Roberto Godoy

Regional cooling for reducing brain temperature and intracranial pressure

OBJECTIVE To evaluate the effectiveness of regional cooling for reducing brain temperature (BrTe) and intracranial pressure (ICP) in patients where conventional clinical treatment has failed. METHOD Regional cooling was carried out using ice bags covering the area of the craniectomy (regional method) in 23 patients. The BrTe and ICP were determined using a fiber optic sensor. Thirteen patients (56.52%) were female. The ages ranged from 16 to 83 years (mean of 48.9). The mean APACHE II score was 25 points (11-35). The patients were submitted, on mean, to 61.7 hours (20-96) of regional cooling. RESULTS There was a significant reduction in mean BrTe (p<0.0001--from 37.1 degrees C to 35.2 degrees C) and mean ICP (p=0.0001--from 28 mmHg to 13 mmHg). CONCLUSION Our results suggest that mild brain hypothermia induced by regional cooling was effective in the control of ICP in patients who had previously undergone decompressive craniectomy.

Infarto cerebelar: análise de 151 pacientes

This report presents the treatment of 151 patients with cerebellar infarction, 98 men (65%) and 53 women (35%), mean age 62.4 years old. Occlusive hydrocephalus was diagnosed in 7.9% of the patients associated with an extensive cerebellar infarction and in all 11 surgical patients (7.2%). Four patients underwent an external ventricular drainage with 3 deaths (75%) and 7 underwent a decompressive suboccipital craniectomy with 2 deaths (28.5%). Mortality of the clinical group was 15 patients (10.7%). Vertigo, vomiting, Romberg sign and dysmetria were the signs and symptoms of cerebellar involvement that were more frequentely observed. Cerebellar infarction from embolism after cardiovascular surgery occurred in 57 patients (37.7%).Cerebellar infarction, as a isolated fact, occurred in 59 patients (39%) and cerebellar plus infarction in other regions occurred in 92 patients (61%). Magnetic resonance image was the best diagnostic form for cerebellar lesions, however computerized tomography could show cerebellar infarction in 68 patients (78%).

Topical antibiotics and neurosurgery: Have we forgotten to study it?

Background: For neurosurgery, the last decades have been a time of incredible improvement in areas such as imaging, microscopy, endoscopy, stereotactic guidance, navigation, radiosurgery and endovascular techniques. However, the efficacy of topical antibiotic prophylaxis in neurological operations remains to be established by neurosurgeons. Methods: The authors did an historical review of the literature regarding the utilization of topical antibiotic prophylaxis in neurological operations. The Pub Med database of the U.S. National Library of Medicine / National Institutes of Health was utilized as the primary source of the literature. The authors performed the search by using the following Mesh terms: “neurosurgery” or “neurosurgical procedures” and “administration, topical” and “antibiotic prophylaxis”; “neurosurgery” or “neurosurgical procedures” and “administration, topical” and “antibacterial agents.” Results: In the last 70 years, we have poorly studied the use of topical antibiotics in neurosurgery. All the papers reported were Class III evidence. Conclusion: To the best of our knowledge, there is no publication that provided Class I or II evidence about topical antibiotic prophylaxis in neurosurgery.

Tratamento cirúrgico da hemorragia cerebral: considerações a propósito de 11 casos

After brief comments about the angiographic findings on 298 consecutive cases of isquemic or hemorrhagic cerebral vascular strokes, cerebral angiography is emphasized as the main diagnostic method, owing to the variety of physiopathogenic and ethiologic factors involved in the genesis of this syndromes. The results of surgical treatment on eleven patients with spontaneous intracerebral hematomata are discussed in detail. Despite the great divergence among the authors about the management of massive intracerebral hemorrhage, the rapid improvement in 54,6% of the patients in this series, in our opinion justifies surgery in the majority of the cases.After brief comments about the angiographic findings on 298 consecutive cases of isquemic or hemorrhagic cerebral vascular strokes, cerebral angiography is emphasized as the main diagnostic method, owing to the variety of physiopathogenic and ethiologic factors involved in the genesis of this syndromes. The results of surgical treatment on eleven patients with spontaneous intracerebral hematomata are discussed in detail. Despite the great divergence among the authors about the management of massive intracerebral hemorrhage, the rapid improvement in 54,6% of the patients in this series, in our opinion justifies surgery in the majority of the cases.

Co-existing fibrous dysplasia and meningothelial meningioma.

Dr. Raphael Vicente Alves – Rua Estado de Israel 907 / 31 04022-002 São Paulo SP Brasil. E-mail: raphaelvalves@yahoo.com.br Co-existing fibrous dysplasia and meningothelial meningioma is extremely rare. A search at “PubMed” (U.S. National Library of Medicine) with terms “fibrous”, “dysplasia” and “meningioma” demonstrated a total of 7 cases reported. Three cases in association with McCune-Albright syndrome, two cases in the Chinese literature, one case with multiple globoid meningiomas with craniomandibular fibrous dysplasia, and one reported case of atypical lymphoplasmacyte-rich meningioma. To the best of our knowledge, this is the first reported case of co-existing fibrous dysplasia and meningothelial meningioma with histopathological diagnosis.