RESUMO
OBJECTIVE: Trigeminal neuralgia (TN) is a neuropathic disorder that can be treated surgically. This study aimed to present the surgical findings and the clinical outcomes of 26 patients with TN treated by minimally invasive asterional surgery. METHODS: Longitudinal descriptive study. Twenty-six patients with TN underwent minimally invasive asterional surgery. The medical history, surgical findings, therapeutic response, and complications were registered. They were followed for 36 months. RESULTS: Nineteen cases were associated with vascular compression; five were associated with arachnoiditis. The two remaining cases were associated with multiple sclerosis and post-herpetic neuralgia. The pain was substantially reduced in all patients in the immediate postoperative period. At 36 months, in 25 patients, total or acceptable pain control was achieved. In the long term, 22 patients evolved with no permanent complications. CONCLUSION: The microvascular decompression surgery by an asterional approach is an alternative with similar results to the classic retrosigmoid approach to treat TN, but that adds the benefits of the principles of minimally invasive surgery. Constant efforts need to be made to optimize minimally invasive surgical techniques for TN.
Assuntos
Cirurgia de Descompressão Microvascular/métodos , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aracnoidite/complicações , Craniotomia/métodos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Ilustração Médica , Cirurgia de Descompressão Microvascular/efeitos adversos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias , Resultado do Tratamento , Neuralgia do Trigêmeo/etiologiaRESUMO
Los quistes aracnoideos son lesiones malformativas que contienen en su interior un líquido de características similares al líquido cefalorraquídeo. Constituyen alrededor del 1% de todos los procesos ocupantes de espacio a nivel intracraneal y, en menor número de casos pueden localizarse a nivel espinal. Presentamos una asociación de aracnoiditis espinal y posterior cavitación.
Arachnoid cysts are malformative lesions that contain a liquid with characteristics similar to cerebrospinal fluid. They constitute about 1% of all space-occupying processes at the intracranial level and, in a smaller number of cases, they can be located at the spinal level. We present an association of spinal arachnoiditis and posterior cavitation
Assuntos
Humanos , Masculino , Adulto , Aracnoidite/patologia , Punção Espinal , Cistos Aracnóideos/cirurgia , Antibacterianos/uso terapêuticoRESUMO
INTRODUCTION: The term 'painful tic convulsive' is used to describe the syndrome involving concomitant hemifacial spasm and ipsilateral trigeminal neuralgia. Vascular compression of the fifth and seventh cranial nerves is the most common cause, involving the entry and exit zone of rootlets coming from the brainstem; nevertheless, different etiologies of this syndrome has been previously reported. Treatment for this disease is based on surgical microvascular decompression of the nerve rootlets, but still a topic of debate. CASE REPORT: A 63-year-old woman with history of 14 years presenting left trigeminal neuralgia, associated with ipsilateral hemifacial spasm for more than ten years. Medical treatment was installed without adequate symptom control. Patient was subjected to surgical treatment via a microasterional approach, with dissection of arachnoid fibrous tissue surrounding fifth and seventh nerves during the first surgery. A second surgery was performed with insertion of a teflon fragment aside of each exit nerve root (V and VII-VIII complex). Symptoms resolved immediately after the surgery and has persisted during the 1-year follow-up. Painful tic convulsive etiology could be multifactorial. CONCLUSION: This report is the first clinical case describing basal arachnoiditis as a primary cause of painful tic convulsive.
TITLE: Presentacion inusual de un tic convulsivo doloroso.Introduccion. La presentacion clinica de un espasmo hemifacial asociado a neuralgia trigeminal ipsilateral se conoce como tic convulsivo doloroso. La causa mas comun de esta patologia es la compresion vascular de los nervios craneales V y complejo VII-VIII en la zona de entrada y salida de las raices en el tronco del encefalo, pero existen informes de diversas etiologias. Su tratamiento, aunque aun esta en discusion, se basa en la descompresion microvascular quirurgica. Caso clinico. Mujer de 63 años, con un cuadro de evolucion de 14 años de neuralgia trigeminal, con predominio en distribucion de la rama maxilar (V2) izquierda, asociado durante mas de 10 años a espasmo hemifacial ipsilateral. Tras fallar el tratamiento medico, se sometio a cirugia por abordaje microasterional, y en un primer momento se realizo una diseccion de adherencias aracnoideas firmes rodeando complejos nerviosos. En un segundo tiempo quirurgico se insertaron fragmentos de teflon en los sitios de entrada de los nervios V y complejo VII-VIII, y se logro una resolucion completa de la sintomatologia durante mas de un año. Conclusion. La etiologia del tic convulsivo doloroso en esta paciente fue aracnoiditis basal, lo cual la convierte en el unico caso comunicado hasta el momento con dicha etiologia.
