Bone Flap Conservation in the Scalp After Decompressive Craniectomy.

BACKGROUND: Decompressive craniectomy may be used as a primary or secondary treatment for intracranial hypertension and is clearly associated with reduced mortality. The removed bone flap is usually preserved in the abdominal subcutaneous tissue or in the bone bank. The aim of this study was to describe an option for preserving the bone flap after decompressive craniectomy using bone flap preservation in the skull subcutaneous tissue in subgaleal space over the pericranium contralateral to the craniectomy site. METHODS: This was a multicenter retrospective study including patients with severe traumatic brain injury from 2014 to 2016. There were 23 patients who had their bone fragments preserved below the scalp in the subcutaneous tissue for analysis. The following results were analyzed: surgical site infection, bone flap resorption during the period of preservation, and patient discomfort. RESULTS: Five patients died of systemic infectious complications, and the remaining patients underwent cranioplasty a mean 118 days after craniectomy. There were no surgical wound infections, macroscopically evident bone absorption, or site discomfort in any of the patients during a period of 18 months. CONCLUSIONS: This variant of the bone flap preservation technique has been shown to be satisfactory as an option for routine use.

Cefaleia Trigêmino-autonômica e Neuromielite Óptica / Trigemino-autonomic Headache and Neuromyelitis Optica

As cefaleias trigêmino-autonômicas compartilham os aspectos clínicos da cefaleia, além de proeminentes sintomas disautonômicos crânio faciais. A Neuromielite Óptica (NMO) ou Doença de Devic é uma doença inflamatória grave, desmielinizante e auto-imune do sistema nervoso central que acomete, preferencialmente, os nervos ópticos e a medula espinhal, causando neurite óptica aguda, uni ou bilateral, e mielite transversa. O objetivo desse trabalho é relatar um caso clínico de NMO, cuja manifestação inicial é atípica. Uma revisão de literatura com as palavras-chaves Neuromielite Óptica e Cefaleia Trigêminoautonômica foi realizada no PubMed e foram selecionados os artigos e relatos de casos mais relevantes sobre o assunto. Conclui-se que estas duas doenças podem ter em comum uma alteração hipotalâmica e uma doença desmielinizante grave pode se iniciar com uma cefaleia trigêmino-autonômica. (AU)

The Trigeminal-autonomic headaches share the clinical features of headache, as well as prominent facial skull disautonomic symptoms. The Neuromyelitis Optica (NMO) or Devic's disease is a severe inflammatory disease, demyelinating and autoimmune of the central nervous system that affects mainly the optic nerves and spinal cord, causing acute optic neuritis, unilateral or bilateral, and transverse myelitis. The objective of this study is to report a case of NMO, whose initial manifestation is atypical. A literature review with keywords Neuromyelitis Optica and Trigeminal-autonomic Headache has conducted in PubMed and we have selected the most relevant articles and case reports on the subject. In conclusion, these two diseases may have a common hypothalamic disturbance and a severe demyelinating disease can start with a trigeminal-autonomic headache. (AU)

[Decompressive craniectomy for treatment of intracranial hypertension secondary to large ischemic cerebral infarction: analysis of 34 cases]. / Craniectomia descompressiva para tratamento de hipertensão intracraniana secundária a infarto encefálico isquêmico extenso: análise de 34 casos.

UNLABELLED: The large ischemic cerebral infarction (LICI) is a blood supply loss of a large area in the brain, mainly on the middle cerebral artery. Is possible that evolutes a major edema, intracranial hypertension and death in about 80% of the cases. OBJECTIVE: To evaluate the results of a decompressive craniectomy on the treatment of the secondary intracranial hypertension to LICI, comparing to other results of medical literature already published. METHOD: Were analysed 34 patients diagnosed with LICI clinically treated unsuccessfully that needed further on the decompressive craniectomy treatment, for the control of intracranial hypertension. RESULTS: 8 patients (23.52%) died, 26 (76.47%) survived, and 2 (7.70%) developed a vegetative state condition. CONCLUSION: The factors age over 50 years and male gender were associated with a high death risk. The level of consciousness at admission and bone flap area were nearer the values of statistic significance.

