Flávio Freinkel Rodrigues

Failed back surgery syndrome: casuistic and etiology

OBJECTIVE To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS From the 121 patients submitted to spine surgical intervention, 47 (38.8%) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7%) had presented FBSS; of the 83 with disc herniation, 31 (37.3%) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3%) had failure of the back surgery. CONCLUSION The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.

Dysembryoplastic neuroepithelial tumor originally diagnosed as astrocytoma and oligodendroglioma

UNLABELLED Dysembryoplastic neuroepithelial tumor (DNT), described in 1988 and introduced in the WHO classification in 1993, affects predominantly children or young adults causing intractable complex partial seizures. Since it is benign and treated with surgical resection, its recognition is important. It has similarities with low-grade gliomas and gangliogliomas, which may recur and become malignant. OBJECTIVES To investigate whether DNT was previously diagnosed as astrocytoma, oligodendroglioma, or ganglioglioma and to determine its frequency in a series of low-grade glial/glio-neuronal tumors. METHODS Clinical, radiological, and histological aspects of 58 tumors operated from 1978 to 2008, classified as astrocytomas (32, including 8 pilocytic), oligodendrogliomas (12), gangliogliomas (7), and DNT (7), were reviewed. RESULTS Four new DNT, one operated before 1993, previously classified as astrocytoma (3) and oligodendroglioma (1), were identified. One DNT diagnosed in 2002 was classified once more as angiocentric glioma. Therefore, 10 DNT (17.2%) were identified. CONCLUSIONS Clinical-radiological and histopathological correlations have contributed to diagnose the DNT.

Cranio-orbital approach for the paraclinoidal and anterior communicating aneurysms

Aneurysms arising at the proximal intracranial carotid artery (between cavernous sinus and posterior communicating artery) and at the anterior communicating complex may present with technical difficulties regarding appropriate access without excessive brain retraction. In a series of 15 patients the authors show the use of the cranio-orbital approach, formerly designed in the access of skull base tumors, for these subgroups of aneurysms. They discuss the advantages of a basal avenue in minimizing brain retraction, better anatomical orientation, obviation of tissue ressection and easier extra-dural bone removal. It was not identified any complication due to the described approach.

Cistos de bolsa de Rathke: diagnóstico e tratamento

We studied retrospectively a series of four patients with Rathke pouch cysts and pointed out to their clinical presentation and treatment. They all occurred with female patients. Predominant symptoms were amenorrhea, headache and visual disorders. We present a revision of the literature concerning various series of Rathkes pouch cysts. We conclude that surgery is the best therapeutical procedure and transsphenoidal approach is the best surgical technique.

Apoplexia hipofisária intradenomatosa

The authors review the literature on intra-adenomatous pituitary apoplexy with special emphasis on pathophysiology, diagnosis and therapeutic approach. They present five cases, from a series of 86 patients with pituitary tumors, that developed this syndrome. The patients were diagnosed and followed by the Neurosurgery and Endocrinology Services of Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Diagnosis was confirmed by CT-Scan and MRI in all cases , and the treatment of choice was surgical. Conclusions point to the diagnostic difficulties and the urgency of treatment in this clincal setting.

Acromegalia: aspectos diagnósticos e terapêuticos: análise de 18 casos

Os autores fizeram estudo retrospectivo de 18 pacientes com acromegalia, que foram diagnosticados, tratados e acompanhados pelos Servicos de Endocrinologia e Neurocirurgia do Hospital Universitario Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, no periodo de 1979 a 1985. A media de idade dos pacientes foi 43,2 anos (variacao entre 15 e 63), as queixas clinicas iniciais se deveram principalmente as alteracoes somaticas (83,33%), em 50% dos casos tivemos manifestacoes secundarias a compressao tumoral e em 53,33% havia alteracoes neuro-oftalmologicas. A comprovacao de hipersecrecao de hormonio de crescimento foi feita por dosagens hormonais basais e por testes dinâmicos. A avaliacao neuro-radiologica evidenciou expansao suprasselar em 61,11% dos casos e em 100% dos casos o acesso cirurgico foi por via transesfenoidal. O objetivo principal deste estudo foi o de estabelecer criterios para o diagnostico, discutir a conduta terapeutica e avaliar os resultados obtidos, comparando-os com outras series da literatura.

Traumatic lesions of internal saphenous nerve and branches

OBJECTIVE To show a rare lesion that sometimes simulates vascular disorder of the lower extremities. METHOD Three patients were operated and the follow-up period was eight months, the surgical technique was neurotomy of the infrapatellar and descendent branches. RESULTS In two cases there were almost total pain resolution, and in other case improvement only. CONCLUSION Surgical treatment yields good results in this type of internal saphenous nerve lesion, and could be useful as an alternative to conservative treatment.

Alteração da função hipofisária associada a mucocele gigante

This paper reports the case of a patient with a giant mucocele of the sphenoidal sinus, which presented like an intracranial mass, invading the sella and leading to pituitary dysfunction with somatotrophic and corticotrophic deficit. A literature search reveals no other reports of such cases. Thus, we discuss some reported cases of intracranial masses associated with mucoceles and the reversibility of the pituitary function after decompressive surgery. (Arq Bras Endocrinol Metab 2000; 44/6: 528-31)

Complicações das cirurgias hipofisárias: análise de 120 cirurgias no HUCFF-UFRJ

We evaluated 120 pituitary operations performed at Hospital Universitario Clementino Fraga Filho of the Universidade Federal do Rio de Janeiro from 1979 to July 1998 with the aim of analysing the immediate post operative morbidity and mortality. The ages ranged from 15 to 70 years and the clinical diagnoses were: nonsecreting adenomas, 46 (38.34%); acromegaly, 30 (25%); prolactinomas, 29 (24.16%) and Cushings disease 15 (12.5%). The main endocrine complications were: panhypopituitarism, 16 (13.34%); diabetes insipidus, 15 (12.5%) and adrenocortical insufficiency, 4 (3.34%). Neurological complications: infection, 13 (10.84%); and cerebrospinal fluid leakage, 6 (5%). Two patients died. Our results agree with those of the international literature. We identified a progressive decrease of morbidity and mortality due to surgeons skill increase and to the uniformity of the clinical team which managed those patients.We evaluated 120 pituitary operations performed at Hospital Universitario Clementino Fraga Filho of the Universidade Federal do Rio de Janeiro from 1979 to July 1998 with the aim of analysing the immediate post operative morbidity and mortality. The ages ranged from 15 to 70 years and the clinical diagnoses were: nonsecreting adenomas, 46 (38,34%); acromegaly, 30 (25%); prolactinomas, 29 (24,16%) and Cushing`s disease 15 (12,5%). The main endocrine complications were : panhypopituitarism, 16 (13,34%); diabetes insipidus,15 (12,5%) and adrenocortical insufficiency, 4 (3,34%). Neurological complications: infection, 13 (10,84%); and cerebrospinal fluid leakage, 6 (5%). Two patients died. Our results agree with those of the international literature. We identified a progressive decrease of morbidity and mortality due to surgeons skill increase and to the uniformity of the clinical team which managed those patients.