Carlos Telles

Urethral extrusion of a peritoneal catheter in a patient with a neobladder: a rare complication of shunt insertion.

The insertion of a ventriculoperitoneal shunt (VPS) is considered the standard of care for several forms of hydrocephalus. Abdominal complications are most common with this procedure, comprising up to 30% of all shunt-related problems. Conversely, visceral perforation or extrusion of the shunt apparatus is rare. Herein we report a rare complication of VPS insertion in which the peritoneal catheter was spontaneously extruded through the urethra of a patient with a neobladder. We further discuss the pathogenesis, diagnosis, and treatment of this condition.

Cerebellopontine angle subependymoma without fourth ventricle extension: an uncommon tumor in a rare location.

Subependymomas are benign tumors that occur predominantly in the ventricular system. We describe a case of a 57‐year‐old man with a large cerebellopontine angle (CPA) tumor which expanded into the jugular foramen. Complete surgical excision of the tumor was achieved through a retrosigmoid approach and the histopathological diagnosis was subependymoma. Subependymomas located exclusively in the CPA without extension into the fourth ventricle are extremely rare. The mainly pathological features and the difficulty in correctly diagnosing these cases preoperatively, even with MRI, are discussed.

Changes in management strategies after spontaneous migration of a retained intraorbital metallic foreign body.

Purpose: Because of the controversial biologic tolerance and management, retained intraorbital metallic foreign body (RIMFb) poses a formidable challenge to surgeons. Besides location of the foreign body, indications for surgical management include neurologic injury, mechanical restriction of the eye movement, and development of local infection or draining fistula. The authors describe an unusual case of spontaneous migration of a RIMFb. Methods: A 26-year-old man had a gunshot injury on the left orbit. The patient was initially managed conservatively because of the posterior position of the bullet fragment. Thereafter, because of the clinical impairments and anterior migration of projectile, surgical treatment was considered. Results: Spontaneous anterior migration has led to mechanical disturbances and inflammatory complications that comprise explicit surgical indications for removal. The patient underwent surgery with complete relief of symptoms. We suppose that extrinsic ocular muscles might play a role in shifting large RIMFb over time, leading to change in the management strategies. Conclusions: Spontaneous migration of RIMFb is a rare clinical situation that can lead to pain, local deformity, as well as changes in the management strategies of the affected patients even in the late phase of follow-up.

Developmental venous anomaly causing trigeminal neuralgia.

Department of Surgical Specialties, Division of Neurosurgery, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro RJ, Brazil; Department of Neurology, University of Sao Paulo, Sao Paulo SP, Brazil. Trigeminal neuralgia (TN) is a syndrome characterized by paroxysms of facial pain affecting mainly middle and oldaged patients. Although TN’s pathogenesis is not fully understood, there is increasing evidence that TN is caused by demyelination of trigeminal sensory fibres mostly owing to an arterial neurovascular compression on the root entry zone (REZ) of the trigeminal nerve. Veins, on the other hand, can be regarded as the only offending vessel in up to 13% of the patients. Other unusual causes of TN include intrinsic brainstem lesions or even compression of the trigeminal nerve root by tumors, in which the compression can occur by the tumor itself, by an interposed blood vessel or by a distortion of the posterior fossa contents displacing the nerve root towards blood vessels or the skull base. Nonetheless, in a small number of patients, the pathogenesis remains to be determined. Although vein compression is usually accepted in TN’s pathogenesis, either alone or in combination to arterial compression, developmental venous anomaly (DVA) causing TN is seldom reported with 17 cases described to date. A patient with a classical longstanding right frontal division TN caused by a DVA is reported emphasizing the clinical features and management of such condition.

