RESUMO
To describe the natural history of spinal gangliogliomas (GG) in order to determine the most appropriate neuro-oncological management. A Medline search for relevant publications up to July 2023 using the key phrase "ganglioglioma spinal" and "ganglioglioma posterior fossa" led to the retrieval of 178 studies. This corpus provided the basis for the present review. As an initial selection step, the following inclusion criteria were adopted: (i) series and case reports on spinal GG; (ii) clinical outcomes were reported specifically for GG; (iii) GG was the only pathological diagnosis for the evaluation of the tumor; (iv) papers written only in English was evaluated; and (v) papers describing each case in the series were included. The World Health Organization (WHO) 2021 grading criteria for gangliogliomas were applied. A total of 107 tumors were evaluated (63 from male patients and 44 from female patients; 1.43 male/1.0 female ratio, mean age 18.34 ± 15.84 years). The most common site was the cervical spine, accounting for 43 cases (40.18%); GTR was performed in 35 cases (32.71%) and STR in 71 cases (66.35%), while this information was not reported in 1 case (0.94%). 8 deaths were reported (7.47%) involving 2 males (25%) and 6 females (75%) aged 4-78 years (mean 34.27 ± 18.22) years. GGs located on the spine displayed the same gender ratio as these tumors in general. The most frequent symptom was pain and motor impairment, while the most prevalent location was the cervical spinal cord. GTR of the tumor posed a challenge for neurosurgeons, due to the difficulty of resecting the lesion without damaging the spinal eloquent area, explaining the lower rate of cure for this tumor type.
Assuntos
Neoplasias Encefálicas , Ganglioglioma , Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Ganglioglioma/cirurgia , Ganglioglioma/diagnóstico , Ganglioglioma/patologia , Resultado do Tratamento , Recidiva Local de Neoplasia/patologia , Neoplasias Encefálicas/cirurgiaRESUMO
OBJECTIVE: The authors searched for genetic and transcriptional signatures associated with tumor progression and recurrence in their cohort of patients with meningiomas, combining the analysis of targeted exome, NF2-LOH, transcriptome, and protein expressions. METHODS: The authors included 91 patients who underwent resection of intracranial meningioma at their institution between June 2000 and November 2007. The search of somatic mutations was performed by Next Generation Sequencing through a customized panel and multiplex ligation-dependent probe amplification for NF2 loss of heterozygosity. The transcriptomic profile was analyzed by QuantSeq 3' mRNA-Seq. The differentially expressed genes of interest were validated at the protein level analysis by immunohistochemistry. RESULTS: The transcriptomic analysis identified an upregulated set of genes related to metabolism and cell cycle and downregulated genes related to immune response and extracellular matrix remodeling in grade 2 (atypical) meningiomas, with a significant difference in recurrent compared with nonrecurrent cases. EZH2 nuclear positivity associated with grade 2, particularly with recurrent tumors and EZH2 gene expression level, correlated positively with the expression of genes related to cell cycle and negatively to genes related to immune response and regulation of cell motility. CONCLUSIONS: The authors identified modules of dysregulated genes in grade 2 meningiomas related to the activation of oxidative metabolism, cell division, cell motility due to extracellular remodeling, and immune evasion that were predictive of survival and exhibited significant correlations with EZH2 expression.
Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirurgia , Neoplasias Meníngeas/cirurgia , Recidiva Local de Neoplasia/patologia , Ciclo Celular , Divisão Celular , Proteína Potenciadora do Homólogo 2 de Zeste/genéticaRESUMO
Objectives The aim of the present study is to analyze if aquaporin-4 (AQP4) may also be a tumor progression marker for meningiomas. Methods This is an immunohistochemistry study realized at the Universidade de São Paulo, São Paulo, state of São Paulo, Brazil: frozen meningioma samples from 81 patients (57 females and 24 males, age range from 22 to 81 years old, average 56.5 14.1 years old), including 57 meningiomas World Health Organization (WHO) grade I (GI); 19 grade II (GII), and 5 grade III (GIII) were analyzed. The relative expression level of AQP4 was analyzed by quantitative polymerase chain reaction (qPCR), using the SYBR Green approach and for staining detection. Tissue sections were routinely processed and subjected to antigen retrieval. Results The expression of AQP4 in meningioma samples ranged from 0 to 10.26, with a median of 0.001 in GI cases, of 0.008 in GII cases, and of 0.006 in GIII cases. Although not statistically significant (p » 0.942), GI meningiomas have a lower median AQP4 expression level than higher malignant grade cases. Conclusion The AQP4 gene and protein expressions presented no association with meningioma malignant progression.
