Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting.

The challenges encountered in performing minimally invasive approaches, such as supraorbital minicraniotomy (SOMC), in services without adequate equipment are rarely reported in the literature. This study analyzes the viability of SOMC in the treatment of cerebral aneurysms, using exactly the same resources as pterional craniotomy (PC). The results of these two techniques are compared. 35 patients underwent SOMC, compared to 50 patients underwent CP (100 aneurysms in total), using the same microsurgical instruments. The following variables were compared: operative time, angiographic cure, length of intensive care unit stay during the post-operative period, surgical complications, length of hospital stay after surgery until hospital discharge, intraoperative aneurysm rupture, aesthetic satisfaction with the scar, and neurological status at discharge. SOMC had a significantly shorter operative time in relation to PC (213.9 ± 11.09 min and 268.6 ± 15.44 min, respectively) (p = 0.0081).With respect to the cosmetic parameters assessed by the Visual Analog Scale, the average for SOMC was 94.12 ± 1.92 points, and the average for PC was 83.57 ± 4.75 points (p = 0.036). SOMC was as effective as PC in relation to successful aneurysm clipping (p = 0.77). The SOMC technique did not show advantages over PC in any other variable. Even in a general neurosurgery service lacking a specific structure for minimally invasive surgeries, SOMC was feasible and effective for treating intracranial aneurysms, using the same set of microsurgical instruments used for PC, obtaining better results in operating time and cosmetic satisfaction.

Pyramidal and Proprioceptive Dysfunctions as the Main Neurologic Features in Symptomatic Type I Chiari Malformation Patients

Objective Broader access to magnetic resonance imaging (MRI) has increased the diagnosis of tonsillar ectopia, with most of these patients being asymptomatic. The early diagnosis and treatment of type I Chiari malformation (CM I) patients has impact on the prognosis. This study supplements information about the neurologic exam of symptomatic patients with CM I. Methods The sample was composed of 32 symptomatic patients with CM I diagnosed by a combination of tonsil herniation of more than 5 mm below the magnum foramen (observed in the sagittal T2 MRI) and at least one of the following alterations: intractable occipital headache, ataxia, upper or lower motor neuron impairment, sensitivity deficits (superficial and deep) or lower cranial nerves disorders. Results Occipital headache was the most frequent symptom (53.12%). During the physical exam, the most common dysfunctions were those from the pyramidal system (96.87%), followed by posterior cord syndrome (87.5%). Discussion In this study, patients became symptomatic around the fifth decade of life, which is compatible with previous descriptions. Patients withmore than 2 years of evolution have worse responses to treatment. Occipital headache, symptoms in the upper limbs, gait and proprioceptive disorders are common findings in patients with CM I. Conclusion Deep tendinous reflexes and proprioception disorders were the main neurologic features found in symptomatic CM I patients.

Surgical treatment of type I Chiari malformation: the role of Magendie's foramen opening e tonsils manipulation.

The treatment for type 1 Chiari malformation (CM 1) is one of the most controversial topics in the neurosurgical field. The present study evaluated two of the most applied surgical techniques to treat CM 1. Method 32 patients were evaluated and divided in two groups: group 1 had 16 patients that were submitted to decompression of occipital bone and dura mater of the craniovertebral junction (CVJ); group 2 also had 16 patients and in addition to the previous procedure, they were submitted to Magendie's foramen opening e tonsils manipulation. The comparison between the groups included neurological exam and cerebrospinal fluid flow imaging during pre and postoperative periods. Results Both techniques were equivalents in terms of neurological improvement of the patients (p > 0.05), but the group 2 had more surgical complications, with relative risk of 2.45 (CI 1.55-3.86) for adverse events. Whatever the cerebrospinal fluid flow at CVJ, the patients of the group 1 achieved greater amount of flow than the group 2 (p < 0.05) during the postoperative period. Conclusion The cranial and dural decompression of the CVJ without arachnoidal violation was the best surgical intervention for treatment of CM 1, between these two compared techniques.

Craniovertebral junction malformation in Northeastern Brazil: the myth of the Dutch colonization.

The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazil's history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.

Craniovertebral junction malformation in Northeastern Brazil: the myth of the Dutch colonization / Malformação da junção craniovertebral no Nordeste do Brasil: o mito da colonização Holandesa

The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazil's history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.

