1
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Bertonha CL, Bertonha LM, Telles SLR, Bertonha JM, Ferreira Neto IR, Acioly MA, Alves ÓL. Translaminar Full Endoscopic Technique with Tom Shidi Needles for Highly- and Dorsally-Migrated Lumbar Disc Herniations. World Neurosurg 2024; 181:6-12. [PMID: 37806520 DOI: 10.1016/j.wneu.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Thirty years have passed since Kambin's first clinical series of lumbar disc herniations (LDH) treated by arthroscopic microdiscectomy. Despite several advances in this interim, sequestrated LDHs over the dorsal aspect of the dura, and high-grade up- or downward disc migration have been a relative limitation of the transforaminal endoscopic technique. The interlaminar window was the next step to deal with such highly migrated LDHs. Favorable outcomes were obtained in 70-90% of the patients in the long-term, but recurrence rates remained high (approximately 12%), and the approach could be limited by the size of the interlaminar window. Few relevant studies have addressed the role of translaminar full endoscopic technique for migrated LDHs. To describe an innovative modification of the translaminar full endoscopic approach with Tom Shidi needles. METHODS This technical modification is presented in a detailed fashion for treating these challenging LDHs and illustrated through a clinical case. RESULTS The patient underwent successful translaminar full endoscopic technique with complete pain resolution postoperatively. The postprocedural course was uneventful. A follow-up imaging showed no evidence of residual LDHs fragments. CONCLUSIONS Translaminar full endoscopic technique with Tom Shidi needles is a promising modification of the previously presented interlaminar and translaminar endoscopic routes in the treatment of migrated LDHs to fasten surgical procedures and increase the safety of spinal canal manipulation.
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Affiliation(s)
- César Luiz Bertonha
- Division of Neurosurgery, Santa Tereza Hospital, Campinas, São Paulo, Brazil
| | | | | | - Juliana M Bertonha
- Division of Neurosurgery, Santa Tereza Hospital, Campinas, São Paulo, Brazil
| | | | - Marcus André Acioly
- Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil; Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - Óscar L Alves
- Department of Neurosurgery, Centro Hospitalar Gaia e Espinho, Porto, Portugal
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2
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Abstract
Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3-7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.
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Affiliation(s)
- Fernanda Bretas
- Division of Hand Surgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | - Gabriel Costa Serrão de Araújo
- Division of Hand Surgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | | | - Marcus André Acioly
- Division of Neurosurgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
- Division of Neurosurgery, Department of Surgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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3
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Pinto da Silva FH, Dos Santos Silva J, Pereira de Barros LF, Souza RDF, Landeiro JA, Rueda Lopes FC, da Silva MB, Fonseca GVDS, Acioly MA. Use of diffusion tensor imaging as a prognostic biomarker after decompression surgery for carpal tunnel syndrome. Acta Radiol 2023; 64:1109-1115. [PMID: 35876308 DOI: 10.1177/02841851221113518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the effect of CTS treatment on median nerve (MN) integrity and functional outcome prediction. PURPOSE To assess how structural changes in MR-DTI of the MN correlates with symptom severity, functional status, and electrophysiological parameters in patients suffering from CTS before and after decompression surgery. MATERIAL AND METHODS Nine wrists were prospectively enrolled to perform MR-DTI pre- and postoperatively. The apparent diffusion coefficients (ADC) and fractional anisotropy (FA) of the MN were examined in three different regions-distal radioulnar joint, pisiform bone, and hamate bone-and correlated with clinical and electrophysiological parameters. RESULTS Postoperatively, mean Boston Carpal Tunnel Questionnaire scores decreased 1.55 points (range = 0.08-3; P = 0.0172) and 1.01 points (-0.13 to 1.88; P = 0.0381) in the symptomatic and functional domains, respectively. Postoperative clinical improvement was reflected in proximal FA elevation (P = 0.0078), but not in diffusivity in comparison to baseline examination. Preoperative electrophysiological parameters were correlated with a reduction in the pre- (sensory latencies [rho = -0.6826; P = 0.0312]) and postoperative (motor latencies [rho = -0.7488; P = 0.0325]) distal FA values. Higher sensory amplitudes indicated higher postoperative proximal FA values (rho = 0.7618; P = 0.0280) and lower postoperative proximal ADC values (rho = -0.9047; P = 0.0020). CONCLUSION Our study demonstrated that pre- and postoperative proximal FA values are useful biomarkers for the structural evaluation of the MN in patients with CTS. Symptomatic improvement can be better predicted by analyzing FA changes.
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Affiliation(s)
- Fábio Henrique Pinto da Silva
- Division of Neurosurgery, 282806Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO)
| | | | | | - Renan de Freitas Souza
- Division of Neurosurgery, 219791Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | - José Alberto Landeiro
- Division of Neurosurgery, 219791Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | - Fernanda Cristina Rueda Lopes
- Division of Radiology, 455295DASA, Rio de Janeiro, Brazil
- Division of Radiology, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | | | | | - Marcus André Acioly
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO)
- Division of Neurosurgery, 219791Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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4
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Dos Santos Silva J, de Barros LFP, de Freitas Souza R, Mendonça SM, Costa FM, Landeiro JA, Lopes FCR, Acioly MA. "Million dollar nerve" magnetic resonance neurography: first normal and pathological findings. Eur Radiol 2021; 32:1154-1162. [PMID: 34363135 DOI: 10.1007/s00330-021-08213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate prospectively the feasibility of magnetic resonance neurography (MRN) in identifying the anatomical characteristics of thenar muscular branch (TMB) of the median nerve, also known as the "million dollar nerve," in patients and controls. METHODS Thirteen patients affected by carpal tunnel syndrome (CTS) and four healthy controls had their hands scanned on a 3-T MR imaging scanner for TMB visualization. Median nerve anatomical variations were classified into four groups according to Poisel's classification system modified by Lanz. TMB signal intensity and diameter were assessed for the diagnosis of neuropathy. RESULTS TMB was successfully identified in all patients and subjects by using MRN. The most suitable pulse sequences to identify and measure nerve diameter were 3D DW-PSIF and T2-FS-TSE. The axial oblique and sagittal oblique planes are complementary in demonstrating its entire course. TMB had mostly an extraligamentous course with radial side origin (93.8%, each). All patients experienced increased T2 signal intensity (p < 0.001) and thickened nerves. Mean TMB diameters were 1.27 ± 0.21 mm (range, 1.02-1.74 mm) and 0.87 ± 0.16 mm (0.73-1.08 mm) (p = 0.008) in the patient and control groups, respectively. CONCLUSION MRN is a reliable imaging technique for identification and anatomical characterization of TMB in patients affected by CTS. This innovative imaging workup may therefore be included in the preoperative evaluation of patients scheduled for carpal tunnel release, especially in CTS with TMB involvement or even in isolated TMB neuropathy. KEY POINTS • Magnetic resonance neurography allows precise visualization of the thenar muscular branch of the median nerve. • Thenar muscular branch anatomical variations can be correctly identified. • Preoperative scanning can contribute to reducing the risk of iatrogenic injuries during carpal tunnel release, especially in carpal tunnel syndrome with thenar muscular branch involvement or even in isolated thenar muscular branch neuropathy.
