Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Mais filtros

Intervalo de ano de publicação
Childs Nerv Syst ; 36(3): 477-484, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31925508


INTRODUCTION: Nasal dermoids with intracranial extension are benign lesions that can have life-threatening consequences, as a nasal punctum may serve as a portal of entry for infection into the central nervous system. The surgical management of these lesions can be challenging, as the extracranial and intracranial cysts and sinus tract must be resected to prevent recurrence, and the surgery must be carried out with an acceptable esthetic result. TECHNIQUE: The authors present a technique for the resection of nasocranial dermoids that eliminates the need to remove and replace the frontonasal segment. Working through a small frontal craniotomy enables the surgeon to drill out the sinus tract through the foramen cecum and inferiorly into the nose. This exposure eliminates the need to enter the frontal sinus, if it is present. CONCLUSION: The extracranial punctum and tract are resected from below in a minimally invasive fashion that permits removal of the lesion without a disfiguring scar.

Childs Nerv Syst ; 35(4): 719-723, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30446813


INTRODUCTION: Subdural empyema (SDE) is a neurosurgical emergency that is typically treated with surgical drainage, either by burr hole or by craniotomy. Escherichia coli is an uncommon cause of SDE and is associated with infection of a pre-existing subdural hematoma. CASE REPORT: We report the case of an otherwise healthy, immunocompetent 4-month-old infant girl with an E. coli-infected subdural hematoma. The infection persisted despite aggressive neurosurgical treatment that included drainage of the subdural space through burr holes and, subsequently, a wide craniotomy was performed. Ultimately, after 30 days, the SDE resolved with good neurological outcome. A review of prior literature indicates that infected subdural hematomas (including those caused by E. coli) are typically less aggressive and respond to burr hole drainage. CONCLUSION: We illustrate the fulminant progression of the SDE in the face of neurosurgical treatment. Our experience suggests lowering the threshold for wide craniotomy in these incompletely understood cases.

Acta Neurochir (Wien) ; 160(9): 1883-1887, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29987392


Cerebral delayed ischemia due to arterial vasospasm is a rare complication following epilepsy surgery. Here we report the third known case and first of diffuse vasospasm. A 48-year-old woman underwent a transcortical anterior left temporal lobectomy. Eleven days later, she had new-onset expressive aphasia with narrowing of the anterior, middle, and posterior cerebral arteries, and increased velocities via transcranial Doppler. She was treated with fluids, nimodipine, and permissive hypertension. At 6 months, her speech was near baseline. Cerebral vasospasm may represent a rare cause of morbidity after anterior temporal lobectomy; a literature review on the subject is presented.

Lobectomia Temporal Anterior/efeitos adversos , Craniotomia/efeitos adversos , Epilepsia Resistente a Medicamentos/cirurgia , Complicações Pós-Operatórias/etiologia , Vasoespasmo Intracraniano/etiologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade
Childs Nerv Syst ; 33(6): 999-1003, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28251324


INTRODUCTION: Arterial cerebral aneurysms in the neonatal population are rare, and while the association of interrupted aortic arch and intracranial aneurysm has been reported in the adult and pediatric population (three cases each), to date, it has not been reported in the neonate. CASE REPORT: We report the case of a 26-day-old girl who presented with a generalized seizure 2 weeks after undergoing congenital heart surgery. Head CT revealed diffuse SAH with a 1.7 × 2.9-cm frontal intra-parenchymal hematoma with subdural extension producing 3 mm of midline shift. CTA evidenced a 2-mm left MCA bifurcation aneurysm, and the patient was taken to the operating room for clipping. Twenty-four-hour post-operative head CT showed ventriculomegaly and an EVD was placed. It was removed 4 days later without the need for permanent CSF diversion, and after this, her hospital stay was uneventful and she was discharged home. At 25 months of age, she was meeting developmental milestones. At this time, she underwent further heart surgery and expired shortly thereafter due to cardiomyopathy. CONCLUSION: Here, we report the successful treatment of a ruptured neonatal aneurysm, and the first known case associated with interrupted aortic arch. Given the time and presentation, this patient likely illustrates the role of hemodynamic factors in the rupture of neonatal aneurysms. In reviewing all of the reported cases of neonatal aneurysms, promptly securing the aneurysm by either open clipping, parent vessel occlusion, or endovascular coiling is strongly preferable to no surgical intervention.

Aneurisma Roto/diagnóstico por imagem , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Roto/cirurgia , Aorta Torácica/cirurgia , Feminino , Humanos , Recém-Nascido , Aneurisma Intracraniano/cirurgia
Acta Neurochir (Wien) ; 159(4): 655-664, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28191601


BACKGROUND: The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES: To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS: Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques. The dimensions, course and branching patterns of the MA were recollected. In addition, 20 three-dimensional reconstruction CT head and neck angiograms (3D CTAs) of actual patients were correlated with the cadaveric findings. RESULTS: The MA can be divided in three segments: mandibular, pterygoid and pterygopalatine. Medial and lateral trunk variants regarding its course around the lateral pterygoid muscle can be found. The different branching patterns of the MA have a direct correlation with the course of its main trunk at the base of the skull. Branching and trunk variants on one side do not predict the findings on the contralateral side. CONCLUSION: In this study the highly variable course, branching patterns and relations of the MA are illustrated and described in human cadaveric heads and 3D CTAs. MA 3D CTA with bone reconstruction can be useful preoperatively for the identification of the medial or lateral course variants of this artery, particularly its pterygoid segment, which should be taken into account when considering the MA as a donor vessel for an EC-IC bypass.

