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Blood Blister-like aneurysms are intracranial non-saccular aneurysms with higher rupture risk due to its fragile wall. Diagnosis is performed in the acute phase of a subarachnoid hemorrhage. There are several treatment options based on reconstructive or deconstructive techniques. This paper aims to discuss the limitations of microsurgery clipping for a ruptured blister aneurysm. We report on a case of a female patient presented with a Fisher III subarachnoid hemorrhage. Cerebral angiography revealed an internal carotid artery blister aneurysm. Initially microsurgery clipping was successfully performed. However, after a few days the patient presented new subarachnoid hemorrhage. The new cerebral angiography showed growth of the previously clipped aneurysm, with displacement of the clip from the position adjacent to the artery. High-flow bypass was performed obtaining definitive treatment. This is a definitive approach for blister aneurysms. If microsurgery clipping is chosen, a strict follow-up is required due to the dynamic nature of this lesion and the chance of re-bleeding even after successfully clipping.

Background Quality of life is essential for oncologic patients. Several tools are available to improve microsurgery and reduce morbidity. Diode laser is a precise and useful technology for microsurgery. The goal of this pioneer case series is to describe the oncologic use of the 980nm diode laser and the qualitative variables analyzed. Besides, review the current literature about lasers in neurosurgery. Methods A longitudinal prospective study described patients with meningioma or glioma submitted to neurosurgical laser-assisted procedures. Also, we performed a review in medical databases using the terms “diode laser” and “neurosurgery.” Results No paper described the use of a diode laser in neurooncology. The 980nm diode laser was used in 15 patients. The device is thin, silent, and easy to handle. Excellent hemostasis was observed, especially in skull base meningiomas. Also, it was easy and fast to delimit tumor from normal brain tissue without damage to surrounding parenchyma. No postoperative complications occurred. Conclusions The diode laser is a useful tool for brain tumor surgery, particularly concerning hemostasis. Surgical site coagulation is effective without damage to adjacent structures, especially in gliomas near eloquent regions. We consider this technique a suitable adjuvant resource for brain tumor surgeries to provide an excellent hemostasis and help cut and vaporize a lesion.

Background Rare and deep located tumors are surgical challenge with high morbidity. Minimal invasive techniques should be encouraged for a better outcome. Intralabyrinthine schwannoma (ILS) is a rare benign tumor that usually presents with hearing loss and tinnitus. Surgery is associated with high rate of facial paralysis and deafness. Radiosurgery is an option for tinnitus treatment, without the risk of facial paralysis. Case Description A young male patient presented with severe hearing loss and incapacitating tinnitus. Magnetic resonance revealed the presence of a small ILS. Radiosurgery was performed and obtained tinnitus control without complications and no further tumor growth. Conclusions Tumor control and symptoms relief could be safely achieved through a precisely plan using Gamma Knife radiosurgery, decreasing morbidity. This is the first radiosurgical description for a transmodiolar schwannoma.

Background: During the surgery for intrinsic brain lesions, it is important to plan the proper site of the craniotomy and to identify the relations with the gyri and superficial veins. This might be a challenge, especially in small subcortical lesions and when there is a distortion of the cortical anatomy. Materials and Methods: Using the free computer software Osirix, we have created a 3-dimensional reconstruction of the head and cerebral showing the gyri and superficial veins. With the aid of some tools, it is possible to create a colored image of the lesion and also to calculate the distance between the areas of interest and some easily identifiable structure, making it easier to plan the site of the craniotomy identify the topography of the lesion. Results: The reconstructions were compared to the intraoperative view. We found this technique to be useful to help identify the gyri and cortical veins and use them to find the lesions. The use of a region of interest to show better the lesion under the cortical surface and in the three-dimensional reconstruction of the head was also helpful. Conclusions: This is a low-cost and easy technique that can be quickly learned and performed before every surgery. It helps the surgeon to plan a safe craniotomy and lesionectomy.

