Rodrigo Becco de Souza

Could craniometric measurements explain the growth of the superior sagittal sinus

Objective: The objective of this study was to relate demographic variables and craniometric measures with measurements of the superior sagittal sinus (SSS) at different points along the path of the SSS. The findings were then discussed with regards to theories of skull growth. Methods: We studied 33 skulls with known demographic characteristics and measured various craniometric parameters and distances related to the specific dimensions of the SSS. These data were statistically analyzed, and the results are presented. Results: Of the 33 cadaver samples, 16 were female and 17 were male, aged between 28 and 87 years at the time of death. The cross-sectional area of the SSS measured at the coronary suture was positively correlated with the biauricular length. In addition, when measured 1.5 cm above the torcula, the cross-sectional area of the SSS was negatively correlated with the distance between the medial epicanthi. Conclusions: The relationships found may indicate that the growth of the SSS is proportional to the activity of each segment of the SSS that occurs along its path.

Retroclival epidural hematoma in a child affected by whiplash cervical injury: a typical case of a rare condition.

Traumatic posterior fossa epidural hematomas are uncommon lesions. Among these lesions, retroclival epidural hematomas (REDH) are particularly rare conditions that usually occur in the pediatric population due to predisposing anatomical features in this patient group. We describe a typical case of traumatic REDH from the mechanism of trauma to outcome. This 8-year-old girl was involved in a motor vehicle accident leading to whiplash cervical injury and cranial nerve palsy. Any children involved in a severe motor vehicle accident with such a sequence of events should raise suspicion for prompt diagnosis.

Traumatic brain injury by a firearm projectile: a 16 years experience of the neurosurgery service of Santa Casa de São Paulo

OBJECTIVE To evaluate the epidemiology and prognostic factors associated with traumatic brain injury by a firearm projectile (FAP). METHODS We reviewed the medical records of 181 patients in the Department of Neurosurgery of Santa Casa de São Paulo (São Paulo Holy House) diagnosed with traumatic brain injury (TBI) resulting from FAP from January 1991 to December 2005. Were evaluated: age, sex, Glasgow Coma Scale (GCS) on admission, brain region affected by the FAP, type of injury (penetrating or tangential), type of treatment and outcome, based on GCS. The relationship between therapeutic strategy and outcome was analyzed using the Chi-square test with Yates correction. The Fisher test was used to verify the same correlation individually for each group stratified by GCS on admission. RESULTS Of the 181 patients, 85% were male (n = 154) and 15% female (n = 27). Mean age was 31.04 years (± 10.98). The mostly affected brain region was the frontal lobe (27.6%), followed by temporal (24.86%) and occipital (16.57%) ones. Of the TBIs evaluated, 16% were tangential and 84%, penetrating. CONCLUSION Patients undergoing surgical treatment had better outcome than those submitted to conservative treatment, and patients who were more severe at admission (GCS 3-8) have better results with the neurosurgical procedure.

Cauda Equina Syndrome Caused by Spontaneous Bleeding in the Filum Terminale Myxopapillary Ependymoma: A Rare Pediatric Case

The majority of the filum terminale ependymomas are of the myxopapillary type, which most commonly present as lumbago or sciatic pain, an insidious clinical condition, at times accompanied by paraparesis, bladder paresis and vesical alterations. We report the case of a 13-year-old patient who presented with acute cauda equina. He underwent total resection of the lesion, which resulted in progressive improvement. The clinical conditions, diagnoses and treatments of the medullary cone and cauda equina myxopapillary ependymomas are also discussed.

Pourfour du Petit syndrome caused by traumatic pseudo-aneurysm of the internal carotid artery

Pourfour du Petit syndrome, or reverse Horner syndrome, is described as an overactive sympathetic nervous system, being characterized by mydriasis, eyelid retraction, and hyperhidrosis. We described a case of Pourfour du Petit syndrome after cervical injury by gunshot, with a little review about this rare syndrome. Angiography revealed dissection and formation of pseudo aneurysm of the left carotid artery. We believe that this lesion caused hyper-stimulation of the left cervical sympathetic chain, resulting in reverse Horner syndrome or Pourfour du Petit syndrome. There was reversal of symptoms spontaneously after 3 wk.

The pathophysiology, classification, treatment, and prognosis of a spontaneous thoracic spinal cord herniation: A case study with literature review

Background: Spinal cord herniation was first described in 1974. It generally occurs in middle-aged adults in the thoracic spine. Symptoms typically include back pain and progressive paraparesis characterized by Brown-Séquard syndrome. Surgical reduction of the hernia improves the attendant symptoms and signs, even in patients with longstanding deficits. Case Description: A 66-year-old female with back pain for 7 years, accompanied by paresthesias and a progressive paraparesis, underwent a thoracic MRI which documented a ventral spinal cord herniation at the T4 level. Following a laminectomy, with reduction of the hernia and ventral dural repair, the patient improved. Conclusion: Herniation of the thoracic cord, documented on MR, may produce symptomatic paraparesis which may resolve following laminectomy with ventral dural repair.