-The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.KEy wORDS: posterior lumbar interbody fusion (PLIF), posterior lumbar fusion, spondylolisthesis, pedicle screws, lumbar spine, spinal instrumentation.estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomáti-ca lombar posterior associada com parafuso pedicular em espondilolistese no adulto RESUMO -O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida.PALAvRAS-CHAvE: fusão intersomática lombar posterior, fusão lombar posterior, espondilolistese, fixação pedicular, coluna lombar,...

-Objective: Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. Method: We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. Results: Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. Conclusion: There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.Key WorDs: low back pain, lumbosacral region, spine.dor lombar associada à vértebra de transição lombossacra: dificuldades no diagnóstico e manejo da síndrome de bertolotti resumo -Objetivo: A síndrome de Bertolotti é uma desordem congênita da coluna vertebral caracterizada pela ocorrência de uma mega-apófise transversa lombar em uma vértebra de aspecto transicional, que geralmente se articula com o sacro ou com o osso ilíaco. Tal síndrome tem sido considerada possível causa de dor lombar. Método: Análise dos casos de síndrome de Bertolotti que apresentavam dor lombar sem melhora com tratamento conservador e revisão dos artigos publicados. Resultados: Foram revisados cinco pacientes que não apresentaram melhora com o tratamento clínico, sendo que dois foram submetidos à ressecção cirúrgica da mega-apófise transversa. Considerando a experiência adquirida com estes casos, os autores propõem um algoritmo para diagnóstico e tratamento da síndrome de Bertolotti. Conclusão: Ainda não há consenso sobre qual é a terapia mais apropriada para a síndrome de Bertolotti. em pacientes em que a mega-apófise parece ser a origem da lombalgia, a ressecção cirúrgica parece ser um procedimento seguro e efetivo.PAlAvrAs-ChAve: dor lombar, região lombossacral, coluna vertebral.

Knowledge of the anatomic variations of the frontal sinus is important in surgical approaches through the superciliary arc in order to avoid complications such as infections and CSF fistula.

Over the last 50 years deep hypothermia (23(0) C) has demonstrated to be an excellent neuroprotective agent in cerebral ischemic injury. Mild hypothermia (31-33(0) C) has proven to have the same neuroprotective properties without the detrimental effects of deep hypothermia. Mechanisms of injury that are exaggerated by moderate hyperthermia and ameliorated by hypothermia include, reduction of oxygen radical production, with peroxidase damage to lipids, proteins and DNA, microglial activation and ischemic depolarization, decrease in cerebral metabolic demand for oxygen and reduction of glycerin and excitatory amino acid (EAA) release. Studies have demonstrated that inflammation potentiates cerebral ischemic injury and that hypothermia can reduce neutrophil infiltration in ischemic regions. To further elucidate the mechanisms by which mild hypothermia produces neuroprotection in ischemia by attenuating the inflammatory response, we provoked inflammatory reaction, in brains of rats, dropping a substance that provokes a heavy inflammatory reaction. Two groups of ten animals underwent the same surgical procedure: the skull bone was partially removed, the duramater was opened and an inflammatory substance (5% carrageenin) was topically dropped. The scalp was sutured and, for the group that underwent neuroprotection, an ice bag was placed covering the entire skull surface, in order to maintain the brain temperature between 29,5-31(0) C during 120 minutes. After three days the animals were sacrificed and their brains were examined. The group protected by hypothermia demonstrated a remarkable reduction of polymorphonuclear leukocytes (PMNL) infiltration, indicating that mild hypothermia can have neuroprotective effects by reducing the inflammatory reaction.

Chronic paroxysmal hemicrania (CPH) is an unusual cause of headache, affecting predominantly women in the third to fourth decade. It is characterized by multiple attacks of unilateral pain, mostly located in fronto-orbito-temporal region, often associated with autonomic symptoms, such as lacrymation, conjunctival hyperaemia and nasal obstruction or rhinorrhea. Each attack usually lasts from 2 to 45 min and as diagnostic criteria it should be absolutely responsive to indomethacin in varying doses (1).Since the first description and definition of diagnostic criteria, few cases of CPH have been described in children. We report a 10 years-old girl with symptoms beginning since early childhood. Case reportA 10-year-old girl complained of attacks of left unilateral headache. Their parents explain that since she was a baby (1 year old), she had sudden periods of apparently unmotivated crying lasting about five minutes, approximately once a week, when she took her hands to the left ear region. As she started communication, on numerous occasions she said that she had pain or cold sensation in the periauricular region. At age 4, these attacks became more severe, lasting about 40 min, many times a day. She had a normal neurological, clinical and otological examination and CT scan, head MRI (three times since then), skull X-ray, auditory evoked-potentials, audiometry and blood tests were all normal. Thermography showed a cold-patch image in left frontal area, characteristic of hemiparoxystic headaches.Since the first attacks, she tried different medication, including NSAIDs, amitryptilin, imipramine, propranolol and carbamazepine, all without pain relief. The only effective medication was indomethacin, with a good efficacy since the first use at age 6, at doses of 25 mg 2-4 times a day it kept her free of headache if taken at least twice per day or with partial relief in lower doses. A psychological evaluation did not show any major affective disorders except coping strategies to avoid pain.At the time of consultation, the attacks varied in intensity and frequency. When she refrained from taking indomethacin, the attacks lasted from 15 to 40 min, followed by a brief relief of symptoms and posterior return after about 40 min. During severe attacks, lacrymation and conjunctival hyperaemia in the left eye could be seen. Rarely, her parents observed ipsilateral eyelid eodema but no nasal congestion or rhinorrhea. Some attacks have been videotaped and her behaviour was stereotyped in all of them, when she remained seated and crying, with her hand over the left side of her head and face, especially in left fronto-temporo-orbital region, sometimes including periauricular region. She markedly closed her left eye. Most of the time she remained seated but with occasional standing.After the diagnosis of possible chronic paroxysmal hemicrania was made, she was prescribed verapamil at increasing doses up to 240 mg, with a partial relief of symptoms, but still required indomethacin at lower doses (about 25 mg) 1-2 times a day.