Objetivo O objetivo do presente estudo é analisar se a aquaporina-4 (AQP4) também pode ser um marcador de progressão tumoral para meningiomas. Métodos Trata-se de um estudo imunohistoquímico realizado na Universidade de São Paulo, SP, Brasil. Amostras congeladas de meningioma de 81 pacientes (57 mulheres e 24 homens, faixa etária de 22 a 81 anos, média de 56,5 14,1 anos), incluindo 57 meningiomas grau I (GI) da Organização Mundial da Saúde (OMS); 19 grau II (GII) e 5 grau III (GIII) foram analisados. O nível de expressão relativa de AQP4 foi analisado por reação em cadeia de polimerase quantitativa (qPCR, sigla em inglês), usando a abordagem SYBR Green e para detecção de manchas. As seções de tecido foram rotineiramente processadas e sujeitas a recuperação de antígeno. Resultados A expressão de AQP4 em amostras de meningioma variou de 0 a 10,26, com mediana de 0,001 nos casos GI; 0,008 nos casos GII; e 0,006 nos casos GIII. Embora não sejam estatisticamente significantes (p » 0,942), os meningiomas GI apresentam mediana mais baixa do nível de expressão de AQP4 do que os casos de grau maligno mais alto. Conclusão Expressões de genes e proteínas AQP4 apresentadas na associação com progressão maligna do meningioma.
RESUMO
ABSTRACT Background: The correlation between angioarchitecture and clinical presentation of brain arteriovenous malformation (bAVM) remains a subject of debate. Objective: The main purpose of the present study was to assess the correlation between angioarchitectural characteristics of bAVM and clinical presentation. Methods: A retrospective review of all consecutive patients presenting a bAVM who underwent a cerebral angiography at Beneficencia Portuguesa Hospital in São Paulo between January 2006 and October 2016 was carried out. Patients were divided in five groups: group 1 - hemorrhage; group 2 - seizure; group 3 - headache; group 4 - progressive neurological deficits (PND); group 5 - incidental). Results: A total of 183 patients were included, with group 1 comprising 56 cases, group 2 49 cases, group 3 41 cases, group 4 28 cases, and group 5 9 cases. Regarding hemorrhage presentation, a statistical correlation was observed with female gender (P < 0.02), Spetzler-Martin 3B (P < .0015), and lesions with low flow (P < 0.04). A positive association was found between group 2 and age less than 36 years (P < 0.001), male sex (P < 0.018), presence of superficial lesions not classified as SM 3B (P < 0.002), presence of venous ectasia (p <0.03), and arterial steal phenomenon (P < 0.03). Group 4 was associated with older age (P < 0.01). Conclusions: Angioarchitectural characteristics can be correlated with some clinical presentations as well as with some clinical data, making it possible to create predictive models to differentiate clinical presentations.
RESUMO Antecedentes: A correlação entre a angioarquitetura e a apresentação clínica da Malformação Arteriovenosa do cérebro (MAVc) permanece um assunto de debate. Objetivos: Correlacionar as características angioarquiteturais das MAVc com a apresentação clínica. Métodos: Estudou-se pacientes consecutivos atendidos no Hospital Beneficência Portuguesa-SP, entre 2006 a 2016. Após análise geral, criaram-se cinco grupos de acordo com a apresentação clínica: 1- Hemorragia; 2 - Epilepsia; 3 - Cefaléia; 4 - Déficit Neurológico Progressivo (DNP) e 5 - Incidental. Características epidemiológicas (clínica e topografia) e angioarquiteturais (Classificação de Spetzler-Martin Modificada - SMM; Fluxo intranidal; Aneurismas arteriais, intranidais e venosos; Ectasia venosa; Congestão venosa; "Roubo" arterial; Vascularização dural; Drenagem Venosa Profunda) foram analisadas. Resultados: 183 pacientes foram incluídos e analisados globalmente. Após essa etapa, foram divididos nos grupos: 1 - 56 casos (30,6%); 2 - 49 casos (26,7%); 3 - 41 casos (22,4%); 4 - 28 casos (15,3%) e 5 - 9 casos (4,9%). Principais achados foram referentes a apresentação hemorrágica, na qual observamos correlação estatística positiva com o sexo feminino (P<0,02), lesões classificadas como SMM 3B (P<0,0015) e baixo fluxo (P<0,04). Relacionado à epilepsia, encontramos significância estatística que possibilitou a correlação com pacientes com idade inferior a 36 anos (P<0,001), sexo masculino (P<0,018), lesões superficiais (P<0,002), presença de ectasia venosa (P<0,003) e "roubo" arterial (P<0,01). Pacientes com DNP se apresentam com idade superior aos demais (P<0,01). Conclusões: Após análise multivariada, foi possível separar as MAV em grupos de acordo com as características angioarquiteturais, comprovando que algumas dessas características estão fortemente relacionadas a determinada manifestação.
