Search

Deep brain stimulation (DBS) is recognized as an established therapy for Parkinson's disease (PD) and other movement disorders in the light of the developments seen over the past three decades. Long-term efficacy is established for PD with documented improvement in the cardinal motor symptoms of PD and levodopa-induced complications, such as motor fluctuations and dyskinesias. Timing of patient selection is crucial to obtain optimal benefits from DBS therapy, before PD complications become irreversible. The objective of this first part review is to examine the fundamental concepts of DBS for PD in clinical practice, discussing the historical aspects, patient selection, potential effects of DBS on motor and non-motor symptoms, and the practical management of patients after surgery.

The field of neuromodulation has evolved significantly over the past decade. Developments include novel indications and innovations of hardware, software, and stimulation techniques leading to an expansion in scope and role of these techniques as powerful therapeutic interventions. In this review, which is the second part of an effort to document and integrate the basic fundamentals and recent successful developments in the field, we will focus on classic paradigms for electrode placement as well as new exploratory targets, mechanisms of neuromodulation using this technique and new developments, including focused ultrasound driven ablative procedures.

Leptomeningeal 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.

Objective To describe the microsurgical anatomy and the physiology of the endolymphatic sac (ES) that a neurosurgeon should know.

Objetivo: Construir uma tecnologia assistencial com diagnósticos e prescrições de enfermagem específico para pacientes em pós-operatório de neurocirurgia admitidos no CTI de um Hospital de Referência em Oncologia em Belém, Pará, Brasil. Método: Pesquisa metodológica, com abordagem quantitativa e de produção tecnológica assistencial, desenvolvido em um hospital público, no período de março a julho de 2021. Foram analisados 90 prontuários de pacientes neurocirúrgicos no ano de 2019. Resultados: A maioria apresentou parâmetros normais, estavam conscientes e faziam uso de algum tipo de dispositivo invasivo. Os principais diagnósticos observados foram os tumores encefálicos e o procedimento mais frequente foi a microcirurgia para tumor intracraniano. Entre as complicações foi observado a hipotensão, a hipertensão e a cefaleia. A construção do instrumento contou com 21 Diagnósticos de enfermagem e intervenções. Conclusão: A compreensão desses achados é essencial para que novos mecanismos de cuidado sejam desenvolvidos, principalmente, por parte da equipe de enfermagem, uma vez que esses profissionais assistem, de forma integral e constante, os pacientes neurocríticos e são os profissionais de primeira linha que atuam nas intercorrências.

Primary 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.

The present review attempts to discuss how some of the central concepts from the Lurian corpus of theories are relevant to the modern neuropsychology of epilepsy and epilepsy surgery. Through the lenses of the main Lurian concepts (such as the qualitative syndrome analysis), we discuss the barriers to clinical reasoning imposed by quadrant-based views of the brain, or even atheoretical, statistically-based and data-driven approaches. We further advice towards a systemic view inspired by Luria's clinical work and theorizing, given their importance towards our clinical practice, by contrasting it to the modular views when appropriate. Luria provided theory-guided methods of assessment and rehabilitation of higher cortical functions. Although his work did not specifically address epilepsy, his theory and clinical approaches actually apply to the whole neuropathology spectrum and accounting for the whole panorama of neurocognition. This holistic and systemic approach to the brain is consistent with the network approach of the neuroimaging era. As to epilepsy, the logic of cognitive functions organized into complex functional systems, contrary to modular views of the brain, heralds current knowledge of epilepsy as a network disease, as well as the concept of the functional deficit zone.

With 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.

