AbstractCharcot arthropathy of the shoulder caused by syringomyelia is a unusual degenerative disorder, frequently misdiagnosed and with few cases described in the literature. The diagnosis is made by clinical evaluation and radiological examinations with radiography and magnetic resonance imaging. However, the correct diagnosis and treatment is possible by carefully medical evaluation and can improve patient symptoms. Therefore, this study aimed to report two cases of Charcot arthropathy caused by syringomyelia. After achieving correct neurosurgical evaluation and magnetic resonance imaging, the diagnosis was made. The first case is a 53-year-old man with a click on his right shoulder for at least 12 months, associated with local edema, pain and limitation of joint range of motion. The second is a 45-year-old man with pain in the right upper limb and difficulty moving the joint for at least 24 months, associated with progressive worsening of the collection and edema in the ipsilateral upper limb. Posterior fossa decompression was performed, with symptoms relief after surgery. Posterior fossa decompression is a treatment that seems to be effective in reducing symptoms, especially when the diagnosis is early. However, this type of treatment still remains controversial, requiring further studies.

AbstractPrimary intraosseous hemangiomas are rare, benign, vascular malformations that account for ∼1% of all primary bone neoplasias. A 59-year-old female patient with unknown comorbidities had a history of headache, visual impairment and dizziness that led to the diagnosis of a clivus tumor. Two resections were attempted through transcranial and transnasal transsphenoidal approach in the last two years in another hospital. The initial MRI scan showed an expansive lesion with T2 hyperintense signal and diffuse, heterogenic contrast enhancement. Clival chordoma was the main diagnostic hypothesis done. A CT scan was performed to evaluate the extent of clival invasion, the sinus anatomy, and the clival destruction - all simulating clival chordoma. The interdisciplinary tumor board decided to proceed with endoscopic endonasal tumor resection. There were no postoperative complications and the histopathological analysis revealed a primary intraosseous haemangioma. Skull base intraosseous hemangiomas are rare entities, with a limited number of case reports found after literature reviews, especially in the clival region. The clinical pattern and imaging characteristics can vary widely according to the tumor extension and development, simulating some other common tumors found at this topography. We present a case report of a clival intraosseous hemangioma presenting as an isolated abducens paresis with a positive outcome after intranasal endoscopic resection after two years of follow-up.

AbstractLeptomeningeal carcinomatosis (LC) is a rare but serious complication when cancer cells infiltrate the meninges. It is most commonly associated with breast cancer, but only 5% of breast cancer patients develop it. Leptomeningeal carcinomatosis typically presents with headaches, mainly due to hydrocephalus, and the diagnosis involves a cytological analysis of cerebrospinal fluid (CSF) and/or magnetic resonance imaging (MRI) scans. The treatment of LC consists of a combination of intra-CSF chemotherapy, systemic therapy, radiation therapy, and/or supportive care, including CSF drainage. In the case herein reported, a technique known as ventriculovesical shunting was performed on a female patient with LC and breast cancer who had hydrocephalus due to this condition. This procedure is not as common as ventriculoperitoneal shunts, which can lead, in this case, to serious complications such as peritoneal carcinomatosis.

Abstract Objective To describe a tubular retractor technique for brain lesions through a series of cases and to conduct a literature review on intracranial tubular retractors with emphasis on the syringe port system. Materials and Methods We described four cases of lesions with an intraventricular component and different pathological patterns. The surgeries were performed between April, 2021 and July, 2022. The images were acquired through computed tomography (CT) and magnetic resonance imaging (MRI) scans and transferred to the Horos software, version 1.1.7. To make the tubular retractor, a 20-mL syringe and a 14-Fr/Ch, 30-mL/cc Foley probe were used. The syringe was sectioned according to the planned depth based on preoperative imaging. The syringe was the retractor itself, while the probe served as a means of dilating the path to the lesion. Results Gross total resection was achieved in all cases, and the samples collected were satisfactory regarding the results of the anatomopathological study. All patients evolved without any additional deficits and with adequate postoperative image control. Conclusion The syringe as a tubular retractor associated with the Foley probe as a surgical port dilator was useful, and it enabled the radical resection of intracranial tumors related to the lateral ventricle, not limiting the use of auxiliary instruments, neither of microsurgical instruments; therefore, it is an affordable, secure, and inexpensive method.

AbstractAir embolism (AE) is a subtype of embolism, caused by the entry of air into the vascular system. It is a predominantly iatrogenic complication, and its symptomatic form is severe, although uncommon. In some cases, a venous thrombi may pass into the arterial system through a venous-arterial shunt, characterizing a paradoxical embolism. Here, we describe the case of a previously healthy 44-year-old female who underwent cauda equina decompression and lumbar epidural abscess drainage. The patient suffered a paradoxical AE intraoperatively and died after 4 days. The occurrence of AE in lumbar spine surgeries in the prone position is rare, but the surgical team must be attentive to its clinical signs and quickly institute initial management when necessary.

Abstract Objective To evaluate the admission brain computed tomography (CT) scan findings in patients with traumatic brain injury (TBI) in a low- and middle-income country (LMIC) to predict long-term neurological outcomes. Materials and Methods Patients admitted to a tertiary emergency hospital between March 2017 and April 2018 who had suffered a TBI and had undergone a brain CT scan within 12 hours of the trauma were prospectively evaluated. All of the patients who were hospitalized for at least 24 hours were contacted by phone after 12 months to evaluate their neurological condition. Results We achieved a 12-month follow-up with 180 patients, most of them male (93.33%). The brain changes identified by CT, such as brain contusion (BC; p = 0.545), epidural hemorrhage (EDH; p = 0.968) and skull base fracture (SBF; p = 0.112) were not associated with worse neurological outcomes; however, subdural hemorrhage (SDH; p = 0.041), subarachnoid hemorrhage (SAH; p ≤ 0.001), brain swelling (BS; p ≤0.001), effacement of cortical sulci (ECS; p = 0.006), effacement of basal cisterns (EBC; p ≤0.001), depressed skull fracture (DSF; p = 0.017), and a brain midline shift > 5 mm (p = 0.028) were associated with worse outcomes. Conclusion Findings such as SAH, BS and DSF were independent predictors of worse neurological outcomes. The rate of 70% of patients lost to follow-up shows the difficulties of conducting long-term research in LMICs.