Introduction: Arteriovenous malformations (AVMs) are abnormal communications between artery and veins without capillary interconnections. Because of this flow alteration, they can easily rupture and bleeding could be catastrophic. Diagnosis is performed through neuroimaging methods. Then, careful evaluation is required in deciding for the best treatment approach: microsurgery, radiosurgery or endovascular. Objective: This paper aims to describe the main indications, advantages and disadvantages of each method. Methods: A PubMed database literature review was performed. The following English language keywords were used: "brain AVM", "arteriovenous malformations", "radiosurgery", "microsurgery", "embolization" and "endovascular". Recent high impact factor papers were selected for this review. Discussion: The Spetzler-Martin classification is indispensable for prognosis acknowledgment and for the proper therapeutic approach selection, however is not sufficient for decision-making. Other factors, such as the patient's general clinical condition, surgeons experience and availability of all of the treatment methods are essential. Microsurgery is the gold standard method for treatment of AVM's, however, more and more, less invasive methods, such as radiosurgery and endovascular, are expanding. In some cases, they could be used as single treatment, nevertheless they act as adjuvants to microsurgery. Conclusions: The knowledge of the advantages, disadvantages and limitations of each technique allow for a better decision, aiming for a greater cure rate and less morbidity. Combined surgical and radiosurgery approaches, embolization and surgical or embolization and radiosurgery are increasingly being used to improve occlusion rates with fewer neurological deficits.Keywords: Arteriovenous malformations, Neurosurgical procedures, Radiotherapy, Endovascular procedures, Combined modality therapy RESUMOIntrodução: As malformações arteriovenosas (MAVs) são comunicações anormais entre artérias e veias, sem a interposição de capilares. Devido a esta troca de fluxo, são propensas a rotura e sangramento, que podem ser catastróficos. Seu diagnóstico é realizado através de métodos de neuroimagem. Após o diagnóstico é necessária cuidadosa avaliação de diversos fatores para decidir sobre o melhor tratamento a ser instituí­do: microcirurgia, radiocirurgia ou embolização endovascular. Objetivo: Este estudo tem objetivo de descrever as principais indicações, vantagens e desvantagens de cada método. Métodos: Revisão da literatura utilizando a base de dados Pubmed, considerando como palavras-chave na lí­ngua inglesa: "brain AVM", "arteriovenous malformations", "radiosurgery", "microsurgery", "embolization" and "endovascular". Discussão: A utilização da classificação de Spetzler-Martin é indispensável para o correto planejamento terapêuticos das MAVs. No entanto, somente isso não é suficiente para a melhor tomada de decisão. Fatores como estado geral do paciente, disponibilidade de todas as modalidades terapêuticas e experiência do cirurgião são essenciais. A microcirurgia é o método consagrado para o tratamento, mas os métodos menos invasivos, como a radiocirurgia e a embolização endovascular, têm ganhado cada vez mais espaço, tanto como modalidade única, ou como tratamento adjuvante í cirurgia, em casos selecionados. Conclusões: O conhecimento das vantagens, desvantagens e limitações de cada técnica propicia a escolha da melhor modalidade terapêutica, objetivando maiores í­ndices de cura e menor morbimortalidade. Cada vez mais o tratamento combinado, seja radiocirurgia com microcirurgia ou embolização com microcirurgia, vem sendo utilizado para maximizar as taxas de oclusões completas, com menos sequelas neurológicas.Palavras Chave: Malformação arteriovenosa, Proce- Introduction: Arteriovenous malformations (AVMs)are abnormal communications between artery and veins without capillary interconnections. Because of this flow alteration, they can easily rupture and bleeding could be catastrophic. Diagnosis is performed through neuroimaging methods. Then, careful evaluation is required in deciding for the best treatment approach: microsurgery, radiosurgery or endovascular. Objective: This paper aims to describe the main indications, advantages and disadvantages of each method. Methods: A PubMed database literature review was performed. The following English language keywords were used: “brain AVM”, “arteriovenous malformations”, “radiosurgery”, “microsurgery”, “embolization” and “endovascular”. Recent high impact factor papers were selected for this review. Discussion: The Spetzler-Martin classification is indispensable for prognosis acknowledgment and for the proper therapeutic approach selection, however is not sufficient for decision-making. Other factors, such as the patient’s general clinical condition, surgeons experience and availability of all of the treatment methods are essential. Microsurgery is the gold standard method for treatment of AVM’s, however, more and more, less invasive methods, such as radiosurgery and endovascular, are expanding. In some cases, they could be used as single treatment, nevertheless they act as adjuvants to microsurgery. Conclusions: The knowledge of the advantages, disadvantages and limitations of each technique allow for a better decision, aiming for a greater cure rate and less morbidity. Combined surgical and radiosurgery approaches, embolization and surgical or embolization and radiosurgery are increasingly being used to improve occlusion rates with fewer neurological deficits. Keywords: Arteriovenous malformations, Neurosurgical procedures, Radiotherapy, Endovascular procedures, Combined modality therapy ResumoIntrodução: As malformações arteriovenosas (MAVs) são comunicações anormais entre artérias e veias, sem a interposição de capilares. Devido a esta troca de fluxo, são propensas a rotura e sangramento, que podem ser catastróficos. Seu diagnóstico é realizado através de métodos de neuroimagem. Após o diagnóstico é necessária cuidadosa avaliação de diversos fatores para decidir sobre o melhor tratamento a ser instituído: microcirurgia, radiocirurgia ou embolização endovascular. Objetivo: Este estudo tem objetivo de descrever as principais indicações, vantagens e desvantagens de cada método. Métodos: Revisão da literatura utilizando a base de dados Pubmed, considerando como palavras-chave na língua inglesa: “brain AVM”, “arteriovenous malformations”, “radiosurgery”, “microsurgery”, “embolization” and “endovascular”. Discussão: A utilização da classificação de Spetzler Martin é indispensável para o correto planejamento terapêuticos das MAVs. No entanto, somente isso não é suficiente para a melhor tomada de decisão. Fatores como estado geral do paciente, disponibilidade de todas as modalidades terapêuticas e experiência do cirurgião são essenciais. A microcirurgia é o método consagrado para o tratamento, mas os métodos menos invasivos, como a radiocirurgia e a embolização endovascular, têm ganhado cada vez mais espaço, tanto como modalidade única, ou como tratamento adjuvante à cirurgia, em casos selecionados. Conclusões: O conhecimento das vantagens, desvantagens e limitações de cada técnica propicia a escolha da melhor modalidade terapêutica, objetivando maiores índices de cura e menor morbimortalidade. Cada vez mais o tratamento combinado, seja radiocirurgia com microcirurgia ou embolização com microcirurgia, vem sendo utilizado para maximizar as taxas de oclusões completas, com menos sequelas neurológicas. Palavras Chave: Malformação arteriovenosa, Procedimentos neurocirúrgicos, Radioterapia, Procedimentos endovasculares, Terapia combinada

