-The cavernous sinus is a complex compartment situated in both sides of the sella turcica, being its microsurgical anatomy knowledge of fundamental importance when consider to approach surgically. We studied the arterial microanatomy of 24 cavernous sinus at the microsurgical laboratory, considering that in all the internal carotid artery were filled with colored latex. The meningohypophyseal trunk was present in 18 cases (75%) with its origin in intracavernous portion of the internal carotid artery. In relation to the 18 presented cases with meningohypophyseal trunk, 14 (77.7%) had a trifurcate and 4 (23.3%) had a bifurcate pattern. The tentorial artery was present in all. Its origin was observed, arising from the meningohypophyseal trunk in 17 (70.8%) and as an isolated artery in some extension of the intracavernous portion in 7 (29.1%). An accessory tentorial artery was found in one specimen. The dorsal meningeal artery was present in 22 cases (91.6%). Its origin was in the meningohypophyseal trunk in 17 cases (77.2%), arising from internal carotid artery in 4 cases (18.1%) and from inferior hypophyseal artery in one case (4.1%).The inferior hypophyseal artery was present in all cases, having its origin at the meningohypophyseal trunk in 16 cases (66.6%). In the remaining 8 cases (33.3%) the artery was found arising alone from the intracavernous portion also. The artery of the inferior cavernous sinus or inferolateral trunk was present in all cases and had its origin from internal carotid artery in its intracavernous segment. The McConnell's artery was not found in any cavernous sinus.KEY WORDS: cavernous sinus, microsurgical anatomy, internal carotid artery. M i c roanatomia do compartimento arterial do seio cavernoso e suas variações: análise de 24 seios cavernososRESUMO -O seio cavernoso é estrutura complexa localizada de cada lado da sela túrcica, sendo seu conhecimento microanatômico indispensável quando se considera abordar cirurgicamente esta região. Estudaramos em laboratório de microcirurgia a microanatomia dos componentes arteriais deste espaço em 24 seios cavernosos, sendo que em todos a artéria carótida interna estava preenchida com látex colorido. O tronco meningo-hipofisário esteve presente em 18 casos (75%). Quando ausente, as artérias constituintes deste tronco se originaram diretamente das artérias carótidas internas (ACIs) intracavernosas. Quando presente, em 14 casos (77,7%), estavam trifurcados e em 4 casos (23,3%) bifurcados. A artéria tentorial foi identificada em todos os casos, porém sua origem foi variada, ocorrendo no tronco meningohipofisário em 17 casos (70,8%) e na artéria carótida interna intracavernosa em 7 casos (29,1%). Em 1 caso verificou-se a presença de uma artéria tentorial acessória. A artéria meningéia dorsal estava presente em 22 casos (91,6%) e ausente em 2 casos (8,4%). Nos seios cavernosos onde a mesma foi identificada, a sua origem ocorreu no tronco meningo-hipofisário em 17 casos (77,2%), da ACI intracavernosa em 4 casos (18,1%) e da artéria hipofisária in...

-Cerebellar glioblastoma multiforme (GBM) is a rare tumor. This is the third case published in Brazilian literature and, the last one has been described more than 15 years ago. The aggressive behavior of GBM prompts for fast treatment, which can be hampered by the fact that the diagnosis of GBM re q u i re s a high degree of suspicion. We describe a case of GBM in a 46 years old man. In conjunction, we pre s e n t a literature review including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options and the behavior of such malignant tumor.KEY WORDS: high grade astrocytoma, cerebellar glioblastoma multiforme, posterior fossa glioma.Glioblastoma multiforme cerebelar primário em um adulto RESUMO -Glioblastoma multiforme (GBM) c e rebelar é um tumor raro. Apresentamos o terc e i ro caso re v i s ado em literatura neurológica brasileira, sendo o último descrito há mais de 15 anos. Devido a sua agre ssividade, o tratamento deve ser instituído rapidamente, porém certa indefinição quanto à conduta pode o c o rre r, pois o diagnóstico de GBM pode não ser lembrado. Apresentamos um caso de GBM c e rebelar em um homem de 46 anos. Também fazemos uma revisão a respeito de seu comportamento, quadro clínico e avanços quanto à investigação por imagem, aspectos histopatológicos, formas de tratamento e suas características peculiares.PA L AV R A S -C H AVE:a s t rocitoma de alto grau, glioblastoma multiforme cere b e l a r, glioma de fossa posterior.Glioblastoma multiforme (GBM) is the most common primary central nervous system (CNS) tumor in adults comprising approximately 50% of all primary intracranial tumors. Primary cerebellar GBM is a rare tumor in adults 1 -7 and accounts for 1% of all GBM 4 . The reason for its rarity is not completely understood 1 -3 , 5 . D i ff e rential diagnosis of GBM from other CNS lesions is an outstanding issue, especially in re g a rd to its diff e rentiation from other primary CNS tumors such as the anaplasic astrocytoma and from metastases 5 , 7 , 8 since the prognosis and outcome is diff e rent. For this reason, neuroimaging and ultimately the immunostainning assessment are important tools for planning the therapeutic course.We re p o rta case of an adult man with a cere b e llar GBM and a literature review concerning the clinical data, diagnosis including radiological and pathological aspects, treatment and its particular behavior is done. CASEA 46 years old man was admitted due to history of headache beginning 4 months before. Ve n t r i c l e -p e r i t o n e a l shunt was perf o rmed in another hospital due to acute h y d rocephalus 1 month after the initial symptoms. The patient developed progressive cerebellar signs with gait disturbance, nystagmus and clumsiness of the extremities, more intense on the left side, and vomiting. He was unable to walk and showed mild degree of confusional state at examination. A magnetic resonance imaging (MRI) revealed an infiltrative mass situated in the left hemisphere and para-

-Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.KEY WORDS: jugular foramen, posterior fossa tumor, lower cranial nerves, skull base reconstruction, glomus tumor. Tumores intradurais do forame jugularRESUMO -Onze pacientes com lesões expansivas do forame jugular associadas ou não a componente extradural foram submetidos a ressecção cirúrgica no Hospital das Clínicas da Universidade Estadual de Campinas (UNI-CAMP) entre 1998 e 2001. Foi utilizada cirurgia combinada com dissecção do pescoço, mastoidectomia sem transposição do nervo facial e técnica de reconstrução miofascial da base do crânio desenvolvida por um dos autores. Quatro pacientes foram operados via craniectomia retrosigmoidea. Ressecção total foi feita em 9 pacientes, subtotal em um e parcial em outro. Nenhum dos 11 pacientes teve progressão da doença em 2 anos de acompanhamento. Não houve mortalidade. Cinco pacientes tiveram déficits adicionais de nervos cranianos baixos. Nove pacientes mantiveram ou melhoraram suas pontuações de acordo com a escala de Karnofsky. Para adequada abordagem do paciente com tumor de forame jugular, são necessários bom conhecimento anatômico da região, exposição cirúrgica ampla, e técnica de reconstrução eficiente para obter cura com baixas taxas de complicações pós-operatórias. PALAVRAS-CHAVE: forame jugular, tumor de fossa posterior, nervos cranianos baixos, reconstrução de base de crânio, tumor de glomus jugular.Jugular foramen (JF) lesions are rare, being paragagliomas and schwannomas the most common tumors 1, 2 . Complete resection of these benign lesions is the treatment of choice. The surgical management of JF lesions remains difficult because their deep location, locally aggressive behavior, involvement of vessels and nerves, infiltration of skull base bone and structures of the high cervical region and the complex anatomy of the region. In the last decades, development of new skull base approaches allowed total resection of large number of skull base tumors. However, the more aggressive the surgical approach becomes, more complications related to it may occur. Reconstru...

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Twenty one patients were submitted to decompressive craniectomy for massive cerebral infarct. Ten patients (47.6%) presented a good outcome at the 6 months evaluation, eight had a poor outcome (38%) and three died (14.2%). There was no outcome statistical difference between surgery before and after 24 hours of ictus, dominant and non-dominant stroke groups. Patients older than 60 years and those who had a Glasgow Coma Scale (GCS)<8 in the pre-surgical exam presented worst outcome at six months (p<0.05). Decompressive craniectomy for space-occupying large hemispheric infarction increases the probability of survival. Age lower than 60 years, GCS ≥8 at pre-surgical exam and decompressive craniectomy before signs of brain herniation represent the main factors related to a better outcome. Dominant hemispheric infarction does not represent exclusion criteria. Key words: cerebral infarction, decompressive hemicraniectomy, surgical decompression.Craniectomia descompressiva no infarto cerebral extenso RESUMO Vinte e um pacientes foram submetidos a craniectomia descompressiva para o tratamento de infarto cerebral extenso. Dez pacientes (47,6%) apresentaram boa evolução em avaliação após 6 meses, 8 apresentaram evolução desfavorável (38%) e 3 faleceram (14,2%). Durante o seguimento, não se evidenciou diferença estatística na evolução entre pacientes operados antes e após 24 horas do ictus, nem entre lesões envolvendo o hemisfério dominante versus não dominante. Pacientes com mais de 60 anos e aqueles com Escala de Coma de Glasgow (ECG)<8 na avaliação pré-operatória apresentaram pior evolução após 6 meses (p<0,05). A craniectomia descompressiva para infartos hemisféricos extensos aumentam a probabilidade de sobrevivência. Idade abaixo de 60 anos e ECG ≥8 no exame pré-operatório e craniectomia descompressiva antes de sinais de herniação cerebral representam os principais fatores relacionados a uma melhor evolução clínica. Infarto hemisférico envolvendo o hemisfério dominante não representa um critério de exclusão. Palavras-chave: infarto cerebral, hemicraniectomia descompressiva, descompressão cirúrgica.