Hildo Azevedo-Filho

Language, Memory, and Verbal Fluency Changes in Patients with Aneurysmal Subarachnoid Hemorrhage: Results of a Preoperative Investigation

OBJECTIVE To detect changes in speech, verbal fluency, and memory in patients with subarachnoid hemorrhage (SAH) caused by ruptured aneurysms and to analyze the results before surgical or embolization procedure. METHODS During the period May 2007 to November 2009, 193 patients with anterior aneurysmal SAH admitted to the Department of Neurosurgery, Hospital da Restauração, Recife, Brazil, were tested for speech, verbal fluency, and memory disturbances after the first week of bleeding and compared with a control group with similar demographics. RESULTS Patients with aneurysmal SAH differed significantly from the control group in language, verbal fluency, and memory functions before clipping or coiling procedures. There were differences in cognitive performance between patients with different aneurysm sites. CONCLUSIONS It was possible to characterize the cognitive impairments of each area affected early on in the preoperative period, confirming the assumptions that the aneurysm site could be a determining factor of cognitive impairment.

PENETRATING SCREWDRIVER WOUND TO THE HEAD

Dr. Hildo Azevedo-Filho – Rua Apipucos 317 / 601 52071-000 Recife PE Brasil. E-mail: azevedoh@uol.com.br, patri_boz@yahoo.fr Penetrating screwdriver wounds to the head (PSWH) are very unusual in neurosurgical practice and are rarely described in the literature. A screwdriver being a tool is rarely used as a weapon. The majority of cases are extracted from medical legal situations or are found among psychiatric patients. However, screwdrivers, because of their rigid structure and narrow tip, may forcefully penetrate the cranial bone and cause severe injuries within the brain substance or to the vascular bed. Intracranial injuries due to PSWH without causing functional deficits as in the present case have not yet been reported in the literature.

Ganglioglioma: comparison with other low-grade brain tumors

METHOD Forty-two patients with low-grade brain tumor and refractory epilepsy were studied. The mean age was 22.3 years. They were divided into two groups: Group A, patients with ganglioglioma (n=19) and group B, patients with other low-grade tumors (n=23) (14 astrocytoma, 6 oligodendroglioma, 2 dysembryoplastic neuroepithelial tumor, and 1 xanthoastrocytoma). RESULTS Age at seizures onset was 7 years or less in 73% of the patients in group A and in 30.4% of the patients in group B (p=0.045). Complex partial occurred frequently in group A and B (94.7% versus 82%, respectively). Seizures frequency was higher in group B (p=0.002). Computerized tomography (CT) was normal in 36.8% of group A patients and abnormal in all group B patients. Magnetic resonance imaging (MRI) was abnormal in all patients. Surgical removal was complete in 89.5% of the patients in group A and in 78.2% of the patients in group B. CONCLUSION The association of refractory epilepsy and complex partial seizures, at a relatively low frequency, in young patients potentially normal CT and a MRI hypointense temporal lobe lesion in T1-weighed slices were habitual image findings in ganglioglioma, rather than other low-grade tumor.

Cognitive Changes in Patients with Aneurysmal Subarachnoid Hemorrhage Before and Early Posttreatment: Differences Between Surgical and Endovascular

INTRODUCTION The main purpose of occluding a ruptured aneurysm is preventing rebleeding, which may be fatal. Microsurgical or endovascular treatments are the main approaches adopted to prevent new bleeding. Among patients presenting with aneurysmal subarachnoid hemorrhage, about 50% had permanent injuries. Cognitive changes are one of the main morbidities from that illness. The type of treatment for the aneurysm (clipping or coil embolization) can also contribute to the genesis of those complications. OBJECTIVE Assessing language and verbal memory changes resulting from the aneurysmal lesion occlusion procedures, as well as establish which treatment offers less cognitive sequels. METHOD This investigation was carried out in Hospital da Restauraão, Recife-PE, from May 2007 to November 2009. One hundred fifty-one patients were divided into two groups, surgical and endovascular, and had their language, fluency, and verbal memory functions tested at two time points, pre- and postoperation. The results of the initial assessment and of the one occurring after the treatment were compared, between both groups and to each other. RESULTS AND CONCLUSIONS One hundred fifty-one patients were assessed, distributed as 122 surgical and 29 coil embolized. The performances in both groups did not differ in the initial assessment. However, endovascular treatment does not show additional cognitive impairment and had a better performance in language and verbal memory, compared with patients submitted to surgical treatment in an early postoperative period.

