Objective: To evaluate the results of an interdisciplinary program administered to patients with failed back surgery syndrome, aiming at functional improvement, modulation of pain, reduction of anxiety symptoms and depression, and improvement of quality of life. Method: This is a non-randomized prospective study with a sample of patients with failed back surgery pain syndrome diagnosed with persistent or recurrent pain after surgery to the lumbar spine (laminectomy and arthrodesis) referred to liaison in the Pain Clinic (n= 26). The instruments used were Brief Pain Inventory, Roland-Morris Questionnaire and Beck Anxiety and Depression Inventories. The generic WHOQOL-bref 13 questionnaire was used to evaluate the quality of life and the fear of moving was assessed by the Tampa Scale for Kinesiophobia. Results: There was a predominance of females, the mean age was 42.3 ± 5.8 years, 43% were married and average schooling was 7 ± 4.5 years. The mean time of pain reported was 8 ± 6.8 months in addition to high levels of anxiety, depression and kinesiophobia. After the intervention, there was a significant improvement in the perception of quality of life and of all parameters evaluated (p<0.05), with functional gains as well as decreased pain threshold. Conclusion: The interdisciplinary intervention in patients with failed back surgery syndrome provides better functional performance, decreases the intensity of pain, anxiety and depression symptoms, and improves quality of life. The inclusion of this intervention associated with drug therapy may the patient develop an active and independent lifestyle. Keywords: Low back pain; Interdisciplinary research; Reoperation. RESUMO
Subependymomas are indolent, low-grade gliomas that comprise approximately 1% of all intracranial tumors. Typical locations are the fourth ventricle in 75% of cases, lateral ventricles, and rarely in the spinal cord. In the fourth ventricle, the tumor commonly arises from the floor, obtaining a polypoid growing pattern that promotes compression and adhesion of adjacent structures such as choroid plexus, medullary velum, nodule, and uvula. Arterial adhesions to tonsilobulbar and telovelotonsilar segments of PICA can be a challenge, increasing bleeding, and ischemia risk. We present a 53-year-old patient with a history of 3 months of progressive occipital headache associated with swallowing difficulty that started 20 days before hospital admission. Physical examination showed a slight uvula deviation. A neurological investigation by magnetic resonance imaging revealed an exophytic fourth ventricle tumor. The patient underwent resection with evoked potential monitoring through a suboccipital approach. The lesion was resected entirely without symptoms worsening. Pathology examination confirms subependymoma diagnosis. In this 3-dimensional video, the authors present a step-by-step microsurgical technique to perform a fourth ventricle subependymoma resection. The patient signed the institutional consent form, which allows the use of his/her images and videos for any medical publications in conferences and/or scientific articles.
A decompressive craniectomy is a therapeutic modality not commonly used in cases of refractory intracranial hypertension due to viral encephalitis. In this article the authors present two cases of patients with viral encephalitis that have undergone decompressive craniectomy to control intracranial pressure. Both evolved with Glasgow outcome score of 4. The main clinical data for the surgical decision are Glasgow coma scale and the pupils of the patient associated with the imaging tests showing a large necrotic area and perilesional edema. The evolution of the patients undergoing decompression was satisfactory in 92.3% of cases.
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