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de Macêdo LP, de Castro Tavares R, Torres Braga M, Dos Santos LM, Donato G, Lima Júnior FASD, de Macêdo RP, Ugulino Netto A, Franke K, Vansant Oliveira Eugênio P, Batista Cezar-Junior A, Vilela Faquini I, Júnior Silva JL, de Carvalho Júnior EV, Almeida NS, Bandeira E Farias FA, Moraes Valença M, Rocha Cirne Azevedo-Filho H. The relationship between the level of vitamin D and ruptured intracranial aneurysms among patients with high sun exposure. Sci Rep 2024; 14:3555. [PMID: 38347057 PMCID: PMC10861505 DOI: 10.1038/s41598-024-53676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
Non-traumatic subarachnoid hemorrhage (SAH) accounts for 3-5% of acute strokes. Intracranial aneurysm is the most common cause of non-traumatic SAH. Vitamin D influences the cardiovascular system, including the formation and rupture of cerebral aneurysms. To evaluate the serum vitamin D level in patients living in the tropical zone who suffered aneurysmal subarachnoid hemorrhage and its correlation with demographic and neurological characteristics. This is an analytical cross-sectional study to assess the serum level of vitamin D in a study population of 99 patients treated and diagnosed with aSAH in a public hospital in Recife-PE over a period of 12 months. In the study sample, composed of individuals with high sun exposure due to the lifestyle they lead in a tropical region, we observed hypovitaminosis D (85.9%), with a median of 19.9 ng/ml, although the majority of individuals are skin with high concentration of melanin (Fitzpatrick skin type IV and V). In addition, rates of sun exposure are high to all patients (Solar Index 9.03 P50). Most individuals were female (79.8%); there was no statistical difference in solar exposure/solar index between genders. As for the neurological repercussions, there was no statistical relevance in the clinical prognostic scales evaluated. As the sample was composed mainly of individuals whose economic activity is agriculture, the values of solar index found are vastly higher than those of other studies conducted in high latitude regions. In line with the literature review, some aspects were raised with the objective of justifying such findings that go from the base of the poor diet of these individuals, the increase of melanin in the skin and genetic alterations that directs us to possible mechanisms of natural photoprotection to high sun exposure. Thus, we had a vast majority (85%) of hypovitaminosis D, which in fact makes us wonder if there is any influence of calcitriol on vitamin D receptors in vascular walls and in the cardiovascular system as a whole, which influence bleeding events of this nature. As for the neurological repercussions, measured using assessment scales (Glasgow coma scale, WFNS scale, Hunt-Hess and Fisher's tomographic scale) there was no significant difference in the results. As it is only a descriptive study, the causal relationship of the facts cannot be established. However, in a population exposed to high sun exposure and affected by aneurysmal SAH, there is a significant rate of hypovitaminosis D, which supports the hypothesis that vitamin D plays a role in vascular pathologies, such as cerebral aneurysms and SAH.
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Affiliation(s)
- Lívio Pereira de Macêdo
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil.
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
- , Recife, Brasil.
| | | | | | | | - Glaudir Donato
- Medical Student, Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | | | | | | | - Kauê Franke
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | - Igor Vilela Faquini
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | - Nivaldo S Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | - Hildo Rocha Cirne Azevedo-Filho
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Ferreira de Araújo MG, Almondes Santana Lemos LE, Negromonte Guerra PL, Marcia dos Santos Lima Didjurgeit F, Batista Cezar A, Faquini IV, Cirne de Azevedo Filho HR. Supratentorial meningeal melanocytoma mimicking meningioma: case report and literature review. Pathol Oncol Res 2024; 29:1611482. [PMID: 38239282 PMCID: PMC10794320 DOI: 10.3389/pore.2023.1611482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024]
Abstract
Introduction: Primary melanocytic tumors originating from CNS melanocytes are rare, with a low incidence of 0.7 cases per 10 million annually. This study focuses on primary leptomeningeal melanocytomas, emphasizing their epidemiology, clinical characteristics, and diagnostic challenges. Despite their infrequency, these tumors warrant attention due to their unique features and potential for local recurrence. Case Report: A 32-year-old female presented with syncope and seizures, leading to the discovery of two left-sided supratentorial lesions initially misidentified as convexity meningiomas. Detailed imaging suggested meningioma-like features, but intraoperative findings revealed unexpected hyperpigmented lesions. Histopathological examination, supported by immunohistochemistry, confirmed primary leptomeningeal melanocytoma. The surgical approach and subsequent management are discussed. Discussion: The discussion emphasizes challenges in diagnosing primary leptomeningeal melanocytomas. Treatment debates, especially regarding adjuvant radiotherapy, are explored. Recurrence risks stress the importance of vigilant follow-up, advocating for complete surgical resection as the primary approach. The rarity of supratentorial cases adds complexity to diagnosis, necessitating a multidisciplinary approach. Insights from this case contribute to understanding and managing primary leptomeningeal melanocytomas, addressing challenges in differentiation from more common tumors and prompting ongoing research for refined diagnostics and optimized treatments. Conclusion: This study contributes insights into primary leptomeningeal melanocytomas, highlighting their rarity in supratentorial regions. The case underscores the importance of a multidisciplinary approach, incorporating clinical, radiological, and histopathological expertise for accurate diagnosis and tailored management. Ongoing research is crucial to refine treatment strategies, enhance prognostic precision, and improve outcomes for individuals with this uncommon CNS neoplasm.