Assuntos
Humanos , Masculino , Feminino , Adulto , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Encéfalo , Brasil , Angiografia Cerebral , Estudos RetrospectivosRESUMO
BACKGROUND: The correlation between angioarchitecture and clinical presentation of brain arteriovenous malformation (bAVM) remains a subject of debate. OBJECTIVE: The main purpose of the present study was to assess the correlation between angioarchitectural characteristics of bAVM and clinical presentation. METHODS: A retrospective review of all consecutive patients presenting a bAVM who underwent a cerebral angiography at Beneficencia Portuguesa Hospital in São Paulo between January 2006 and October 2016 was carried out. Patients were divided in five groups: group 1 - hemorrhage; group 2 - seizure; group 3 - headache; group 4 - progressive neurological deficits (PND); group 5 - incidental). RESULTS: A total of 183 patients were included, with group 1 comprising 56 cases, group 2 49 cases, group 3 41 cases, group 4 28 cases, and group 5 9 cases. Regarding hemorrhage presentation, a statistical correlation was observed with female gender (P < 0.02), Spetzler-Martin 3B (P < .0015), and lesions with low flow (P < 0.04). A positive association was found between group 2 and age less than 36 years (P < 0.001), male sex (P < 0.018), presence of superficial lesions not classified as SM 3B (P < 0.002), presence of venous ectasia (p <0.03), and arterial steal phenomenon (P < 0.03). Group 4 was associated with older age (P < 0.01). CONCLUSIONS: Angioarchitectural characteristics can be correlated with some clinical presentations as well as with some clinical data, making it possible to create predictive models to differentiate clinical presentations.
Assuntos
Malformações Arteriovenosas Intracranianas , Adulto , Encéfalo , Brasil , Angiografia Cerebral , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Estudos RetrospectivosRESUMO
A 79-year-old patient was admitted to the emergency room with transitory monoparesis in the left hand and dysphasia. The brain computed tomography (CT) and magnetic resonance imaging (MRI) showed a spontaneous right convexity subarachnoid hemorrhage (cSAH). Digital subtraction angiography (DSA) confirmed an asymptomatic occlusion of the right internal carotid artery (ICA) . Cases related to stenosis have already been described, but there is no similar report of a case related to occlusion, even though the pathophysiology of both entities is similar. Atraumatic SAH has been associated with intracranial and extracranial artery stenosis.
Assuntos
Humanos , Feminino , Idoso , Hemorragia Subaracnóidea/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Artéria Carótida Interna/anormalidades , Estenose das Carótidas , Angiografia Cerebral/métodosRESUMO
Review the data published on the subject to create a more comprehensive natural history of intraventricular meningiomas (IVMs). A Medline search up to March 2018 using "intraventricular meningioma" returned 98 papers. As a first selection step, we adopted the following inclusion criteria: series and case reports about IVMs, as well as papers written in other languages, but abstracts written in English were evaluated. Six hundred eighty-one tumors were evaluated from 98 papers. The majority of the tumors were located in the lateral ventricles (602-88.4%), fourth ventricle (59-8.7%), and third ventricle (20-2.9%). These tumors accounted for a mortality rate of 4.0% (25 deaths) and a recurrence rate of 5.3% (26 recurrences). The majority of the tumors were grade I (89.8%) and consisted of the following subtypes: fibrous, 39.7% (n = 171); transitional, 22.0% (n = 95); meningothelial, 18.6% (n = 80); angiomatosus, 3.2% (n = 14); psammomatous, 2.6% (n = 11); and others, 13.9% (n = 60). Forty-five patients (7.4%) presented with grade II (GII) tumors, and 17 patients (2.8%) presented with grade III (GIII) tumors. These tumors follow the histopathological distribution of meningiomas in general, with the exception of the higher prevalence of the fibrous subtype, possibly due to its embryonic origin. Recurrence and mortality were lower than in other localizations likely due to a complete surgical resection rate than in the convexity and skull base, which suggests that GTR is the gold standard for the management of IVMs.
