoria y así reducir las readmisiones no planificadas. Nivel de Evidencia III; Estudio comparativo retrospectivo.

Aggressive dissemination of central nervous system hemangioblastoma without association with von Hippel-Lindau disease: A case report and literature review.

Background: Hemangioblastomas (HBs) typically present with benign behavior and are most commonly found in the posterior fossa. Multiple central nervous system (CNS) HBs are usually associated with von Hippel-Lindau disease, and leptomeningeal dissemination of sporadic HBs is extremely rare. A review of the literature identified 30 cases of leptomeningeal dissemination of sporadic HBs previously published in the literature. Case Description: We report the case of a patient who was diagnosed with multiple CNS HBs with aggressive progression 6 years after resection of a posterior fossa HB. He underwent multiple surgeries and died 4 years after the diagnosis of the first spinal dissemination. Conclusion: Dissemination of sporadic HBs is rare and aggressive disease evolution is usually observed. Further studies are necessary to determine the optimal therapeutic options.

The surgical treatment of subaxial acute cervical spine facet dislocations in adults: a systematic review and meta-analysis.

Adult cervical spine traumatic facet joint dislocations occur when excessive traumatic forces displace the vertebrae's facets, leading to loss of joint congruence. Reduction requires either cranial traction or open surgical procedures. This study aims to appraise the effects of different surgical techniques in the treatment of subaxial cervical spine acute traumatic facet blocks in adults. This study was based on a systematic literature review and meta-analysis, registered in Prospero (CRD42021279249). The PICO question was composed of adults with acute cervical spine traumatic facet dislocations submitted to anterior or posterior surgical approaches, associated or not with cranial traction for reduction. Each surgical technique was compared to the other. The primary clinical outcomes included neurological improvement or worsening and surgical success/failure rates. The anterior approach without cranial traction was efficient in reducing facet displacements. Skull traction was an efficient and immediate method to achieve spine dislocation reductions. Differences were not present among techniques regarding neurological improvement. There were no surgical failures in patients operated on via the posterior approach. The need to decompress and stabilize the cervical spine can be achieved by anterior or posterior surgical approaches, and there is no clear answer as to which initial approach is superior to the other.

Effect of interbody fusion compared with posterolateral fusion on lumbar degenerative spondylolisthesis: a systematic review and meta-analysis.

BACKGROUND CONTEXT: Lumbar degenerative spondylolisthesis is a relatively common pathology, and surgical treatment is an option in selected cases. The common use of anterior column support by interbody fusion (IBF) has not been adequately studied. PURPOSE: The primary objective of this systematic review and meta-analysis was to compare the functional and surgical outcomes after posterolateral fusion (PLF) and IBF for the treatment of degenerative spondylolisthesis. STUDY DESIGN: A systematic review and meta-analysis was conducted to identify studies analyzing the effects of IBF compared to those of instrumented PLF on degenerative spondylolisthesis. PATIENT SAMPLE: A total of 1,063 patients were included in the analysis. Of them, 470 patients were treated with PLF and 593 with IBF. OUTCOME MEASURES: The outcomes analyzed were the visual analog scale and numerical rating scale scores for back pain, Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36) score, 12-Item Short Form Health Survey (physical and mental components) score, blood loss amount, surgical time, hospital stay duration, fusion rate, lumbar lordosis, sacral slope, and postoperative complications. METHODS: A search was conducted using the MEDLINE, Cochrane, and Google Scholar databases for studies published between January 1985 and February 2021. Both retrospective and prospective studies that compared between IBF and PLF were included. RESULTS: A total of 2,819 articles were screened, and 38 full-text articles were selected for a detailed investigation, of which 12 articles were found to match all the inclusion criteria and were included in the meta-analysis. There was an improvement in the sacral slope (mean difference [MD] = 3 [95% confidence interval {CI} = 0.83-5.17]) and fusion rate (odds ratio [OR] = 0.47 [95% CI = 0.26-0.86]) in the IBF group. The incidence of neural injury was higher in the IBF group (OR = 0.28 [95% CI = 0.13-0.60]) than in the PLF group. There were no differences in the back pain scores, ODI, SF-36 score, blood loss amount, surgical time, hospital stay duration, lumbar lordosis, infection, and durotomy between the groups. CONCLUSIONS: IBF for the treatment of lumbar degenerative spondylolisthesis showed better results in terms of the fusion rate and sacral slope, but which did not translate into better clinical outcomes. Further randomized and prospective studies are necessary to elucidate the optimal therapeutic options.

