PurposeTo analyze the pathways to brainstem tumors in childhood, as well as safe entry zones.MethodWe conducted a retrospective study of 207 patients less than 18 years old who underwent brainstem tumor resection by the first author (Cavalheiro, S.) at the Neurosurgical Service and Pediatric Oncology Institute of the São Paulo Federal University from 1991 to 2011.ResultsBrainstem tumors corresponded to 9.1 % of all pediatric tumors operated in that same period. Eleven previously described “safe entry zones” were used. We describe a new safe zone located in the superior ventral pons, which we named supratrigeminal approach. The operative mortality seen in the first 2 months after surgery was 1.9 % (four patients), and the morbidity rate was 21.2 %.ConclusionsAnatomic knowledge of intrinsic and extrinsic brainstem structures, in association with a refined neurosurgical technique assisted by intraoperative monitoring, and surgical planning based on magnetic resonance imaging (MRI) and tractography have allowed for wide resection of brainstem lesions with low mortality and acceptable morbidity rates.

The cerebral cortex folding in humans allow that an extensive area of cerebral cortex fit into the limited space of the skull. The factors that guide this folding are complex and its final result leads to sulci and gyrus patterns in adult brain. These patterns, depending on the region of cerebral cortex analyzed, can have or not a high degree of variability 1 . There are some evidence that factors guiding the cerebral cortex folding starts in the beginning of cerebral morphogenesis. First, in a coronal brain slice, we can see that sulcus in the inferior and lateral surface of the brain are oriented toward the ventricular cavity and sulcus in the medial surface are oriented parallel to corpus callosum fibers. (In cases of total corpus callosum agenesis, the sulcus in the medial surface seems to be ventricular-guided too). Second, neurons sends axons across the corpus callosum even before the neuron migration process end 2 , and this neuronal projection affect the final brain morphology 3 . Based on these observations, we can suppose that the final brain morphology depends on neuronal migration, axonal connection and probably others factors.The frontal lobe has four surfaces: a lateral, a medial, a basal and a sylvian surface 4 . The basal surface is in contact with the orbital roof, compounded of the frontal, ethmoid and sphenoid bones being, for this reason, called orbitofrontal surface.In the last ten years, many studies have showed the relationship between altered orbitofrontal cortical pattern and ABSTRACTThe anatomical characterization of the orbitofrontal cortex in human is limited in literature instead of many functional and clinical studies involving it. Objective: Anatomically define the orbitofrontal region aiming to possible neurosurgical treatments and unify the scientific nomenclature as well. Method: We analyze eighty four human hemispheres using a surgical microscope. Then we chose four hemispheres and dissect them according to Klinger' technique. Results: We found five main sulcus: olfatory sulcus, orbital medial sulcus, orbital lateral sulcus, orbital transverse sulcus and orbital intermediate sulcus. These sulcus, excluding the intermediate sulcus, delimit five gyrus: rectus gurys, orbital medial gyrus, orbital anterior gyrus, orbital lateral gyrus and orbital posterior gyrus. The main sulcal configuration can be divided on four more frequently patterns. Conclusion: Orbitofrontal cortex is associated with many psychiatric disorders. Better anatomical and functional characterization of the orbitofrontal cortex and its connections will improve our knowledge about these diseases.

No abstract

Acapulco epitomises the (in)security of urban zones in the Americas whose geographical, political and economic divisions are exacerbated by the political economy and geopolitics of drug trafficking, as well as by militarised attempts to fight it. Various geographic, political, and economic factors in the Acapulco Metropolitan Zone (AMZ) have impacted drug trafficking and organised crime and contributed to high levels of violence. As a result, Acapulco now ranks among the 50 most violent cities in the world. This article analyses the trends in drug trafficking and organised crime in the AMZ, and highlights the lessons for scholars and policy-makers.

At least 1 variation in ACP anatomy was found in 38.7% of cases with this simple method. Thus, a preoperative computed tomography scan could improve surgical procedures that involve removal of the anterior clinoid process.

