To compare the survival of glioblastoma multiforme (GBM) patients operated on at public hospital ... more To compare the survival of glioblastoma multiforme (GBM) patients operated on at public hospital with that of patients operated on at the private hospitals. We carried out a retrospective analysis of the patients' medical records, the surgical reports and the pre- and post-operative images of patients with a histopathological confirmed adult supratentorial GBM. Sixty-three patients were treated at public hospital and twenty-one at private hospitals. The present study revealed that the survival of patients treated in private hospitals was statistically superior to that of patients treated in public hospitals (11.9 vs. 7.7). Our study advances towards the confirmation of the hypothesis that socioeconomic and educational factors influence the Karnofsky Performance Score (KPS) and the performance of radiotherapy treatment, with negative effects over the GBM patients' survival.
Many recent series of surgery for intracranial aneurysms have been based on experience of develop... more Many recent series of surgery for intracranial aneurysms have been based on experience of developed countries with great resources and a state of art health care. The purpose of the current study is to correlate the outcome of patients operated for intracranial aneurysms. reported from intensive high technology neurosurgical centers with the results of low technology, environment, where we practice. Between January 1986 and December 1996, 337 patients with intracranial aneurysms were operated on at the Servidores do Estado Hospital. We retrospectively reviewed the medical and radiologic records and compared the outcome of this group with other series derived from developed countries. The overall mortality of this series was 6.9%. Of the 313 good grades surgical patients, the mortality was 4.7% and the sucessfull results were obtained in 88.8% individuals. We conclude that patients harboring intracranial aneurysms can be satisfactory handled in less developed nations, if a meticulous...
A hemorragia intracraniana que acontece na gravidez é um fenômeno raro, porém, apresenta mortalid... more A hemorragia intracraniana que acontece na gravidez é um fenômeno raro, porém, apresenta mortalidade e morbidades elevadas. Analisamos 15 pacientes com hemorragia intracraniana que ocorreu durante a gravidez ou puerpério. Em cinco casos a hemorragia decorria da ruptura de aneurisma, em 6, de malformação. A mortalidade materna foi 20%, e a fetal 33%. Quando a causa do sangramento é proveniente de ruptura de um aneurisma, deve-se realizar a oclusão cirúrgica do aneurisma durante a gravidez o que aconteceu em 4 pacientes desta série. Entretanto, se a hemorragia decorre de uma malformação arteriovenosa, o melhor tratamento ainda não está estabelecido.
Low-grade supratentorial astrocytomas and oligodendrogliomas in adults are uncommon tumors of the... more Low-grade supratentorial astrocytomas and oligodendrogliomas in adults are uncommon tumors of the central nervous system. We analyzed retrospectively 23 patients with this type of neoplasia, who were operated on between 1986 and 2002. There were no post-operative deaths. The survival rate at 5 and 10 years post-surgery for the entire sample was 67 and 30% respectively, similar to other outcomes. With 14 patients we achieved a complete removal of the lesion (60.8%) and with 9 (39.2%) partial removal of the tumor. In the sub-group which underwent total resection of the tumor, 89% survived 5 years and 45% attained 10 years of survival, in contrast with the sub-group that underwent partial removal in which only 35% attained 5 years of survival and none 10 years. Due to the deleterious effects of radiation therapy, we preferred to prescribe it only in cases of tumor recurrence.
