Bilateral arteriovenous malformations: case report.

The authors describe a case of supratentorial bilateral arteriovenous malformations in a patient who suffered an intracerebral hemorrhage. It was radiologically demonstrated that the arteriovenous malformations were separate and bilateral, located in the temporal lobes. They were removed in two operations with preoperative embolization of one. The patient did well with no neurological damage.

Giant posterior cerebral artery aneurysm in a 4-year-old child: case report.

Posterior cerebral artery aneurysms in children aged 5 years or less are very rare. We were able to find only 10 cases previously described in the literature. We present a case of giant bilobulated aneurysm of the distal right posterior cerebral artery in a 4-year-old child with an initial history of spontaneous subarachnoid hemorrhage. The aneurysm was clipped and the patient had full recovery. Based on the literature review, we discuss the characteristics of these rare aneurysms, making a comparison with different age groups.

Distal anterior cerebral artery aneurysms.

BACKGROUND: The incidence of saccular aneurysms in the distal anterior cerebral artery (DACA aneurysms), also called pericallosal or A2 aneurysms, has been estimated to be from 1.5 to 9.0% of all intracranial aneurysms in large series in the literature [5,10,12,18]. All reported series of DACA aneurysms have shown a high association with intracranial aneurysms in other locations. These aneurysms are fragile, frequently rupture prematurely during exposure, and have a higher morbidity than expected from their angiographic appearance and location. METHODS: A total of 1,350 patients with cerebral aneurysms were operated in the Department of Neurosurgery at Santa Casa Hospital in Belo Horizonte from January 1982 to January 1998. Seventy-two of those 1,350 patients had DACA aneurysms (5.3%), 51 female and 21 male. The age ranged from 26 to 69 years, the mean age being 44 years. This group of patients is reported herein. We propose three different approaches to DACA aneurysms depending on their location, all of them performed through a unilateral triangular bone flap that can then vary from fronto-basal to parietal. RESULTS: There was no mortality among patients with a single DACA aneurysm. Five deaths in this series were cases of multiple aneurysms. In patients with preoperative Hunt and Kosnick grades I and II [9], we had 90% good results. In grade III patients, we achieved 68.4% good results. The only grade IV patient had a full recovery. All 74 DACA aneurysms in the 72 operated patients were completely clipped, including two giant aneurysms. CONCLUSION: DACA aneurysms have higher morbidity and mortality rates when compared to other supratentorial aneurysms. We recommend the use of a unilateral interhemispheric approach as the most appropriate for aneurysms in this location. In cases of patients with multiple aneurysms who require two different craniotomies, we propose two surgical stages, starting with the aneurysm that has bled. A high mortality rate was noted when two craniotomies were performed in the same sitting.

Congenital inclusion cysts of the anterior fontanelle.

BACKGROUND: Congenital inclusion cysts of the anterior fontanelle are rare lesions. Both dermoid and epidermoid cysts are located in the midline of the scalp and occupy the subgaleal space. METHODS: We report 7 cases, 4 boys (57.1%), and 3 girls (42.9%), with ages ranging from 3 months to 16 years (mean 40.85 +/- 68.56 months; median 10 months). Four patients (57.1%) were white and 3 (42.9%) were Afro-Brazilian. RESULTS: The cysts had manifested soon after birth in all patients. They gradually enlarged, with no intracranial extensions. Four patients had dermoid cysts and the others had epidermoid cysts. All of them underwent surgery with complete excision of the cyst and no capsular rupture. There were no complications and no deaths. CONCLUSIONS: Congenital inclusion cysts of the anterior fontanelle are rare lesions that usually manifest at birth. The diagnosis is usually easy and surgery is mandatory, with a good prognosis. Recurrence is rare.

Basilar bifurcation aneurysms.

