Rafael Augusto Castro Santiago Brandão

Intracranial aneurysms in sickle cell patients: report of 2 cases and review of the literature.

BACKGROUND The sickle cell disease has different neurologic complications, including cerebral aneurysms. This disease may lead to endothelial damage, which favors the development of cerebral aneurysms. Only a few cases demonstrated by cerebral angiography or surgery have been reported in the English literature referring to cerebral aneurysms in sickle cell patients. CASE DESCRIPTION We report 2 patients with sickle cell disease whose cerebral aneurysms were successfully treated by open surgery. CONCLUSION Sickle cell patients have a high occurrence of multiple aneurysms, and a high prevalence of posterior circulation aneurysms. This must be interpreted with caution, and further studies are needed to confirm this association.

Early shunt complications in 46 children with hydrocephalus

OBJECTIVE To determine the causes of early shunt complications in 46 children with hydrocephalus. METHOD A retrospective study was conducted on 46 children submitted to ventriculoperitoneal shunt surgery between February 2005 and February 2007. RESULTS Thirteen (28%) patients presented complications, which were due to infection in 9 (69%) and to malfunction of the shunt system in 4 (31%).The mean number of surgical procedures performed on patients who presented complications was 2.8 per patient, with a total of 46 surgeries in this group. All patients with infectious complications were identified during their hospital stay. CONCLUSIONS Infection was the most common complication. The infection rate was proportional to the length of hospital stay. All patients with hydrocephalus due to tumors or myelomeningocele presented complications. A higher incidence of infections was observed in children older than 2 years.

Malignant meningioma with extracranial metastases

Assistant, Head and Neck Surgery Service, Santa Casa de Belo Horizonte, Belo Horizonte MG, Brazil.Received 10 November 2008, received in final form 19 May 2009. Accepted 13 June 2009.Dr. Baltazar Leao Reis – Avenida Francisco Sales 1813 / 102 - 30150-221 Belo Horizonte MG - Brasil. E-mail: baltazarleao@yahoo.com.br

Papillary tumor of the pineal region.

Tumors of the pineal region are rare in adulthood, accounting for approximately 1% of intracranial neoplasms in this age range. Papillary tumor of the pineal region (PTPR) was first described by Jouvet et al. in 2003. In 2007, PTPR was included by the World Health Organization as a distinct entity in their new classification of central nervous system tumors. We report a case of PTPR, and undertake a literature review of this rare neuroepithelial neoplasm. Patients with PTPR need long-term follow up, and new cases should be well documented so that we can gain a better understanding of this neoplasm.

Hemangioma primário do crânio

CORRECAO / CORRECTIONPrimary hemangioma of the skullB L Reis, G T C Carvalho, A A Sousa, W B Freitas, R A C SantiagoArq Neuropsiquiatr 2008;66:569-571O ultimo autor solicita a correcao de seu nome, para a forma certa Rafael Augusto Castro Santiago Brandao.A correcao esta feita, lembrando o Editor aos AA que a forma publicada foi aquela recebida no texto definitivo.Antonio Spina-Franca Editor

Efficacy and Safety of a Porcine Collagen Sponge for Cranial Neurosurgery: A Prospective Case-Control Study

OBJECTIVE The use of dural grafts is very useful when primary dural closure cannot be achieved. Our primary objective was to study the incidence of postoperative cerebrospinal fluid leak, including fistula and pseudomeningocele, and postoperative infection by comparing autologous material and a new collagen graft. MATERIALS AND METHODS A prospective nonrandomized study with a new collagen-based product derived from porcine cells (Peridry) was performed. It was used for dural replacement in 50 patients who underwent a variety of neurosurgical procedures requiring the use of a dural graft. These results were compared with a control group of 50 patients who were treated with autologous duraplasty material. The follow-up period was 3 months. RESULTS Postoperative overall cerebrospinal fluid fistula occurred in 6% of both groups. No patient in the collagen group developed any sort of infection. One patient in the control developed osteomyelitis in the bone flap. CONCLUSION The new collagen-based product derived from porcine cells (Peridry), compared with an autologous tissue, is safe, effective, easy to use, as well as time saving in cranial neurosurgery.