Journal of Neurological Surgery Part B: Skull Base
Background The purpose of this article is to describe our approach, surgical strategies, and resu... more Background The purpose of this article is to describe our approach, surgical strategies, and results for resection of meningiomas located at cerebellopontine angle (CPA). Methods We retrospectively identified 28 patients with CPA meningiomas operated by the extended retrosigmoid approach. This approach incorporates a generous mastoidectomy and the sigmoid sinus exposure. Results The mean age was 33.8 years, with a follow-up of 12.5 years. Gross total removal (GTR) was achieved in 22 (78.5%) patients with low surgical mortality, acceptable morbidity, and recurrence rate of 7.1% (2 patients). Conclusion The extended retrosigmoid approach enhances the exposure of the CPA and posterior fossa cisterns and increases the surgical angle of maneuverability. This approach provides adequate access even to extensive CPA meningiomas, enabling, in most of cases, GTR to be safe and effective. The extended retrosigmoid approach used in this group of patients is an alternative to more extensive cran...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Objective To describe our surgical techniques, analyze their safety and their postoperative outco... more Objective To describe our surgical techniques, analyze their safety and their postoperative outcomes for foramen magnum tumors (FMTs). Methods From 1986 to 2014, 34 patients with FMTs underwent surgeries using either the lateral suboccipital approach, standard midline suboccipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions. Results In the present series, there were 22 (64.7%) female and 12 (35.2%) male patients. The age of the patients ranged from 12 to 63 years old. We observed 1 operative mortality (2.9%). A total of 28 patients (82.3%) achieved a score of 4 or 5 in the Glasgow Outcome Scale (GOS). Gross total resection (GTR) was obtained in 22 (64.7%) patients. After the surgery, 9 (26%) patients developed lower cranial nerve dysfunction (LCNd) weakness. The follow-up varied from 1 to 24 years (mean: 13.2 years). Conclusion The majority of tumors located in the FM can be safely and efficiently removed using either the lateral sub oc...
Objectives: Glioblastoma multiforme (GBM) has the highest malignancy grade in the astrocitic tumo... more Objectives: Glioblastoma multiforme (GBM) has the highest malignancy grade in the astrocitic tumor group besides being the most common central nervous system tumor in adults. This paper aims to evaluate if the following factors: age, Karnofski Performance Status (KPS), extension of surgical removal, radiotherapy (RT), tumor volume and symptoms duration influenced the survival. Methods: We performed a retrospective analysis of GBM operated on at Hospital dos Servidores do Estado between 1986 and 2008. Results: We could observe that age, KPS and radiotherapy influenced the survival of patients. The other variables studied didnot have any prognostic implications. Conclusions: Despite many researches and several improvements regarding diagnosis and surgical techniques, the survivalof patients presenting with GBM could not be changed in the last 30 years. Surgical resection followed by RT is the standard treatment for patients with GBM. The importance of each prognostic factor is still t...
Journal of Neurological Surgery Part B: Skull Base
Background To describe our operative strategy and analyze its safety and effectiveness for the re... more Background To describe our operative strategy and analyze its safety and effectiveness for the removal of medial sphenoid wing meningiomas (MSWMs) through the extended pterional approach. Method We identified 47 patients with MSWMs who were operated using this approach between 1986 and 2016. Medical charts, operative reports, imaging results, and clinical follow-up evaluations were reviewed and retrospectively analyzed. Results No surgical mortality was observed in this sample. Gross total resection was achieved in 30 (63.8%) patients. Intradural clinoidectomy was performed in 16 (34%) patients. The median length of follow-up was 8.5 years (range, 1–30 years). Conclusion The extended pterional approach associated with microsurgery techniques provided excellent results for the removal of MSWMs.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Resumo Objetivo: Analisar 17 casos de tumores epidermóides e dermóides do neuroeixo tratados nos ... more Resumo Objetivo: Analisar 17 casos de tumores epidermóides e dermóides do neuroeixo tratados nos últimos 20 anos no Hospital dos Servidores do Estado do Rio de Janeiro. Método: Estudo retrospectivo que analisa as manifestações clínicas, os aspectos de imagem e os resultados do tratamento cirúrgico. Resultados: Houve nítido predomínio dos tumores epidermóides (13:4), com a localização intracraniana sendo a mais comum, principalmente nas regiões parasselar, do ângulo pontocerebelar e no interior do quarto ventrículo. Foi possível a remoção completa em 15 dos 17 casos, com excelente resultado. Conclusão: A remoção total desses tumores sem provocar danos às estruturas neurovasculares é possível por meio de meticulosa técnica microneurocirúrgica, porém, quando a lesão se estende anteriormente ao tronco cerebral, a remoção subtotal é a escolha correta, conforme optamos em um dos casos.