Sonival C. Hunhevicz

Cerebral cysticercosis presenting as mass lesion.

Four cases of cerebral cysticercosis that presented as brain tumor are reported. The diagnosis of these lesions was possible only after the operation. The clinical manifestations of these patients are discussed. The findings on computed tomography scanning as well as the possibilities for differential diagnosis are presented. All the patients were operated on and the diagnosis confirmed histologically. The difficulties encountered at the operations and the alternative methods for the treatment of these lesions are discussed.

Comparison of MRI-guided and ventriculography-based stereotactic surgery for Parkinson's disease

Stereotactic surgery for Parkinsons disease can be performed using different neuroimaging methods. Ventriculography has been used to locate the coordinates of the structures close to the third ventricle. Although it has several potential disadvantages related to the intraventricular injection of iodine contrast, it is considered a precise method. Computed tomography and magnetic resonance imaging have been used in some centers. In order to compare their efficacy, 50 stereotactic thalamotomies for Parkinsons disease were performed using either ventriculography (VE) (25) or magnetic resonance imaging (MRI) (25). In 14 out of 25 VE procedures, computed tomography (CT-scan) was also used and showed a significant mean difference of coordinate Y and Z. The clinical results employing either VE or MRI were similar, with 80% abolition of tremor in the VE group, and 84% in the MRI group, after a follow up period of at least 3 months. Another 12% of VE and 16% of MRI group showed significant improvement of tremor. Complication rate was 4% in both groups. MRI-guided stereotactic thalamotomy in Parkinsons disease has shown good clinical results, comparable to VE-guided stereotaxis.

Thoracic intraspinal paracoccidioidomycosis: case report

Intramedullary lesions caused by Paracoccidioides brasiliensis have been rarely described. Its diagnosis may be challenging and surgical approach is indicated for diagnostic and therapeutic purposes. We hereby report a case with MRI and surgical findings in a 45 year-old woman with intramedullary paracoccidioidomycosis, and make a review of other cases presented in the literature.

Cirurgia estereotáxica guiada para angiomas cavernosos

Intracerebral cavernous angiomas may cause hemorrhage, epileptic seizures and neurological deficits. The diagnosis of these lesions became easier with the advent of the magnetic resonance image (MRI). Radical resection is the treatment of choice. Due to frequent subcortical or deep location, image-guided techniques, such as stereotactic-guided surgery, offer many advantages as smaller skin incision and craniotomy, less brain manipulation with consequently lower morbidity. We present a series of nine cavernous angiomas treated by stereotactic-guided radical surgical resection. The diagnosis was done by MRI and confirmed by pathologic studies in all cases. Mean age of patients was 30 years old (range 20-54 years). Postoperative morbidity occurred in two cases: one patient had a convulsion on the third postoperative day and the other presented dysphasia and hemiparesis on the second postoperative day, both with total recovery. Total resection of the lesion was possible in all cases with no neurological deficit.

Tratamento cirúrgico da epilepsia do lobo temporal: análise de 43 casos consecutivos

Quarenta e tres pacientes com epilepsia refrataria ao tratamento medicamentoso foram submetidos a cirurgia de epilepsia do lobo temporal no Instituto de Neurologia de Curitiba, entre os anos de 1998 a 2003. Trinta e nove (90,6%) pacientes apresentavam esclerose mesial temporal, e quatro (9,4%), tumores cerebrais. Dos trinta e sete pacientes que possuiam avaliacao pos-operatoria completa, 83,7% apresentaram classificacao I, segundo Engel (livres de crises incapacitantes). Complicacoes pos-operatorias ocorreram em 18,6%: uma infeccao da ferida operatoria, um caso de hidrocefalia, um de fistula liquorica, dois casos de paralisia transitoria do IV nervo craniano e um de hemiparesia transitoria. Nao houve nenhum obito relacionado a cirurgia de epilepsia no presente estudo.Forty-three patients with epilepsy resistant to drug therapy were submitted to temporal lobe epilepsy surgery at the Instituto de Neurologia de Curitiba, from 1998 to 2003. Thirty-nine patients (90.6%) had mesial temporal sclerosis, and four had brain tumors. According to Engels rating, 83.7% from 37 patients with complete postoperative evaluation were classified as Class I (free of disabling seizure). Postoperative complications (18.6%) were evaluated, with one case of surgical wound infection, one case of hydrocephalus, one case of cerebrospinal fluid fistula, two cases of transient palsy of the trochlear nerve and one case of transient hemiparesis. No death related to epilepsy surgery was found in our study.

