Primary meningiomas of the jugular foramen are extremely rare. There is controversy regarding the management of these tumors. The objective of this article is to analyze the treatment and results in a series of ten cases. From a series of 107 patients that had been operated on for jugular foramen tumors between 1987 and 2005, ten had meningiomas. The clinical, histological and imaging findings, as well as the outcome of these cases, were reviewed. A high incidence of malignant or aggressive tumors (six cases) was found. Gross total resection (Simpson I and II) was achieved in five patients. Four patients with meningotheliomatous meningiomas are alive, with a mean follow-up time of 71.8 months (6.5 years). Two patients (one with anaplastic type and one with papillary type) died in the immediate postoperative period. Four patients (two with papillary type, one with microcystic type and one with anaplastic type) died because of disease progression, with a mean survival time of 35 months. Radical removal of benign jugular foramen meningiomas is possible. The incidence of postoperative deficit of cranial nerves is higher than in other benign tumors of the jugular foramen. A high incidence of aggressive (malignant) tumors was observed in this series.

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Pedicle screws are widely used for instrumentation of the thoracolumbar spine. The anatomic studies performed in the last two decades, detailing the complex morphometry and three-dimensional anatomy of the thoracolumbar pedicles, have enabled the emergence of the so-called "free-hand" technique of pedicle screw placement based exclusively on anatomical parameters. However, in the thoracic spine, the benefits of pedicle screws have been tempered by its potential risks, such as, spinal canal violation, pedicle fracture, nerve root compression, and vascular lesions. Furthermore, the narrow and inconsistent shape of the thoracic pedicles, especially in spinal deformity, makes their placement technically challenging. In this article, the authors make a critical appraisal of current "state-of-art" of "free-hand" technique of pedicle instrumentation, analyzing its anatomical basis, surgical technique, present indications and limitations as well as the role of adjuvant image-guided and neurophysiological monitoring methods.

Bleeding from brainstem cavernomas may cause severe deficits due to the absence of non-eloquent nervous tissue and the presence of several ascending and descending white matter tracts and nerve nuclei. Surgical removal of these lesions presents a challenge to the most surgeons. The authors present their experience with the surgical treatment of 43 patients with brainstem cavernomas. Important aspects of microsurgical anatomy are reviewed. The surgical management, with special focus on new intraoperative technologies as well as controversies on indications and timing of surgery are presented. According to several published studies the outcome of brainstem cavernomas treated conservatively is poor. In our experience, surgical resection remains the treatment of choice if there was previous hemorrhage and the lesion reaches the surface of brainstem. These procedures should be performed by experienced neurosurgeons in referral centers employing all the currently available technology.

Introdução: A Doença de Parkinson (DP) é um dos distúrbios do movimento mais encontrados na população idosa. Cursa com perda progressiva e irreversível de células da substância negra (locus niger) do mesencéfalo, o que resultará numa diminuição da produção de dopamina, levando à sintomatologia da DP. Objetivo: Averiguar a relevância de testes eletrofisiológicos, capazes de monitorar a integridade funcional das vias cerebrais, no diagnóstico e/ou prognóstico de pacientes com DP, uma vez que tais testes não-invasivos são de fácil aplicabilidade, rápidos e facilmente compreendidos por quem participa de sua aplicação. Forma de estudo: Prospectivo clínico randomizado. Material e Método: Grupo de 32 pacientes com diagnóstico prévio de DP, submetidos aos testes de potencial evocado BERA e P300. Pacientes de ambos os sexos, entre 44 e 85 anos, com tempo de doença variando de 8 meses a 21 anos de evolução. Resultados: os valores do BERA e do P300 encontrados em pacientes com DP não se mostraram diferentes dos limites de normalidade para a idade. Conclusão: Observou-se integridade das vias auditivas em pacientes portadores de DP. Uma vez que a latência do P300 aumenta de forma linear com a idade, a partir dos 45 anos, aceitando-se um aumento de 1 a 1,5ms por ano 1 ; observou-se integridade nas vias cerebrais que refletem a habilidade de performance cognitiva em pacientes portadores de DP sem comprometimento demencial exuberante.