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Resumo Objetivo: Descrever uma patologia rara, de crescimento lento, com bom prognóstico se adequ... more Resumo Objetivo: Descrever uma patologia rara, de crescimento lento, com bom prognóstico se adequadamente tratada. Método: Análise e descrição de um caso de mucopiocele fronto-orbitária e transtorno comportamental, submetido ao tratamento cirúrgico no Hospital dos Servidores do Estado do Rio de Janeiro. Resultados: O paciente evoluiu com regressão completa dos sintomas prévios. Conclusão: Nas mucopioceles, os objetivos da cirurgia são: a confirmação do diagnóstico, a drenagem do conteúdo de muco e pus e a excisão ou marsupialização das paredes do cisto e da mucosa do seio comprometido. O diagnóstico correto dessa lesão leva à diminuição da morbidade e mortalidade, em virtude de o tratamento cirúrgico associado à antibioticoterapia venosa ser curativo.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoQuinze pacientes com abscesso epidural raquiano foram tratados entre janeiro de 1986 e jane... more ResumoQuinze pacientes com abscesso epidural raquiano foram tratados entre janeiro de 1986 e janeiro de 1996. Dez eram homens e 5, mulheres, com idade mediana de 50 anos. A associação de patologias que levam à imunodepressão, como diabetes e infecções, ocorreu em 67% dos casos. Todos os pacientes tinham dor na coluna vertebral, 11 apresentavam fraqueza muscular, 6 tinham parestesias e 5, alterações esfincterianas.Dezesseis procedimentos cirúrgicos foram realizados nos 15 pacientes. Em 6 casos, o abscesso continha material francamente purulento; em 3, a coleção epidural apresentava-se como tecido de granulação e, em outros 4 casos, ambos estavam presentes. O Staphylococcus aureus foi isolado em 53% dos abscessos, e o bacilo da tuberculose em 20%. A coluna lombar foi comprometida em 8 casos e a cervical em 3.O tratamento de escolha consiste na imediata drenagem cirúrgica do abscesso antes do desenvolvimento de déficit neurológico grave, combinado com antibioticoterapia específica.Onze...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoOs carcinomas adenoides císticos são tumores de crescimento lento, localmente agressivos e ... more ResumoOs carcinomas adenoides císticos são tumores de crescimento lento, localmente agressivos e com tendência à recorrência. Têm particular interesse por infiltrar estruturas neurais e disseminar-se pelo perineuro. Envolvimento intracraniano é raro. Descreve-se um caso de carcinoma adenoide cístico originado na glândula lacrimal esquerda e invasão do seio cavernoso. Ressonância magnética demonstrou lesão tumoral, extra-axial, bem delimitada, semelhante a um meningioma da asa do esfenoide com invasão do seio cavernoso. O paciente apresentou boa resposta ao tratamento com cirurgia e radioterapia complementar.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoEntre 1986 e 1998, 44 pacientes com adenomas hipofisários gigantes foram tratados em nossa ... more ResumoEntre 1986 e 1998, 44 pacientes com adenomas hipofisários gigantes foram tratados em nossa instituição. Adenomas não-funcionantes ocorreram em 63,6% dos casos e os adenomas secretantes em 36,4%. Diminuição significativa da acuidade visual foi encontrada em 79,5% dos pacientes e 20 olhos estavam cegos. Foram realizadas 48 operações nesses doentes. Vinte e oito pacientes foram operados por uma via transcraniana: em 19 casos, a via pterional foi a escolhida; em 6 casos, optamos pela via orbitozigomática e, em 3, a via subfrontal. A via transesfenoidal foi utilizada em 20 casos. Foi possível a remoção total em 26 (59,0%) casos, subtotal em 18 (40,9%). A mortalidade, nessa série, foi de 9% e, a morbidade, de 47,7%.Adenomas hipofisários gigantes e invasivos são lesões de cura extremamente difícil. No entanto, muitos desses tumores podem ser totalmente removidos por microcirurgia com abordagens pela base do crânio com morbidade e mortalidade aceitáveis e sobrevida a longo prazo.
The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event,... more The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care. Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Department of the Servidores do Estado Hospital and Rede D'Or/São Luis. The Neurosurgery Department teamed up with Obstetrics Anesthesiology Departments in establishing the procedures. The patients' records, surgical descriptions, imaging studies, and histopathological material were reviewed. Among 12 patients presenting with brain tumors, there were neither operative mortality nor fetal deaths. Among the vascular lesions, aneurysm rupture was responsible for bleeding in 6 instances. Arteriovenous malformation was ...
