Jose Marcus Rotta
IAMSPE, Neurosurgery, Department Member
- neursurgeryedit
Os autores apresentam 7 casos de pacientes portadores de hemangiopericitomas meningeos (HPM), operados no Hospital das Clínicas da Universidade de São Paulo (HCFMUSP) de 1990 a 1997 Aspectos relativos ao quadro clinico, anatomia... more
Os autores apresentam 7 casos de pacientes portadores de hemangiopericitomas meningeos (HPM), operados no Hospital das Clínicas da Universidade de São Paulo (HCFMUSP) de 1990 a 1997 Aspectos relativos ao quadro clinico, anatomia patológica e terapêutica são discutidos, com ênfase na necessidade de embolização pré-operatória e na complementação terapêutica com radioterapia.
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✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral... more
✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral brainstem decompression by reduction or elimination of the odontoid invagination is part of the desired treatment. The authors describe a case of BI in an adult, who was effectively treated with the easy and safe reduction of odontoid invagination via cervical traction. Normalization of kyphosis at the craniovertebral junction and the vertical position of both a previously horizontal clivus and the cerebellar tentorium demonstrated that these conditions were not part of the original malformation but instead were caused by a reducible craniovertebral instability.
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Introduction Reoperations are a common scenario among glioma patients. There is crescent evidence of its benefit in low- and high-grade gliomas. Here we discuss our experience with inert expanded polytetrafluoroethylene (ePTFE) dura... more
Introduction Reoperations are a common scenario among glioma patients. There is crescent evidence of its benefit in low- and high-grade gliomas. Here we discuss our experience with inert expanded polytetrafluoroethylene (ePTFE) dura substitute in glioma surgeries. Technical note We generally put the ePTFE dura substitute below the dura of the patient, even if it is intact. This membrane should be sutured in place using a tension-free technique, with 4-0 polypropylene. Expanded polytetrafluoroethylene minimizes tissue attachment and fibrosis when performing reoperation in glioma patients. Discussion Since the literature has shown benefits in survival with reoperation in glioma patients, the use of ePTFE dura substitute can improve surgical time and minimize complications in a second surgery.
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Internal carotid artery bifurcation (ICAb) aneurysms account for about 2-15% of all intracranial aneurysms. In giant and complex cases, treatment may be difficult and dangerous, once some aneurysms have wide neck and anterior cerebral... more
Internal carotid artery bifurcation (ICAb) aneurysms account for about 2-15% of all intracranial aneurysms. In giant and complex cases, treatment may be difficult and dangerous, once some aneurysms have wide neck and anterior cerebral artery (ACA) and middle cerebral artery (MCA) may arise from the aneurysm itself. Clip reconstruction may be difficult in such cases. Whenever possible, the occlusion of ACA transform the bifurcation in a single artery reconstruction (ICA to MCA), much easier than a bifurcation reconstruction. In patients with giant and complex ICAb aneurysms, we propose routine preoperative angiography with anatomical evaluation of anterior communicating artery (ACoA) patency during cervical common carotid compression with concomitant contralateral carotid artery injection. This allowed visualization of the expected reversal of flow in the A1 segment-ACoA complex. When test is positive, we can perform ipsilateral ACA (A1 segment) clip occlusion and flow modification o...
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Recurrent or residual pituitary adenomas previously treated by transsphenoidal surgery are not uncommon. There are no strongly established guidelines to perform treatment of such cases. The objective of this study is to elucidate the... more
Recurrent or residual pituitary adenomas previously treated by transsphenoidal surgery are not uncommon. There are no strongly established guidelines to perform treatment of such cases. The objective of this study is to elucidate the effect of transsphenoidal reoperation in residual or recurrent pituitary adenomas. We made a systematic review of the literature to elucidate this effect through electronic search in MEDLINE/PubMed and Cochrane Central database. PRISMA statement was used as a basis for this systematic review and analysis of the risk of bias was made according to the Grading of Recommendations, Assessment, Development and Evaluation recommendations. In this review, fifteen studies were finally pooled analyzed. Although remission rates (RRs) and follow-up periods varied widely, from 149 patients with growth hormone-secreting tumors the mean RR was 44.5%, from 273 patients with adrenocorticotropic hormone-secreting tumors the mean RR was 55.5% and among 173 patients with n...
