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Editorial: Decompressive craniectomy

Oren Sagher

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Letter to the Editor. Do bacteria contribute to formation and rupture of intracranial aneurysms?

Nícollas Nunes Rabelo, Renan Salomão Rodrigues, Arthur Araújo Massoud Salame, Paulo Henrique Braz-Silva, Manoel Jacobsen Teixeira, and Eberval Gadelha Figueiredo

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The nerve to the levator scapulae muscle as donor in brachial plexus surgery: an anatomical study and case series

Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Luciano Foroni, Hugo Sterman Neto, and Manoel Jacobsen Teixeira

OBJECTIVE

Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series.

METHODS

Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength.

RESULTS

The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade ≥ 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer.

CONCLUSIONS

The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.

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Letter to the Editor. The minipterional craniotomy: beyond the keyhole concept

Nícollas Nunes Rabelo, Manoel Jacobsen Teixeira, Robert F. Spetzler, and Eberval Gadelha Figueiredo

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The nerve to the levator scapulae muscle as donor in brachial plexus surgery: an anatomical study and case series

Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Luciano Foroni, Hugo Sterman Neto, and Manoel Jacobsen Teixeira

OBJECTIVE

Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series.

METHODS

Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength.

RESULTS

The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade ≥ 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer.

CONCLUSIONS

The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.

Free access

Letter to the Editor. The minipterional craniotomy: beyond the keyhole concept

Nícollas Nunes Rabelo, Manoel Jacobsen Teixeira, Robert F. Spetzler, and Eberval Gadelha Figueiredo

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Letter to the Editor. Minimally invasive techniques: the new frontier in neurosurgery

Nícollas Nunes Rabelo, Bruno Braga Sisnando da Costa, Manoel Jacobsen Teixeira, and Eberval Gadelha Figueiredo

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Letter to the Editor. PbtO₂ and prognosis after decompressive craniectomy

Marcelo de Lima Oliveira, Juliana R. Caldas, Manoel Jacobsen Teixeira, and Edson Bor-Seng-Shu

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Application of a 980-nanometer diode laser in neuroendoscopy: a case series

Rodolfo Casimiro Reis, Manoel Jacobsen Teixeira, Marilia Wellichan Mancini, Luciana Almeida-Lopes, Matheus Fernandes de Oliveira, and Fernando Campos Gomes Pinto

OBJECT

Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. High-power (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases.

METHODS

Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and follow-up were recorded.

RESULTS

Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24–48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation.

CONCLUSIONS

The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.

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Sonothrombolysis for acute ischemic stroke: a systematic review of randomized controlled trials

Edson Bor-Seng-Shu, Ricardo De Carvalho Nogueira, Eberval G. Figueiredo, Eli Faria Evaristo, Adriana Bastos Conforto, and Manoel Jacobsen Teixeira

Object

Sonothrombolysis has recently been considered an emerging modality for the treatment of stroke. The purpose of the present paper was to review randomized clinical studies concerning the effects of sonothrombolysis associated with tissue plasminogen activator (tPA) on acute ischemic stroke.

Methods

Systematic searches for literature published between January 1996 and July 2011 were performed for studies regarding sonothrombolysis combined with tPA for acute ischemic stroke. Only randomized controlled trials were included. Data extraction was based on ultrasound variables, patient characteristics, and outcome variables (rate of intracranial hemorrhages and arterial recanalization).

Results

Four trials were included in this study; 2 trials evaluated the effect of transcranial Doppler (TCD) ultrasonography on sonothrombolysis, and 2 addressed transcranial color-coded duplex (TCCD) ultrasonography. The frequency of ultrasound waves varied from 1.8 to 2 MHz. The duration of thrombus exposure to ultrasound energy ranged from 60 to 120 minutes. Sample sizes were small, recanalization was evaluated at different time points (60 and 120 minutes), and inclusion criteria were heterogeneous. Sonothrombolysis combined with tPA did not lead to an increase in symptomatic intracranial hemorrhagic complications. Two studies demonstrated that patients treated with ultrasound combined with tPA had statistically significant higher rates of recanalization than patients treated with tPA alone.

Conclusions

Despite the heterogeneity and the limitations of the reviewed studies, there is evidence that sonothrombolysis associated with tPA is a safe procedure and results in an increased rate of recanalization in the setting of acute ischemic stroke when wave frequencies and energy intensities of diagnostic ultrasound systems are used.