Artéria Maxilar/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Adulto , Angiografia , Feminino , Humanos , Masculino , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/diagnóstico por imagem , Nariz/anatomia & histologia , Nariz/cirurgia , Músculos Pterigoides/anatomia & histologia , Músculos Pterigoides/diagnóstico por imagem , Músculos Pterigoides/cirurgia , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Tomografia Computadorizada por Raios X
J Craniofac Surg ; 28(4): 1052-1054, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28178101


INTRODUCTION: The increased incidence and success of strip craniectomy with postoperative helmet therapy in the treatment of sagittal craniosynostosis has been documented by multiple centers throughout the country and world. The authors report a child with a postoperative implantation intradiploic epidermoid cyst following a strip craniectomy, a complication, that to our knowledge, has not been reported. METHODS: This clinical report involves a 3-year-old boy with a scaphocephalic appearance who was transferred to our center following an interstate adoption. He underwent a strip craniectomy with helmet therapy in infancy. On presentation to our facility the chief complaint was a scaphocephalic appearance. Preop computed tomography scans showed areas of bone gaps along the sagittal suture. RESULTS: The child was brought to the operating room for a mid-vault expansion. At surgery, a large intradiploic epidermoid cyst was noted on the posterior aspect of the area of the sagittal suture, immediately beneath to posterior incision for the strip craniectomy. The cyst extended through the inner table of the skull and necessitated split cranial grafts to aid in the reconstruction. CONCLUSION: The authors present a patient with an iatrogenic intradiploic epidermoid cyst of the posterior skull following strip craniectomy, which has not been previously been described in association with strip craniectomy. This patient underlies the importance of a strong working relationship between craniofacial surgery and neurosurgery.

Craniossinostoses/cirurgia , Craniotomia/efeitos adversos , Cisto Epidérmico/etiologia , Pré-Escolar , Craniossinostoses/diagnóstico por imagem , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Humanos , Doença Iatrogênica , Masculino , Tomografia Computadorizada por Raios X
Av. cardiol ; 30(4): 408-411, dic. 2010. ilus, graf
Artigo em Espanhol | LILACS | ID: lil-607785


Se presenta el caso de un paciente que ingresa a nuestro servicio presentando terapias inapropiadas e infección del bolsillo, posterior al implante de un desfibrilador automático implantable con un electrodo Sprint Fidelis 6949 en estado de alerta del fabricante...

A case of a patient who was admitted to our department with inappropriate therapies and infection of the pocket, after implantation of an implantable defibrillator with a Sprint Fidelis 6949 electrode on alert of the manufacturer...

Humanos , Masculino , Idoso , Desfibriladores Implantáveis/efeitos adversos , Infecções Cardiovasculares/complicações , Infecções Cardiovasculares/etiologia , Complicações Pós-Operatórias , Cirurgia Torácica
Am J Ther ; 15(4): 377-88, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18645343


High-density lipoprotein (HDL) cholesterol is a heterogeneous group of lipoproteins exhibiting a variety of properties like prostacyclin production stimulation, decrease in platelet aggregation, endothelial cell apoptosis inhibition, and low-density lipoprotein oxidation blockade. Epidemiologic studies have shown an inverse relation between HDL cholesterol levels and cardiovascular risk. Low HDL cholesterol is associated with increased risk for myocardial infarction, stroke, sudden death, peripheral artery disease, and postangioplasty restenosis. In contrast, high HDL levels are associated with longevity and protection against atherosclerotic disease development. Given the evolving epidemic of obesity, diabetes mellitus, and metabolic syndrome, the prevalence of low HDL will continue to rise. In the United States, low HDL is present in 35% of men, 15% of women, and approximately 63% of patients with coronary artery disease. Data extracted from the Framingham study highlight that 1-mg increase in HDL levels decreases by 2% to 3% the risk of cardiovascular disease. There is no doubt regarding clinical importance about isolated low HDL, but relatively few clinicians consider a direct therapeutic intervention of this dyslipidemia. In this sense, lifestyle measures should be the first-line strategy to manage low HDL levels. On the other hand, pharmacologic options include niacin, fibrates, and statins. Fibrates appear to reduce risk preferentially in patients with low HDL with metabolic syndrome, whereas statins reduce risk across all levels of HDL. Torcetrapib, a cholesteryl esters transfer protein inhibitor, represented a hope to raise this lipoprotein; however, all clinical trials on this drug had ceased after ILLUMINATE, RADIANCE and ERASE trials had recorded an increase in mortality, rates of myocardial infarction, angina, and heart failure. In the near future, drugs as beta-glucans, Apo-A1 mimetic peptides, and ACAT inhibitors, are the new promises to treat this condition.

Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/efeitos dos fármacos , Dislipidemias/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , LDL-Colesterol/sangue , Ensaios Clínicos Controlados como Assunto , Dislipidemias/complicações , Dislipidemias/epidemiologia , Feminino , Humanos , Estilo de Vida , Masculino , Prevalência , Fatores de Risco , Síndrome , Estados Unidos/epidemiologia