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SUMMARY OBJECTIVE To evaluate the survival of patients with brain metastases treated surgically according to the potentially involved factors. METHODS 71 patients treated surgically were analyzed with the diagnosis of brain metastases... more
SUMMARY OBJECTIVE To evaluate the survival of patients with brain metastases treated surgically according to the potentially involved factors. METHODS 71 patients treated surgically were analyzed with the diagnosis of brain metastases during the period from January 2011 to November 2014, totaling 47 months of follow-up. The Kaplan-Meier curve method was used for survival analysis. Results We evaluated 71 patients with brain metastases treated surgically, 44 female and 27 male, mean age of 60.1 years. According to the Karnofsky scale, 44 patients were classified with Karnofsky greater than or equal to 70 and 27 patients with Karnofsky inferior to 70. Lung was the primary site most commonly found. Death occurred in twenty patients (28%), and lung tumors were responsible for the most deaths. Twelve patients had supra and infratentorial metastases, fifty-nine only had supratentorial lesions, and lesions were multiple in twenty-eight patients and single in forty-three. Thirty patients we...
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Introduction. Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease, which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We... more
Introduction. Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease, which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We performed an evaluation to determine whether the postoperative use of TXA reduces recurrence rate. Method. A prospective, randomized and controlled trial. Patients with unilateral or bilateral chronic subdural hematoma undergoing surgical treatment by burr-hole were randomized as to whether or not to use TXA in the postoperative period. We evaluated image and clinical recurrence of CSDH at follow up of 6 months and potential clinical and/or surgical complications impact of TXA. Results. Twenty-six patients were then randomized to the control group (52%) and twenty-four patients to the TXA group (48%). Follow-up ranged from 3 months to 16 months. There were no significant difference between baseline data in groups regarding to age, gender, use of antiplate...
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Objective Patients with craniocervical junction malformations (CCJM) tend to suffer more frequently from sleep respiratory disturbances, which are more frequent and severe in patients with basilar invagination. Here we evaluate if... more
Objective Patients with craniocervical junction malformations (CCJM) tend to suffer more frequently from sleep respiratory disturbances, which are more frequent and severe in patients with basilar invagination. Here we evaluate if patients with CCJM and sleep respiratory disorders (SRD) present smaller airway dimensions than patients without SRD. Method Patients with CCCM with and without sleep respiratory disturbances were evaluated clinically by Bindal's score, modified Mallampati classification, full-night polysomnography and upper airway cone beam tomography. Results Eleven patients had sleep respiratory disorders (SRD), and nine patients performed control group without SRD. CCJM patients with SRD were predominantly female, older, had higher BMI, were more likely to have Mallampati grades 3 and 4 and had statistically significant smaller anteroposterior diameter of the upper airway than patients without SRD. Conclusion Patients with CCJM and sleep respiratory disturbances ha...
Research Interests: Cognitive Science, Nonparametric Statistics, Anthropometry, Medicine, Humans, and 15 moreObstructive sleep apnea, Female, Male, Risk factors, Clinical Sciences, Polysomnography, Middle Aged, Adult, Airway, Risk Factors, Arnold Chiari Malformation, Reference Values, Cone Beam Computed Tomography, Case Control Studies, and Pharynx
Abstract: Introduction: For patients with a solitary and well-delimitated spinal metastasis that resides inside the vertebral body, without vertebral canal invasion, and who are in good general health with a long life expectancy, en bloc... more
Abstract: Introduction: For patients with a solitary and well-delimitated spinal metastasis that resides inside the vertebral body, without vertebral canal invasion, and who are in good general health with a long life expectancy, en bloc spondylectomy/total vertebrectomy combined with the use of primary stabilizing instrumentation has been advocated. However, clinical experience suggests that these qualifying conditions occur very rarely. Objective: The purpose of this paper is to quantify the distribution of vertebral involvement in spinal metastases and
✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral... more
✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral brainstem decompression by reduction or elimination of the odontoid invagination is part of the desired treatment. The authors describe a case of BI in an adult, who was effectively treated with the easy and safe reduction of odontoid invagination via cervical traction. Normalization of kyphosis at the craniovertebral junction and the vertical position of both a previously horizontal clivus and the cerebellar tentorium demonstrated that these conditions were not part of the original malformation but instead were caused by a reducible craniovertebral instability.
