Tratamento cirúrgico das patologias vasculares cerebrais nos pacientes epilépticos

Abstract

-A series of 50 consecutive children with premature sagittal synostosis is reported. All were treated surgically; 43 were male, 47 were leukodermic and two are siblings. In the pre-operative examination, the head shape, skull measurements and radiologic findings were evaluated; 38 children were operated on before six months of age and 12 of them, between six and 12 months of age. The surgical technique used was a wide biparietal craniectomy. Blood transfusions were occasional, being necessary for only six (12%) children. The children were admitted at the day of surgery and discharged between the second and the third post-operative day. No local or general complications were observed and no one died. The aesthetic result was considered good. The altered skull measurements before surgery reached normalization as far as the end of the first year after the treatment. It may be concluded that wide biparietal craniectomy is a procedure of great effectiveness in the treatment of the premature fusion of the sagittal suture.KEY WORDS: craniosynostosis, sagittal suture.Tratamento cirúrgico da fusão prematura da sutura sagital RESUMO -É apresentada uma série de 50 crianças com fusão isolada e prematura da sutura sagital, tratadas cirurgicamente; 43 eram do sexo masculino, 47 leucodérmicas e duas irmãs. No pré-operatório foram avaliados o formato da cabeça, medidas do crânio e medidas radiológicas, 38 crianças foram operadas antes dos 6 meses de idade e 12 entre os 6 e 12 meses. A técnica cirúrgica usada foi a craniectomia parcial, ampla e biparietal. A transfusão sanguínea foi eventual, sendo necessária em somente 6 crianças (12%). As crianças foram admitidas no dia da cirurgia e receberam alta entre o segundo e terceiro dia após a cirurgia. Não foram observadas complicações locais ou gerais e não houve óbito. O resultado estético final foi considerado bom; as medidas do crânio, alteradas antes da cirurgia, se normalizaram até um ano após o tratamento. Conclui-se que a craniectomia parcial, ampla e biparietal é eficiente no tratamento da fusão isolada e prematura da sutura sagital, até o primeiro ano de vida. PALAVRAS-CHAVE: craniossinostose, sutura sagital.The first papers concerning the surgical treatment, of premature craniosynostosis were already published in the last century 17,18 . Nevertheless, as recently as the middle of the twentieth century, the surgical treatment of the premature fusion of the sagittal suture faced a strong resistance among experts. Since Faber and Towne (1943) 9 , Simmons and Peyton (1947) 26 , Ingraham and cols. (1948) 14 many techniques have been proposed for the surgical correction of this malformation. It is already universally accepted that children having such a deformity should be treated early by surgical correction. The most used surgical techniques are the linear craniectomy with placemení of interpositional material (polyethylene, silastic) 7,25 and the wide vertex craniectomy 8,11,12,21,28,29 . Some surgeons use wire to reduce the length of me skull 1,15,30 or multipl...

Prevalence, and Intellectual Outcome of Unilateral Focal Cortical Brain Damage as a Function of Age, Sex and Aetiology

“…We have not been able to determine whether these steroid actions are operant in the foetal or infant brain however. In the specific case of juvenile brain vascular anomalies, the evidence is to the effect of a higher male risk for brain vascular developmental anomalies [62] and intracranial hemorrhage [16], but not hemangioma [1] or Sturge-Weber syndrome [7].…”