RESUMEN
Crossbow injuries to the head have seldom been reported in the literature, and they represent a unique type of penetrating brain injury (PBI) in which a low-velocity arrow results in an intracranial fragment larger than most high-velocity projectiles, usually with a lethal outcome.We present the case of a 34-year-oldman who attempted suicide with a self-inflicted cranial injury from a crossbow arrow, with a right parietal point of entry and a palpable subcutaneous tip in the left parietal region. The emergency team reported a Glasgow coma scale (GCS) score of 15, and the patient was brought sedated and intubated. Computed tomography (CT) imaging scans showed that the arrow crossed both parietal lobes, with mild subarachnoid hemorrhage and small cerebral contusions adjacent to its intracranial path. Careful retrograde removal of the penetrating arrow was performed in the CT suite, followed by an immediate CT scan, which excluded procedure-related complications. The patient woke up easily and was discharged 3 days later withmild left hand apraxia and no other neurologic deficits. To the best of our knowledge, there are no similar case reports describing both good clinical outcome and rapid discharge after a bihemispheric PBI. Individualizing the management of each patient is therefore crucial to achieve the best possible outcome as PBI cases still represent a major challenge to practicing neurosurgeons worldwide.
Asunto(s)
Humanos , Masculino , Adulto , Lóbulo Parietal/cirugía , Lóbulo Parietal/lesiones , Heridas Punzantes/cirugía , Lesiones Traumáticas del Encéfalo/cirugía , Hemorragia Subaracnoidea/complicaciones , Puntaje de Gravedad del Traumatismo , Resultado del Tratamiento , Lesiones Traumáticas del Encéfalo/diagnóstico por imagenRESUMEN
BACKGROUND: Resective surgeries around eloquent areas challenge neurosurgeons and neuroimaging professionals due to difficulties to find anatomic references during surgery. Advances in magnetic resonance (MR) may prevent such deficits and provide information for accurate surgical planning. However, most of these techniques are expensive and not feasible in most centers. Using brain surface reformatted imaging (BSRI) of 3-D MR images, we sought to obtain data for surgical planning in patients with lesions around the motor cortex. METHODS: Thirteen patients with lesions around the eloquent areas and considered for resective surgery were evaluated. Patients had different ages with tumors and malformative lesions. They were scanned in a 1.5-T Siemens magnet with volumetric sequence after injection of Gadolinium. Postprocessing was done in an auxiliary console using MRI station software. We performed reformatting as described by Hattingen et al. [J Neurosurg 102:302-310, 2005] and used fixed skull and vascular structures as anatomical references. Distances to the reference points were measured to allow surgical planning and locate sites for cortical stimulation. Patients were also studied by blood-oxygen-level-dependent functional magnetic resonance imaging to locate the hand area before the surgical procedure. All patients had cortical stimulation during the resective procedure or chronic electrode stimulation before surgery. RESULTS: There was concordance between data from functional and structural data. In one case, partial resection was performed due to the high risk of severe deficits. Even in this case, there were clinical improvements and no additional deficits were observed. CONCLUSION: BSRI may be a useful tool for surgical planning around eloquent areas. It can reduce surgical time and morbidity and showed correlation with functional studies. Added to this is the low cost and feasibility in most centers that have standard MR scanners with Multiplanar Reformatting software.
