José Alberto Landeiro

Transoral approach to the craniovertebral junction

The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.

Long-term Outcome in Patients with Recurrent Malignant Glioma Treated with Perillyl Alcohol Inhalation

As you begin the journey to understand the Emotional Core Therapy process please keep in mind the scientific method. The scientific method is a process for creating models of the natural world that can be verified experimentally. The scientific method requires making observations, recording data, and analyzing data in a form that can be duplicated by other scientists. The subject of a scientific experiment has to be observable and reproducible. Observations may be made with the unaided eye or any other apparatus suitable for detecting the desired phenomenon. The apparatus for making a scientific observation has to be comprised of well-known scientific principles. The scientific method requires that theories be testable. If a theory cannot be tested, it cannot be a scientific theory. The scientific method requires and relies on direct evidence. This means evidence that can be directly observed and tested. Scientific experiments are designed to be repeated by other scientists and to demonstrate unequivocally the point they are trying to prove by controlling all the factors that could influence the results. Source (Scientificpsychic.com/Scientific Method) Here are the four steps to the scientific method and the Emotional Core Therapy process. 1). Observation made both visually and with scientific equipment Stress affects both the mind and body. There exists a cause and effect relationship with stress. Oftentimes this stress can be uncomfortable for humans. 2) Formulation of a hypothesis to explain the phenomenon in the form of a causal mechanism/method/approach. Many psychology methods (REBT, CBT, ACT, DBT, etc.), religious approaches (Buddhism, 12 steps, etc.), and educational programs (Smart Recovery) have attempted to fully and completely explain via a model, how this cause and effect relationship with stress occurs. Up until this point in time, we have not had a model in the world that can successfully depict how this stress occurs each and every time. To their credit, many of these methods partially work and have contributed greatly to humanity. See Wiki.com for information on all the psychology methods and techniques mentioned in this book. With the invention/discovery of Emotional Core Therapy (ECT) we now have a psychology method that accurately can depict this causal relationship between stress and humans through my Eight Step Emotional Core Therapy Flowchart. With ECT, we now have a psychology approach that identifies and treats the root cause of psychological stress. The root cause is the temporary arousal of one of the four true emotions (joy, grief, fear, and relief). ECT also shares and borrows many psychological techniques from the aforementionedMethods: Adult male Wistar rats (225-275 g) were selected randomly and divided into 10 groups. All groups underwent stereotaxic surgery and in order to induce dependency, morphine was administered subcutaneously) Sc) at an interval of 12 hours for nine continuous days. On the ninth day of the experiment, animals received vehicle or CBX (100, 400, 600 μg/10μl/ rat, ICV) or MFQ (50, 100 and 200 μg/10μl/rat, ICV) after the last saline or morphine (Sc) injection. Morphine withdrawal symptoms were precipitated by naloxone hydrochloride 10 min after the treatments. The withdrawal signs including: jumping, rearing, genital grooming, abdomen writhing, wet dog shake and stool weight, were recorded for 60 minutes.D to the effect of thoracotomy on respiratory and circulatory systems, the anesthetic technique, one lung ventilation (OLV) is applied. With the consistent improvement and widespread application of double lumen endobronchial tube and novel endobronchial blockers, OLV is more popular for surgical performance. However, there are some issues of OLV, such as the dismatching of ventilation perfusion ratio, hypoxemia, SpO2 and increase of Pmax, which limited the use of OLV. Recently, many studies have been done in the advancement of safety of OLV and on the prevention and treatment of hypoxemia. This review briefly introduces the progress of OLV and discusses the function of OLV in anesthesia.BACKGROUND Treatment of patients with chronic conditions requiring hospitalization requires patient acceptance and cooperation and adoption of coping strategies. Inappropriate coping strategies such as substance abuse are concerning in the course of treatment. This study sought to explore the association of coping strategies with suicidal behavior in substance abusers and non substance abuser patients with chronic pulmonary diseases namely asthma and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS This comparative study was performed on 100 patients with asthma and COPD selected via convenience sampling. Subjects with and without substance abuse were separated into two groups of 50 patients each. Ways of Coping Questionnaire of Lazarus (WOCQ) and Suicide Behavior Questionnaire-Revised (SBQ-R) were completed by them. Five Persian speaking patients rated this questionnaire to be easily understandable in the pre-test stage. Cronbachs alpha was calculated to measure the internal consistency. RESULTS The mean (±standard deviation) age of participants was 40 (±14) years; 58% of individuals were men; 62% had chosen problem-focused coping. The most abused substances were cigarettes (78%) and opium (42%); 6% of substance abusers had thought about suicide five times or more in the past year; 5% of substance abusers had seriously attempted suicide. Tendency to commit suicide was greater in men, substance abusers and participants who had chosen emotion-focused coping strategies, based on a regression model. Average score of suicide tendency was significantly higher in substance abusers (B=2.196, P =0.007). CONCLUSION Chronic disease is a crisis and patients need to acquire appropriate coping strategies to deal with it, especially in substance abusers and suicidal patients. Precise recognition of coping strategies in chronic pulmonary patients with substance abuse is necessary via a team cooperation among psychiatrics, psychologists and an internal physician in hospitals because medical treatment alone is not sufficient in such cases.N oxide is a colorless and virtually odorless gas with a faint, sweet smell. It is a safe and effective tool used in dental clinics to reduce anxiety, produce analgesia, and cause the depression of the central nervous system (CNS), leading to the sensation of euphoria with little effect on the respiratory system. It also enhances effective communication between the patient and their healthcare provider. The decision to use nitrous oxide/oxygen must take into consideration the alternative behavioral guidance modalities, the patient’s dental needs, the effect on the quality of dental care, the patient’s emotional development, and the patient’s physical considerations.AIM This retrospective study aimed to evaluate the long-term response and toxicity of recurrent malignant glioma patients to inhalation chemotherapy with perillyl alcohol (POH). PATIENTS AND METHODS The cohort included 117 men and 81 women with primary glioblastoma multiforme (GBM; n=154), grade III astrocytoma (AA; n=26) and anaplastic oligodendroglioma (AO; n=5). POH inhalation schedule 4-times daily started with 66.7 mg/dose; 266 mg/day and escalated up to 133.4 mg/dose; 533.6 mg/day. Clinical toxicity and overall survival following treatment were compared with tumor size, topography, extent of peritumoral edema and histological classification. RESULTS Adhesion to the protocol was high (>95%), POH (533.6 mg/daily) occasionally caused nose soreness but rarely nosebleed. Tumor size, peritumoral edema and the oligodendroglial component influenced response to treatment. CONCLUSION After 4 years under exclusive POH treatment, 19% of patients still remain in clinical remission. Long-term POH inhalation chemotherapy is a safe and non-invasive strategy efficient for recurrent malignant glioma.