Craniectomia descompressiva para tratamento de hipertensão intracraniana secundária a infarto encefálico isquêmico extenso: análise de 34 casos / Decompressive craniectomy for treatment of intracranial hypertension secondary to large ischemic cerebral infarction: analysis of 34 cases

Infarto encefálico isquêmico extenso (IEIE) é a perda do suprimento sangüíneo de uma grande área cerebral, principalmente do território da artéria cerebral média. Pode evoluir com edema importante, hipertensão intracraniana e óbito em até 80 por cento dos casos. OBJETIVO: Avaliar os resultados da craniectomia descompressiva no tratamento da hipertensão intracraniana secundária ao IEIE, comparando com os resultados de outros estudos publicados na literatura. MÉTODO: Foram analisados 34 pacientes com IEIE tratados clinicamente sem sucesso e que necessitaram de craniectomia descompressiva para controle da hipertensão intracraniana. RESULTADOS: 8 pacientes (23,52 por cento) faleceram, 26 (76,47 por cento) sobreviveram, sendo que 2 (7,70 por cento) permaneceram em estado vegetativo. CONCLUSÃO: Os fatores idade acima de 50 anos e sexo masculino se associaram a maior risco de evolução para óbito. O nível de consciência à admissão e a área do retalho ósseo apresentaram valores próximos de significância estatística.

The large ischemic cerebral infarction (LICI) is a brain supply loss of a large area in the brain, mainly on the middle cerebral artery. Is possible that evolutes a major edema, intracranial hypertension and death in about 80 percent of the cases. OBJECTIVE: To avaliate the results of a descompressive craniectomy on the treatment of the secundary intracranial hypertension to LICI, comparing to other results of medical literature already published. METHOD: Were analysed 34 pacients diagnosed with LICI clinically treated unsuccesfully that needed forther on the decompressive craniectomy treatment, for the control of intracranial hypertension. RESULTS: 8 pacients (23.52 percent) died, 26 (76.47 percent) survived, and 2 (7.70 percent) developed a vegetative state condition. CONCLUSION: The factors age over 50 years and male gender were associated with a high death risk. The level of consciousness at admission and bone flap area were nearer the values of statistic significance.

[Transspheinoidal transpalatal meningoencephalocele]. / Meningoencefalocele transesfenoidal transpalatina.

Transspheinoidal meningoencephalocele is a rare presentation of dysraphism of the neural tube. It is characterized by the herniation of the neural tissue through a bony defect in the sphenoid bone. The clinical presentation is variable. It may be assymptomatic or it may include an upper airway obstruction, rhinorrhea, meningitis, hypothalamic dysfunction and optic anomalies. The surgical treatment is controversial. We describe the case of a 7-year-old boy who presented a pulsate structure filling the palate, palate digenesis and hypertelorism. The diagnosis of transsphenoidal transpalatal meningoencephalocele was confirmed by a computerized tomography and a magnetic resonance imaging. The child was operated on by the transpalatal/transspheinoidal approach with a good result.

Meningoencefalocele transesfenoidal transpalatina / Transspheinoidal transpalatal meningoencephalocele / Transspheinoidal transpalatal meningoencephalocele

A meningoencefalocele transesfenoidal é rara apresentação dos disrafismos do tubo neural. Caracteriza-se pela herniação do tecido neural através de uma falha óssea no osso esfenóide. A apresentação clínica é variável, podendo ser desde assintomática até obstrução das vias aéreas, rinorréia, meningite, disfunção hipotalâmica e anomalias ópticas. Seu tratamento cirúrgico é controverso. Descrevemos o caso de um menino de 7 anos que apresentava uma estrutura pulsátil preenchendo o teto da cavidade oral, disgenesia palatina e hipertelorismo. O diagnóstico de meningoencefalocele transesfenoidal transpalatina foi confirmado pela tomografia computadorizada e ressonância magnética. A criança foi operada com sucesso pela via transpalatal/transesfenoidal.

Transspheinoidal meningoencephalocele is a rare presentation of dysraphism of the neural tube. It is characterized by the herniation of the neural tissue through a bony defect in the sphenoid bone. The clinical presentation is variable. It may be assymptomatic or it may include an upper airway obstruction, rhinorrhea, meningitis, hypothalamic dysfunction and optic anomalies. The surgical treatment is controversial. We describe the case of a 7-year-old boy who presented a pulsate structure filling the palate, palate digenesis and hypertelorism. The diagnosis of transsphenoidal transpalatal meningoencephalocele was confirmed by a computerized tomography and a magnetic resonance imaging. The child was operated on by the transpalatal/transspheinoidal approach with a good result.