J. Francisco Salomão

Malformação de Chiari do tipo II sintomática

The Chiari type II malformation is the leading cause of death in infants with myelomeningocele. The authors report 17 cases of symptomatic Chiari type II malformation occurring in two distinct age dependent population. In Group I, 13 neonates and infants in the first year of life presented with cranial nerve and brain stem dysfunction characterized by vocal cord paralysis, apnea, dysphagia and laryngeal stridor. In Group II, 4 patients developed signs and symptoms after the first year of life. In this group, the presentation was more insidious and included neck pain and cerebellar manifestations. The surgical treatment consisted initially in shunt implantation or revision and when there was no improvement, posterior fossa decompression was performed. The response to the surgical treatment differed considerably between the two groups: older patients improved promptly after surgery and there was no casualties; in newborn and infants, especially those under 6 months of age, the mortality rate was 46.1%. The authors stress that prompt diagnosis and surgical intervention should be performed in order to produce a favorable outcome.

Esquistossomose medular: forma tumoral. Relato de um caso

Os autores relatam o caso de um jovem procedente de area endemica e que apresentou quadro de compressao medular por um granuloma esquistos-somotico. A lesao encontrava-se localizada ao nivel do cone medular e epicone, sendo parcialmente removida. Discutem as caracteristicas clinicas e patologicas da mielopatia esquistossomotica, com enfase especial a forma tumoral da parasitose. Discute-se tambem a frequencia do acometimento medular, admitindo-se ser a doenca bem mais frequente do que se supoe. Revisao da literatura pertinente e realizada.A case of schistosomiasis of the spinal cord is presented. A 16 years old boy developed a progressive spinal cord compression syndrome suggesting an intramedullary tumor. At the operation a granulomatous mass of the conus and epiconus was found and partially resected. The histopathological examination showed a granulomatous reaction surrounding Schistosoma mansoni eggs. The authors review the various aspects of spinal cord schistosomiasis, particularly the tumoral or granulomatous form. A comprehensive review of the literature is made.

Hematoma subdural crônico como complicação de derivações ventrículo-peritoneais

Os autores relatam sua experiencia com 9 casos de derivacao ventriculo-peritoneal que desenvolveram hematoma subdural cronico como complicacao do procedimento. Tres pacientes eram criancas, dois eram adultos com estenose do aqueduto de Sylvius e quatro, com hidrocefalia normobarica. Nos casos de hidrocefalia cronica, os hematomas foram drenados por orificio de trepano associado a oclusao temporaria do cateter distal da derivacao. Em dois pacientes, extremamente dependentes de valvula, optou-se por derivacao subduro--peritoneal e manutencao da derivacao ventriculo peritoneal original, observando-se gradual e completa reabsorcao da lesao em tomografias computadorizadas de crânio seriadas. Em dois casos foi necessario trocar o sistema de drenagem por outro de pressao mais elevada. Em um caso procedeu-se a craniotomia e exerese da capsula do hematoma para tratar colecoes recidivantes. Com excecao de um paciente falecido em decorrencia de complicacoes infecciosas, todos retornaram ao estado anterior ao desenvolvimento do hematoma.

Angioma cavernoso intracraniano

Clinical, radiological and histopathological features of eight cases of symptomatic cavernous angioma are presented. Five patients were being evaluated for seizure, two for mass lesions and one for intracranial hemorrhage. CT and/or MRI detected the lesion in all cases, but there is not a characteristic image for cavernous angioma. Good results were obtained by microsurgical approach to these malformations in seven patients with only one patient suffering a worsening of neurological status after surgery.

Hematoma subdural crônico tratamento cirúrgico e resultados em 96 pacientes operados

Ninety-six patients with chronic subdural hematoma were treated surgically and their clinical features presented in detail. Carotid angiography gave the correct diagnosis in all patients. CT scan was performed in 38 and was diagnostic in 92.1% of the cases. The clots were removed through burr-holes or small trephines: 78 (81.3%) patients were cured, 6 (6.2%) had permanent disabilities and 12 (12.5%) died. Operative mortality was related to the degree of neurological impairment, advanced age and systemic diseases. Neurologic sequelae were mostly related to reoperations due to recurrence of the hematoma and bilateral clots, as well. Low intracranial pressure syndrome with brain collapse was seen in 3 cases and treated with lumbar injection of saline solution. The delay in diagnosis and operation as cause of bad outcome is stressed.Ninety-six patients with chronic subdural hematoma were treated surgically and their clinical features presented in detail. Carotid angiography gave the correct diagnosis in all patients. CT scan was performed in 38 and was diagnostic in 92.1% of the cases. The clots were removed through burr-holes or small trephines: 78 (81.3%) patients were cured, 6 (6.2%) had permanent disabilities and 12 (12.5%) died. Operative mortality was related to the degree of neurological impairment, advanced age and systemic diseases. Neurologic sequelae were mostly related to reoperations due to recurrence of the hematoma and bilateral clots, as well. Low intracranial pressure syndrome with brain colapse was seen in 3 cases and treated with lumbar injection of saline solution. The delay in diagnosis and operation as cause of bad outcome is stressed.

