Bleeding from brainstem cavernomas may cause severe deficits due to the absence of non-eloquent nervous tissue and the presence of several ascending and descending white matter tracts and nerve nuclei. Surgical removal of these lesions presents a challenge to the most surgeons. The authors present their experience with the surgical treatment of 43 patients with brainstem cavernomas. Important aspects of microsurgical anatomy are reviewed. The surgical management, with special focus on new intraoperative technologies as well as controversies on indications and timing of surgery are presented. According to several published studies the outcome of brainstem cavernomas treated conservatively is poor. In our experience, surgical resection remains the treatment of choice if there was previous hemorrhage and the lesion reaches the surface of brainstem. These procedures should be performed by experienced neurosurgeons in referral centers employing all the currently available technology.
Os grandes avanços da gerontología nos últimos anos não encontraram na neurocirurgia um éco tão grande quanto nas outras especialidades médicas. Em geral as contribuições encontradas na literatura médica se restringem aos aspectos diagnósticos e terapêuticos especiais dos tumores e insuficiências vasculares cerebrais nessa faixa etária ( Para evitar repetição no texto, usaremos as seguintes siglas para designar os diferentes grupos de casos: TCFL -traumatismos cranianos fechados leves; TCFG = traumatismos cranianos fechados graves; TCA = traumatismos cranianos abertos; HI •= hematomas intracranianos.
RESUMO
PALAVRAS-CHAVE
KEY WORDS
Brain stem abscess.
IntroduçãoEste trabalho tem por finalidade mostrar a experiên-cia do Serviço em abscessos de tronco cerebral e suas diversas formas de abordagem, respeitando a gravidade da lesão e particularidades de cada caso, além de nossa visão sobre os diversos tratamentos, tanto clínicos como cirúrgicos, este por via aberta ou estereotáxica.O abscesso de tronco cerebral apresenta elevada morbidade e mortalidade, como poucas doenças do sistema nervoso central. Representa de 0,5% a 6% de todos os abscessos encefálicos. É conseqüência da disseminação hematogênica do patógeno que, freqüentemente, é facilitada pela fístula arteriovenosa pulmonar e cardiopatias. Nos casos de imunodeficiên-cia, devemos levar em conta todas as particularidades desses pacientes.
The authors present a series of 25 cases of haemangioma of the skull and review the literature. Frontal localization was the most frequent, contrary to the data in the literature which suggest predominance in the parietal region. The reported predominance of females has not been confirmed. In the present series the relation of males to females was 17:8. The radiological findings and treatment of haemangiomas are discussed. Direct puncture and injection of contrast medium is the best method of visualization of the tumour. Treatment should be surgical, consisting of total extirpation of the tumour with a margin of healthy tissue. Simple extirpation is indicated only when the soft tissues are involved and there is no bone lesion. Excision en bloc is the tehcnique of choice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.