The present study aims to review the influence of glycemia and natremia on the propensity to develop complications, worse prognosis, and mortality risk in patients with aneurysmal subarachnoid hemorrhage (aSAH). This is an integrative literature review guided by the guiding question: “Do changes in blood glucose levels or plasma sodium concentration influence in-hospital morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage?”. The search for articles was performed on the PubMed platform, limiting the selection to works published in English in the period from 2017 to 2022. The results found demonstrate that the role of sodium ions in changes in the prognosis of patients is complex, with hypernatremia being the main factor described to worse outcomes. In contrast, the part of hyponatremia is controversial and may not have prognostic value, and serum sodium concentration is increasingly an important item to be evaluated in patients with aSAH. As for glucose, the variability of this substrate, both hyperglycemia and hypoglycemia, may be correlated with in-hospital and long-term mortality in patients with aSAH. Thus, the present study concludes that changes in blood glucose values and plasma sodium concentration influence the in-hospital morbidity and mortality of patients with aSAH. However, it is emphasized that the analysis of the independent influence of each of the related predictors must be done with caution due to the heterogeneity of the results found.

O canal do nervo hipoglosso é uma estrutura óssea presente acima do côndilo occipital e dá passagem a importantes estruturas, tais como o nervo hipoglosso, o ramo meníngeo da artéria faríngea ascendente e a veia emissária do plexo basilar. Essa estrutura pode sofrer variações sendo um campo de estudo de particular interesse dos pesquisadores, especialmente devido às suas implicações clínicas, radiológicas e cirúrgicas. O presente estudo visou relatar uma variação anatômica rara do canal do nervo hipoglosso e descrever os aspectos morfológicos, morfométricos e sua relação topográfica com o côndilo occipital, além de discorrer sobre as principais implicações clínicas e cirúrgicas dessa estrutura.

Objective Much has been discussed about gender diversity in all professional fields, particularly in medicine. Recent studies showing that there are fewer than ten female professionals in interventional neuroradiology (INR) in a continental country like Brazil, and less than thirty in all of Latin America, have prompted an investigation into the causes of the low numbers of women choosing to follow this medical specialty. This project intended to reveal the reasons through an anonymous form applied to women in the final year of the three medical residencies considered prerequisites for INR in Brazil: neurology, radiology and neurosurgery.

Introduction Leptomeningeal carcinomatosis results from metastatic neoplastic cells that reach the leptomeninges through the cerebrospinal fluid. The presentation of the disease is variable, making prognosis challenging. However, the presence of intracranial hypertension is common, which has prompted new treatments to mitigate this effect.

Introdução/Objetivo: A vigilância epidemiológica das Infecções representa uma das principais atividades exercidas pelo Serviço de Controle de Infecção (SCIH), e um dos aspectos desta atividade é a definição e elaboração de indicadores de resultado. Quando apresentados de forma global, nem sempre é possível compreender as especificidades, bem como planejar medidas de prevenção e controle. O objetivo deste estudo foi avaliar o impacto da reestruturação do sistema de vigilância das Infecções do Sítio Cirúrgico (ISC), estratificando os indicadores de resultado por especialidade cirúrgica e por cirurgião. Métodos: Estudo descritivo, retrospectivo, com avaliação dos dados de ISC obtidos do banco eletrônico do SCIH do Hospital. Até setembro de 2022, os indicadores de resultado consistiam em: taxa de ISC global, taxa de ISC em cirurgias limpas e proporção de ISC por especialidades. Em outubro de 2022, foi reestruturada a vigilância, com cálculo de taxas de ISC em cirurgias limpas por especialidade e por cirurgião, ambos realizados retroativamente desde janeiro de 2022, e consequente programação de intervenção. Para o cálculo das taxas, dividiu-se o número de ISC de determinada especialidade ou cirurgião (numerador) pelo número total de cirurgias daquela especialidade ou cirurgião (denominador), respectivamente; a razão foi multiplicada por 100, sendo expressa sob a forma percentual. Definiu-se iniciar o processo, incluindo intervenção, com a especialidade com maior taxa. Resultados: Foram diagnosticados 70 casos de ISC em 19.258 cirurgias realizadas em 2022, com taxa global de 0,36%, sendo 40 ISC em cirurgias limpas, com taxa de 0,48%. Nas taxas por especialidade, detectou-se taxa de 0,99% na neurocirurgia (NC) e de 0,54% na ortopedia. Optou-se, portanto, por iniciar a avaliação individualizada pela NC. Na taxa estratificada por cirurgião da NC, obteve-se a incidência distribuída por 5 cirurgiões: cirurgião 1 (4,55%), cirurgião 2 (3,39%), cirurgião 3 (9,09%), cirurgião 4 (3,03%) e cirurgião 5 (11,76%). As ações de intervenção foram planejadas e priorizadas para as equipes conforme volume cirúrgico e taxa detectada. Conclusão: O detalhamento do indicador permitiu identificar os potenciais fatores de risco, de acordo com perfil dos procedimentos cirúrgicos (especialidade e equipes), em cada período de vigilância. Este acompanhamento individualizado tem o potencial de otimizar medidas de prevenção e controle, a fim de proporcionar maior segurança ao paciente.

