Spinal subdural hematoma after lumbar discectomy without dural injury - Is it possible? A case report and literature review.

BACKGROUND: Spinal subdural hematoma (SSDH) is a rare complication of lumbar discectomy. Here, the authors reviewed 10 articles concerning the etiology, clinical, diagnostic, and surgical management of SSDH. CASE DESCRIPTION: A postoperative SSDH occurred following a lumbar microdiscectomy in an 80-year-old patient in the absence of a dural injury. CONCLUSION: SSDH is a rare complication of lumbar discectomy and may even occur without a dural fistula. Notably, magnetic resonance is the diagnostic study of choice to identify this pathology that may then be appropriately managed.

Neurosarcoidosis Associated with Psychiatric Symptoms: Case Report

Background Sarcoidosis is a granulomatous disease predominant in women and black men that has inflammatory origin of unknown etiology; neurosarcoidosis is a rare and critical presentation of the disease. Case description A 26-year-old black female presented frontal headache for 1 year, as well as behavioral and mood changes for 15 days. Skull tomography and nuclear magnetic imaging of the skull revealed damaged meninges, a right frontal bone lesion, and an intraparenchymal contrast-enhancing lesion. Screening with computed tomography (CT) scans was performed, and it showed signs of bronchiectasis in the lower third of the right lung, but it was asymptomatic. The biopsy showed signs of reactional lesion with the presence of non-caseating granulomas. After the treatment with corticosteroids, the patient presented progressive improvement. Conclusions Neurosarcoidosis is a rare and critical pathology of sarcoidosis that presents a lytic bone lesion and clinical psychiatric symptoms; neurosarcoidosis is also rare in the literature.

Introdução A sarcoidose é uma doença granulomatosa de origem inflamatória de etiologia desconhecida, predominante em mulheres e negros, sendo a neurosarcoidose uma apresentação da doença rara relacionada a gravidade. Relato de Caso Paciente com 26 anos, negra, apresenta quadro cefaleia frontal ha 1 ano e há 15 dias apresentando sinais de alterações de comportamento e humor. Tomografia de crânio e Ressonância nucelar magnética de crânio que evidenciaram lesão óssea frontal direita, comprometimento meninges e lesão intraparenquimatosa captante de contraste. Realizado screening com tomografias que evidenciaram sinais de bronquiectasia em terço inferior pulmão direito, assintomática. Biopsia indicando sinais de lesão reacional com presenças de granulomas não caseosos, Após a manutenção da corticoterapia, a paciente apresentou melhora progressiva. Conclusões A neurosarcoidose é uma patologia grave e rara da sarcoidose, nesse caso apresenta uma lesão óssea lítica e sintomas psiquiátricos, apresentação rara na literatura.

Vertex epidural hematoma: A rare cause of post-traumatic headache and a diagnostic challenge.

BACKGROUND: Vertex epidural hematomas (VEH) account for only 8% of all epidural hematomas. However, these traumatic injuries may be underestimated or overlooked altogether when only computed tomography (CT) scans are used for diagnosis. The vertex may be a potential anatomic "blind spot" on this radiological method. In such cases, magnetic resonance (MRI) offers a great diagnostic aid. CASE DESCRIPTION: This manuscript reports a patient of a head trauma who developed progressive and intractable headache. MRI made the diagnosis of progressive VEH and highlighted the detachment of the superior sagittal sinus by the hematoma. Surgical treatment, because of the refractory clinical findings, was performed with good postoperative recovery. CONCLUSION: Multiple trauma patients with progressive and refractory headache should have their head CT thoroughly reviewed and, if necessary, be investigated with MRI.

McCune-Albright syndrome with craniofacial dysplasia: Clinical review and surgical management.

BACKGROUND: Fibrous dysplasia (FD) is a benign fibro-osseous lesion related to an abnormal bone development and replacement by fibrous tissue. FD has three clinical patterns namely monostotic, polyostotic, and the McCune-Albright syndrome (MAS). MAS is a rare genetic disorder (about 3% of all FD's) that comprises a triad of polyostotic FD, café-au-lait skin macules, and precocious puberty. MAS can involve the orbit region and cause stenosis in the optic canal, leading the patient to a progressive visual loss. METHODS: We reported a case of craniofacial FD in MAS in a 9-year-old male with progressive visual loss, submitted to optic nerve decompression by fronto-orbito-zygomatic approach, with total recovery. A research was made at Bireme, PubMed, Cochrane, LILACS, and MEDLINE with the keywords: FD/craniofacial/McCune-Albright/Optic compression for the clinical review. RESULTS: A clinical review of the disease was made, the multiple, clinical, and surgical management options were presented, and the case report was reported. CONCLUSION: MAS is a rare disease with a progressive polyostotic FD. Whenever it affects the orbit region, the optic canal, and it is associated with a progressive visual loss, the urgent optic nerve decompression is mandatory, either manually or with a rapid drill. It is known that aggressive approach is associated with less recurrence; it is also associated with worsening of the visual loss in optic nerve decompression. In MAS cases, multiple and less aggressive surgeries seem to be more suitable.

Schwannomas of Peripheral Nerves: Unusual Cause of Sciatic and Literature Review / Schwanomas dos nervos periféricos: causa rara de ciatalgia e revisão da literatura

Schwannomas of peripheral nerves are the most common benign tumors in this location; it has specific radiologic and histologic features that enable its fundamental distinction of neurofibromas. Given its importance in neurosurgical practice, known radiologic and histologic criteria must be updated regarding this disease entity, as well as its therapeutic strategy and results obtained with it. This article reviews this subject, followed by a case report considered out of the ordinary, in which the tumor was located in the sciatic nerve in a patient with neurofibromatosis type 1, treated by microsurgical resection, which evolved favorably.

