-Vein of Galen aneurysm is a rare pathology, representing less than 1% of intracranial vascular malformations. We report on a 65 years-old man who experienced a generalized tonic-clonic seizure. Brain imaging showed a large calcified expanding mass in the pineal region, confirming the diagnosis of a vein of Galen aneurysm. Because of the spontaneous thrombosis of the malformation, there was no need for microsurgical or endovascular treatment and he is been regularly followed since that.KEY WORDS: vein of Galen aneurysm, vein of Galen malformation, cerebral vein, congenital vascular malformation. Aneurisma da veia de Galeno em adulto: relato de casoRESUMO -Aneurisma da veia de Galeno é patologia rara, representando menos de 1% das malformações vasculares intracranianas. Apresentamos o caso de um homem de 65 anos que teve episódio de crise convulsiva tônico-clônica generalizada. Exames de imagem evidenciaram grande processo expansivo calcificado na região pineal, confirmando o diagnóstico de aneurisma trombosado de veia de Galeno. Devido à trombose espontânea da malformação, foi excluída a possibilidade de tratamento endovascular bem como microcirúrgico, mantendo-se o acompanhamento clínico. PALAVRAS-CHAVE: aneurisma da veia de Galeno, mal-formação da veia de Galeno, veias cerebrais, malformação vascular congênita.Vein of Galen aneurysm (VGA) is a rare vascular malformation representing less than 1% of vascular intracranial abnormalities. It is a congenital process frequently detected between the 6 th and 11 th months of gestational age 1 , during early childhood or neonatal period 2 . This finding in adult age is very rare, presenting or not symptoms throughout childhood 3 . Clinical manifestations can present at any age in the form of heart failure, delayed neuropsychomotor development, hydrocephalus and seizures 4 .We describe a case of VGA reporting clinical symptoms, radiological findings and management relating to current published literature. CASEA 65 year-old man was brought to the emergency room at the University Hospital of the Pontifical Catholic University of Paraná, Brazil because of generalized tonic-clonic seizures. On admission, he was treated with anticonvulsant therapy for status epilepticus. Past medical history was significant for treated high blood pressure and heart failure diagnosed late in life. Also significant for an episode of ischemic cerebrovascular disease two years before, resulting in left hemiparesis. During childhood and adult life there was no neuropsycomotor development delay, no signs of cardiopathy, no neurological signs or symptoms as well as no history of epilepsy.CT scan showed a calcified expanding process in the pineal region (Fig 1). MRI showed a heterogenic roundshaped mass localized in the supra-vermian cistern with dimensions of 35x32x30 mm showing high signal in T2-weight imaging (Fig 2). The MRI images were suggestive of a thrombosed VGA. Cerebral angiography showed a thrombosed VGA also (Fig 3).Considering the fact that the aneurysm was already thrombosed ...

No abstract

RESUMO -I n t rodução: Uma nova via relacionada com a dor visceral foi recentemente descrita. Esta via localiza-se na linha média da coluna dorsal na medula espinhal, sendo o alvo da técnica cirúrgica aqui descrita. Objetivo: Apresentar os resultados de três pacientes submetidos ao tratamento da dor visceral oncológica por mielotomia punctiform e . Método: Três pacientes, com dor abdominal oncológica re f r a t á r i a ao tratamento clínico, foram submetidos à mielotomia punctiforme por meio de de pequena laminectomia torácica. Resultados: Dois pacientes obtiveram controle completo da dor, sendo que um deles não mais necessitou de opióides. O terceiro paciente, que era intolerante aos opióides, obteve melhora de 80% da d o r. Nenhum dos pacientes apresentou déficit neurológico no pós-operatório. Conclusão: Ratificamos a existência de uma via, localizada na linha média da coluna dorsal, relacionada com a dor visceral em humanos, cuja ablação está relacionada à melhora da dor abdominal visceral de origem oncológica. PALAVRAS-CHAVE: mielotomia, dor oncológica, dor visceral.Punctate midline myelotomy for the treatment of oncologic visceral pain: analysis of three cases ABSTRACT -I n t roduction: A new midline posterior column pathway related to visceral pain has been re c e n t l y d i s c o v e re d . Objective: To present its interruption by a punctate midline myelotomy providing significant visceral oncologic pain re l i e f . Method: T h ree patients with abdominal cancer re f r a c t o ry pain from opiate analgesics were treated by a punctate midline myelotomy through thoracic laminectomy. Results: C o m p l e t e pain control was achieved in two patients, one had no more narcotics and the other one had significant lowering of opiate intake doses. The third patient was intolerant to narcotics having 80% relieving pain. T h e rewere no postoperative neurological deficits. Conclusion: The present re p o rt re a ff i rms the existence of a dorsal column midline pathway related to visceral pain in humans, and its interruption ameliorates abdominal pain due to cancer. KEY WORDS: myelotomy, oncologic pain, visceral pain.O tratamento da dor abdominal de origem oncológica é um dos grandes desafios na prática clínica, sendo o uso racional de analgésicos opióides o tratamento pre f e r i d o 1 , 2 . Todavia, em pacientes que não toleram ou que não têm uma melhora adequada apenas com o tratamento clínico, é necessária a utilização de medidas não farmacológicas para o cont role da dor. Classicamente aceita-se que as aferências da dor somática ascendem pelo trato espinotalâmico â n t e ro-lateral enquanto que as sensações epicríticas p e rc o rrem o cordão dorsal da medula espinhal 2 . Contudo, recentemente, foi descoberta uma nova via relacionada com a dor visceral localizada na coluna dorsal da medula, independente e muito mais importante para esta modalidade sensorial do que as fibras do trato espinotalâmico [3][4][5][6] .A primeira tentativa de ablação desta via em humanos para o tratamento da dor oncológica visceral fo...

Venous aneurysms are rare lesions that have been described within the venous system and may be discovered at any age. The lower extremities are most frequently involved, with the popliteal vein being the most common location. Clinical presentations are often initially classified as subcutaneous masses or alternatively, as an incidental finding during imaging studies for pain or chronic venous disease of the lower limb. They may be asymptomatic and/or initially present as a pulmonary embolism (PE), thrombosis, or vessel rupture with bleeding. Although benign, venous aneurysms have the potential for complications depending on location, size, and type. Here, the author presents two cases of saccular popliteal vein aneurysm that did not receive surgical treatment. Case 1: A 66-year-old male presented with a venous aneurysm without any previously reported symptoms that suggested new onset of claudication. He had an episode of PE in the past. Upon outpatient follow-up for his arterial exam, duplex ultrasound was performed, and a popliteal vein outpouching was visualized. Results: The ultrasound demonstrated a patent arterial bypass graft, with an incidental finding of saccular popliteal vein aneurysm without evidence of thrombus. The patient received no further surgical treatment (considering his comorbidities) and began daily warfarin with close clinical monitoring. Case 2: A 49-year-old male presented with bilateral varicose veins (worse on the left side) with recurrent posterior calf pain. He was referred for a bilateral venous insufficiency ultrasound. The patient had no prior history of deep vein thrombosis or PE. Results: Deep and superficial venous insufficiency was identified bilaterally. In addition, a saccular vein aneurysm without thrombus measuring 3.3 × 2.7 × 2.1 cm was identified in the popliteal vein. The patient received surgical treatment for venous insufficiency and is doing well.

No abstract