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Com a progressão da complexidade dos casos neurocirúrgicos houve concomitante o avanço técnico no manejo diagnóstico e no tratamento de tais agravos. Por “Cirurgia” entende-se procedimentos invasivos com propósitos precisos que podem ser empregados tanto para a definição diagnóstica quanto para o tratamento paliativo ou definitivo de determinadas afecções orgânicas, visando a adequação/alteração das funções fisiológicas ou da estrutura anatômica propriamente dita. A manobra operatória para estabelecer uma via de acesso ao cérebro é intitulada “Craniotomia”. Na abordagem de pequenos animais as craniotomias utilizadas com maior frequência subdividem-se em: Craniotomia Lateral ou Rostrotentorial, Craniotomia Transfrontal e Craniotomia Suboccipital, utilizadas para o tratamento de elucidações de casos clínicos neurológicos visando a melhoria da qualidade de vida, neurovegetativa dos animais acometidos por tais patologias. O presente trabalho tem como objetivo explanar as principais Cirurgias Cerebrais em cães e gatos dentro da Medicina Veterinária.

Neuropsychology applied in a hospital context, an emerging expertise of Psychology has been extremely relevant in recent studies, since the possibilities of action permeate from early stages of surgical procedures, from functional cognitive assessments, to later stages, reaching the neuropsychological rehabilitation process. Despite this, there is a lack of more detailed data on the particularities of this work with the interprofessional staff. In this sense, this study aimed to describe the perception of neuropsychologists and healthcare professionals who work in hospital teams about hospital neuropsychology. This is an exploratory study with a qualitative approach, according to the analysis criteria of semiotic phenomenology. Twenty-one professionals from hospitals in the southeast region of Brazil participated (nine neuropsychologists and twelve professionals from different specialties in the healthcare area), who responded to a semi - structured interview via video conference. The results revealed nine different themes: "Hospital scenario entrance", "Ignorance of the area versus Appreciation", "Attributions of the neuropsychology in the hospital", "Financial obstacles", "Training processes", "Divergence of functions", "Relevance versus Costs", "Interaction between professionals from different specialties" and "Knowledge about the neuropsychologist's attributions". The discussion of the results points out the lack of knowledge from healthcare professionals, of the possibilities of the contribution of hospital neuropsychology as a limiting factor for the insertion of professionals in this field, as well as fragility in interprofessionality, evidenced by the deficient communication between team members. It is concluded that these findings expose the need to rethink training processes in the field of healthcare and psychology, in addition to indicate the need for further studies to explore neuropsychology fields that go beyond the traditional clinical context. [ABSTRACT FROM AUTHOR]

