3-D simulation of posterior fossa reduction in Chiari I.

We proposed a 3D model to evaluate the role of platybasia and clivus length in the development of Chiari I (CI). Using a computer aided design software, two DICOM files of a normal CT scan and MR were used to simulate different clivus lengths (CL) and also different basal angles (BA). The final posterior fossa volume (PFV) was obtained for each variation and the percentage of the volumetric change was acquired with the same method.

Spondylectomy for Giant Cell Tumor After Denosumab Therapy.

Study Design: A case report.

Objective: To report a case of the lumbar giant cell tumor (GCT) utilizing a new clinical treatment modality (denosumab therapy), which showed a massive tumor reduction combined with the L4 spondylectomy.

Summary Of Background Data: There are some controversies about spinal GCT treatments.

Incidence of basilar invagination in patients with tonsillar herniation? A case control craniometrical study.

A retrospective case-control study based on craniometrical evaluation was performed to evaluate the incidence of basilar invagination (BI). Patients with symptomatic tonsillar herniation treated surgically had craniometrical parameters evaluated based on CT scan reconstructions before surgery. BI was diagnosed when the tip of the odontoid trespassed the Chamberlain's line in three different thresholds found in the literature: 2, 5 or 6.

Endoscopic endonasal transsphenoidal resection of pituitary adenomas: preliminary evaluation of consecutive cases.

Introduction: Endoscopic endonasal transsphenoidal surgery has gained increasing acceptance by otolaryngologists and neurosurgeons. In many centers throughout the world, this technique is now routinely used for the same indications as conventional microsurgical technique for pituitary tumors.

Objective: To present a surgical experience of consecutive endoscopic endonasal trans-sphenoidal resections of pituitary adenomas.

Evolutionary hypothesis for Chiari type I malformation.

Chiari I malformation (CM-I) is classically defined as a cerebellar tonsillar herniation (≥5 mm) through the foramen magnum. A decreased posterior fossa volume, mainly due to basioccipital hypoplasia and sometimes platybasia, leads to posterior fossa overcrowding and consequently cerebellar herniation. Regardless of radiological findings, embryological genetic hypothesis or any other postulations, the real cause behind this malformation is yet not well-elucidated and remains largely unknown.

A pituitary adenoma secreting follicle-stimulating hormone with ovarian hyperstimulation: treatment using a gonadotropin-releasing hormone antagonist.

Objective: To describe the management of a patient with a pituitary adenoma secreting follicle-stimulating hormone (FSH) associated with ovarian hyperstimulation who was treated with a gonadotropin-releasing hormone (GnRH) antagonist.

Design: Case report.

Setting: University teaching hospital.

Carpal tunnel syndrome: treatment with small transverse incision.

Objective: To evaluate the application of a limited transverse incision technique to treat the carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the flexor retinaculum (FR).

Method: A prospective analysis of thirty FR release procedures performed on twenty-eight patients subjected to the proposed incision technique. Safety and total opening of the FR were evaluated through a questionnaire and an endoscopic inspection respectively.

Long-term facial nerve clinical evaluation following vestibular schwannoma surgery.

Background: Facial function is important in accompaniment of patients operated on vestibular schwannoma (VS).

Objective: To evaluate long term facial nerve function in patients undergoing VS resection and to correlate tumor size and facial function in a long-term follow-up.

Method: Transversal study of 20 patients with VS operated by the retrosigmoid approach.

[The influence of early tracheostomy in the weaning of patients with severe traumatic brain injury].

Background And Objectives: Actually, It’s doubtful if early tracheostomy (ET) can influence mechanical ventilation (MV) weaning time or the hospital length of stay in patients with traumatic brain injury (TBI). The main objective of this trial was to verify the influence of ET on weaning time of patients with severe TBI.

Methods: Prospective, observational study, including 33 patients with severe TBI (GCS < 10 at hospital admission), evaluated according to tracheostomy performance time (early: t < 6 days; intermediate: t = 7 to 11 days; and late: t > 12 days) and the weaning from MV.

Central neurocytoma: report of two cases.

Introduction: Central neurocytomas are rare neuroectodermal tumors believed to arise from the subependymal matrix of the lateral ventricles.

Case Reports: A 26-year-old woman and a 33-year-old man each had a large, heterogeneous, contrast enhancing mass in the lateral ventricles at the foramen of Monro causing bilateral hydrocephalus. The woman died after surgery, but the man is asymptomatic after three years.

Meningiomas of the jugular foramen.

Primary meningiomas of the jugular foramen are extremely rare. There is controversy regarding the management of these tumors. The objective of this article is to analyze the treatment and results in a series of ten cases.

Imaging features and treatment of an intradural lumbar cystic schwannoma.

Spinal schwannomas are frequently observed among patients treated in a reference neurosurgery center. Cystic spinal schwannomas, however, are very scantly found. Due to its indolent behavior and benign course, the diagnosis of schwannomas may pose a challenge to the care giver, and the imaging findings can be misleading.

Tumors of the jugular foramen: diagnosis and management.

Objective: Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. With the availability of new diagnostic procedures these tumors have been more precisely studied and questions of whether, when, and how these lesions should be treated often arise. Data from 106 consecutive patients surgically treated in the past 17 years were retrospectively analyzed to identify surgical outcomes.

Intrinsic tectal low grade astrocytomas: is surgical removal an alternative treatment? Long-term outcome of eight cases.

Low-grade gliomas arising in dorsal midbrain in children and young patients usually present few neurological symptoms and findings, and patients management is controversial. Some authors propose only clinical observation until the patient present signs of increased intracranial pressure when a shunt with or without biopsy, is inserted; others recommend radiotherapy after stereotactic or open biopsy. Microsurgical total removal of tumor may be curative.

Jugular foramen tumors: diagnosis and treatment.

Object: Jugular foramen tumors are rare skull base lesions that present diagnostic and complex management problems. The purpose of this study was to evaluate a series of patients with jugular foramen tumors who were surgically treated in the past 16 years, and to analyze the surgical technique, complications, and outcomes.

Methods: The authors retrospectively studied 102 patients with jugular foramen tumors treated between January 1987 and May 2004.

Multiple systemic metastases of posterior fossa - primitive neuroectodermal tumor (PF-PNET) in adult: case report.

We present the case of a 30-year female patient with multiple systemic metastases of posterior fossa primitive neuroectodermal tumor (PF- PNET) and present a review concerning the usual presentation, sign and symptoms, radiological aspects, pathways of spread, genetic patterns and treatment of PF-PNET. The biological behavior of PF - PNET is analyzed taking into consideration the presence of systemic metastases.

Bilateral internuclear ophthalmoplegia and clivus fracture following head injury: case report.

Internuclear ophthalmoplegia is a remarkable finding, particularly in patients victims of head injury. The medial longitudinal fasciculus, which is believed to be lesioned in cases of internuclear ophthalmoplegia, has an unique brain stem position and the mechanism involved in brain stem contusions implies a maximal intensity of shearing forces on the skull base. We describe a very rare association of bilateral ophthalmoplegia and clivus fracture following head injury, without further neurological signs.

Supraorbital eyebrow approach to skull base lesions.

We report our experience with a supraorbital eyebrow minicraniotomy. This technique is suitable to lesions situated in the region of the anterior fossa, suprasellar cisterns, parasellar region and Sylvian fissure. A 50 mm incision in the eyebrow and a supraorbital minicraniotomy is performed.