Bruno Silva Costa

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.

Early shunt complications in 46 children with hydrocephalus

OBJECTIVE To determine the causes of early shunt complications in 46 children with hydrocephalus. METHOD A retrospective study was conducted on 46 children submitted to ventriculoperitoneal shunt surgery between February 2005 and February 2007. RESULTS Thirteen (28%) patients presented complications, which were due to infection in 9 (69%) and to malfunction of the shunt system in 4 (31%).The mean number of surgical procedures performed on patients who presented complications was 2.8 per patient, with a total of 46 surgeries in this group. All patients with infectious complications were identified during their hospital stay. CONCLUSIONS Infection was the most common complication. The infection rate was proportional to the length of hospital stay. All patients with hydrocephalus due to tumors or myelomeningocele presented complications. A higher incidence of infections was observed in children older than 2 years.

Clinical experience with a novel bovine collagen dura mater substitute

UNLABELLED Dural substitutes are used to achieve watertight closure of the dura mater when adequate closure is not possible. The purpose of this study was to evaluate the efficacy and safety of a new collagen matrix dural substitute (Duradry, Technodry, Belo Horizonte MG) in the repair or expansion of cranial and spinal dura mater. METHOD Thirty patients, operated on between March and September, 2008, were studied. Surgical records were reviewed for sex, age, location of graft, technique, and presence of fistula or infection. The patients were followed up for at least 3 months, and presence of complications, such as cerebrospinal fluid leakage, infection, aseptic meningitis hydrocephalus, pseudomeningocele, was analyzed. RESULTS Only one patient presented cerebrospinal fluid fistula. No patients presented wound infections, hydrocephalus, pseudomenigocele, meningitis, brain abscesses or signs of toxicity related to the dural substitute. CONCLUSION The new dural substitute used in this study is effective and safe, and the initial results are similar to those of other dural substitutes reported in the literature.

Traumatic Brain Injury Epidemiology in Brazil.

BACKGROUND Traumatic brain injury (TBI) stands out as a grave social and economic problem. Emerging countries possess few epidemiologic studies on the range and impact of TBI. OBJECTIVE Our study aimed to characterize the demographic, social, and economic profile of people suffering from TBI in Brazil. METHODS Data on TBI cases in Brazil between 2008 and 2012 were collected through the website of the Information Technology Department of the Unified Health System (DATASUS) maintained by the Brazilian Ministry of Health. This database is fed by public hospital admission authorization forms provided nationwide. RESULTS There were around 125,000 hospital admissions due to TBI a year, an incidence of 65.7 admissions per 100,000 inhabitants per year. Hospital mortality was 5.1/100,000/year, and the case fatality rate was 7.7%. The average annual cost of hospital expenses was US

Treatment of cerebral cysticercosis with albendazole in elevated dosages

70,960,000, with an average cost per admission of US

Efficacy and Safety of a Porcine Collagen Sponge for Cranial Neurosurgery: A Prospective Case-Control Study

568. The age group 20-29, frequently admitted to the hospital due to TBI, presented the largest number of hospital deaths; however, the population >80 years of age showed the highest admission rate per age group, around 138/100,000/year, followed by the age group 70-79. CONCLUSIONS TBI should be recognized as an important public health problem in Brazil because it is responsible for considerable social and economic costs. Besides the young adult age group (20-29 years old), the geriatric age group is especially vulnerable to the frequent and devastating consequences of TBI. The implementation of a system of effective epidemiologic vigilance for neurotrauma is urgent in Brazil and other countries worldwide.

Glioblastoma multiforme in childhood: a case report.