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Descrevemos o caso de uma paciente de 42 anos portadora de cisticerco racemoso na região do ângulo ponto-cerebelar (APC) direito com trigeminalgia bilateral mais intensa no lado ipsilateral à localização do parasita. O cisticerco foi... more
Descrevemos o caso de uma paciente de 42 anos portadora de cisticerco racemoso na região do ângulo ponto-cerebelar (APC) direito com trigeminalgia bilateral mais intensa no lado ipsilateral à localização do parasita. O cisticerco foi totalmente removido por meio de craniotomia suboccipital. No primeiro dia pós-operatório houve desaparecimento bilateral da dor. Duas hipóteses fisiopatológicas foram aventadas para explicar a sintomatologia: lesões que ultrapassam os limites da cisterna do APC poderão através da cisterna pré-pontina alcançar a cisterna do APC atingindo o trigêmeo contralateral; lesões com grande efeito de massa poderão provocar rotação do tronco cerebral e deslocamento e tração de estruturas ipsi e contralaterais, provocando compressão arteriovenosa sobre o trigêmeo contralateral na porção superior da cisterna do APC. Salientamos a necessidade de exames de imagem ante qualquer algia craniofacial e observamos que, em lesões na região do APC, a cisticercose não pode ser ...
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BACKGROUND The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. 'Neurosurgery cocktail' (NC) was developed by a group of young neurosurgeons as a... more
BACKGROUND The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. 'Neurosurgery cocktail' (NC) was developed by a group of young neurosurgeons as a means of sharing didactic materials and clinical experiences via social media. It connects 35.000 neurosurgeons worldwide on multiple platforms, primarily Facebook and Twitter. Given the rising utilization of social media in neurosurgery, the popularity of NC has also increased since its inception. In this study, the authors surveyed the social media analytics of NC for both Facebook and Twitter. Besides, we reviewed the literature on the use of social media in neurosurgery. METHODS Facebook and Twitter metrics were extracted through each respective platform's analytics tools from December 2020 (earliest available date for data analysis) through January 2021. A literature search was conducted using PubMed (MEDLINE) and Scopus databases. RESULTS On...
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Blister-like aneurysms (BAs) are usually defined as arterial lesions arising from non-branching sites on intracranial arteries. Due to specific peculiarities such as different pathophysiology, fragility of aneurismal wall, high risk of... more
Blister-like aneurysms (BAs) are usually defined as arterial lesions arising from non-branching sites on intracranial arteries. Due to specific peculiarities such as different pathophysiology, fragility of aneurismal wall, high risk of intraoperative bleeding and a high probability of losing parent vessel patency, their current treatment persists controversial, being endovascular and surgical options applicable and reported. From 2006 to 2015 (10 years), a total of 7 aneurysms in 6 patients were treated. We retrospectively reviewed the records of these patients to analyze clinical pictures and outcomes, which are expressed as modified Rankin Scale. In our sample of 7 aneurysms in 6 patients, all BAs were successfully treated (complete exclusion in 100% on follow-up angiography). A good outcome (mRs of 0) was achieved in all patients, with no difference related to aneurysm size and location. There was no mortality. Surgical treatment of BAs may be effective and with acceptable complications and outcomes.
Research Interests: Medicine, Humans, Female, Male, Middle Aged, and 3 moreAdult, Retrospective Studies, and Intracranial aneurysm
O tratamento das metástases vertebrais depende do grau de malignidade e do estadiamento do tumor primário. A biópsia vertebral é uma arma fundamental no diagnóstico e planejamento terapêutico dos tumores vertebrais. Objetivos: Avaliar... more
O tratamento das metástases vertebrais depende do grau de malignidade e do estadiamento do tumor primário. A biópsia vertebral é uma arma fundamental no diagnóstico e planejamento terapêutico dos tumores vertebrais. Objetivos: Avaliar segurança e eficácia da biópsia vertebral percutânea (BVP) pelo método de preensão direta em diagnosticar malignidades e excluir outras lesões; avaliar a possibilidade de obtenção direta dos espécimes de tumor paraexame de congelação. Método: Foram estudados 10 casos submetidos à biópsia vertebral percutânea de lesões sugestivas de neoplasia no períodode janeiro de 2002 a janeiro de 2006, sendo analisados: indicação da biópsia, estado neurológico do paciente pré e pós-procedimento, complicações e diagnóstico. Em três pacientes, foi realizado exame de congelação da lesão vertebral biopsiada. Resultados: A via predominantemente utilizada para a realização da BVP foi a via transpedicular (9 casos). O diagnóstico histológico foi obtido em 8 casos. O exame ...