Meningioma da goteira olfativa e câncer de mama relato de dois casos

Two cases of olfactory groove meningiomas are presented in patients with breast cancer. Predominance of breast cancer and meningiomas in the age decades of the forties and the fifties, presence of steroid hormones receptors in both and prevalence of meningiomas in women are referred as significant correlations. Examination of the breast of women with meningiomas is recommended. Tomographic images are sometimes atypical, and a surgical intervention may be necessary.Two cases of olfactory groove meningiomas are presented in patients with breast cancer. Predominance of breast cancer and meningiomas in the age decades of the forties and the fifties, presence of steroid hormones receptors in both and prevalence of meningiomas in women are referred as significant correlations. Examination of the breast of women with meningiomas is recommended. Tomographic images are sometimes atypical, and a surgical intervention may be necessary.

The Orbitopterional Approach for Large and Giant Middle Cerebral Artery Aneurysms: A Report of Two Cases and Literature Review

We report two cases of complex middle cerebral artery aneurysms that were surgically treated using the orbitopterional approach in a two-piece method. The objective of this work is to discuss the usefulness of the orbitopterional approach in the surgical management of large and giant middle cerebral artery aneurysms. A 32-year-old man with a giant aneurysm and a 50-year-old woman with a large and complex aneurysm presented with subarachnoid hemorrhages. Both aneurysms were successfully clipped through an orbitopterional approach. This approach permits a more basal view of the vascular structures with only a minor retraction of frontal lobe. It also increases the view angle and amount of working space available. This approach should be considered as an alternative to the classic pterional craniotomy for the surgical management of such complex lesions.

Bilateral mini-open decompression in the treatment of carpal tunnel syndrome caused by persistent median artery: case report.

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy that is caused by increased pressure within the carpal tunnel resulting in a chronic process of median nerve ischemia and segmental demyelination. We report on a patient with bilateral patent persistent median artery (PMA) affected by typical symptomatic CTS who was treated by bilateral mini-open decompression with complete improvement. For PMA-associated CTS, standard decompression is considered the treatment of choice, whereas resection should be reserved for pathological PMA. Mini-open decompression can be an alternative, as we have verified in this first description.

Anatomical classification of anterior encephaloceles

The authors present an anatomical classification of the anterior encephaloceles. The importance of a topographic knowledge of such anomalies in their diagnosis and treatment is emphasized in order to avoid complications during the investigation of a cranio-facial protrusion.

Tratamento da dor neuropática crônica pós-trauma com o uso do bloqueio periférico: relato de caso

BACKGROUND AND OBJECTIVES: Neuropathic pain may have earmarks, but may be difficult to diagnose and treat. This study aimed at reporting a case of post-traumatic chronic pain, with poor adherence to pharmacological treatment, which was treated with peripheral blocks and adjuvants. CASE REPORT: Male patient, 42 years old, who suffered a car accident with hip and right lumbar region trauma. Patient was submitted to laparotomy with right nephrectomy, right femur and right lunate osteosynthesis. Patient evolved with right lumbar region pain not improving with prescribed drugs and with poor adherence to proposed therapeutic approach due to his difficult socio-economic status. We decided for peripheral nerve blocks in five sessions, in outpatient regimen. CONCLUSION: Treatment with peripheral nerve blocks in the lumbar region was effective and has decreased neuropathic pain symptoms in up to 60%, remaining with intensity between 3 and 4 by the visual analog scale and with no pain when the scar was touched.

Enhanced CT view of contrast extravasation in a patient with an actively bleeding aneurysm.

Guilherme Brasileiro de Aguiar a , Marcus André Acioly a , José Carlos Zirretta b , Carlos Telles a , José Ricardo Pinto a , Alexandre Martins Cunha a a Department of Surgical Specialties, Division of Neurosurgery, and b Department of Radiology, Division of Neuroradiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro , Brazil Reference 1 Koerbel A, Ernemann U, Freudenstein D: Acute subdural hematoma without subarachnoid hemorrhage caused by rupture of an internal carotid artery bifurcation aneurysm: case report and review of the literature. Br J Radiol 2005; 78: 646–650.