th 2006, the patient was readmitted with paralysis of the right third nerve and left hemiparesis. MRI revealed a resolution of the hydrochepaly and an increase on the size of the lesion in the prepontine cisterna, with a significant compression of the mesencephalous, which justified the alternate syndrome (Fig 2D and 2E). Also, there is still presence of bilateral chronic subdural hematoma, bigger at right, which was probably a consequence of the shunt (Fig 2F). The patient went through surgical drainage of the hematoma but there was no improvement of the hemiparesis and ptosis. The ventricular cateter was not removed. A new therapeutic treatment was accomplished using albendazole 30 mg/Kg dose, for 30 days, along with dexamethasone IV during the first week of treatment. The patient was discharged and completed the treatment at home, with oral corticoids in a decreasing way. Control CT after 15 days of treatment showed a resolution of the subdural hematoma, but also the persistence of the lesion in the cistern (Figs 3-A and 3-B). The patient’s neurological deficits did not change. After the therapeutic treatment was finished, the patient re turned with significant improvement of the hemiparesis and pto sis. No side effects were noticed during this time. A CT scan, 60 days after the beginning of the treatment, revealed a decrease in the size of the cyst of the basal cistern, and totally recovery of the focal deficits (Fig 3C).

Levels of MMP-9 in patients with intracranial aneurysm: Relation with risk factors, size and clinical presentation.

OBJECTIVE The use of dural grafts is very useful when primary dural closure cannot be achieved. Our primary objective was to study the incidence of postoperative cerebrospinal fluid leak, including fistula and pseudomeningocele, and postoperative infection by comparing autologous material and a new collagen graft. MATERIALS AND METHODS A prospective nonrandomized study with a new collagen-based product derived from porcine cells (Peridry) was performed. It was used for dural replacement in 50 patients who underwent a variety of neurosurgical procedures requiring the use of a dural graft. These results were compared with a control group of 50 patients who were treated with autologous duraplasty material. The follow-up period was 3 months. RESULTS Postoperative overall cerebrospinal fluid fistula occurred in 6% of both groups. No patient in the collagen group developed any sort of infection. One patient in the control developed osteomyelitis in the bone flap. CONCLUSION The new collagen-based product derived from porcine cells (Peridry), compared with an autologous tissue, is safe, effective, easy to use, as well as time saving in cranial neurosurgery.

NR9 Interet des sequences IRM non morphologiques dans l’exploration des lesions expansives intracraniennes

Among high-grade gliomas, childhood glioblastoma multiforme (GBM) is particularly challenging in terms of therapeutic treatment.1-5 Cerebral tumors are the most frequent childhood solid neoplastic disorders and are the primary cancer-related cause of death among children.1,3 Gliomas constitute approximately 60% of all cerebral tumors, and approximately half of them are considered to be high-grade malignant tumors.1 The prognosis for recovery is conservative, and 5-year survival rates range from 5% to 15%.2,6,7 This case report documents a GBM that was located deep in the right cerebral hemisphere of a 9-year-old child. Because this is a rare illness for a patient of this age, we also provide a brief literature review to supplement this case report.

Carotid Endarterectomy: Part II—Surgical Technique and Postoperative Surveillance

BACKGROUND Intracranial aneurysms are arterial anomalies affecting 2% to 3% of the general population in the world and these ruptures are associated with a high mortality. Some risk factors, such as age, gender, smoking, alcohol, hypertension and familial history are associated with the number of aneurysms and their size. In addition, inflammatory processes within the blood vessels of the brain can activate matrix metalloproteinase-9 (MMP-9), which degrades various components of the extracellular matrix, such as elastin. Thereby, this work has aimed at evaluating the relationship between plasma MMP-9 levels and the risk factors that are associated with intracranial aneurysm, as well as investigating the aneurysm statuses (ruptured and unruptured) and comparing them with the control volunteers. METHODS Between August 2014 to June 2016, blood samples were collected from 282 patients (204 ruptured and 78 unruptured saccular intracranial aneurysms) and 286 control volunteers. The MMP-9 plasma levels were measured by ELISA. Statistical analyzes were performed with SPSS software when using parametric or nonparametric tests, after the normality tests. RESULTS Higher levels of MMP-9 were found in the aneurysm groups as a whole and when they were stratified by rupture status, then compared with the control group (p < 0.0001). When stratifying them by diameter, those smaller than 7 mm presented high levels of MMP-9 (p < 0.0001), especially in the ruptured ones. As for risk factors, hypertension and smoking were the most important. However, hypertension was mostly associated with the ruptured aneurysms (p < 0.0001). CONCLUSIONS High levels of MMP-9 were found in smaller ruptured and unruptured intracranial aneurysms (<7 mm) with strongest statistical associations than other sizes, especially when associated with smoking and hypertension.