Introduction: “Mini brain” image pattern has been identified as a radiological sign for diagnosing multiple myeloma (MM) and solitary plasmacytomas in magnetic resonance imaging (MRI). However, there is still very little data on the... more
Introduction: “Mini brain” image pattern has been identified as a radiological sign for diagnosing multiple myeloma (MM) and solitary plasmacytomas in magnetic resonance imaging (MRI). However, there is still very little data on the frequency with which it can be observed, and its real diagnostic accuracy. Objetive: In this study, we present our case series, discuss sensitivity and specificity of “mini brain” in the diagnosis of multiple myeloma (MM)/plasmacytoma, and conduct a literature review. Methods: The study sample consisted of asymptomatic and/or symptomatic patients consecutively diagnosed with expansive vertebral disease. Patients were evaluated with MRI. A literature review was conducted on the relationship of the radiological sign “mini brain” and the diagnosis of multiple myeloma (MM) or plasmacytoma. Results: Forty-seven patients were evaluated consecutively. Among five patients diagnosed with multiple myeloma, four had an MRI pattern of “mini brain”. The sensitivity o...
ResumoA malformação de Chiari (MFCh) é caracterizada, fundamentalmente, pela herniação das tonsilas cerebelares por meio do forâmen magno. Dois tipos principais representam a maioria das apresentações: a MFCh do tipo I (do adulto) e a do... more
ResumoA malformação de Chiari (MFCh) é caracterizada, fundamentalmente, pela herniação das tonsilas cerebelares por meio do forâmen magno. Dois tipos principais representam a maioria das apresentações: a MFCh do tipo I (do adulto) e a do tipo II (da criança). A MFCh pode produzir acometimentos neuronais do tronco cerebral, medula espinhal, cerebelo e nervos cranianos. Parte dos sistemas aferentes e eferentes e do sistema controlador central da respiração se localiza na transição craniovertebral, podendo ser acometido nessas patologias, produzindo disfunções respiratórias. Insuficiência respiratória e óbito têm sido descritos em associação com essas malformações. Durante o sono, a resposta ventilatória aos estímulos exógenos e endógenos, tais como resposta à hipóxia e à hipercapnia, estão geralmente diminuídas nesses pacientes, permitindo o diagnóstico do distúrbio respiratório na MFCh. Nos indivíduos com malformações da transição craniovertebral, há uma prevalência aumentada das dis...
ResumoA monitorização intraoperatória multimodal (MIOM) tornou-se um método amplamente utilizado para monitorização da função neural durante as cirurgias espinais. Um estudo prospectivo de 52 pacientes que foram monitorados durante os... more
ResumoA monitorização intraoperatória multimodal (MIOM) tornou-se um método amplamente utilizado para monitorização da função neural durante as cirurgias espinais. Um estudo prospectivo de 52 pacientes que foram monitorados durante os procedimentos cirúrgicos, entre outubro de 2009 e dezembro de 2010, no Hospital do Servidor Público Estadual de São Paulo, a fim de determinar a sensibilidade e especificidade das técnicas utilizadas para monitorar a medula espinhal e raízes nervosas durante as cirurgias espinais. Portanto, o objetivo deste estudo prospectivo foi avaliar a eficácia da MIOM, que inclui os potenciais evocados somatossensitivos (PESS), os potenciais evocados motores com estimulação transcraniana (MEPS), a eletromiografia contínua (EMG) captada nos músculos eletricamente estimulados a partir do córtex motor, na própria medula espinal, na cauda equina e nas raízes nervosas, comparando os dados eletrofisiológicos com os achados clínicos neurológicos no pós-operatório imediat...
Holmes' tremor (rubral tremor, cerebellar outflow tremor) is characterized by rest, intention and postural tremor, often localized to one upper extremity, associated with ipsilateral dysmetria and dysdiadochokinesia. We describe a... more
Holmes' tremor (rubral tremor, cerebellar outflow tremor) is characterized by rest, intention and postural tremor, often localized to one upper extremity, associated with ipsilateral dysmetria and dysdiadochokinesia. We describe a case of successful treatment of Holmes' tremor with unilateral nucleus ventralis intermedius (VIM) thalamotomy. The subject is a 43-year-old woman with unremarkable previous medical history. She presented with complete left hemiparesis in the context of human immunodeficiency syndrome and the magnetic resonance image disclosed a contrast-enhancing lesion in right brain peduncle, in topography of red nucleus. She developed a progressive rest, intention and postural tremor in left upper limb. She was submitted to a stereotactic biopsy and the tremor became worse. She performed awake right VIM thalamotomy, with immediate complete resolution of tremor. There were no complications after procedure, and the result is stable after six months. We highlight ...
