-The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients' ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.KEY WORDS: basilar invagination, odontoidectomy, transoral approach. Acesso transoral para a junção craniocervicalRESUMO -O acesso transoral é uma via direta e segura às lesões situadas na linha média e na face anterior da junção craniocervical. As vantagens do acesso transoral são as seguintes:1) a compressão óssea e o tecido de granulação localizam-se anteriormente e são accessíveis pela via anterior; 2) a cabeça do paciente é colocada em extensão, diminuindo a angulação do tronco cerebral durante a cirurgia; e 3) a cirurgia é feita através de um plano avascular na linha média faríngea e clivo. Analisamos os resultados obtidos após odontoidectomia por via transoral em 38 pacientes portadores de invaginação basilar. Trinta e oito pacientes com compressão ventral da junção craniocervical foram submetidos a odontoidectomia por via transoral. A idade dos pacientes variou de 34 a 67 anos. Quatorze pacientes apresentavam associação com malformação de Chiari tipo I e 8 já haviam sido submetidos à cirurgia descompressiva por via posterior. A maioria dos pacientes apresentou nucalgia, mielopatia, déficits dos nervos cranianos baixos, nistagmo, e distúrbio da marcha. Em 24 pacientes foi necessário ampliar o acesso transoral através de miotomia do palato mole, ou osteotomia do palato duro ou maxilotomia. A cirurgia proporcionou melhora dos sintomas na maioria dos pacientes. Um paciente faleceu no pós-operatório imediato por causa de embolia pulmonar. Dois paci...

Steroid therapy has been tested as a neuronal protector in spinal cord injury. Multicenter studies evaluating the efficacy of methylprednisolone (MP) in posttraumatic neurological recovery have shown promising results (NASCIS). However, several critical studies related to NASCIS results have been published. Objective. To review the literature concerning the use of methylprednisolone compared with placebo. MethOds. This analysis added the mean improvement obtained by groups of patients using MP and placebo (PL) to their mean scores at baseline, before treatment, resulting in the final neurological outcome for both groups. Results. The motor score in the MP group was only 2.5 points higher than in the PL group after a one-year follow-up. In neurologically intact individuals, the motor score is 70 points. Improvement in sensory scores was also discrete (1.1 and 1.7 points for pinprick and light touch sensation, respectively). A high rate of complications was observed in a group of patients aged about 60 years who used MP. cOnclusiOn. Differences in the clinical magnitude of the benefits obtained (not confirmed by other studies) with the use of MP and PL are not significant against the potential complications when using this medication.

-We report a case of cellular schwannoma, a rare benign nerve-sheath tumor in a 27 year-old woman. It was presented as a voluminous lesion in the paraspinal region that caused lumbar vertebral body destruction. These features, in association to the microscopic aspects of a hypercellular, pleomorphic neoplasm may lead to a false impression of a malignant tumor. Therefore, it is important to have an accurate examination to confirm the benign nature of this tumor thus avoiding unnecessary therapy.KEY WORDS: cellular schwannoma, benign nerve-sheath tumor, bone destruction. Schwanoma celular: um tumor benigno com características malignas. Relato de casoRESUMO -Apresentamos caso de schwanoma celular, um tumor raro da bainha nervosa em mulher de 27 anos. Tratava-se de volumosa lesão que ocupava e destruía o corpo da 4 a vértebra lombar e invadia o retroperitônio. Estes dados associados com achados microscópicos de hipercelularidade, pleomorfismo e atividade mitótica podem dar a falsa impressão de malignidade. Apurado estudo histopatológico e imunohistoquímico confirma a natureza benigna da lesão evitando terapias desnecessárias. PALAVRAS-CHAVE: schwanoma celular, tumor benigno da bainha nervosa, destruição óssea.

RESUMO O tratamento ideal dos meningiomas do seio cavernoso é remover a lesão sem morbidade ou mortalidade. .oram estudados 16 pacientes portadores de meningiomas do seio cavernoso, sendo 11 do sexo feminino e 5 do sexo masculino, cujas idades variaram de 31 a 63 anos e que foram submetidos ao tratamento cirúrgico. Analisou-se a extensão da remoção tumoral baseado na escala de De Monte, a função pré e pós-operatória dos nervos cranianos, as complicações, a mortalidade cirúrgica e o grau de envolvimento da porção cavernosa da artéria carótida interna. A remoção total foi conseguida em seis pacientes. Dos 10 pacientes nos quais não se conseguiu a remoção total, um faleceu no pós-operatório imediato e quatro foram submetidos à radioterapia. A morbidade nos nervos cranianos que controlam os movimentos extrínsecos oculares foi de 24%: não houve melhora da função trigeminal e cinco novas raízes foram afetadas. A recidiva tumoral ocorreu em dois pacientes com remoção incompleta e em um com ressecção total. A média de seguimento pós-operatório foi de 26 meses. De acordo com estes dados concluímos: 1) a remoção total do tumor depende do grau de envolvimento da artéria carótida interna e seus ramos; 2) a remoção total dos meningiomas restritos ao seio cavernoso é difícil; 3) a morbidade dos nervos cranianos é significativa; 4) a ressecção subtotal é um método eficaz para o controle da doença. PALAVRAS-CHAVE: seio cavernoso, meningiomas, nervos cranianos, cirurgia.Meningiomas of the cavernous sinus: the surgical resectability and complications ABSTRACT -The optimal management for patients with cavernous sinus meningiomas is to evacuate tumor without causing mortality or morbidity. The records of 16 patients, including 11 women and 5 men ranging in age from 31 to 63 years, underwent surgical treatment for this condition were reviewed. Completeness of tumor ressection, cranial nerve morbidity, complications, mortality, the internal carotid artery encasement and outcome were studied. Total removal was achieved in six patients. Of ten patients who underwent subtotal resection there was one death and four were sent to radiotherapy. Morbidity was 24% for cranial nerves controlling extraocular motor function; trigeminal nerve function did not improve after surgical treatment. Simptomatic recurrence ocurred in two patients who underwent subtotal tumor resection and in one who underwent complete tumor resection. The average follow-up period was of 26 months. According to our findings, we conclude: 1) the resectability of meningiomas of cavernous sinus depends on the degree of internal carotid artery involvement; 2) total resection of meningiomas confined in cavernous sinus is rare; 3) morbidity of the cranial nerves is significant; 4) subtotal resection is an effective mean to obtain control of the disease.KEY WORDS: cavernous sinus, meningioma, cranial nerves, surgery. Os meningiomas são os tumores benignos mais comuns do seio cavernoso (SC). Desde os estudos pioneiros de Parkinson 1 que descreveu em pormenores a complexa anatomia...

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