-Objective: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. Methods: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. .or statistical analysis, we applied the chisquared test or .isher s test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%. Results: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%), while grade 3 of .isher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%). Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively). Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and .isher scale. Conclusion: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.
-Objective: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). Method: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7 th and 8 th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. Results: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. Conclusion: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.KEY WORDS: acoustic neuroma, vestibular schwannoma, mastoid position, venous air embolism.Neurinoma do acústico (schwannoma do vestibular): resultados do tratamento cirúrgico de 240 pacientes operados na posição de decúbito dorsal RESUMO -Objetivo: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). Método: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. Resultados: A exérese foi completa em 99% dos casos, com mortalidade de 1,6%. Houve preservação da função do nervo facial em 85% dos casos e da audição em 40% dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8% e meningite 2,9%. Embolia gasosa foi registrada em 3% dos casos, não associada à mortalidade. Conclusão: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade. PALAVRAS-CHAVE: neurinoma do acústico, schwannoma vestibular, posição de mastóide, embolia gasosa.
Epidermoid cyst is a congenital benign lesion, rarely seen in the topography of the fourth ventricle. The authors report a case of a 48-year-old patient with headache and cerebellar ataxia due to an epidermoid cyst in the fourth ventricle. We performed a surgical resection with histopathological confirmation of the lesion.
Introdução: O novo coronavírus (COVID-19) é uma doença que se disseminou a nível mundial gerando um grande problema de saúde pública, que ocasionou diversos transtornos, principalmente no início de 2020, auge da propagação do vírus. Em alguns casos a infecção pelo vírus apresentava maiores riscos, sendo eles em indivíduos com idade avançada, sexo 9 masculino, histórico de tabagismo e comorbidades, entre as quais, o câncer, e sobretudo um conjunto de fatores patológicos característico dessa doença. Objetivo: Realizar uma análise na literatura sobre aspectos relacionados as neoplasias malignas em tempos de Covid-19 e a importância dos cuidados intensivos ao paciente oncológico. Metodologia: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados SciELO e LILACS, por meio do cruzamento dos Descritores em Ciências da Saúde (DeCS): Coronavírus, Neoplasias, Pandemia e Terapia Intensiva. Foram incluídos estudos disponíveis na íntegra no idioma português, espanhol e inglês, entre 2020 à 2022, excluiu-se da amostra estudos duplicados, incompletos e que não abordava a temática proposta. Resultados e Discussão: Como consequência da pandemia da COVID-19, houve o atraso nas cirurgias, devido a questão da priorização por leitos quem estava em estado mais grave da doença tiveram que ceder os leitos da Unidade de Terapia Intensiva (UTI), o mesmo aconteceu com os pacientes oncológicos que dependiam de procedimentos invasivos tiveram um impacto grande, como o adiamento de cirurgias para a remoção de tumores e o atraso no tratamento puderam fazer com que a doença progredisse, diminuindo as chances de cura. Conclusão: Observou-se que os pacientes neoplásicos e aqueles que se submeteram à cirurgia oncológica ao tratamento quimioterápico apresentam maiores possibilidades de infecção pela COVID-19 e o desenvolvimento de sintomas grave da doença, sendo estes mais susceptíveis as manifestações clínicas grave, caso entre em contato com o vírus.
Anterior inferior cerebellar artery (AICA) aneurysms are extremely rare, accounting for only 0.75% of all intracranial aneurysms. The average age of patients suffering from those aneurysms found in the literature was 44 years, with no significant difference between the sexes. These aneurysms can manifest clinically through expansive symptoms in cerebellopontine angle or through signs and symptoms of subarachnoid hemorrhage, such as nausea, vomiting, headache, nystagmus and paresis. The gold standard exam for diagnosis is cerebral angiography. The treatment of these lesions is controversial. The main difficulty of the surgical treatment of these aneurysms is the location of the AICA, which lies close to critical neurovascular structures. In this article, we describe a proximal AICA aneurysm embolization without occlusion of the parent artery, with excellent results in the postoperative period. Palavras-chave► artéria cerebelar anterior inferior ► procedimentos endovasculares ► aneurisma intracraniano ResumoOs aneurismas da artéria cerebelar anterior inferior (AICA) são extremamente raros, representando apenas 0,75% de todos os aneurismas intracranianos. A idade média de acometimento encontrada na literatura é de 44 anos, não havendo diferença significativa entre os sexos. A etiologia do aneurisma da AICA é controversa, porém, acreditase haver semelhanças com aneurismas em geral. Clinicamente, esses aneurismas podem manifestar sintomas expansivos no ângulo ponto-cerebelar, ou sinais e sintomas de hemorragia subaracnóidea (HSA), como náuseas, vômitos, cefaleia, nistagmo. O exame padrão-ouro para o diagnóstico é a angiografia cerebral. A maior controvérsia dos aneurismas da AICA é o tratamento. A principal dificuldade no tratamento cirúrgico desses aneurismas é a localização da AICA, perto de estruturas neurovasculares críticas. Neste artigo, descrevemos a embolização de um aneurisma proximal da AICA sem oclusão da artéria portadora, com excelentes resultados no pós-operatório.