Development of the Portuguese Version of the Modified Japanese Orthopaedic Association Score: Cross-Cultural Adaptation, Reliability, Validity, and Responsiveness.

BACKGROUND: Spondylotic cervical myelopathy (SCM) is a common cause of spinal-related disability in elderly patients. The assessment of this disability is a challenging task and depends on the subjective evaluation of the investigator. As a widespread-used scale, the modified version of the Japanese Orthopaedic Association score (mJOA) should be translated and culturally adapted in the Brazilian Portuguese language (i.e., mJOA-Br) to provide its clinical and research use. This study aimed to perform translation, transcultural adaptation, and validation of the mJOA into Brazilian Portuguese. METHODS: Following the transcultural adaptation model described by Guillemin et al., the scale as translated into Brazilian Portuguese and back-translated to English. Afterwards, questionnaires were applied in consecutive patients with SCM and compared with a control group (without SCM). The final scale was compared with the Brazilian version of Neck Disability Index for validation. RESULTS: Sixty patients were submitted to the translated version of mJOA. There was a strong correlation between mJOA-Br scores and Neck Disability Index scores to evaluate SCM symptoms (R = -0.75). CONCLUSIONS: mJOA-Br was considered a valid and reliable tool to evaluate patients with SCM.

Cervical Myelopathy Caused by Engorgement of the Epidural Venous Plexus due to Cerebrospinal Fluid Overdrainage: Case Report and Review of the Literature

This is a case report of a 33-year-old woman with cervical myelopathy caused by an enlargement of the cervical venous plexus, after she was submitted to a ventriculoperitoneal (VP) shunt that evolved to overdrainage. Magnetic Resonance Imaging (MRI) revealed an epidural venous enlargement within the spinal channel, with a 50% narrowing from C2 to C5, and spinal cord compression. A shunt revision was performed using a programmable drainage system, and a second MRI revealed the absence of the venous enlargement, resulting in cervical spinal cord decompression and remission of neurological symptoms. Compressive myelopathy consequent to the enlargement of the epidural venous plexus related to the overdrainage of the ventriculoperitoneal shunt system without typical signs of intracranial hypotension may result in misleading etiological diagnoses. Acknowledging this disorder is important to distinguish it from neoplastic processes or hematomas, for which surgical intervention may be needed.

Este é um relato de caso de uma paciente de 33 anos de idade que apresentou mielopatia cervical devido a alargamento do plexo venoso cervical, após ser submetida a uma derivação ventriculoperitoneal que evoluiu com hiperdrenagem. Exame de Ressonância Nuclear Magnética (RNM) revelou alargamento do plexo venoso epidural no canal espinhal, com estreitamento de 50% em C2 a C5, e compressão da medula espinhal. Uma revisão da derivação foi feita com um sistema de drenagem programável, e uma segunda RNM revelou ausência de ingurgitamento venoso, resultando em descompressão medular e remissão dos sintomas neurológicos. Mielopatia compressiva consequente ao alargamento do plexo venoso epidural relacionado à hiperdrenagem do sistema de derivação ventriculoperitoneal sem sinais típicos de hipotensão intracraniana pode resultar em diagnósticos incorretos. O conhecimento dessa patologia é importante para distingui-la de processos neoplásicos ou hematomas, nos quais intervenções cirúrgicas podem ser necessárias.

Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis.

The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis

The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida.

[Management of odontoid fractures using anterior screw fixation: analysis of 15 cases]. / Tratamento cirúrgico das fraturas do odontóide tipo II com parafuso anterior: análise de 15 casos.

A retrospective analysis of the results of 15 patients with odontoid fractures type II P and II N, according to Roy-Camille's classification is presented. They were operated on by an anterior approach and direct fixation of the odontoid process through a screw. There were 13 men and 2 women, the age ranging from 14 to 74 years. The follow up period was from 6 to 36 months (mean 20 months). There was only one complication related to the surgical technique: one screw was misplaced and it was necessary another surgery to replace it. There were no deaths in this series. There were no screw breakdown and the fusion rate was 94%. We propose, based on this study, that the classification of Roy-Camille for odontoid fractures should be always used, since it proposes one surgical approach for each type of fracture. The results of this series show that this technique is useful and has advantages over another modalities of treatment. The correct diagnosis of the type of fracture and an appropriate selection of patients are the main elements to achieve good results.

