The white matter fiber dissection reveals the tridimensional intrinsic architecture of the brain, and its knowledge regarding the temporal lobe is particularly important for the neurosurgeon, mostly because of the complexity of the optic radiation and related fibers.

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.

Droperidol, propofol and alizapride, in a decreasing order of effectiveness in the doses used in this study, reduced the incidence of pruritus induced by the use of morphine 0.2 mg intrathecally. On the other hand, promethazine 50 mg was shown to be ineffective.

T he primary goal of intracranial aneurysm treatment is complete, permanent, and safe aneurysm occlusion while maintaining flow in the vessels associated with the aneurysm. Aneurysms are very diverse; therefore, the surgical approach depends in large part on the specific aneurysm to be treated, its relationship to the skull, the surrounding structures, and morphology. In this context, the pterional (PT), or frontotemporosphenoidal, approach is one of the most commonly used in vascular neurosurgery. 1,2,6,12,[26][27][28] abbreviatioNs MPT = minipterional; mRS = modified Rankin Scale; PT = pterional; ROI = region of interest. methods Fifty-eight patients with ruptured and unruptured anterior circulation aneurysms were enrolled into a prospective randomized study. The first group included 28 patients who underwent the MPT technique, and the second group comprised 30 patients who underwent the classic PT craniotomy. To evaluate the aesthetic effects, patients were asked to grade on a rule from 0 to 100 the best and the worst aesthetic result. Photographs were also taken, assessed by 2 independent observers, and classified as showing excellent, good, regular, or poor aesthetic results. Furthermore, quantitative radiological assessment (percentage reduction in thickness and volumetric analysis) of the temporal muscle, subcutaneous tissue, and skin was performed. Functional outcomes were compared using the modified Rankin Scale (mRS). Frontal facial palsy, postoperative hemorrhage, cerebrospinal fistula, hydrocephalus, and mortality were also analyzed. results Demographic and preoperative characteristics were similar in both groups. Satisfaction in terms of aesthetic result was observed in 19 patients (79%) in the MPT group and 13 (52%) in the PT group (p = 0.07). The mean score on the aesthetic rule was 27 in the MPT group and 45.8 in the PT group (p = 0.03). Two independent observers analyzed the patient photos, and the kappa coefficient for the aesthetic results was 0.73. According to these observers, excellent and good results were seen in 21 patients (87%) in the MPT and 12 (48%) in the PT groups. The degree of temporal muscle, subcutaneous tissue, and skin atrophy was 14.9% in the MPT group and 24.3% in the PT group (p = 0.01). Measurements of the temporal muscle revealed 12.7% atrophy in the MPT group and 22% atrophy in the PT group (p = 0.005). The volumetric reduction was 14.6% in the MPT and 24.5% in the PT groups (p = 0.012). Mortality and mRS score were similar in both groups at the 6-month evaluation (p = 0.99). coNclusioNs Minipterional craniotomy provides clinical results similar to those of the PT technique. Moreover, it provides better cosmetic results. It can be used safely and effectively to surgically treat aneurysms of the anterior circulation instead of the PT approach.Clinical trial registration no.: NCT01872741 (clinicaltrials.gov)

Satisfactory results were obtained after both treatments, with improvements following high energy microwave thermotherapy being in the same range as those after transurethral resection of the prostate.

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...

Schwannomas are solitary, benign, slow-growing, encapsulated neoplasms composed of differentiated neoplastic Schwann cells. The melanocytic schwannoma, a schwannian tumor variant, is rarely encountered and its ocurrences have been described as single case reports 1 . The most common site of these tumors is the posterior spinal nerve root 1,2 . However, they can occur in other locations, such as the sympathetic chain, acoustic nerve, cerebellum, orbit, choroid, soft tissues, heart, oral cavity, esophageal wall, stomach, bronchus, retroperitoneum, uterine cervix and parotid gland 2,3 . The melanotic schwannomas can be related as a part of a syndrome named Carney complex (described in 1990), characterized by the association of cutaneous pigmentation, fibromyxoid tumors of the skin, myxoma of the heart, endocrine overactivity and autosomal dominant inheritance 4 . The largest series in spinal melanotic schwanommas is composed by 5 cases. In these series, we report our experience with three cases. CASESThree cases of spinal melanotic schwannoma were studied between 2006 and 2010 in authors' institution. None of the patients had a familial history or any component of Carney complex (spotty pigmentation, endocrine overactivity or myxomas).The patients were two male and one female. The mean age was 50 years (range 42-59 years). The most frequent symptom was pain followed by motor deficit. The mean duration of symptoms was 15 months. Magnetic resonance images showed intradural, extramedullary lesions iso/hyperintense in T1- (Fig A) and hypointense in T2-weighted sequences.The histological examination revealed fusiform and epithelioid cells, with highly pigmented cytoplasm ( Fig B). Immunohistochemical studies revealed intense cytoplasm and nuclear expression of S100 protein (Fig C), HMB-45 and Melan-A (Fig D). DiSCuSSionGenerally, melanotic schwannomas affect spinal nerves, the central nervous and the autonomous nervous system, but extra-nervous locations also occur 1 . The dorsal location represents 30.5% of the spinal melanotic schwannomas and clinical presentation is similar to other extramedullary spinal tumors 5 . Psammomatous melanotic schwannoma is a distinct clinicopathologic entity and may be considered as a part of the Carney complex, which is characterized by myxomas (heart, skin and breast), mucocutaneous spotty pigmentations and endocrine overactivity (due to thyroid dysfunction or hypophysial adenoma, or Cushing's syndrome secondary to primary pigmented nodular adrenocortical hyperplasia) 4 . About 50% of patients with melanotic psammomatous schwannomas are affected by the syndrome of Carney and one-fifth of them present multiple lesions 1 . None of our patients exhibits these manifestations.The preoperative diagnosis is based on magnetic resonance imaging. While conventional schwannomas are hypointense on T1-weighted and hyperintense on T2-weighted sequences, the melanotic variant is hyperintense on T1-and hypointense on T2-weighted sequences 1 . Zhang et al. 3 demonstrated that melanotic schwannomas rec...

-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 ...