Neurorradiologia
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- Fístulas da tenda do cerebelo: diagnóstico e tratamentoPublication . Machado, E; Santos, N; Carvalho, S; Freitas, P; Filho, T; Machado, C; Martins, FAmong the 17 intracranial dural fistulae treated in the Department of Neuroradiology of the University Hospital of Coimbra (17 patients, 28 embolizations) between 19/10/98 and 20/11/2000, 4 cases (23%) were located on the tentorium cerebelli. Three patients were men aged 45, 53 and 56 years old. The remaining patient was an 85-year-old woman. All 4 patients were treated by embolization. One underwent post embolization surgical interruption of the draining vein. The authors analyse clinical presentation, complementary tests, therapy and outcome.
- Choroid plexus tumours: a surgically treated seriesPublication . Barbosa, MD; Rebelo, O; Barbosa, P; Lacerda, A; Fernandes, RChoroid plexus tumours-carcinomas and papillomas are rare, especially in adults, and they pose some problems in their diagnosis and management. We have reviewed a series of nine cases from our institution surgically treated during the last 18 years. Their clinical charts, neuroradiological examinations, surgical technique, neuropathology and follow-up were analysed. In only one case total removal proved to be impossible, but even in cases of total removal recurrence appeared in two cases (one carcinoma and one papilloma). Morbility is especially associated with posterior fossa tumours. These rare tumours are managed surgically. They are usually associated with hydrocephalus, and it is difficult to forecast whether or not permanent CSF drainage will be required. A long-term follow-up is needed in patients with this type of tumour.
- Cystic intraventricular schwannoma: case report and review of the literaturePublication . Barbosa, MD; Rebelo, O; Barbosa, P; Gonçalves, J; Fernandes, RIntraventricular schwannoma is an exceedingly rare tumour with only 6 cases described in the literature. One case of a cystic intraventricular schwannoma operated on at our Institution is analyzed and the other cases reported in the literature are reviewed. Complete removal was achieved and no recurrence was noted after a follow-up period of 10 years. Intraventricular schwannomas are rare tumours that are amenable to complete surgical removal, having a good prognosis without the need of adjuvant therapy.
- Malformações do desenvolvimento cortical em doentes com epilepsia: estudo neurorradiológico de 17 casosPublication . Carvalho, S; Brito, O; Machado, E; Santos, N; Melo Freitas, P; Bento, C; Santana, I; Sales, F; Martins, FThis article reviews Malformations of Cortical Development (MCD) diagnosed by Magnetic Resonance Imaging (MRI) in a series of patients with epilepsy. This study spans a five year period. The frequency of these malformations was 7.1%. Most of these were focal or multifocal and the most common ones were polymicrogyria (35.3% of the patients), heterotopia (29.4%), and focal cortical dysplasia (29.4%). The frontal lobes were the most frequently affected regions. The various MCD encountered reflect the wide spectrum of MCD leading to epilepsy.
- Hemorragia Subaracnoideia e Angiografia Cerebral por Tomografia ComputorizadaPublication . Santos, N; Machado, E; Carvalho, S; Barbosa, MD; Martins, FWe present a review of 57 cases of nontraumatic subarachnoid hemorrhagesubmitted to CT angiography of the cerebral vessels. The purpose of our study was to estimate the value of CT angiography in the detection of intracranial aneurysms. These findings were compared with those from selective angiography. The results showed that CT angiography is a rapid, low-risk technique with a low level of invasiveness and high specificity and sensitivity in the detection of cerebral aneurysms, allowing the planning of endovascular intervention and surgical approach.
- Neurorradiologia da síndroma de KallmannPublication . Melo Freitas, P; Carvalho, S; Ribeiro, F; Marnoto, D; Martins, FThe present study refers to the magnetic resonance characteristics observed in a group of three patients with clinical and laboratory evidence of Kallmann's Syndrome. This disease, also named olfactogenital dysplasia, affects the normal gonadal and olfactory development and is clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia/hyposmia. The study protocol, which included the attainment of sagittal and coronal T1-weighted MPRAGE (Multiplanar Rapid Acquisition Gradient Echo) volumetric sequences, showed defective rhinocephalon development in all patients, expressed by the aplasia/hypoplasia of the olfactory bulbs/tracts and/or of the olfactory sulci. The changes observed corroborate the predictable imaging of this genetic disorder and have been mainly visible in the coronal slices obtained. The results shown are more clear evidence that magnetic resonance is an effective method to show the abnormalities in the olfactory region that are invariably found in this syndrome.
- Pittfalls em Neuro-cirurgia: Onde está o aneurisma?Publication . Barbosa, MD; Santos, N; Barbosa, P; Fernandes, R
- Blue rubber-bleb nevus syndrome: report of a familial case with a dural arteriovenous fistulaPublication . Carvalho, S; Barbosa, V; Santos, N; Machado, EWe report a case of a 45-year-old woman known to have a familial form of blue rubber-bleb nevus syndrome (BRBNS). The patient developed severe occipital headaches and bilateral retroauricular bruits. Cerebral angiography showed a large dural arteriovenous fistula in the torcular region. Central nervous system involvement in BRBNS is not often reported, and most cases of BRBNS are sporadic.
- Vasospasmo precoce na HSA AneurismáticaPublication . Barbosa, MD; Machado, E; Gonçalves, J; Fernandes, R
- Síndroma de Cushing ACTH-dependente: estudo retrospectivoPublication . Paiva, I; Ribeiro, C; Gomes, L; Baptista, C; Gomes, F; Rito, M; Rebelo, O; Marnoto, D; Moura, C; Leitão, F; Carvalheiro, MAIM: To evaluate the characteristics and outcomes of the patients diagnosed as ACTH-dependent Cushing syndrome, registered in the department. MATERIAL AND METHODS: We reviewed the files of forty-three patients followed from 1974 to 2002. RESULTS: A progressive rise in the number of patients diagnosed was found, being 80% females. Clinical suspicion was based mostly on the typical fat distribution; hirsutism and amenorrhoea were important in women. The more reliable diagnostic tests were: 11 pm cortisol, day curve of ACTH and cortisol, and dexamethasone suppression tests. The ACTH response to CRH during inferior petrosal sinus sampling permitted the diagnosis of ectopic source. In thirty-seven patients a pituitary adenoma was diagnosed. The three patients diagnosed before 1985 went for bilateral adrenalectomy (Nelson's syndrome in two); the others were submitted to transsphenoidal pituitary adenomectomy, obtaining remission in twenty six at the first operation and in two others at the second. Three patients had a recidive. Of the six patients with persistent disease (all treated with metyrapone or ketoconazole), three were submitted to radiotherapy, two to bilateral adrenalectomy, and one was waiting for surgery. Four patients had a bronchial carcinoid, successfully removed in three. One patient was lost to follow-up and another was still being evaluated. CONCLUSIONS: We found a positive evolution in the capacity to diagnose and treat these patients. Neurosurgical ability to achieve remission was 80% in the operated cases. More effective technical methods and drugs, as well as a multidisciplinary and dedicated medical team, lead to long lasting remissions in most of the patients.
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