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Affiliation(s)
| | | | - Renan de Freitas Souza
- Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | | | - José Alberto Landeiro
- Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Fernanda Cristina Rueda Lopes
- Division of Radiology, DASA, Rio de Janeiro, Brazil.,Division of Radiology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Marcus André Acioly
- Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. .,Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
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5
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Gonçalves Pacheco Junior M, de Melo Junior JO, André Acioly M, Mansilla Cabrera Rodrigues R, Lima Pessôa B, Fernandes RA, Landeiro JA. Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts. Cureus 2021; 13:e14874. [PMID: 34104602 PMCID: PMC8179565 DOI: 10.7759/cureus.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon’s experience, should always be considered for surgical planning.
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6
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Chaves LDQ, Fonseca GVDS, da Silva FHP, Acioly MA. Osseous morphology of the medial epicondyle: an anatomoradiological study with potential clinical implications. Surg Radiol Anat 2021; 43:713-720. [PMID: 33420865 DOI: 10.1007/s00276-020-02669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The cubital tunnel is limited anteriorly by the medial epicondyle (ME), laterally by the medial collateral ligament, and superiorly by Osborne's fascia and the cubital tunnel retinaculum. Previous studies were mostly dedicated to the roof of the cubital tunnel, in the way that the study of the groove for ulnar nerve and ME anatomy is relatively scarce in the literature. We sought to describe the radiological anatomy of the groove for ulnar nerve and ME in healthy volunteers with multiplanar computed tomography (CT). METHODS We analyzed 3D CT images of 30 healthy volunteers (mean age 39 years, range 18-66 years). Nine variables were measured from the right elbow, including sizes, areas and angles in two different planes (coronal and axial). RESULTS Mean ME width and length were 17.3 ± 3.5 mm and 31.7 ± 4.5 mm, respectively. According to categorical correlation studies, ME width (X) was deemed the most representative morphological characteristic because of the positive correlation to five other different anatomical measurements. A three-tiered anatomical classification was proposed based on data distribution. CONCLUSION Large individual variation is found in the shape of ME, both in coronal and axial planes. The knowledge of individual osseous morphology is of great value potentially contributing to the surgical decision-making in patients affected by cubital tunnel syndrome.
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Affiliation(s)
- Lucas de Queiroz Chaves
- Division of Neurosurgery, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil.,Institute of Biomedical Research, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil.,Post-Graduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | - Fábio Henrique Pinto da Silva
- Division of Neurosurgery, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil.,Institute of Biomedical Research, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil
| | - Marcus André Acioly
- Institute of Biomedical Research, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil. .,Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. .,Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
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7
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Junior MGP, Junior MGP, Pessôa BL, André Acioly M, Pereira Escudeiro G, Cabrera Rodrigues RM, Abbud Fernandes R, Tavares Ribeiro R, dos Santos NQ, Alberto Landeiro J. Tailored Optic Unroofing for Type III Clinoidal Meningioma: Description of a Surgical Technique. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.12.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Anterior clinoidal meningiomas are heterogeneous types of lesions that comprise the
parasellar lesions group. Due to their close relationship with the optic nerve and internal carotid artery, they
become challenging pathologies for neurosurgeons.
Case Description: Female 47, presented with superior temporal quadrantanopsia on the right side. Magnetic
resonance image revealed type III clinoidal meningioma on the right side. She has undergone a pterional
craniotomy for an optic canal unroofing and tumor extraction. Two years of postoperative follow-up the
patient underwent a campimetry, which revealed an almost complete visual improvement.
Conclusion: To date, the best surgical technique has not yet been defined, so the choice of treatment and
surgical technique is based on each case and on the surgeons’ experience.
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8
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Watabe LT, Santos PVBD, Mendes FDA, Lima CRD, Acioly MA. Fibular Nerve Repair by Lateral Sural Cutaneous Nerve Graft: Anatomic Feasibility Study and Clinical Results. World Neurosurg 2020; 146:e537-e543. [PMID: 33130134 DOI: 10.1016/j.wneu.2020.10.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The common fibular nerve (CFN) is the most frequently injured nerve in the lower limbs. Surgical management is necessary in approximately two thirds of patients and includes neurolysis, suture, graft repair, or nerve transfer. The distal sural nerve is the preferred donor for grafting, but it is not without complications and requires a second incision. We sought to study the surgical anatomy of the lateral sural cutaneous nerve (LSCN) with the aim of repairing CFN injuries through the same incision and as a potential source for grafting in other nerve injuries. METHODS The popliteal fossa was dissected in 11 lower limbs of embalmed cadavers to study LSCN variations. Four patients with CFN injuries then underwent surgical repair by LSCN grafting using the same surgical approach. RESULTS At the medial margin of the biceps femoris, the LSCN emerged from the CFN approximately 8.15 cm above the fibular head. The LSCN ran longitudinally to the long axis of the popliteal fossa, with an average of 3.2 cm medial to the fibular head. The mean LSCN length and diameter were 9.61 cm and 3.6 mm, respectively. The LSCN could be harvested in all patients for grafting. The mean graft length was 4.4 cm. Motor function was consistently recovered for foot eversion but was recovered to a lesser extent for dorsiflexion and toe extension. All patients recovered sensitive function (75% of S3). Hypoesthesia was recognized at the calf. CONCLUSIONS LSCN harvest is a viable alternative for nerve grafting, especially for repairing short CFN injuries, thereby avoiding the need for a second incision.