To compare the survival of glioblastoma multiforme (GBM) patients operated on at public hospital ... more To compare the survival of glioblastoma multiforme (GBM) patients operated on at public hospital with that of patients operated on at the private hospitals. We carried out a retrospective analysis of the patients' medical records, the surgical reports and the pre- and post-operative images of patients with a histopathological confirmed adult supratentorial GBM. Sixty-three patients were treated at public hospital and twenty-one at private hospitals. The present study revealed that the survival of patients treated in private hospitals was statistically superior to that of patients treated in public hospitals (11.9 vs. 7.7). Our study advances towards the confirmation of the hypothesis that socioeconomic and educational factors influence the Karnofsky Performance Score (KPS) and the performance of radiotherapy treatment, with negative effects over the GBM patients' survival.
Many recent series of surgery for intracranial aneurysms have been based on experience of develop... more Many recent series of surgery for intracranial aneurysms have been based on experience of developed countries with great resources and a state of art health care. The purpose of the current study is to correlate the outcome of patients operated for intracranial aneurysms. reported from intensive high technology neurosurgical centers with the results of low technology, environment, where we practice. Between January 1986 and December 1996, 337 patients with intracranial aneurysms were operated on at the Servidores do Estado Hospital. We retrospectively reviewed the medical and radiologic records and compared the outcome of this group with other series derived from developed countries. The overall mortality of this series was 6.9%. Of the 313 good grades surgical patients, the mortality was 4.7% and the sucessfull results were obtained in 88.8% individuals. We conclude that patients harboring intracranial aneurysms can be satisfactory handled in less developed nations, if a meticulous...
A hemorragia intracraniana que acontece na gravidez é um fenômeno raro, porém, apresenta mortalid... more A hemorragia intracraniana que acontece na gravidez é um fenômeno raro, porém, apresenta mortalidade e morbidades elevadas. Analisamos 15 pacientes com hemorragia intracraniana que ocorreu durante a gravidez ou puerpério. Em cinco casos a hemorragia decorria da ruptura de aneurisma, em 6, de malformação. A mortalidade materna foi 20%, e a fetal 33%. Quando a causa do sangramento é proveniente de ruptura de um aneurisma, deve-se realizar a oclusão cirúrgica do aneurisma durante a gravidez o que aconteceu em 4 pacientes desta série. Entretanto, se a hemorragia decorre de uma malformação arteriovenosa, o melhor tratamento ainda não está estabelecido.
Low-grade supratentorial astrocytomas and oligodendrogliomas in adults are uncommon tumors of the... more Low-grade supratentorial astrocytomas and oligodendrogliomas in adults are uncommon tumors of the central nervous system. We analyzed retrospectively 23 patients with this type of neoplasia, who were operated on between 1986 and 2002. There were no post-operative deaths. The survival rate at 5 and 10 years post-surgery for the entire sample was 67 and 30% respectively, similar to other outcomes. With 14 patients we achieved a complete removal of the lesion (60.8%) and with 9 (39.2%) partial removal of the tumor. In the sub-group which underwent total resection of the tumor, 89% survived 5 years and 45% attained 10 years of survival, in contrast with the sub-group that underwent partial removal in which only 35% attained 5 years of survival and none 10 years. Due to the deleterious effects of radiation therapy, we preferred to prescribe it only in cases of tumor recurrence.