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ABSTRACT Central nervous system tumors are a major cause of morbidity and mortality. Outside of brain metastasis, low and high grade gliomas are the most common intrinsic brain tumors. The optimal treatment of malignant gliomas has... more
ABSTRACT Central nervous system tumors are a major cause of morbidity and mortality. Outside of brain metastasis, low and high grade gliomas are the most common intrinsic brain tumors. The optimal treatment of malignant gliomas has developed through the last years. Early management with radical surgery and adjuvant chemotherapy and radiotherapy are the standard protocol. Prognostic factors involved are age at presentation, histology, molecular biology characteristics, Karnofsky Score (KS), surgical results and adjuvant therapy. Once age, histology, tumor behavior and KS are independent factors associated to patient and adjuvant therapy is usually standard for all patients, surgery is the one in which medical management can perform greatest change in evolution of disease. Therefore, surgical results with maximal resection of neoplastic tissue and minimal risk of functional neurological deficit, is the aim in malignant glioma surgery. Surgical act involves a complex structure which demands planning, knowledge of cerebral anatomy and physiology, and technical execution. A special anatomic and physiological knowledge must involve the white matter, once malignant gliomas spread through such structures. Key words: malignant gliomas, treatment, complications
Base de dados : LILACS. Pesquisa : 157797 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. experimental, Documentos... more
Base de dados : LILACS. Pesquisa : 157797 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. experimental, Documentos relacionados. Id: 157797. ...
... Rotta, José Marcus. Plese, José Píndaro Pereira. experimental, Documentos relacionados. Id: 249298. Autor: Aguiar, Paulo Henrique; Prudente, Marcelo; Freitas, Alexandre Bruno Raul; Rotta, José Marcus; Plese, José Píndaro Pereira;... more
... Rotta, José Marcus. Plese, José Píndaro Pereira. experimental, Documentos relacionados. Id: 249298. Autor: Aguiar, Paulo Henrique; Prudente, Marcelo; Freitas, Alexandre Bruno Raul; Rotta, José Marcus; Plese, José Píndaro Pereira; Andrioli, Mario Sergio Duarte. ...
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Spinal instability neoplastic score (SINS) classification evaluates spinal stability by adding together six radiographic and clinical components. The objective of this study was to verify the association between SINS and Tokuhashi scoring... more
Spinal instability neoplastic score (SINS) classification evaluates spinal stability by adding together six radiographic and clinical components. The objective of this study was to verify the association between SINS and Tokuhashi scoring system (TSS) score. Fifty-eight patients with vertebral metastases were admitted from 2010 to 2014 at Hospital do Servidor Público Estadual de São Paulo. They were evaluated according to their SINS and Tokuhashi SS score. Fourteen patients (24.13 %) scored from 0 to 6 points (stable spine), 37 (63.79 %) scored from 7 to 12 (potentially unstable), and 7 (12.06 %) scored from 13 to 18 (unstable). In stable spine patients according to SINS, the mean TSS score was 9.2. In potentially unstable spine patients, the mean TSS score was 8.24. In unstable spine patients, mean TSS score was 6.28. There was a statistically significant difference of the TSS score between stable and unstable patients. After evaluating TSS score in each patient, the worse the SINS...
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Research Interests: Electrocardiography, Prospective studies, Humans, Female, Male, and 15 moreExploration, Electromyography, Respiration, Clinical Sciences, Polysomnography, Aged, Middle Aged, Adult, Physical examination, Arnold Chiari Malformation, Neurosciences, Magnetic resonance image, Neurosurgical, Epworth sleepiness scale, and Apnea hypopnea index
Object One of the feared consequences of craniovertebral junction diseases is apnea. Although several cases of patients with central apnea have been described, obstructive sleep apnea has been identified as the most frequent manifestation... more
Object One of the feared consequences of craniovertebral junction diseases is apnea. Although several cases of patients with central apnea have been described, obstructive sleep apnea has been identified as the most frequent manifestation of sleep respiratory disorder. Neuronal involvement may be responsible for both central and obstructive apneas. The objective of this work was to study the effect of posterior fossa decompressive surgery on respiratory parameters during sleep in patients with craniovertebral junction malformations and breathing-related sleep disorders. Methods In this study, prospectively enrolled consecutive symptomatic adult patients were monitored with full-night polysomnography before and after surgical decompression of the cranial posterior fossa. Results Of the 25 patients who were evaluated, 68% received a diagnosis of sleep apnea. After surgery, the mean number of respiratory events decreased from 180.70 to 69.29 (p = 0.005); the mean number of obstructive ...
