Marco Antonio Zanini

Purpose: To retrospectively evaluate magnetic resonance images acquired from rats subjected to a murine model of extraparenchymal neurocysticercosis. Methods: The model consisted of injecting 50 Taenia crassiceps cysticerci into the cisterna magna of Wistar rats. To validate disease induction, magnetic resonance imaging was performed, focusing on the assessment of hydrocephalus and cysts distribution throughout the cerebrospinal fluid compartments. Ventricular dilation was quantified using the frontal horn ratio (FHR), calculated by dividing the maximal width of the frontal horns by the inner-table internal diameter. Results: Intracranial abnormalities were found 63.0% of the animals, predominantly ventricular dilation (> 90%), mainly involving the lateral ventricles. The most affected compartments were the cisterna magna (85.2%) and supratentorial basal cisterns (78.8%). Cysts were identified in the cerebral convexity in 10.6% of cases and in the subcutaneous tissue in 39.2% of infected animals. The mean FHR was 0.62 ± 0.13. Higher FHR values were associated with the presence of cysts in the CSF, but not in the subcutaneous tissue ( p = 0.743). Conclusion: The translational relevance of this extraparenchymal NCC model is underscored by neuroimaging findings that closely resemble the human condition, providing a valuable platform for future mechanistic studies on pathogenesis and treatment development.

Introduction: Ventriculoperitoneal (VP) shunts are widely used to manage hydrocephalus providing significant relief from cerebrospinal fluid (CSF) accumulation. However, abdominal complications, such as aseptic ascites, can occur, albeit rarely. This condition is characterized by the diffuse accumulation of CSF in the peritoneal cavity without evidence of infection, often requiring specific interventions. Case presentation: We present the case of a 3-year-old child with abdominal distension for the past 15 days, without other abnormalities. The child was in the late postoperative period for optic pathway pilocytic astrocytoma, with surgeries performed at 1 year and 7 months of age and VP shunt (VPS) placement at 1 year and 10 months of age. Abdominal ultrasound, computed tomography, and magnetic resonance imaging revealed large-volume ascites without additional findings. Diagnostic paracentesis showed a serum-ascites albumin gradient (SAAG) of 3.1. Biochemical and microbiological analyses showed no signs of infection, and liver, cardiac, and renal function markers were within normal ranges. Cytological analysis revealed no neoplastic cells. A ventriculoatrial shunt was placed, resolving the ascites. Conclusions: Aseptic ascites is a rare dysfunction of VPS, with limited cases reported. Most cases of peritoneal fluid accumulation are associated with shunt infections resulting in peritonitis. In aseptic ascites, however, microbiological analysis of ascitic fluid was negative. Intracranial hypertension symptoms are not usual - typically, the main symptom is abdominal distension without signs of peritonitis. Owing to the high protein accumulation and CSF production in certain conditions, ventriculoatrial shunting is commonly chosen as an alternative.

Introduction Autologous fat grafting remains a topic of debate, involving not only the pathophysiology of its absorption but also the techniques that promote better integration for more predictable results. Objective This study aimed to assess the impact of poly-L-lactic acid (PLLA) on fragmented fat grafts in the dorsal region of Wistar rats. Method Twenty-one male Wistar rats, weighing 283 to 394 g, were randomly divided into three groups and monitored over 150 days. Fat was harvested from the flanks via direct incision, mechanically fragmented, and grafted into the dorsum. Group 1 received 1ml of fragmented fat; Group 2 received 0.5 ml of fragmented fat, and Group 3 received a mixture of 0.5 ml of fat with 0.5ml of PLLA. The grafts were evaluated for final volume, necrosis, fibrosis, and inflammation. Results The group treated with PLLA demonstrated reduced inflammatory and necrotic changes, alongside superior volume retention (p < 0.05), when compared to groups receiving fat grafts alone. No differences were observed between groups 1 and 2 in any of the measured parameters. Conclusion The incorporation of PLLA with fragmented fat grafts in rats resulted in decreased inflammation and necrosis and improved fat retention compared to isolated fat grafts. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

This study aimed to analyze preoperative, intraoperative, and postoperative factors that affect the surgical prognosis of non-functioning pituitary adenomas (NFPA) and to determine postoperative complication rates. We conducted a retrospective cohort study of patients with NFPA who underwent surgery between 1995 and 2024 at a tertiary public hospital in Brazil. Variables analyzed included tumor size, cavernous sinus invasion (Knosp classification), endocrinological status, preoperative clinical features, surgical complications, and outcomes. Statistical significance was set at p ≤ 0.05. Seventy-three patients were included, with a mean age of 53 years and a slight predominance of females. Tumors were classified as macroadenomas (59%) and giant adenomas (41%). The transsphenoidal approach was used in 81% of cases. Partial resection was achieved in 56%, subtotal in 16%, and total in 27%. Immediate postoperative complications included diabetes insipidus (30%), bleeding (11%), hydrocephalus (10%), ischemia (10%), meningitis (6%), and cerebrospinal fluid fistula (11%). Mortality was 9.6%, significantly associated with postoperative hydrocephalus, ischemia, and larger tumor size. Giant tumors were correlated with higher rates of preoperative neurological deficits and postoperative complications. Transcranial surgery was more frequently performed in cases of giant adenomas and was associated with increased rates of ischemia and neurological deficits. Tumor recurrence was observed in 33% of patients over a mean follow-up of 48 months. Tumor size and postoperative complications such as hydrocephalus and ischemia were associated with increased morbidity and mortality. Postoperative hydrocephalus, ischemia, and tumor size are key determinants of mortality in NFPA surgical treatment. Implementing preventive and management strategies targeting these complications could improve patient outcomes, albeit rigorous long-term follow-up is essential due to the high rates of recurrence and reoperation.