Assuntos
Neoplasias do Ventrículo Cerebral/patologia , Meningioma/patologia , Neoplasias do Ventrículo Cerebral/cirurgia , Humanos , Meningioma/cirurgia , PrognósticoRESUMO
Evaluate whether radiotherapy (RT) after the neurosurgical treatment of atypical meningiomas (AM) has an impact on the reduction rate of recurrence. A Medline search through October 2017 using "atypical meningioma" returned 1277 papers for initial review. Inclusion criteria were as follows. We analyzed the database and included articles in which the anatomic pathological classification of atypical meningiomas was in accordance with WHO 2007 or WHO 2016 criteria, patients > 18 years of age, and there was postoperative external beam radiation to the tumor bed. Exclusion criteria were WHO grade I or III meningioma, patients who underwent whole-brain radiation, RT used as salvage therapy for recurrence, palliative dose of RT (< 45 Gy), recurrent AMs, and multiple AMs. Papers reporting outcomes in which atypical and anaplastic meningiomas were analyzed together were rejected, as were papers with small samples that may compromise evaluation. After filtering our initial selection, only 17 papers were selected. After reviewing the seventeen articles including a total of 1761 patients (972 female and 799 male; 1.21 female/1.0 male), the difference in proportion of tumor recurrence between patients with and without radiotherapy after neurosurgical procedure was 1.0448, 95% CI [0.8318 to 1.3125], p value = 0.7062. On the basis of this review, there is no evidence to suggest that RT decreases the rate of recurrence in patients with atypical meningiomas.
Assuntos
Neoplasias Encefálicas/radioterapia , Meningioma/radioterapia , Terapia Combinada , Humanos , Recidiva Local de Neoplasia/radioterapia , Procedimentos Neurocirúrgicos , Terapia de SalvaçãoRESUMO
OBJECTIVE: To analyze the surgical and oncologic treatment of a Brazilian cohort of patients with grade II and III meningioma at a follow-up time of 15 years to get an overview of these patients' outcomes. METHODS: Cross-sectional study of 43 patients (26 women, 17 men; age range 20 to 83 years; average 57.72 ± 14.54) operated on from 2000 to 2014 at a single institution, with the neuropathologic diagnosis of meningioma grade II (39 patients) and grade III (4 patients). RESULTS: Radiotherapy: 24 patients (55.81%) underwent radiotherapy; the time between the surgical procedure and the beginning of radiotherapy was 5 months; 7 patients with a diagnosis of AM underwent a new surgical procedure, albeit of adjuvant therapy, because of tumor recurrence, and only 3 of them underwent radiotherapy after the first resection. Mortality: in total, 19 deaths (44.18%) were identified in this sample: 15 (38.46%) with GII and 4 (100%) with GIII. The 10-year survival was expected in 35% of GII patients and 0% of GIII patients. CONCLUSION: Surgery is still the main form of treatment and the mainstay for prolonging survival. Radiotherapy is still controversial; however, we observed its positive impact on recurrence and progression-free survival.
Assuntos
Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Meningioma/radioterapia , Meningioma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Terapia Combinada , Estudos Transversais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/mortalidade , Neoplasias Meníngeas/patologia , Meningioma/mortalidade , Meningioma/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia , Radioterapia Adjuvante , Estudos Retrospectivos , Adulto JovemAssuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Angiografia Cerebral , Cavidades Cranianas/anormalidades , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , MasculinoAssuntos
Humanos , Masculino , Recém-Nascido , Cavidades Cranianas/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Imageamento por Ressonância Magnética , Angiografia Cerebral , Cavidades Cranianas/anormalidades , Malformações Vasculares do Sistema Nervoso Central/terapiaAssuntos
Oftalmoplegia Externa Progressiva Crônica/diagnóstico por imagem , Oftalmoplegia Externa Progressiva Crônica/cirurgia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Adolescente , Feminino , Humanos , Imageamento por Ressonância Magnética , Ilustração Médica , Resultado do TratamentoAssuntos
Lipoma , Polirradiculopatia , Neoplasias da Medula Espinal , Adulto , Feminino , Humanos , Lipoma/complicações , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Imageamento por Ressonância Magnética , Polirradiculopatia/diagnóstico por imagem , Polirradiculopatia/etiologia , Polirradiculopatia/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgiaAssuntos
Humanos , Feminino , Adulto , Polirradiculopatia/cirurgia , Polirradiculopatia/etiologia , Polirradiculopatia/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Lipoma/cirurgia , Lipoma/complicações , Lipoma/diagnóstico por imagem , Imageamento por Ressonância MagnéticaRESUMO
Infundibular dilations (IDs) are funnel-shaped enlargements in the origin of intracranial arteries. Usually, IDs occur at the junction between posterior communicating artery (PcomA) and internal carotid artery (ICA). Progression from an ID of the PcomA to aneurysms has been described, but is unclear whether an ID is a preaneurysmal state or a normal anatomical variant. The authors describe a 55-year-old female patient presenting multiple intracranial aneurysms with a small one arising from an ID at the level of posterior communicating segment of ICA. To the best of our knowledge, after a criterious search in the English literature, it is the first description of such unusual combination. The preoperative neurosurgical planning is discussed as well as the importance of intraoperative findings to the best management of this unusual situation.