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de Macêdo LP, Baptista-André DC, Ugulino-Netto A, Franke K, Oliveira Eugênio PV, Cezar-Junior AB, Faquini IV, de Carvalho-Júnior EV, Almeida NS, Azevedo-Filho HRC. Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report. J Cerebrovasc Endovasc Neurosurg 2023:jcen.2023.E2023.05.006. [PMID: 38151969 DOI: 10.7461/jcen.2023.e2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 12/29/2023] Open
Abstract
Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.
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Affiliation(s)
| | | | | | - Kauê Franke
- Department of Neurosurgery, Hospital da Restauração, Recife, Brazil
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Macêdo LPD, Netto AU, Franke K, Eugenio PVO, Freitas LRDM, Costa VRX, Carvalho Júnior EVD, Faquini IV, Almeida NS, Azevedo-Filho HRC. Spontaneous Anal Extrusion of Ventriculoperitoneal Shunt Catheter: Case Report. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022. [DOI: 10.1055/s-0042-1748848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
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.
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Affiliation(s)
| | | | - Kauê Franke
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | | | | | - Igor Vilela Faquini
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | - Nivaldo S. Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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Junior LSB, Ferreira Neto ODC, Araruna Dias AJ, Do Rêgo Aquino PL, Miranda Cavalcante Filho JR, Silva Diniz AM, Gonçalves de Lima LF, Lemos NB, de Alencar Neto JF, Lima Da Silva T, Andrade De Abreu T, De Lima Guerra Barros JG, da Silva Junior EJ, Veiga Silva AC, Faquini IV, Almeida NS, de Azevedo Filho HRC. Pediatric Gunshot Head Injury: Prevalence of Prognostic Factors in Surgical Patients: An Institutional Experience in Ten Years. Neurotrauma Rep 2022; 2:669-675. [PMID: 35018367 PMCID: PMC8742276 DOI: 10.1089/neur.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article aims to evaluate the predictive factors of morbidity and mortality in pediatric patients who suffered gunshot wounds to the head. We reviewed a series of 43 patients who were admitted to a referential neurosurgical hospital between 2010 and 2019. Data from 43 patients who underwent a surgical treatment in our institution were collected, and the following parameters were considered in the analysis: the initial Glasgow Coma Scale (GCS), age, sex, bullet entry site, and bullet trajectory. Computed tomography (CT) scans at admission, complications, midline crossing, and Glasgow score scale at the time of discharge (Glasgow Outcome Scale; GOS) were also factored in. Male sex corresponded to 90.7% of cases (N = 39), and 16–17 years of age was the most common age (60.5%). The frontal region was the most common entry site (41.9%), followed by the parietal wall and occipital entry. Penetrating trajectory was shown in 48.8% of cases, perforation/transfixing in 39.5%, and tangential in 11.6%. CT showed that sinking is the most common alteration (74.4%), followed by cerebral contusion (44.2%). According to the GOS, 23.3% died, 23.3% were classified by an unfavorable outcome (GOS, 2–3), and 53.5% a favorable outcome (GOS, 4 and 5). In our study, there was a significant association between the low GCS scores on admission and low GOS (1–3; p = 0.001) at time of discharge. Patients with wounds that crossed the midline also had a significant association with low GOS (p = 0.014) in our clinical experience. We concluded that low GCS scores at admission and children with a wound that crosses the midline are predictive factors of high mortality and morbidity, in our clinical experience.
