ObjectiveEvaluate the discal height and lumbar lordosis gains, comparatively, according to the two lumbar arthrodesis techniques, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), used in the treatment of spinal degenerative diseases.MethodsThe present study, retrospective, was done with 60 patients who underwent decompression and 1 level lumbar arthrodesis in the Hospital Santa Casa de Misericórdia de Vitória (HSCMV), between January 2010 and December 2015. The patients were divided in two groups of 30 each, according to the utilized intersomatic arthrodesis technique: TLIF or PLIF. All patients presented pathologies at the L4-L5 level. In this study, the discal height gain and lumbar lordosis variation were evaluated by analyzing spinal radiographies of the pre and post-operatory periods from patients of the two groups, measured by the software Surgimap®. In addition, the pain intensity in the post-operatory period was estimated by the Visual Analog Scale for Pain (VAS Pain).ResultsBoth techniques presented a gain in the discal height in the post-operatory. There was no statistically significant difference between the discal height variation obtained with the PLIF technique when compared to the TLIF technique (p = 0.139). In the same way, there was no statistically significant difference in the lumbar lordosis variation between the two studied groups (p = 0.184). By the EVA Pain analysis, there was no significant difference in the pain intensity in the post-operatory period between both arthrodesis surgeries.ConclusionThere is no difference in the discal height gain and lumbar lordosis variation, as well as in the pain intensity in the post-operatory periods, in patients who underwent 1 level intersomatic arthrodesis when comparing the PLIF and TLIF techniques.

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Subependymomas are indolent, low-grade gliomas that comprise approximately 1% of all intracranial tumors. Typical locations are the fourth ventricle in 75% of cases, lateral ventricles, and rarely in the spinal cord. In the fourth ventricle, the tumor commonly arises from the floor, obtaining a polypoid growing pattern that promotes compression and adhesion of adjacent structures such as choroid plexus, medullary velum, nodule, and uvula. Arterial adhesions to tonsilobulbar and telovelotonsilar segments of PICA can be a challenge, increasing bleeding, and ischemia risk. We present a 53-year-old patient with a history of 3 months of progressive occipital headache associated with swallowing difficulty that started 20 days before hospital admission. Physical examination showed a slight uvula deviation. A neurological investigation by magnetic resonance imaging revealed an exophytic fourth ventricle tumor. The patient underwent resection with evoked potential monitoring through a suboccipital approach. The lesion was resected entirely without symptoms worsening. Pathology examination confirms subependymoma diagnosis. In this 3-dimensional video, the authors present a step-by-step microsurgical technique to perform a fourth ventricle subependymoma resection. The patient signed the institutional consent form, which allows the use of his/her images and videos for any medical publications in conferences and/or scientific articles.

Tentorial meningiomas comprise about 5% of all intracranial meningiomas. This tumor grow pattern can be classified in superior, inferior, or both extensions. The classical surgical approaches for microsurgical resection of superior extended tumor are subtemporal or posterior interhemispheric which consists in a challenge for neurosurgeon due an important brain retraction necessary an access the lesion dural tail and elevated risk of vascular structures like vein of Labb é and superior sagittal sinus damage. The transtentorial approach is an interesting alternative which permits early access to tumor dural tail and vascularization control without great brain manipulation. We present a 56-year-old patient with a tentorial meningioma with superior extension. The patient had a history of progressive loss of vision started about 3 months after admission associated with occipital headache. The neurologic investigation was performed by magnetic resonance imaging that revealed a meningioma located in the intermediate left side of tentorium, posterior to forth nerve entry point in tentorial edge. The patient underwent resection of the lesion through a transtentorial approach with lesion successfully resected. The patient presented the maintenance of initial evocated potentials and previous vision alterations in the post operatory. The pathology exam reveals a grade I meningioma. In this video, authors present step by step the microsurgical technique to perform a transtentorial meningioma resection. The patient consented to the procedure and publication of his images. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any medical publications in conferences and/or scientific article.

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