Decompressive surgery, which uses an in-window craniotomy that gradually opens according to the intracranial pressure, is an alternative solution for deploying autologous material. The procedure has the advantage of obviating the need for a second surgical procedure to close the bone defect, and thus preventing the metabolic cerebral impairment associated with the absence of an overlying skull.
The findings demonstrate higher efficacy of the 10% NaCl treatment in this comparison with 20% mannitol. Further efforts should be directed toward development of clinical studies using iso-osmotic doses of mannitol and HS in specific etiologies of intracranial hypertension.
The high prevalence of craniovertebral junction (CVJ) malformation among the population born in Northeastern Brazil has been described for a long time 1,2 . It is usually associated with brachycephalic biotype ( flat head), that is common in this region.Virchow' s seminal works described higher levels of basilar invagination among inhabitants of the Islands of the North Sea, the Netherlands and the Territory of Bremen (apud Silva) 1 . Silva 3 also described a doctoral thesis about this theme developed by Bogtstra in 1864 in the Netherlands. No other correlation was found between CVJ malformation and the Dutch.Despite the lack of any specific publication about this issue, it is widely accepted that the high prevalent rates of CVJ malformation among individuals born in Northeastern Brazil came from miscegenation with the Dutch during the colonial period of Brazil´s history 2 . The purpose of this article was to confront this paradigm against historical facts in order to verify the veracity of this assertion. DUTCH'S HABITS DURING THE COLONIAL PERIODDuring their brief stay in Northeastern Brazil, the Dutch preserved the same habits of their homeland. In contrast to the Portuguese, which adapted very well to the local Amerindian culture, the Dutch that came here were people from the city ABSTRACT The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazil's history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.Key words: platybasia, brachycephalic biotype, cranial junction malformation. RESUMOA alta prevalência de malformação da junção craniovertebral no Nordeste do Brasil é historicamente associada ao biótipo braquicefálico (cabeça chata), também comum nessa região. Postula-se que essa característica tenha sido introduzida na região pelos holandeses durante o período colonial da história do Brasil. Com base na confrontação desse paradigma com alguns fatos históricos, os autores concluem que o fenótipo braquicefálico foi herdado de ancestrais pré-históricos (ameríndios) que já habitavam a região no momento da chegada do homem branco europeu.Palavras-Chave: platibasia, biótipo braquicefálico, malformação da junção craniovertebral.
Aneurysms located at nonbranching sites in the supraclinoid internal carotid artery (ICA) were originally characterized, in 1986, as aneurysms protruding from the dorsal wall of the ICA 1 , but they are also known as blood blisterlike aneurysms (BBLA) 2 or ICA anterior wall aneurysms 3 . They are rare, comprising 0.9 to 6.5% of all ICA aneurysms 3 .These lesions are fairly small, sometimes appearing as just a protrusion of the vessel wall (expressed as being "blood blister-like"). They grow rapidly in a short time and easily rupture, especially during surgery. Eventually they cannot be eliminated easily by the ordinary clipping procedure requiring wrapping or encircling methods [4][5][6] .Curiously these aneurysms are more often reported by oriental authors [1][2][3][4][5][7][8][9] . We will present a 37-year male Brazilian case successfully treated with clip application. CASEA 37-year-old man presented with sudden onset of severe headache, vomiting and briefly consciousness disturbance. Examination revealed mild meningismus, but no focal neurological deficits. A CT scan of the brain revealed thick and diffuse subarachnoid hemorrhage (SAH) involving the carotid cistern and left sylvian fissure. The angiogram revealed a small irregularity of the ventral left supraclinoid artery suspicious for a BBLA. (Fig 1) We performed a left pterional craniotomy, with micro dissection and exposure of the optic nerve and the ICA. The lateral fissure was widely opened allowing visualization of ICA bifurcation, middle and anterior cerebral arteries. There were signs of hemorrhage in the carotid cistern and sylvian fissure. The clot was carefully dissected away from the optic nerve and ICA in order to approach the involved segment. The aneurysm resembled a focal dissection, with no emerging vessels in neighborhood. Parallel application of a titanium straight angle clip was performed without temporary clipping of ICA. Care was taken to extend the clip beyond the aneurysm margins with minimal ICA stenosis (Figs 2 and 3).The post-operative period was uneventful and the patient was discharged after control angiogram which revealed completely exclusion of the aneurysm and ICA patency (Fig 4).