Purpose In low- and middle-income countries, there is a lack of data on neurosurgical costs. These data are relevant to help international cooperation, especially for huge trials. This study aims to estimate the direct cost of an adult neurooncological patient during hospital admission in the largest philanthropic hospital in Latin America. Methods This observational economic analysis describes the direct cost of a neurooncological patient at Santa Casa de São Paulo, Brazil. For this analysis, only adult patients with the two more common primary brain tumors were considered. Results Between January 2008 and December 2019 a total of 1279 charts were reviewed. 53.57% were female patients. Most patients had an age range between 56 and 65 years (22.5%). A statistically significant sample of patients with meningiomas and gliomas were analyzed. The estimated mean cost of neurosurgical hospitalization was U$ 4.166. The operating room and ICU costs represented the largest proportion of the total cost (29.24% and 24.95%, respectively). 17.5% of patients had some types of infection and 66.67% them occurred in nonelective procedures. The mortality rate was 12.7% and 92.3% occurred in emergency procedures. Conclusions This study evaluated the cost of oncological neurosurgical patients. The operating room was the most expensive variable, followed by the ICU hospitalization period. Surgery performed in an emergency was more associated with infections and mortality. Findings from this study could be used by stakeholders and policymakers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals.

Espasmos faciais constituem afecção rara, caracterizada por contrações assimétricas, involuntárias e paroxísticas da musculatura facial. Frequentemente são de acometimento unilateral e levam a situação desconfortável e prejudicial à qualidade de vida dos pacientes. Na maioria das vezes, o quadro inicia-se gradualmente no músculo orbicular dos olhos, seguindo-se por acometimento do andar inferior da face ipsilateralmente. Os espasmos são causados por compressão vascular, mais comumente provocada pela presença da artéria cerebelosa póstero-inferior (PICA) ou da artéria cerebelosa antero-inferior (AICA) (sendo mais raro o envolvimento da artéria vertebral) sobre a raiz do nervo facial, na REZ (Root Entry Zone). Injeção de toxina botulínica no músculofacial envolvido é uma opção terapêutica medicamentosa, no entanto possui benefícios transitórios ao longo da terapia. A descompressão microvascular é um tratamento efetivo, com baixas taxas de complicação. Descreve-se o caso de um paciente de 65 anos portador de contrações involuntárias e esporádicas da musculatura orbicular do olho esquerdo de caráter insidioso e progressivo. Optou-se por microcirurgia descompressiva com interposição de teflon entre artéria vertebral esquerda e o nervo facial na fossa posterior, com significativa melhora clínica, e regressão progressiva dos espasmos até sua completa remissão.

Objetivo: Describir un caso raro de una paciente previamente diagnosticada con cáncer de mama que evolucionó después de algunos años con metástasis intraorbitaria. Métodos: Relato del caso y revisión de literatura. Resultados: La correlación del diagnóstico previo de neoplasia de mama y la presencia de múltiples lesiones en la órbita y regiones adjacentes ha permitido concluir que la paciente presentaba enfermedad metastásica. Las metástasis se presentan como manifestaciones cada vez más frecuentes en enfermos oncológicos. La órbita y estruturas próximas constituyen topografías poco usuales de diseminación de células neoplásicas y manifestaciones iniciales pueden mimetizar otras condiciones, retrasando el diagnóstico. Como se trataban de pequeñas lesiones, se ha optado por radioterapia como tratamiento único. Después del término la paciente evolucionó con regresión de sintomatología. Conclusiones: Aunque infrecuentes, manifestaciones oculares pueden ocurrir en enfermos oncológicos y la investigación de enfermedad metastático de la órbita es esencial para el seguimiento adecuado.

Pineal region tumors are uncommon among neoplasm of the central nervous system, with this region being the most heterogeneous in terms of histological types. Meningiomas are rarer still, but can be found at this site, with origins in either the velum interpositum or falcotentorial junction. Neuroimaging exams can distinguish malignant from benign lesions besides helping to define the origin of the lesion as the pineal parenchymal or surrounding structures. We report the case of a woman with a pineal region tumor in which differential diagnoses included meningioma and germinoma, with confirmation of the former based on radiological characteristics and histopathology. In addition, a brief review of differential diagnoses and approaches for cases of lesions in this region is provided.

Background Laboratory training is a very important step on the development of the skills necessary for a neurosurgeon. This can be achieved using animal models and surgical microscopes or stereomicroscopes. Methods, like the use of fluorescein, increase the lifelike situation and allow anyone to assess the patency of an anastomosis and improve the quality of this training. Methods We report the use of a stereomicroscope with white light and a fluorescence mode used to perform dissection of small arteries and anastomosis using a chicken wing model. Using an affordable device, we could perform fluorescein videoangiography to asses the patency of those anastomosis and improve the quality of the training skills in microsurgery. Results The stereomicroscope is a useful tool for laboratory training and can be used as a substitute of a surgical microscope for microsurgery training. The fluorescence mode allowed us to perform fluorescein videoangiography with very a good quality of image. Conclusions Microsurgery training is important part in the life of any neurosurgeon. Using a stereomicroscope with a fluorescence mode is an affordable method that can be reproduced in any laboratory in the world.