AbstractChordomas are rare neoplasms of low to intermediate grades, which arise from ectopic remnants of notochordal tissue, presenting a slow growth pattern and locally aggressive behavior. Due to their insidious course, the diagnosis is late, requiring immediate therapeutic intervention. The main prognostic factor is total surgical resection with wide margins. This therapeutic objective is only achieved in 40% to 55.6% of the cases, since chordoma tends to present an aggressive behavior, invading adjacent tissues and neurovascular structures. Currently, the main challenge of sacrectomy is to balance a wide resection with the preservation of the neurological function of the patient. Despite cases of successful gross total resection, local recurrence is an inevitable reality, and the overall survival is relatively low. The indication of adjuvant therapies is not well stablished in the literature, since the response to radiotherapy is not satisfactory for these tumors. The aim of the present study is to present a report the case of a patient with sacral chordoma (SC) who underwent partial sacrectomy and to carry out a brief review of the literature on sacrococcygeal chordomas.

AbstractScaphocephaly remains the most prevalent form of isolated single-suture synostosis. In most Pediatric Neurosurgery Centers, the treatment consists of extensive calvarial reshaping operations which are performed in relatively late ages. We described a modified open technique of cranial vault reconstruction for scaphocephaly and we report the anesthetic approach and how it influences our results and enables the performance of this surgery at earlier ages. A total of 47 patients with an average age of 11 ± 2.72 months underwent to the same surgical technique. Blood transfusion during the surgical intervention was needed in 25 patients (53%), and 22 patients (46.8%) did not need blood transfusion. None of the 14 patients who used tranexamic acid (TXA) needed blood transfusions. We reported a statistically significant association between the use of TXA and blood transfusion (p < 0.0001), with a decreased need for blood transfusion with the use of TXA. Besides sagittal suturectomy, we create new parasagittal sutures by replacing the prematurely fused one, and 1.5 cm of the anterior segment of bone of those 2 rectangular structures are cut before fixation, to enable the immediate shortening of the anteroposterior (AP) diameter of the skull. Finally, we put a mesh plate (SonicWeld Rx, KLS Martin Group, Tuttlingen, Baden-Wuerttemberg, Germany) over the superior sagittal sinus (SSS), which is fixed anteriorly and posteriorly with pins (SonicPins Rx, KLS Martin Group). This procedure enables an immediate reduction of the AP diameter of the skull, with no further therapies needed, and promotes a wide decompression and remodeling of the skull. With an experienced surgical team and an anesthesiologic protocol, we were able to perform this surgery at early ages, requiring no blood transfusions.

Abstract Introduction Nasal gliomas - or nasal glial heterotopias - are rare congenital malformations, which correspond to 5% of the congenital nasal masses. It is a mass composed of mature glial tissue that can be located outside, inside or near the nasal region, and may or may not be connected to the brain by a fibrous pedicle. This report addresses a case of nasal glioma that suffered recurrence after endoscopic treatment. Case Report A 1-year-old boy has, since birth, a mass inside the left nostril, which obstructs and widens the bridge of the nose. Upon physical examination, it is observed that the mass does not increase in size with crying and presents negative transluminescence and Furstenberg test. Upon being biopsied, the lesion reveals malignancy and the presence of inflammatory cells. MRI ruled out communication with intracranial structures. The endoscopic resection of the heterotopia removed a mass of 3,0 × 2,5 × 1,7 cm, whose histological and immunohistochemical analysis revealed glial pattern cell proliferation in the nasal mucosa. Conclusion Considering that nasal glial heterotopy is frequently present at birth, and that newborns breathe predominantly through this route, early diagnosis of the lesion is of great importance, as it can cause signs and symptoms of respiratory distress. In addition, it is worth noting that the early approach also prevents bone deformities.

AbstractWith the advancement of technology in Neurosurgery, imaging guidance for surgical planning and intraoperative assessment has become relevant. Currently, two major methods of imaging guidance are generally explored in the literature, namely based on imaging and fluorescence. These techniques, however, are not without limitations. Thermal imaging has potentially broad applications in clinical practice, especially for intracranial diseases. Infrared thermography (IT) has been an underestimated tool with few reports on its usefulness during intracranial surgeries. In this article, we aim to provide a brief discussion on the limitations of current intraoperative imaging techniques for intracranial surgeries and to provide an in-depth state-of-the-art review on intraoperative IT (IIT) for intracranial lesions. High-resolution IIT is a non-invasive alternative imaging method that provides real-time estimation of regional cerebral blood flow. For brain tumors, the studies were mostly directed to diagnostic purposes and occasionally for lesion-localization. The use of IIT to address the extent of resection is a potential new application. Clinical data in this issue suggests that IIT might detect residual tumors, occasionally not assessed by other imaging technologies. Thermographic measurements during vascular and epilepsy surgeries comprise an interesting field for future research with potential clinical implications. Further experimental and clinical studies should be addressed to provide technical refinements and verify the usefulness of this noninvasive technology in neurosurgery.