Implantação estereotáxica de eletrodos profundos por ressonância magnética para cirurgia de epilepsia

We present the case of a 40-year-old woman with refractory epilepsy since aged 18, who was submitted to video-EEG monitoring with intracerebral depth electrodes. The clinical history and examination, magnetic resonance image (MRI), video-EEG and neuropsychological study did not allow the determination of the cerebral onset of epileptic seizures. Depth electrodes inserted by MRI-guided stereotaxis allowed the recording of the epileptic activity and thus showed quite accurately the area of the brain to be surgically resected. She underwent a right anterior temporal lobectomy with amygdalohippocampectomy. The immediate postoperative period was uneventful and she is without epileptic seizures after three months of follow-up. The average pre-operative free-seizure period was two weeks. To our knowledge, this is the first stereotactic surgery for insertion of depth intracerebral electrodes in epilepsy in Brazil.We present the case of a 40-year-old woman with refractory epilepsy since aged 18, who was submitted to video-EEG monitoring with intracerebral depth electrodes. The clinical history and examination, magnetic resonance image (MRI), video-EEG and neuropsychological study did not allow the determination of the cerebral onset of epileptic seizures. Depth electrodes inserted by MRI-guided stereotaxis allowed the recording of the epileptic activity and thus showed quite accurately the area of the brain to be surgically resected. She underwent a right anterior temporal lobectomy with amygdalohippocampectomy. The immediate postoperative period was uneventful and she is without epileptic seizures after three months of follow-up. The average pre-operative free-seizure period was two weeks. To our knowledge, this is the first stereotactic surgery for insertion of depth intracerebral electrodes in epilepsy in Brazil.

Cirurgia estereotáctica para processos expansivos intracranianos: diagnóstico e tratamento

Os autores apresentam serie 50 pacientes submetidos a cirurgia estereotactica para processos expansivos intracranianos. Em 12 casos realizou-se um procedimento terapeutico: resseccao tumoral guiada em 5 pacientes e aspiracao do conteudo da lesao nos outros 7. Neste estudo confirmam-se a grande precisao e a baixa morbidade relacionadas com as tecnicas estereotacticas. A tomografia computadorizada e a ressonância magnetica determinam com acuracia as coordenadas estereotacticas, mas em certos casos a estereo-angiografia cerebral deve ser realizada. As resseccoes tumorais guiadas por estereotaxia permitem o tratamento de lesoes cerebrais profundas ou em areas funcionais anteriormente consideradas como inoperaveis. A literatura pertinente e discutida.

O Methohexital Sódico (Brevital ® ) no Teste de Wada: Relato de Dois Casos

ABSTRACT INTRODUCTION: The Wadas test is still being frequently used at epilepsy surgery centers in temporal lobectomy candidates to evaluate the extent, quality and lateralization of memory functions, and to estimate residual deficit, since it simulates the effects of the surgery. In Brazil, Amytal® is very difficult to be obtained due to local regulatory barriers. OBJECTIVES: To describe the Wada procedure carried out with Brevital® in two temporal lobectomy candidates, and to comment on its efficacy and differences regarding the Wada procedure carried out with Amytal®. METHODS: The Wada procedure carried out with Brevital ® in two patients in order to determine the laterality of language and memory through an adjusted protocol is reported. RESULTS: We report two cases submitted to the Wada test with sodium methohexital. RESULTS: Brevital®, a short-lasting anesthetic, showed good results as an Amytal® substitute. CONCLUSION: Brevital® may be used in Brazil for Wada tests, with the additional advantages of allowing a shorter procedure, as well as a comprehensive assessment of memory.

Alternative option for osteogenesis imperfecta and trigeminal neuralgia

Osteogenesis imperfecta (OI) is a bone disorder that can lead to skull base deformities such as basilar invagination, which can cause compression of cranial nerves, including the trigeminal nerve. Trigeminal neuralgia in such cases remains a challenge, given distorted anatomy and deformities. We present an alternative option, consisting in cannulation of the foramen ovale and classical percutaneous treatment. Percutaneous balloon microcompression was performed in a 28 year-old woman with OI and severe trigeminal neuralgia using computed tomography (CT) and radiographic-guided cannulation of the Gasserian ganglion without neuronavigation or stereotactic devices. The patient developed hypoesthesia on the left V1, V2 and V3 segments with good pain control. This alternative technique with a CT-guided puncture, using angiosuite without the need of any Mayfield clamp, neuronavigation systems, frame or frameless stereotactic devices can be a useful, safe and efficient alternative for patients with trigeminal neuralgia with other bone deforming diseases that severely affect the skull base.