Journal of Neurological Surgery Part B: Skull Base
Background The purpose of this article is to describe our approach, surgical strategies, and resu... more Background The purpose of this article is to describe our approach, surgical strategies, and results for resection of meningiomas located at cerebellopontine angle (CPA). Methods We retrospectively identified 28 patients with CPA meningiomas operated by the extended retrosigmoid approach. This approach incorporates a generous mastoidectomy and the sigmoid sinus exposure. Results The mean age was 33.8 years, with a follow-up of 12.5 years. Gross total removal (GTR) was achieved in 22 (78.5%) patients with low surgical mortality, acceptable morbidity, and recurrence rate of 7.1% (2 patients). Conclusion The extended retrosigmoid approach enhances the exposure of the CPA and posterior fossa cisterns and increases the surgical angle of maneuverability. This approach provides adequate access even to extensive CPA meningiomas, enabling, in most of cases, GTR to be safe and effective. The extended retrosigmoid approach used in this group of patients is an alternative to more extensive cran...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Objective To describe our surgical techniques, analyze their safety and their postoperative outco... more Objective To describe our surgical techniques, analyze their safety and their postoperative outcomes for foramen magnum tumors (FMTs). Methods From 1986 to 2014, 34 patients with FMTs underwent surgeries using either the lateral suboccipital approach, standard midline suboccipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions. Results In the present series, there were 22 (64.7%) female and 12 (35.2%) male patients. The age of the patients ranged from 12 to 63 years old. We observed 1 operative mortality (2.9%). A total of 28 patients (82.3%) achieved a score of 4 or 5 in the Glasgow Outcome Scale (GOS). Gross total resection (GTR) was obtained in 22 (64.7%) patients. After the surgery, 9 (26%) patients developed lower cranial nerve dysfunction (LCNd) weakness. The follow-up varied from 1 to 24 years (mean: 13.2 years). Conclusion The majority of tumors located in the FM can be safely and efficiently removed using either the lateral sub oc...
Objectives: Glioblastoma multiforme (GBM) has the highest malignancy grade in the astrocitic tumo... more Objectives: Glioblastoma multiforme (GBM) has the highest malignancy grade in the astrocitic tumor group besides being the most common central nervous system tumor in adults. This paper aims to evaluate if the following factors: age, Karnofski Performance Status (KPS), extension of surgical removal, radiotherapy (RT), tumor volume and symptoms duration influenced the survival. Methods: We performed a retrospective analysis of GBM operated on at Hospital dos Servidores do Estado between 1986 and 2008. Results: We could observe that age, KPS and radiotherapy influenced the survival of patients. The other variables studied didnot have any prognostic implications. Conclusions: Despite many researches and several improvements regarding diagnosis and surgical techniques, the survivalof patients presenting with GBM could not be changed in the last 30 years. Surgical resection followed by RT is the standard treatment for patients with GBM. The importance of each prognostic factor is still t...
Journal of Neurological Surgery Part B: Skull Base
Background To describe our operative strategy and analyze its safety and effectiveness for the re... more Background To describe our operative strategy and analyze its safety and effectiveness for the removal of medial sphenoid wing meningiomas (MSWMs) through the extended pterional approach. Method We identified 47 patients with MSWMs who were operated using this approach between 1986 and 2016. Medical charts, operative reports, imaging results, and clinical follow-up evaluations were reviewed and retrospectively analyzed. Results No surgical mortality was observed in this sample. Gross total resection was achieved in 30 (63.8%) patients. Intradural clinoidectomy was performed in 16 (34%) patients. The median length of follow-up was 8.5 years (range, 1–30 years). Conclusion The extended pterional approach associated with microsurgery techniques provided excellent results for the removal of MSWMs.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Resumo Objetivo: Analisar 17 casos de tumores epidermóides e dermóides do neuroeixo tratados nos ... more Resumo Objetivo: Analisar 17 casos de tumores epidermóides e dermóides do neuroeixo tratados nos últimos 20 anos no Hospital dos Servidores do Estado do Rio de Janeiro. Método: Estudo retrospectivo que analisa as manifestações clínicas, os aspectos de imagem e os resultados do tratamento cirúrgico. Resultados: Houve nítido predomínio dos tumores epidermóides (13:4), com a localização intracraniana sendo a mais comum, principalmente nas regiões parasselar, do ângulo pontocerebelar e no interior do quarto ventrículo. Foi possível a remoção completa em 15 dos 17 casos, com excelente resultado. Conclusão: A remoção total desses tumores sem provocar danos às estruturas neurovasculares é possível por meio de meticulosa técnica microneurocirúrgica, porém, quando a lesão se estende anteriormente ao tronco cerebral, a remoção subtotal é a escolha correta, conforme optamos em um dos casos.