Sandro L. Rossitti

Breve comentário sobre a patogenia da cisticercose espinhal

The spinal forms of neurocysticercosis are rather rare. The more common presentation is the leptomeningeal form. We have reported two patients with an exclusively spinal involvement verified through surgery. The current theory of downward migration of the parasites from the cerebral to the spinal subarachnoid space cannot explain primary spinal forms, and it is suggested that retrograde flow through the epidural vertebral veins provides an alternative route.

Cisticercose espinhal leptomeníngea pura

An adult female patient presented with an exclusively spinal leptomeningeal infestation by cysticercosis (restricted to the cauda equina), verified in surgery. The role of the vertebral vein system in the spread of cysticercotic larvae is discussed. A commentary on the possibility that cysticercosis of the batal cisterns may be due to ascending migration of primarily spinal cysticerci, as originally proposed by Isamat de la Riva, is stated.An adult female patient presented with an exclusively spinal leptomeningeal infestation by cysticercosis (restricted to the cauda equina), verified in surgery. The rôle of the vertebral vein system in the spread of cysticercosis larvae is discussed. A commentary on the possibility that cysticercosis of the basal cisterns may be due to ascending migration of primarily spinal cysticerel, as originally proposed by Isamat de la Riva, is stated.

Observações sobre o deslocamento da dura-máter nas punções cisternais laterais

Report of an anatomic study of the lateral cisternal punctures (at the atlanto-occipital and C1-2 interspaces), carried out on fresh cadavers. Direct visualization of the internal surface of the dura mater (DM) at the cranio-cervical junctions was possible by removing the calvarium and brain (sectioned at the upper cervical spinal cord). Dislocation («tenting») of the DM over the needle was observed in all occasions (n = 42), measuring 3.46 mm (2-6 mm).

Radiculopatia neoplásica lombossacral

Lumbar-disc protrusions (LDP) constitute well-defined syndromes on clinical and anatomical grounds, and neurosurgeons are prone to rely upon the clinical signs to identify the level of disc protrusion when a «typical» case is found. Sometimes, non-contrasted computerized tomographic (CT) scans centered on the L5-S1, L4-L5 and L3-L4 interspaces and spine roentgenograms are the only special ancilary means in presurgical evaluation. We report three patients from our series, in which neoplasic spinal disease presented as classic LDP (one patient with a cauda equina schwannoma, and two with metastatic carcinoma). The cases were chosen because they posed special problems to the referred radiodiagnostic routine. Systematic CT-evaluation of the sacrum and conus medullaris zone is recommended in every patient with lumbosacral radiculopathy, and intratecal contrast should be employed in patients with unreliable findings or normal CT-scans.Lumbar-disc protrusions (LDP) constitute well-defined syndromes on clinical and anatomical grounds, and neurosurgeons are prone to rely upon the clinical signs to identify the level of disc protrusion when a «typical» case is found. Sometimes, non-contrasted computerized tomographic (CT) scans centered on the L5-S1, L4-L5 and L3-L4 interspaces and spine roentgenograms are the only special ancilary means in presurgical evaluation. We report three patients from our series, in which neoplasic spinal disease presented as classic LDP (one patient with a cauda equina schwannoma, and two with metastatic carcinoma). The cases were chosen because they posed special problems to the referred radiodiagnostic routine. Systematic CT-evaluation of the sacrum and conus medullaris zone is recommended in every patient with lumbosacral radiculopathy, and intratecal contrast should be employed in patients with unreliable findings or normal CT-scans.

Mensuração do deslocamento da dura-máter na punção suboccipital mediana

Report of a study of the dynamic anatomy of the median suboccipital puncture of the cisterna magna cerebellomedullaris, carried out on fresh cadavers. Direct inspection of the internal surface of the dura mater (DM) at the craniocervical region was possible by removing the calvarium and brain (seccioned at the upper cervical cord), during routine necropsies. Dislocation of the DM over the needle tip preceding dural penetration (so-called «durai tenting») was observed in all punctures (n = 30), measuring 3.12 (2.0-4.2) mm.

Lateral cervical puncture for myelography and cerebrospinal fluid collection: technical note

The lateral cervical puncture for myelography or cerebrospinal fluid collection is a modification of the technique of percutaneous cervical cordotomy. It may be performed at the atlanto-axial or atlanto-occipital interspace. It is simple to perform, and appears to be safer and more easily mastered than suboccipital puncture, with no more discomfort to the patient than that associated with lumbar puncture.

Manual operacional da escala de nível reativo (RLS 85)

The Reaction Level Scale (RLS85) is a range scored coma scale (8 levels) for the assessment of responsiveness in patients with acute brain disorders. Its feasibility in clinical pratice and for research studies has been verified in a multicentre study and by comparison with other current coma scales. Range scoring and abscence of pseudoscoring are its most significant advantages over the other current scales. An operative manual of the RLS85 in Portuguese is standardized in this text which also provides a selected bibliography on the subject.The Reaction Level Scale (RLS85) is a range scored coma scale (8 levels) for the assessment of responsiveness in patients with acute brain disorders. Its feasibility in clinical practice and for research studies has been verified in a multicentre study and by comparison with other current coma scales. Range scoring and absence of pseudoscoring are its most significant advantages over the other current scales. An operative manual of the RLS85 in Portuguese is standardized in this text which also provides a selected bibliography on the subject.

