Roberto Leal Silveira

Tumoral form of cerebral schistosomiasis mansoni. A report of four cases and a review of the literature.

We describe four cases of the tumoral form of cerebral schistosomiasis mansoni. The patients had symptoms of increased intracranial pressure and focal neurological signs that varied according to the site of the lesion. Computerized tomography showed a hyperdense, enhancing lesion located in the cerebellum (2 patients), frontal lobe and thalamus (1 patient), and temporal subdural region (1 patient), with associated mass effects. The lesion was resected in three patients and a stereotactic biopsy was performed in one. Histopathologic specimens of all four patients revealed multiple schistosomal granulomas in various evolutive phases. Two of these patients differ from previously described cases; one because of the subdural location of the lesion, mimicking a meningioma, and the other one because two lesions were present.

Pontos referenciais nos acessos cranianos

The knowledge of the craniotopography allows the delimitation of the cranial approaches. In this study the landmarks, defined in relation to the craniometric points and used in the different cranial approaches, were systematized. Twenty two landmarks are described: the first twelve are in relation to the skull base and the remainder are in relation to the skull vertex.

Angioma cavernoso do meato acústico interno envolvendo o complexo VII e VIII nervos cranianos: relato de caso

We report the surgically treated case of a 21-year-old caucasian male harboring a cavernous hemangioma of the right internal auditory canal encasing the seventh and eighth cranial nerves complex. Only 18 cases of cavernous hemangiomas of this location have been previously reported. The clinical features, the differential diagnosis and the treatment are discussed.

Surgical treatment of the occipital condyle fracture: case report

We present a case of fracture of the occipital condyle showing neck pain, lesion of IX, X and XII cranial nerves and pyramidal syndrome of the four members. A review of the literature about the surgical treatment of the occipital condyle fracture is done.

Relações da sutura coronária com os sulcos da face súpero-lateral do lobo frontal: aplicações neurocirúrgicas

An anatomical study of the relationships between the coronal suture and the sulci of the convexity of the frontal lobe was accomplished in seven cephalic segments. The pre-central and central sulci are, respectively, 26,5 mm and 40,5 mm behind the bregma and 15,0 mm and 35,5 mm behind the pterion. The use of the coronal suture as point of reference, and especially, its relationship with the sulci of the lateral surface of the frontal lobe, allows to determine the projection on the cranium of the superficial cerebral lesions with the purpose to delimit the surgical access and to guide the approach to the cerebral convexity.

Aneurisma paraclinóideo: técnica cirúrgica e resultados em 51 pacientes

An analysis of the surgical results of 51 patients harboring 55 paraclinoid aneurysms is performed, along with a throughoutful description of its complex microsurgical technique. The anterior clinoid process was removed by the extradural route after sectioning the dural duplication between the superior orbital fissure and the dura of the temporal lobe, and/or by the intradural approach. All 55 aneurysms was excluded. In two cases the clipping was partial and the internal carotid artery were occluded in three cases. The surgical outcome was good in 42 (82%) patients, moderate incapacity occurred in five (10%) and severe incapacity in one patient (2%). Three patients (6%) died due to brain infarction. Seven patients (13,7%) had additional lesion of the optic nerve, being partial in 4 (7,7%) and total in 3 (6%).

Variações da extensão anterolateral do acesso suboccipital lateral: estudo anatômico

We studied the extensions of the lateral suboccipital approach (LSOA) in seven cadaver heads, in the microsurgical laboratory, in order to stablish the extensions necessary to approach the anterolateral area of the foramen magnum and the jugular foramen. The extensions (bone resection) were accomplished in five progressive steps: 1) suboccipital retrossigmoid craniectomy (LSOA retrocondylar); 2) extending the craniectomy with removal of half the occipital condyle (LSOA partial transcondylar); 3) extending the drilling of the occipital condyle to open the hypoglossal foramen, followed by removal of the jugular tubercle and opening the jugular foramen (LSOA transcondylar-transjugular); 4) complete drilling of the occipital condyle (LSOA complete transcondylar); 5) LSOA complete transcondylar plus removal of the atlas lateral mass up to the odontoid process (ASOL transcondylar-transjugular). We concluded that the extensions of LSOA should be adapted to the topography of the lesion: the LSOA retrocondylar for the lateral area of the foramen magnum; the LSOA partial transcondylar for the anterolateral portion; the LSOA transcondylar-transjugular to reach the jugular foramen; the LSOA complete transcondylar for the anterior part, and the LSOA complete transcondylar/translateral mass of the atlas for extradural lesions anterior to the foramen magnum.

Angiopatia amilóide cerebral simulando tumor cerebral: relato de caso

We describe the unusual case of a 45-year-old male patient harboring an intracranial mass due to cerebral amyloid angiopathy whose clinical and radiological features were those of a low grade glioma. Biopsy revealed cerebral amyloid angiopathy. The clinical, radiological and pathological findings are discussed as we review the available literature.

Lesão cerebral penetrante por grande fragmento de fibra de amianto tratada por craniectomia descompressiva: relato de caso

We report the case of a 22-year-old man victim of penetrating brain injury due to a 15 x 12 asbestos fragment and a successfully treatment via decompressive craniectomy. Unlike gunshot wounds to the head, penetrating brain injury from low energy objects are unusual. Most cases reported involve cranio-orbitary injuries as well as self inflicted lesions in mentally ill patients. The reported case is noteworthy due to the large dimensions of the foreign body, the treatment via decompressive craniectomy and the good patient functional outcome.

Definição do limite anterolateral do lobo occipital em peças anatômicas e exames de imagem

The anterolateral limit of the occipital lobe was studied in anatomical specimens and with neuroimaging. Seven human cadaver heads, 103 normal CT-scan and 104 MRJ of the brain were studied. There was a fold of the dura mater on the transverse sinus (preoccipital tentorial plica) and a bony protuberance related directly to the preoccipital notch. It was also determined the mean distance between the parieto-occipital sulcus and the lambdoid suture. In the imaging studies, especially magnetic resonance, it was possible to identify the preoccipital notch and/or a protuberance in the cranial vault related to this notch, besides the parieto-occipital sulcus and lambdoid suture, making possible, therefore, the definition of the anterolateral limit of the occipital lobe.The anterolateral limit of the occipital lobe was studied in anatomical specimens and with neuroimaging. Seven human cadaver heads, 103 normal CT-scan and 104 MRJ of the brain were studied. There was a fold of the dura mater on the transverse sinus (preoccipital tentorial plica) and a bony protuberance related directly to the preoccipital notch. It was also determined the mean distance between the parieto-occipital sulcus and the lambdoid suture. In the imaging studies, especially magnetic resonance, it was possible to identify the preoccipital notch and/or a protuberance in the cranial vault related to this notch, besides the parieto-occipital sulcus and lambdoid suture, making possible, therefore, the definition of the anterolateral limit of the occipital lobe.