Assuntos
Aracnoidite/complicações , Espasmo Hemifacial/etiologia , Neuralgia do Trigêmeo/etiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
La aracnoiditis se refiere al compromiso inflamatorio de uno, varios o todos los segmentos de la capa media de las meninges, es decir la aracnoides. Se encuentra asociada con meningitis, neoplasias, hemorragia subaracnoidea, enfermedades infecciosas como tuberculosis, procedimientos invasivos por el uso de medios de contraste tecales, colocación de analgésicos y anestésicos a nivel del raquis, quimioterápicos intratecales, procesos autoinmunes, afecciones ginecológicas e incluso procesos no invasivos. Como en la actualidad esta entidad no se considera entre los primeros diagnósticos en pacientes con clínica de dolor tipo ardor en región lumbar irradiado a miembros inferiores, incontinencia urinaria y disestesias en artejos, queremos resaltar la importancia de tener en cuenta esta patología como diagnóstico diferencial...
Arachnoiditis is a broad term denoting inflammation of one, several or all segments of the middle layer of the meninges known as the arachnoid mater. It is related to meningitis, neoplasia, subarachnoid hemorrhage, infectious diseases such as tuberculosis, invasive procedures using intrathecal injection of contrast media, epidural injection of analgesics and anesthetic agents, intrathecal chemotherapy, autoimmune processes, gynecological disorders and even non invasive procedures. As this disorder is nowadays not considered within the main diagnostic possibilities in patients who manifest burning back pain irradiated to the lower limbs, bladder dysfunction and dysethesia of the toes, we wish to highlight the importance of also considering arachnoiditis as a differential diagnosis...
Assuntos
Analgésicos , Aracnoidite , Anestésicos , Espectroscopia de Ressonância MagnéticaRESUMO
BACKGROUND: Management of communicating hydrocephalus associated with infectious meningitis and arachnoiditis of the basal cisterns can be challenging if no microorganism or pathological diagnosis is established. The purpose of our series is to elucidate the efficacy of endoscopic basal cistern exploration, biopsy, and endoscopic third ventriculostomy (ETV) in patients with basal cistern meningitis and hydrocephalus. METHODS: Between 2005 and 2010, all patients who underwent transventricular endoscopic exploration biopsy and biopsy of the basal cisterns were analyzed and prospectively followed up. Particular attention was given to neuroendoscopic findings, sensitivity of biopsy, and the role of ETV. RESULTS: Twenty-four patients, ranging in age from 2 to 63 years, underwent transventricular endoscopic biopsy and exploration of the basal cisterns. All patients had negative cerebrospinal fluid analysis obtained by lumbar puncture. Successful ETV, exploration, dissection, and biopsy of the basal cisterns were performed successfully in all patients with a flexible neuroendoscope. Neuroendoscopic findings included: unusually thick Liliequist membrane, moderate to severe adhesive arachnoiditis, inflammatory and cotton-like exudates, granulations, and narrow subarachnoid space. Definitive histopathological diagnosis from the basal cisterns specimen was obtained in 79% of patients. There were no complications related to the procedure. At 15 months of follow-up, 70% of the patients with hydrocephalus did not require a ventriculoperitoneal shunt. CONCLUSIONS: Endoscopic transventricular basal cisterns exploration is feasible with a flexible neuroendoscope. It is a viable alternative in the management of patients with basal cistern meningitis and arachnoiditis without histopathological diagnosis. It yields to an accurate diagnosis in 79% of the patients. ETV is a good alternative in the management of intracisternal extraventricular obstructive hydrocephalus.