Tratamento cirúrgico das fraturas do odontóide tipo II com parafuso anterior: análise de 15 casos / Management of odontoid fractures using anterior screw fixation: analysis of 15 cases

Apresentamos estudo retrospectivo dos resultados de 15 pacientes consecutivos, com fratura do odontóide tipo II P (fratura com traço oblíquo e deslocamento posterior) e II N (fratura com traço horizontal na base do odontóide), segundo a classificaçäo de Roy-Camille , que foram submetidos a fixaçäo anterior direta do odontóide com parafuso. A série é composta por 13 homens e 2 mulheres, com idade variando entre 14 a 74 anos e período de acompanhamento de 6 a 36 meses (média 20 meses). Tivemos apenas uma complicaçäo relacionada com a técnica cirúrgica: um parafuso mal posicionado necessitando de uma reoperaçäo para ser reposicionado. Näo houve óbito. Näo houve saída nem quebra de parafuso. Obteve-se 94 por cento de fusäo óssea. Propomos que seja utilizada a classificaçäo de Roy-Camille na seleçäo dos casos cirúrgicos de fraturas do odontóide, pois ela fornece uma abordagem cirúrgica específica para cada tipo de fratura

Doença de Forestier. Relato de caso / Forestier's disease. Case report

A doença de Forestier, ou hiperostose esquelética idiopática difusa (diffuse idiopatic skeletal hyperostosis) é uma doença sistêmica de etiologia desconhecida caracterizada pela presença de calcificação e ossificação da face ântero-lateral de no mínimo quatro corpos vertebrais adjacentes, relativa preservação da altura dos discos intervertebrais dos segmentos envolvidos e grandes osteófitos. Os autores apresentam um caso de um paciente do sexo masculino de 55 anos de idade com quadro de disfagia conseqüente a essa doença. Discutem no presente registro os aspectos clínicos da dença, o tratamento e o diagnóstico diferencial.

Tratamento da instabilidade degenerativa da coluna lombar com fixação transpedicular / Transpedicular lumbar fixation for degenerative lumbar instability. An analysis of 53 cases

Os autores apresentam um estudo retrospectivo dos resultados de 53 pacientes, com instabilidade degenerativa da coluna lombar e toracolombar, que foram tratados consecutivamente com fixaçãotranspedicular por via posterior usando material Socon e Spine System da Aesculap. A casuística é constituída por 27 homens e 26 mulheres, com média etária de 53,4 anos (27 a 81 anos). A média do acompanhamento foi de 15 meses. O procedimento foi feito nos casos de espondilolistesedegenerativa (25 casos), instabilidade pós-operatória (12 casos), escoliose degenerativa (7 casos), fraturas degenerativas (5 casos), canal estreito lombar (2 casos) e instabilidade segmentar (2 casos).A cirurgia consistiu em descompressão neural, fixação interna com instrumentação transpedicular e enxerto ósseo. Em 18 casos foi associado o cage metálico. Obtiveram-se 90% de resultados bons e satisfatórios pela escala de Stauffer e Coventry, com 96% de taxa de fusão e 4% de pseudo-artrose. As complicações incluíram quatro casos de radiculalgia pós-operatória em virtude do contato da raiz com o instrumental, dois de fístulas liquóricas com resolução espontânea, duas infecções (uma profunda e outra superficial) e dois casos de estenose acima do nível t ratado. Destes pacientes, sete (14%) necessi taram dereoperação. Não houve óbito nem quebra do instrumental. Os resul tados comprovaram que, apesar do cur to per íodo de acompanhamento, a fixação transpedicular é um bom método para instrumentação e tratamento das instabilidades degenerativas, oferecendo vantagens biomecânicas comparadas com outras formas de tratamento, permitindo montagens curtas, preservando segmentos adjacentes e a lordose fisiológica. A seleção apropriada dos pacientes para a cirurgia é provavelmente o fator mais importante associado com bons resultados.

