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Publicações | 2018
Auditory brainstem implant in postmeningitis totally ossified cochleae. Acta Otolaryngol.
Malerbi AFDS, Goffi-Gomez MVS, Tsuji RK, Gomes MQT, Brito Neto R, Bento RF. 2018 Apr
An auditory brainstem implant (ABI) is an option for auditory rehabilitation in patients with totally ossified cochleae who cannot receive a conventional cochlear implant.
To evaluate the outcomes in audiometry and speech perception tests after the implantation of an ABI via the extended retrolabyrinthine approach in patients with postmeningitis hearing loss.
MATERIALS AND METHODS:
Ten patients, including children and adults, with postmeningitis hearing loss and bilateral totally ossified cochleae received na ABI in a tertiary center from 2009 to 2015. The extended retrolabyrinthine approach was performed in all the patients by the same surgeons. A statistical analysis compared pure tonal averages and speech perception tests before and at least 12 months after the ABI activation.
Eight patients (80%) showed improvements in tonal audiometry and the word and vowel perception tests after an average follow-up of 3.3 years. Two patients recognized up to 40% of the closed-set sentences without lip-reading. Two patients had no auditory response.
The ABI improved hearing performance in audiometry and speech perception tests in cases of postmeningitis hearing loss. The extended retrolabyrinthine approach is a safe surgical option for patient with postmeningitis hearing loss and bilateral totally ossified cochleae.
Endoscopic Endonasal Transplanum Transtuberculum Approach for the Resection o f a Large Suprasellar Craniopharyngioma.
Mangussi-Gomes J, Vellutini EA, Truong HQ, Pahl FH, Stamm AC. J Neurol Surg B Skull Base. 2018 Apr;79(Suppl 3):S249-S250
To demonstrate an endoscopic endonasal transplanum transtuberculum approach for the resection of a large suprasellar craniopharyngioma. Design Single-case-based operative video. Setting Tertiary center with dedicated skull base team.
A 72-year-old male patient diagnosed with a suprasellar craniopharyngioma. Main Outcomes Measured Surgical resection of the tumor and preservation of the normal surrounding neurovascular structures. Results A 72-year-old male patient presented with a 1-year history of progressive bitemporal visual loss. He also referred symptoms suggestive of hypogonadism. Neurological examination was unremarkable and endocrine workup demonstrated mildly elevated prolactin levels. Magnetic resonance images demonstrated a large solid-cystic suprasellar lesion, consistent with the diagnosis of craniopharyngioma. The lesion was retrochiasmatic, compressed the optic chiasm,and extended into the interpeduncular cistern ( Fig. 1 ). Because of that, the patient underwent an endoscopic endonasal transplanum transtuberculum approach. 1 2 3 The nasal stage consisted of a transnasal transseptal approach, with complete preservation of the patient's left nasal cavity. 4 The cystic component of the tumor was decompressed and its solid part was resected. It was possible to preserve the surrounding normal neurovascular structures ( Fig. 2 ). Skull base reconstruction was performed with a dural substitute, a fascia lata graft, and a right nasoseptal flap ( Video 1 ). The patient did well after surgery and referred complete visual improvement. However, he also presented pan-hypopituitarism on long-term follow-up.
The endoscopic endonasal route is a good alternative for the resection of suprasellar lesions. It permits tumor resection and preservation of the surrounding neurovascular structures while avoiding external incisions and brain retraction.
Rapid progression of neurotoxoplasmosis in a patient with concomitant rheumatoid arthritis and systemic lupus erythematous.
Oliveira MF, Pereira CB, Silva VB, Costa MC, Paes VR, Ibrahim RE. Medical Express. 2018; 5:ml18002.
Toxoplasmosis is one of the most common human infections. About one-third of the entire world population is infected with latent toxoplasmosis.1-6Central nervous system (CNS) toxoplasmosis occurs due to reactivation of previous latent infection. Patients usually present with fever, headache, impaired consciousness, seizures, and/or focal neurological deficits. CNS toxoplasmosis may complicate the clinical course of patients with acquired human immunodeficiency (e.g. AIDS), immune system disease, or prolonged pharmacologic immunosuppressive treatment.1-5 Because the clinical picture and diagnosis are challenging, neurotoxoplasmosis may mimic several other CNS disorders, being especially difficult to manage and frequently requiring empiric treatment.We present an unusual case of neurotoxoplasmosis developing in a patient with concomitant rheumatoid arthritis and systemic lupus erythematous (SLE).
Orbital Compartment Syndrome After Frontotemporal Craniotomy: Case Report and Review of Literature.
Orbital compartment syndrome (OCS) is a rare condition characterized by increased intraorbital pressure and hypoperfusion of critical neural structures. It is usually associated with external ophthalmoplegia. We report a case of postoperative OCS following a frontotemporal craniotomy and review pertinent literature.