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Affiliation(s)
- Luiz Severo Bem Junior
- Departament of Neurosurgery, Hospital da Restauração, Recife, Brazil.,College of Medical Sciences, Unifacisa University Center, Campina Grande, Paraíba, Recife, Brazil
| | | | | | | | | | | | | | - Nilson Batista Lemos
- College of Medical Sciences, Unifacisa University Center, Campina Grande, Paraíba, Recife, Brazil
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Faquini IV, Fonseca RB, Correia AO, Cezar Junior AB, De Carvalho Junior EV, de Almeida NS, Azevedo-Filho HRC. Endoscopic third ventriculostomy in the treatment of hydrocephalus: A 20-year retrospective analysis of 209 consecutive cases. Surg Neurol Int 2021; 12:383. [PMID: 34513150 PMCID: PMC8422502 DOI: 10.25259/sni_458_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background Endoscopic third ventriculostomy (ETV) has been shown to be a sufficient alternative to shunts in surgical treatment of obstructive hydrocephalus. Long-term failure, age limitations, and outcome by cause are some of the issues debated in literature. The objective of this article is to analyze the clinical success and failure of ETV and its main complications. Methods A total of 209 patients with hydrocephalus were submitted to ETV, including a mixed population of children and adults (from 0 to 59 years). Patients were divided into five groups: A - tumors, B - aqueductal stenosis, C - myelomeningocele, D - infection and hemorrhage, and E - arachnoid cyst. Variables were analyzed: age, ETV success rate, cerebrospinal fluid (CSF) fistula, mortality, and complications. Results The two main causes of hydrocephalus were tumors (44.9%) and aqueductal stenosis (25.3%). The overall success rate was of 82.8%, and patients in Group E had the highest rate 90.9%. Group A had a success rate of 89.3%, and Group B had a rate of 88.6%. The ETV success rate was significantly higher in patients older than 1 year (P < 0.001); the former also had a lower risk of CSF fistula (P < 0.0001). The overall mortality rate was 2.8%. Conclusion Better results were observed in the groups of patients with tumors, aqueductal stenosis, and arachnoid cysts, while those whose primary causes of hydrocephalus were myelomeningocele, infections, or bleeding had higher rates of failure after the procedure. This study demonstrated that age under 1 year and hydrocephalus caused by myelomeningocele, bleeding, and infection were considered independent risk factors of poor prognosis in ETV.
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Affiliation(s)
- Igor Vilela Faquini
- Department of Pediatric Neurosurgery, Instituto Materno Infantil Professor Fernando Figueira-IMIP and Department of Neurosurgery, Hospital da Restauracao, Recife, Brazil
| | | | | | - Auricelio Batista Cezar Junior
- Department of Pediatric Neurosurgery, Instituto Materno Infantil Professor Fernando Figueira-IMIP and Department of Neurosurgery, Hospital da Restauracao, Recife, Brazil
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Vilela Faquini I, Brandão Fonseca R, Batista Cezar Junior A, Corrêa de Albuquerque Leimig B, Just da Costa e Silva E, Santana Lima L, Barreto Machado Galvão L. Vaginal cerebrospinal fluid discharge due to fallopian tube perforation by distal catheter of ventriculoperitoneal shunt: A case report. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cezar-Junior AB, Faquini IV, Silva JLJ, de Carvalho Junior EV, Lemos LEAS, Freire Filho JBM, de Lira Filho HT, Pontes ECDA, Almeida NS, Azevedo-Filho HRC. Subarachnoid hemorrhage and COVID-19: Association or coincidence? Medicine (Baltimore) 2020; 99:e23862. [PMID: 33371170 PMCID: PMC7748374 DOI: 10.1097/md.0000000000023862] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT Some evidences suggest the involvement of the central nervous system in patients infected with SARS-CoV-2. We aim to analyze possible associations between coronavirus disease 2019 (COVID-19) pandemic and spontaneous subarachnoid hemorrhage (SAH), in a comprehensive neurological center.We conducted a retrospective case series of 4 patients infected by COVID-19, who developed spontaneous SAH. Clinical data were extracted from electronic medical records.Between March 24, 2020, and May 22, 2020, 4 cases (3 females; 1 male) of SAH were identified in patients infected with SARS-CoV-2, in a comprehensive neurological center in Brazil. The median age was 55.25 years (range 36 -71). COVID-19-related pneumonia was severe in 3 out of 4 cases, and all patients required critical care support during hospitalization. The patients developed Fisher grade III and IV SAH. Digital subtraction angiography (DSA) was performed in 3 of the 4 patients. However, in only 1 case, an aneurysm was identified. Inflammatory blood tests were elevated in all cases, with an average D-dimer of 2336 μg/L and mean C-reactive protein (CRP) of 3835 mg/dl The outcome was poor in the majority of the patients, with 1 death (25%); 2 (50%) remained severely neurologically affected (mRS:4); and 1 (25%) had slight disability (mRS:2).This study shows a series of 4 rare cases of SHA associated with COVID-19. The possible mechanisms underlying the involvement of SARSCoV-2 and SHA is yet to be fully understood. Therefore, SHA should be included in severe neurological manifestations in patients infected by this virus.