Pseudotumoral Form of Cerebral Schistosomiasis Mansoni

OBJECTIVE To describe published cases of cerebral mansoni schistosomiasis and three others and discuss the diagnosis and treatment of cerebral pseudotumoral schistosomiasis. CASE DESCRIPTIONS In case 1, a 20-year-old man presented with occipital headache, intense dizziness, visual alterations, nausea, decreased appetite, and asthenia. Cranial computed tomography (CT) revealed an expansive cerebellar lesion in the right hemisphere with no contrast enhancement. The patient had complete resection of the lesion. Anatomicopathological examination revealed a schistosomal granuloma. In case 2, a 22-year-old man presented with generalized tonic-clonic seizure. Cranial CT and magnetic resonance imaging (MRI) revealed an expansive bilateral middle frontal lesion, with contrast uptake close to the cingulate gyrus and corpus callosum. The patient underwent left frontal craniotomy, and an interhemispheric approach was used to resect part of the lesion. In case 3, a 32-year-old man presented with generalized tonic-clonic seizures. Cranial CT showed a hyperdense intense intracranial expansive lesion that presented contrast uptake in the left temporal region. The patient had complete resection of the lesion. CONCLUSIONS A surgical approach with lesion resection or stereotaxic biopsy is warranted to determine the diagnosis definitively. Antiparasitic drugs must be administered to complete treatment.

Glioblastoma multiforme in childhood: a case report.

Among high-grade gliomas, childhood glioblastoma multiforme (GBM) is particularly challenging in terms of therapeutic treatment.1-5 Cerebral tumors are the most frequent childhood solid neoplastic disorders and are the primary cancer-related cause of death among children.1,3 Gliomas constitute approximately 60% of all cerebral tumors, and approximately half of them are considered to be high-grade malignant tumors.1 The prognosis for recovery is conservative, and 5-year survival rates range from 5% to 15%.2,6,7 This case report documents a GBM that was located deep in the right cerebral hemisphere of a 9-year-old child. Because this is a rare illness for a patient of this age, we also provide a brief literature review to supplement this case report.

Conservative treatment of large spontaneous spinal extradural hematoma

Spontaneous epidural hematoma (SEH) is a rare condition, which, in most cases, requires surgical treatment due to neuro-logical worsening that occurs within the first 12 hours after the ictus. We describe the surgical indication for SEH and show that conservative treatment might be a treatment option in selected cases, presenting good outcomes.CaseA 47-year-old woman had deep venous thrombosis and was using an oral antico-agulant. On July 28, 2007, the patient de-veloped sudden signs and symptoms of in-tense back pain, followed by rapidly pro-gressing paraparesis associated with uri-nary retention 12 hours later. The patient thus sought a hospital emergency service.On July 30, 2007, magnetic resonance (MR) imaging of the cervicothoracic spine showed a large anterior extradural hema-toma extending from C7 to T6 and causing marked compression of the underlying spi -nal segment, and an area of edema or isch-emia of the spinal segment corresponding to vertebral bodies C7 to T6 (Fig 1). Conservative treatment was chosen be -cause of the presence of important coag-ulation disorder and the progressive neu-rological improvement of the patient af-ter the first 24 hours of ictus. In view of her low prothrombin time, the patient re-ceived activated factor VII for correction of the coagulation disorder and to prevent new bleedings. The patient presented important pro-gressive improvement of the sensorimo-tor deficit in the lower limbs. Control RM imaging of the cervicothoracic spine per-formed on August 8, 2007 revealed al-most complete absorption of the hema-

Gliomatosis cerebri: Diagnostic considerations in three cases

Clinical symptoms and radiologic characteristics of gliomatosis cerebri (GC) are non-specific and the condition may be confused with other central nervous system diseases. We report three patients with GC; all the three patients had involvement of more than three lobes and the deep white matter, as well as bilateral involvement. Differentiation of GC from other neurologic diseases involving diffuse white matter may be difficult. However, the diagnosis can be based on the combination of radiologic and histopathologic features.