Assuntos
Artérias Cerebrais , Aneurisma Intracraniano , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Pessoa de Meia-IdadeRESUMO
Relato de cisticercose intramedular em homem de 42 anos que há seis anos sentia parestesias em ambas as pernas, que evoluíram para ausência de sensação dolorosa, por fim paraparesia espástica dos membros inferiores. Ao exame físico, verificaram-se sinal de Babinski bilateral, espasticidade dos membros inferiores e déficit de sensibilidade abaixo de T7. Ressonância nuclear magnética mostrou uma lesão expansiva ao nível de T5. Durante a exérese do processo, constatou-se que se tratava de cisticercose, em sua forma tumoral intramedular. Após a retirada, o mesmo evoluiu de maneira satisfatória, porém sem regressões dos sintomas.
A case of spinal cord cysticercosis in a 42 year-old man is reported. He presented a six years history of paresthesia in both legs, which progressed to lack of feeling pain, spastic paraparesis of the lower limbs. On physical examination there was bilateral Babinski sign, spasticity of the lower limbs, and lack of sensitivity below T7. The magnetic resonance imaging showed an expansive lesion at the level of T5. Patient was referred for excision of the process, and while it was withdrawn, it was found that to be a cysticercosis in a shape of spinal cord tumor. There was no postoperative complication but the symptoms did not improve.
Assuntos
Humanos , Masculino , Adulto , Neurocisticercose/complicações , Paraplegia/etiologiaRESUMO
Objetivo: Demonstrar o valor da resposta dolorosa à realização da manobra de Valsalva na escolhado tratamento adequado da hérnia discal lombar. Casuística e método: Estudo prospectivo de 2.200pacientes de ambos os gêneros, de diversas faixas etárias, atendidos e acompanhados no HospitalAntônio Targino e na Clínica de Neurologia e Neurocirurgia Domício Holanda, na cidade de CampinaGrande, PB, com diagnóstico de hérnia discal, no período de janeiro de 1993 a outubro de 2008. Ospacientes foram divididos em dois grupos: um grupo de 2.000 pacientes com lombociatalgia decorrentesde hérnias lombares que apresentavam dor durante a manobra de Valsalva e outro grupo de 200 pacientes que tinham as mesmas características clínicas do primeiro grupo, porém não apresentavam exacerbação da dor durante manobra de Valsalva. Resultado: Os 2.000 pacientes que apresentaram dor com a execução da manobra e foram submetidos à cirurgia tiveram boa resposta, enquanto os outros200 pacientes que não referiram a mesma dor e que foram seguidos de maneira ambulatorial tiveramuma diminuição dessa dor, porém não precisaram de tratamento cirúrgico. Conclusão: A dor provocada pela manobra de Valsalva é sinal extremamente útil no que se refere à triagem desses pacientes.
Valsalva maneuver as a predictor of herniated lumbar disc surgical treatment resultsObjective: Demonstrate the value of pain response to the Valsalva maneuver in choosing the appropriate treatment of lumbar disc herniation. Patients and methods: Prospective study of 2,200 patients of both genders in various age groups, treated and followed at Hospital Antônio Targino and Clínica de Neurologia e Neurocirurgia Domício Holanda, Campina Grande, PB, Brazil with disc herniation in theperiod from January 1993 to and in October 2008. Patients were divided into two groups: one group of2,000 patients with herniated lumbar disc with radicular pain that presented pain to maneuver Valsalvaand another group of 200 patients who had similar clinical characteristics of the first group, but showed no exacerbation of pain during maneuver of Valsalva. Results: The 2,000 patients from the first group (Valsalva-positive) underwent surgery and had a good response, while the other 200 Valsalva-negativepatients were followed in outpatient settings, had the pain decreased but did not require surgical treatment. Conclusion: The pain caused by the Valsalva maneuver is extremely useful signal with regard to triage these patients.