Positive reaction for cysticercosis and multicentric anaplastic oligoastrocytoma

IntroductionAn unusual case of positive immunological testing for cysticercosis in the cystic fluid obtained from an anaplastic oligoastrocytoma is presented.Case reportA 15-year-old boy was admitted with multiple brain lesions. The biggest was a cyst with a mural node and neurocysticercosis was suspected. In order to relieve intracranial pressure, the cyst was punctured and the immunological testing for cysticercosis was positive, reinforcing the clinical suspicion and leading to a clinical trial with albendazole and steroids. As the patient deteriorated the cystic lesion was removed and the diagnosis of anaplastic oligoastrocytoma was established. A second lesion was eventually approached and the histopathological diagnosis of both specimens concurred.DiscussionAlthough some authors believe that chronic inflammatory changes following neurocysticercosis could induce the formation of brain tumors, this association may be a mere coincidence. In our case no clinical evidence of a prior infestation by Cysticercus was found. In fact, an exhaustive examination of the specimens did not reveal any areas of inflammatory reaction. We believe that the similarity of the glioma and cysticercosis antigens may be the cause of the positive reactions in the cystic fluid.

Acompanhamento ambulatorial de pacientes com mielomeningocele em um hospital pediátrico

Myelomeningocele is the most common congenital malformation of the nervous system and despite its complexity and involvement of multiple organs is compatible with long survival. The peculiar characteristics of this malformation expose myelomeningocele patients to acute and chronic care problems with effects in quality of survival. In order to evaluate the quality of the follow-up of spina bifida patients in a pediatric hospital, the authors examined 54 patients attending the neurosurgical outpatient unity of a pediatric hospital. The lack of a multidisciplinary spina bifida clinic in Rio de Janeiro forced the patients to pursuit for complimentary medical and paramedical care outside the hospital with significant effects in the quality of survival. In consequence, only 25% of the patients were able to walk and community ambulation was nearly absent. Only 66.6% had a regular rehabilitation program and nearly 50% had routine orthopedics consultations. Almost half of the patients had no urological referral at all and 75% were incontinent, with recurrent urinary infections ranging 72.2%. The rates of neurosurgical complications were similar to those observed in the literature. We concluded that the quality of survival of patients with neural tube defects is strongly influenced by the adverse socio-economical conditions and the lack of a spina bifida multidisciplinary clinic.

Hematoma primário do tronco cerebral: consideraçöes a propósito de um caso

Os autores relatam o caso de hematoma primario do tronco cerebral em uma paciente de 48 anos, normotensa. A evolucao arrastada do processo sugeria tumor de tronco, sendo o diagnostico de hematoma estabelecido por exploracao cirurgica. Discute-se a origem desses hematomas, consequentes a ruptura de angiomas cripticos ou microangiomas, bem como o diagnostico diferencial com hemorragias hipertensivas do tronco cerebral, patologia de prognostico sombrio, na maioria das vezes sem indicacao cirurgica. Dao enfase a necessidade da sistematica exploracao das lesoes expansivas do tronco cerebral, principalmente em se tratando de individuos jovens e normotensos.

The nature of double concomitant myxopapillary ependymoma: report of a case

Myxopapillary ependymomas are almost exclusively seen at the conus medullaris/filum terminale/cauda equina region, usually as solitary space-occupying lesions. The authors report the case of a 14-year-old boy with double concomitant myxopapillary ependymoma, proximal and caudal on the filum terminale in which a totally gross removal was achieved in two stages. This presentation is rare and, so far, we have known just three similar cases that were previously reported in children. The true nature of these lesions is controversial, and while some argue that they are related to metastatic seeding, others consider them independent lesions developing synchronously. A review on dissemination of spinal myxopapillary ependymomas was done.

Metástase craniana de adenocarcinoma de próstata simulando meningioma parassagital

The authors report the case of a 69 year-old man in whom X-Ray, CT and angiography findings typical for a parietal parasagital meningioma were caused by cranial metastasis from prostatic adenocarcinoma. The authors stress the importance of the correct interpretation of the clinical features in order to achieve a correct diagnosis.The authors report the case of a 69 year-old man in whom X-Ray, CT and angiography findings typical for a parietal parasagittal meningioma were caused by cranial metastasis from prostatic adenocarcinoma. The authors stress the importance of the correct interpretation of the clinical features in order to achieve a correct diagnosis.