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Affiliation(s)
- Larissa Thiene Watabe
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Fábio de Almeida Mendes
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Roberto de Lima
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcus André Acioly
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Division of Neurosurgery, Fluminense Federal University, Niterói-Rio de Janeiro, Brazil.
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9
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Chai CL, Pyeong Jeon J, Tsai YH, Whittaker P, Macdonald RL, Lindgren AE, Ayling OG, Acioly MA, Cohen-Gadol A, Huang YH. Endovascular Intervention Versus Surgery in Ruptured Intracranial Aneurysms in Equipoise. Stroke 2020; 51:1703-1711. [DOI: 10.1161/strokeaha.120.028798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The benefits of endovascular intervention over surgery in the treatment of ruptured aneurysms of anterior circulation remains uncertain. Recently, published studies did not find superiority of endovascular intervention, challenging earlier evidence from a clinical trial. The earlier evidence also had a higher than average proportion of patients in good clinical status, leading to uncertainty about external validity of earlier trials.
Methods—
We performed a systematic review of studies after 2005 under a protocol published in the International Prospective Register of Systematic Reviews. Primary outcomes were posttreatment rebleeding and adverse events (procedural complications). Secondary outcomes were dependency at 3 to 6 and 12 months, delayed cerebral ischemia, and seizures.
Results—
Rebleeding was more frequent after endovascular intervention (Peto OR, 2.18 [95% CI, 1.29–3.70]; 3104 participants; 15 studies; I
2
=0%, Grading of Recommendations, Assessment, Development and Evaluation: very low certainty of evidence). Fewer adverse events were reported with the endovascular intervention (RR, 0.71 [95% CI, 0.53–0.95]; 1661 participants; 11 studies; I
2
=14%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence). Three to six months dependency (RR, 0.82 [95% CI, 0.73–0.93]; 4081 participants; 18 studies; I
2
=15%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) and 12-month dependency (RR, 0.76 [95% CI, 0.66–0.86]; 1981 participants; 10 studies; I
2
=0%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) were lower after endovascular intervention.
Conclusions—
This study found consistent results between recent studies and the earlier evidence, in that endovascular intervention results in lower chance of dependency compared with surgery for repair of ruptured anterior circulation aneurysms. A lower proportion of patients in good clinical status in this review supports the application of the earlier evidence.
Registration—
URL:
https://www.crd.york.ac.uk/PROSPERO
. Unique identifier: CRD42018090396.
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Affiliation(s)
- Chung Liang Chai
- From the School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, United Kingdom (C.L.C., P.W.)
- Department of Neurosurgery, Yee Zen General Hospital, Taoyuan, Taiwan (C.L.C.)
| | - Jin Pyeong Jeon
- Institute of New Frontier Stroke Research, Chuncheon, Republic of Korea (J.P.J.)
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Republic of Korea (J.P.J.)
- Genetic and Research Incorporation, Chuncheon, Republic of Korea (J.P.J.)
| | - Yi-Hsin Tsai
- Neurointensive Care Unit, Division of Neurosurgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (Y.-H.T.)
| | - Paula Whittaker
- From the School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, United Kingdom (C.L.C., P.W.)
| | - R. Loch Macdonald
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, ON, Canada (R.L.M.)
| | - Antti E. Lindgren
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (A.E.L.)
| | - Oliver G.S. Ayling
- Division of Neurosurgery, The University of British Columbia, Vancouver, Canada (O.G.S.A.)
| | - Marcus André Acioly
- Universidade Federal Fluminense, Division of Neurosurgery, Rio de Janeiro, Brazil (M.A.A.)
- Universidade Federal do Rio de Janeiro, Brazil (M.A.A.)
| | - Aaron Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis (A.C.-G.)
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10
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Acioly MA, Shaikh KA, White IK, Ziemba-Davis M, Bohnstedt BN, Cohen-Gadol A. Predictors of Outcomes and Complications After Microsurgical and Endovascular Treatment of 1300 Intracranial Aneurysms. World Neurosurg 2019; 122:e516-e529. [PMID: 31108070 DOI: 10.1016/j.wneu.2018.10.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular expertise. METHODS From January 2005 to December 2011, 1297 consecutive patients presenting with ruptured (n=829) or unruptured (n=468) aneurysms were prospectively enrolled in our vascular database. The treatment modality was determined by consensus of the endovascular and microsurgical teams. The patients' medical and neurological conditions and aneurysm characteristics were compared against the postintervention complication rates and outcomes using multivariate analyses. RESULTS The patients mostly underwent clipping for ruptured (63.7%) or unruptured (56.6%) aneurysms. For ruptured aneurysms, higher Hunt and Hess and Fisher grades on admission were key predictors of increased neurological (P < 0.001 and P < 0.001, respectively) and medical (P < 0.001 and P=0.041, respectively) complication rates. No significant differences in the outcomes were observed between the coiling or clipping groups during the follow-up period. For the unruptured group, a family history of intracranial aneurysms was the most relevant predictor for reducing neurological complication rates and increasing survival at 6 months. Hypertension was, however, the strongest factor associated with complications negatively affecting the outcomes. CONCLUSIONS For the ruptured and unruptured groups both, the outcomes were generally good, although neurological and medical complications were reasonably more frequent for the ruptured aneurysms. Coiling provided a sustained benefit in lowering the complication rates only in the short term for the unruptured aneurysms. Smoking was associated, paradoxically, with improved outcomes.
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Affiliation(s)
- Marcus André Acioly
- Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Division of Neurosurgery, Fluminense Federal University, Niterói-Rio de Janeiro, Brazil
| | - Kashif A Shaikh
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Ian K White
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Mary Ziemba-Davis
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Bradley N Bohnstedt
- Department of Neurosurgery, Oklahoma University, Oklahoma City, Oklahoma, USA
| | - Aaron Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA.