Background: A subdural hematoma is defined as clot formation in the subdural space after vessel rupture or brain parenchyma damage. Several demographic and tomographic factors were associated to poor prognosis, although some debate according to their specific roles still remains. Methods: Retrospective cohort study of comatose patients admitted to a single-institution, tertiary hospital center, between the years 2013 and 2019 with traumatic acute subdural hematoma requiring surgical evacuation were studied. Demographic and tomographic data were obtained from medical records. Univariate and multivariate statistical analysis were performed, using a value of P < 0.05 for significance. Results: Seventy-seven patients were selected using the criteria and a total of 37 (48%) head CT exams were evaluated. The overall mortality was 57.1% and achieved 100% at ≥75-years-old subgroup. Univariate analysis only found young age as a good prognosis factor (P = 0.002). Gender (P = 0.784), abnormal pupillary response (P = 0.643), midline shift (P = 0.874), clot thickness (P = 0.206), compressed basal cisterns (P = 0.643), hematoma side (P = 0.879), and subarachnoid hemorrhage (P = 0.510) showed no association. Multivariate analysis showed no statistically significant association between covariates. Conclusion: Traumatic acute subdural hematoma is a life-threatening condition. Younger age was the only positive prognostic factor identified. More research is necessary to establish age as a rule-out criterion to surgical indication.

Objective To perform a quantitative analysis of the brain volume of elderly individuals in a population-based sample. Materials and Methods This was a radiological assessment and voxel-based quantitative analysis, with surface alignment, of 525 magnetic resonance imaging scans of individuals between 60 and 103 years of age who participated in the Saúde, Bem-estar e Envelhecimento (Health, Well-being, and Aging) study in the city of São Paulo, Brazil.Results We noted a median rate of reduction in total brain volume of 2.4% per decade after 60 years of age. Gray and white matter both showed volume reductions with age. The total brain volume/intracranial brain volume ratio differed between males and females. Conclusion We have corroborated the findings of studies conducted in the United States and Europe. The total brain volume/intracranial brain volume ratio is higher in men, representing a potential bias for the conventional radiological assessment of atrophy, which is typically based on the evaluation of the cerebrospinal fluid spaces.

Resumo Objetivo: Averiguar se as características hidrodinâmicas das válvulas se alteram significativamente quando os dimensionamentos originais são violados e a possível repercussão clínica desse fato. Métodos: Foi utilizada uma bancada de testes automatizada, conforme a norma ISO 7197. Um sistema valvular foi testado inicialmente com os componentes preconizados e embalados originalmente com o produto. A seguir, substituiu-se o cateter peritoneal original por diversos dimensionamentos encontrados no mercado nacional. Nos testes para a avaliação da influência do diâmetro do cateter no escoamento, foi utilizado sempre o mesmo comprimento original do cateter. Aplicou-se o mesmo raciocínio lógico para a análise do comprimento do cateter. Nove perfis hidrodinâmicos foram obtidos para as diferentes montagens valvulares. Resultados: Diminuições imperceptíveis no diâmetro do cateter peritoneal alteraram o perfil hidrodinâmico do sistema valvular testado. Alterações de 0,1 mm no diâmetro de um cateter peritoneal aumentaram o efeito resistivo do sistema valvular suficientemente para que ele funcionasse fora do perfil hidrodinâmico preconizado; o efeito resistivo se acentuou conforme o diâmetro diminuiu, e vice-versa. A diminuição do comprimento do cateter também influenciou significativamente no desempenho hidráulico da válvula, de um regime inicial de alta pressão para um regime de média pressão. Conclusão: Alterações de dimensionamento em cateteres peritoneais trazem complicações para o paciente e desorientam o julgamento clínico do neurocirurgião no período pós-implante, pois o sistema valvular funcionará em regime hidráulico fora do especificado, e o raciocínio lógico do neurocirurgião também se torna comprometido. Esse fato pode ser crítico principalmente em crianças e neonatos. Não foram identificados relatos desse fato na literatura que antecede esta apresentação.