A 3-year-old female patient presented with a 3-year history of refractory epilepsy and diagnosis of right frontobasal cortical dysplasia. She underwent an elective frontotemporal craniotomy to allow resection of dysplastic cortex. The intraoperative period was uneventful. Postoperatively, following removal of operating fields, we noticed proptosis and right periorbital swelling. A diagnosis of orbital compartment syndrome was made. At the pediatric intensive care unit, the patient underwent an emergency right lateral canthotomy with wide inferior and superior cantholysis. Nowadays she is in the fourth month of postoperative follow-up. There is still slight and almost indistinguishable exophthalmos, but her extrinsic eye movement ranges and reaction to light are normal.
OCS is a rare ophthalmologic emergency characterized by an acute rise in orbital pressure and may result in complete irreversible blindness if not rapidly treated. The frontotemporal or "pterional" craniotomy exposure requires a myocutaneous flap to be retracted anteriorly and inferiorly near the orbit. There may be orbital compression due to this flap leading to potential harmful complications. Attention to factors such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection may reduce the risk or allow faster management.
Clinical follow-up study for sphera duo ® hydrocephalus shunt.
Cerebral hydrodynamics complications in shunted patients are due to malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. Data were generated by reviewing 55 adult patient’s charts that were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. The result shows us that 85.4% of the patients improved the neurological symptoms and the reoperation rate was 12.5% in the first year after surgery.
Sensitivity and specificity of 'mini brain' image pattern to diagnose multiple myeloma and plasmacytoma.
“Mini brain” image pattern has been identified as a radiological sign for diagnosing multiple myeloma (MM) and solitary plasmacytomas in magnetic resonance imaging (MRI). However, there is still very little data on the frequency with which it can be observed, and its real diagnostic accuracy.
In this study, we present our case series, discuss sensitivity and specificity of “mini brain” in the diagnosis of multiple myeloma (MM)/plasmacytoma, and conduct a literature review.
The study sample consisted of asymptomatic and/or symptomatic patients consecutively diagnosed with expansive vertebral disease. Patients were evaluated with MRI. A literature review was conducted on the relationship of the radiological sign “mini brain” and the diagnosis of multiple myeloma (MM) or plasmacytoma.
Forty-seven patients were evaluated consecutively. Among five patients diagnosed with multiple myeloma, four had an MRI pattern of “mini brain”. The sensitivity of “mini brain” was 80%. The specificity was 97.6%. The accuracy was 95.8%. Sensitivity and specificity were 100% when we considered differential diagnoses only with neoplastic lesions involving the spine. Conclusions: “Mini brain” is a feasible and reliable sign for the diagnosis of multiple myeloma /plasmacytoma, guiding physicians for adequate screening and treatment. Nevertheless, it should not replace pathological investigation after vertebral biopsy. Level of Evidence III; Study of case: Case-control study.
Traumatic Lumbosacral Spondyloptosis in a Pediatric Patient: Case Report and Literature Review.
A 4-year-old girl was admitted to the emergency department after having been buried beneath a wall. A computed tomography scan revealed anterior grade V L5-S1 spondylolisthesis, and magnetic resonance imaging showed a traumatic rupture of the fibrous annulus of the L5-S1 intervertebral disc and lesion of the anterior longitudinal and yellow ligaments. The patient underwent anterior and posterior fixation. Four months later she was able to walk independently, despite a persistent left foot drop. Additionally, we conducted a literature review on lumbosacral spondyloptosis in the pediatric population published between 1990 and 2017. We found 16 cases, 86.6% of which were male, with a mean patient age of 16 ± 5.05 years. Most patients underwent spine instrumentation. Based on the data reviewed, the neurological status at admission might be a valid predictor of outcome. Pedicle screws are a safe and reliable procedure for stable fixation of the spine in these cases. The removal of screws is discouraged.
The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis.
Chiari malformation (CM) and basilar invagination (BI) are mesodermal malformations with disproportion between the content and volume of posterior fossa capacity and overcrowding of neural structures at the level of foramen magnum. Several alternatives for posterior approaches are available, including extradural (ED), extra-arachnoidal, and intradural (ID) approaches. The objectives are to evaluate the effect of several surgical techniques for posterior fossa decompression (PFD) in the outcomes of patients with CCJM and to evaluate complications in the techniques reported. A systematic review of the literature on the effects of PFD surgery was performed using the MEDLINE (via PubMed) database and the Cochrane Central Register of Controlled Trials. The PRISMA statement and MOOSE recommendations were followed. Five hundred and thirty-nine (539) articles were initially selected by publication title. After abstract analysis, 70 articles were selected for full-text analysis, and 43 were excluded. Ultimately, 27 studies were evaluated. The success rate (SR) with ED techniques was 0.76 versus 0.81 in EA technique and 0.83 in IA technique. All posterior fossa decompression techniques were very successful. Results from observational studies were similar to that of the randomized trial. The main complications were CSF fistulas, most common in patients with IA approach. The overall mortality rate was 1%.