Italo Capraro Suriano

Familial trigeminal neuralgia

The authors present the cases of four brothers and sisters, two women and two men, who had trigeminal neuralgia, with the onset of pain occurring between the ages of 24 and 31 years. Three of them were treated surgically. A review of the literature reveals that familial trigeminal neuralgia is a very rare condition.

Cervical epidural haematoma with clivus fracture: case report

Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.

Neuroendoscopic surgery for unilateral hydrocephalus due to inflammatory obstruction of the Monro foramen

OBJECTIVE Unilateral hydrocephalus (UH) is characterized by enlargement of just one lateral ventricle. In this paper, the authors will demonstrate their experiences in the neuroendoscopic management of this uncommon type of hydrocephalus. METHOD The authors retrospectively reviewed a series of almost 800 neuroendoscopic procedures performed from September 1995 to July 2010 and selected seven adult patients with UH. Clinical and radiological charts were reviewed and analyzed. RESULTS Six patients had intraventricular neurocysticercosis and one patient had congenital stenosis of the foramen of Monro. Headaches were the most common symptom. A septostomy restored cerebrospinal fluid circulation. During follow-up period (65.5 months, range 3-109) no patient has presented clinical recurrence as well as no severe complications have been observed. CONCLUSION UH is a rare condition. A successful treatment can be accomplished through a neuroendoscopic approach avoiding the use of ventricular shunts.

Affective responses after different intensities of exercise in patients with traumatic brain injury

Background: Patients with traumatic brain injury (TBI) usually have mood and anxiety symptoms secondary to their brain injury. Exercise may be a cost-effective intervention for the regulation of the affective responses of this population. However, there are no studies evaluating the effects of exercise or the optimal intensity of exercise for this clinical group. Methods: Twelve male patients with moderate or severe TBI [mean age of 31.83 and SD of 9.53] and 12 age- and gender-matched healthy volunteers [mean age of 30.58 and SD of 9.53] participated in two sessions of exercise of high and moderate-intensity. Anxiety and mood was evaluated, and subjective assessment of experience pre- and post-exercise was assessed. A mixed between and within-subjects general linear model (GLM) analysis was conducted to compare groups [TBI, control] over condition [baseline, session 1, session 2] allowing for group by condition interaction to be determined. Planned comparisons were also conducted to test study hypotheses. Results: Although no group by condition interaction was observed, planned comparisons indicated that baseline differences between patients and controls in anxiety (Cohens’ d = 1.80), tension (d = 1.31), depression (d = 1.18), anger (d = 1.08), confusion (d = 1.70), psychological distress (d = 1.28), and physical symptoms (d = 1.42) disappear after one session of exercise, independently of the intensity of exercise. Conclusion: A single-section of exercise, regardless of exercise intensity, had a positive effect on the affective responses of patients with TBI both by increasing positive valence feelings and decreasing negative ones. Exercise can be an easily accessible intervention that may alleviate depressive symptoms related to brain injury.

Antenatal management of fetal neurosurgical diseases

The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.

Hemorrhagic onset of spinal angiolipoma

Spinal angiolipomas are rare benign tumors that generally induce slow progressive cord compression. Here, the authors describe a case of sudden-onset palsy of the lower extremities caused by hemorrhagic spinal angiolipoma. An emergent laminectomy was performed to achieve total lesion removal. Follow-up examinations indicated neurological improvement and the absence of recurrence.

Avaliação eletrofisiológica da audição em indivíduos após traumatismo cranioencefálico

OBJETIVO: caracterizar o potencial evocado auditivo de tronco encefalico e de longa latencia em pacientes pos traumatismo cranioencefalico, comparando-os com individuos normais. METODO: estudo clinico transversal realizado com 20 individuos audiologicamente normais divididos em dois grupos pareados por idade e sexo: a) 10 individuos que sofreram traumatismo cranioencefalico (grupo pesquisa); b) 10 individuos sem qualquer tipo de alteracao neurologica (grupo controle). Foram submetidos a avaliacao audiologica basica, ao potencial evocado auditivo de tronco encefalico e ao potencial evocado auditivo de longa latencia (P300). RESULTADOS: observou-se no potencial evocado auditivo de tronco encefalico, latencias absolutas das ondas I, III e V e intervalo interpico I-III mais prolongados no grupo pesquisa do que no grupo controle, sendo estatisticamente significante para as latencias absolutas das ondas I e III a direita e para a onda III e intervalo interpico I-III a esquerda. A amplitude das ondas I, III e V na orelha direita e das ondas III e V na orelha esquerda foram maiores no grupo controle. Em relacao ao P300, o grupo pesquisa apresentou maior latencia e menor amplitude em ambas as orelhas, sem significância estatistica, quando comparado ao grupo controle. CONCLUSAO: individuos que sofreram traumatismo cranioencefalico apresentam alteracoes no potencial evocado auditivo de tronco encefalico e nao apresentam diferencas significantes no potencial evocado auditivo de longa latencia (P300) quando comparados a individuos sem lesoes cerebrais.

Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study

Describe outcomes of open fetal surgery for myelomeningocele (MMC) repair in two Brazilian hospitals and the impact of surgical experience on outcome.

Idiopathic Intracranial Hypertension Associated with Symptomatic Perineural Cysts: Presentation of 2 Cases

OBJECTIVES Idiopathic intracranial hypertension refers to cases of intracranial hypertension and normal brain parenchyma without ventriculomegaly or any kind of mass lesion. Perineural cysts are cerebrospinal fluid-filled cysts that usually arise from nerve roots near the dorsal ganglia. Often asymptomatic, they rarely cause mass effect symptoms. The association of these conditions is discussed herein. METHODS We describe 2 patients with idiopathic intracranial hypertension and symptomatic sacral perineural cysts. In both cases the treatment of idiopathic intracranial hypertension ameliorated the sacral perineural cyst symptoms, and in 1 case we observed shrinking of the sacral perineural cysts. RESULTS On the basis of this review, it is impossible to conclude whether there is an association between idiopathic intracranial hypertension and symptomatic perineural cysts. However, as an initial observation, this report can reveal a possible association. CONCLUSIONS In some instances, idiopathic intracranial hypertension can be associated with symptomatic sacral perineural cysts. In this clinical scenario, the treatment of idiopathic intracranial hypertension may improve perineural cyst symptoms.

Behavioral and electrophysiological auditory processing measures in traumatic brain injury after acoustically controlled auditory training: a long-term study

ABSTRACT Objective To investigate the long-term efficacy of acoustically controlled auditory training in adults after tarumatic brain injury. Methods A total of six audioogically normal individuals aged between 20 and 37 years were studied. They suffered severe traumatic brain injury with diffuse axional lesion and underwent an acoustically controlled auditory training program approximately one year before. The results obtained in the behavioral and electrophysiological evaluation of auditory processing immediately after acoustically controlled auditory training were compared to reassessment findings, one year later. Results Quantitative analysis of auditory brainsteim response showed increased absolute latency of all waves and interpeak intervals, bilaterraly, when comparing both evaluations. Moreover, increased amplitude of all waves, and the wave V amplitude was statistically significant for the right ear, and wave III for the left ear. As to P3, decreased latency and increased amplitude were found for both ears in reassessment. The previous and current behavioral assessment showed similar results, except for the staggered spondaic words in the left ear and the amount of errors on the dichotic consonant-vowel test. Conclusion The acoustically controlled auditory training was effective in the long run, since better latency and amplitude results were observed in the electrophysiological evaluation, in addition to stability of behavioral measures after one-year training.