Antonio de Pádua Furquim Bonatelli

Chordoid meningioma: report of two cases

We present CT scan, MRI and histopathologic findings of two patients harboring a rare type of meningioma. In the first case, a 52 year-old male patient, a large parasellar mass invading the cavernous sinus, infiltrating the infratemporal fossa and extending as low as C2 was founded. The tumor was isointense on T1, enhanced strongly with gadolinium injection, and was hyperintense on T2. In the second case, a 19-year-old male patient, a large high density temporal right mass was disclosed by CT scan. Both patients were taken to surgery. In the first case, only a partial removal was possible to be accomplished due to a severe intra operative bleeding. In the second case, the tumor was totally removed. Both showed characteristic pathologic findings of a meningioma resembling a chordoma. Meningioma is a relatively common intracranial tumor, occurring most frequently in adults, showing a wide variety of growth patterns. We described a pattern that had a peculiar chordoma-like appearance. The pathological findings and the differential diagnosis from chordoma are discussed.

Espondilodiscites sépticas: diagnóstico e tratamento

We studied retrospectively 24 patients with septic discitis of different etiologies (hematogenic, primary and infantile) and the different aspects involved in its diagnosis and treatment. Erythrocyte sedimentation rate proved to be a valuable parameter and should always be interpreted carefully along with the clinical and neuroimaging findings. Biopsies should be reserved for doubtful cases with atypical course. Clinical treatment should be initiated after the following situations have been ruled out: sepsis, neurological deficit, severe deformity, epidural abscess and foreign body (primary disease). The surgical approach may be chosen based on the stage of disease, being preferably posterior in suppurative forms and anterior in the non-suppurative stage. Based on our experience and on information gathered by literature review, we propose an algorithm to guide diagnosis and treatment in patients with septic discitis.

Estimulação cerebral profunda no núcleo subtalâmico para doença de Parkinson

We present the preliminary results in patients well selected to be implanted by deep brain stimulation (DBS) for Parkinsonss disease (PD). METHODS: 8 PD patients with disabled tremor, akinetic/bradikinetic and rigidity, in spite of best therapeutic assay with poor response were referred to surgery. It was implanted DBS Itrell 2. Theses patients were evaluated by the following scales: UPDRS, Schwab and England. RESULTS: The preliminary results in 6 months showed significant improvement of motor performance and it is shown by the scores. There were no complications so far with these procedures. CONCLUSION: The preliminary results indicate that DBS is highly effective, with benefit to those patients and it is according to literature.

Estimulação cerebral contínua (DBS) talâmica para controle do tremor

PURPOSE: We present our results in 4 patients with tremor, in whom electrodes (uni and bilateral) for Deep Brain Stimulation (DBS) were implanted in the ventral intermediate nucleus (VIM) of the thalamus. METHOD: Four patients with disabling tremor, with drug-resistant spite of optimum therapeutic trials with poor response were referred to do surgery. Two patients had bilateral essential tremor. These patients were implanted with electrodes for DBS 3387 (Medtronic). Two patients had unilateral parkinsonian tremor and they received unilateral implantation of model 3387 DBS. RESULTS: All four patients showed relieve of the tremor symptoms with significant tremor control seen at the scores. There were no definite adverse events after the electrodes implants for DBS; adverse events were transient and promptly reversed after the adjustment of the parameters. CONCLUSIONS: The results the authors found in this study indicate that VIM-stimulation is effective for tremor control either parkinsonian or essential tremor. The results correlate with the data in the literature.

Tratamento cirúrgico das lesoes traumáticas do segmento médio-inferior da coluna cervical

The most frequently injury level of cervical spine is C2, followed by C5 and C6. Injuries were most commonly sustained in the third decade of life, with a decreasing incidence in the advanced age. As part of these lesions is located in the elements of the anterior column, according to Deniss definition and, taking in consideration the biomechanics studies of the segment medium¾inferior of the cervical spine, as well as the mechanisms that cause their lesions, this study was elaborated, with the intention of presenting the techniques of anterior cervical fusion, with bony graft and plates of Caspar, Morscher (CSLP) and ORION™. The advantages and disadvantages of each type of anterior fixation are presented accordind to the literature review. The improvement in the material relate to plates and screws fixation techniques are illustrated.The most frequently injury level of cervical spine is C2, followed by C5 and C6. Injuries were most commonly sustained in the third decade of life, with a decreasing incidence in the advanced age. As part of these lesions is located in the elements of the anterior column, according to Deniss definition and, taking in consideration the biomechanics studies of the segment medium - inferior of the cervical spine, as well as the mechanisms that cause their lesions, this study was elaborated, with the intention of presenting the techniques of anterior cervical fusion, with bony graft and plates of Caspar, Morscher (CSLP) and ORION. The advantages and disadvantages of each type of anterior fixation are presented accordind to the literature review. The improvement in the material relate to plates and screws fixation techniques are illustrated.

Estudo sobre a associação de cerâmica a plasma rico em plaquetas na coluna vertebral de ratos

OBJECTIVE: To assess the osteoinductive action of platelet-rich plasma when associated to ceramics in the spine of rats. MATERIAL AND METHOD: Laminectomy was performed in 16 isogenic Lewis rats for posterior ceramic grafting. PRP was prepared intraoperatively using blood collected from two other rats. Study and control groups were set by randomization, with the study group receiving ceramics associated to PRP, and the control group receiving only ceramics. The animals were sacrificed for histopathological analysis after 10 weeks. RESULTS: Strong osteoblastic and osteoclastic activity and full re-absorption of ceramics were found on study group. In control group, small bone islands across fibrous tissue and non-reabsorbed were seen. Discussion: growth factors released by platelets bind to osteoblasts and fibroblasts surfaces, stimulating collagen synthesis to form bone matrix. Activated macrophages keep releasing growth factors and stimulating osteogenesis. CONCLUSION: The use of PRP associated to ceramics showed stronger osteoblastic and osteoclastic activity and full ceramics re-absorption compared to standalone grafting on the spine of rats.

Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator

PURPOSE The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. METHODS Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this thrombolytic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. CONCLUSION Early treatment and drainage with minimally invasive neurosurgery, can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.

Anaplastic meningioma: case report

Intracranial meningiomas continue to challenge our best clinical efforts to eliminate them once discovered and deemed appropriate for treatment. Malignant meningiomas constitute 10% to 15% of all meningiomas and limited information exists regarding adjuvant treatment. The external whole brain irradiation is recommended. Traditional chemotherapy has proven ineffective; thus, new chemotherapeutic agents and new methods of delivery should be developed. Immunotherapy may be considered for patients with malignant meningiomas when all others previous treatment have failed. We report a case of anaplastic papillary meningioma. A 67-year-old man presented with partial complex seizures, headache and aggressiveness. A computerized tomography and magnetic resonance image demonstrated a large left temporo-occipital mass with diffuse contrast enhancement and extensive surrounding edema. A left temporo-occipital flap was performed. The tumor and the infiltrated dura were radically removed. Postoperatively, the patient remained neurologically intact. The treatment was complemented by external whole brain radiation.