Os coronavírus, um gênero da Família Coronaviridae, são conhecidos por serem vírus envelopados com genoma de RNA grande de cadeia positiva. Entre as principais vias de transmissão do coronavírus estão: a direta, por meio de tosse, espirro e perdigotos e transmissão por contato com mucosa oral, nasal e dos olhos. Apesar de que a presença de sintomas neurológicos nos primeiros pacientes infectados pelo COVID-19 tenha sido de baixa escala, nos últimos dias, os relatos de casos neurológicos estão mais frequentes, além daqueles sobre consequências da pandemia a médio e longo prazo no Sistema Nervoso Central (SNC) e/ou dos impactos sobre as doenças neurológicas. Com isso, a presente pesquisa teve como objetivo descrever as complicações neurológicas em pacientes infectados pelo novo coronavírus. Trata-se de uma revisão integrativa da literatura, de caráter exploratório, com abordagem qualitativa. Para a realização desse estudo foram consultadas as bases de dados: MEDLINE, Google Acadêmico e SCIELO. Utilizou-se os descritores de forma associada: Complicações Neurológicas, Neurologia, COVID-19 e Infecções por Coronavírus. Considerou-se, inicialmente, artigos que abordassem a temática proposta. Para compor a fundamentação da discussão deste estudo, foram recuperados pelas estratégias de busca um total de 9 artigos, que foram analisados e discutidos integralmente. Os sintomas neurológicos foram enquadrados em três categorias: sintomas ou doenças do Sistema Nervoso Central, como dor de cabeça, tontura, prejuízo da consciência, ataxia, doença cerebrovascular aguda e epilepsia, sintomas do Sistema Nervoso Periférico, como hipogeusia, hiposmia, hipopsia e neuralgia, e sintomas musculoesqueléticos.
BackgroundGliomas are the most common primary tumors of the central nervous system with unclear etiology, however hereditary factors may play important roles in the development of gliomas with mutations and single nucleotide polymorphisms (SNPs) being prominent among the genetic changes. this systematic review and meta-analysis assess the association of XRCC1 (rs1799782) and ERCC2 (rs13181) gene polymorphisms and glioma risk.MethodsThis study included articles indexed in the PUBMED and EMBASE databases published during the past 15 years. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PICOS model was used to develop the inclusion criteria and search terms. This review was recorded at PROSPERO International prospective register of systematic reviews, ID 196173. The META-MAR V2.7.0 meta-analysis calculator was used for the statistical analysis with p-values < 0.05 being considered statistically significant. Dichotomous data are presented as odds ratios (OR) with a 95% confidence interval (CI). Statistical heterogeneity was measured using the I2 test and I2 > 50% were regarded as high heterogeneity. Funnel plots, Begg (BT) and Egger Tests (ET) were used to assess publication bias (p<0.1). Results Literature review identified 10 articles on ERCC2 gene rs13181 variant and 11 on XRCC1 rs1799782. The meta-analysis identified a risk for gliomas for the TT genotype of the XRCC1 rs1799782 SNP in Asians (OR: 1.59, 95% CI: 1.3-1.93; p=0.006; I2 13.1%). ERCC2 rs13181 polymorphisms identified as risks for gliomas were AC genotypes in Asians (OR: 2.06, 95% CI: 1.75-1.42; p = 0.00057; I2 91.1%) and Caucasians (OR: 1.16, 95% CI: 1.01-1.31; p = 0.02; I2 12.2%), and CC genotypes in Caucasians (OR: 2.06, 95% CI: 1.75-1.42; p = 0.0001; I2 98.9%).Conclusions TT genotypes of the XRCC1 rs1799782 SNP in Asians, AC genotypes of ERCC2 rs13181 polymorphisms in Asians and Caucasians, and CC genotypes of ERCC2 rs13181 polymorphisms in Caucasians were associated with increased risk for gliomas that may benefit these patients with early diagnostic and therapeutic strategies.
Breast cancer is the most common malignancy affecting women worldwide. The insulin-like growth factor 1 (IGF-1) gene encodes a protein responsible for a wide variety of physiological processes, including differentiation and cell proliferation. Despite several studies on tumor tissues, no study has evaluated IGF-1 expression in the peripheral blood of women with recurrent breast cancer. In this cross-sectional study, IGF-1 expression in the peripheral blood of 146 women with breast cancer treated approximately 5 years ago was quantified by quantitative reverse transcription polymerase chain. The women were divided into 2 groups: non-recurrence (n = 85) and recurrence (n = 61). Statistical analysis of the data was performed using ANOVA, Mann–Whitney, and Chi-squared tests ( P < .05). The results showed no significant difference in IGF-1 expression between the non-recurrence and recurrence groups ( P = .988). In the subgroups of patients with lymph node involvement, no statistically significant difference was observed in IGF-1 expression between women with recurrence and those non-recurrence ( P = .113). In patients without lymph node metastases, IGF-1 messenger ribonucleic acid (mRNA) expression levels were significantly higher in the non-recurrence group than in the recurrence group ( P = .019). Furthermore, using the median IGF-1 mRNA expression as the cutoff point, it was obtained a statistically significant difference in tumor histological grade among women with recurrent breast cancer ( P = .042). These data showed significantly higher IGF-1 expression in women without lymph node metastases in the non-recurrence group compared with the recurrence group. In addition, a significant difference was observed in median IGF-1 mRNA expression in relation to tumor histological grade in women with recurrent breast cancer.
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