Background Stereotactic biopsy is necessary for diagnosing deep-seated brain tumors that are not amenable to surgical resection. The diagnostic yield of stereotaxy ranges from 76.2 to 100%. Several methods have been suggested to improve the yield. These include planning the trajectory on 3D multiplanar reconstruction (3D MPR) software, planning two different trajectories for different target points, centering the burr hole at the entry point, taking at least six specimens from each target, macroscopic assessment of the biopsy bits, and postbiopsy scan. We implemented similar precautions to ensure the diagnostic yield. Three cases were analyzed retrospectively and descriptively. Case descriptions The contrast-enhanced magnetic resonance imaging (CEMRI) of the first patient showed a high-grade neoplasm of the left corona radiata and corpus callosum. Craniostomy and stereotactic biopsy were done. Computed tomography (CT) showed the tract as dots of bleed into the lesion. The histopathological report (HPR) was of anaplastic astrocytoma. The second case was peculiar in the presentation as bilateral high-grade glioma. The CT imaging after stereotaxy showed air within the lesion, confirming the site. The immunohistochemistry (IHC) was suggestive of grade 3 astrocytoma. The third case was a diagnostic dilemma, with incomplete ring enhancement on CEMRI. Postoperative CT confirmed the site of biopsy as a cut. The IHC proved diagnosis of diffuse large B cell lymphoma. Conclusion Placing the stereotactic ring around the lesion, making a craniostomy of size 3 cm, doing surgery under general anesthesia, biopsy from multiple targets, harvesting more than six specimens, and immediate postoperative CT helped in ensuring the accuracy of biopsy.
Rasmussen et al. described a syndrome characterized by intractable focal seizures in childhood, leading to focal motor seizures, progressive hemiparesis, and cognitive impairment. Rasmussen's encephalitis (RE) is now defined as an autoimmune disorder that determines progressive multifocal encephalopathy associated to unilateral cortical atrophy and progressive deterioration. Histologically, RE is characterized by an inflammatory lesion compromising the gray and white matters, with frequent lymphocytes arising in sanguineous vessels and respective perivascular tissues, glial nodules, hydropic degeneration, and atrophy. Currently, conventional antiepileptic therapy drugs remain unhelpful in treating the seizures, but the process appeared to be halted by hemispherectomy. We herein report three cases of RE treated by surgical resection and discuss the pathogenesis and diagnostic histopathological findings of this uncommon process.
Approximately 30% of the patients with treatment-resistant schizophrenia do not respond to clozapine, and approximately 25% do not tolerate its adverse effects, and there is no widely-accepted therapeutic consensus for these patients. In view of the refractoriness of a considerable percentage of patients to the antipsychotic treatment, other therapeutic modalities have become the object of study in the treatment of this disorder. Modulation with an inhibitory effect on the nucleus accumbens is based on the fact that this structure is necessary for the release of dopamine secondary to hippocampal activation, as well as the fact that the nucleus accumbens regulates the release of dopamine intrinsically and in the associative striatum, which is also involved in psychotic manifestations. Bilateral radiofrequency ablation of the ventromedial portion of the accumbens shell has already been performed in the treatment of refractory drug addiction, showing an adequate safety profile and a low rate of complications. Considering the pathophysiology of schizophrenia, the evidence of the preferential action of atypical antipsychotics on the ventromedial portion of the accumbens shell, the diversity of theories related to the mechanisms of resistance to antipsychotics, the promising results presented by the inhibitory modulation of the accumbens, and the safety profile and low complication rate of radiofrequency ablation of the ventromedial portion of the accumbens shell, it is reasonable to infer that this procedure is an admissible therapeutic proposal in the context of clozapine-resistant schizophrenia.
Intraventricular hemorrhage (IVH) is a condition linked to high rates of morbidity and mortality. External ventricular drainage (EVD) is commonly used to treat it, particularly in cases of obstructive hydrocephalus. Placing the EVD in the ventricle with the most considerable clot burden may improve the effectiveness of blood clearance, especially when combined with intraventricular thrombolysis using a tissue plasminogen activator. This paper explores the physiological rationale, indications, and clinical considerations for preferentially placing the EVD in the “bloodier” ventricle to enhance IVH resolution.
Objective To quantify the surgeries for epilepsy performed within the Brazilian Unified Health System (Sistema Unico de Saude, SUS, in Portuguese) in Brazil, analyze their evolution from 2008 to 2022 and evaluate the historical trend within the national territory. Materials and Methods The present is a quantitative and descriptive study, with a cross-sectional design, that deals with resective surgeries for epilepsy performed by the SUS, in its regions and federative units from 2008 to 2022. The information was summarized in graphs and tables, with the help of the GraphPad Prism (GraphPad Software, LLC) and R (R Core Team) software. Results From 2008 to 2022, 2,921 procedures of microsurgery for temporal lobectomy and selective amygdalohippocampectomy were recorded in the Department of Informatics of the Unified Health system (Departamento de Informatica do Sistema Unico de Saude, DATASUS, in Portuguese). Out of the total 2,921 microsurgeries performed, 588 were carried out through the Treatment Outside the Home (Tratamento Fora do Domicilio, TFD, in Portuguese) program. Of the 27 federative units, 9 states did not perform this type of surgery. The procedure rate started at 0.145 per 100 thousand inhabitants and reached its peak in 2010 (0.170), representing an increase of 17.2%. From 2011 to 2020, the procedure rate plummeted to its lowest point of 0.027 in 2020, growing again in 2021 and 2022, but with a cumulative decline of 76.9%. Conclusion Compared to developed countries, Brazil follows the trend of declining rates of temporal lobectomy and selective amygdalohippocampectomy. Although the reasons are not yet clear, while in developed countries this decline seems to be linked to the incorporation of new technologies, in Brazil, the low access of the population to reference centers appears to be the predominant factor.