Assuntos
Ventrículos Cerebrais/cirurgia , Hidrocefalia/patologia , Hidrocefalia/cirurgia , Meningite/patologia , Meningite/cirurgia , Neuroendoscopia/métodos , Adolescente , Adulto , Idoso , Anestesia Geral , Aracnoide-Máter/patologia , Aracnoidite/cirurgia , Biópsia , Córtex Cerebral/patologia , Córtex Cerebral/cirurgia , Líquido Cefalorraquidiano/química , Líquido Cefalorraquidiano/citologia , Criança , Pré-Escolar , Estudos de Coortes , Dura-Máter/patologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite/complicações , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Subarachnoid S(+)-ketamine is a matter of much debate as the results regarding its toxicity are contradictory. OBJECTIVES: Our objective was to investigate possible histopathological alterations after subarachnoid administration of different doses of preservative-free S(+)-ketamine to dogs. STUDY DESIGN: A randomized, blind, prospective experimental study. SETTING: Center for Research on Pain at the Federal University of Maranhão, Brazil. METHODS: Sixteen adult mongrel dogs of both sexes, each weighing 11 to 20 kg were divided into 3 groups: Group I (n=6), 0.7 mg/kg-1 S(+)-ketamine; Group II (n=6), 0.5 mg/kg-1 S(+)-ketamine, and a control group, Group III, (n=4), 0.9% NaCl. All substances were administered in one mL volume doses. The animals were kept in captivity for 2 weeks; after this period, they were put down and lumbar and sacral portions of the spinal cords were removed for histological examination using conventional light microscopy. RESULTS: There were histological alterations in the spinal cords of the test subjects in the control group. Comparison showed significant histological abnormalities in Groups I and II when compared to the control group, including gliosis, axonal edema, central chromatolysis, lymphocyte infiltration and fibrous thickening of the dura mater. LIMITATIONS: Test subjects received only a single dose each. The observation period was not very long, less than a month. CONCLUSIONS: Subarachnoid administration of S(+)-ketamine without preservative caused histological lesions on the spinal cord and meninges in the dogs studied. S(+)-ketamine should not be given to clinical patients in this way until further evaluation of the significance of this toxicity has been conducted.
Assuntos
Analgésicos/toxicidade , Ketamina/toxicidade , Degeneração Neural/induzido quimicamente , Conservantes Farmacêuticos , Medula Espinal/efeitos dos fármacos , Espaço Subaracnóideo/efeitos dos fármacos , Animais , Aracnoidite/induzido quimicamente , Aracnoidite/patologia , Cães , Dura-Máter/efeitos dos fármacos , Dura-Máter/patologia , Feminino , Fibrose , Injeções Espinhais/efeitos adversos , Injeções Espinhais/métodos , Masculino , Modelos Animais , Degeneração Neural/patologia , Conservantes Farmacêuticos/efeitos adversos , Medula Espinal/patologia , Vasculite/induzido quimicamente , Vasculite/patologiaRESUMO
Various conditions of the spinal column occur at the lumbar level and new therapeutic surgical techniques have been applied to reduce the length of hospital stay, contribute to a quick return of patients to their activities of daily living, and reduce the postoperative limitations. However, a silent complication, adhesive arachnoiditis, has been reported with a frequency of 6-16% in cases undergoing lumbar surgery or with a history of revision surgery, and thus a second complication may occur, paraplegia, since the common symptom of arachnoiditis is persistent low back pain. The case of a 40-year-old patient is presented herein, who underwent lumbar spine surgery for herniated discs, and developed adhesive arachnoiditis involving the cauda equina, which was diagnosed with MRI. He had irreversible paraplegia with diffuse involvement of the cauda equina despite the mechanical lavage and surgical debridement performed due to the persistence of serous fluid discharge from the wound. The interbody implant placed during the first surgery was removed and the treatment was completed with posterior stabilization reinstrumentation; the patient had persistent neurologic impairment. There are few reports in the world literature of paraplegia due to non-infectious adhesive arachnoiditis. The remaining reports of paraplegia have been in patients with spinal infection, such as HIV-TB, mycosis, brucellosis or meningeal hemorrhage. It is not easy for patients to understand the very likely irreversible neurologic lesion of his complication. However, it is important for the spine surgeon to bear in mind the occurrence and frequency of adhesive arachnoiditis which could lead to irreversible neurologic deficit in patients undergoing lumbar spine surgery.
Assuntos
Aracnoidite/complicações , Deslocamento do Disco Intervertebral/cirurgia , Paraplegia/etiologia , Complicações Pós-Operatórias , Adulto , Humanos , MasculinoRESUMO
A tese de medicina defendida em 1822, em Paris, por Antoine-Laurent Bayle, intitulada Pesquisas sobre as doenças mentais, constitui um momento de virada na história das concepções biológicas em psicopatologia. Apoiado sobre um método anátomo-clínico rigoroso. Bayle apresenta seis observações clínicas de pacientes com uma história crônica e progressiva de comportamento exaltado, idéias de grandeza, de poder e de ambição que se transformam no final de algum tempo em delírios maníacos com agitação psicomotora. Simultaneamente, vai-se instalando um quadro de paralisia progressiva de vários grupos musculares, chegando até a incapacidade física extrema. Na fase terminal, os pacientes apresentam uma condição tipicamente demencial e de profundo comprometimento corporal, que os conduz à morte. Ao exame cadavérico, Bayle constatou a presença sistemática de uma inflamação crônica das meninges cerebrais (aracnoidite crônica) à qual ele atribui o fundamento biológico dos sintomas observados. Dessa forma. Bayle realiza uma descrição clínica rigorosa de uma entidade psicopatológica típica, de evolução crônica e progressiva e demonstra sua relação com uma lesão cerebral específica e objetivamente demonstrável. Tal descoberta, inicialmente recebida com muitas reservas, constituiria posteriormente uma espécie de paradigma para a pesquisa e para o projeto teórico e terapêutico para a psiquiatria biológica que começava a se organizar na França ao longo do século XIX.
