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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...

-Multiple intracranial meningiomas (MIM) are a rare pathology when not associated with neurofibromatosis. The prevalence rate of those tumors varied from 2.3 to 8.9% of all intracranial meningiomas.Objective: To present, analyze and discuss the cases of seven patients diagnosed with multiple intracranial meningiomas, describing their clinical and histological characteristics, as well as their biological behavior. Method: The patients records, surgical descriptions, imaging studies and the histopathological exams were retrospectively reviewed. This is the largest series of MIM publisted in Brazil. Results: This sample consists of five women and two men. The age varied from 42 to 84 (average 53.8). Twenty-two meningiomas were identified and varied from 1.5 to 192 cm 3 , with an 62.8 cm 3 average volume. The number of procedures varied from 1 to 5 per patient. No surgical death occurred in this series. Conclusion: Despite the multiplicity of tumors, number of recurrences, the new tumors, repeated operations and re-operations, radiotherapy and a number of postoperative complications, the patients experienced a long survival in conjunction with a fairly good quality of life.Key WorDs: brain tumors, meningiomas, multiple intracranial meningiomas, microneurological surgery. Meningiomas intracranianos múltiplos: diagnóstico, comportamento biológico e tratamentoResumo -os meningiomas intracranianos múltiplos são tumores raros quando não associados a neurofibromatose, correspondem de 2,3 a 8,9% de todos os meningiomas intracranianos. Objetivo: Apresentar, analisar e discutir 7 pacientes com diagnóstico de meningioma intracraniano múltiplo, descrevendo as características clínicas, histológicas e o comportamento biológico desses tumores. Método: Trata-se de revisão retrospectiva incluindo a análise dos prontuários, das descrições cirúrgicas, dos estudos de imagem e do material histopatológico. esta série é a maior série de meningiomas intracranianos múltiplos publicada no Brasil. Meningiomas are tumors originated from arachnoidal cells present in the villi, in the granulations, in the stroma of the perivascular spaces and in the choroid plexus; corresponding to 13 to 20% of all intracranial tumors [1][2][3] . Multiple intracranial meningiomas (MIM), when not associated with neurofibromatosis, are a rare event, which corresponding to 2.3 to 8.9% of all intracranial meningiomas [4][5][6][7][8][9][10][11] . The multiple intracranial meningiomas terminology should be used only when two or more meningiomas occur either simultaneously or sequentially in different locations. It is important to establish the difference between this pathology and tumor recurrence or diffuse meningiomatosis 1,3,4,[7][8][9][10] . our study aims presenting, analyzing and discussing 7 patients diagnosed with multiple intracranial meningiomas, describing their clinical, radiological, and histological characteristics, as well as their biological behavior. It also highlights the fact that, although the patients underwent a number of surgeries and ...

Hematomas intracerebrais podem apresentar-se como manifestação imediata ou tardia dos traumatismos cranio-encefálicos, podem ocorrer devido a rotura de aneurisma ou angioma, podem ser devidos a tumores cerebrais, trombose venosa, discrasias sangüíneas, uso de anticoagulantes, periarterite nodosa, lupus eritematoso, sífilis, amiloidose, angeíte necrotizante, doença de Moyamoya, podem decorrer de hipertensão arterial ou podem ser idiopáticos 2,4,6,7,8,10,14,21,22,30,34,36,43,48,49. Os hematomas relacionados a hipertensão arterial sistêmica são denominados hematomas intracerebrais hipertensivos.De acordo com Ztilch52 e outros 6,12,21,41 os hematomas hipertensivos ocorrem devido a rotura de parede arterial previamente lesada pela hipertensão crônica que levaria a formação de hialinose e necrose arterial. Se em um determinado momento a pressão arterial sistêmica ultrapassar a resistência da parede enfraquecida pela hialinose e necrose, ocorrerá então rotura, sangramento e formação de hematoma.

A 42-year-old patient had undergone total hip replacement for aseptic femoral head necrosis 9 years previously. He now presented with loosening of the prosthesis and pseudoarthrosis sustained following a femoral shaft fracture 7 months earlier. A total hip replacement was carried out in general anaesthesia combined with an epidural catheter. The epidural catheter was removed on the third postoperative day, after which the patient complained of persistent lumbar pain which was associated with meningismus, fever, leucocytosis and a raised erythrocyte sedimentation rate. In spite of intensive laboratory and radiological investigation, 15 weeks elapsed before a radiological diagnosis of spondylitis of L1 and L2 could be made. Aspiration biopsy of the L1/L2 disc space yielded a growth of Pseudomonas aeruginosa. Antibiotic therapy was begun immediately but could not prevent spread of infection to the adjacent disc-space T12/L1 and the vertebral body T12. The patient made a slow recovery and was discharged in a satisfactory condition wearing a lumbar brace some 9 months after the operation. No evidence of epidural abscess formation was found at any stage and no direct connection between the use of the epidural catheter and spondylitis could be established.

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.