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Batista Cezar-Junior A, Faquini IV, Frank K, Euripedes Almondes S Lemos L, de Carvalho EV, Almeida NS, Azevedo-Filho HRC. Limited dorsal myeloschisis with a contiguous stalk to human tail-like cutaneous appendage, associated with a lipoma of conus medullaris: A case report. Int J Surg Case Rep 2020; 71:303-306. [PMID: 32480343 PMCID: PMC7264008 DOI: 10.1016/j.ijscr.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Limited dorsal myeloschisis (LDM) is a recently described pathological entity, characterized by a defect of the closed focal neural tube and a fibroneural pedicle connecting the cutaneous lesion to the spinal cord. PRESENTATION OF THE CASE This case describes a 9-month-old child with a human tail and an underlying spinal dysraphism. This was represented by LDM stalk associated with a medullary lipoma, in connection with the dorsal cutaneous appendage. We also report the therapeutic proposal for this case and its clinical outcome. DISCUSSION LDM is a distinctive clinicopathological presentation of a spinal dysraphism, associated with numerous anomalies, such as lipomyelomeningocele, tethered cord, lipoma, congenital heart disease and teratoma. In this case, surgical treatment for LDM consists of surgical resection of the appendage, untethering of the spinal cord and resection of conus medullaris lipoma in the same procedure. CONCLUSION In this case report, we share the experience of a referral service in pediatric neurosurgery regarding clinical and radiological diagnosis, and the successful treatment of this rare type of congenital malformation. Therefore, clinicians should be aware of possible morphological variations of the skin lesion associated with LDM.
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Affiliation(s)
| | - Igor Vilela Faquini
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil.
| | - Kauê Frank
- Neurosurgery Department of the Hospital da Restauração Gov. Paulo Guerra, Recife, Brazil.
| | | | | | - Nivaldo S Almeida
- Neurosurgery Department of the Hospital da Restauração Gov. Paulo Guerra, Recife, Brazil.
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Nicácio JM, Rodrigues JC, Galles MHL, Faquini IV, de Brito Pereira CA, Ganau M. Cervical intramedullary schwannoma: a case report and review of the literature. Rare Tumors 2009; 1:e44. [PMID: 21139923 PMCID: PMC2994477 DOI: 10.4081/rt.2009.e44] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 07/14/2009] [Indexed: 11/22/2022] Open
Abstract
Intramedullary schwannomas unrelated with neurofibromatosis are uncommon tumors, but if correctly diagnosed and properly treated they may have a good prognosis.They have a wide range of clinical presentations, commonly presenting as a slowly progressive motor or sensory syndrome. We present a case report of a patient without neurofibromatosis with a surgically treated cervical intramedullary schwannoma.
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Affiliation(s)
| | | | | | - Igor Vilela Faquini
- Pediatric Neurosurgery Fellow of the Federal University of São Paulo, Brazil
| | | | - Mario Ganau
- Resident in Neurosurgery of the University of Verona, Italy
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Silva JCD, Lima FDMTD, Faquini IV, Costa LF, Valença MM, Mello RJVD. Multiple midline intracranial germinoma managed by neuroendoscopy. Arq Neuro-Psiquiatr 2009; 67:125-6. [DOI: 10.1590/s0004-282x2009000100033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Almeida JPCD, Quinino S, Faquini IV, Silva DODA, Albuquerque LAFD, Mendes JCDA, Azevedo-Filho H. Neuroendoscopic treatment of quadrigeminal arachnoid cyst in a two-year-old child. Arq Neuropsiquiatr 2008; 66:758-60. [PMID: 18949280 DOI: 10.1590/s0004-282x2008000500032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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