SSEff detected in the first 24 hours posttrauma in our series evolved into TSHy suggesting that this is an early lesion; all THSy were divided in three groups according to the pathophysiologic mechanism. These three groups probably represent a continuum of CSF absorption impairment. Group Ia represents what most authors consider a simple hygroma, with no impairment on CSF absorption. Group Ib represent the external hydrocephalus form with various degrees of CSF imbalance, and group II were the cases presenting marked mass effect.

Objective: Report our experience with trigone ventricular meningiomas and review the surgical approaches to the trigone. Method: From 1989 to 2006, six patients with meningiomas of the trigone of the lateral ventricles underwent microsurgical resection. Their clinical features, image, follow up, and surgical approaches were retrospectively analyzed. Results: Five patients presented with large and one with small volume meningioma. Unspecific symptoms occurred in three patients; intracranial hypertension detected in three patients; homonymous hemianopsy in three; and motor deficit present in one patient. Three patients were operated by transparietal transcortical approach, two by middle temporal gyrus approach, and one by parieto-occipital interhemispheric precuneus approach. Total resection was achieved in all patients without additional deficits. Conclusion: Judicious preoperative plan, adequate knowledge of anatomy, and use of correct microsurgical techniques are fundamental in achieving complete resection of trigone meningioma with low morbidity. Key words: meningioma, lateral ventricle, trigone, surgical approach.Meningiomas do trígono ventricular: abordagens cirúrgicas RESUMO Objetivo: Relatar a experiência com seis meningiomas do trígono ventricular e discutir as várias vias de abordagem para o trígono descritos na literatura. Método: Seis pacientes com meningiomas do trígono ventricular operados entre 1989 e 2006 foram analisados quanto às suas características clínicas, de imagem, evolução e às vias de abordagem. Resultados: Cinco pacientes apresentaram meningiomas de grande volume e um pequeno. Sintomas inespecíficos ocorreram em três pacientes, hipertensão intracraniana em outros três pacientes; hemianopsia homônima em três e déficit motor em um paciente. Três pacientes foram operados por via transcortical transparietal, dois através do giro temporal médio, e um por abordagem interhemisférica precuneus. A ressecção total foi possível em todos os pacientes, sem défices adicionais. Conclusão: Planejamento operatório cuidadoso aliado ao uso de técnicas microcirúrgicas são fundamentais na ressecção completa dos meningiomas do trígono com baixa morbidade. Palavras-chave: meningioma, ventrículo lateral, trígono, abordagem cirúrgica.

RESUMO -Com o propósito de analisar os aspectos clínicos da hidrocefalia (HDC) na neurocisticercose (NCC), realizou-se o estudo retrospectivo de 47 prontuários de pacientes com HDC e NCC. Verificou-se que 70,2% eram homens, entre 21 e 50 anos. A hipertensão intracraniana (HIC) ocorreu em todos os pacientes, cefaléia (CEF) em 89,4%, meningoencefalite (ME) em 80,8% e distúrbios psíquicos (PSI) em 74,5%. A síndrome liquórica da NCC foi detectada em 65,9% pacientes. Além da HDC, as tomografias computadorizadas de crânio (TC) mostraram lesões císticas e edema cerebral difuso em 59,6% cada, calcificações em 55,3%. Dos 41 pacientes (87,2%) com derivação ventriculoperitoneal (DVP), em 22 (53,7%) deles foram necessárias uma a sete revisões/paciente (média=3). A evolução foi satisfatória em 51,1% e fatal em 31,9%. Conclui-se que a hidrocefalia é mais comum no sexo masculino em idade produtiva, tendo a HIC, CEF, MN e PSI como manifestações freqüentes e que, a necessidade de revisões de DVP, piora o prognóstico. PALAVRAS-CHAVE: aspectos clínicos, hidrocefalia, neurocisticercose.clinical and evolutive aspects of hydrocephalus in neurocysticercosis ABSTRACT -With the purpose to verify clinical aspects of hydrocephalus (HC) in patients with neurocysticercosis (NCC), a retrospective study of 47 patients was performed. The majority of patients (70.2%) were men aging 21-50 years. Intracranial hypertension (ICH) occurred in all patients, headache (HA) in 42 (89.4%), meningoencephalitis (ME) in 38 (80.8%) and psychiatric disorders (PD) in 34 (72.3%). The cerebrospinal fluid syndrome of NCC was detected in 31 patients (65.9%). In addition to HC, computed tomography (CT) scans showed cystic lesions in 28 (59.6%) patients, diffuse brain edema also in 28 (59.6%), and calcifications in 26 (55.3%). Shunts were inserted in 41 (87.2%) patients and 22 (53.7%) of them were submitted to 1-7 surgical revision/patient (mean=3) that were higher (mean=4) in those who died than in survivors (mean=2). Evolution was satisfactory in 24 (51.1%) patients and fatal in 15 (31.9%). It is possible to conclude that, in patients with NCC, HC occurs predominantly in men in productive life with ICH, HA, ME and PD as common manifestations, and the need for shunt revision makes patient's prognosis worse. A ventriculomegalia (VM) ou hidrocefalia (HDC), como é mais conhecida, caracteriza-se por aumento de volume do líquido cefalorraqueano (LCR) associado a dilatação dos ventrículos cerebrais. Dependendo do mecanismo responsável pela formação dessa dilatação, classifica-se em HDC ex-vácuo (VM conseqüen-te à perda de parênquima cerebral sem alteração na pressão liquórica), HDC de pressão normal (VM conseqüente à redução da vazão liquórica por defeito na absorção de LCR e/ou insuficiência do espaço subaracnóideo), HDC comunicante (VM conseqüente à secreção excessiva de LCR, insuficiência venosa ou alteração da absorção do LCR) e HDC não-comunicante ou obstrutiva (VM conseqüente à obstrução do fluxo liquórico causada pela presença de processo expansivo ou por fibrose ...