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Object. Craniovertebral junction malformation (CVJM) or Chiari malformation in adults, with or without syringomyelia and basilar invagination, produces neuronal dysfunction of the brainstem, cerebellum, cranial nerves, and upper spinal... more
Object. Craniovertebral junction malformation (CVJM) or Chiari malformation in adults, with or without syringomyelia and basilar invagination, produces neuronal dysfunction of the brainstem, cerebellum, cranial nerves, and upper spinal cord. The respiratory center and some of its afferent and efferent components can be altered in these diseases. The authors studied patients with and without CVJM to determine whether this physical feature contributed to sleep disturbances. Methods. Respiratory manifestations during sleep were studied prospectively, by using whole-night polysomnography, in 32 symptomatic patients (CVJM group) and 16 healthy volunteers (control group). Patients with CVJM presented with more sleep disturbances (reports of snoring and apnea) than those in the control group. The apnea/hypopnea index values were higher in patients with CVJMs than in the control group (13 ± 15 compared with 3 ± 6; p = 0.007) and the rate of central sleep apneas was higher in the CVJM than i...
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Intracranial epidermoid cysts (ECs) are rare, histologically benign, slow-growing, congenital neoplasms of central nervous system that may arise from retained ectodermal implants. Malignant transformation of an EC to squamous-cell... more
Intracranial epidermoid cysts (ECs) are rare, histologically benign, slow-growing, congenital neoplasms of central nervous system that may arise from retained ectodermal implants. Malignant transformation of an EC to squamous-cell carcinoma is rare; only 13 cases have been reported. We present the case of a 42-year-old woman presenting with left hemiparesis 18 months after performing partial resection of an epidermoid cyst of right middle and posterior fossa, whose pathological report revealed to be a malignant transformation of previous epidermoid tumor. Additionally, we performed pertinent literature review.
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Analisamos 15 casos de meduloblastoma em adultos (8 homens e 7 mulheres), com idade média de 23,7 anos (variação de 13 a 46) submetidos a ressecção cirúrgica no período de fevereiro de 1988 a outubro de 1995. Os tumores se localizavam no... more
Analisamos 15 casos de meduloblastoma em adultos (8 homens e 7 mulheres), com idade média de 23,7 anos (variação de 13 a 46) submetidos a ressecção cirúrgica no período de fevereiro de 1988 a outubro de 1995. Os tumores se localizavam no hemisfério cerebelar em 7 casos (1 com extensão supratentorial e outro atingindo a cisterna do ângulo pontocerebelar), no vermis e hemisférico em 4 e apenas no vermis em outros 4. A ressecção foi considerada radical em 7 casos, subtotal em 7 e parcial em um. Não houve mortalidade operatória. Aspectos relativos ao comportamento biológico e prognóstico são discutidos.
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Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard... more
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the tr...
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Spine is the most common site for skeletal metastasis in patients with malignancy. Vertebral involvement quantification, neurological status, general health status and primary tumor histology are factors to set surgical planning and... more
Spine is the most common site for skeletal metastasis in patients with malignancy. Vertebral involvement quantification, neurological status, general health status and primary tumor histology are factors to set surgical planning and therapeutic targets. We evaluated the impact of general clinical and neurological status, histologic type and surgery in survival. The study sample consisted of consecutive patients admitted from July 2010 to January 2013 for treatment. Sixty eight patients were evaluated. 23 were female and 45 were male. Main primary neoplasic sites were: breast, prostate, lung/pleura and linfoproliferative. Thirty three out of 68 received surgical treatment, 2 received percutaneous biopsy and 33 had nonsurgical treatment. Survival : Log Rank curves revealed no statistical significant difference according to histological type, surgical approach and Frankel Score. Karnofsky Score was statistically different. Histological type and clinical status were statistically associated with life expectancy in vertebral metastatic disease.
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Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence... more
Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.
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Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge. We describe an unusual clinical picture of... more
Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge. We describe an unusual clinical picture of SAH due to rupture of anterior spinal artery aneurysm in a patient with previous normal angiogram. Due to the location of the aneurysm and clinical status of the patient, conservative management was proposed, and she was discharged to further follow-up. Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding, which was highly suggestive of vascular dissection. We highlight the need to consider these aneurysms in the differential diagnosis of SAH, especially when occurring in the posterior fossa and when angiography findings are inconclusive.