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11
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Abstract
Brainstem gliomas are rare tumours in adults, accounting for only 1%-2% of all intracranial gliomas. They are recognised as a heterogeneous group, in which most are malignant tumours. Brainstem gliomas are classified into four major groups according to the growth pattern on imaging, namely diffuse, focal, exophytic and cervicomedullary. Such a classification system is also useful for surgical decision making. The exophytic variant is extremely rare having anecdoctal reports in the literature. We report the case of an adult patient affected by an exophytic glioblastoma of the pons, which was submitted to subtotal resection followed by radiation therapy and chemotherapy with a longer overall survival. To the best of our knowledge, this is the seventh adult patient reported of an exophytic brainstem glioblastoma.
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Affiliation(s)
- Marco Antonio Negreiros
- Departamento de Especialidades Cirúrgicas, Universidade Federal do Rio de Janeiro Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Fred Franklin Batista
- Departamento de Especialidades Cirúrgicas, Universidade Federal do Rio de Janeiro Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, Brazil
| | | | - Marcus André Acioly
- Departamento de Especialidades Cirúrgicas, Universidade Federal do Rio de Janeiro Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, Brazil.,Departamento de Especialidades Cirúrgicas, Universidade Federal Fluminense Faculdade de Medicina, Niteroi, Brazil
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12
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Vasconcelos RATD, Guimarães Coscarelli P, Vieira TM, Noguera WS, Rapozo DCM, Acioly MA. Prognostic significance of mast cell and microvascular densities in malignant peripheral nerve sheath tumor with and without neurofibromatosis type 1. Cancer Med 2019; 8:972-981. [PMID: 30735009 PMCID: PMC6434338 DOI: 10.1002/cam4.1977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rare and aggressive soft tissue sarcomas with a significant susceptibility to metastasize early in their course. Pathogenesis is yet to be fully elucidated. Recently, the essential role of mast cells in the tumor onset of neurofibromatosis type 1 (NF1)‐associated neurofibromas and MPNSTs was confirmed in both experimental and human studies. In this study, we investigate mast cell density (MCD), microvascular density (MVD), and proliferation index (Ki‐67) in MPNST. A secondary aim was to correlate histological staining to clinical data and survival in patients with and without NF1. In total, 34 formalin‐fixed paraffin‐embedded MPNST tissues from 29 patients were eligible. MCD, MVD, and Ki‐67 labeling index (LI) were analyzed in all stained tissues by a computer‐based quantitative algorithm (Aperio ImageScope). In addition, chart review was performed for clinical data and survival analysis. Overall, MCD, MVD, and Ki‐67 LI were evenly distributed throughout tumor tissue. There was a negative correlation of NF1 status (affected, P = 0.037), tumor size (>10 cm, P = 0.023), and MVD in the tumor periphery (higher tercile, P = 0.002) to survival. Multivariate analysis confirmed the association of MVD in the tumor periphery (higher tercile, P = 0.019) with a decreased overall survival. Diverse mast cell and microvascular distributions suggest that angiogenesis in MPNST occurs independently. The role of mast cells in tumor progression is unclear and lacks prognostic value. Higher MVD has prognostic significance with possible therapeutic implications in MPNST.
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Affiliation(s)
- Roberto André Torres de Vasconcelos
- Division of Bone and Connective Tissue, Department of Surgical Oncology, National Cancer Institute, Rio de Janeiro, Brazil.,Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Marcus André Acioly
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Amorim Correa JL, Acioly MA. The Enigma of Orbital Compartment Syndrome After Lumbar Spine Surgery in the Prone Position: Case Report and Literature Review. World Neurosurg 2018; 110:309-314. [DOI: 10.1016/j.wneu.2017.11.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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Freitas B, Figueiredo R, Carrerette F, Acioly MA. Retroperitoneoscopic Resection of a Lumbosacral Plexus Schwannoma: Case Report and Literature Review. J Neurol Surg A Cent Eur Neurosurg 2017; 79:262-267. [PMID: 29241265 DOI: 10.1055/s-0037-1608814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Schwannomas are benign tumors derived from the Schwann cells of the peripheral nerve sheath that rarely affect the retroperitoneum. When symptomatic, surgical resection is usually recommended via open surgery or the laparoscopic transperitoneal approach. We discuss the retroperitoneoscopic resection of lumbosacral plexus schwannomas through an illustrative case and literature review. A new management classification is also proposed. PATIENTS A 61-year-old woman affected by schwannomatosis presented with neuropathic pain in her right inguinocrural area for the past 4 years before admission. Preoperative imaging revealed a 2-cm right retroperitoneal tumor lateral to the psoas muscle. The diagnosis of a schwannoma of the ilioinguinal nerve was then suggested. The patient underwent complete tumor resection through retroperitoneoscopy, and no recurrence was observed over the long term. A review of the relevant literature revealed that surgical strategy depends on tumor location, and therefore patients are divided into three groups by tumor position to guide trocar placement: type 1 (paravertebral or over the psoas muscle), type 2 (lateral to the psoas muscle), and type 3 (sacral or pelvic). RESULTS Four patients were classified as type 1, one as type 2, and three as type 3, thereby guiding trocar placement to a lateral, anterior, or inferior montage, respectively. CONCLUSIONS Retroperitoneoscopy is a minimally invasive technique that offers some potential advantages in approaching retroperitoneal masses. This new classification is useful to group patients and thus provide guidance on the best retroperitoneoscopic surgical strategy.
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Affiliation(s)
- Bruno Freitas
- Division of Neurosurgery, Department of Surgery, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Rui Figueiredo
- Division of Urology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabrício Carrerette
- Division of Urology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcus André Acioly
- Division of Neurosurgery, Department of Surgery, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
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Salomão R, Canêdo NHS, Abrão GP, Lima C, Acioly MA. Foix-Alajouanine syndrome mimicking a spinal cord tumor. Rev Assoc Med Bras (1992) 2017; 63:564-565. [PMID: 28977080 DOI: 10.1590/1806-9282.63.07.564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 03/01/2017] [Indexed: 11/22/2022] Open
Abstract
Subacute necrotizing myelopathy (SNM) or Foix-Alajouanine syndrome is a rare disease characterized by progressive neurological dysfunction caused by a spinal dural arteriovenous fistula (AVF). Radiological diagnosis is usually suspected when there is intramedullary nonspecific enhancement and perimedullary flow voids. Ring-enhancement is rarely reported in the scope of AVF, which poses a diagnostic challenge and raises the suspicion of a spinal cord tumor. In such situations, biopsy can be required and delay proper diagnosis. We report the case of a patient with SNM, who underwent biopsy on the assumption of it being a spinal cord tumor.