A alta prevalência de malformação da junção craniovertebral no Nordeste do Brasil é historicamente associada ao biótipo braquicefálico (cabeça chata), também comum nessa região. Postula-se que essa característica tenha sido introduzida na região pelos holandeses durante o período colonial da história do Brasil. Com base na confrontação desse paradigma com alguns fatos históricos, os autores concluem que o fenótipo braquicefálico foi herdado de ancestrais pré-históricos (ameríndios) que já habitavam a região no momento da chegada do homem branco europeu.

Extensive spinal cord involvement in magnetic resonance imaging evaluation on schistosomal myelitis.

UNLABELLED: The diagnosis of schistosomal myelitis (SM) is frequently presumptive because no findings from any complementary examination are pathognomonic for this disease. The present report describes some abnormalities seen on magnetic resonance imaging (MRI) evaluation of a series of SM patients and discusses their etiopathogenesis. METHODS: This study evaluated SM patients at the time of their diagnosis. These patients routinely underwent MRI on all segments of the spinal cord. RESULTS: Thirteen patients were evaluated. The MRI was abnormal in 12 (92.3%) of them. In 11 patients (84.61%), the damage reached two or more spinal segments. CONCLUSIONS: MRI was an important diagnostic aid in this sample, because of the high rate of abnormalities detected. The tissue damage observed on MRI was extensive in the majority of the patients.

Extensive spinal cord involvement in magnetic resonance imaging evaluation on schistosomal myelitis / Envolvimento difuso da medula espinhal na avaliação pela ressonância magnética da mielite esquistossomótica

The diagnosis of schistosomal myelitis (SM) is frequently presumptive because no findings from any complementary examination are pathognomonic for this disease. The present report describes some abnormalities seen on magnetic resonance imaging (MRI) evaluation of a series of SM patients and discusses their etiopathogenesis. Methods: This study evaluated SM patients at the time of their diagnosis. These patients routinely underwent MRI on all segments of the spinal cord. Results: Thirteen patients were evaluated. The MRI was abnormal in 12 (92.3 percent) of them. In 11 patients (84.61 percent), the damage reached two or more spinal segments. Conclusions: MRI was an important diagnostic aid in this sample, because of the high rate of abnormalities detected. The tissue damage observed on MRI was extensive in the majority of the patients.

O diagnóstico da mielite esquistossomótica é frequentemente realizado por presunção, não havendo achado de exame complementar que seja patognomônico à condição. O presente estudo descreve alterações presentes na avaliação desses pacientes pela técnica da ressonância magnética e discute sua etiopatogênese. Métodos: O estudo avaliou pacientes com mielite esquistossomótica no momento do diagnóstico, os quais foram submetidos, rotineiramente, à ressonância magnética de todos os segmentos medulares. Resultados: Foram avaliados 13 pacientes, sendo a ressonância magnética alterada em 92.3 por cento dos casos. Em 11 pacientes (84.61 por cento), o dano abrangeu dois ou mais segmentos espinais. Conclusões: A ressonância magnética espinhal foi um importante auxílio diagnóstico nessa casuística em virtude da alta taxa de alterações detectadas. O dano tecidual observado foi extenso na maioria dos pacientes.

Radicular dysfunction preponderance at early phase clinical evaluation in myelitis by Schistosoma mansoni.

UNLABELLED: In neuroschistosomiasis, the spinal cord is the most common place of the disease. In high prevalent areas for schistosomiasis mansoni, the clinical alertness is important for an early diagnostic, in order to decrease the final neurological damage. This study provides some useful neurologic information about a series of patients with schistosomal myelitis. METHOD: The sample consisted of 13 schistosomiasis mansoni carriers examined at the moment of the diagnosis of myelitis. RESULTS: The classical triad (lumbago, weakness at the lower limbs and urinary dysfunctions) was documented in 11 (86.61%) patients. The distribution of the clinical forms was: myeloradicular in six patients (46.15%), radicular in four (30.76%) and myelitic in three (23.07%). CONCLUSION: The radicular dysfunction and their clinical associated forms were the most prominent pattern during the early phase of this disease.

