Spontaneous Bone Flap Resorption Following Cranioplasty Using Autologous Bone.

ABSTRACT: Cranioplasty is a common neurosurgical procedure. The main reasons for performing cranioplasty are, in addition to aesthetic correction and protection of the brain, the reestablishment of the adequate flow of cerebrospinal fluid and the prevention of complications inherent to the perpetuation of bone failure. In our institution the patient's autologous bone remains the best method for performing cranioplasty, despite the existence of other heterologous grafts and bone substitutes. Despite representing for us, the best material for cranioplasty, the use of autologous grafting is subject to complications. In this paper, the authors present the case of a patient who underwent cranioplasty with autologous bone that progressed with spontaneous resorption of the bone flap. The authors herein briefly discuss the case and review the literature on the subject, with an emphasis on the factors that can lead to such an outcome.

Report of intradural aneurysm in the cavernous segment of the internal carotid artery presented with subarachnoid hemorrhage and oculomotor palsy.

BACKGROUND: Aneurysms of the cavernous segment of the internal carotid artery (ICA) do not usually cause subarachnoid hemorrhage (SAH). We report a patient who presented with this condition due to a ruptured aneurysm located on the posterior genu of the cavernous segment, raising the question of what factors could have led to such evolution. CASE DESCRIPTION: A 55-year-old male patient presented with sudden, intense thunderstorm headache, associated with complete palsy of the left oculomotor nerve and neck stiffness. Cranial computed tomography (CT) showed no SAH, but showed an expansive process in the sella turcica, consistent with a pituitary macroadenoma. After that, SAH was confirmed by lumbar puncture (Fisher I). Cranial angio-CT revealed an intradural saccular aneurysm in the cavernous segment of the left ICA. The patient underwent cranial microsurgery for cerebral aneurysm clipping. Unlike the normal anatomic pattern, the cavernous segment of the carotid artery in this patient was located in the intradural compartment. CONCLUSION: Intradural rupture of proximal cavernous segment carotid aneurysms is rare. We review the literate for such cases and discuss the possible causes.

Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury.

BACKGROUND: Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. METHODS: A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. RESULTS: Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). CONCLUSIONS: Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

Surgical treatment of neurocysticercosis. Retrospective cohort study and an illustrative case report.

CONTEXT AND OBJECTIVE:: Neurocysticercosis is prevalent in developing countries and manifests with several neurological signs and symptoms that may be fatal. The cysts may be parenchymal or extraparenchymal and therefore several signs and symptoms may occur. Depending on their location, neurosurgical procedures may be required, sometimes as emergencies. The aim here was to review 10-year statistics on all surgical neurocysticercosis cases at a large public tertiary-level hospital. DESIGN AND SETTING:: Retrospective cohort at a large public tertiary-level hospital. METHODS:: All surgical neurocysticercosis cases seen between July 2006 and July 2016 were reviewed. Parenchymal and extraparenchymal forms were considered, along with every type of surgical procedure (shunt, endoscopic third ventriculostomy and craniotomy). The literature was reviewed through PubMed, using the terms "neurocysticercosis", "surgery", "shunt" and "hydrocephalus". RESULTS:: 37 patients underwent neurosurgical procedures during the study period. Most were male (62.16%) and extraparenchymal cases predominated (81%). Patients aged 41 to 50 years were most affected (35.13%) and those 20 years or under were unaffected. Ventricular forms were most frequently associated with hydrocephalus and required permanent shunts in most cases (56.57%). CONCLUSIONS:: The treatment of neurocysticercosis depends on the impairment: the parenchymal type usually does not require surgery, which is more common in the extraparenchymal form. Hydrocephalus is a frequent complication because the cysts often obstruct the cerebrospinal flow. The cysts should be removed whenever possible, to avoid the need for permanent shunts.

Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury / Análise dos custos diretos da craniectomia descompressiva em vítimas de traumatismo cranioencefálico

ABSTRACT Background: Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. Methods: A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. Results: Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). Conclusions: Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

