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The occurrence of brain tumours during pregnancy is unusual, when this happen jeopardises the lives of both the mother and infant. This article aims at identifying the best medical management to be followed for a pregnant patient harbouring a brain tumour. The records of 10 patients with brain tumours diagnosed during pregnancy were retrospectively examined. The histological diagnosis revealed 3 grade 2 astrocytomas, and 1 grade 2 oligodendroglioma. All this gliomas (100%) developed dedifferentiation in the mean period of 27 months. The histology of the others tumours were 2 grade 1 meningiomas, 1 melanoma metastasis, 1 epidermoid tumour, 1 case of chemodectoma and 1 patient with a pituitary apoplexy in a non-function adenoma. There was no operative mortality in these series, and no fetal deaths were observed. Prior to craniotomy, five patients had caesarean sections, two others had vaginal deliveries. In three patients the delivery took place after the brain tumour treatment. Two patients had vaginal delivery and eight caesarean sections. The best moment to recommend the craniotomy and the neurosurgical removal of the tumour will depend of the mother's neurological condition, the tumour histological type as well as the gestational age. A multi-disciplinary approach was used to determine the optimal management for each patient.

Background:The aim of this paper is to report on our surgical strategy and technique and to identify the best management for intracranial dermoids and epidermoids tumors (IDETs).Methods:We retrospectively reviewed 33 consecutive patients (14 males and 19 females; mean age at surgery, 37.9 years) with pathologically confirmed IDETs who underwent surgical resection, with mean follow-up of 7.2 years.Results:Gross total tumor removal was achieved in 24 cases (72.7%) with zero surgical mortality and a recurrence rate of 9%.Conclusions:The surgical strategies used in this group of patients enabled total removal of most tumors without surgical mortality and with low morbidity and recurrence rates, proving to be safe and effective.

Objective: Observe whether a microsurgical gross total removal (GTR) of a spinal nerve sheath tumors (SNSTs) is safe and decreases the tumor recurrence. Method: We identify 30 patients with 44 SNSTs. Results: We operated upon 15 males and 15 females patients; mean age 40 years. GTR was achieved in 29 (96.6%) instances. Surgical mortality was 3.3% and the recurrence rate was 3.3%. The median follow-up time was 6.2 years. Conclusion: The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality and low recurrence rates, proving to be safe and effective.Keywords: microsurgery, neurofibroma, schwannoma, spinal nerve sheath tumors, surgical treatment. RESUMOObjetivo: Observar se a ressecção microcirúrgica completa dos shwannomas ou neurofibromas raquianos é uma técnica segura e efetiva. Método: Foram operados 30 pacientes com 44 schwannomas ou neurofibromas intrarraquiano. Resultados: A remoção total da lesão ocorreu em 27 casos (96.6%). A taxa de mortalidade cirúrgica observada nesta série foi de 3.3%. O tempo médio de seguimento foi de 6.2 anos. Conclusão: A estratégia microcirúrgica empregada com esses pacientes propiciou a remoção total dos tumores na maioria dos pacientes, com baixa mortalidade e recidiva tumoral, mostrando ser segura e efetiva.Palavras-chave: microcirurgia, neoplasia raquiana, neurofibroma, tumors da bainha dos nervos, schwannoma raquiano.The annual incidence rates for primary spinal neoplasms are reported to be in the range of 1.3 to 10.0 per 100,000 1 . One-third is nerve sheet tumors 1,2,3 . The spinal nerve sheet tumors (SNSTs) comprise the schwannomas and neurofibromas 1,2,3,4 . Nevertheless little attention has been paid to this subject within Brazilian settings, which motivated us to review and present the cases of this pathological condition treated by our medical team, and to assess the safety and efficiency of microsurgical removal of those lesions.Various terms have been used for this tumor: neuroma, neurinoma, neurilemoma, perineurial fibroblastoma, schwannoma gliome peripherique, schwannoma and neurofibroma 2,4 . The SNSTs are benign, usually solitary, slowgrowing, encapsulated neoplasms composed of differentiated neoplastic Schwann cells. The most common origin of these tumors is the posterior spinal nerve root 1,2,3,4,5,6 . METHOD Data collectionThe 30 patients registered in this retrospective study with SNSTs were operated at the Hospital Federal dos Servidores do Estado (RJ) and at Rede D'Or São Luiz between 1986 and 2012. The medical charts, pre and postoperative imaging, and pathological reports were retrospectively reviewed for each patient to confirm the diagnosis of SNSTs; creating a database from which information pertinent to the present study was collected. The intraoperative videos of 11 patients were analyzed for nuances of the microsurgical technique. The need for informed consent was waived due to the retrospective character of the study. Detailed neurological examinations were perfo...