Radicular dysfunction preponderance at early phase clinical evaluation in myelitis by Schistosoma mansoni / Preponderância de disfunções radiculares na avaliação clínica precoce da mielite pelo Schistosoma mansoni

In neuroschistosomiasis, the spinal cord is the most common place of the disease. In high prevalent areas for schistosomiasis mansoni, the clinical alertness is important for an early diagnostic, in order to decrease the final neurological damage. This study provides some useful neurologic information about a series of patients with schistosomal myelitis. METHOD: The sample consisted of 13 schistosomiasis mansoni carriers examined at the moment of the diagnosis of myelitis. RESULTS: The classical triad (lumbago, weakness at the lower limbs and urinary dysfunctions) was documented in 11 (86.61 percent) patients. The distribution of the clinical forms was: myeloradicular in six patients (46.15 percent), radicular in four (30.76 percent) and myelitic in three (23.07 percent). CONCLUSION: The radicular dysfunction and their clinical associated forms were the most prominent pattern during the early phase of this disease.

Na neuroesquistossomose, a medula espinhal é o sítio de predileção da doença. Em áreas de alta prevalência para esquistossomose mansoni, o conhecimento clínico dessa condição é importante para o seu diagnóstico precoce e consequente redução da lesão neurológica definitiva. Este estudo provê informações neurológicas relevantes pertinentes a uma série clínica de pacientes com mielite esquistossomótica. MÉTODO: A amostra consistiu de 13 pacientes portadores de esquistossomose mansoni examinados no momento do diagnóstico de sua forma mielítica. RESULTADOS: A tríade clássica (lombalgia, fraqueza nos membros inferiores e disfunções urinárias) foi documentada em 11 (86,61 por cento) pacientes. Quanto à distribuição das formas clínicas, se observou a ocorrência da mieloradicular em seis pacientes (46,15 por cento), da radicular em quatro (30,76 por cento) pacientes e da mielítica em três (23,07 por cento) pacientes. CONCLUSÃO: A disfunção radicular e suas formas clínicas associadas foram o padrão mais frequente durante a avaliação na fase precoce da doença.

Portal Doppler ultrasound evaluation in myelitis by Schistosoma mansoni.

UNLABELLED: The mechanism for development of schistosomal myelitis has not yet been completely understood. Few publications have tried to establish a link between the general clinical presentation of the illness and its neurological manifestations. OBJECTIVE: To evaluated the portal blood flow in patients with schistosomal myelitis and controls. METHOD: Forty-three individuals were evaluated using portal Doppler ultrasound. Group I consisted of 13 patients with the spinal form of schistosomiasis. Group II included 10 patients with intestinal and hepatointestinal forms of schistosomiasis, but no neurological symptoms; while group III involved 20 healthy controls. RESULTS: Portal venous speed and portal venous flow were significantly elevated in group I (p<0.001) compared with the others. CONCLUSION: Doppler ultrasound demonstrated a situation of high flow within the portal venous system of patients with schistosomal myelitis.

Epidemiological aspects in neuroschistosomiasis.

UNLABELLED: The urbanization process of schistosomiasis has been described in the literature. The present report shows and discusses some epidemiological aspects of neuroschistosomiasis that emphasizes this trend. METHOD: The study was done between July, 2005 and June, 2006, and consisted of spinal cord schistosomiasis carriers at the moment of diagnosis. These patients were evaluated whatever the origin and period of the year that they developed the symptoms. RESULTS: A total of 13 patients were evaluated. Ten cases (76.92%) came from the Metropolitan Region of Recife, while the other zones (Zona da Mata, Agreste e Sertão) contributed with just three cases (23.07%). October, November and December (post rainy period) concentrated the majority of the cases (61.54%). CONCLUSION: The high spatial and temporal concentration of cases in relation to a recent endemic area for Schistosomiasis suggests that the immunological status may be an important factor for installation of Sschistosomal myelitis.

Portal Doppler ultrasound evaluation in myelitis by Schistosoma mansoni / Avaliação pela ultrassonografia com Doppler portal na mielite pelo Schistosoma mansoni

The mechanism for development of schistosomal myelitis has not yet been completely understood. Few publications have tried to establish a link between the general clinical presentation of the illness and its neurological manifestations. Objective: To evaluated the portal blood flow in patients with schistosomal myelitis and controls. Method: Forty-three individuals were evaluated using portal Doppler ultrasound. Group I consisted of 13 patients with the spinal form of schistosomiasis. Group II included 10 patients with intestinal and hepatointestinal forms of schistosomiasis, but no neurological symptoms; while group III involved 20 healthy controls. Results: Portal venous speed and portal venous flow were significantly elevated in group I (p<0.001) compared with the others. Conclusion: Doppler ultrasound demonstrated a situation of high flow within the portal venous system of patients with schistosomal myelitis.