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Affiliation(s)
- Renan Salomão
- Division of Neurosurgery, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Guilherme P Abrão
- Division of Neuroradiology, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Carlos Lima
- Division of Neurosurgery, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Marcus André Acioly
- Division of Neurosurgery, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Division of Neurosurgery, UFF, Niterói, RJ, Brazil
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Vasconcelos RATD, Coscarelli PG, Alvarenga RP, Acioly MA. Malignant peripheral nerve sheath tumor with and without neurofibromatosis type 1. Arq Neuro-Psiquiatr 2017; 75:366-371. [DOI: 10.1590/0004-282x20170052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/14/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective In this study, we review the institution’s experience in treating malignant peripheral nerve sheath tumors (MPNSTs). A secondary aim was to compare outcomes between MPNSTs with and without neurofibromatosis type 1 (NF1). Methods Ninety-two patients with MPNSTs, over a period of 20 years, were reviewed. A retrospective chart review was performed. The median age was 43.5 years (range, 3–84 years) and 55.4% were female; 41 patients (44.6%) had NF1-associated tumors. Results Mean tumor sizes were 15.8 ± 8.2 cm and 10.8 ± 6.3 cm for patients with and without NF1, respectively. Combined two- and five-year overall survival was 48.5% and 29%. Multivariate analysis confirmed the association of tumor size greater than 10 cm (hazard ratio (HR) 2.99; 95% confidence interval (CI) 1.14–7.85; p = 0.0258) and presence of NF1 (HR 3.41; 95%CI 1.88–6.19; p < 0.001) with a decreased overall survival. Conclusion Tumor size and NF1 status were the most important predictors of overall survival in our population.
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Affiliation(s)
| | | | | | - Marcus André Acioly
- Universidade Federal do Estado do Rio de Janeiro, Brasil; Universidade Federal do Rio de Janeiro, Brasil; Universidade Federal Fluminense, Brasil
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Acioly MA, Soares AM, Almeida MLD, Barbosa R, Daxbacher E, Carvalho CH. Modified simple decompression in the treatment of cubital tunnel syndrome: avoiding ulnar nerve subluxation. Arq Neuropsiquiatr 2017; 75:238-243. [PMID: 28489144 DOI: 10.1590/0004-282x20170023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/30/2016] [Indexed: 11/21/2022]
Abstract
Objective In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. Methods Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. Results The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. Conclusion This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.
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Affiliation(s)
- Marcus André Acioly
- Universidade Estadual do Rio de Janeiro, Disciplina de Neurocirurgia, Rio de Janeiro RJ, Brasil.,Universidade Federal do Rio de Janeiro, Disciplina de Neurocirurgia, Rio de Janeiro RJ, Brasil
| | - Amanda Mendes Soares
- Universidade Federal do Rio de Janeiro, Disciplina de Neurocirurgia, Rio de Janeiro RJ, Brasil
| | | | - Renata Barbosa
- Universidade Estadual do Rio de Janeiro, Disciplina de Dermatologia, Rio de Janeiro RJ, Brasil
| | - Egon Daxbacher
- Universidade Estadual do Rio de Janeiro, Disciplina de Dermatologia, Rio de Janeiro RJ, Brasil
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Portella ST, Acioly MA. The course of Modic vertebral body changes after posterolateral lumbar fusion on fused and adjacent levels: A systematic review of the literature. J Clin Neurosci 2017; 41:6-10. [PMID: 28431955 DOI: 10.1016/j.jocn.2017.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
According to the original description by Modic et al., the natural course of bone marrow signal abnormalities is an inexorable, progressive one, however recent evidence has demonstrated in healthy individuals and those suffering from lumbar disc herniation that the course of endplate degenerative changes is rather dynamic and sometimes regressive. The evolution of such changes in lumbar fused segments and adjacent levels is largely unknown. The literature relevant to the course of Modic changes on fused and adjacent levels, as well as its clinical correspondence in patients undergoing posterolateral lumbar fusion was collected. Two studies met the criteria. Of 38 patients with Modic type I signals preoperatively, 6 regressed to type 0, 22 progressed to type 2, and 10 remained the same postoperatively. Of 12 patients with Modic type 2 signals preoperatively, 2 regressed to type 0 and 10 remained the same postoperatively. None of the articles described the Modic changes in adjacent levels. Clinical and functional outcomes were significantly improved at follow-up regardless of the endplate signal changes. The best available evidence points out to a reduction in Modic type I frequency on fused segments, either regressive or progressive. There was a predominance of new type II changes in postoperative images, which might represent improvement of instability. This study calls into attention the controversial role of Modic changes as an indicator of clinical significance, since clinical and functional outcomes significantly improved regardless of the endplate signal changes.
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Affiliation(s)
- Stella Taylor Portella
- Post-graduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; Division of Emergency - Armed Forces Hospital, Brasília, Brazil.
| | - Marcus André Acioly
- Post-graduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Constantino ER, Leal R, Ferreira CC, Acioly MA, Landeiro JA. Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications. Arq Neuro-Psiquiatr 2016; 74:388-95. [DOI: 10.1590/0004-282x20160042] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/17/2016] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications. Method The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014. Results The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%), new pituitary deficit (35.7%), endonasal adhesions (21.4%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 7.1%. Conclusions Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.
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Ugarte ON, Acioly MA. The principle of autonomy in Brazil: one needs to discuss it ... Rev Col Bras Cir 2014; 41:374-7. [PMID: 25467104 DOI: 10.1590/0100-69912014005013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 05/06/2014] [Indexed: 11/22/2022] Open
Abstract
The principle of patient autonomy is a cornerstone of bioethics. According to this concept, patients should be given the power to make decisions related to their treatment. It is an important component of modern medical ethics, which has received much interest in current literature. However, the rate of participation of patients and their willingness to participate are variable according to the cultural, social and family environments in which they are inserted. The aim of this paper is to promote a brief descriptive review on autonomy, the preferences of patients and the use of informed consent as an instrument for the exercise of autonomy in literature, and to stress the lack of debate, as well as the pressing need for discussion of these current issues nationwide.