RESUMO -A hemorragia intracraniana que acontece na gravidez é um fenômeno raro, porém, apresenta mortalidade e morbidades elevadas. Analisamos 15 pacientes com hemorragia intracraniana que ocorreu durante a gravidez ou puerpério. Em cinco casos a hemorragia decorria da ruptura de aneurisma, em 6, de malformação. A mortalidade materna foi 20%, e a fetal 33%. Quando a causa do sangramento é proveniente de ruptura de um aneurisma, deve-se realizar a oclusão cirúrgica do aneurisma durante a gravidez o que aconteceu em 4 pacientes desta série. Entretanto, se a hemorragia decorre de uma malformação arteriovenosa, o melhor tratamento ainda não está estabelecido.PALAVRAS-CHAVE: aneurisma cerebral, hemorragia intracraniana, hemorragia sub-aracnoideia, gravidez, malformação arteriovenosa e puerpério. Intracranial hemorrhage during pregnancy and puerperium: experience with fifteen casesABSTRACT -Intracranial hemorrhage due to arteriovenous malformation or intracranial aneurysms is a rare but grave complication of pregnancy. We analyse 15 cases. Among these, aneurysms ruptures were responsible for the bleending in 5 instances. Arteriovenous malformation was diagnosed in other 6 patients. The maternal and fetal mortality was 20% and 33% respectively. Four aneurysm patients were operated on before delivery. We conclue that surgical management of the aneurysms is associated with lower maternal and fetal mortality than the conservative treatment. The management of angiomatous hemorrhage during pregnancy remains controversial.

Objective:It was to observe whether a microsurgical gross total removal (GTR) of a parasagittal meningioma (PSM) outside the sinus is a safe and efficient procedure.Method:We identify 58 parasagittal meningiomas patients. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed.Results:GTR of the mass was achieved in 45 (77.7%) instances. The surgical mortality rate was 1.7%. The median follow-up time was 63 months.Conclusion:The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality, proving to be safe and effective.

Clinical, radiological and histopathological features of eight cases of symptomatic cavernous angioma are presented. Five patients were being evaluated for seizure, two for mass lesions and one for intracranial hemorrhage. CT and/or MRI detected the lesion in all cases, but there is not a characteristic image for cavernous angioma. Good results were obtained by microsurgical approach to these malformations in seven patients with only one patient suffering a worsening of neurological status after surgery.

Objective To describe a unique operative strategy, instead the classical pterional approach, and to analyses it safety and effectiveness for removal of anterior cranial fossa meningiomas. Method We identify 38 patients with tuberculum sellae and olphactory groove meningiomas operated between 1986 and 2013. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed and analyzed retrospectively. The pterional craniotomy is extended toward the frontal bone providing access through the subfrontal route, besides the usual anterolateral view provided by the classical pterional approach. Results Surgical mortality occurred in one patient (2.6%). Gross total resection was achieved in 27 patients (86.8%). Median time of follow-up was 69.4 months. Conclusion The extended pterional approach allows excellent results. Total removal of meningiomas of the anterior cranial fossa was obtained in 86.8 % of patients, with low morbidity and mortality.