Estudo da anatomia dinâmica da punção suboccipital mediana da cisterna magna em cadáveres frescos. O deslocamento («tenda») da dura-máter foi observado em todas as punções (n = 30), medindo 3,12 (2,0-4,2) mm.

Report of a study of the dynamic anatomy of the median suboccipital puncture of the cisterna magna cerebellomedullaris, carried out on fresh cadavers. Direct inspection of the internal surface of the dura mater (DM) at the craniocervical region was possible by removing the calvarium and brain (seccioned at the upper cervical cord), during routine necropsies. Dislocation of the DM over the needle tip preceding dural penetration (so-called «durai tenting») was observed in all punctures (n = 30), measuring 3.12 (2.0-4.2) mm.

Estudo da anatomia dinâmica da punção cisternal lateral (suboccipital e C1-2) em cadáveres frescos, sob visão direta da dura-máter da junção crânio-vertebral. O deslocamento («tenda») da dura foi observado em todas as punções (n = 42), em média 3,46 mm (2 a 6 mm).

Report of an anatomic study of the lateral cisternal punctures (at the atlanto-occipital and C1-2 interspaces), carried out on fresh cadavers. Direct visualization of the internal surface of the dura mater (DM) at the cranio-cervical junctions was possible by removing the calvarium and brain (sectioned at the upper cervical spinal cord). Dislocation («tenting») of the DM over the needle was observed in all occasions (n = 42), measuring 3.46 mm (2-6 mm).

Comentário crítico da rotina radiodiagnóstica nas radiculopatias Iombossacrala no que concerne ao uso da tomografia computadorizada (CT). São relatadas as observações clínicas de três pacientes nos quais neoplasias acometeram uma única raiz lombossacral, simulando uma hérnia de disco lombar do ponto de vista clínico, com ênfase nos aspectos neurorradiológicos. Recomenda-se o estudo sistemático do sacro e da zona do cone medular em todo caso de radiculopatia lombossacral.

Lumbar-disc protrusions (LDP) constitute well-defined syndromes on clinical and anatomical grounds, and neurosurgeons are prone to rely upon the clinical signs to identify the level of disc protrusion when a «typical» case is found. Sometimes, non-contrasted computerized tomographic (CT) scans centered on the L5-S1, L4-L5 and L3-L4 interspaces and spine roentgenograms are the only special ancilary means in presurgical evaluation. We report three patients from our series, in which neoplasic spinal disease presented as classic LDP (one patient with a cauda equina schwannoma, and two with metastatic carcinoma). The cases were chosen because they posed special problems to the referred radiodiagnostic routine. Systematic CT-evaluation of the sacrum and conus medullaris zone is recommended in every patient with lumbosacral radiculopathy, and intratecal contrast should be employed in patients with unreliable findings or normal CT-scans.

Foi observada queixa de dor orofaríngea em cinco pacientes, conscientes e bons informantes, durante realização de punção suboccipital lateral da cisterna magna para mielo-grafia e/ou coleta de liqüido cefalorraqueano. São revisadas as anastomoses dos nervos cranianos inferiores, com ênfase às relações do primeiro nervo ín.) cervical (Cl) com o gânglio cervical superior da cadeia simpática e com o n. acessório (n. XI), a convergência anatômica sensitiva no subnúcleo caudal do núcleo do tracto espinhal do n. trigêmeo e sua importância na cirurgia funcional da dor. É sugerido que a referência de dor faríngea durante a punção suboccipital lateral se deva a estimulação de fibras aferentes viscerais de Cl ou de ramos comunicantes cinzentos do gânglio cervical superior para Cl.

Oropharyngeal pain was referred by five fully conscious and collaborative patients during lateral suboccipital puncture (LSP) of the cisterna magna, performed for myelography and/or cerebrospinal fluid collection. The anastomotic connections between the lower cranial nerves, the sympathetic nerves and the upper cervical spinal nerves are reviewed, with emphasis on the relationship between the first cervical nerve (CI), the superior cervical ganglion of the sympathetic trunk, and the spinal accessory nerve (nerve XI), and their central connections. The authors conclude that pharyngeal pain during LSP is provoked by the stimulation of afferent visceral fibers of CI, or of the gray communicating branches of the superior cervical ganglion to CI.

A punção cervical lateral para mielografia ou obtenção de líqüido cefalorraqueano é modificação da técnica de cordotomia ântero-lateral cervical percutânea e pode ser realizada nos níveis atlanto-axial e atlanto-occipital. Técnica simples e segura, oferece em casos específicos vantagens óbvias sobre a punção lombar e cisternal mediana, sem grande desconforto para o paciente.

The lateral cervical puncture for myelography or cerebrospinal fluid collection is a modification of the technique of percutaneous cervical cordotomy. It may be performed at the atlanto-axial or atlanto-occipital interspace. It is simple to perform, and appears to be safer and more easily mastered than suboccipital puncture, with no more discomfort to the patient than that associated with lumbar puncture.

Os autores sumariam os conceitos vigentes sobre a patogênese e a cirurgia dos abscessos cerebrais múltiplos e relatam sua experiência recente em dois casos, com acompanhamento por tomografia computadorizada.

The authors summarize the current concepts regarding pathogenesis and surgical management of multiple brain abscesses, and report their experience with two recent cases with computerized tomographic follow-up.