Spinal trauma is any injury of external cause in the spine, which results in spinal cord injury (SCI), leading to motor, sensory, autonomic and psycho-affective changes, which may be transient or irreversible. The objective study was to describe the sociodemographic and clinical aspects associated with the length of stay of patients suffering from spinal trauma undergoing surgery at a University Hospital. Analytical, observational, descriptive, retrospective study with a quantitative approach, including patients admitted to a University Hospital, between January and December 2017, with only the data referring to the first hospitalization being collected, medical records with missing or incomplete information were excluded. With a sample of 18 medical records. Male predominance mean, age 32.72 years, brown, resident in the interior of the state, single. The main cause was a motorcycle accident, the most affected cervical region, diagnosed with dislocation, as a surgical procedure they underwent arthrodesis, and presented paraplegia in the postoperative period. The median hospital stays of 9.5 days, waiting time for surgery obtained a median of 4 days. It was observed that patients with infection (p = 0.007) and the waiting time for surgery (p <0.001), correlated with a longer hospital stay. The length of hospital stay is linked to the appearance of complications. The most associated type of infection was urinary tract infection. It is concluded that the variables infection and waiting time for surgery showed a statistically significant association with the length of hospital stay of patients with spinal cord injury undergoing surgery. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of frameless and frame-based techniques for biopsies of intracranial lesions in an exclusive assistance service at a public health center in Brazil (SUS).

Calcified chronic subdural hematomas (CCSDHs) are rare entities, whose yearly incidence ranges from 1.72 to 20.6 per every 100 thousand persons. Several different approaches to their management are reported in the literature, ranging from conservative treatment to craniotomy with full removal of the neomembranes. Currently, there are no guidelines or consensus that establish the best technique. We herein report a case of symptomatic CCSDH initially drained through a burr-hole craniotomy, with no resolution of the symptoms. Later, our patient underwent a craniotomy and partial membranectomy, which resulted in full symptomatic recovery.

Background: Trigeminal neuralgia (TN) is a painful disease of the trigeminal nerve, triggered by chewing or manipulating the gums. It is urgent for the dentist to be aware of this pathology of non-odontogenic pain, avoiding root canals and extractions for proper interconsultation with neurology and neurosurgery. Purpose: To identify the most common etiology of TN in patients treated at EsSalud Cusco from January 2019 to August 2022. Method: Observational type, descriptive and retrospective design; the calculated sample of 127 medical records was obtained according to inclusive criteria; the instrument validated by specialists, computerized data from medical records; the variables, measured in data collection sheets by a single evaluator in an Excel sheet. For the most common etiology variable, the scores were according to predisposing factors and etiological factors; while for the NT variable, according to the types of NT and pain scales, both measured by international standards. Finally, the type of analysis was descriptive statistics, the score relationship thanks to Pearson's partial correlation coefficient, and interpreted according to Cohen's Kappa values. Results: Most common etiology variable: Predisposing factor, sex at 79.5 % and as an etiological factor, unknown etiology at 55.1 %. Variable NT: idiopathic type at 34.6 %; according to the EVA scale, of intense pain at 59.1 %. Conclusion: According to chi-square 879, the average relationship of the most common etiology of NT has sex as a predisposing factor, being female the most affected at 79.5 %; and unknown etiology as an etiological factor in 55.1 %. [ABSTRACT FROM AUTHOR]

Introdução: Os tumores hipofisários secretores de prolactina compreendem cerca de 50% de todos os adenomas hipofisários, dentre os quais apenas 10% são macroadenomas. Relato do caso: Paciente do sexo feminino, 63 anos, refere diminuição da acuidade visual há aproximadamente 06 meses e cefaleia esporadicamente. Foi avaliada pela endocrinologia devido à hiperprolactinemia, sendo submetida a exame de imagem que detectou a presença formação expansiva ocupando tecido hipofisario sugestivo de adenoma hipofisario. Foi então tratada com uso de cabergolina oral, sem controle da hiperprolactinemia. A ressonância magnética de controle há seis meses revelou aumento nas dimensões do adenoma, sendo a paciente submetida a tratamento cirúrgico de ressecção de tumor hipofisário, por via transnasal-transfenoidal. Comentários: Os macroprolactinomas são tumores secretores de prolactina, cujo tratamento de primeira escolha é clínico, com agonistas dopaminérgicos. O tratamento de ressecção cirúrgica é raro e indicado para os casos que não respondem ao tratamento clínico.