Asunto(s)
Neoplasias Encefálicas/cirugía , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Corteza Motora/cirugía , Neuronavegación/métodos , Adolescente , Adulto , Mapeo Encefálico/métodos , Neoplasias Encefálicas/patología , Niño , Preescolar , Medios de Contraste , Dominancia Cerebral/fisiología , Femenino , Estudios de Seguimiento , Lóbulo Frontal/patología , Lóbulo Frontal/cirugía , Gadolinio , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/patología , Lóbulo Occipital/patología , Lóbulo Occipital/cirugía , Oxígeno/sangre , Lóbulo Parietal/patología , Lóbulo Parietal/cirugía , Complicaciones Posoperatorias/etiología , Programas Informáticos , Lóbulo Temporal/patología , Lóbulo Temporal/cirugíaAsunto(s)
Lóbulo Frontal/parasitología , Neuroesquistosomiasis/patología , Neuroesquistosomiasis/parasitología , Lóbulo Parietal/parasitología , Schistosoma mansoni/aislamiento & purificación , Anciano , Animales , Biopsia con Aguja , Técnica del Anticuerpo Fluorescente Directa , Lóbulo Frontal/patología , Lóbulo Frontal/cirugía , Humanos , Inmunoglobulina G/inmunología , Imagen por Resonancia Magnética , Masculino , Neuroesquistosomiasis/cirugía , Lóbulo Parietal/patología , Lóbulo Parietal/cirugía , Radiocirugia/métodos , Schistosoma mansoni/inmunología , Médula Espinal/parasitología , Médula Espinal/patologíaRESUMEN
PURPOSE: Posterior cortex epilepsies (PCEs) encompass a group of epilepsies originating from the occipital, parietal, or occipital border of the temporal lobe, or from any combination of these regions. When their seizures are refractory to pharmacologic treatment, these patients are usually referred for surgery. The aim of our study was to analyze clinical characteristics of all PCE patients referred for surgery from 1994 to 2003, and to search for predictors of surgical outcome. METHODS: We performed a retrospective analysis of clinical and laboratory data from 81 consecutive refractory PCE patients referred for surgery. Surgical and nonsurgical groups of patients were compared, and detailed analyses of all variables of the surgical cases were performed in the search for predictors of seizure outcome. RESULTS: Risk factors for PCEs included gliosis (34.56%), malformations of cortical development (33.33%), tumors (8.64%), brain trauma (3.70%), Sturge-Weber disease (4.93%), vascular malformations (3.70%), family history of epilepsy (3.70%), history of CNS infections (2.46%), and low IQ (2.46%). Of the 81 patients, 44 were submitted to surgery at the time of the completion of this study. Surgical treatment was highly effective in improving seizures (p<0.001) when compared with previous pharmacologic treatment alone. Twenty-eight (65.11%) patients became seizure free after surgery versus none in the nonsurgical group. Regarding outcome predictors, patients with shorter duration of epilepsy and those without neurologic abnormalities on clinical examination had higher chances of favorable evolution. CONCLUSIONS: Surgical treatment is effective for the treatment of PCEs and superior to pharmacologic therapy alone. In our series, shorter duration of epilepsy and normal neurologic examination were the only independent variables that predicted better surgical outcome.
Asunto(s)
Corteza Cerebral/fisiopatología , Epilepsia/diagnóstico , Adulto , Corteza Cerebral/cirugía , Electroencefalografía/estadística & datos numéricos , Epilepsias Parciales/diagnóstico , Epilepsias Parciales/fisiopatología , Epilepsias Parciales/cirugía , Epilepsia/fisiopatología , Epilepsia/cirugía , Epilepsia del Lóbulo Temporal/diagnóstico , Epilepsia del Lóbulo Temporal/fisiopatología , Epilepsia del Lóbulo Temporal/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Lóbulo Parietal/fisiopatología , Lóbulo Parietal/cirugía , Pronóstico , Factores de Riesgo , Resultado del Tratamiento , Grabación de Cinta de VideoRESUMEN
Central pain derived from cerebral tumors is considered rare by most authors. The few cases described in literature refer to central pain caused by expansive lesions in the contralateral parietal cortex. Usually, not even thalamic tumors cause central pain. We describe two cases of central pain related to expansive lesions in the parietal cortical region - a low grade astrocytoma and a meningioma. Both patients reported pain relief after lesions were removed by surgery.
Asunto(s)
Astrocitoma/complicaciones , Neoplasias Encefálicas/complicaciones , Cefalea/etiología , Neoplasias Meníngeas/complicaciones , Meningioma/complicaciones , Lóbulo Parietal , Adolescente , Anciano , Astrocitoma/diagnóstico , Astrocitoma/cirugía , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico , Meningioma/cirugía , Lóbulo Parietal/cirugíaRESUMEN
Intracranial fibrous tumors are unusual growths that occur almost exclusively in young individuals. Most of these lesions are intra-axial, however, on extremely rare occasions they arise from the leptomeninges and compress the adjacent brain. The authors report the case of a benign solitary fibrous tumor of the meninges in a 14-year-old girl who presented with a 5-month history of generalized headaches. NMR imaging displayed a left parietal mass, which mimicked a meningioma.
Asunto(s)
Fibroma/patología , Neoplasias Meníngeas/patología , Adolescente , Transformación Celular Neoplásica/patología , Craneotomía , Diagnóstico por Imagen , Femenino , Fibroblastos/patología , Fibroma/diagnóstico , Fibroma/cirugía , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirugía , Meninges/patología , Meninges/cirugía , Microscopía Electrónica , Lóbulo Parietal/patología , Lóbulo Parietal/cirugíaRESUMEN
The impairment of the purinergic system, characterized by reduced adenosinergic activity, has been implicated in the neurobiology of aggressive behaviour. Since there are no direct adenosine agonists available for human use, inhibition of purine degradation by allopurinol was conceived as a possible strategy. We report two cases of adults with refractory aggressive behaviour due to a neurological condition (one mainly with self-inflicted behaviour) with dramatic response to therapy with allopurinol, 300 mg/day p.o. These preliminary results reinforce the involvement of the purinergic system in the neurobiology of aggression, warranting further testing of allopurinol as a new treatment for aggressive and self-inflicted behaviours.