Malignant paraganglioma with vertebral metastasis: case report.

A paraganglioma is a rare tumor, composed of chromaffin cells, groups of cells associated to the autonomous system. When the tumor occurs in the adrenal gland, it is called pheochromocitoma. The malignant paraganglioma is a very rare presentation; it is diagnosed by local recurrence after total resection of the primary mass, or findings of distant metastases. We present a case report of a 29-year-old woman with cervico-brachial pain. In 1995 she underwent a carotid body tumor resection. Magnetic resonance imaging (MRI), plain X-rays and computerized tomography scan revealed multiple lesions in C5, T5 and T12. She underwent a surgical procedure to correct the cervical lesion. The histological and immunohistochemical assays revealed a malignant paraganglioma. She received adjuvant radiotherapy, showing clinical improvement after treatment, presenting no symptoms after one year. The therapeutic approach is based on the total resection of the tumor. The treatment of distant metastases can be made with adjuvant measures such as conventional radiotherapy, I 131-MIBG, or chemotherapy, especially in malignant pheochromocitomas.

Surgical management of cerebrospinal fluid rhinorrhea under endoscopic control

The surgical management of cerebrospinal fluid (CSF) rhinorrhea has changed after the introduction of functional endoscopic sinus surgery.The following three cases illustrate the repair of CSF leaks with the use of rigid endoscope. Two patients had the diagnosis and the site confirmed after intrathecal fluoresceine saline injection. The obliteration of the CSF was achieved with fat free, mucoperichondrial or mucoperiostal free grafts taken from middle or inferior turbinate and kept in place by fibrin glue. Primary closure was achieved in all patients. The repair of the CSF rhinorrhea by endonasal endoscopic surgery is safe, effective and is a valid alternative to the cranial approach.

Tuberculum sellae meningiomas: surgical considerations

We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.