The authors present the results of the treatment of 53 consecutive patients with lumbar and thoraco-lumbar spine degenerative instability by a posterior transpedicular fixation using Socon and Spine Aesculap instrumentation systems. The mean follow-up was 15 months. Surgery was performed for degenerative spondilolisthesis (25 cases), post-surgical instability (12 cases), degenerative scoliosis (7 cases), degenerative fractures (5 cases), lumbar spine stenosis (2 cases) and segmental instability (2 cases). There were 27 men and 26 women, aging from 27 to 81 years (mean 53,4), all of them complained of back pain.The surgical procedure consisted in neural decompression, transpedicular fixation and instrumentation and bone graft. In eighteen cases we associated the use of a metallic cage. The results were good or fair in 90% of the cases (according to the Stauffer and Coventry?s scale), with 96% of fusion rate and 4% of pseudarthrosis. Complications included: four cases of radiculopaty due the contact of the nerve roots with the instrumentation system; two cases of CSF leak, both clearing spontaneously; two cases of infection (one superficial, the other deep) and two cases of stenosis above the level of instrumentation. Seven (14%) of these complication cases required reoperation. There were no deaths in this series and no problems with the instrumentation device itself. We concluded that, despite the short follow-up period, the transpedicular fixation is a good methodfor treatment of degenerative instability, with biomechanical advantages if compared with other modalities of treatment. It allows short instrumentation, sparing adjacent segments and the physiological lordosis is preserved. Careful selection of the patients for surgery is probably themost important factor associated with good outcome.

Hérnia de disco cervical gigante: relato de caso / Giant cervical disc herniation: case report

As doenças do disco intervertebral são muito frequentes na prática neurocirúrgica. No Serviço de Neurocirurgia da Santa Casa de Belo Horizonte, em 1997, 17 por cento das intervenções cirúrgicas foram por hérnia de disco, sendo 7 por cento destas de localização cervical. Apresentamos um caso de hérnia de disco cervical volumosa em pacientes de 72 anos, masculino, que apresentava tetraparesis espástica, com hiperreflexia associada a hipoestesia superficial com nível sensitivo em C5 e retenção urinária. Foi submetido a tratamento microcirúrgico com discectomia C4-C5, por via anterior e enxerto ósseo de crista ilíaca. Evoluiu bem no pós-operatório com recuperação completa dos déficits motores e sensitivos. Propomos nova classificação para as hérnias de disco medianas posteiores, baseada na compressão que exercem no canal dural: pequena (até 12 por cento), média (12,5 a 25 por cento), grande (25 a 50 por cento) e gigante (mais de 50 por cento).

Cisticercose intramedular: relato de caso / Intramedular cysticercosis: case report

A cisticercose é a doença parasitária que mais comumente envolve o sistema nervoso central. O acometimento espinhal varia de 0,7 por cento a 5,8 por cento, sendo que a forma intramedular é uma manifestação rara. Relatamos um caso de cisticercose intramedular ao nível de C4-C5, em paciente de 52 anos, feminina, atendida no serviço de Neurologia e Neurocirurgia da Santa casa de Belo Horizonte. Foi submetida a tratamento cirúrgico para exérese da lesão, com boa evolução pós-operatória e recuperação progressiva dos déficits. Concluimos que apesar de patologia rara (foram encontrados 45 casos após revisão da literatura), deve entrar no diagnóstico diferencial de lesões medulares, especialmente em pacientes com história de neurocisticercose e naqueles que vivem ou procedem de regiões onde é a doença é endêmica.

Schwannoma e neurofibroma intramedular / Intramedullary schwannoma and neurofribroma

O neurofibroma e o schwannoma são neoplasias raras que envolvem a medula e suas raízes, correspondendo, respectivamente, a 3% e 27% dos tumores espinhais. Os autores apresentam dois casos de tumores intramedulares operados no Serviço de Neurologia e Neurocirurgia da Santa Casa de Belo Horizonte. O estudo anatomopatológico mostrou tratar-se de um schwannoma e de um neurofibroma, respectivamente. A partir desses achados é feita uma discussão sobre os aspectos clínicos e patológicos desses tumores, salientado a importância do diagnóstico diferencial entre eles. Atualmente, embora ainda não seja reconhecido de maneira universal, esses tumores são considerados como unidades distintas. Além do interesse teórico em diferenciar tais lesões,existe a importância clínica do prognóstico, pois a malignidade não ocorrenos schwannomas, e é extremamente rara nos neurofibromas solitários, ecomum nos múltiplos.

Spinal neurofibroma is one of the rarest neoplasm involving the spinal cordand roots. The intramedullary localization of schwannomas is rare, corresponding to 0,3% of all intraspinal tumors. The authors report two cases of cervico-toracic intramedullary tumors, respectively a schwannoma and a neurofibroma, surgically treated. The present study analysis the clinical and pathological aspects of these tumors and the importance of its differential diagnosis.