A 57-year-old male with multiple supratentorial and infratentorial cavernomas presented with subacute-onset headache, tinnitus, and worsening neurological deficits. Imaging revealed spontaneous thrombosis of a previously documented developmental venous anomaly (DVA) in the posterior fossa, resulting in cerebellar parenchymal hemorrhage and posterior fossa hypertension consistent with venous infarction. This case highlights the rare occurrence of spontaneous DVA thrombosis, emphasizing its potential for severe complications, such as venous ischemic infarction, parenchymal hemorrhage, venous congestion, or subarachnoid hemorrhage, as well as the importance of sequential imaging in documenting pathological progression.

Subarachnoid hemorrhage secondary to a ruptured brain aneurysm should be promptly diagnosed. The angiographic study allows the diagnosis of vascular alterations that determine subarachnoid hemorrhage. The risk of rebleeding is highest in the first 24 h following the first bleeding. The prognosis of the surgical treatment of a brain aneurysm depends on many factors. The aim of the present retrospective study was to determine which prognostic factors are related to the morbidity and mortality of the microsurgical treatment of different brain aneurysms. A total sample of 371 patients with subarachnoid hemorrhage due to aneurysm bleeding treated by microsurgery from 2013 to 2022 were studied. The variables studied were patient characteristics (age, gender, smoking status, systemic arterial hypertension, and diabetes mellitus), the tomographic findings classified by the Fisher scale, the interval between stroke and surgery, and the clinical condition of patients at admission classified by the Hunt-Hess scale. The primary outcome was the occurrence of death, and the secondary outcomes were the length of hospital stay and the length of stay in the intensive care unit. The clinical presentation (characterized by the Hunt-Hess scale) at the time of admission of the patient was an important determining factor in the length of hospital stay and intensive care unit stay and the occurrence of death in these patients. Older age and occurrence of diabetes mellitus were also associated with the outcome of death. The surgical moment characterized by the time between stroke and surgery was inversely associated with the outcome of death. The timing for surgery has to be analyzed concerning the clinical presentation of the patient at the time of admission.

Introduction: Cerebral Cavernous Malformations (CCMs) are rare vascular lesions, often associated with genetic mutations. The association between these malformations and Developmental Venous Anomaly (DVA) has been the focus of recent studies, as they may influence the evolution of the lesions. Case Presentation: A 26-year-old female patient presented with a sudden onset of severe headache, vertigo, and ataxia, requiring hospitalization due to cerebellar hemorrhage confirmed by CT scan. Magnetic Resonance Imaging (MRI) revealed a cavernoma in the right cerebellar peduncle with an adjacent DVA. The patient underwent surgical intervention with intraoperative neuronavigation, where the DVA was used as an anatomical landmark to locate and completely excise the cavernoma while preserving the anomalous vein. Postoperatively, the patient showed significant improvement without neurological deficits. Conclusion: CCMs can be sporadic or familial, and they are frequently associated with DVAs. DVA resection can impair venous drainage and cause infarction, making its preservation crucial during surgery. A conservative approach is recommended in most cases, with resection indicated for symptomatic lesions or those at high risk of bleeding.

Background: Experimental models of neurocysticercosis (NCC) are helpful for an improved understanding of the pathophysiological mechanisms of human diseases and for testing novel therapeutic approaches. Controlling inflammation without reducing the effectiveness of anthelmintics is an important challenge in treating neurocysticercosis. This study investigates the effects of currently used drugs (Albendazole and Dexamethasone) in treating murine extraparenchymal NCC. Methods: Twenty-two rats were inoculated with Taenia crassiceps in the subarachnoid space. The animals underwent magnetic resonance imaging to ascertain the success of infection 3 months after inoculation. The infected animals were randomly assigned to one of the three groups (five rats each): control (no treatment), Albendazole (ABZ), or Albendazole + Dexamethasone (ABZ + DXM) for 14 days. The animals were subsequently euthanised for morphological assessment 2 weeks after the end of treatment. Results: Macroscopically integrated cysts were found in all animals. The ABZ + DXM animals demonstrated lower ventricular sizes, lymphocyte infiltration rates, and immunopositivity for IL-6, with statistical differences in lymphocytes within the arachnoid region. Conclusions: This experimental model, which has previously shown similarities to human infections, is also helpful in reproducing the morphological changes upon treatment with Albendazole and Dexamethasone.

Oxidative stress is associated with several infectious diseases, as well as the severity of inflammatory reactions. The control of inflammation during parasite destruction is a target of neurocysticercosis treatment, as inflammation is strongly related to symptom severity. In this study, we investigated the presence of malondialdehyde and protein carbonyl, two by-products of reactive oxygen species (ROS), in an experimental model of extraparenchymal neurocysticercosis. Twenty male and twenty female rats were inoculated with 50 cysts of Taenia crassiceps in the subarachnoid space of the cisterna magna. Ten animals (five males and five females) were used as controls. Three months after inoculation, their brains were harvested for oxidative stress and histological assessments. Infected animals had higher scores for inflammatory cell infiltrates, malondialdehyde, and protein carbonyl. These results encourage future efforts to monitor oxidative stress status in neurocysticercosis, particularly in the context of controlling inflammation.