CONTEXT: Presence of an arachnoid cyst and a non-ruptured intracystic brain aneurysm is extremely rare. The aim of this paper was to describe a case of a patient with an arachnoid cyst and a non-ruptured aneurysm inside it. Clinical, surgical and radiological data were analyzed and the literature was reviewed. CASE REPORT: A patient complained of chronic headache. She was diagnosed as having a temporal arachnoid cyst and a non-ruptured middle cerebral artery aneurysm inside it. Surgery was performed to clip the aneurysm and fenestrate the cyst. CONCLUSIONS: This report raises awareness about the importance of intracranial vascular investigation in patients with arachnoid cysts and brain hemorrhage.

Cavernous angiomas (cavernomas) are vascular malformations of the brain characterized by abnormal capillaries. Ventricular cavernomas are considered rare; however, an extremely unusual topography is the septum pellucidum, with only five reported cases in the English literature. These malformations may rupture and cause very large hematomas, leading to neurological impairment. Cavernomas can be familial or sporadic; additionally, these may appear following brain radiotherapy in extremely rare cases. Herein, we present an extremely rare and unique case of a septum pellucidum cavernoma that occurred in a young male who had previously undergone brain radiotherapy in childhood due to acute lymphoid leukemia. Following presentation, he was diagnosed with generalized seizures. The cavernoma was resected via an anterior interhemispheric transcallosal approach, following which the patient remained stable without neurological sequelae. To conclude, ventricular cavernomas are rare lesions, especially when located at the septum pellucidum, thus constitute a challenging neurosurgical approach.

Traumatic brain injury (TBI) is less common in children than in adults. Posterior fossa lesions are even more uncommon, but, when present, are usually epidural hematomas. These lesions, even when small, may have a bad outcome because of the possibility of compression of the important structures that the infratentorial compartment contains, such as the brainstem and cranial nerves, and the constriction of the fourth ventricle, causing acute hydrocephalus. Although unusual, posterior fossa lesions are increasingly being diagnosed because of the better quality of and easier access to cranial tomography. In this paper, we report a case of a 12-year-old male patient who had suffered a TBI and presented with several pneumocephali, one of them in the retroclival region, causing a mass effect and then compression of the sixth cranial nerve which is the most susceptible to these injuries. We discuss these traumatic posterior fossa lesions, with an emphasis on retroclival pneumocephalus, not yet described in the literature in association with bilateral abducens palsy. In addition, we discuss associated lesions and the trauma mechanism.

Background: Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. Methods: A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. Results: Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). Conclusions: Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority. RESUMO Introdução: A craniectomia descompressiva (CD) é procedimento necessário em alguns casos de trauma cranioencefálico (TCE). Este manuscrito objetiva avaliar os custos diretos e desfechos da CD no TCE em um país em desenvolvimento e descrever o perfil epidemiológico. Métodos: Estudo retrospectivo foi realizado usando banco de dados neurocirúrgico de cinco anos, considerando amostra de pacientes com TCE que realizaram CD. Algumas variáveis foram analisadas e foi desenvolvida uma fórmula para cálculo do custo total. Resultados: A maioria dos pacientes teve múltiplas lesões intracranianas, sendo que 69.0% evoluíram com algum tipo de complicação infecciosa. A taxa de mortalidade foi de 68,8%. O custo total foi R$ 2.116.960,22 (US$ 653,216.00) e o custo médio por paciente foi R$ 66.155,00 (US$ 20,415.00). Conclusões: CD no TCE é um procedimento caro e associado á alta morbidade e mortalidade. Este foi o primeiro estudo realizado em um país em desenvolvimento com o objetivo de avaliar os custos diretos. Medidas de prevenção devem ser priorizadas.