RESUMO O objetivo deste relato foi descrever o caso de um paciente submetido à craniotomia, acordado, para a ressecção neurocirúrgica de um glioma e a avaliação linguística pré-operatória, intraoperatória e pós-operatória. Paciente do gênero masculino, 27 anos, escolaridade nível superior incompleto, apresentando vômitos, confusão mental e crise convulsiva tônico-clônica. Após a avaliação do paciente pela equipe e devidas orientações pré-operatórias, a proposta de excisão da lesão em estado de vigília foi esclarecida e aceita. Ao iniciar o procedimento, os campos foram ajustados para manter as vias aéreas e os olhos acessíveis para mapeamento com estimulação elétrica e avaliação da linguagem no período intraoperatório. Devido à localização do tumor próximo à área motora da fala, foram propostas tarefas para a avaliação da linguagem em quatro momentos: pré-operatório, intraoperatório, pós-operatório imediato e pós-operatório mediato. As habilidades linguísticas testadas nas quatro avaliações foram: compreensão e expressão da linguagem oral, transposição linguística, linguagem associativa, nomeação, discriminação visual, fluência e organização da sintaxe. Com o objetivo de controlar e eliminar o efeito de aprendizagem da testagem, foram solicitadas as mesmas tarefas, porém, com diferentes conteúdos para a testagem das habilidades nas quatro fases. A cirurgia com o paciente acordado permitiu a ressecção completa e segura do tumor, sem prejuízo motor ou linguístico. O engajamento da equipe, a interação interdisciplinar e o planejamento cirúrgico detalhado constituem um pilar para o bom resultado de um procedimento tão complexo e delicado.

Introduction: Neurosurgical patients are at high risk of local and systemic complications that can increase the length of stay and the risk of death. This study aims to assess the incidence of healthcare-related infections and associated risk factors in patients undergoing neurosurgery. Materials and Methods: prospective cohort study, carried out in a large hospital in the state of Rondônia, in the period from 2018 to 2019, including 36 patients. Results: The incidence of healthcare-related infections was 19.4 per 100 patients (95% CI: 8,19 - 36,02). The use of nasoenteral tube increased the risk of HAI by 6.5 times (95% CI: 1,26 - 33,5), mechanical ventilation increased 5.52 times the risk (95% CI: 1,23 - 24,6), the presence of tracheostomy increased six times (95% CI: 1.34 - 26.8) and invasive examination increased the risk by 6.79 to have infection (95% CI: 1,31 - 35,05). In the adjusted analysis, the variables were not statistically significant. Discussion: The incidence of infections was higher than in regions with better socioeconomic conditions, which may be related to lower adherence to good care practices. Conclusion: in neurosurgeries, in addition to surgical site infections, other topographies should also be considered for investigation of infection. The use of invasive devices has been associated with the occurrence of healthcare-related infections, so good practices in their use are essential when referring and using these devices. [ABSTRACT FROM AUTHOR]

Introdução: As malformações arteriovenosas cerebrais (MAV) são lesões vasculares do sistema vascular cerebral durante o período de embriogênese. Relato de Caso: Trata-se de um paciente do gênero masculino de 19 anos, diagnosticado e tratado da primeira MAV no esplênio do corpo caloso. Após 1 ano e meio, o mesmo paciente foi diagnosticado com uma segunda MAV no joelho do corpo caloso, recebendo o segundo tratamento adequado. Comentários: Embora a angiografia cerebral seja considerada padrão ouro para avaliar a angioarquitetura da MAV, torna-se indispensável o acompanhamento de sua evolução após o tratamento cirúrgico, radiocirúrgico ou por embolização, para um diagnóstico decisivo e expansivo, principalmente, em casos de micromalformações.