A fisiopatogênese da mielopatia esquistossomótica não é completamente entendida, sendo escassas as publicações que tentam inferir a relação entre a forma clínica da esquistossomose e suas manifestações neurológicas. Objetivo: Avaliar o fluxo sanguíneo do sistema porta em pacientes com mielite esquistossomótica, contribuindo no entendimento dos mecanismos que favorecem a chegada dos parasitas e/ou seus derivados ao sistema nervoso. Método: Foram avaliados 43 indivíduos pela Dopplerfluxometria portal. O grupo I constou de 13 pacientes com esquistossomose medular, sendo o grupo II composto por 10 portadores de formas intestinal e hepatointestinal (sem doença neurológica), e o grupo III, por 20 controles sadios. Resultados: A velocidade venosa portal e o fluxo venoso portal foram significativamente elevados (p-valor<0,001) no grupo I. Conclusão: A Dopplerfluxometria demonstrou a presença de estados hiperdinâmicos do leito vascular porta em pacientes com mielite pelo Schistosoma mansoni.

Epidemiological aspects in neuroschistosomiasis / Aspectos epidemiologicos na neuroesquistossomose

The urbanization process of schistosomiasis has been described in the literature. The present report shows and discusses some epidemiological aspects of neuroschistosomiasis that emphasizes this trend. Method: The study was done between July, 2005 and June, 2006, and consisted of spinal cord schistosomiasis carriers at the moment of diagnosis. These patients were evaluated whatever the origin and period of the year that they developed the symptoms. Results: A total of 13 patients were evaluated. Ten cases (76.92 percent) came from the Metropolitan Region of Recife, while the other zones (Zona da Mata, Agreste e Sertão) contributed with just three cases (23.07 percent). October, November and December (post rainy period) concentrated the majority of the cases (61.54 percent). Conclusion: The high spatial and temporal concentration of cases in relation to a recent endemic area for Schistosomiasis suggests that the immunological status may be an important factor for installation of Sschistosomal myelitis.

O processo de urbanização da esquistossomose vem sendo descrito na literatura. O presente estudo apresenta e discute alguns aspectos epidemiológicos na neuroesquistossomose que confirmam essa tendência. Método: O estudo foi realizado entre julho de 2005 e junho de 2006, sendo composto por portadores de mielite esquistossomótica no momento do diagnóstico. Os pacientes foram avaliados quanto à procedência e ao período do ano que desenvolveram a doença. Resultados: No total foram 13 pacientes avaliados, sendo 10 casos (76,92 por cento) provenientes da Região Metropolitana do Recife, enquanto as demais regiões (Zona da Mata, Agreste e Sertão) contribuíram com apenas um caso cada. Os meses de outubro, novembro e dezembro concentraram a maioria dos pacientes (61,54 por cento). Conclusão: A alta concentração espacial e temporal de casos em relação a uma área endêmica recente para esquistossomose sugere que a participação de fatores imunológicos possa ser importante para o desenvolvimento de sua forma medular.

Aneurisma intrameatal da AICA: relato de caso e discussão / AICA intrameatal Aneurysm: case report and discussion

Introdução: Os aneurismas distais da artéria cerebelarântero-inferior representam 0,1% dos aneurismas intracranianos(3% dos aneurismas da fossa posterior). Métodos: Nopresente artigo reportamos um caso tratado com êxito dessarara entidade e discutimos alguns aspectos da literatura sobreo tema. Conclusão: O manuseio dessa patologia requer umconhecimento detalhado da anatomia local, sendo a exclusãoda lesão com preservação da integridade das estruturas vascularesenvolvidas, a abordagem terapêutica mais adequada.

Fratura condilar occipital bilateral. Relato de caso / Bilateral occipital condyle frature. Case report

A fratura do côndilo occipital (FCO) é uma rara forma de trauma raquimedular. Há 96 casos previamente relatados na literatura mundial, nenhum dos quais bilateral. Apresentamos um caso único de FCO bilateral em um paciente de 23 anos do sexo masculino, vítima de acidente automobilístico. A apresentação clínico-radiológica e o manejo ideal são discutidos. Um alto grau de suspeição clínica é fortemente recomendado para evitar retardos no diagnóstico.