Rupture of a cerebral aneurysm into an arachnoid cyst is rare. Clinical presentation may be unusual because the cyst can prevent subarachnoid hemorrhage. A middle fossa cranial arachnoid cyst in the presence of temporal bone depression, small middle fossa, and thickness of squamous temporal bone and the lesser wing of sphenoid is rare and suggests that congenital factors may play an important role in their development. The exceptional association between "mirror" aneurysms and arachnoid cyst with bone changes suggests a possible congenital form of dysplasia.

There is substantial controversy in literature about human dermatomes. In this work, C5 and C6 superior limb dermatomes were studied. The method consisted of comparing clinical signs and symptoms with conduction studies, electromyographical data, neurosurgical findings, and imaging findings obtained by computerized tomography (CT) or magnetic resonance imaging (MRI), for each patient. Data analysis from superior members in 18 patients suggests that C5 is located in the lateral aspect of the shoulder and arm, and C6 in the lateral aspect of the forearm and 1st, 2nd, and 3rd fingers. To our knowledge this is the first time that C5 and C6 human dermatomes have been studied by all the following methods together: clinical, electromyographical, CT and MR imaging, and surgical findings.

-There is substantial controversy in literature about human dermatomes. We studied L4, L5, and S1 inferior limb dermatomes by comparing clinical signs and symptoms with conduction studies, electromyographical data, neurosurgical findings, and imaging data from computerized tomography (CT) or magnetic resonance imaging (MRI). After analyzing 60 patients, we concluded that L4 is probably located in the medial aspect of the leg, L5 in the lateral aspect of the leg and foot dorsus, and S1 in the posterior aspect of the backside, tight, leg and plantar foot skin. This is the first time that these human dermatomes have been evaluated by combined analysis of clinical, electromyographical, neurosurgical, and imaging data.KEY WORDS: eletromyography, human dermatome, imaging, inferior member. Dermátomos humanos L4, L5 e S1: achados clínicos, eletromiográficos, de imagem e cirúrgicosResumo -Há controvérsia na literatura sobre os dermátomos humanos. Estudamos dermátomos do membro inferior comparando sinais e sintomas com estudos eletromiográficos, de imagem e achados cirúrgicos. Analisando 60 pacientes, concluímos que o dermátomo L4 provavelmente está localizado na região medial da perna, o dermátomo L5 na região lateral da perna e dorso do pé, e o dermátomo S1 na nádega, região posterior da coxa e da perna e na região plantar. Este é o primeiro estudo que os dermátomos do membro inferior foram analisados através de dados clínicos, eletromiográficos, imagem e achados cirúrgicos. PALAVRAS-CHAVE: dermátomo humano, eletromiografia, imagem, membro inferior. The most commonly affected territory of human inferior limb dermatomes in neurology are L4, L5, and S1, but controversy exists as to their exact location in the legs. Classical anatomy and neurology text-books contain discrepancies presenting these human dermatomes in different skin territories. The L4 map is presented differently

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RESUMO -Relatamos um caso de aneurisma da bifurcação da artéria carótida interna, cuja ruptura se deu para dentro de cisto de aracnóide da fissura silviana. Em revisão da literatura apenas 3 casos foram descritos. Discutimos ainda os aspectos clínicos atípicos do caso, as características dos achados cirúrgicos e uma correlação etiopatogênica entre as duas patologias.PALAVRAS-CHAVE: aneurisma cerebral, cisto de aracnóide, hemorragia subaracnóide, hemorragia intracística, etiopatogenia. Cerebral aneurysm and arachnoid cyst: about a case with intracystic hemorrhageABSTRACT -We report a case of a carotid artery bifurcation aneurysm which ruptured into a silvian fissure arachnoid cyst. In the review of the literature, only three cases were before reported. We discuss about uncommom clinical findings, the surgical aspects and the associations among the lesions.