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Resumo Objetivo: Descrever uma patologia rara, de crescimento lento, com bom prognóstico se adequ... more Resumo Objetivo: Descrever uma patologia rara, de crescimento lento, com bom prognóstico se adequadamente tratada. Método: Análise e descrição de um caso de mucopiocele fronto-orbitária e transtorno comportamental, submetido ao tratamento cirúrgico no Hospital dos Servidores do Estado do Rio de Janeiro. Resultados: O paciente evoluiu com regressão completa dos sintomas prévios. Conclusão: Nas mucopioceles, os objetivos da cirurgia são: a confirmação do diagnóstico, a drenagem do conteúdo de muco e pus e a excisão ou marsupialização das paredes do cisto e da mucosa do seio comprometido. O diagnóstico correto dessa lesão leva à diminuição da morbidade e mortalidade, em virtude de o tratamento cirúrgico associado à antibioticoterapia venosa ser curativo.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoQuinze pacientes com abscesso epidural raquiano foram tratados entre janeiro de 1986 e jane... more ResumoQuinze pacientes com abscesso epidural raquiano foram tratados entre janeiro de 1986 e janeiro de 1996. Dez eram homens e 5, mulheres, com idade mediana de 50 anos. A associação de patologias que levam à imunodepressão, como diabetes e infecções, ocorreu em 67% dos casos. Todos os pacientes tinham dor na coluna vertebral, 11 apresentavam fraqueza muscular, 6 tinham parestesias e 5, alterações esfincterianas.Dezesseis procedimentos cirúrgicos foram realizados nos 15 pacientes. Em 6 casos, o abscesso continha material francamente purulento; em 3, a coleção epidural apresentava-se como tecido de granulação e, em outros 4 casos, ambos estavam presentes. O Staphylococcus aureus foi isolado em 53% dos abscessos, e o bacilo da tuberculose em 20%. A coluna lombar foi comprometida em 8 casos e a cervical em 3.O tratamento de escolha consiste na imediata drenagem cirúrgica do abscesso antes do desenvolvimento de déficit neurológico grave, combinado com antibioticoterapia específica.Onze...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoOs carcinomas adenoides císticos são tumores de crescimento lento, localmente agressivos e ... more ResumoOs carcinomas adenoides císticos são tumores de crescimento lento, localmente agressivos e com tendência à recorrência. Têm particular interesse por infiltrar estruturas neurais e disseminar-se pelo perineuro. Envolvimento intracraniano é raro. Descreve-se um caso de carcinoma adenoide cístico originado na glândula lacrimal esquerda e invasão do seio cavernoso. Ressonância magnética demonstrou lesão tumoral, extra-axial, bem delimitada, semelhante a um meningioma da asa do esfenoide com invasão do seio cavernoso. O paciente apresentou boa resposta ao tratamento com cirurgia e radioterapia complementar.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoEntre 1986 e 1998, 44 pacientes com adenomas hipofisários gigantes foram tratados em nossa ... more ResumoEntre 1986 e 1998, 44 pacientes com adenomas hipofisários gigantes foram tratados em nossa instituição. Adenomas não-funcionantes ocorreram em 63,6% dos casos e os adenomas secretantes em 36,4%. Diminuição significativa da acuidade visual foi encontrada em 79,5% dos pacientes e 20 olhos estavam cegos. Foram realizadas 48 operações nesses doentes. Vinte e oito pacientes foram operados por uma via transcraniana: em 19 casos, a via pterional foi a escolhida; em 6 casos, optamos pela via orbitozigomática e, em 3, a via subfrontal. A via transesfenoidal foi utilizada em 20 casos. Foi possível a remoção total em 26 (59,0%) casos, subtotal em 18 (40,9%). A mortalidade, nessa série, foi de 9% e, a morbidade, de 47,7%.Adenomas hipofisários gigantes e invasivos são lesões de cura extremamente difícil. No entanto, muitos desses tumores podem ser totalmente removidos por microcirurgia com abordagens pela base do crânio com morbidade e mortalidade aceitáveis e sobrevida a longo prazo.
The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event,... more The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care. Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Department of the Servidores do Estado Hospital and Rede D'Or/São Luis. The Neurosurgery Department teamed up with Obstetrics Anesthesiology Departments in establishing the procedures. The patients' records, surgical descriptions, imaging studies, and histopathological material were reviewed. Among 12 patients presenting with brain tumors, there were neither operative mortality nor fetal deaths. Among the vascular lesions, aneurysm rupture was responsible for bleeding in 6 instances. Arteriovenous malformation was ...
Uploads
Papers by Celestino Pereira