Introdução: Os meningiomas são tumores altamente vascularizados cujo tratamento de escolha é a ressecção cirúrgica. Contudo, a embolização pré-operatória do meningioma tem sido estabelecida para facilitar a ressecção cirúrgica, uma vez que pode reduzir a perda sanguínea intraoperatória e o tempo cirúrgico. Relato do caso: Paciente sexo feminino, 45 anos, com história de cefaleia recorrente há seis meses, que não cedeu aos analgésicos e apresentando déficit visual, com perda de campo visual principalmente à esquerda há três meses. Foi submetida à ressonância magnética do encéfalo e a angiorressonância magnética com contraste, na qual foi evidenciada processo expansivo sólido extra-axial vascularizado na fossa craniana anterior, sen- do a principal hipótese, lesão de linhagem meningotelial (entre elas o meningioma). Em seguida, realizada uma embolização pré-operatória da vascularização tumoral e, no dia seguinte, a neurocirurgia de ressecção tumoral. No pós-operatório a paciente cursou sem déficit visual, consciente e orientada. Comentários: A embolização pré-operatória pode nos dar uma vantagem na cirurgia para meningioma. O procedimento reduz a perda sanguínea intraoperatória e o tempo de operação, suavizando a consistência do tumor. No entanto, devemos prestar atenção à possibilidade de complicações embólicas e manter o preparo da craniotomia de emergência, principalmente em pacientes com grandes meningiomas.

Background: Postoperative care after thoracolumbar hemilaminectomy in dogs generally includes rest, physical therapy, and analgesics such as opioids. Currently, there is no established standard for the management of postoperative pain in patients undergoing hemilaminectomy. Ideally, an analgesic protocol should provide adequate pain relief with limited sedation, low adverse effects, and postoperative patient comfort. Therefore, this study aimed to evaluate postoperative analgesia using transdermal fentanyl or intramuscular methadone in dogs undergoing thoracolumbar hemilaminectomy associated with intervertebral disc fenestration (HT) for the treatment of intervertebral disc extrusion (IVDE). Materials, Methods & Results: Eight dogs from the Department of Neurology and Neurosurgery of a Veterinary Teaching Hospital, submitted to HT for the treatment of IVDE, were included. The dogs were randomly distributed into 2 groups of equal numbers, namely the transdermal fentanyl (FT) group and the intramuscular methadone (IM) group. At the end of the surgical procedure, a fentanyl adhesive patch was applied to the animals in the FT group, which remained there for 72 h. In the IM group, analgesia was induced by intramuscular administration of methadone at intervals of 6 h until 72 h after surgery. The animals were evaluated using the short form of the Glasgow Composite Measure Pains Scale (CMPS-SF). Evaluations of physiological parameters, side effects, and pain were performed by 2 assessors who had experience using the pain scale and were blinded to the analgesic protocol. Pain evaluations were performed every 2 h (from T4) until 24 h after the surgical procedure. Evaluations were performed every 4 h from 24 h to 48 h after the surgical procedure and at intervals of 24 h from 48 h to 72 h. Discussion: Transdermal fentanyl provided the lowest pain scores, when evaluated by the CMPS-SF, for both assessors. These data are presented as a function of time and shows the variation in pain scores by CMPS-SF over time. It should be noted that, for both assessors, animals in the FT group had lower pain scores than animals in the IM group. There was also less variation in pain scores in the FT group, indicating better analgesic quality. This can be explained by the maintenance of the drug’s plasma concentrations in a stable manner, avoiding periods of greater or lesser pain throughout the evaluation period due to the absence of increases or decreases in plasma concentration. In the IM group, 3 analgesic rescues were required; in the FT group, there was no rescue. Although the data indicate that IM was responsible for a greater occurrence in the number of rescues, it is worth noting that this information is based on a small group of animals. One dog needed 2 rescues (at T4 and T8), regarding which both assessors agreed, while another required one rescue (at T18), but there was a difference of one point between the raters. However, pain scores in all of the cases were considered to be mild, not moderate or severe, with rescues occurring on scores of 5/20. Both fentanyl used by the transdermal route and intramuscular methadone promoted analgesia in the first three postoperative days in dogs undergoing HT. Better stability in postoperative pain scores without the need for analgesic rescue and less occurrence of adverse effects were observed in dogs treated with FT. [ABSTRACT FROM AUTHOR]

