Hildo Rocha Cirne de Azevedo Filho

This study evaluates the functional and aesthetic outcomes of cranioplasty using customized polymethyl methacrylate (PMMA) prostheses produced through a low-cost 3D printing technique. A clinical trial was conducted including 174 patients who underwent decompressive craniectomy and were later submitted to cranial reconstruction with custom-made PMMA implants between 2014 and 2024. Patients were followed for at least 3 months, and functional and aesthetic outcomes were assessed through a questionnaire applied preoperatively and at 6 months postoperatively. Among the 174 patients, 117 returned for postoperative evaluation, and 80 completed the outcome questionnaire. All patients demonstrated symptomatic improvement after cranioplasty. Aesthetic outcomes were rated as "excellent" by 73 patients and "very good" by 7. Significant postoperative improvement was observed in symptoms such as headache, local discomfort, dizziness, tinnitus, insomnia, and vibration intolerance (p < 0.001). Complications included seroma (49.4%), extradural hematoma (5.1%), dehiscence (2.8%), and seizures within the first 12 hours (8.6%). Reoperation occurred in 22.4% of cases. The infection rate was 5.7%, lower than rates reported in previous studies using PMMA. Cranioplasty with customized PMMA prostheses resulted in significant neurological symptom improvement and high patient satisfaction with cranial contour restoration. This technique demonstrated safety, reproducibility, and feasibility in a resource-limited public hospital setting, offering an accessible alternative for personalized cranial reconstruction.

The middle meningeal artery (MMA) supplies over two-thirds of the cranial dura mater, making its anatomical knowledge crucial for surgery. Rarely, the MMA may originate from the basilar artery. Typically, it arises between the superior cerebellar artery and anterior inferior cerebellar artery, following a course near the trigeminal nerve to reach the petrous branch of the MMA. An embryological origin involves anastomosis between persistent stapedial and trigeminal arteries. The image illustrates an unusual case of a patient with right MMA originating from the posterior circulation via the basilar artery.

Of great concern to the neurosurgical community is this novel coronavirus pandemic 2019, a result of dissemination to all continents of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Without proper care, there is a very high chance of being infected by the lethal SARS-CoV-2 during a routine neurosurgical procedure. SARS-CoV-2 infected a significant part of the healthcare workers, including neurosurgeons, responsible for direct care for patients with Covid-19, and several of those infected have already died. Drastic modifications should be made in the process the operating room is prepared, and in the attitudes taken by medical personnel in an attempt to minimize a possible contact of the SARS-CoV-2. The novel coronavirus is present not only in the respiratory tract, but the virus may also be encountered in blood, stool, and CSF. In this article, the authors want to address the topic of how the neurosurgeons can mitigate the chance of being infected with SARS-CoV-2 during a surgical procedure performed on a patient with Covid-19. For this, we chose a common condition in neurosurgery practice - and one of the simplest in its execution - the chronic subdural hematoma (CSDH). There is still no consensus on how to operate patients with CSDH. This article aimed to elaborate a protocol with effective and minimally invasive techniques to be performed in the patient with both CSDH and Covid-19, with the dual intention of protecting the surgeon from SARS-CoV-2 infection and optimizing the patient's chance of healing.

Idiopathic spinal cord herniation (ISCH) is a rare condition caused by a defect in the dura mater, resulting in ventral displacement of the spinal cord. Its etiology is not fully understood, but it mainly affects middle-aged women and manifests as progressive myelopathy. Surgical treatment is the best option to avoid neurological worsening. This report presents a case of spinal cord herniation in a 45-year-old man, complaining of numbness for 4 months, with paraparesis that progressed to gait disorder. This condition was diagnosed by magnetic resonance imaging and computed tomography. The patient underwent T2 to T3 laminectomy, hernia reduction, and duroplasty, with successful resolution of the condition.

A Neurofobia definida como um receio e repulsa das neurociências, consiste em um problema evidenciado em diversas escolas médicas pelo mundo, em diversos países, em que vários estudantes vivenciam, em diferentes fases da formação. As motivações exatas que justifiquem a neurofobia ainda são alvo de estudos, análises e debates entre acadêmicos e os educadores, entretanto, a complexidade dos assuntos e a necessidade da reformulação da didática empregada no ensino de tal conteúdo possa compor, ao menos em parte a origem de tal falha pedagógica. Mediante a identificação de tal lacuna, o Projeto de Extensão de combate a Neurofobia pautou-se em utilizar uma didática mais chamativa e acessível, utilizando-se as redes sociais, haja vista o seu fácil acesso e a larga utilização pelo público acadêmico. Durante o período de um ano, foram postados diversos conteúdos das neurociências, de modo digital para os estudantes, com espaço aberto para dúvidas e sugestões. Ao longo desse processo foram utilizadas métricas disponibilizadas pela própria plataforma da rede social, tendo sido comprovado o grande alcance e visibilidade que tal método de divulgação de ciência possui, bem como a facilidade de salvar o contéudo e divulgá-lo. Por isso é fundamental que novos Projetos sejam desenvolvidos no âmbito universitário digital, para que sejam discutidos os melhores caminhos e formatos, de modo que se estimule o contato com tal modelo de aprendizagem e aprimorem-se as plataformas.