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Parise M, Acioly MA, Vincent M, Gasparetto EL. Decision-making in classic trigeminal neuralgia concurrent with a pontine cavernous malformation: Causal or coincidental association? Neurocirugia (Astur) 2014; 26:90-4. [PMID: 25450011 DOI: 10.1016/j.neucir.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/16/2014] [Accepted: 09/06/2014] [Indexed: 01/03/2023]
Abstract
Trigeminal neuralgia is classically associated with neurovascular compression of the trigeminal nerve, at the root entry zone (REZ). However, patients are occasionally affected by intra-axial involvement of trigeminal sensory fibers caused by demyelinating diseases, strokes and, rarely, pontine cavernous malformations. We discuss the management strategies and decision-making process in a 55-year-old patient, affected by trigeminal neuralgia with 2 potential causative mechanisms: a neurovascular conflict at the trigeminal REZ and an ipsilateral cavernous malformation at the pontine nucleus of the trigeminal nerve.
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Affiliation(s)
- Maud Parise
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Surgical Specialties, Division of Neurosurgery, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Marcus André Acioly
- Department of Surgical Specialties, Division of Neurosurgery, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maurice Vincent
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Neurology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Uygur S, Andrade MCD, Brum CDAI, Monerat ALC, Landeiro JA, Acioly MA. Lhermitte-Duclos disease. Arq Neuropsiquiatr 2014; 72:392-3. [PMID: 24863518 DOI: 10.1590/0004-282x20140026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/14/2014] [Indexed: 11/21/2022]
Affiliation(s)
- Sayg Uygur
- Divisão de Neurocirurgia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Marina Coelho de Andrade
- Divisão de Neurocirurgia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Carolina de Almeida Ito Brum
- Departamento de patologia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Andrea Lima Cruz Monerat
- Departamento de patologia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - José Alberto Landeiro
- Divisão de Neurocirurgia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Marcus André Acioly
- Divisão de Neurocirurgia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Acioly MA, Liebsch M, de Aguiar PHP, Tatagiba M. Facial Nerve Monitoring During Cerebellopontine Angle and Skull Base Tumor Surgery: A Systematic Review from Description to Current Success on Function Prediction. World Neurosurg 2013; 80:e271-300. [DOI: 10.1016/j.wneu.2011.09.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 09/06/2011] [Indexed: 11/17/2022]
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Acioly MA, Maior PS, Telles C, de Aguiar GB. Bilateral mini-open decompression in the treatment of carpal tunnel syndrome caused by persistent median artery: case report. J Neurol Surg A Cent Eur Neurosurg 2013; 74 Suppl 1:e124-7. [PMID: 23504667 DOI: 10.1055/s-0032-1328959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy that is caused by increased pressure within the carpal tunnel resulting in a chronic process of median nerve ischemia and segmental demyelination. We report on a patient with bilateral patent persistent median artery (PMA) affected by typical symptomatic CTS who was treated by bilateral mini-open decompression with complete improvement. For PMA-associated CTS, standard decompression is considered the treatment of choice, whereas resection should be reserved for pathological PMA. Mini-open decompression can be an alternative, as we have verified in this first description.
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Affiliation(s)
- Marcus André Acioly
- Division of Neurosurgery, Department of Surgical Specialties, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paolo Souto Maior
- Division of Neurosurgery, Department of Surgical Specialties, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Telles
- Division of Neurosurgery, Department of Surgical Specialties, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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de Oliveira Barbosa MD, de Bellis T, Pousa MS, da Silva RSC, Garcia FA, Acioly MA. Treatment strategy in a child with a retained bullet in the cerebellomedullary cistern. J Neurosurg Pediatr 2012; 10:192-4. [PMID: 22793164 DOI: 10.3171/2012.5.peds1239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 6-year-old girl was admitted to our emergency room because of a gunshot wound in the posterior craniocervical junction. On admission, she was alert, but left hemiplegia and right hemiparesis were noted. Cranial CT scanning showed a retained bullet in the cerebellomedullary cistern without bone destruction. Moreover, fourth ventricle hemorrhage was observed. There were no signs of acute hydrocephalus. The patient underwent suboccipital craniectomy and C-1 laminectomy for bullet removal. Postoperatively, the patient experienced significant neurological improvement. To the best of the authors' knowledge, this is the first documented case of a patient with a retained bullet in the cerebellomedullary cistern. The management strategies in such a unique case are discussed.
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Abstract
A 58-year-old man with clinical diagnosis of phacomatosis pigmentovascularis (PPV) experienced tinnitus and progressive hearing loss due to a jugular foramen tumor.Attached to the tumor capsule, were several pigmented spots. Pathological examination revealed a tumor composed by two different tissues, namely a Schwannoma grade I associated with a leptomeningeal blue nevus. The neuropathological aspects of this unusual association are discussed. The association of PPV with a pigmented skull base tumor has not been described to date and illustrates the importance of systemic examination in PPV.
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Acioly MA, Farina EM, Dalmônico AC, Aguiar LR. Severe Cerebral Vasculitis in Systemic Lupus Erythematosus: From Stroke to Multiple Fusiform Aneurysms. Eur Neurol 2012; 67:352-3. [DOI: 10.1159/000336570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 01/16/2012] [Indexed: 11/19/2022]
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Acioly MA, de Aguiar PHP, Tatagiba M. Continuous monitoring of evoked facial nerve electromyograms: a new device for an old concept. Acta Neurochir (Wien) 2011; 153:2271-2; author reply 2273-4. [PMID: 21809001 DOI: 10.1007/s00701-011-1103-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
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de Oliveira Barbosa MD, da Silva RSC, Garcia FA, Acioly MA. Lumbar mass as the presentation form of a tuberculous spondylodiscitis. Arq Neuropsiquiatr 2011; 69:725. [PMID: 21877054 DOI: 10.1590/s0004-282x2011000500033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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de Aguiar GB, Mizrahi C, Aquino JHW, Tavares CM, Telles C, Nigri F, Acioly MA. Urethral extrusion of a peritoneal catheter in a patient with a neobladder: a rare complication of shunt insertion. Neuropediatrics 2011; 42:124-7. [PMID: 21735369 DOI: 10.1055/s-0031-1283109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The insertion of a ventriculoperitoneal shunt (VPS) is considered the standard of care for several forms of hydrocephalus. Abdominal complications are most common with this procedure, comprising up to 30% of all shunt-related problems. Conversely, visceral perforation or extrusion of the shunt apparatus is rare. Herein we report a rare complication of VPS insertion in which the peritoneal catheter was spontaneously extruded through the urethra of a patient with a neobladder. We further discuss the pathogenesis, diagnosis, and treatment of this condition.