E bem estabelecido que o diagnostico da fratura de condilo occipital tem aumentado nas ultimas decadas, provavelmente devido a disponibilidade e ao uso comum da tomografia computadorizada durante a investigacao do trauma craniano, alem da maior gravidade dos mecanismos de trauma. Por causa da baixa especificidade da apresentacao clinica, e tambem pelo pouco conhecimento sobre o mecanismo de lesao, o diagnostico desta condicao e um desafio para neurocirurgioes. A abordagem terapeutica destes pacientes e baseada em estudos com baixa casuistica e em relatos de caso. Uma revisao sobre este tema foi realizada a fim de discutir alguns aspectos controversos sobre o manejo da fratura de condilo occipital. As fraturas de condilo occipital sao eventos raros, entretanto podem relacionar-se a alta morbidade em pacientes que sofreram trauma encefalico. Alguns sintomas, como intensa dor cervical, podem estar associados com esta fratura; portanto, paciente com suspeita de fratura de condilo occipital deve ser submetido a investigacao radiologica detalhada da regiao. O diagnostico precoce desta fratura permite investigacao apropriada, minimizando a chance de sequelas.

CONTEXT: Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. CASE REPORT: A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. CONCLUSIONS: Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.

CONTEXT AND OBJECTIVE: Neurocysticercosis is prevalent in developing countries and manifests with several neurological signs and symptoms that may be fatal. The cysts may be parenchymal or extraparenchymal and therefore several signs and symptoms may occur. Depending on their location, neurosurgical procedures may be required, sometimes as emergencies. The aim here was to review 10-year statistics on all surgical neurocysticercosis cases at a large public tertiary-level hospital. DESIGN AND SETTING: Retrospective cohort at a large public tertiary-level hospital. METHODS: All surgical neurocysticercosis cases seen between July 2006 and July 2016 were reviewed. Parenchymal and extraparenchymal forms were considered, along with every type of surgical procedure (shunt, endoscopic third ventriculostomy and craniotomy). The literature was reviewed through PubMed, using the terms “neurocysticercosis”, “surgery”, “shunt” and “hydrocephalus”. RESULTS: 37 patients underwent neurosurgical procedures during the study period. Most were male (62.16%) and extraparenchymal cases predominated (81%). Patients aged 41 to 50 years were most affected (35.13%) and those 20 years or under were unaffected. Ventricular forms were most frequently associated with hydrocephalus and required permanent shunts in most cases (56.57%). CONCLUSIONS: The treatment of neurocysticercosis depends on the impairment: the parenchymal type usually does not require surgery, which is more common in the extraparenchymal form. Hydrocephalus is a frequent complication because the cysts often obstruct the cerebrospinal flow. The cysts should be removed whenever possible, to avoid the need for permanent shunts.

Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction. RESUMO Objetivo: avaliar o tratamento endovascular de lesões vasculares da artéria carótida interna (ACI), segmento cavernoso, realizado na Santa Casa de São Paulo. Métodos: estudo descritivo, retrospectivo e prospectivo, de pacientes com aneurisma da porção cavernosa da ACI ou com fístulas carótido-cavernosas diretas (FCCd) submetidos a tratamento endovascular. Resultados: foram incluídos 26 pacientes com aneurismas intracavernosos e dez com FCCd. Todos os aneurismas foram tratados com oclusão da ACI. Os com FCCd foram tratados com oclusão, em sete casos, e com oclusão seletiva da fístula nos outros três. Houve melhora da dor e proptose ocular em todos os pacientes com FCCd. Nos pacientes com aneurisma intracavernoso, a incidência de dor retro-orbitária caiu de 84,6% para 30,8% após o tratamento. Após o tratamento endovascular houve uma melhora importante da disfunção de nervos cranianos afetados em ambos os grupos, sobretudo no nervo oculomotor. Conclusão: o tratamento endovascular trouxe melhora para os pacientes deste estudo, especialmente nos critérios dor e acometimento do nervo oculomotor.

