RESUMO
A case of a 3-year-old boy with severe haemophilia A who had a successful neurosurgical drainage of a combined spontaneous left temporal subdural and intra-parenchimal haematoma is reported. Surgical intervention was required because of clinical worsening during conservative treatment with dexamethasone and factor VIII (FVIII) replacement therapy. Continuous FVIII infusion was given before, during and after the procedure. There were no surgical complications and neurological examination remains intact. Neurosurgical interventions may be reserved for special, high-risk cases, as the one presented.
Assuntos
Hematoma Subdural/cirurgia , Hemofilia A/complicações , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pré-Escolar , Fator VIII/administração & dosagem , Humanos , Infusões Intravenosas , Masculino , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
The increasing interest in selective posterior rhizotomy for reduction of spasticity in children with cerebral palsy and other neurological disorders comes from the selectivity that this procedure has achieved with intraoperative electromyographic monitoring. Thirty patients were operated on between April 1989 and October 1991. Spasticity was of cerebral origin in 27 cases and secondary to spinal cord lesion in 3 others. A reduction in the abnormally high muscle tone was observed in all cases, mainly in the lower extremities, but also, to a lesser degree, in the upper extremities. All patients showed functional improvements that depended on the individual preoperative condition. Even severely disabled patients with quadriplegia and intellectual impairment, whose spasticity interfered with their daily care, had a significantly improved quality of life after rhizotomy. These patients became much looser, with better swallowing and less drooling, and were much more easily managed by their caretakers. Preliminary results with follow-up from 1 to 30 months indicates that selective posterior rhizotomy is a safe procedure which contributes to significant functional improvement in spastic patients.
Assuntos
Paralisia Cerebral/cirurgia , Espasticidade Muscular/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adolescente , Adulto , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/fisiopatologia , Dano Encefálico Crônico/cirurgia , Paralisia Cerebral/etiologia , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Eletromiografia/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Monitorização Intraoperatória/instrumentação , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Músculos/inervação , Exame Neurológico , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgia , Raízes Nervosas Espinhais/fisiopatologiaRESUMO
Ten infants and children with choroid plexus papilloma of the III ventricle are presented. Hydrocephalus of various degrees was present in all patients, and seven patients had bilateral ventriculoperitoneal shunts prior to craniotomy. All patients were investigated with computed tomography and angiography. Tumor was resected through the transfrontal-transventricular approach in nine and through a transcallosal approach in one. One patient died intraoperatively due to an uncontrollable hemorrhage from a subependymal vein at its point of entry into the homolateral internal cerebral vein, and another died shortly after surgery due to hypothalamic trauma. The remaining eight patients are alive without recurrence over a minimum follow-up period of 3 years; three have mental retardation and seizure disorder. Despite this tumor's deep location and vascularity and occurrence in infancy, choroid plexus papillomas of the III ventricle can be successfully resected. Appropriate care for hydrocephalus and intra- and postoperative management are important.
Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Plexo Corióideo , Ependimoma/cirurgia , Angiografia Cerebral , Neoplasias do Ventrículo Cerebral/complicações , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Derivações do Líquido Cefalorraquidiano , Criança , Pré-Escolar , Ependimoma/complicações , Ependimoma/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Lactente , Masculino , Neurocirurgia/métodos , Tomografia Computadorizada por Raios XRESUMO
Vascular and neoplastic lesions of the lateral and III ventricles, the pineal region, or the basal ganglia affect highly critical areas. For surgical treatment of these lesions, the interhemispheric, transcallosal approach was studied in our laboratory in an attempt to evaluate the surgical procedure. The advantages and disadvantages are described in comparison with those for other approaches in the same regions. To this end, we dissected 20 anatomical specimens interhemispherically using the surgical microscope (with a magnification of 6 x to 25 x); the specimens were fixed for 6-8 weeks in formaldehyde 10%). In each specimen the corpus callosum was exposed and then sectioned to a length of 2 to 2.5 cm over its anterior, middle, and posterior thirds. The anatomy of the lateral and III ventricles and of the pineal region was explored; the arrangement configuration of the anterior cerebral arteries and their branches was also evaluated, as were the thalamostriate and other subependymal veins, the internal cerebral veins, the choroid plexus, the trigone, and the septum pellucidum.
Assuntos
Gânglios da Base/cirurgia , Encéfalo/anatomia & histologia , Ventrículos Cerebrais/cirurgia , Microcirurgia/métodos , Glândula Pineal/cirurgia , Encéfalo/cirurgia , Cadáver , Corpo Caloso , HumanosRESUMO
Durante un periodo de un ano fueron estudiados 103 pacientes con hidrocefalia, 55 del sexo masculino y 48 del femenino, cuyas edades oscilaron entre recien nacidos y los doce anos. Se ha evidenciado la importancia que presentan, para el pronostico de la enfermedad, un perimetro cefalico dentro de los limites normales o solo ligeramente aumentado y un sistema ventricular leve o moderadamente dilatado. La tomografia computada ha resultado el metodo diagnostico de eleccion, por ser incruento y eficaz. Se destaca la utilidad de la gentamicina parenteral en el periodo pre y posoperatorio inmediato, asi como su uso local intraoperatorio en la profilaxis de la colonizacion bacteriana del sistema valvular
Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Hidrocefalia , Cefalometria , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
Durante un periodo de un ano fueron estudiados 103 pacientes con hidrocefalia, 55 del sexo masculino y 48 del femenino, cuyas edades oscilaron entre recien nacidos y los doce anos. Se ha evidenciado la importancia que presentan, para el pronostico de la enfermedad, un perimetro cefalico dentro de los limites normales o solo ligeramente aumentado y un sistema ventricular leve o moderadamente dilatado. La tomografia computada ha resultado el metodo diagnostico de eleccion, por ser incruento y eficaz. Se destaca la utilidad de la gentamicina parenteral en el periodo pre y posoperatorio inmediato, asi como su uso local intraoperatorio en la profilaxis de la colonizacion bacteriana del sistema valvular