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Affiliation(s)
- G B de Aguiar
- State University of Rio de Janeiro, Department of Surgical Specialties, Division of Neurosurgery, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
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Acioly MA, Carvalho CH, Tatagiba M, Gharabaghi A. The parahippocampal gyrus as a multimodal association area in psychosis. J Clin Neurosci 2011; 17:1603-5. [PMID: 20817470 DOI: 10.1016/j.jocn.2010.03.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/16/2010] [Accepted: 03/17/2010] [Indexed: 11/30/2022]
Abstract
Temporal lobe lesions may lead to schizophrenia-like psychosis, a phenomenon resembling psychotic disorders such as schizophrenia. We discuss a patient with a temporo-basal low-grade glioma presenting with bimodal hallucinosis (visual and auditory), a symptom set that is rarely described in psychotic disorders associated with morphological correlates. In light of a literature review of patients experiencing similar bimodal psychotic symptoms and electrophysiological data obtained in non-human primates, we suggest the parahippocampal gyrus to be a multimodal association area with bimodal units.
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Affiliation(s)
- Marcus André Acioly
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
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Becco de Souza R, Brasileiro de Aguiar G, Sette Dos Santos ME, Acioly MA. Retroclival epidural hematoma in a child affected by whiplash cervical injury: a typical case of a rare condition. Pediatr Neurosurg 2011; 47:288-91. [PMID: 22310377 DOI: 10.1159/000335446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/24/2011] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Rodrigo Becco de Souza
- Division of Neurosurgery, Santa Marcelina de Itaquaquecetuba Hospital, São Paulo, Brazil
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Acioly MA, Carvalho CH, Koerbel A, Heckl S, Tatagiba M, Gharabaghi A. The role of the trigeminocardiac reflex in postoperative hearing function in non-vestibular schwannoma cerebellopontine angle tumors. J Clin Neurosci 2010; 18:237-40. [PMID: 21163655 DOI: 10.1016/j.jocn.2010.03.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 03/19/2010] [Accepted: 03/23/2010] [Indexed: 11/30/2022]
Abstract
The trigeminocardiac reflex (TCR) is a common event during skull base surgery that can lead to intraoperative arterial hypotension and bradycardia. Arterial hypotension associated with TCR can be a negative prognostic factor for postoperative auditory function and ipsilateral tinnitus in patients undergoing surgery for vestibular schwannoma (VS). In this study, the contribution of TCR to postoperative auditory function in non-VS cerebellopontine angle (CPA) tumor surgery was investigated. From a consecutive series of 102 patients with CPA tumors, we studied the occurrence of TCR and its influence on postoperative auditory function in patients with non-VS tumors. Pre- and postoperative auditory function, pre- and intraoperative mean arterial blood pressure, as well as preoperative medication, tumor size, and occurrence of TCR were evaluated. Of the 35 patients evaluated, four developed intraoperative TCR, of whom one was preoperatively deaf. Preoperative functional hearing was detected in 30/35 patients (85.7%): preoperative deafness was documented in one patient in the TCR group and in four patients in the non-TCR group. Of the 30 patients with preoperative functional hearing, 1/3 (33.3%) patients in the TCR group and 23/27 (85.2%) patients in the non-TCR group had functional hearing postoperatively. When patients with large tumors and functional, hearing were considered, only 33.3% of patients in the TCR group and 77.8% of patients in the non-TCR group remained within the same hearing classes following surgical treatment (p=0.1573). TCR may be a negative prognostic factor for postoperative auditory function in patients with large, non-VS CPA tumors.
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Affiliation(s)
- Marcus André Acioly
- Department of Neurosurgery, Eberhard Karls University Hospital, Hoppe-Seyler Strasse 3, D-72076 Tübingen, Germany
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Batista LM, Carvalho CH, Acioly MA, Gharabaghi A, Ramina KF, Schittenhelm J, Tatagiba M. Spinal metastasis of endometrial stromal sarcoma: clinicopathological features and management. Surg Oncol 2010; 20:e78-83. [PMID: 21071207 DOI: 10.1016/j.suronc.2010.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 10/16/2010] [Accepted: 10/18/2010] [Indexed: 10/24/2022]
Abstract
BACKGROUND Endometrial Stromal Sarcoma (ESS) is a rare uterine malignancy which often metastasizes several years after initial diagnosis. Thoracic spine is a rare ESS metastatic site and its proper management is still not a consensus. We discuss the histopathological features and the management strategies through an illustrative case of a 77 year-old woman with metastasis to the thoracic spine 13 years after total hysterectomy for ESS. METHODS Review of the literature and identification of 5 patients, including our present case, with ESS involving the spinal cord. We discuss the outcomes achieved after each therapy. In our case, the patient presented a mass involving the thoracic spinal canal constricting the spinal cord at T7 level. A two-level decompression laminectomy was performed and the lesion was partially excised. RESULTS The histopathological along with the immunohistochemical profile mitotic rate indicated the endometrial stromal cells origin of the tumor, confirming the diagnosis of a low-grade ESS metastasis. The patient was managed with surgery in combination with postoperative radiation therapy. CONCLUSIONS The small number of published cases precludes definitive conclusions regarding standard management. However, it seems that treatment of metastatic ESS to the spine matches the same general concepts of spine metastasis, namely surgery followed by radiation therapy, due to clinical improvement and long-term disease control of the reported cases. Hormonal therapy may be considered in recurrent disease with strong expression of estrogen and progesterone receptors. However, these findings need confirmation in larger studies.