A via lateral modificada para a cirurgia da hérnia de disco torácica: nota técnica

The thoracic spine may be approached by different ways: posterior, posterolateral, anterolateral and anteriorly, with associated removal of diverse osseous structures as facet joints, costal processes, pedicles and ribs, subsequently imposing the use of diverse fusion procedures in some cases. The extreme lateral approach to the thoracic disc space produces minimum disruption of the normal spinal musculoskeletal anatomy, avoids retraction of the spinal cord and preserves the intercostal neurovascular bundle and the segmental radicular arteries. The operation is carried out with the patient in the prone position, and the patient is rotated away from the surgeon as necessary when the deeper levels are accessed. Radioscopy is used to identify the correct level after positioning of the patient A straight transversal paravertebral incision is recommended in single-level operations. Alternatively an elliptical incision, concave medially and centered at the marked rib, is done and the skin flap is refleted medially. The muscles are partially divided at rigth angles over the rib to be excised and refleted cranial and caudally, exposing the rib and transverse process. The target disc is approached by removal of about 5 cm of the rib which has its insertion at the disc level, if necessary associated with partial removal of the transverse process, followed by partial pediculotomy (exclusively at the base of the pedicle) and a little lateral rachotomy (vertebral body ressection), which permits opening of the spinal canal exclusively ventral to the intervertebral foramen. In this way any kind of hemilaminectomy or facectomy is avoided. The discectomy is then carried out. This is a minimally invasive approach in comparison to the current ones. As the facet joint is preserved and the pedicle just partially removed, a fusion procedure is not necessary. This technique has potentially important consequences for long term spinal stability after multilevel operations. The initial results of nine patients are promising. In this little series up to four disc herniations in the same patient were operated at the same occasion.The thoracic spine may be approached by different ways: posterior, posterolateral, anterolateral and anteriorly, with associated removal of diverse osseous structures as facet joints, costal processes, pedicles and ribs, subsequently imposing the use of diverse fusion procedures in some cases. The extreme lateral approach to the thoracic disc space produces minimum disruption of the normal spinal musculoskeletal anatomy, avoids retraction of the spinal cord and preserves the intercostal neurovascular bundle and the segmental radicular arteries. The operation is carried out with the patient in the prone position, and the patient is rotated away from the surgeon as necessary when the deeper levels are accessed. Radioscopy is used to identify the correct level after positioning of the patient. A straight transversal paravertebral incision is recommended in single-level operations. Alternatively an elliptical incision, concave medially and centered at the marked rib, is done and the skin flap is refleted medially. The muscles are partially divided at right angles over the rib to be excised and refleted cranial and caudally, exposing the rib and transverse process. The target disc is approached by removal of about 5 cm of the rib which has its insertion at the disc level, if necessary associated with partial removal of the transverse process, followed by partial pediculotomy (exclusively at the base of the pedicle) and a little lateral rachotomy (vertebral body ressection), which permits opening of the spinal canal exclusively ventral to the intervertebral foramen. In this way any kind of hemilaminectomy or facectomy is avoided. The discectomy is then carried out. This is a minimally invasive approach in comparison to the current ones.(ABSTRACT TRUNCATED AT 250 WORDS)

Operational manual of the reaction level scale (RLS85)

The Reaction Level Scale (RLS85) is a range scored coma scale (8 levels) for the assessment of responsiveness in patients with acute brain disorders. Its feasibility in clinical pratice and for research studies has been verified in a multicentre study and by comparison with other current coma scales. Range scoring and abscence of pseudoscoring are its most significant advantages over the other current scales. An operative manual of the RLS85 in Portuguese is standardized in this text which also provides a selected bibliography on the subject.The Reaction Level Scale (RLS85) is a range scored coma scale (8 levels) for the assessment of responsiveness in patients with acute brain disorders. Its feasibility in clinical practice and for research studies has been verified in a multicentre study and by comparison with other current coma scales. Range scoring and absence of pseudoscoring are its most significant advantages over the other current scales. An operative manual of the RLS85 in Portuguese is standardized in this text which also provides a selected bibliography on the subject.

Dor faríngea durante punção suboccipital lateral: lateral suboccipital puncture

Foi observada queixa de dor orofaringea em cinco pacientes, conscientes e bons informantes, durante realizacao de puncao suboccipital lateral da cisterna magna para mielo-grafia e/ou coleta de liquido cefalorraqueano. Sao revisadas as anastomoses dos nervos cranianos inferiores, com enfase as relacoes do primeiro nervo in.) cervical (Cl) com o gânglio cervical superior da cadeia simpatica e com o n. acessorio (n. XI), a convergencia anatomica sensitiva no subnucleo caudal do nucleo do tracto espinhal do n. trigemeo e sua importância na cirurgia funcional da dor. E sugerido que a referencia de dor faringea durante a puncao suboccipital lateral se deva a estimulacao de fibras aferentes viscerais de Cl ou de ramos comunicantes cinzentos do gânglio cervical superior para Cl.Oropharyngeal pain was referred by five fully conscious and collaborative patients during lateral suboccipital puncture (LSP) of the cisterna magna, performed for myelography and/or cerebrospinal fluid collection. The anastomotic connections between the lower cranial nerves, the sympathetic nerves and the upper cervical spinal nerves are reviewed, with emphasis on the relationship between the first cervical nerve (C1), the superior cervical ganglion of the sympathetic trunk, and the spinal accessory nerve (nerve XI), and their central connections. The authors conclude that pharyngeal pain during LSP is provoked by the stimulation of afferent visceral fibers of C1, or of the gray communicating branches of the superior cervical ganglion to C1.