Auras as a prognostic factor in anterior temporal lobe resections for mesial temporal sclerosis.

BACKGROUND AND PURPOSE: Anterior temporal lobectomy for mesial temporal sclerosis (MTS) is a very effective measure for the control of seizures, and the probability of becoming seizure-free is approximately 70-90%. However, 30% of patients still experience seizures after surgery. An aura is a subjective ictal phenomenon that may precede an observable seizure. However, there are few studies on the prognostic factor aura although, being the initial symptoms of epileptic seizures, many types of auras have significant localizing or lateralizing value. This study hypothesized that the type of pre-operative aura may predict the post-surgical outcome in patients with medically refractory temporal lobe epilepsy due to MTS. METHODS: Of 1214 patients evaluated for surgery in the Epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent anterior temporal lobectomy (ATL) for MTS. The number and type of auras were analyzed and compared with the Engel classification for outcome. RESULTS: Analyzing the patients by the type of aura, those who had extratemporal auras had the worst post-surgical result according to the Engel classification. Although mesial auras are apparently a good prognostic factor, patients without aura also had a worse prognosis. There were no differences between simple and multiple auras. To identify the most appropriate candidates for ATL, it is very important to consider the favorable prognostic factors for counseling patients in daily practice. CONCLUSIONS: Patients with symptoms and clinical signs that suggest extratemporal involvement may have unfavorable outcomes.

Traumatísmo craneoencefálico por accidente con vehículos de dos ruedas / Head injury and accident by two wheels vehicles

En los EE.UU., el traumatísmo craneoencefálico (TCE) es la principal causa mortis entre individuos de 10 a 44 años y constituye por más del 50 por ciento de los órbitos por trauma alcanzado, por lo tanto, una importante parcela económicamente activa de la población. El uso de vehículos de dos ruedas, sea como medio de transporte, recreación o para la práctica de deportes, no está exento de accidentes, siendo el TCE relevante consecuencia de esa práctica y la principal causa de muerte e invalidez. Se realizó un estudio prospectivo de 20 pacientes atendidos en el Hospital Universitario Vírgen de la Arrixaca, Murcia, España, con diagnóstico de TCE por caída de vehículo de dos ruedas, en el período de enero a junio de 2002, utilizando un protocolo patrón, el cual fue rellenado por el autor o por el equipo del hospital. En nuestra muestra, hubo una nítida predominancia del sexo masculino (95 por ciento de los casos), siendo el grupo más afectado el de los jóvenes de 11 a 20 años, con el 65 por ciento de los casos. Hubo 17 accidentes por motocicleta y tres por bicicleta. En el primer grupo, siete (41,2 por ciento) usaban casco y entre los usuarios de bicicleta, dos (67 por ciento). En todo el muestreo, el uso de casco fue relatado por el 45 por ciento de los pacientes. La tomografía computarizada (TC) fue el método de elección para la evaluación de esos pacientes, pues es un método rápido que tiene la posibilidad de reconocer a los pacientes que necesitan intervención quirúrgica. En cuanto a las lesiones encontradas en las imágenes por TAC, el 85 por ciento del muestreo evidenció la presencia de lesiones intracraneales, siendo el hematoma subdural la más frecuente, seguido de la hemorragia subaracnoidea, la contusión cerebral y el edema cerebral. El tratamiento instituído fue conservador en la mayoría de los casos, siendo en apenas 5 pacientes (25 por ciento) necesaria la cirugía. El tiempo medio de internación fue significativamente más alto en los pacientes sometidos a tratamiento quirúrgico en relación al grupo sometido a tratamiento conservador (26,6 días y 15,3 días, respectivamente). La mortalidad fue de 10 por ciento (2 pacientes). La atención en el lugar del accidente es de importancia fundamental para reducir el número de óbitos y secuelas después del traumatísmo en general y el TEC en particular.

Surgical approach to far lateral lumbar disc herniations: a review of the literature and report of 3 cases

Far lateral disc herniations are nor rare, However its management is still controversial. Neuroimaging is a fundamental tool in such a degree that diagnosis of this entity would be difficult if not impossible without CT or MRI. We report three cases and describe the surgical thechnique we practiced as well as the pros and cons of the principal techniques found in the literature. Although each surgical approach has its own main indications, there is no significant diference in the outcomes. One of the most important factors in the decision making is the neurosurgeonïs familiarity with the technique

Intracranial subfrontal schwannoma: a case report

Intracranial schwannoma is an extremely rare pathology. The preoperative diagnosis is usually mistaken for one of a meningioma, being extremely rare to be suspicious of this entity before the pathological findings from the biopsy are examined. Fortunately, there is no practical need to make the distinction between those two pathologies preoperatively. There must be two different types of intracranial schwannomas not related to cranial nerves with distinct etiopathogenesis as suggested by reviewing the medical literature: the extra axial intracranial schwannoma as opposed to the intracerebral schwannoma

Epidural hematoma after ventriculoperitoneal shunt surgery. Report of two cases.

Ventriculoperitoneal shunt operations represent the most used choice for treating hydrocephalus, although some related complications have been reported. Due to its rarity, potential dangers, and mortality rate, we present two cases of epidural hematoma following ventriculoperitoneal shunt, discussing its pathophysiology and prophylaxis.

Isolated fourth ventricle in neurocysticercosis: pathophysiology, diagnosis, and treatment.

Four cases of isolated fourth ventricle in neurocysticerocosis are reported (three after ventriculoperitoneal shunting, and one after hydrocephalus without shunting). Diagnosis was made based on computed tomography (CT) and/or CT cisternogram/ventriculogram. Three patients underwent fourth ventricle drainage (two died and the third remains well). The fourth patient refused surgical treatment and continues to have severe ataxia. Diagnosis, pathophysiology, and treatment of this entity in neurocysticercosis are discussed.

Hemangioma vertebral. Consideracoes sobre 4 casos. / Vertebral hemangioma: considerations on 4 cases

Os autores apresentam 4 casos de hemangioma vertebral. Relatam a incidencia quadros clinicos e radiologico e o tratamento. Em apenas 1 caso houve comprometimento medular, Nos demais os hemangiomas foram achados radiologicos casuais