Aplasia cutis congenita of the scalp

Dr. João Paulo Cavalcante de Almeida – Rua Paulo Morais 130 60175-175 Fortaleza CE Brasil. E-mail: jpaulocavalcante@yahoo.com.br Aplasia cutis congenita (ACC) is an uncommon disorder that presents as a focal defect of the skin at birth, frequently involving the midline over the skull vertex (70%), but it may affect any region of the body. Since 1767, about 500 cases have been reported in medical literature. The skin lesions are quite variable, ranging from absence of skin to a complete lack of subcutaneous tissue, bone or even the dura. The ACC can be isolated or associated with other malformations in a genetic syndrome, like Adams-Oliver syndrome. There are no exact etiologies for ACC, but some conditions have been associated to it like intrauterine vascular ischemia, amniotic adherences and viral infections. Teratogenic medications like metimazole and misoprostol have been proposed as causes of ACC. There is no consensus about the ideal treatment for the ACC, which is probably related to the low prevalence and incidence of this condition. The treatment options are conservative management or surgical correction, based on the clinical picture presented by each patient.

Epidemiological aspects in neuroschistosomiasis

UNLABELLED The urbanization process of schistosomiasis has been described in the literature. The present report shows and discusses some epidemiological aspects of neuroschistosomiasis that emphasizes this trend. METHOD The study was done between July, 2005 and June, 2006, and consisted of spinal cord schistosomiasis carriers at the moment of diagnosis. These patients were evaluated whatever the origin and period of the year that they developed the symptoms. RESULTS A total of 13 patients were evaluated. Ten cases (76.92%) came from the Metropolitan Region of Recife, while the other zones (Zona da Mata, Agreste e Sertão) contributed with just three cases (23.07%). October, November and December (post rainy period) concentrated the majority of the cases (61.54%). CONCLUSION The high spatial and temporal concentration of cases in relation to a recent endemic area for Schistosomiasis suggests that the immunological status may be an important factor for installation of Sschistosomal myelitis.

Endovascular treatment of traumatic carotid cavernous fistula with balloon-assisted sinus coiling. A technical description and initial results.

This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail. Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a “U-turn” maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon. Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months). An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe.

Neuroendoscopic treatment of quadrigeminal arachnoid cyst in a two-year-old child.

Professor and Chairman, Department of Neurosurgery, Hospital da Restauracao, Recife PE, Brazil.Received 29 May 2008, received in final form 21 July 2008. Accepted 28 July 2008.Dr. Joao Paulo Cavalcante de Almeida – Rua Paulo Morais 130 - 60175-175 Fortaleza CE - Brasil. E-mail: jpaulocavalcante@yahoo.com.br

Trigone ventricular meningiomas: Is it possible to achieve good results even in the absence of high tech tools?

Background: Intraventricular meningiomas constitute 2% of intracranial meningiomas, representing a challenging disease for neurosurgeons; we report our experience through a case series, emphasizing surgical approaches and results. Methods: Between 2009 and 2012, four patients underwent microsurgical resection in our department. Clinical and imaging findings, surgical approaches, outcomes, and follow-up were analyzed. Results: Four patients (three females and one male) were included and the signs of intracranial hypertension were the main clinical presentation in all cases. The parietal approach through intraparietal sulcus was performed in 3 cases and parieto-occipital interhemispheric surgical route in 1 case. Gross total resection was achieved in all the patients without additional deficits and without the aid of neuronavigation, intraoperative monitoring, and intraoperative magnetic resonance imaging. Conclusion: Gross total resection is the gold standard treatment for such tumors and the intraparietal sulcus approach is an excellent choice for most of the cases. Careful anatomical knowledge contributes to a safer procedure even in the absence of high tech equipment assistance.

Dissecting anterior inferior cerebellar artery aneurysm treated by endovascular route: report of three cases and review.

ANGIORAD, Interventional Radiology, Hospital Santa Joana, Recife PE, Brazil: Interventional Radiologist, Scientific Director of ANGIORAD; Neurosurgeon, Hospital da Restauração, Recife PE, Brazil; Chaiman of the Department of Neurosurgery, Hospital da Restauração, Recife PE, Brazil; Resident of Neurosurgery, Hospital da Restauração, Recife PE, Brazil; Resident of Interventional Radiology, ANGIORAD; Interventional Radiologist, Chairman of ANGIORAD. Among the major arteries of the posterior fossa, the anterior inferior cerebellar artery (AICA) is the least likely to harbor an aneurysm, being a very rare pathology. Only two AICA aneurysms were found in 7,933 lesions. In the presence of a high flow lesion, aneurysms tend to occur more commonly in the feeding arteries. These flow-related aneurysms in the posterior fossa can be found mainly associated with arteriovenous malformations (AVM) or hemangioblastomas, which represents the majority of AICA aneurysms reported. For eight years, 1,450 aneurysms were seen in a single-center, with only two AICA aneurysms, both flow-related (AVM). Aside from flow-related aneurysms, almost all distal AICA aneurysms are dissecting aneurysms, usually presenting in otherwise healthy adults. Again the AICA is the least likely to present an isolated dissection among the major arteries. We report three cases of “spontaneous” AICA dissection aneurysms.