RESUMO Introdução: A craniectomia descompressiva (CD) é procedimento necessário em alguns casos de trauma cranioencefálico (TCE). Este manuscrito objetiva avaliar os custos diretos e desfechos da CD no TCE em um país em desenvolvimento e descrever o perfil epidemiológico. Métodos: Estudo retrospectivo foi realizado usando banco de dados neurocirúrgico de cinco anos, considerando amostra de pacientes com TCE que realizaram CD. Algumas variáveis foram analisadas e foi desenvolvida uma fórmula para cálculo do custo total. Resultados: A maioria dos pacientes teve múltiplas lesões intracranianas, sendo que 69.0% evoluíram com algum tipo de complicação infecciosa. A taxa de mortalidade foi de 68,8%. O custo total foi R$ 2.116.960,22 (US$ 653,216.00) e o custo médio por paciente foi R$ 66.155,00 (US$ 20,415.00). Conclusões: CD no TCE é um procedimento caro e associado á alta morbidade e mortalidade. Este foi o primeiro estudo realizado em um país em desenvolvimento com o objetivo de avaliar os custos diretos. Medidas de prevenção devem ser priorizadas.

Surgical treatment of neurocysticercosis. Retrospective cohort study and an illustrative case report / Tratamento cirúrgico da neurocisticercose. Estudo de coorte retrospectivo e um caso ilustrativo

ABSTRACT CONTEXT AND OBJECTIVE: Neurocysticercosis is prevalent in developing countries and manifests with several neurological signs and symptoms that may be fatal. The cysts may be parenchymal or extraparenchymal and therefore several signs and symptoms may occur. Depending on their location, neurosurgical procedures may be required, sometimes as emergencies. The aim here was to review 10-year statistics on all surgical neurocysticercosis cases at a large public tertiary-level hospital. DESIGN AND SETTING: Retrospective cohort at a large public tertiary-level hospital. METHODS: All surgical neurocysticercosis cases seen between July 2006 and July 2016 were reviewed. Parenchymal and extraparenchymal forms were considered, along with every type of surgical procedure (shunt, endoscopic third ventriculostomy and craniotomy). The literature was reviewed through PubMed, using the terms “neurocysticercosis”, “surgery”, “shunt” and “hydrocephalus”. RESULTS: 37 patients underwent neurosurgical procedures during the study period. Most were male (62.16%) and extraparenchymal cases predominated (81%). Patients aged 41 to 50 years were most affected (35.13%) and those 20 years or under were unaffected. Ventricular forms were most frequently associated with hydrocephalus and required permanent shunts in most cases (56.57%). CONCLUSIONS: The treatment of neurocysticercosis depends on the impairment: the parenchymal type usually does not require surgery, which is more common in the extraparenchymal form. Hydrocephalus is a frequent complication because the cysts often obstruct the cerebrospinal flow. The cysts should be removed whenever possible, to avoid the need for permanent shunts.

RESUMO CONTEXTO E OBJETIVO: A neurocisticercose é prevalente em países em desenvolvimento e manifesta-se com vários sinais e sintomas neurológicos que podem ser fatais. Os cistos podem ser parenquimatosos ou extraparenquimatosos, portanto vários sinais e sintomas podem estar presentes. Dependendo da sua localização, procedimentos neurocirúrgicos podem ser necessários, às vezes em caráter emergencial. O objetivo foi revisar dados estatísticos de um período de 10 anos de todos os casos cirúrgicos de neurocisticercose num grande hospital público terciário. TIPO DE ESTUDO E LOCAL: Coorte retrospectiva de um grande hospital público terciário. MÉTODOS: Todos os casos cirúrgicos de neurocisticercose de pacientes tratados entre julho 2006 e julho 2016 foram revisados. As formas parenquimatosas e extraparenquimatosas foram consideradas, assim como tipo de procedimento cirúrgico (derivação, terceiroventriculostomia endoscópica e craniotomia). A literatura foi revisada por meio da PubMed, utilizando-se os termos “neurocysticercosis”, “surgery”, “shunt” e “hydrocephalus”. RESULTADOS: 37 pacientes foram submetidos a procedimentos neurocirúrgicos nesse período, a maioria do sexo masculino (62.16%%) e casos extraparenquimatosos predominaram (81%). Pacientes com idade 41-50 anos foram os mais afetados (35,13%) e aqueles com 20 anos ou menos não foram afetados. As formas ventriculares mais frequentemente estiveram associadas a hidrocefalia e necessitaram da realização de shunts definitivos na maior parte dos casos (56,57%). CONCLUSÕES: O tratamento depende da forma de acometimento: o tipo parenquimatoso usualmente não necessita de cirurgia que é mais comum na forma extraparenquimatosa. Hidrocefalia é uma complicação frequente pois muitas vezes os cistos obstruem o fluxo liquórico. A remoção dos cistos deve ser realizada sempre que possível para evitar a necessidade de derivações definitivas.