Asunto(s)
Agresión/efectos de los fármacos , Alopurinol/administración & dosificación , Inhibidores Enzimáticos/administración & dosificación , Trastornos Neurocognitivos/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Conducta Autodestructiva/tratamiento farmacológico , Administración Oral , Adulto , Alopurinol/efectos adversos , Astrocitoma/radioterapia , Astrocitoma/cirugía , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Terapia Combinada , Relación Dosis-Respuesta a Droga , Inhibidores Enzimáticos/efectos adversos , Femenino , Humanos , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/tratamiento farmacológico , Masculino , Meningitis/complicaciones , Trastornos Neurocognitivos/diagnóstico , Lóbulo Parietal/efectos de la radiación , Lóbulo Parietal/cirugía , Complicaciones Posoperatorias/diagnóstico , Radioterapia Adyuvante , Conducta Autodestructiva/diagnósticoRESUMEN
INTRODUCTION: Use of the electrocorticogram (EcoG) in planning lesionectomies is a controversial subject at present. MATERIAL AND METHODS: We describe a series of 5 patients with epileptic crises, 3 with arteriovenous malformations in whom the lesion was completely resected, followed by postoperative angiography, and two with gliomas with low grade malignancy in whom iridium 192 was implanted. RESULTS: 1. The most frequent reason for consultation was convulsions. 2. In our series of patients the commonest site was the frontal zone of the right hemisphere. 3. Potentials with epileptiform characteristics were registered at the edges of the lesions and occasionally over the lesion itself. In two cases electro-clinical crises were seen. 4. The lesions were resected from normal tissue independently of the EcoG results. CONCLUSION: Although they are preliminary findings, the results of the study support the usefulness of this technique to guide the surgical procedures used for the treatment of intractable epilepsy.
Asunto(s)
Astrocitoma/cirugía , Neoplasias Encefálicas/cirugía , Craneotomía , Electroencefalografía , Epilepsia del Lóbulo Frontal/fisiopatología , Lóbulo Frontal/cirugía , Malformaciones Arteriovenosas Intracraneales/cirugía , Adolescente , Adulto , Astrocitoma/complicaciones , Astrocitoma/fisiopatología , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/fisiopatología , Epilepsia del Lóbulo Frontal/etiología , Femenino , Lóbulo Frontal/fisiopatología , Humanos , Malformaciones Arteriovenosas Intracraneales/complicaciones , Malformaciones Arteriovenosas Intracraneales/fisiopatología , Masculino , Persona de Mediana Edad , Lóbulo Parietal/fisiopatología , Lóbulo Parietal/cirugía , Cuidados PreoperatoriosRESUMEN
A case of a patient operated on twice for a temporoparietal anaplastic oligondendroglioma, followed by radiotherapy, is reported. Although no intracranial recurrence has happened, a biopsyproven extracranial cervical lymphnode metastasis was diagnosed 15 months later. Surgical manipulation of the primary lesion by lymphatic and/or blood vessel invasion seem to be the main suspected factors in the development of CNS tumors metastasis in the head and neck region.
Asunto(s)
Humanos , Masculino , Adulto , Neoplasias Encefálicas/patología , Ganglios Linfáticos/patología , Metástasis Linfática , Neoplasias de Cabeza y Cuello/secundario , Oligodendroglioma/patología , Lóbulo Parietal/patología , Lóbulo Temporal/patología , Anaplasia , Neoplasias Encefálicas/cirugía , Cuello , Oligodendroglioma/cirugía , Lóbulo Parietal/cirugía , Lóbulo Temporal/cirugíaRESUMEN
Disturbance of motor reaching behavior was found in a patient submitted to a partial lobectomy including the posterior regions of the parietal cortex. The altered function could be objectivated by means of a battery of tests designed to detect visuo-spatial appreciation following which the subject has to point out to the center of figures with different configurations. Likewise, the damaged motor function could also be detected when the patient intended to reproduce, by copying, models of a figure as well as of straight lines of different lengths. Difficulties to reach -on first attempt- the proper point on the sheet with the point of the pencil, brought the performance of these tests to a high degree of inexactness and showed clearly the inaccuracy in production of voluntary motor responses within concretely definable visuo-spatial limits. These findings can be considered to be similar to those described in monkeys after removal of parieto-occipital cortex. It might be that a lesion in this part of the brain disrupt the high level of elaboration of different kind of stimuli (tactile, proprioceptive, visual, etc.) indispensable to attain normal reaching motor functions.