Objetivo: discutir a aplicabilidade atual do Bisturi Inteligente (iKnife) na medicina e avaliar as projeções futuras de seu uso na neurocirurgia. Materiais e Métodos: trata-se de uma revisão integrativa da literatura com buscas nas bases PubMed, LILACS e SciELO no período de agosto e setembro de 2021. Os descritores utilizados foram: “knife”, “cancer” e “neurosurgery”. Utilizou-se o operador booleano “AND”. Foram selecionados 5 de 99 artigos em inglês e português, publicados entre 2014 e 2020, usando como critério de inclusão artigos originais completos disponíveis na íntegra e como critério de exclusão a não pertinência ao tema. Resultados: o iKnife, através da técnica de espectrometria de massa de ionização evaporativa rápida (REIMS), tornou-se uma das ferramentas mais modernas e promissoras da oncologia. É um recurso usado, principalmente, para operações oncológicas do colo de útero e colorretal, a fim de diminuir as margens cirúrgicas na ressecção do tumor, uma vez que, em contato com o tecido, fornece, em tempo real, informações sobre presença ou ausência de malignidade daquelas células. Em concomitância, na neurocirurgia oncológica, têm crescido o uso de tecnologias que, assim como o iKnife, otimizam o tratamento e melhoram o prognóstico, a exemplo da radiocirurgia por Gamma Knife. Isto posto, técnicas menos invasivas e mais efetivas são de muita importância nessa especialidade, visto que neoplasias de maiores dimensões ou metástases cerebrais necessitam, com grande frequência, de manejo cirúrgico. No entanto, estudos que comprovam a efetividade do iKnife na neurocirurgia não foram encontrados, sugerindo-se que pesquisas científicas sejam realizadas, comparando-se os resultados e o verdadeiro benefício de seu uso nessa área. Conclusão: é sabido que o iKnife tem ganhado notoriedade no sucesso terapêutico do câncer cervical, mas sua aplicabilidade na neurologia ainda não é amplamente documentada. Dessa forma, relatos de casos e pesquisas científicas adicionais são necessárias.

O presente trabalho apresenta relato de craniectomia descompressiva em raposa (Cerdocyon thous), macho, jovem, após diagnóstico de trauma cranioencefálico. O paciente foi graduado pela escala de Glasgow modificada como grave (grau 7), e por não ter apresentado melhora durante as primeiras quatro horas de tratamento, optou-se então pelo procedimento cirúrgico de craniectomia descompressiva com o intuito de diminuir a pressão intracraniana para prevenção e controle de danos do sistema nervoso. O paciente apresentou melhoras progressivas, após 60 dias obteve alta. A sequela observada nesse caso foi de déficit visual do olho direito, retornando com a movimentação e resposta ao ambiente. Após alta médica o paciente foi encaminhado a zoológico, mostrou interação com outros indivíduos da mesma espécie e reproduziu com uma fêmea do mesmo recinto.

La patogenia de las mal formaciones vasculares cerebrales aun no está totalmente definida. La mayoría son congénitas y esporádicas. Su tamaño varía ampliamente y algunas experimentan crecimiento, remodelación o regresión con el tiempo. La cirugía de cavernomas solo está indicada cuando existen síntomas y signos de sangrado. La escisión radical tiene como objetivo eliminar el riesgo de sangrado adicional y, finalmente, eliminar el efecto de masa. En cuanto al pronóstico, depende principalmente de la ubicación de la lesión.

La patogenia de las mal formaciones vasculares (MAV) cerebrales aun no está totalmente definida. La mayoría son congénitas y esporádicas. Su tamaño varía ampliamente y algunas experimentan crecimiento, remodelación o regresión con el tiempo. La cirugía de cavernomas solo está indicada cuando existen síntomas y signos de sangrado. La escisión radical tiene como objetivo eliminar el riesgo de sangrado adicional y, finalmente, eliminar el efecto de masa. En cuanto al pronóstico, depende principalmente de la ubicación de la lesión. [ABSTRACT FROM AUTHOR]