Direct operative management of basilar bifurcation aneurysms is one of the most challenging procedures in the realm of vascular neurosurgery, as these lesions are deeply situated in the interpeduncular region and maintain an intimate relationship with important anatomical structures. Direct clipping of aneurysms generally represents the gold standard of surgical treatment, as it allows exclusion of the aneurysmal sac from the circulation, evacuation of aneurysmal contents for decompression, and preservation of efferent flow. The author describes his experience with 123 operated patients of basilar bifurcation aneurysms from January 1977 till December 1995. In these 123 consecutive surgeries the results were 85% good outcome, 8.1% morbidity, and 6.5% mortality. In the first years of this series the pterional or subtemporal approaches were used, depending on the level of the basilar bifurcation, the exact origin of the sac, its projection and size. From 1987 on all patients were operated by a modified pterional approach described initially by Sano as temporopolar approach.

Carotid endarterectomy under regional anesthesia.

Regional anesthesia for carotid endarterectomy is a simple, reliable, and virtually complication-free technique. We began to perform a series of carotid endarterectomy under regional anesthesia at our institution in May 1990. This report describes our experience with 180 operated patients from May 1990 till December 1995, with regional anesthesia. All patients were operated with microsurgery and we utilized the deeply cervical plexus block at the C-4 level associated with superficial block, along the posterior border of the externocleidomastoid muscle. The main advantage of this technique of anesthesia is that it is the only exact method of assessing the need of a shunt by using the neurological status of the awaken patient during trial carotid cross-clamping. The regional anesthesia allows carotid endarterectomy to be safely performed on patients with advanced cardiac disease or severe chronic obstructive pulmonary disease who were not good candidates for general anesthesia. In this 180 patients we performed 198 consecutive endarterectomies (10% bilateral) with a total morbidity-mortality rate of 2.0%.

[Raeder paratrigeminal neuralgia as expression form of intracavernous giant aneurysm]. / Nevralgia paratrigeminal de Raeder como forma de expressão de aneurisma gigante intracavernoso.

The authors report the case of a 50-year-old female patient with right orbital headache secondary to a giant intracavernous aneurysm, diagnosed as Raeder paratrigeminal neuralgia. The patient was surgically treated with internal carotid artery trapping together with brain revascularization (superficial temporal artery to a deep branch of the middle cerebral artery). The patient had an excellent outcome. The identity of the syndrome and the differential diagnosis are discussed based on literature review.

[Extrapyramidal syndrome and hypoparathyroidism. On the identity of Fahr disease]. / Síndrome extrapiramidal e hipoparatireoidismo. Acerca da identidade da doença de Fahr.

Bilateral calcifications in the basal ganglia associated with neurological manifestations was diagnosed as Fahr disease for a long time. We present the cases of two patients with bilateral calcifications in the basal ganglia who presented hypoparathyroidism and extrapyramidal syndrome. Based on literature review we discuss the identity of Fahr disease and the relationship between calcifications in the basal ganglia and manifestations of endocrine system dysfunctions.

[Experience with knowledge development in food handlers with te implementation of Hazard Analysis Critical control points (HACCP) in a hospital food service]. / Uma experiência de construção de conhecimento com manipuladores de alimentos a partir da implantação da análise de perigos e pontos críticos de controle (APPCC) em uma unidade de alimentação e nutrição hospitalar.

The present article has as objective to describe the methodology of an experience of implantation of Hazard Analyses Critical Control Points (HACCP) with food handlers in a hospital food service establishment, inside of a conception of relationship and construction of knowledge. Meetings with the food handlers and nutritionists, with the objective of raising the difficulties poined for the sector and the work to be developed. The HACCP consisted of the evaluation of the operations, following the sequential steps recommended, looking itself to instruct the food handlers on the methods of the operations and its interpretations. The detected critical points, the measures of control, the criteria of correction and the monitoring have widely been argued, serving as didactic elements for the reconstruction of quality of the preparations. The discussions generated actions that were developed in short term, revealing the need of a more effective and continuous partnership for the new proposals.