Antoine Laurent Bayles medical thesis, entitled Studies on mental diseases and defended in Paris in 1822, represented an important advance in the history of biological conceptions in psychopathology. Based on a rigorous anatomic and clinical method, Bayle presented clinical observations on six patients with chronic and progressive histories of exalted behavior and ideas of grandeur: power and ambition, a condition that eventually evolved to maniac delusion with psychomotor agitation. Simultaneously, a situation of progressive paralysis of several muscle groups set in, leading to extreme physical incapacity. In the final stage the patients showed a typically demential condition with serious physical impairment which led to death. Post-mortem examinations showed the presence, is all cases, of chronic inflammation of the cerebral meninges (chronic arachnoidits), which Bayle held to be the biological basis of the symptoms noted. Bayle thus provided a rigorous clinical description of typical psychopathological entity with chronic and progressive evolution, and showed its relationship to specific and objectively demonstrable cerebral damage. This discovery, first received with considerable reservation, later served as a type of paradigm for research and for the theoretical and therapeutic project for biological psychiatry that began in France during the 19th century.
La tesis de medicina defendida en 1822 en Paris, por Antoine-Laurent Bayle, titulada Investigación sobre las enfermedades mentales, constituye un momento de viraje en la historia de las concepciones biológicas en psicopatología. Apoyado sobre un método anatómico-clínico riguroso. Bayle presenta seis observaciones clínicas de pacientes con una historia crónica y progresiva de comportamiento exaltado, ideas de grandeza, de poder y de ambición que se transformaron al final de algún tempo en delirios maníacos con agitación psicomotora. Simultáneamente, se va instalando un cuadro de parálisis progresiva de varios grupos musculares, llegando hasta la incapacidad física extrema. En la fase terminal, los pacientes presentan una condición típicamente demencial e de profundo comprometimiento corporal, que los conduce a muerte. Al examen cadavérico, Bayle constato la presencia sistemática de una inflamación crónica de las meninges cerebrales (aracnoidits crónica) a la cual él atribuyó el fundamento biológico de los síntomas observados. De esta forma, Bayle realiza una descripción clínica rigurosa de una entidad psicopatológica típica, de evolución crónica y progresiva y demuestra su relación con una lesión cerebral específica y objetivamente demostrable. Tal descubierta, inicialmente recibida con muchas reservas, constituiría posteriormente una especie de paradigma para la investigación y para el proyecto teórico e terapéutico para la psiquiatría biológica que comenzaba a organizarse en Francia a lo largo del siglo XIX.
La thèse de médecine soutenue en 1822 à Paris par Antoine-Laurent Bayle, intitulée "Recherches sur les maladies mentales" constitue un tournant dans l'histoire des conceptions biologiques en psychopathologie. Fondé sur une méthode anatomoclinique rigoureuse, Bayle y présente six observations cliniques de patients ayant une histoire chronique et progressive de comportement exalté, idées de grandeur, de puissance et d'ambition qui se transforment au bout d'un certain temps en délires maniaques accompagnés d'agitation psychomotrice. Simultanément, un tableau de paralysie progressive de plusieurs groupes musculaires se met en place, allant jusqu'à l'incapacité physique extrême. Dans la phase terminale, les patients présentent une condition typiquement démentielle et de profond affaiblissement corporel, finissant par en mourir. À l'examen cadavérique, Bayle a constaté la présence systématique d'une inflammation chronique des méninges cérébrales (arachnites chronique) à laquelle il attribue le fondement biologique des symptômes observés. Bayle nous fournit ainsi une description clinique rigoureuse d'une entité psychopathologique typique à l'évolution chronique et progressive et démontre son rapport à une lésion cérébrale spécifique et objectivement démonstrable. Telle découverte, reçue avec beaucoup de réserves au départ, constituera ensuite une sorte de paradigme pour la recherche et pour le projet théorique et thérapeutique de la psychiatrie biologique qui commençait à s'organiser en France au cours du XIX siècle.