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Affiliation(s)
- Leonardo Moura Batista
- Department of Neurosurgery, University of Tübingen, Eberhard Karls University Hospital, Hoppe-Seyler-Strasse 3, D-72076 Tübingen, Germany.
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Acioly MA, Liebsch M, Carvalho CH, Gharabaghi A, Tatagiba M. Transcranial Electrocortical Stimulation to Monitor the Facial Nerve Motor Function During Cerebellopontine Angle Surgery. Oper Neurosurg (Hagerstown) 2010; 66:354-61; discussion 362. [DOI: 10.1227/01.neu.0000369654.41677.b7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
This study was conducted to investigate the success rate of using the facial motor evoked potential (FMEP) of orbicularis oculi and oris muscles for facial nerve function monitoring with use of a stepwise protocol, and its usefulness in predicting facial nerve outcome during cerebellopontine angle (CPA) surgeries.
METHODS
FMEPs were recorded intraoperatively from 60 patients undergoing CPA surgeries. Transcranial electrocortical stimulation (TES) was performed using corkscrew electrodes positioned at hemispheric montage (C3/C4 and CZ). The contralateral abductor pollicis brevis muscle was used as the control response. Stimulation was always applied contralaterally to the affected side using 1, 3, or 5 rectangular pulses ranging from 200 to 600 V with 50 μs of pulse duration and an interstimulus interval of 2 ms. Facial potentials were recorded from needles placed in the orbicularis oculi and oris muscles.
RESULTS
FMEP from the orbicularis oris and oculi muscles could be reliably monitored in 86.7% and 85% of the patients, respectively. The immediate postoperative facial function correlated significantly with the FMEP ratio in the orbicularis oculi muscle at 80% amplitude ratio (P = .037) and orbicularis oris muscle at 35% ratio (P = .000). FMEP loss was always related to postoperative facial paresis, although in different degrees.
CONCLUSION
FMEPs can be obtained reliably by using TES with 3 to 5 train pulses. Stable intraoperative FMEPs can predict a good postoperative outcome of facial function. However, further refinements of this technique are necessary to minimize artifacts and to make this method more reliable.
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Affiliation(s)
- Marcus André Acioly
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany, and Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Marina Liebsch
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | | | | | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
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Abstract
Endoscopic third ventriculostomy (ETV) has been established as an effective method in the treatment of tumoral obstructive hydrocephalus. Delayed closure of the ETV stoma has been attributed to scarring involving the third ventricular floor. Secondary obstruction of the stoma due to intraventricular tumor seeding is an extremely rare condition, with only one case described to date. The authors report on a unique case of late closure of the ETV stoma caused by metastatic seeding of a recurrent medulloblastoma 9 years after the initial treatment. The patient was submitted to a second endoscopic procedure in which a reddish mass located just at the third ventricular floor was resected, leading to reopening of the previous ETV stoma. To the best of the authors' knowledge, this case is the first report of an ETV obstruction due to metastatic CSF seeding of a medulloblastoma. In such cases of late failure of the ETV stoma because of tumor obstruction, a second ETV can be safely performed and lead to adequate function of the stoma, even if limited by the aggressive nature of the disease.
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Affiliation(s)
- Flávio Nigri
- Department of Surgical Specialties, Division of Neurosurgery, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil.
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Acioly MA, Carvalho CH, Pinheiro-Franco JL, Schittenhelm J, Ernemann U, Weller M, Honegger J. Unusual presentation of central nervous system metastases: mechanisms of spread and radiological findings. Arq Neuropsiquiatr 2008; 66:755-7. [PMID: 18949279 DOI: 10.1590/s0004-282x2008000500031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Moura Batista L, Acioly MA, Carvalho CH, Ebner FH, Tatagiba M. Cystic lesion of the ventriculus terminalis: proposal for a new clinical classification. J Neurosurg Spine 2008; 8:163-8. [PMID: 18248288 DOI: 10.3171/spi/2008/8/2/163] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The ventriculus terminalis is a small cavity inside the conus medullaris that is formed during the embryonic development. Previous reports regarding cystic lesion of the ventriculus terminalis (CLVT) in adults have detailed a broad and diversified distribution in terms of clinical symptoms, clinical evolution, neurological findings, and treatment. Therefore, nonstandardized management has led to unsatisfactory outcomes. Thus, the authors propose a new classification system in which the clinical presentation is taken into account to standardize the cases and facilitate the proper management of these lesions. Two more cases are described. The literature was reviewed, dividing the patients into 3 groups by clinical presentation as follows: CLVT Type I, patients with nonspecific neurological symptoms or nonspecific complaints; CLVT Type II, presence of focal neurological deficit; and CLVT Type III, presence of sphincter disturbances (bowel or bladder dysfunction). Two patients were classified as CLVT Type I, 3 as CLVT Type II, and 12 as CLVT Type III. In Type I, no improvement was observed in clinical evaluation after surgery, and stable symptoms were achieved with clinical management. In Type II, 2 patients had total improvement and 1 had subtotal improvement after surgery. Finally, in Type III, 92% of the patients improved postoperatively; among these 33% presented with total improvement. Only 1 case in this group was handled conservatively and no improvement was documented. This new classification is useful to group the patients into 3 clinical types to provide guidance as to the best management options. Treatment for the Type I lesion seems to be best conducted conservatively, whereas Types II and III seem to be best handled surgically.
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Carvalho CHA, Acioly MA, Will B, Tatagiba M. Magnetic resonance angiography of a complex occipital meningoencephalocele involving the confluence of sinuses. Case illustration. J Neurosurg Pediatr 2008; 1:261. [PMID: 18352775 DOI: 10.3171/ped/2008/1/3/261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Carlos H A Carvalho
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany.
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Gharabaghi A, Acioly MA, Koerbel A, Tatagiba M. Prognostic factors for hearing loss following the trigeminocardiac reflex. Acta Neurochir (Wien) 2007; 149:737; author reply 737-8. [PMID: 17604993 DOI: 10.1007/s00701-007-1175-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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