Objective The objective of the present study was to assess the hormonal alterations that occurred in patients with subarachnoid hemorrhage. Methods This is a case series with 21 patients diagnosed with subarachnoid hemorrhage of aneurysmal etiology up to 30 days after the ictus. The following hormonal measurements were performed in these patients: cortisol, GH, testosterone, prolactin, estradiol, FSH, LH, FSH, T3, T4 and free T4. The hormonal results of the cases were compared with the results of twelve volunteers from the control group and correlated with findings in brain tomography, cerebral angiography, Hunt-Hess scale, and vasospasm. Results The main altered hormones were cortisol (52.6%), GH (42.9%) and TSH (28.6%). There was a trend towards more severe cases in the following groups of patients: Hunt-Hess scale > 2, Fisher scale > 1, aneurysmal topography in the anterior communicating artery and those who had vasospasm. Conclusion The present study observed the tendency of pituitary hormonal changes in patients with subarachnoid hemorrhage of aneurysmal etiology, corroborating the need for dosage of hormones from the hypothalamic-pituitary axis in the management of these cases.

Letter to the Editor Telencephalic variant of the anterior choroidal artery: clinical significance and management considerations Lívio Pereira de Macêdo, Ítalo Emmanuel Lima Ferreira, Marcos Alcino Soares Siqueira Marques-Júnior, Renata Raizza Monterazzo-Cysneiros, Ubiratan Alves Viturino da Silva, Marcos Antonio Barbosa da Silva, Bruno Anderson Araújo da Mota, Romero Marques, José Laercio Júnior-Silva, Carlos Gustavo Coutinho Abath, Hildo Rocha Cirne Azevedo-Filho

O tratamento da meningite é uma questão complexa quando se trata de bactérias multiresistente a antibióticos (ATB) limitando as opções de medicamentos que podem atravessar a barreira hematoencefálica e atingir efetivamente o espaço subaracnóide. O impacto na eficácia do arsenal terapêutico disponível, devido ao uso indiscriminado de antibacterianos em escala global, aumenta as chances de falha terapêutica do tratamento empírico inicial e a persistência da falha, apesar da cultura direcionar o tratamento aos patógenos, sem obter resultados satisfatórios. Assim, a utilização de estratégias para otimizar a entrega de antibacterianos ao local da patologia envolve o uso do mecanismo farmacocinético, a fim de alcançar o efeito desejado por meio da administração intratecal. Durante esta revisão, objetivamos avaliar o uso da antibioticoterapia intratecal em pacientes infectados por bactérias multirresistentes e analisar os possíveis efeitos adversos.

Os cistos epidermóides possuem etiologia benigna e podem ser congênitos, geralmente associados a malformações, ou adquiridos, relacionados a eventos externos, e até iatrogênicos. Quanto à sua localização, classificam-se em extradurais, intradurais, extramedulares e intramedulares. Os cistos epidermóides intramedulares intradurais são bastante incomuns, com poucos casos relatados na literatura até o momento. Devido ao seu desenvolvimento lento, pode haver atraso no diagnóstico. Seus sintomas dependem da topografia da lesão, sendo recomendada a remoção total do cisto para melhorar o quadro. Neste trabalho, relatamos o caso de um paciente adulto com paraparesia crural espástica progressiva, sem malformações associadas. Os exames de imagem mostraram um cisto epidermóide intradural intramedular, que foi completamente removido, com posterior melhora do quadro clínico do paciente.

Background Ventriculoperitoneal shunt (VPS) has become the standard treatment for congenital hydrocephalus. In the neurosurgical practice, it is a common procedure which usually results in low rates of complication. However, some serious complications can occur, including infections, intestinal perforation, and even death. Case Description A 19-year-old, female, asymptomatic patient, with a history of appendectomy and revision of the VPS 6 years before, presented spontaneous transanal extrusion of the catheter. Abdominal radiographs and tomography scans showed perforation of the descending colon without peritonitis, with expulsion of the distal tip of the catheter through the anus. The patient underwent removal of the proximal part of the VPS and installation of an external ventricular drain (EVD). On the second postoperative day, there was spontaneous elimination of the distal portion of the catheter, dispensing any additional surgical procedures. With antimicrobial prophylaxis and the contralateral VPS performed, the patient evolved without further complications until discharge. Diverging from cases reported in the literature, the patient in question did not present any abdominal manifestations. Conclusion Intestinal perforation by VPS may be asymptomatic until anal extrusion occurs. However, the early approach should avoid infections, which are associated with increased mortality. Removing only the proximal catheter, together with antimicrobial prophylaxis, can be an effective, safe and less invasive alternative to manage this complication of VPS.