Chiari malformation (CM) and basilar invagination (BI) are mesodermal malformations with disproportion between the content and volume of posterior fossa capacity and overcrowding of neural structures at the level of foramen magnum. Several alternatives for posterior approaches are available, including extradural (ED), extra-arachnoidal, and intradural (ID) approaches. The objectives are to evaluate the effect of several surgical techniques for posterior fossa decompression (PFD) in the outcomes of patients with CCJM and to evaluate complications in the techniques reported. A systematic review of the literature on the effects of PFD surgery was performed using the MEDLINE (via PubMed) database and the Cochrane Central Register of Controlled Trials. The PRISMA statement and MOOSE recommendations were followed. Five hundred and thirty-nine (539) articles were initially selected by publication title. After abstract analysis, 70 articles were selected for full-text analysis, and 43 were excluded. Ultimately, 27 studies were evaluated. The success rate (SR) with ED techniques was 0.76 versus 0.81 in EA technique and 0.83 in IA technique. All posterior fossa decompression techniques were very successful. Results from observational studies were similar to that of the randomized trial. The main complications were CSF fistulas, most common in patients with IA approach. The overall mortality rate was 1%.

Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.

Hemifacial spasm (HS) is a movement disorder characterized by paroxysmal and irregular contractions of the muscles innervated by the facial nerve. Chiari malformation type I (CM I) is a congenital disease characterized by caudal migration of the cerebellar tonsils, and surgical decompression of foramen magnum structures has been used for treatment. The association of HS with CM I is rare, and its pathophysiology and therapeutics are speculative. There are only a few cases reported in the literature concerning this association. The decompression of the posterior fossa for the treatment of CM I has been reported to relieve the symptoms of HS, suggesting a relation between these diseases. However, the possible complications of posterior fossa surgery cannot be underrated. We report the case of a 66-year-old patient, in ambulatory follow-up due to right HS, no longer responding to botulinum toxin treatment. Magnetic resonance imaging (MRI) of the skull revealed compression of the facial nerve and CM I. The patient underwent surgery for HS by neurovascular microdecompression of the facial nerve via right lateral suboccipital craniectomy, but presented significant clinical worsening in the postoperative period even though the cerebellum edema related to surgical manipulation was mild. Due to the clinical worsening, the patient underwent a median suboccipital craniectomy with decompression of the foramen magnum structures. After this second surgery, the patient had progressive improvement and was discharged from the hospital for ambulatory care.

No abstract

Efeito da cifoplastia no tratamento de fraturas vertebrais osteoporóticas comparado ao da vertebroplastia -revisões das revisões sistemáticas publicadas AbstractIntroduction Vertebroplasty and kyphoplasty are possible options for vertebral augmentation after osteoporotic fractures. Both are percutaneous techniques with specific advantages and disadvantages. Our aim is to compare the clinical and radiological results of these two procedures. Methods An overview of published systematic reviews in the literature on the effects of kyphoplasty compared with vertebroplasty was performed. Results After short and long follow-up, the kyphoplasty group had lower pain scores on the visual analogue scale (VAS), lower scores in the Oswestry Disability index (ODI), greater restoration of the vertebral body height and lower kyphosis angle in the immediate postoperative period. There was less leakage of cement to the vertebral canal and extraspinal spaces. Conclusions Compared with vertebroplasty, kyphoplasty achieved better results in pain relief, quality of life, correction of spinal deformity and lower risk of cement leakage.