The use of real simulators in association with image-guided navigation proved to be an effective tool in training for neuroendoscopy.

Intracerebral cavernous angiomas may cause hemorrhage, epileptic seizures and neurological deficits. The diagnosis of these lesions became easier with the advent of the magnetic resonance image (MRI). Radical resection is the treatment of choice. Due to frequent subcortical or deep location, image-guided techniques, such as stereotactic-guided surgery, offer many advantages as smaller skin incision and craniotomy, less brain manipulation with consequently lower morbidity. We present a series of nine cavernous angiomas treated by stereotactic-guided radical surgical resection. The diagnosis was done by MRI and confirmed by pathologic studies in all cases. Mean age of patients was 30 years old (range 20-54 years). Postoperative morbidity occurred in two cases: one patient had a convulsion on the third postoperative day and the other presented dysphasia and hemiparesis on the second postoperative day, both with total recovery. Total resection of the lesion was possible in all cases with no neurological deficit.

-Intramedullary lesions caused by Paracoccidioides brasiliensis have been rarely described. Its diagnosis may be challenging and surgical approach is indicated for diagnostic and therapeutic purposes. We hereby report a case with MRI and surgical findings in a 45 year-old woman with intramedullary paracoccidioidomycosis, and make a review of other cases presented in the literature.KEY WORDS: paracoccidioidomycosis, central nervous system, spinal cord. Paracoccidioidomicose intramedular torácica: relato de casoRESUMO -Lesões intramedulares causadas pelo Paracoccidioides brasiliensis são raras. O quadro clínico de lesão expansiva medular é inespecífico e uma intervenção cirúrgica com fins diagnósticos e terapêuticos constitui o único método de diagnóstico eficiente. Os autores relatam um caso em uma mulher de 45 anos com lesão medular ao nível torácico. Descrevem-se os achados clínicos, cirúrgicos e de ressonância magnética nesta situação incomum. (Table 1). We describe a case of thoracic intramedullary paracoccidioidomycotic granuloma. CASE REPORTSTN, a 45 year-old woman, was admitted in our Service on July 14, 1994, with complaints of progressive lower limbs weakness and paresthesias. Her symptoms started 30 days before her admission. At that time, she underwent a lumbal myelography with normal findings. Five months before, she was submitted to laminectomy and L4-L5 discectomy in another Service. She told us about a lip ulceration three years ago. A local biopsy of the ulceration and pathological examination disclosed the presence of fungi. She was medicated (drug unknown) for some weeks with complete resolution of the oral lesion. She was otherwise a healthy person, without reference to any other systemic diseases, including the respiratory tract. Her general physical examination was normal.

Quarenta e três pacientes com epilepsia refratária ao tratamento medicamentoso foram submetidos à cirurgia de epilepsia do lobo temporal no Instituto de Neurologia de Curitiba, entre os anos de 1998 a 2003. Trinta e nove (90,6%) pacientes apresentavam esclerose mesial temporal, e quatro (9,4%), tumores cerebrais. Dos trinta e sete pacientes que possuíam avaliação pós-operatória completa, 83,7% apresentaram classificação I, segundo Engel (livres de crises incapacitantes). Complicações pós-operatórias ocorreram em 18,6%: uma infecção da ferida operatória, um caso de hidrocefalia, um de fístula liquórica, dois casos de paralisia transitória do IV nervo craniano e um de hemiparesia transitória. Não houve nenhum óbito relacionado à cirurgia de epilepsia no presente estudo.

Stereotactic surgery for Parkinson's disease can be performed using different neuroimaging methods. Ventriculography has been used to locate the coordinates of the structures close to the third ventricle. Although it has several potential disadvantages related to the intraventricular injection of iodine contrast, it is considered a precise method. Computed tomography and magnetic resonance imaging have been used in some centers. In order to compare their efficacy, 50 stereotactic thalamotomies for Parkinson's disease were performed using either ventriculography (VE) (25) or magnetic resonance imaging (MRI) (25). In 14 out of 25 VE procedures, computed tomography (CT-scan) was also used and showed a significant mean difference of coordinate Y and Z. The clinical results employing either VE or MRI were similar, with 80% abolition of tremor in the VE group, and 84% in the MRI group, after a follow up period of at least 3 months. Another 12% of VE and 16% of MRI group showed significant improvement of tremor. Complication rate was 4% in both groups. MRI-guided stereotactic thalamotomy in Parkinson's disease has shown good clinical results, comparable to VE-guided stereotaxis.

No abstract

Osteogenesis imperfecta (OI) is a bone disorder that can lead to skull base deformities such as basilar invagination, which can cause compression of cranial nerves, including the trigeminal nerve. Trigeminal neuralgia in such cases remains a challenge, given distorted anatomy and deformities. We present an alternative option, consisting in cannulation of the foramen ovale and classical percutaneous treatment. Percutaneous balloon microcompression was performed in a 28 year--old woman with OI and severe trigeminal neuralgia using computed tomography (CT) and radiographic-guided cannulation of the Gasserian ganglion without neuronavigation or stereotactic devices. The patient developed hypoesthesia on the left V1, V2 and V3 segments with good pain control. This alternative technique with a CT-guided puncture, using angiosuite without the need of any Mayfield clamp, neuronavigation systems, frame or frameless stereotactic devices can be a useful, safe and efficient alternative for patients with trigeminal neuralgia with other bone deforming diseases that severely affect the skull base.

This model for foramen ovale puncture training has demonstrated valuable help for initial practicing of this common neurosurgical procedure, particularly in centers where there are not many cadavers available for training.