Assuntos
Humanos , Masculino , Feminino , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/terapia , Dor Lombar , Manobra de ValsalvaRESUMO
Contexto: O tratamento proposto para síndrome do túnel do carpo é dividido em conservador e cirúrgico. O tratamento conservador versa em fisioterapia e uso de medicamentos. A cirurgia para liberação do túnel do carpo é um assunto corrente na literatura, motivo de diversas publicações, principalmente a partir dos anos 1950. Na liberação tradicional, o cirurgião faz uma incisão de 5 cm a 6 cm, estendida longitudinalmente em relação à prega formada pelo punho, e realiza a liberação do ligamento transverso do carpo sob visualização direta. Objetivo: Apresentar a técnica cirúrgica desenvolvida por nós, que consiste em uma microincisão de 1 cm na linha média da prega do punho e recortar os bordos do retináculo dos flexores, e demonstrar as vantagens dessa técnica, perante a vigente. Casuística: A técnica foi utilizada em 40 pacientes de ambos os gêneros, das mais variadas faixas etárias, atendidos e acompanhados no Hospital Antônio Targino e na Clínica de Neurologia e Neurocirurgia Domício Holanda, (ambos situados na cidade de Campina Grande, PB) com síndrome do túnel do carpo no período de janeiro de 1993 a dezembro de 2008. Resultados: Verificou-se que houve diminuição da dor, a técnica proporcionou melhor efeito estético, uma vez que, pela microincisão na linha da prega palmar, pouco tempo após o procedimento a cicatriz perdia-se entre as pregas palmares; em nenhum dos pacientes acompanhados após a cirurgia houve recidiva, constituindo uma vantagem sobre a técnica vigente; quanto à cicatrização, não houve formação de queloides em nenhum dos pacientes, ratificando-se melhor reposta cicatrizante; melhor exequibilidade ao cirurgião e menor tempo cirúrgico. Conclusão: A técnica apresentada oferece resultados extraordinários, diminuindo a chance de recidivas, trazendo melhor exequibilidade ao cirurgião e levando maior satisfação aos pacientes.
Background: The proposed treatment for carpal tunnel syndrome is divided into conservative and surgical. Conservative treatment consists in physiotherapy and medication. Surgery to release the carpal tunnel is a current topic in the literature, subject to various publications, mostly from the 50s. In the traditional release, the surgeon makes an incision from 5 cm to 6 cm long, extended longitudinally in relation to the fold formed by the handle, and holds the release of the transverse carpal ligament under direct visualization. Objective: To present the surgical technique developed by us, which is a micro-incision 1 cm long in the midline of the wrist crease and cut the edges of the flexor retinaculum and demonstrate the advantages of this technique. Methods: The technique was used in forty patients presenting carpal tunnel syndrome, of both genders in a wide range of age groups from January 1993 to December 2008. Results: We found in all the cases that the pain was relieved, a better cosmetic result, the surgical scar was imperceptible shortly after the procedure lost in the palmar crease, there was no recurrence, providing an advantage over the usual techniques as for healing, no keloid formation confirming that there was better healing response, best feasibility for the surgeon and a shorter duration of surgery. Conclusion: The technique presented provides extraordinary results, reducing the chance of recurrence, easier feasibility to the surgeon and more patient?s satisfaction.
Assuntos
Humanos , Masculino , Feminino , Procedimentos Neurocirúrgicos/métodos , Síndrome do Túnel Carpal/cirurgiaRESUMO
Um caso de hematoma na intradural espinal espontâneo ao nível de T11-12, simulando um quadro de tumor, é relatado. O diagnóstico de processo expansivo intradural extramedular foi feito por meio de ressonância magnética. O exame histopatológico confirmou tratar-se de hematoma organizado. Hematomas espinais espontâneos são raros, e os casos descritos referem-se a hematomas extradurais. Não encontramos na literatura pesquisada hematoma intradural espinal espontâneo.
A case of intradural spontaneous hematoma in the thoracic spine (T11-12), simulating a tumor is presented. The mass lesion was detected by nuclear magnetic resonance imaging, in a patient presenting paraplegia. The diagnosis of organized hematoma was coinfirmed by histopathology. Spinal spontaneous hematomas are very rare and the reports refer to extradural hematomas. Descrition of spontaneous subdural spinal hematoma was not found in the literature searched.