A different and rare type of atrophy with a predominant pattern in scapulo-peroneal distribution was described by Davidenkow in 1939. The syndrome was characterized by some researchers as a variant of Charcot-Marie-Tooth disease, however Davidenkow noticed that clinical and laboratorial manifestations did not corroborate exactly with this hypothesis. We describe a case of a female patient, 39 years-old, clinical picture similar to the syndrome described by Davidenkow, presenting scapulo-peroneal atrophy. Her first symptoms had appeared when she was 24, initially with proximal motor weakness in the upper limbs. This patient did not have family history of myopathy or neuropathy. Several tests were performed to exclude other syndromes that could be included in the differential diagnosis, by testing gene mutation, in addition to the physical examination and electromyography. The large spectrum of neuromuscular diseases makes difficult the diagnosis of Davidenkow's syndrome which always should be considered in the differential diagnosis.

PURPOSE: To study histopathological findings due to a model of closed head injury by weight loss in rats. METHODS: A platform was used to induce closed cranial lesion controlled by weight loss with a known and predefined energy. 25 male Wistar rats (Rattus novergicus albinus) were divided in five equal groups which received different cranial impact energy levels: G1, G2, G3 and G4 with 0.234J, 0.5J, 0.762J and 1J respectively and G5 (Sham). Under the effect of analgesia, the brain of each group was collected and prepared for histopathological analysis by conventional optic microscopy. RESULTS: It was observed greater number of injured neurons in animals of group 4, however neuronal death also could be noticed in animals of group 5. Intraparenchymal hemorrhages were more frequent in animals of group 4 and the cytotoxic brain swelling and vascular congestion were more intense in this group CONCLUSION: The histopathological analysis of these findings allowed to observe typical cranial trauma alterations and these keep close relation with impact energy. OBJETIVO: Investigar as alterações histopatológicas produzidas por um modelo de trauma craniano fechado por queda de peso em ratos. MÉTODOS: Utilizando uma plataforma para produção de lesão craniana fechada controlada por queda de peso com energia pré-definida e conhecida, 25 ratos Wistar machos (Rattus norvegicus albinus) foram divididos em cinco grupos iguais que receberam níveis diferentes de energia de impacto craniano: G1, G2, G3 e G4 com 0,234J, 0,5J, 0,762J e 1J respectivamente e G5 (Sham). Sob analgesia, cada grupo teve seus encéfalos coletados e processados para análise histopatológica por microscopia óptica convencional. RESULTADOS: Houve maior número de neurônios lesados em animais do grupo 4, mas morte neuronal também pôde ser constatada nos animais do grupo 5. Hemorragias parenquimatosas foram mais frequentes nos animais do grupo 4 e o inchaço cerebral citotóxico e congestão vascular foram mais intensos neste grupo. CONCLUSÃO: Os achados à análise histopatológica permitem observar alterações típicas do trauma craniano e estas guardaram proporção direta com a energia do impacto.

Summary Eagle syndrome is a rare condition presenting with retroauricular pain (usually as main symptom) associated with dysphagia, headache, neck pain on rotation and, much rarelier, stroke. This occurs due to styloid process elongation. Sometimes, there is also styloid ligament calcification, which can cause compression of nerves and arteries and the symptoms above. Treatment can be conservative with pain modulators (e.g. pregabalin) or infiltrations (steroids or anesthetics drugs). In refractory cases, surgical approach aiming to reduce the size of the styloid process can be performed. We present a rare case of Eagle syndrome (documented by computed tomography) with good response to clinical treatment.

SUMMARY Introduction: the treatment of human immunodeficiency virus (HIV) infection has been decreasing patient morbidity and mortality by opportunistic infections and, thus, survival has increased. This new reality has been changing the spectrum of diseases affecting such patients. Objective: to discuss the association between HIV and the emergence of aneurysmal brain injuries. Method: it was performed a literature review using medical database. The following descriptors were searched: "Intracranial Aneurysms and HIV", "Intracranial Aneurysms and Acquired Immunodeficiency Syndrome," "aneurysm and brain and HIV". Results: after performed a literature review, it was observed that the relationship between HIV infection and the formation of aneurysms appears to be real, however, it still lacks data to confirm the pathophysiology of this condition and its best treatment. Conclusion: there are new signs and symptoms that should be studied and researched relating HIV with other changes not previously known.