Os schwannomas dos nervos periféricos são os tumores benignos mais comuns nesta localização. Apresentam características radiológicas e histológicas específicas que possibilitam a sua fundamental distinção dos neurofibromas. Dada a sua importância na prática neurocirúrgica, devem ser conhecidos os critérios radiológicos e histológicos atualizados à respeito desta entidade nosológica, bem como sua estratégia terapêutica e o resultado com ela obtido. Neste artigo, é feita uma revisão do tema, seguido do relato de um caso considerado fora do habitual, no qual o tumor localizava-se no nervo ciático, em uma paciente portadora de neurofibromatose tipo 1, tratada por meio de ressecção microcirúrgica, que evoluiu de forma favorável.

Tratamento intracístico de craniofaringioma com interferon alfa: relato de caso / Intracystic Treatment of Craniopharyngiomas with Interferon Alpha: A Case Report

Craniofaringiomas são tumores histologicamante benignos, extrínsecos ao parênquima cerebral. Visando ao controle da doença, preconiza-se, como tratamento padrão, a tentativa de ressecção completa, meticulosamente planejada com vistas a preservar as funções habituais do paciente. Outras formas de terapias podem ser utilizadas como alternativas ou comoadjuvantes à cirurgia. Considerando-se quemuitos craniofaringiomas apresentam componente cístico, a utilização de cateteres posicionados no interior do lúmen cístico para aplicação de agentes quimioterapêuticos, como o interferon alfa (IFNa), tem-se mostrado promissora. Administração intratumoral de 3 milhões de unidades de IFNa em dias alternados, totalizando doze ciclos, tem sido utilizada empiricamente. Relatamos o caso de uma paciente de 12 anos de idade, com diagnóstico de craniofaringioma de predomínio cístico, tratada no Hospital de Câncer de Barretos (HCB) utilizando a aplicação de IFNa semanalmente, que apresentou evolução favorável.

Craniopharyngiomas are histologicaly benign tumors, whose ideal brain treatment requires its complete surgical resection, while preserving most of the usual functions of the patient. Due to the complexity of the surgical procedure, related to location (surrounded by paraselar structures), it is often difficult to achieve its complete resection. Thus, alternative therapies have been reported, including the use of intracystic IFNa on alternate days. We report the case of a 12 year-old female, diagnosed with cystic craniopharyngioma, weekly treated with intracystic IFNa, for a total of 12 cycles, with favorable outcome.

Resultados da laringectomia horizontal supraglótica / Supraglottic horizontal laryngectomy outcome

Introdução: O câncer supraglótico pode ser removido por meio da laringectomia horizontal supraglótica (LHSG), obtendo-se bons resultados oncológicos e funcionais. Objetivo: Avaliar os resultados em um grupo de pacientes consecutivos submetidos à LHSG. Métodos: Entre 1997 e 2007, 13 pacientes tratados por carcinoma espinocelular (CEC) de supraglote e base de língua por meio da LHSG foram retrospectivamente estudados. Resultados: Houve oito pacientes estadiados como T2 e cinco como T3. Dentre eles, três pacientes apresentavam pescoço clinicamente negativos. Todos os pacientes foram submetidos à LHSG. Em oito pacientes, realizou-se esvaziamento cervical bilateral e, em quatro, esvaziamento cervical radical ipsilateral e jugular contralateral. Radioterapia adjuvante foi feita em todos os pacientes. O seguimento variou de 12 a 60 meses. A sobrevida específica para a doença e o controle loco-regional a cinco anos foram de 69,2%. Todos os pacientes obtiveram resultados funcionais próximos ao normal após o tratamento. Uma mediana de 16 dias (7-60) foi necessária para a aquisição de uma dieta próxima do normal. A decanulação levou uma mediana de 17 dias (8-65). Não houve caso de aspiração persistente. Não houve traqueostomia permanente nem laringectomia total por razões funcionais. Conclusão: A LHSG permanece sendo uma alternativa terapêutica adequada para o CEC supraglótico. O restabelecimento de boa função laríngea é a regra.

Introduction: Supraglottic cancer can be removed by horizontal supraglottic laryngectomy (HSGL) obtaining good oncological and functional outcome. Objective: To evaluate the outcome in a group of consecutive patients undergoing HSGL. Methods: Between 1997 and 2007, 13 patients treated for supraglottic and base of the tongue squamous cell carcinoma (SCC) with HSGL were retrospectively studied. Results: There were 8 patients with T2 and 5 with T3 tumors. Among these, 3 patients had clinical negative neck disease. All patients underwent HSGL. Eight patients were submitted to bilateral radical neck dissection, whereas 4 patients were submitted to ipsilateral radical and contralateral lateral neck dissection. Adjuvant radiotherapy was given to all patients. The follow up ranged from 12 to 60 months. Five-year disease-specific survival and locoregional control were 69.2%. All patients recovered a close to normal function after the treatment. A median of 16 days (7-60) was necessary to recover a close to normal diet. Decannulation took a median of 17 days (8-65). There was no persistent aspiration. There was no permanent tracheostomy or total laryngectomy for functional purposes. Conclusion: HSGL remains an adequate therapeutic alternative for supraglottic SCC. Good laryngeal function recovery is the rule.