Background: Deep brain stimulation (DBS) is a well-established procedure for treating Parkinson's disease (PD). Although its mechanisms of action are still unclear, improvements in motor symptoms and reductions in medication side effects can be achieved for a significant proportion of patients, with consequent enhancement of quality of life. Objective: To investigate the impact of DBS on the quality of life of PD patients. Methods: This was a retrospective longitudinal study with collection of historical data in a neurosurgery center, from June 2019 to December 2020. The sample was obtained according to convenience, and the Parkinson's Disease Questionnaire (PDQ-39), Unified Parkinson's Disease Rating Scale (UPDRS) III and IV, Trail-Making Test and Verbal Fluency Test were used. Results: Data were collected from 17 patients (13 with subthalamic nucleus DBS and 4 with globus pallidus pars interna DBS). Significant improvement (p=0.008) on the UPDRS III was observed in comparing the preoperative without DBS with the postoperative with DBS. About 47.0% of the patients showed post-surgical improvement in QoL (p=0.29). Thirteen patients were able to complete part A of the Trail-Making Test and four of these also completed part B. Almost 60% of the patients scored sufficiently on the semantic test, whereas only 11.8% scored sufficiently on the orthographic evaluation. No association between implant site and test performance could be traced. Conclusions: Improvements in quality of life and motor function were observed in the majority of the patients enrolled. Despite the limitations of this study, DBS strongly benefits a significant proportion of PD patients when well indicated.

Introdução: O tumor de células gigantes (TCG) é raro, geralmente benigno, e pode ser localmente agressivo, com incidência quase desconhecida no crânio. Relato do caso: Paciente pediátrico com diagnóstico de sarcoma de Ewing (SE) e posteriormente de TCG, quando procurou atendimento médico por conta do aumento de volume em arco zigomático e região pré-auricular à direita. Os exames de imagem evidenciaram lesão expansiva em porção zigomática e escamosa do osso temporal à direita, com componente intracraniano extradural em fossa média, sem evidências de infiltração. Do ponto de vista anatomopatológico, observou-se neoplasia fusocelular. O marcador CD68 foi positivo e o marcador S100, negativo. Realizou-se microcirurgia para ressecção do tumor. O paciente permanece em acompanhamento com exames de imagem nos serviços de neurocirurgia e ortopedia, com as últimas ressonâncias magnéticas de crânio mostrando redução no tamanho da lesão. Além disso, não realiza terapia adjuvante e atualmente não apresenta queixas. Conclusão: Este é um caso importante em razão da sua raridade e dos dados clínicos que agregam informações sobre as patologias apresentadas, permitindo que, no futuro, novas pesquisas possam otimizar o tratamento da referida neoplasia e o prognóstico desses pacientes.

Introduction Primitive neuroectodermal tumors are rare neoplasms of the central nervous system that occur in children, with few reports in adults. These tumors are found most often in the cerebral hemispheres, with spinal cord disorders being rare. Case Report A 71-year-old man with motor and sensory deficits in the upper limbs, cervical pain, and urinary incontinence presented to the Neurosurgery Service. The physical examination revealed grade-III motor strength on the right side, grade IV- on the left upper limb, and grade IV+ on the left lower limb. A magnetic resonance imaging scan showed an expansive intramedullary lesion with a C3-C4 epicenter. Spinal decompression, lesional biopsy, and adjuvant radiotherapy were performed. The anatomopathological report showed a primitive neuroectodermal tumor. After a new treatment with adjuvant radiotherapy (20 × 1.8 Gy in the skull and neuroaxis and 5 × 1.8 Gy in tumor boost), the patient progressed without recurrence. Conclusion Since the characteristics of the tumor are similar to those of medulloblastoma, it is necessary to expand the studies on these lesions, to better understand their pathophysiology and list better diagnostic and therapeutic methods, in addition to those already available.

Introduction The occurrence of malignant ocular melanomas is uncommon, and the association of these tumors with intradural extramedullary metastases in the cervical spine is exceptionally rare. Case Report A 62-year-old woman undergoing adjuvant chemotherapy after surgical treatment for malignant ocular melanoma begins to experience vertigo and headache. The condition evolved with walking difficulty and neck pain that was exacerbated by swallowing and mobilizing the neck. During her ocular melanoma follow-up, lesions suggestive of metastasis in the central nervous system were not evidenced until this moment. The physical examination did not show significant findings, and a cranial computed tomography scan was performed. The image showed a hyperdense lesion with postcontrast enhancement inside the vertebral canal, at the level of C1-C2. Spinal decompression and subtotal resection were performed. The anatomopathological report revealed intradural metastasis of a malignant ocular melanoma. The postoperative period was uneventful, with significant pain improvement and no recurrences. Conclusion Intradural extramedullary metastases are rare presentations of malignant ocular melanoma. In addition, less than ten similar cases have been reported in the literature. When caring for a patient with melanoma and neurological deficits, always consider evaluating central nervous system metastases. To evaluate this patient, a sensible and detailed neurological exam is extremely important to recognize the location of the deficits and guide the best approach, such as an indication for surgery.

Normal pressure hydrocephalus – NPH is one of the potentially reversible causes of dementia. In this work, we provide the clinical tools for the management of NPH to the Primary Health Care – PHC physicians. The PubMed and Cochrane databases were reviewed, and 40 articles were chosen, which include randomized clinical trials, metanalysis and systematic reviews. The symptoms of the classic triad are nonspecific and found in the elderly with other diseases. Gait apraxia is the earliest symptom, followed by cognitive impairment and urinary incontinence. The concomitance of the three symptoms occurs in about 60% of the cases in the advanced stages. Apraxia of gait is presented with short steps, without sensorial, vestibulocerebellar or muscle strength changes, which allows it to be distinguished from other pathological marches. Cognitive impairment is subcortical – psychomotor slowliness, inattention, loss of working memory and executive function and preservation of episodic memory – unlike cortical dementias, such as Alzheimer's disease. Urinary incontinence must be distinguished from overflow by prostatism and stress incontinence in women. The PHC physician, when faced with the triad, should request a CT scan or brain MRI and, in the presence of one or two symptoms, rule out other diagnoses. Patients with NPH seek help from the physician in the PHC who must know how to identify and differentiate their symptoms. In the case of suspicion, the study of neuroimaging is mandatory and referral to neurosurgery or neurology is recommended.