Tectal plate tumors

Tectal plate is a rare location for a tumor. Many papers have described different types of pathology arising in that location including tumors, vascular lesions, inflammatory and infectious processes. In this paper we describe our experience in treating seven patients with tectal plate lesions, with different ages and types of pathology: five patients presented with low grade gliomas, one with lung cancer metastasis and the last presenting with a tectal plate cavernoma. Open surgery was performed in three cases (due to tumor enlargement or need for the exact diagnosis). In the other cases, the treatment of non-communicating hydrocephalus was the only treatment employed. The prognosis is of course dependent on the underlining pathology. In our series, except in the metastatic tumor case and the cavernoma, the other types of lesion consisted of low grade gliomas. These lesions represent a different type of brain stem tumor sharing a common good prognosis, with a benign behavior. We believe that tectal tumors must be managed case by case. When a patient presents with a benign lesions in the tectal region, treating the main symptom--hydrocephalus--should be the first attempt in management of these lesions.

INTERNAL STRUCTURE OF THE CEREBRAL HEMISPHERES An introduction of fiber dissection technique

The aim of this study is to introduce the fiber dissection technique and its importance in the comprehension of the three-dimensional intrinsic anatomy of the brain. A total of twenty brain hemispheres were dissected. Using Kinglers technique we demonstrated the intrinsic structures of the brain. The supra lateral aspect of the brain as well as the medial aspect were presented. The most important fiber systems were demonstrated. The use and comprehension of new neuroimaging techniques demand a better understanding of this fascinating anatomy. The knowledge acquired with this technique will improve our understanding of critical pathways of the central nervous system.

Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature.

The cavernous sinus (CS) has one of the most complex anatomical networks of the skull base and because of the diversity of its contents is involved in many pathological processes. Nevertheless, anatomical literature concerning the CS is still controversial, so a systematic literature review was performed to find out the microanatomy of the medial wall of the CS and its clinical importance on sellar pathologies. Experimental studies from English-language literature between 1996 and 2010 were identified in MEDLINE, LILACS, and Cochrane databases. After analysis, two tables were prepared exhibiting the major points of each article. Fourteen experimental studies were included in the tables. Four studies concluded that the medial wall of the CS is composed of a loose, fibrous structure, and the remaining ten presumed that the medial wall is formed by a dural layer that constitutes the lateral wall of the sella. The lack of definition standards and of methodological criteria led to variation in the results among different studies. Thus, this hindered results comparison, possibly explaining the different observations.

Peripheral primitive neuroectodermal tumor of the cervical spine

Background: Primitive neuroectodermal tumor (PNET) is a malignant neoplasm that generally arises from bone and soft tissues, with predilection for young adults. This neural crest origin tumors share biologic and histologic features with Ewings sarcoma (ES). Case Description: We present a case of a 22-year-old woman with history of severe progressive neck pain, without radiation, associated with paresthesia in the right arm, and palpable right posterior cervical mass. Neurological examination showed increased reflexes in all four limbs, bilateral Hoffmans sign, right Babinskis sign, and right hemi-hypoesthesia. Neuroimaging revealed a right posterior cervical lesion with heterogeneous contrast enhancement extending to the neural foramina of the atlas and axis. Patient underwent microsurgical removal of the lesion, and histopathological and immunohistochemical analysis confirmed the diagnosis of peripheral primitive PNET (pPNET). The patient had adjuvant treatment with radiotherapy and chemotherapy. After twelve months, neuroimaging showed no signs of tumor regrowth and the patient had no neurological deficits. However, three months later, the patient developed hydrocephalus and cerebrospinal fluid (CSF) was positive for neoplastic cells. No other treatment was administered and the patient died. Conclusion: pPNET is a rare malignant tumor with poor prognosis, although promising results with multimodal treatment-surgery, radiotherapy, and chemotherapy. Diagnosis requires immunohistochemical analysis, with identification of neuronal differentiation markers.

Dural arteriovenous fistula presenting as thalamic dementia

Chefe do Servico de Neurocirurgia do HFAG, Professor Adjunto da Disciplina de Neurocirurgia da Universidade Federal Fluminense, Brasil (UFF).Received 11 December 2007. Accepted 27 February 2008.Dra. Mariangela Barbi Goncalves – Rua Nina Rodrigues 72/602 - 22461-100 Rio de Janeiro RJ - Brasil. E-mail: goncalvesmb@gmail.com