-the Manson's schistosomiasis tumoral form rarely affects the brain. there are only 12 cases prior related with a mean age of 25 years and a male predominance. We describe a 16-year-old Brazilian Northeastern boy with a cerebellar mass lesion. the radiological aspect was considered compatible with glioma and a gross total resection was performed. Microscopic examination disclosed intraparenchymal granulomas surrounding Schistosoma mansoni eggs. the case is compared with the literature findings and some peculiar aspects of this trematode infection are reviewed.Key Words: schistosomiasis, tumor, cerebellum.esquistossomose mansônica apresentando-se como tumor cerebelar: relato de caso resuMo -A forma pseudotumoral da esquistossomose mansônica raramente acomete o encéfalo. Apenas 12 casos foram previamente descritos com idade média de 25 anos e predominância do sexo masculino. relatamos um caso em paciente do nordeste brasileiro de 16 anos portador de lesão expansiva cerebelar. o aspecto radiológico foi considerado compatível com tumor cerebelar primário e ressecção radical realizada. estudo histopatológico demonstrou granulomas intraparenquimatosos contornando ovos de Schistosoma mansoni. o caso é comparado com os achados da literatura e aspectos peculiares dessa neuropasitose são discutidos.PAlAvrAs-ChAve: esquistossomose, tumor, cerebelo. department of Neurosurgery, restauração hospital, recife Pe, Brazil.
PURPOSE: To measure the healed areas of osteochondral defects produced in femoral condyles of rabbits filled with biopolymer sugar cane gel and to compare these with those of the control group at 90, 120 and 180 days. METHODS: A study was made of 16 New Zealand rabbits, 6 and 7 months old, weighing between 2 and 2.5 kg. Defects of 3.2 x 4 mm were made, with trephine, in the femoral condyles of the right and left knees. As to the study group defects of the medial and lateral condyles of the right knee were used which were filled with Biopolymer Sugar Cane Gel; as to the Control Group defects of the medial and lateral condyles of the left t knees were used which were left open for natural healing. The defects were analyzed at 90, 120 and 180 days after surgery. After euthanasia, the knees were removed and fixed in Bouin's solution for later digital photographic documentation with a digital camera. The areas healed were measured in both the study and control groups using the images obtained from an Image-J® program. Statistical analysis was conducted using the non-parametric Mann-Whitney test. RESULTS: There were no significant differences between the means of the healed areas in the study and control groups at 90, 120 and 180 days after surgery. CONCLUSION: The dimension of the healed areas of the defects treated with the biopolymer sugar-cane gel in the study group was similar to those of the control group, which healed naturally.
Objective: To study the surface, coloring, consistency, continuity and healing of osteochondral defects produced in the femoral condyles of rabbits and filled with sugar cane biopolymer gel (SCBG), after 90, 120 and 180 days, and in comparison with a control group. Method: Sixteen adult New Zealand white rabbits aged 6 to 7 months, weighing between 2 and 2.5 kg and without locomotor system abnormalities were studied. In all the animals, a defect was made in the femoral condyles of the right and left knees, measuring 3.2 mm in diameter and 4 mm in depth, using a trephine. The animals were divided into two groups: study group formed by the right knees, in which the medial and lateral condyles received implants of SCBG; and control group formed by the left knees, in which the medial and lateral condyles were allowed to heal naturally. The knees were assessed 90, 120 and 180 days after the operation. After the animals had been sacrificed, the anatomical specimens were resected and placed in Bouin's solution. They were then photographed with a Nikon Coolpix 5400® coupled to a Nikon SM2800® stereoscopic loupe, to analyze the surface, coloring, consistency, continuity and healing. Results: The results were evaluated using the chi-square test. There were no significant differences in the macroscopic assessments of healing between the study and control groups. Conclusion: With regard to the surface, coloring, consistency, continuity and healing of the defects, the macroscopic appearance of the tissue repaired with SCBG was similar to that of the control group.
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